Provider Notice May 30, Pre-Authorization 1915(b) Service

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1 Provider Notice 1.13 May 30, 2008»» Pre-Authorization 1915(b) Service 1915(b) Attendant Care Services (CPT T1019HE) and 1915(b) Case Conference services (CPT 99366, 99367, 99368) are pre-authorized services and authorization must be obtained prior to rendering these services. These services have limited funding available and a review of the level of authorized services in our first year indicated that if fully utilized, we would exceed available funds. Additionally, authorizations for these services are tied to the member s benefit year which will end on June 30th. Because of these issues, KHS is making changes in the 1915(b) pre-authorization process. Authorization for continued services must be obtained beginning with the new benefit year, starting July 1, To assist with the transition into year 2, KHS has established the following steps for pre-authorized services only. These procedures do not apply to SED Waiver or PRTF Waiver Services. 1. Effective July 1, 2008, requests for new authorizations will not be granted retro-active. These services must be authorized prior to service delivery or claims will be denied. 2. Because these services have limited funding and KHS wanted to manage the available funds to ensure all members receive medically necessary services, new authorizations will be limited to 1,000 units of Attendant Care and 16 units of Case Conference. 3. If members require additional services beyond the 1,000 unit limit for Attendant Care, an exception may be requested through Care Management, and if approved, additional services will be authorized. Exceptions will not be granted to exceed the 16 unit limit for Case Conference. 4. Existing authorizations will end on June 30, 2008 as part of member benefit year. 5. Member registrations which were scheduled to expire on June 25th and where Providers received worksheets requiring new authorization and medical necessity justification will be granted 1,000 units of Attendant Care and 16 units of Case Conference per member upon return of completed worksheets, effective July 1, Existing authorizations that would have continued beyond July 1, 2008 will be zeroed out and a new one-time authorization will be granted for 500 units of Attendant Care and 16 units of Case Conference, effective July 1, Providers will be required to update the medical necessity justification for Attendant Care in the authorization request on Provider Connect before September 30, 2008 or these authorizations will expire. 7. If a members KHS eligibility is issued retroactive, contact Care Management for authorization of these services. Once auth 8. orization for these two services is granted, the authorization number is not required to be placed on the claim. Changes will go into effect 30 days following the date of publication of Provider Notice. Page 1 of 5

2 »» Psychiatric Diagnostic Interview Exams ( CPT 90801) Effective July 1, 2008 KHS will pay for the diagnostic interview examinations (intakes) under the following conditions: When billed with place of service 21 (Acute Inpatient Hospital) by participating Physician, PA or ARNP. When billed with place of service 51 (Non-state Inpatient Psychiatric Facility) by participating Physician, PA or ARNP. When billed with a recognized Outpatient place of service by a participating LMHP, Physician, PA or ARNP.»» Psychological Testing Reminders All Providers are remained that certain psychological testing codes have unit values of one HOUR and some are performed PER SESSION. Psychological testing (96101 & 96102) and Neuropsychological testing (96118 & 96119) are hourly codes and must be billed as 1 unit = 1 hour. Psychological testing and Neuropsychological testing by computer are billed as per session and must be billed as 1 unit = the entire length of the session. Steve Richards Chief Financial Officer»» Kansas Health Solutions Covered Diagnoses Dementia of the Alzheimer s Type, With Early Onset, With Delusions Dementia of the Alzheimer s Type, With Early Onset, With Depressed Mood Dementia of the Alzheimer s Type, With Late Onset, With Delusions Dementia of the Alzheimer s Type, With Late Onset, With Depressed Mood Vascular Dementia, With Delusions Vascular Dementia, With Depressed Mood Cognitive Disorder NOS Schizophrenia, Disorganized Type Schizophrenia, Catatonic Type Schizophrenia, Paranoid Type Schizophreniform Disorder Schizophrenia, Residual Type Schizoaffective Disorder Schizophrenia Undifferentiated Type 296.0x Bipolar I Disorder Single Manic Episode 296.2x Major Depressive Disorder Single Episode 296.3x Major Depressive Disorder Recurrent Bipolar I Disorder Most Recent Episode Hypo manic Provider Notice 1.13 Page 2 of 5

3 296.4x Bipolar I Disorder Most Recent Episode Manic 296.5x Bipolar I Disorder Most Recent Episode Depressed 296.6x Bipolar I Disorder Most Recent Episode Mixed Bipolar I Disorder, Most recent episode Unspecified Bipolar Disorder NOS Bipolar II Disorder Mood Disorder NOS Delusional Disorder Shared Psychotic Disorder Brief Psychotic Disorder Psychotic Disorder NOS Rett s Disorder Asperger s Disorder Anxiety Disorder NOS Panic Disorder Without Agoraphobia Generalized Anxiety Disorder Conversion Disorder Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder Dissociative Disorder NOS Factitious Disorder With Predominantly Psychological Signs and Symptoms Factitious Disorder NOS Factitious Disorder With Combined Psychological and Physical Signs and Symptoms Factitious Disorder With Predominantly Physical Signs and Symptoms Panic Disorder With Agoraphobia Agoraphobia Without History of Panic Disorder Social Phobia Specific Phobia Obsessive-Compulsive Disorder Dysthymic Disorder Depersonalization Disorder Body Dysmorphic Disorder Hypochondriasis Somatization Disorder Undifferentiated Somatoform Disorder Somatoform Disorder NOS Unspecified Mental Disorder (nonpsychotic) Paranoid Personality Disorder Cyclothymic Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Obsessive-Compulsive Personality Disorder Provider Notice 1.13 Page 3 of 5

4 Histrionic Personality Disorder Dependent Personality Disorder Antisocial Personality Disorder Narcissistic Personality Disorder Avoidant Personality Disorder Borderline Personality Disorder Personality Disorder NOS Pedophilia Transvestic Fetishism Exhibitionism Gender Identity Disorder NOS Gender Identity Disorder in Children or Gender Identity Disorder NOS Sexual Dysfunction NOS Hypoactive Sexual Desire Disorder Female Sexual Arousal Disorder Male Erectile Disorder Female Orgasmic Disorder Male Orgasmic Disorder Premature Ejaculation Dyspareunia (Not Due to a General Medical Condition) Sexual Aversion Disorder Fetishism Voyeurism Sexual Masochism Sexual Sadism Gender Identity Disorder in Adolescents or Adults Frotteurism Sexual Disorder NOS Paraphilia NOS Vaginismus (Not Due to a General Medical Condition) Stuttering Anorexia Nervosa Tic Disorder NOS Transient Tic Disorder Chronic Motor or Vocal Tic Disorder Tourette s Disorder Stereotypic Movement Disorder Primary Insomnia Primary Hypersomnia Sleep Terror Disorder Sleepwalking Disorder Dyssomnia NOS Provider Notice 1.13 Page 4 of 5

5 Nightmare Disorder Parasomnia NOS Eating Disorder NOS Bulimia Nervosa Pica Rumination Disorder Enuresis (Not Due to a General Medical Condition) Encopresis Without Constipation and Overflow Incontinence Pain Disorder Associated With Psychological Factors Pain Disorder Associated With Both Psychological Factors and a General Medical Condition Acute Stress Disorder Adjustment Disorder With Depressed Mood Separation Anxiety Disorder Adjustment Disorder With Anxiety Adjustment Disorder With Mixed Anxiety and Depressed Mood Adjustment Disorder With Disturbance of Conduct Adjustment Disorder With Mixed Disturbance of Emotions and Conduct Posttraumatic Stress Disorder Adjustment Disorder Unspecified Personality Change Due to General Medical Condition 311 Depressive Disorder NOS Impulse-Control Disorder NOS Pathological Gambling Kleptomania Pyromania Intermittent Explosive Disorder Trichotillomania Conduct Disorder, Childhood-Onset Type Conduct Disorder, Adolescent-Onset Type Conduct Disorder, Unspecified Onset Disruptive Behavior Disorder NOS Selective Mutism Oppositional Defiant Disorder Reactive Attachment Disorder of Infancy or Early Childhood Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type Attention-Deficit/Hyperactivity Disorder Combined Type Attention-Deficit/Hyperactivity Disorder Predominantly hyperactive-impulsive Type Attention-Deficit/Hyperactivity Disorder NOS Neglect of child- clinical attention on victim Sexual Abuse of child- clinical attention on victim Physical Abuse of child- clinical attention on victim Carol Neeley Clinical Director Provider Notice 1.13 Page 5 of SW Jackson, Suite 310 Topeka, KS toll free fax

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