Current through September 24, 2024
A. Mental health
services provided in an outpatient department of a general hospital are covered
when:
1. Provided by appropriate staff
operating within the scope of their practice,
2. Appropriate for the setting according to
the licensure of the hospital,
3.
Prior authorized by the Utilization Management and Quality Improvement
Organization (UM/QIO).
B.
Partial hospitalization services are covered:
1. When prior authorized as medically
necessary through the Utilization Management and Quality Improvement
Organization (UM/QIO).
2. When
provided in an outpatient department of a general hospital or an acute
freestanding psychiatric facility.
3. And include, but are not limited to:
a) Group Therapy,
b) Individual Therapy,
c) Drugs and biologicals that cannot be
self-administered,
d) Family
Therapy, and
e) Diagnostic
services, to include, psychiatric and psychological evaluations and
assessments.
4. When the
services are part of an individualized treatment plan provided and approved by
the appropriate practitioner.
5.
When the beneficiary:
a) Has been diagnosed
with a mental disorder that severely interferes with multiple areas of daily
life, including social, vocational, and/or educational functioning,
b) Is able to cognitively and emotionally
participate in the active treatment process, and be capable of tolerating the
intensity of a partial hospitalization program,
c) Requires a minimum of twenty (20) hours
per week of therapeutic services, as evidenced by their plan of care,
and
d) Is being discharged from an
inpatient hospitalization or is at risk of inpatient hospitalization.
C. Partial
hospitalization services are reimbursed:
1.
When provided for no less than four (4) hours per day at a minimum of five (5)
days per week.
2. A facility
fee.
D. A professional
fee for the physician, nurse practitioner and/or physician assistant services
are reimbursed separately from the facility fee.
E. Intensive outpatient psychiatric services
are covered:
1. When prior authorized as
medically necessary through the Utilization Management and Quality Improvement
Organization (UM/QIO).
2. When
provided in an outpatient department of a general hospital or an acute
freestanding psychiatric facility.
3. And include, but are not limited to:
a) Group Therapy,
b) Individual Therapy,
c) Medication management when
applicable,
d) Case
Management,
e) Psychiatric and
psychological evaluations and assessments.
4. When the services are part of an
individualized treatment plan provided and approved by the appropriate
practitioner.
5. When the
beneficiary:
a) Has been diagnosed with a
mental disorder that interferes with multiple areas of daily life, including
social, vocational, and/or educational functioning,
b) Is able to cognitively and emotionally
participate in the active treatment process, and
c) Requires a minimum of nine (9) hours per
week of therapeutic services, as evidenced by their plan of care.
F. Intensive outpatient
psychiatric services are reimbursed:
1. When
provided for no less than three (3) hours per day at a minimum of three (3)
days per week.
2. A facility
fee.
G. A professional
fee for the physician, nurse practitioner and/or physician assistant services
is reimbursed separately from the facility fee.
H. Outpatient hospital mental health services
are reimbursed using the same methodology as other outpatient hospital
services.
42 CFR §
410.155; Miss. Code Ann. §§
43-13-117,
43-13-121.
