Current through September 24, 2024
A. The Division of
Medicaid covers four (4) medically necessary mental health assessments by a
non-physician per fiscal year when:
1.
Completed during the intake process and/or when there is a need for
reassessment.
2. Provided by a
staff member who holds a master's degree and professional license or is one (1)
of the following as appropriate:
a) A
Department of Mental Health (DMH) Certified Mental Health Therapist
(CMHT),
b) DMH Certified
Intellectual and Developmental Disabilities Therapist (CIDDT), or
c) A DMH Certified Addiction Therapist
(CAT).
B. The
Division of Medicaid covers up to twelve (12) brief emotional/behavioral health
assessments per state fiscal year when administered via a standardized
behavioral or emotional assessment tool when medically necessary to identify
emotional and/or behavioral conditions, including, but not limited to:
1. Depression,
2. Alcohol, substance use or substance
abuse,
3. Attention Deficit
Hyperactivity Disorder (ADHD), or
4. Other behavioral disorders that may
require treatment and/or other forms of intervention.
C. The Division of Medicaid covers four (4)
medically necessary treatment plan development and reviews per state fiscal
year when:
1. Part of a treatment plan
approved by one (1) of the providers listed in Miss. Admin. Code Title 23, Part
206, Rule
1.1.B.1 through B.8., and
2. Provided by one of the providers listed in
Miss. Admin. Code Title 23, Part 206, Rule
1.1 B.1 through B.8 or
B.9.c.
D. The Division
of Medicaid covers medically necessary Targeted Case Management which must
include:
1. Completion of a comprehensive
assessment and periodic reassessments of beneficiary needs to determine the
need for services, including:
a) Beneficiary
history,
b) Identifying the needs
of the beneficiary and completing related documentation, and
c) Gathering information from other sources
to form a complete assessment/reassessment of the beneficiary.
2. Development and periodic
revisions of a specific treatment plan that is based on the information
collected through the assessment/reassessments that:
a) Specifies the goals and actions to address
the medical, social, educational, and other services needed by the
beneficiary,
b) Includes activities
such as ensuring the active participation of the eligible beneficiary, and
working with the beneficiary or the beneficiary's authorized health care
decision maker and others to develop those goals,
c) Identifies a course of action to respond
to the assessed needs of the eligible beneficiary,
d) Provides referral and related activities,
such as scheduling appointments for the beneficiary, to address any identified
needs including medical, social, educational providers, or other programs and
services to address identified needs and achieve goals specified in the
treatment plan.
3.
Monitoring and follow-up activities including:
a) Activities and contacts necessary to
ensure the treatment plan is implemented and adequately addresses the
beneficiary's needs, which may include with the family members, service
providers, or other entities or individuals conducted as frequently as
necessary including at least one (1) annual monitoring, to determine whether
the following conditions are met:
b) Services are being furnished in accordance
with the beneficiary's treatment plan;
c) Services in the treatment plan are
adequate; and
d) Changes in the
needs or status of the beneficiaries are reflected in the treatment plan.
Monitoring and follow-up activities at least annually include making necessary
adjustments in the treatment plan and service arrangements with
providers.
E.
The Division of Medicaid covers medically necessary crisis response services.
1. Crisis response services include:
a) Assessment,
b) De-escalation, and
c) Service coordination and
facilitation.
2. Crisis
response teams must include:
a) A Certified
Peer Support Professional with specific roles and responsibilities,
b) A licensed and/or Credentialed Master's
Level Therapist with experience and training in crisis response,
c) A Community Support Specialist with
experience and training in crisis response,
d) A Crisis Response Coordinator for the
provider's catchment area who is a licensed and/or credentialed master's level
therapist with a minimum of two (2) years' experience and training in crisis
response, and
e) At least one (1)
employee with experience and training in crisis response to each population
served by the provider.
F. The Division of Medicaid covers up to
sixty (60) days of medically necessary crisis residential services per state
fiscal year when ordered by a psychiatrist, physician, psychologist,
psychiatric mental health nurse practitioner (PMHNP) or physician assistant
(PA) and prior authorized by the Division of Medicaid, Utilization
Management/Quality Improvement Organization (UM/QIO) or designee.
1. Crisis residential services must provide
the following within twenty-four (24) hours of admission:
a) Initial assessment,
b) Medical screening,
c) Drug toxicology screening, and
d) Psychiatric consultation.
2. Crisis residential services
include:
a) Treatment plan development and
review,
b) Medication
management,
c) Nursing
assessment,
d) Individual
therapy,
e) Family
therapy,
f) Group
therapy,
g) Crisis response,
and
h) Skill building groups such
as social skills training, self-esteem building, anger control, conflict
resolution and daily living skills.
3. Crisis residential room and board is not
covered by the Division of Medicaid.
4. Crisis residential providers must maintain
staffing ratios according to DMH standards.
G. The Division of Medicaid covers up to four
hundred (400) fifteen (15) minute units per state fiscal year of medically
necessary community support services.
1.
Community support services must include:
a)
Resource coordination that directly increases the acquisition of skills needed
to accomplish the goals set forth in the treatment plan.
b) Monitoring and evaluating the
effectiveness of interventions, as documented by symptom reduction and progress
toward goals.
c) Psychoeducation:
(1) On the identification and self-management
of prescribed medication regimen and communication with the prescribing
provider.
(2) And training of
family, unpaid caregivers, and/or others who have a legitimate role in
addressing the needs of the beneficiary.
d) Direct interventions in de-escalating
situations to prevent crisis.
e)
Home and community visits for the purpose of monitoring the beneficiary's
condition and orientation.
f)
Assisting the beneficiary and natural supports in implementation of therapeutic
interventions outlined in the treatment plan.
2. Community support services must be
provided by a Certified Community Support Specialist professional.
H. The Division of Medicaid covers
up to four (4) units of medically necessary psychiatric diagnostic evaluations
per state fiscal year when prior authorized by the Division of Medicaid, UM/QIO
or designee.
I. The Division of
Medicaid covers up to four (4) hours of medically necessary psychological
diagnostic evaluations per state fiscal year when prior authorized by the
Division of Medicaid, UM/QIO or designee and entirely completed by a
psychologist.
J. The Division of
Medicaid covers medically necessary medication evaluation and management
services.
1. Medication evaluation and
management services provided by community/private mental health centers are not
limited.
2. Medication evaluation
and management services provided by independent practitioners within their
scope of practice are subject to the physician visit limits in Miss. Admin.
Code Title 23, Part 203, Rule 9.5.C.1.
3. Medication evaluation and management must
be provided by one (1) of the following:
a)
Psychiatrist,
b)
Physician,
c) PMHNP, or
d) PA.
K. The Division of Medicaid covers medically
necessary medication administration per state fiscal year when provide by one
(1) of the following:
1.
Psychiatrist,
2.
Physician,
3. PMHNP,
4. PA,
5. RN, or
6. LPN.
L. The Division of Medicaid covers up to one
hundred forty-four (144), fifteen (15) minute units of nursing assessments
performed by an RN per state fiscal year.
M. The Division of Medicaid covers the
following medically necessary psychotherapeutic services when part of a
treatment plan approved by one (1) of the providers listed in Miss. Admin. Code
Part 206, Rule
1.1.B.1 through B.8. and provided by
one of the providers listed in Miss. Admin. Code Part 206, Rule
1.1.B.1 through B.8. or B.9.c) as
appropriate:
1. Up to thirty-six (36)
individual therapy sessions per state fiscal year,
2. Up to twenty-four (24) family therapy
sessions per state fiscal year,
3.
A combined total of up to forty (40) group therapy or multi-family group
therapy sessions per state fiscal year, and
4. Interactive complexity for individual and
group therapy as appropriate within yearly limits.
N. The Division of Medicaid covers up to one
hundred (100) days of medically necessary acute partial hospitalization
services when prior authorized by the Division of Medicaid, UM/QIO or designee.
1. Acute partial hospitalization includes,
but is not limited to:
a) Treatment plan
development and review,
b)
Medication management,
c) Nursing
assessment,
d) Individual
therapy,
e) Group therapy,
and
f) Family therapy.
2. Acute partial hospitalization
programs must be provided by licensed/certified providers including, but not
limited to:
a) CMHC/PMHC,
b) The outpatient department of a hospital or
free-standing psychiatric unit,
c)
A private psychiatric clinic, or
d)
Other provider approved by the Mississippi Department of Mental
Health.
O.
The Division of Medicaid covers up to five (5) hours per day, five (5) days per
week of medically necessary psychosocial rehabilitation when prior authorized
by the Division of Medicaid, UM/QIO or designee.
1. Psychosocial rehabilitation services are
not covered when provided on the same day as group therapy, crisis residential
services or acute partial hospitalization.
2. Psychosocial rehabilitation services must
be included in a treatment plan approved by one (1) of the providers listed in
Miss. Admin. Code Title 23, Rule
1.1.B.1 through B.8.
3. Psychosocial rehabilitation service must
be provided according to DMH standards for that population.
P. The Division of Medicaid covers
one thousand six hundred (1600) fifteen minute units per state fiscal year of
medically necessary assertive community treatment services provided through
Programs of Assertive Community Treatment (PACT).
1. PACT is an all-inclusive service that
includes, but is not limited to:
a) Treatment
plan review and development,
b)
Medication management,
c)
Individual therapy,
d) Family
therapy,
e) Group
therapy,
f) Community support,
and
g) Peer support.
2. The composition of the PACT
team members must include, but is not limited to:
a) A team leader,
b) A Psychiatrist or PMHNP,
c) RN,
d) Master's level mental health
professional,
e) Substance use
disorder specialist,
f) Employment
specialist,
g) Certified peer
support specialist professional, and
h) Other clinical personnel as determined by
DMH.
Q. The
Division of Medicaid covers up to two hundred and seventy (270) days per year
of medically necessary intensive community outreach and recovery team (ICORT)
services when prior authorized by the Division of Medicaid, UM/QIO or designee.
1. ICORT services include:
a) Treatment plan development and
review,
b) Medication
management,
c) Individual therapy
and family therapy in the home,
d)
Group therapy,
e) Peer support
services,
f) Community support
services,
g) Skill building groups,
including but not limited to:
1) Social skills
training,
2) Self-esteem
building,
3) Anger
control,
4) Conflict resolution,
and
5) Daily living
skills.
2.
ICORT providers must have the following staff:
a) Team Leader which must be a full-time
Master's Level Mental Health Therapist,
b) A full-time registered nurse,
c) A full-time equivalent Certified Peer
Support Specialist Professional,
d)
A part-time clerical personnel, and
e) If deemed necessary by the DMH, a
part-time Community Support Specialist must be added to ICORT.
3. ICORT services must be included
in a treatment plan approved by one (1) of the providers listed in Miss. Admin.
Code. Title 23, Part 106, Rule
1.1.B.1. through B.8.
4. Development and revision of a specific
treatment plan based on the information collected through the assessment which
must include:
a) Goals and actions to address
the medical, social, educational, and other services needed by the
beneficiary,
b) Activities such as
ensuring the active participation of the beneficiary and working with the
beneficiary or beneficiary's representative and others to develop goals,
and
c) A course of action to
respond to the assessed needs of the beneficiary.
5. Referral and related activities to help
the beneficiary obtain needed services, including but not limited to:
a) Scheduling appointments, and
b) Linking the beneficiary with medical,
social and educational providers or other programs and services that provide
needed services as identified in the treatment plan.
6. Monitoring and follow-up activities to
ensure the treatment plan is effectively implemented and adequately addresses
the needs of the beneficiary conducted annually and as necessary to ensure:
a) Services are being furnished in accordance
with the beneficiary's treatment plan,
b) Services in the treatment plan are
adequate, and
c) Any necessary
changes to the treatment plan are made based on any changes in the needs or
status of the beneficiary.
R. The Division of Medicaid covers up to two
hundred (200) fifteen (15) minute units per state fiscal year of medically
necessary peer support services.
1. Peer
support services must include:
a) Development
of a recovery support plan, and
b)
Skill building for coping with and managing symptoms while utilizing natural
resources, and the preservation and enhancement of community living
skills.
2. Services must
be provided by a certified Peer Support Specialist Professional.
S. The Division of Medicaid covers
medically necessary opioid treatment services that comply with all state and
federal requirements.
1. Opioid Treatment
services include, but are not limited to:
a)
Assessments,
b) Laboratory
services,
c) Physician services
including Medication Evaluation and Management,
d) Medication Administration,
e) Therapy Services,
f) Medical Services, and
g) Pharmacy Services.
2. Opioid treatment services are provided by
professionals operating within their scope of practice as part of a DMH
certified opioid treatment program.
3. Physician visits provided as part of an
opioid treatment program do not count toward the beneficiary's physician visit
annual limit.
42
C.F.R. §§
440.130,
440.169;
Miss. Code Ann. §§
43-13-117,
43-13-121.
