Current through September 21, 2024
(a) Covered
services shall be:
(i) Furnished to a client
or collateral contact for the direct and exclusive benefit of the
client;
(ii) Furnished by a
clinical professional or clinical staff member who meets the requirements of
the specific service and who practices within the scope of their license or
certification.
(iii) Furnished
pursuant to a treatment plan, updated and signed by a clinical professional at
least every ninety (90) days. Unless the service is an initial clinical
assessment, the treatment plan shall list the type, frequency, and duration of
each service provided.
(iv)
Documented by providing a legible progress note in the client's medical record.
Each progress note shall contain a hand-written or electronic signature and
credentials of the provider and shall specify:
(A) Service type and setting (if outside of
the office);
(B) Begin and end
times (Military or Standard Time); and
(C) Client progress towards goals identified
in their current treatment plan; and
(v) Rehabilitative and medically
necessary.
(b) The
following are covered services when furnished by a certified center:
(i) Clinical assessments;
(ii) Office-based individual and family
therapy;
(iii) Community-based
individual and family therapy;
(iv)
Psychosocial rehabilitation (day treatment);
(v) Intensive outpatient program
(IOP);
(vi) Group
therapy;
(vii) Comprehensive
medication services;
(viii)
Individual rehabilitative services (IRS);
(ix) Certified peer specialist
services;
(x) Targeted case
management provided to clients twenty-one (21) years of age and older;
and
(xi) Ongoing case management
provided to clients under twenty-one (21) years of age.
(c) The following are covered services when
furnished by a licensed psychologist, licensed APRN, or licensed mental health
professional:
(i) Clinical
assessment;
(ii) Office-based
individual and family therapy services;
(iii) Community-based individual and family
therapy;
(iv) Group
therapy;
(v) Ongoing case
management services provided to clients under twenty-one (21) years of age;
and
(vi) Additional services as
specified in Medicaid policy manuals and provider bulletins. These services
provided by licensed psychologists or licensed APRNs may include psychological
testing, psychotherapy, and evaluation and management services.
(d) The following are covered
services when furnished by an enrolled hospital providing outpatient mental
health or substance use services:
(i) Clinical
assessments;
(ii) Office-based
individual and family therapy;
(iii) Community-based individual and family
therapy;
(iv) Intensive outpatient
program (IOP);
(v) Group
therapy;
(vi) Comprehensive
medication services;
(vii) Ongoing
case management provided to clients under twenty-one (21) years of
age.
(e) The following
are covered services when furnished by a licensed BCBA-D or BCBA:
(i) Behavior identification
assessments,
(ii) Observational
behavioral follow-up assessments,
(iii) Adaptive behavior treatments,
and
(iv) Family adaptive behavior
treatment guidance.
(f)
Adaptive behavior treatment is a covered service when furnished by a licensed
BCaBA or a RBT under the supervision by a BCBA-D or BCBA.
(g) An RBT shall not be assigned duties which
include designing assessment or intervention plans or procedures.
