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Mental health skill-building services (MHSS) shall be defined as goal-directed training to enable individuals to achieve and maintain community stability and independence in the most appropriate, least restrictive environment. The following Manuals and Supplements can be found on the Provider Manuals Library. If you are the designated primary account holder (PAH) for your organization and did not receive emails explaining how to register for the new provider portal, you must submit a Primary Account Holder Request Form to obtain access. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Optima Health Insurance Company. (2) The individual shall require individualized goal-directed training in order to acquire or maintain self-regulation of basic living skills, such as symptom management; adherence to psychiatric and physical health medication treatment plans; appropriate use of social skills and personal support systems; skills to manage personal hygiene, food preparation, and the maintenance of personal adequate nutrition; money management; and use of community resources. Medallion 4.0 isVirginias Medicaid program for infants,children,pregnant women and adults in low-income families with children. f. These services may only be rendered by an LMHP, LMHP-R, LMHP-RP, LMHP-S, a QMHP-A, a QMHP-C, a QMHP-E, or a QPPMH. Derived from Virginia Register Volume 14, Issue 7, eff. (4) Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or significantly inappropriate social behavior. "Affiliated" means any entity or property in which a provider or facility has a direct or indirect ownership interest of 5.0% or more, or any management, partnership, or control of an entity. ARTS and Behavioral Health HCBS Rate Increases (3) Mental health skill-building services shall not be reimbursed for individuals who are also receiving services under the Department of Social Services independent living program (22VAC40-151), independent living services (22VAC40-131 and 22VAC40-151), or independent living arrangement (22VAC40-131) or any Comprehensive Services Act-funded independent living skills programs. Mental health peer support services are peer recovery support services and are nonclinical, peer-to-peer activities that engage, educate, and support an individual's self-help efforts to improve health recovery, resiliency, and wellness. b. Direct supervisors shall maintain documentation of all supervisory sessions. (2) The individual has a history (three months or more) of a need for intensive mental health treatment or treatment for co-occurring serious mental illness and substance use disorder and demonstrates a resistance to seek out and utilize appropriate treatment options. Instead, CMHRS and Behavioral Therapy will transition into the Medallion 4.0 MCO contract, utilizing DMAS current CMHRS coverage criteria and program requirements. Discharge summaries from prior providers that clearly indicate (i) the type of treatment provided, (ii) the dates of the treatment previously provided, and (iii) the name of the treatment provider shall be sufficient to meet this requirement. Staff travel time shall not be included in billable time for reimbursement. Provider Appeals . Day treatment/partial hospitalization services shall be provided in sessions of two or more consecutive hours per day, which may be scheduled multiple times per week, to groups of individuals in a nonresidential setting. e. Services must be documented through daily progress notes and a daily log of times spent in the delivery of services. On October 6, 2021, DMAS issued a Medicaid memo with additional information about this initiative. Day treatment/partial hospitalization services shall be time limited interventions that are more intensive than outpatient services and are required to stabilize an individual's psychiatric condition. The Community Mental Health Rehabilitation Services (CMHRS) and Behavioral Therapy transition to Medallion 4.0 will occur in accordance with the regional implementation of the program, beginning August 1, 2018. 32.1-325 of the Code of Virginia; 42 USC 1396 et seq. Provider FAQ. Provider Manuals Library. Community mental health services. Member and Provider Services. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590. Individuals 21 years of age and older shall meet all of the following criteria in order to be eligible to receive mental health skill-building services: (1) The individual shall have one of the following as a primary mental health diagnosis: (a) Schizophrenia or other psychotic disorder as set out in the DSM-5; (c) Recurrent Bipolar I or Bipolar II; or. Site developed by the Division of Legislative Automated Systems (DLAS). Medicaid providers will now use the Provider Services Solution (PRSS) to complete enrollment and maintenance processes. Their income must be within the limits. (4) Outpatient psychiatric services provider. Using the Integrated Care Model, this benefit will impact over 750,000 Medicaid members, including children enrolled in Medallion 4.0 and Family Access to Medical Insurance Security (FAMIS) Plan. Requirements for the comprehensive needs assessment are set out in 12VAC30-60-143. Under the clinical oversight of the LMHP, LMHP-R, LMHP-RP, or LMHP-S assessing the individual and making the recommendation for mental health support services, the peer recovery specialist in consultation with his direct supervisor shall develop a recovery, resiliency, and wellness plan based on the recommendation of the LMHP, LMHP-R, LMHP-RP, or LMHP-S for service, the individual's perceived recovery needs, and any clinical assessments or comprehensive needs assessments as defined in this section within 30 calendar days of the initiation of service. Training courses are available for all Medicaid providers. (5) Mental health skill-building services shall not be available to individuals who reside in intermediate care facilities for individuals with intellectual disabilities or hospitals. 600 East Broad Street Richmond Virginia. Medallion 4.0 Non-Expansion Members . 600 East Broad Street Richmond Virginia. If a physician or other practitioner who is authorized by his license to prescribe medications indicates that antipsychotic, mood stabilizing, or antidepressant medications are medically contraindicated for the individual, the provider shall obtain medical records signed by the physician or other licensed prescriber detailing the contraindication. Enhanced Behavioral Health services seek to keep Virginians well and thriving in their communities, reduce the need to focus on crisis by investing in prevention and early intervention for mental health and substance use disorder (SUD) comorbidities, and support a comprehensive alignment of services across the systems that serve Medicaid members. View a one-page overview of the program. Residential Treatment Services and Treatment Foster Care Case Management are excluded from Medicaid MCOs and continue to be obtained through our Fee-for-Service vendor Magellan of Virginia. a. of Title 37.2 of the Code of Virginia. All rights reserved. The training shall be rehabilitative and based on a variety of incremental (or cumulative) approaches or tools to organize and guide the individual's life planning and shall reflect what is important to the individual in addition to all other factors that affect the individual's functioning, including effects of the disability and issues of health and safety. "Direct supervisor" means the person who provides direct supervision to the peer recovery specialist. The system enables DMAS to track the time between a request for a screening and completion of that screening as well as whether an individual chooses a nursing facility or community-based program for services. Please review this memo to learn more about the specific services covered by the rate increase and the timeframe when the new rate will be effective. "Qualified paraprofessional in mental health" or "QPPMH" means the same as defined in 12VAC35-105-20. Authorization and Registration DMAS. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590. The PRS shall perform mental health peer support services under the oversight of the LMHP, LMHP-R, LMHP-RP, or LMHP-S who shall provide the clinical oversight of the recovery, resiliency, and wellness plan. Services that are rendered before the date of service authorization shall not be reimbursed. February 16, 2011; Volume 31, Issue 9, eff. Specific peer support service activities shall emphasize the acquisition, development, and enhancement of recovery, resiliency, and wellness. "Qualified mental health professional-eligible" or "QMHP-E" means the same as the term "qualified mental health professional trainee" as defined in 54.1-3500 of the Code. Pleasevisit the MES website to review Frequently Asked Questionsand answers about provider claims, enrollment and training. b. The recovery, resiliency, and wellness plan shall also include documentation of how many days per week and how many hours per week are required to carry out the services in order to meet the goals of the plan. One unit is 1 to 2.99 hours per day, and two units is 3 or more hours per day. For provider enrollment inquiries, contact the Virginia Medicaid Provider Enrollment Helpdesk by phone at 804-270-5105 or 888-829-5373. "DBHDS" means the Department of Behavioral Health and Developmental Services consistent with Chapter 3 ( 37.2-300 et seq.) For children under the age of 21 who are currently enrolled in, or those seeking new enrollment in to the CCCP Waiver, their personal care and attendant care needs are to be reviewed under the CCCP Waiver benefit, rather than EPSDT. a. Navigate. All services which do not require service authorization require registration. State regulations related to behavioral health services and provider manuals on the Virginia Medicaid Portal, CMHRS Training and Outreach, Magellan-Behavioral Health Administrator, Licensing, Credentialing, Registration and Transportation Resources, Background, Stakeholder Presentations, Implementation Workgroups and Enhancement Image Files, Archives for Medallion 3.0 and the Governor's Access Plan for Individuals with serious Mental Illness, Community Mental Health Rehabilitative Services. The clinical management of CMHRS services have transitioned to Managed Care Organizations (MCOs), providing coverage for over 90% of Medicaid enrollees through the Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus) health plans (effective 8/1/18 for CCC Plus, 8/1/18 for Medallion 4). The Community Mental Health Rehabilitation Services (CMHRS) and Behavioral Therapy transition to Medallion 4.0 will occur in accordance with the regional implementation of the program, beginning August 1, 2018. Discharge summaries from prior providers that clearly indicate (i) the type of treatment provided, (ii) the dates of the treatment previously provided, and (iii) the name of the treatment provider shall be sufficient to meet this requirement. Family member statements shall not suffice to meet this requirement. You will get a letter with more information. The clinical management of CMHRS services have transitioned to Managed Care Organizations (MCOs), providing coverage for over 90% of Medicaid enrollees through the Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus) health plans (effective 8/1/18 for CCC Plus, 8/1/18 for Medallion 4). d. Admission and services for time periods longer than 90 calendar days must be authorized based upon a face-to-face evaluation by an LMHP, LMHP-R, LMHP-RP, or LMHP-S. e. These services may only be rendered by an LMHP, LMHP-supervisee, LMHP-resident, LMHP-RP, QMHP-A, QMHP-C, QMHP-E, or a QPPMH. On and after June 1, 2019 Kepro will require the updated forms to be submitted with requests for Personal/Attendant Care Services. "DSM-5" means the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, copyright 2013, American Psychiatric Association. (7) Mental health skill-building services shall not be available for residents of psychiatric residential treatment centers except for the comprehensive needs assessment code H0032 (modifier U8) in the seven days immediately prior to discharge. For Members; For Providers; COVID-19 Response; Contact; Data and Reports; This applies to individuals who are receiving additional services through the Intellectual Disability Waiver (12VAC30-120-1000 et seq. Medallion 4.0 CMHRS & Behavioral Therapy Provider Training Slide Deck July2018. You can find notices related to regulatory and manual updates, including dates for public comment periods, are posted on the Virginia Regulatory Townhall Website at: Community Mental Health Rehabilitative Services (CMHRS) are intended to provide clinical treatment to those individuals with significant mental illness or children with, or at risk of developing, serious emotional disturbances. Click below to learn more about how MES directly and efficiently supports the business needs of DMAS and our Providers. Please contact the Provider Helpline at 1-800-552-8627 (in-state long distance) or (804) 786-6273 (local and out of state customers) for services that are currently authorized by DMAS Medical Support Unit; Certain waiver enrollment/service authorizations [pdf] Maintained by DMAS Office of Community Living
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