Behavioral Health Assessment Services

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.028Behavioral Health Assessment Services

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 44 No. 218, November 7, 2018 issue of the Florida Administrative Register.

Notice is hereby given that the following changes have been made to the notice of change for the proposed rule, published in Vol. 45, No. 126, June 28, 2019, issue of the Florida Administrative Register.

The Florida Medicaid Behavioral Health Assessment Services Coverage Policy has changed as follows:

1.0, Introduction.

Florida Medicaid provides behavioral health assessment services to recipients for screening and identification of mental health and substance use disorders in order to develop, plan, and maintain a schedule of services to restore a recipient to the best possible functional level community support services to promote recovery from

behavioral health disorders or cognitive symptoms by improving the ability of recipients to

strengthen or regain skills necessary to function successfully.

2.0, Eligible Recipient.

2.1, General Requirements, No change.

2.2, Who Can Receive now reads:

Florida Medicaid recipients requiring medically necessary behavioral health assessment services.

Some services may be subject to additional coverage criteria as specified in section 4.0.behavioral health communitysupport services that have a mental health diagnosis and exhibit one of the following symptoms: Addictive behavior, Behavioral or cognitive, Clinical conditions severe enough to cause significant impairment in day-to-day functioning, Psychiatric

2.3, Coinsurance and Copayments, No change.

3.0, Eligible Provider.

3.1, General Criteria, No change.

3.2, Who Can Provide now reads:

All providers that deliver behavioral health assessment services must be either employed by, or contracted with, a Florida Medicaid-enrolled community behavioral health agency.

The following providers may can deliver all services specified in section 4.0:

Community behavioral health agencies that employ or contract with practitioners who perform services under the supervision of a treating practitioner.

Practitioners licensed in accordance with Chapters 458 or 459, F.S.

Psychiatric advanced practice registered nurses licensed in accordance with Chapter 464, F.S.

No changes to remainder of Who Can Provide.

4.0, Coverage Information.

4.1, General Criteria, No change.

4.2, Specific Criteria now reads:

Florida Medicaid covers the following in accordance with the Healthcare Common Procedure Coding System and the applicable Florida Medicaid fee schedule, or as specified in this policy. Recipients residing in a nursing facility, reimbursed on a per diem basis, can receive behavioral health assessment services reimbursed under this benefit.

4.2.1 through 4.2.9, No change.

4.3, Early and Periodic Screening, Diagnosis, and Treatment, No change.

5.0, Exclusion, No change.

6.0, Documentation.

6.1, General Criteria, No change.

6.2, Specific Criteria, Bullet added to list that reads:

Providers must maintain the following in the recipient’s file:

•Copy of the assessment

7.0, Authorization, No change.

8.0, Reimbursement.

8.1 through 8.4, No change.

8.5, Rate, 8.5.1 added after paragraph:

8.5.1              Nursing Facilities.

Florida Medicaid reimburses separately for all covered behavioral health assessment services provided to recipients who reside in a nursing facility that is reimbursed per diem.

There are no changes to the rule text.