Statewide Inpatient Psychiatric Program

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.120Statewide Inpatient Psychiatric Program

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. 41 No. 14, January 22, 2015 issue of the Florida Administrative Register.

(2) All providers of the Statewide Inpatient Psychiatric Program must be in compliance with the provisions of the Florida Medicaid Statewide Inpatient Psychiatric Coverage Policy, __________, incorporated by reference. The policy is available on the Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks.

The following changes have been made to the Florida Medicaid Statewide Inpatient Psychiatric Program Coverage Policy:

Table of Contents has been renumbered and updated accordingly.

Section 1.1, Description, now reads:

Florida Medicaid’s Statewide Inpatient Psychiatric Program (SIPP) services provide extended residential psychiatric treatment to recipients under the age of 21 years, with the goal of facilitating successful return to treatment in a community-based setting.

Section 1.1.1, Medicaid Policies, now reads:

Florida Medicaid Policies

This policy is intended for use by SIPP providers that render services to eligible Florida Medicaid recipients. It must be used in conjunction with the Florida Medicaid Provider General Handbook, which describes requirements under the Florida Medicaid program that apply to all Medicaid providers. A provider who renders more than one type of Medicaid service will have more than one coverage and limitations handbook or coverage policy with which they must comply.

Note: Policies are available on the Florida Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic. All policies are incorporated by reference in Rule Division 59G, Florida Administrative Code (F.A.C.).

Section 1.1.2, Statewide Medicaid Managed Care Plan Contracts, now reads:

Statewide Medicaid Managed Care Plans

This Florida Medicaid policy provides the minimum requirements for all providers of SIPP services. This includes providers who contract with Florida Medicaid managed care plans (i.e., provider service networks and health maintenance organizations). Providers must comply with the coverage requirements outlined in this policy, unless otherwise specified in the Agency for Health Care Administration’s (AHCA) contract with the Medicaid managed care plan. The provision of services to recipients in a Medicaid managed care plan must not be subject to more stringent coverage than specified in Florida Medicaid policies.

Section 1.3.6, Provider, now reads:

The term used to describe any entity, facility, person, or group that has been approved for enrollment or registered with Florida Medicaid.

Section 1.3.13, Therapeutic Home Assignment, has been added and reads as follows:

Therapeutic home assignments are clinical interventions that allow a recipient to practice acquired skills in an identified discharge setting. Therapeutic home assignments require daily intervention with the family by the recipient’s physician, primary therapist, certified behavior analyst, or other licensed practitioner.

Section 2.2, Who Can Receive, first and second paragraph now reads:

Florida Medicaid recipients requiring medically necessary SIPP services. Some services may be subject to additional coverage criteria as specified in section 4.0.

SIPP services provide residential psychiatric treatment to recipients for whom acute inpatient or intensive outpatient services cannot resolve the recipient’s symptoms. SIPP services provide extended inpatient psychiatric treatment, for an anticipated length of stay of 120 days, to recipients for whom acute inpatient or intensive outpatient services have failed to bring about sufficient resolution of the recipient’s symptoms.

Section 2.2, Who Can Receive, third bullet has been deleted.

Section 2.3, Exception Provision for Recipients Under the Age of 21 Years, has been deleted.

Section 2.4, Coinsurance, Copayment, or Deductible, has been renumbered to section 2.3.

Section 3.1, General Criteria, now reads:

To be reimbursed for services rendered to eligible recipients, providers must meet at least one of the following:

 Directly enrolled in Florida Medicaid if providing services through a fee-for-service arrangement

 Registered with Florida Medicaid if providing services through a managed care plan

Section 3.2, Who Can Provide, third bullet has been deleted.

Section 3.2, Who Can Provide, fourth bullet now reads:

In compliance with 42 CFR 483.374 for attestation requirements and reporting serious occurrences to AHCA.

Section 4.1, General Criteria, first sentence now reads:

Florida Medicaid reimburses services that:

Section 4.1.1 has been renumbered to 4.2.1 and the second paragraph now reads:

Recipients not in the care and custody of the state must be assessed by a Florida-licensed psychologist or psychiatrist, with experience or training in childhood disorders. The assessment must result in a report with written findings as required by the Department of Education in Rule 65E-9.008, F.A.C.

Section 4.1.2 has been renumbered to 4.2.2 and a new bullet was added that now reads:

 Therapeutic home assignment

Section 4.2, Specific Criterial, now reads:

Specific Criteria

Section 4.3, Place of Service, has been added and now reads:

Inpatient Psychiatric Facility

Section 5.2, Specific Non-Covered Criteria, now reads:

Florida Medicaid will not reimburse SIPP services, when the recipient is:

 Receiving any other 24-hour service.

 Eligible as medically needy.

Therapeutic home assignments are not reimbursable when no service has been provided on that day.

The SIPP per diem will not be reimbursed for the day of discharge.

Emergency admissions to SIPP are not permitted. The SIPP service is not an acute care service.

Section 6.0, Authorization, is now titled Documentation.

Section 6.1, General Criteria, now reads:

For information on general documentation requirements, please refer to the Florida Medicaid Provider General Handbook.

Section 7.0, Documentation, is now titled Authorization.

Section 7.1, General Criteria, now reads:

As required by federal law, Florida Medicaid provides services to eligible recipients under the age of 21 years, if such services are medically necessary to correct or ameliorate a defect, a condition, or a physical or mental illness. Included are diagnostic services, treatment, equipment, supplies, and other measures described in section 1905(a) of the SSA, codified in Title 42 of the United States Code 1396d(a). As such, services for recipients under the age of 21 years exceeding the coverage described within this policy or the associated fee schedule may be approved, if medically necessary.

For recipients enrolled in a managed care plan, providers should request authorization through the recipient’s managed care plan. For recipients receiving services through the fee-for-service delivery system, providers should request authorization through the process described in this policy.

Section 7.2, Specific Criteria, first two paragraphs now read:

The authorization information described below is applicable to the fee-for-service delivery system, unless otherwise specified.

SIPP services must be prior authorized by the contracted AHCA Quality Improvement Organization (QIO) if the services are determined to be medically necessary and meet all other criteria as specified in this section.

Section 8.1, General Criteria, now reads:

The reimbursement information below is applicable to the fee-for-service delivery system, unless otherwise specified.

Providers may bill the per diem rate for up to 365 days per year for services delivered to a recipient who has been certified as meeting the eligibility criteria and when the service is prior authorized.

Section 8.2, Claim Type, now reads:

Institutional (8371/UB-04)

Section 8.3, Place of Service, has been deleted.

Section 8.4, Billing Code, Modifier, and Billing Unit, has been renumbered to section 8.3 and the last sentence now reads:

Providers will be reimbursed for a unit of service for recipients present at the facility at 11:59 p.m., or for recipients on therapeutic home assignments.

Section 8.5, Diagnosis Code, has been renumbered to section 8.4 and now reads:

Providers must report the most current and appropriate diagnosis code to the highest level of specificity that supports medical necessity, as appropriate for this service.

Section 8.6, Rates, is now titled Rates and has been renumbered to section 8.5.