Behavioral Health Medication Management Services.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.029Behavioral Health Medication Management 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.

The Florida Medicaid Behavioral Health Medication Management Services Coverage Policy has been changed as follows:

Section 1.0, Introduction now reads:

Florida Medicaid provides behavioral health medication management (BHMM) including medication assistaed treatmeant in conjunction with psychiatric evaluations, counseling, and behavioral therapies for a comprehensive treatment approach to behavioral health and substance use disorders.

Subsection 1.1, through subsection 1.4, No change.

Section 2.0, Eligible Recipient,  No change.

Section 3.0, Eligible Provider

Subsection 3.1, General Criteria, No change.

Subsection 3.2, Who Can Provide now reads:

All providers that deliver behavioral health medication management services must be either employed or contracted with a community behavioral health agency. Programs that deliver medication assisted treatment must be licensed by the state and certified by the Federal Substance Abuse and Mental Health Services Administration. The following providers can deliver medication assisted treatment, medication management, medical procedures, medical screenings, and alcohol and other drug screening specimen collection:

         Practitioners licensed in accordance with Chapters 464, 458, or 459, F.S. and working within the scope of their practice.

The following providers can deliver medication assisted treatment, medical procedures, and alcohol and other drug screening specimen collection:

         Medical assistants certified in accordance with Chapter 458, F.S. and working under the supervision of a physician

The following providers can only deliver alcohol and other drug screening specimen collection:

         Bachelor’s level practitioners

         Certified addiction professionals

         Certified behavioral health technician

         Certified psychiatric rehabilitation practitioner

         Certified recovery peer specialist

         Certified recovery support specialist

         Master’s level certified addiction professionals

         Master’s level practitioners

         Substance abuse technician

Section 4.0, Coverage Information

Section 4.1, General Criteria, No change.

Section 4.2, Specific Criteria now includes:

4.2.1 Behavioral Health-Related Medical Services

Florida Medicaid covers the following behavioral health-related medical services:

         Alcohol and other drug screening specimen collection

         Medical procedures directly related to a behavioral health disorder or for monitoring the effects of psychotropic medication that include the following:

         Administering injections

         Specimen collection for medication management

         Taking of vital signs

         Medical screenings that must consist of a face-to-face physical examination, brief health history, and decision-making of low complexity. Screenings must include the following:

         Addressing medication concerns

         Brief mental health status assessment

         Planning for follow-ups as necessary

         Taking of vital signs

4.2.2 Medication Assisted Treatment

Medication assisted treatment for opioid addiction must be delivered under the supervision of a physician or psychiatrist. Providers must deliver the service in accordance with Rule 65D-30.014, F.A.C.

         Providers may prescribe take-home methadone doses after 30-days of treatment.

         Take-home doses require documentation of the recipient participating in a methadone maintenance regimen.

4.2.3 Medication Management

Medication management consists of discussing indications and contraindications for treatment, risks, and management strategies with the recipient or responsible persons in addition to review of the following:

         Current medication usage

         Prior pharmacy interventions

         Relevant laboratory test results

Recipients residing in a nursing facility, reimbursed on a per diem basis, can receive medication management reimbursed under this benefit.

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

Section 5.0, Exclusion

Subsection 5.1, General Non-Covered Criteria, No Change.

Subsection 5.2, Specific Non-Covered Criteria now includes:

         Case management services

Section 6.0, Documentation through 8.0, Reimbursement, No change.