Behavioral Health Medication Management Services.  





    59G-4.029Behavioral Health Medication Management Services.


    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.

Document Information

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