Behavioral Health Therapy Services

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.052Behavioral Health Therapy 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 Therapy Services  Coverage Policy has been changed as follows:

Section 1.0, Introduction, through 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:

The following providers can deliver all services specified in section 4.0

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

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

The following providers can deliver individual and group therapy services:

         Master’s level certified addiction professionals

         Master’s level practitioners

         Practitioners licensed in accordance with Chapters 490 or 491, F.S.

The following providers can only deliver group therapy services:

         Bachelor’s level practitioners

         Certified addiction professionals

The following providers can only deliver brief group medical therapy:

         Psychiatric nurses licensed in accordance with Chapter 464, F.S.

Section 4.0, Coverage Information

Subsection 4.1, General Criteria, No change.

Subsection 4.2, Specific Criteria now reads:

Florida Medicaid covers behavioral health therapy services, including documentation, education, and referrals, in accordance with the applicable Florida Medicaid fee schedule, or as specified in this policy. All therapy services must consist of insight oriented, cognitive behavioral, or supportive therapy interventions.

 

4.2.1 Brief Individual Medical Psychotherapy

Brief individual medical psychotherapy must assist the recipient with achieving the following:

         Maximizing behavioral self-control

         Reducing maladaptive behaviors related to a behavioral health disorder

         Restoring normalized functioning and appropriate interpersonal and social relationships

 

Recipients residing in a nursing facility, reimbursed on a per diem basis, can receive brief individual medical psychotherapy services reimbursed under this benefit.

 

4.2.2 Brief Group Medical Therapy

Brief group medical therapy consists of continuing medical diagnostic evaluation and drug management to assist the recipient with achieving the following:

      Maximizing behavioral self-control

      Reducing maladaptive behaviors

      Restoring normalized functioning, reality orientation, and emotional adjustment

Groups may include participants who are not Medicaid eligible and must be between two and 10 participants.

4.2.3 Individual and Family Therapy

Individual and family therapy services may include the recipient, the recipient’s family, or a combination of both. When the recipient is not present, the services must always focus on the recipient.

 

Recipients residing in a nursing facility, reimbursed on a per diem basis, can receive individual and family therapy services reimbursed under this benefit.

 

4.2.4 Group Therapy

Group therapy services delivered to individuals and their families can include the following in addition to therapy:

      Education related to the recipient’s behavioral health issues

      Guidance on how to assist the recipient

      Sharing of clinical information

Groups may include participants who are not Medicaid eligible and must be between two and 15 participants.

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:

      Behavior analysis services

      Case management services

      Childcare programs for developmental delays, preschool, or enrichment programs

      Non-therapy related interactions (e.g., socializing)

      Services for a recipient receiving any 24-hour a day Florida Medicaid-funded residential

      or institutional service

      Services for a recipient residing in an institution for mental diseases

      Services rendered to institutionalized individuals as defined in 42 CFR 435.1009

      Travel time

Section 6.0, Documentation

Subsection 6.1, General Criteria, No change.

Subsection 6.2, Specific Criteria now reads:

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

      Daily progress notes that address each service provided

      Documentation of approved services on the treatment plan developed and maintained in accordance with Rule 59G-4.028, F.A.C.

Section 7.0, Authorization through Section 8.0, Reimbursement, No change.