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.

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

Section 1.0, Introduction,  now reads:

Florida Medicaid provides behavioral health 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.

Section 2.0, Eligible Recipient,  No Change.

Subsection 2.2, now reads:

Who Can Receive:

Florida Medicaid recipients requiring medically necessary behavioral health community

support services that have a mental health diagnosis and exhibit one of the following

symptoms:

Psychiatric

Behavioral or cognitive

Addictive behavior

Clinical conditions severe enough to cause significant impairment in day-to-day

functioning

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 assessment services must be either employed or contracted with a community behavioral health agency. The following providers 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.

The following providers can deliver all services specified in section 4.0 except for psychiatric evaluations and psychiatric reviews of records

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

The following providers can deliver brief behavioral health status examinations, in-depth assessments, and bio-psychosocial evaluations and participate on treatment teams

         Master’s level certified addiction professionals

The following providers can deliver in-depth assessments and bio-psychosocial evaluations and participate on treatment teams:

         Certified addiction professionals

         Master’s level practitioners

The following providers can deliver bio-psychosocial evaluations and participate on treatment teams:

         Bachelor’s level practitioners

Providers delivering limited functional assessments using the Functional Assessment Rating Scale (FARS) or Children’s Functional Assessment Rating Scale (C-FARS) must hold certification from the Department of Children and Families.

Section 4.0, Coverage Information

Section 4.1, General Criteria, No Change.

Section 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 Bio-psychosocial Evaluation

Bio-psychosocial evaluations describe biological, psychological, and social factors that contribute to a recipient’s need for services and include brief mental health status examinations and preliminary service recommendations.

Bio-psychosocial evaluations must provide information on the following:

      Biological factors

      Diagnostic impressions

      Mental health status examinations

      Presenting problems

      Psychological factors

      Social factors

      Summary of findings

      Treatment recommendations or plans

Master’s level, bachelor’s level certified addiction professionals, or treating practitioners must review bio-psychosocial evaluations completed by bachelor’s level practitioners and include a statement that concurs with the findings or provides alternative recommendations.

 

4.2.2 Brief Behavioral Health Status Examination

Brief behavioral health status examinations consist of brief clinical, psychiatric, diagnostic, or evaluative interviews to assess behavioral stability or treatment status. An examination is required prior to the development of a recipient’s treatment plan. Brief behavioral health status examinations must provide information on the following:

      Diagnostic formulation

      Mental health status

      Purpose of the exam

      Summary of findings

      Treatment recommendations or plans

Brief behavioral health status examinations are not required prior to the development of a recipient’s treatment plan when a bio-psychosocial evaluation or in-depth assessment had been completed during the previous six months.

 

4.2.3 In-depth Assessment

In-depth assessments gather information to establish or support a diagnosis, provide the basis for developing or modifying a treatment plan, and developing discharge criteria.

 

In-depth assessments for recipients ages seven and older must provide information on the following:

      Personal history that includes the following:

         Alcohol and other drug use

         Educational analysis

         Identifying information

         Legal involvement

         Medical information

         Resources and strengths

         Traumatic experiences

      Recipient’s perception of problems, needs, or symptoms

      History of treatment that includes the following:

         Acute care treatment

         Desired services and goals from the recipient’s viewpoint

         Inpatient behavioral health treatment

         Mental health status examinations

         Psychiatric treatment and psychotropic medication information

         Therapy and counseling

         Treatment recommendations or plans

In-depth assessments for recipients under the age of seven must include the following:

      Clinical interview with the primary caretaker and observation of the caretaker and recipient

      Developmental and medical history that includes the following:

   Developmental milestones

   History of the mother’s pregnancy and delivery

   Past and current medical conditions

      Family functioning, cultural and communication patterns, and current environmental conditions and stressors

      Family psychosocial and medical history

      Observation and assessment of the recipient’s affective, language, cognitive, motor, sensory, self-care, and social functioning

      Presenting symptoms and behaviors

 

In-depth assessments for new patients must be administered to recipients for one of the following reasons:

         Another type of assessment is insufficient for providing a comprehensive evaluation for treatment planning.

         Recipient is high risk

In-depth assessments for established patients must be administered to recipients for one of the following reasons:

      Recipient has received outpatient treatment with unsuccessful results and may require more intensive services.

      Recipients identified as high utilizers of behavioral health services.

In-depth assessments require completion of an integrated summary that evaluates history and assessment information collected and provides the following:

      Diagnosis

      Discharge criteria

      Evaluation of past intervention efficacy

      Service needs

4.2.4 Limited Functional Assessment

Limited functional assessments consist of the following:

      American Society for Addiction Medicine Patient Placement Criteria (ASAM PPC-2R)

      Children’s Functional Assessment Rating Scale (C-FARS)

      Functional Assessment Rating Scale (FARS)

      Other functional assessment required by the Department of Children and Families

4.2.5 Psychiatric Evaluation

Psychiatric evaluations consist of comprehensive evaluations that investigate a recipient’s clinical status and include the following:

      Establishment of a therapeutic doctor-patient relationship

      Gather accurate data to formulate a diagnosis

      Initiation of an effective treatment plan

Psychiatric evaluations must include information on the following:

      Alcohol and other drug abuse history

      Diagnostic formulation

      History of presenting illnesses or problems

      Mental health status examination

      Personal strengths

      Presenting problems

      Psychiatric, physical, medication, and trauma history

      Relevant personal and family medical history

      Summary of findings

      Treatment recommendations or plans

Psychiatric evaluations must occur at the onset of illness and can be utilized following an extended hiatus, marked change in mental status, or admission to an inpatient setting due to psychiatric illness.

Psychiatric evaluations are not necessary for recipients diagnosed with an organic brain disorder unless a change in mental status requires an evaluation.

 

4.2.6 Psychiatric Review of Records

Psychiatric reviews of records consist of reviewing the following to evaluate and plan recipient care:

      Clinical and psychological evaluation data for diagnostic use

      Psychiatric reports

      Psychometric or projective tests

 

Psychiatric reviews of records must include a written report or progress note to be included in the recipient’s clinical record.

 

4.2.7 Psychological Testing

Psychological testing consists of the assessment, evaluation, and diagnosis of the recipient’s mental status or   psychological condition through the use of standardized testing methodologies.

Psychological testing must be administered to recipients for one of the following reasons:

      Extended hiatuses, marked changes in mental status, or assessing for admission or readmission to a psychiatric inpatient setting

      Onset of illness or suspected illness when a recipient first presents for treatment

      To obtain additional information needed to evaluate treatment or make a diagnosis

4.2.8 Treatment Plan Development

Treatment plans include individualized, structured, and goal-oriented schedules of services with measurable objectives that promote the maximum reduction of a recipient’s disability and restoration to the best possible functional level. Plans must address a recipient’s primary and secondary diagnoses and be consistent with assessments.

 

Treatment teams that are recipient-centered must develop treatment plans that consistent with a recipient’s identified strengths, abilities, needs, and preferences.

Treatment plans must include the following:

      Amount, frequency, and duration of each service for the six-month duration of the treatment plan

   Providers may not specify that services will be provided “as needed” or within a given range.

      Dated signature of the recipient or recipient’s guardian if the recipient is under the age of 18

      Diagnoses consistent with assessment

      Discharge criteria

      Individualized and strength-based goals that are appropriate to each recipient

      List of services to be provided

      Measurable objectives with target completion dates listed for each goal

      Treating practitioner statement that services are medically necessary

      Treatment team member signatures

Treatment plans become effective on the date of the treating practitioner’s signature. Florida Medicaid reimburses for services provided within 45 days of the signature.

 

Providers may use addendums to modify treatment plans when significant changes have not occurred. Addendums can add or modify services and must be signed by the treating practitioner and recipient.

 

4.2.9 Treatment Plan Review

Treatment plan reviews occur once per six months or when significant changes occur and consist of the treatment team and recipient reviewing the goals, objectives, and services to determine whether they continue to be appropriate for the recipient’s needs and progress.

Treatment plan reviews must consist of the following:

      Dated signature of the recipient or recipient’s guardian if the recipient is under the age of 18

      Diagnosis and justification for changes in diagnosis

      Findings

      Recipient’s progress toward meeting individualized goals, objectives, and discharge criteria

      Recommendations

      Treating practitioner statement that services are medically necessary

      Treatment team member signatures

      Updates to aftercare plan

Treatment teams must document activities, notations of discussions, findings, conclusions, and modifications. If a recipient does not meet treatment goals, the treatment team must provide justification if it makes no changes.

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

5.0, Exclusion

5.1, General Non-Covered Criteria, No Change.

5.2, Specific Non-Covered Criteria

Florida Medicaid does not cover the following as part of this service benefit:

      Activities performed to maintain and review records for facility utilization, continuous quality improvement, recipient eligibility status processing, and staff training purposes

      Behavior analysis assessments or reassessments on the same day as behavioral health assessments

      Bio-psychosocial evaluation for the same recipient after an in-depth assessment has been completed, unless there is a documented change in the recipient’s status and additional information must be gathered to modify the recipient’s treatment plan

      Brief behavioral assessment on the same day that a psychiatric evaluation, biopsychosocial assessment, or in-depth assessment has been completed

      Case management services

      Services provided to a recipient on the day of admission into the Statewide Inpatient Psychiatric Program (SIPP); however, community behavioral health services are reimbursable on the day of discharge

      Services rendered to individuals residing in an institution for mental diseases

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

      Travel time

6.0, Documentation

6.1, General Criteria, No Change

6.2, Specific Criteria, now reads:

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

Record of a mental health diagnosis from a licensed practitioner

Daily progress notes that list each service and activity provided

      7.0, Authorization through 8.0, Reimbursement, No Change.