CENTRAL OHIO MENTAL HEALTH CENTER
Subject:
Billable Services
Section:
04.04.03.00
Effective Date: 10/16/2009
Approved by: ______________________________
Larry Westbrook, Board President
PURPOSE:
To establish the documentation requirement for covered service and ensure
compliance with the Medicaid billing requirements as defined in OAC 5101:3-2702 and 5101:3-27-03 for Mental Health Services and 5101:3-30-02 and 5101:330-03 for Alcohol and Drug Addiction Services.
POLICY:
I.
Covered services are to be billed on a unit rate basis in accordance with the definition,
standards, and eligible providers of services as defined in OAC 5101:3-27, 5122-29,
5101:3-30 and 3793:2-1-08. Medicaid Covered Mental Health Services include the
following:
A.
Individual Behavioral Health Counseling and Therapy
B.
Group Behavioral Health Counseling and Therapy
C.
Mental Health Assessment
D.
Pharmacological Management
E.
Partial Hospitalization
F.
Mental Health Crisis Intervention
G.
Individual Community Psychiatric Supportive Treatment
H.
Group Community Psychiatric Supportive Treatment
II.
Medicaid Covered Alcohol and/or Other Drug Services include the following:
A.
Alcohol and/or Other Drug Service Assessment
B.
Alcohol and/or Other Drug Service Individual BH Counseling and Therapy
C.
Alcohol and/or Other Drug Service Group Counseling
D.
Alcohol and/or Other Drug Service Case Management
E.
Alcohol and/or Other Drug Service Crisis Intervention
F.
Alcohol and/or Other Drug Service Medication-Somatic Service
III.
A covered services must be recommended by an individual who is qualified to supervise
the specific service, be identified on the Individual Service Plan (ISP) according to the
Center’s policies (04.05.01.00 and 11.04.05.01.00), and performed by an individual
qualified to perform the specific service as set for in the service definitions found in OAC
5122-29 and 3793:2-1-08.
IV.
All covered service contacts must have written documentation in the Individual Client
Record (ICR) that includes all the required elements outlined in Center’s Individual
Service Notes Policy (04.04.02.00).
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V.
A billable unit of service is defined as a face-to-face contact between a client and a
professional authorized to provide the reimbursable service. Units of services with
individuals other than the client are not billable, with some exceptions. Only the
following exceptions may be considered billable units of service:
A.
Mental Health Services:
1)
Community Psychiatric Supportive Treatment (CPST) service may
include either face-to-face or telephone contacts between the mental
health professional and the client or individuals essential to the mental
health treatment of the client.
2)
CPST may be billed for consultation between CPST staff and Mental
Health Partial Hospitalization or Mental Health Residential staff when the
client is not present provided the CPST services and CPST staff are
organized as distinctive services and CPST services are not time limited
or site specific.
3)
Children and adolescents receiving Behavioral Health Counseling and
Therapy, Pharmacological Management, Mental Health Assessment, and
Mental Health Crisis Intervention Services may include face-to-face
consultation with family members, parent, guardian, and/or significant
others.
4)
Adults receiving Crisis Intervention services may include face-to-face
consultation with family members.
B.
Alcohol and Drug Addiction Services:
1)
Case Management may include face-to face or telephone contact with
the client or persons other than the client.
2)
Case Management may include time spent without the client present for
monitoring service delivery to individual clients (i.e. Medical/Clinical
staffing or supervision) and assisting an individual in obtaining necessary
services (i.e. preparing letters on behalf of the client to another agency)
3)
Counseling and Diagnostic Assessment may include face-to-face
interactions with family members, parent, guardian and significant others
of a child or adolescent when the intended outcome is improved
functioning of the child or adolescent and such intervention is written in
the ISP
VI.
Alcohol and Drug Addiction Services must be provided at a site certified for participation
in the alcohol and drug addiction treatment program.
VII.
Each service contact must be provided in independent timeframes and shall not overlap
with another billable unit of services. The Center’s Correction Process for Overlapping
Services procedure (04.04.01.02) shall be used to resolve time conflicts prior to seeking
reimbursement for the services.
VIII.
Written documentation for services provided to either multiple clients seen during the
same time OR by multiple providers serving a single client at the same time, so that the
individual time assigned to each client or provider does not exceed the total amount of
time spent providing the service. The total amount of time spent must be divided among
either the clients or the providers, depending on the circumstance. For example, if a
provider sees a parent and a child for an hour and both the parent and child are clients,
the provider may choose ONE of the following options for documenting the service:
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A.
B.
C.
Document one hour of service to the parent,
Document one hour of service to the child; OR
Document a portion of the service to the parent (i.e. 30 minutes) and a portion of
the service to the child (i.e. 30 minutes) where the TOTAL time documented
equals one hour.
IX.
Service provided to adult client who are inmates at a correctional facility or
children/adolescents sentenced to a juvenile detention center (for punishment of a
crime) are not Medicaid eligible services, but may be billable to another funding source.
All services provided to these clients and/or collaterals must be coded with a “J” under
the Recipient Code on the SAL during the duration of the incarceration.
X.
Service provided to clients placed in a state operated psychiatric hospital are not
Medicaid eligible services, but may be billable to another funding source. All services
provided to these clients and/or collaterals must be coded with “H” under the Recipient
Code on the SAL during the duration of the hospitalization.
XI.
All service contacts must be medically necessary in order to be a billable service.
Medically necessary mental health services include, but are not limited to preventative,
diagnostic, therapeutic, rehabilitative, and palliative intervention provided for the
symptoms, diagnosis, and treatment of a particular disease or condition that:
A.
Is defined under the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) or International Classification of Diseases, Ninth Edition
(ICD-9) or their successors;
B.
Without which the person could be expected to suffer prolonged, increased or
new psychiatric symptomatology or impairment of function;
C.
Is based on an ISP that included interventions to ameliorate symptoms or
achieve treatment goals;
D.
Is provided in the least restrictive setting available to the person
E.
Reflects consumer participation; and
F.
For children age zero to eighteen, is developmentally appropriate and designed
to address the needs of the child and family.
XII.
Medicaid, Medicare, and most third party payors consider the following activities
unallowable activities or non-billable services:
A.
Services provided by ineligible providers;
B.
Transportation in and of itself;
C.
Vocation job training activities;
D.
Academic education services;
E.
Providing Support Groups;
F.
Social/Recreational services (i.e. crafts, non-therapeutic art projects, recreational
outings);
G.
Phone calls to leave messages or schedule appointments;
H.
Monitoring clients while they are sleeping;
I.
Observing clients when not performing a therapeutic interventions (i.e. client is
watching a movie or TV, eating, resting, etc.);
J.
Waiting with clients for appointments at social service agencies, court hearings,
and similar activities, in and of itself
RESPONSIBILITY:
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The Executive Director is responsible for the communication and implementation of this policy and
any subsequent procedures that are applicable.
Reviewed:
10/16/2009
09/29/2005
Revised:
10/16/2009
Approved:
10/16/2009
11/20/2003
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