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H0039 www.dmas.virginia.gov 1 Department of Medical Assistance Services Intensive Community Treatment (ICT) 2013.

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Presentation on theme: "H0039 www.dmas.virginia.gov 1 Department of Medical Assistance Services Intensive Community Treatment (ICT) 2013."— Presentation transcript:

1 H Department of Medical Assistance Services Intensive Community Treatment (ICT) 2013

2 2 Disclaimer These slides contain only highlights of the Virginia Medicaid Community Mental Health Rehabilitative Services Manual (CHMRS) and are not meant to substitute for the comprehensive information available in the manual or state and federal regulations. *Please refer to the manual, available on the DMAS website portal, for in-depth information on Community Mental Health Rehabilitative Services criteria. Providers are responsible for adhering to related state and federal regulations. 2 Department of Medical Assistance Services

3 3 Intensive Community Treatment - ICT Objectives of this Training Are: To define the criteria of Intensive Community Treatment To identify staff qualifications; To clarify eligibility criteria; To identify required activities; To review limitations of the service; To outline service units and reimbursement; and To review service authorization requirements. 3 Department of Medical Assistance Services

4 H Department of Medical Assistance Services ICT Service Definition 2013

5 5 Intensive Community Treatment - ICT Intensive Community Treatment (ICT) is an array of mental health services for individuals with serious emotional illness who need intensive levels of support and service in their natural environment to permit or enhance functioning in the community. ICT has been designed to be provided through a designated multi-disciplinary team of mental health professionals. It is available either directly or on call 24 hours per day, seven days per week, 365 days per year. 5 Department of Medical Assistance Services

6 H Department of Medical Assistance Services ICT Licensing

7 7 Intensive Community Treatment - ICT Intensive Community Treatment providers must have a Department of Behavioral Health and Developmental Services (DBHDS) license to provide Intensive Community Treatment (ICT) or Program of Assertive Community Treatment (PACT). 7 Department of Medical Assistance Services

8 H Department of Medical Assistance Services ICT Staff Qualifications

9 9 Intensive Community Treatment - ICT  Licensed Mental Health Professional (LMHP) or LMHP Supervisee or Resident  Qualified Mental Health Professional-Adult (QMHP-A)  Qualified Mental Health Professional-Eligible (QMHP-E)  Qualified Mental Health Paraprofessional (QPP or QMHPP) * Qualification definitions may be found in Chapter II of the CMHRS Manual 9 Department of Medical Assistance Services

10 H Department of Medical Assistance Services ICT Eligibility Criteria

11 11 Intensive Community Treatment - ICT In order to be eligible for ICT the individual is best served in the community and meets at least one of the following: 1.The individual must be at high risk for psychiatric hospitalization or becoming or remaining homeless due to mental illness, or require intervention by the mental health or criminal justice system due to inappropriate social behavior. 2.The individual has a history (three months or more) of a need for intensive mental health treatment or treatment for co- occurring serious mental illness and substance use disorder and demonstrates a resistance to seek out and utilize appropriate treatment options Department of Medical Assistance Services

12 12 Intensive Community Treatment - ICT If an individual has co-occurring mental health and substance use disorders, integrated treatment for both is allowed as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition. The impact of the substance abuse condition on the mental health condition must be clearly documented in the assessment, treatment plan and progress notes Department of Medical Assistance Services

13 H Department of Medical Assistance Services ICT Required Activities

14 14 Intensive Community Treatment - ICT Services include medical psychotherapy, psychiatric assessment, medication management, and case management activities offered outside of the clinic, hospital, or office setting provided to individuals who are best served in the community. A service-specific provider assessment which documents eligibility and need for this service must be completed by a Licensed Mental Health Professional (LMHP), LMHP Supervisee or Resident, Qualified Mental Health Professional-Adult (A) or QMHP-Eligible (E) prior to the initiation of services. Service authorization is not needed for the assessment Department of Medical Assistance Services

15 15 Intensive Community Treatment - ICT An Individual Service Plan (ISP), based on the needs as determined by the service-specific provider assessment, must be initiated at the time of admission and fully developed by the LMHP or LMHP Supervisee or Resident, QMHP-A or QMHP-E and approved by the LMHP or LMHP Supervisee or Resident within 30 days of the initiation of services. Services are provided in accordance with the ISP. Services provided by a paraprofessional must be done under the supervision of a QMHP, LMHP, or LMHP Supervisee or Resident Department of Medical Assistance Services

16 16 Intensive Community Treatment - ICT Services must be documented through a daily log of time spent in the delivery of services and a description of the activities/services provided. There must also be at least a weekly note documenting progress or lack of progress toward goals and objectives outlined in the ISP. Coordination to ensure there is no duplication in services or billing and to ensure continuity of care Department of Medical Assistance Services

17 17 Intensive Community Treatment - ICT The service provider must notify or document the attempts to notify the primary care provider of the individual’s receipt of community mental health rehabilitative services Department of Medical Assistance Services

18 H Department of Medical Assistance Services ICT Limitations and Supervision Requirements

19 19 Intensive Community Treatment - ICT In preparation for transition to a lesser level of care, if an ICT member goes to the clinic independently as part of the plan of care for transitioning, then psychotherapy and medication management may be billed as ICT. The ICT plan must continue to document the need for the intense level of services. If the individual regularly attends office appointments that are no more than 25% of billed ICT time, the need for continuance of ICT services based on resistance and/or inability to benefit from a lesser level of intensity than ICT shall be documented in the record. Time billed for psychotherapy, med management, and other clinic services may not exceed 25% of the total time billed for ICT during this transition period. The transition period is limited to 8 weeks Department of Medical Assistance Services

20 20 Intensive Community Treatment - ICT ICT services may be billed if the individual is brought to the facility by ICT staff to see the psychiatrist. Documentation must be present to support this intervention. No billing is allowed during the same time period for any outpatient psychotherapy services or case management. Crisis stabilization may be billed if: (1) Services are provided in a community-based residential setting; and (2) Services meet the criteria for crisis stabilization services; and (3) ICT is not billed for the days that crisis stabilization is billed Department of Medical Assistance Services

21 H Department of Medical Assistance Services ICT Units and Reimbursement

22 22 Intensive Community Treatment - ICT Intensive Community Treatment (H0039) requires service authorization before any services (beyond the service specific provider assessment) are reimbursed. The service limit for service-specific provider assessments is 2 per provider per individual per fiscal year. This allows each provider to bill 2 service-specific provider assessments for each individual from July 1 – June 30 of every year. The service-specific provider assessment code (H0032 with a U9 Modifier) must be billed before the service treatment (H0039) will pay in the Medicaid Management of Information System (MMIS) claims system Department of Medical Assistance Services

23 23 Intensive Community Treatment - ICT Initial authorization is for a maximum of 26 weeks. Continuation of service may be reauthorized at 26 week intervals based on written service specific provider assessment and certification of need by an LMHP. A maximum of 130 units is available annually. One unit equals one hour. Time may be accumulated to reach a billable unit. Each July 1st all service limits will be set to zero. A fiscal year is July 1 through June Department of Medical Assistance Services

24 H Department of Medical Assistance Services ICT Service Authorization

25 25 Intensive Community Treatment - ICT KePRO is the DMAS contractor for Service Authorization (SA). For questions go to the SA website: DMAS.KePRO.org and click on Virginia Medicaid Phone: VAPAUTH or Fax: OKBYFAX or Web: 25 Department of Medical Assistance Services

26 26 Intensive Community Treatment - ICT Submitting a request  The preferred method is through the Atrezzo® web-based program  Registration is required  Information on Atrezzo is available on the KePRO website, or call or (804) or mail to: »KePro »2810 North Parham Rd, Suite 305 »Henrico, Virginia Department of Medical Assistance Services

27 27 Intensive Community Treatment - ICT  Initial review is required to be submitted to the SA contractor at admission.  Continued stay reviews are required to be submitted to the SA contractor prior to, however not more than 30 days before, the end of the current approval.  Clinical information is needed from the provider for review for medical necessity criteria. A checklist for both the initial and continued stay review is located at dmas.kepro.org.  Requests are authorized for up to 6 months at one time Department of Medical Assistance Services

28 28 Intensive Community Treatment - ICT Requests should include:  A DSM diagnosis (V codes are not acceptable as stand alone diagnosis);  If there is a dual diagnosis of mental health and substance abuse, services must be integrated;  A description of symptoms/severity of illness; and  Demonstrate clinical necessity for the service with specific examples of how the individual meets each of the eligibility criteria Department of Medical Assistance Services

29 29 Intensive Community Treatment - ICT  For continued stay submissions, examples of clinical necessity (eligibility) criteria must be within the past 30 days.  Use of the KePRO checklist helps to ensure that all required information is submitted and expedites review by reducing the need for requests to be pended for additional information Department of Medical Assistance Services

30 30 Intensive Community Treatment - ICT Helpful Resources: 12VAC Emergency Regulations for Community Mental Health Services Virginia Medicaid Web Portal link DMAS Office of Behavioral Health: – Address DMAS Helpline: Richmond Area All other 30 Department of Medical Assistance Services

31 31 Intensive Community Treatment - ICT Thank you for attending this training and helping to serve Virginia’s Medicaid Recipients Department of Medical Assistance Services


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