Psychological and Behavioral Health Services

Psychological and Behavioral Health Services School-Based Medicaid Expansion Information

Psychological and Behavioral Health Services from the UMASS and MassHealth

***Important information to bill Mental/Behavioral Health Services. You may have a school title as an Adjustment Consular, School Psychologist, ect. In order to bill Medically Necessary services, you must also have one of the following licenses and be listed on your district’s Random Moment Time Study (RMTS). Please contact nembclientservices@nembgroup.com if your questioning if you qualify to bill. 

    • Licensed Mental Health Counselor
    • Licensed Psychiatrist
    • Licensed Psychologist
    • Licensed Educational Psychologist
    • Lic. Clinical Social Worker/Lic. Independent Clinical Social Worker
    • Licensed Marriage and Family Therapist
    • Department of Elementary and Secondary Education Licensed School Psychologist *New as of 7/1/19
    • Description: Use this PowerPoint as your guide for the requirements to complete billing under the Expansion program. Please read the entire presentation and pay extra attention to the following slides:
        • To determine if services provided meet the definition of Medicaid Medical Necessity and Covered vs. Non-Covered Services: Slides 13-17, 30-40
          • *** Services must require the clinical expertise of the practitioner
        • What is included in Comprehensive Assessment: Slide 39
          • *** The CANS requirement was redacted
        • What is included in Treatment Plans: Slide 40
        • What is included in Service Authorization: Slide 41-43
          • *** Treatment plans can serve as Service Authorization if all information is included.
        • What should be included in the Activity/Procedure Note on Service Documentation: Slide 48
        • Procedure codes using TM or TR Modifiers: Slide 58
          • ***TM is for services pursuant to an IEP. TR for services not pursuant to an IEP. You may find many of the students you provide Medically Necessary services to are not on an IEP but on a 504 or other counseling plan. These services would be billed with a TR modifier.
        • ICD-10 Diagnosis Codes: Slide 64

Service Authorization and Service Authorization Guide

  • Description: A requirement for “backup” to substantiate Medicaid Medical Necessity includes comprehensive evaluation, treatment plan, and service authorization. Here you will find a copy of the Service Authorization for Occupational Therapy. You will also find a guide that includes all the elements of Service Authorization.  ***It is advised that you combine all the elements found on the Service Authorization Guide with your treatment plan for one document. Please note all required “backup” should be kept for 7 years in the case of an audit.

 

Service Documentation Paper Billing Form

  • In-District Service Documentation Billing Form
    • Description: The In-District Service Documentation form can be used to document Medicaid Medically Necessity services that occurred and to submit for paper billing to NEMB. Please note many clinicians will be documenting in another platform such as Frontline, Aspen, PowerSchool, SNAP, or SimpleNote. Yet, the form can be used as a guide to identify the procedure codes for your specialty. ***If your district uses the paper Service Documentation forms to submit billing to NEMB please use this form. Once completed send them to your District’s internal Medicaid contact for the forms to be uploaded via the Sharefile to NEMB, minimally on a monthly basis.
  • Out-of-District Day & Residential Service Documentation Billing Forms
    • Description: The Out-Of-District Service Day and Residential Documentation form can be used to document Medicaid Medically Necessity services that occurred and to submit for paper billing to NEMB. Please provide these to the Out-of-District schools that your district’s Medicaid eligible students attend. They should be collected from the school at the end of each month and uploaded to the NEMB secure Sharefile, by your district’s internal Medicaid contact.

Hearing Screenings

  • Description: The following screenings can be billed if given by one of the required licensures for Mental/Behavioral Health on the RMTS. Screenings require no Service Authorization, care plan, and are not subject to the 8-minute rule: From Slide 33

In performing a behavioral health screening, providers must use one of the clinically appropriate tools from the following list of approved, standardized behavioral-health screening tools.

  • Ages and Stages Questionnaires (ASQ: SE); 
  • Brief Infant-Toddler Social and Emotional Assessment (BITSEA); 
  • Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT); 
  • Early Childhood Screening Assessment (ECSA); 
  • Edinburgh Postnatal Depression Scale (EPDS); 
  • Modified Checklist for Autism in Toddlers (M-CHAT) and M-CHAT-Revised (M-CHAT-R); 
  • Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F); 
  • Parents’ Evaluation of Developmental Status (PEDS); 
  • Patient Health Questionnaire-9 (PHQ-9); 
  • Pediatric Symptom Checklist (PSC-35), Pediatric Symptom Checklist (PSC-17), and Pediatric Symptom Checklist-Youth Report (PSC-Y); 
  • Strengths and Difficulties Questionnaire (SDQ); and 
  • Survey of Well-being of Young Children (SWYC) and Survey of Well-being of Young Children–MA (SWYC-MA).

Screening Documentation Billing Form

  • Description: The In-District Service Documentation form can be used to document screening services that occurred and to submit for paper billing to NEMB. Please note many clinicians will be documenting in another platform such as Aspen, SNAP, or other nursing software. Yet, the form can be used as a guide to identify the procedure codes for your specialty. ***If your district uses the paper Service Documentation forms to submit billing to NEMB please use this form. Once completed send them to your District’s internal Medicaid contact for the forms to be uploaded via the Sharefile to NEMB, minimally on a monthly basis.
    • *** Screenings use a TR modifier with the procedure code: 96110-TR
    • *** ICD-10 Codes for Mental Behavioral Health Screenings:
      • Z13.30
  • Out-of-District Day & Residential Screening Service Documentation Billing Forms
    • Description: The Out-Of-District Service Day and Residential Documentation form can be used to document screenings that occurred and to submit for paper billing to NEMB. Please provide these to the Out-of-District schools that your district’s Medicaid eligible students attend. They should be collected from the school at the end of each month and uploaded to the NEMB secure Sharefile, by your district’s internal Medicaid contact.

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