POLICY AND METHODS FOR ESTABLISHING PAYMENT RATES FOR OTHER TYPES OF CARE FOR SERVICES

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POLICY AND METHODS FOR ESTABLISHING PAYMENT RATES FOR

OTHER TYPES OF CARE FOR SERVICES

C. Community Behavioral Health Rehabilitation Services

Effective for services provided on or after July 1, 2009, providers of Community

Behavioral Health Rehabilitation Services (CBHRS) will be reimbursed at fee for

service rates based on:

Practitioner type;

Service costs (salaries, fringe benefits, allocable direct and appropriate indirect

costs);

Location of services (in-clinic and out-of-clinic) and productivity factors;

State-developed fee schedule rates are the same for both governmental and private

providers of all community mental health services. The fee schedule and any

annual/periodic adjustments to the fee schedule are published in state plan

amendments, Georgia Medicaid policy manuals and provider correspondence.

Detail on each of the factors involved in the CBHRS is described below. The fee

schedule for Community Behavioral Health Rehabilitation Services is also presented

below and is grouped by service area to correspond with the section 3.1-A of the

Georgia Medicaid Plan. In addition, provider qualifications are detailed in section

3.1-A.

Practitioner Type

Each practitioner type is grouped into levels consistent with specific credentials and

range of salaries. Salary data was derived from the May 2007 Occupational

Employment and Wage Estimates for Georgia from the United States Department of

Labor’s Bureau of Labor Statistics and are generally classified below:

Level 1: Physician, Psychiatrist

Level 2: Psychologist, Physician’s Assistant, Nurse Practitioner, Clinical Nurse Specialist/PMH, Pharmacist

Level 3: Registered Nurse, Licensed Dietician, Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT)

Level 4: Licensed Practical Nurse (LPN); Licensed Associate Professional Counselor (LAPC); Licensed Master’s Social Worker (LMSW); Licensed Associate Marriage and Family Therapist (LAMFT);

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Professionals (CPRP) with Bachelor’s degrees or higher in the social sciences/helping professions

Level 5: Trained Paraprofessionals, Certified/Registered Addiction Counselors (CAC-I, RADT), Certified Peer Specialists, Certified Psychiatric Rehabilitation Professionals, and Qualified Medication Aides

Service Costs

Service costs include practitioner salaries, fringe benefits, allocable direct and

appropriate indirect costs. Service costs do not include room, board, or watchful

oversight. Service costs were calculated as follows:

Salaries and Fringe Benefits

Using the annual salaries of the practitioners that were included within a level (data

source described above), a median salary was calculated for each band. Salaries are

increased by 41.71% to account for employee fringe benefits.

Allocable Direct and Appropriate Indirect Costs

The Community Behavioral Health Rehabilitation Services (CBHRS) rates also take

into account costs that are directly allocable to individual practitioners. Allocable

direct costs include those costs which are critical to the practitioner in providing

treatment services to the patient. These costs include:

Program clinical supervisors and support staff

Staff training costs

Staff mileage and vehicle costs

Telephone costs

Office supplies

Computer costs

Office space allocated to staff providing MRO services

Liability/malpractice insurance

Indirect costs include:

Management personnel costs (CEO, Medical Director, CFO)

Support staff personnel costs such as human resources, payroll, quality

improvement/accreditation, procurement, billing, accounting, information system

technicians

Management information system costs such as billing and general ledger

accounting systems

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Federal Financial Participation through CBHRS is not available for:

a. room and board services;

b. educational, vocational and job training services;

c. habilitation services;

d. services to inmates in public institutions as defined in 42 CFR §435.1010;

e. services to individuals residing in institutions for mental diseases as described

in 42 CFR§435.1010;

f. recreational and social activities; and

g. Services that must be covered elsewhere in the state Medicaid plan.

Based on data received through surveys of a large sample of agencies currently

providing Community Behavioral Health Rehabilitation Services in multiple states,

average allocable direct and indirect cost factors were calculated as a percentage of

direct personnel costs. These costs were then calculated for each service and for each

applicable practitioner level. All of these cost components were summed to yield an

annual cost for the service for the particular practitioner level. Due to the large

difference between the median annual salaries in Level 1 (physicians/psychiatrists)

and the other levels, it was necessary to adjust the support and administrative factors

applied to the highest level versus the other levels so that the support and

administrative costs associated with the highest levels were not over-inflated. This

was accomplished by adjusting the direct and indirect cost factors according to the

proportion of personnel costs in an average agency accounted for by the top level

versus the other four practitioner levels. The overall direct services cost factor is 39%

and indirect is 15%. Once the factors were adjusted to account for the disparity

between physician salaries and the other levels the cost factors became 19% for direct

costs and 7% for indirect costs for Level 1 and 45% for direct costs and 17% indirect

costs for the remaining four levels.

Once the total cost of a service for a practitioner at a particular level was calculated,

the cost was distributed to billable time for staff providing CBHRS in the following

manner:

o

Total hours were reduced by the average paid time off for vacation, holiday and

sick time to yield available time per practitioner per year.

o

Productivity factors were established based on the CBHRS requirements for the

service: national and state experience with the amount of billable time that can be

expected over the course of an average week or month: consideration of travel

time required for a community-based service in a large, rural state; time

associated with missed appointments; and staff time required for chart

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Location of Services (In-Clinic and Out-of-Clinic) and Associated Productivity Factors

Except as noted below, for services provided in clinic locations the targeted

productivity is 60-70% of available hours depending on the service and practitioner.

Productivity factors were set at 70% for in-clinic services provided by physicians and

for all medication administration services and 60% for most other in-clinic services.

Except as noted otherwise below, for out-of-clinic services the productivity time was

45-55% of available hours, with physician and medication administration services

calculated using the 55% factor and most other out-of-clinic service rates calculated

using the 50% factor. In addition, the following adjustments were made:

productivity factors were reduced by 5% for services provided in a group setting to

account for additional documentation time; productivity for Level 3 professionals for

most services was also reduced by 5% to account for the required supervisory

responsibilities of these licensed staff (e.g. RNs, LPCs, LCSWs) that reduce the

amount of time available for direct billable services; productivity for Intensive Family

Intervention team members was set at 45% to account for additional time required for

IFI team meetings and contacts in which two team members are providing services in

conjunction but only one is billing. Available hours times the productivity factor

yields billable hours for each service for each practitioner level/band, and the total

program costs (salary, fringe, direct and indirect costs) are then divided by billable

time to arrive at a unit rate.

KEY: Code Modifiers Used:

GT = Via interactive audio and video telecommunication systems HA = Child/Adolescent Program

HK = High Risk Population HQ = Group Setting

HR = Family/Couple with client present HS = Family/Couple without client present HT = Multidisciplinary team

TG = Complex Level of Care TF = Intermediate Level of Care TN = Rural Service Area

U1 = Practitioner Level 1 (see below for description of all practitioner levels) U2 = Practitioner Level 2 U3 = Practitioner Level 3 U4 = Practitioner Level 4 U5 = Practitioner Level 5 U6 = In-Clinic U7 = Out-of-Clinic UK = Collateral Contact

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Day

Service Area = Behavioral Health Assessment

Mental Health Assessment by a non-physician

Practitioner Level 2, In-Clinic H0031 U2 U6 15 minutes $ 38.97 24 Practitioner Level 3, In-Clinic H0031 U3 U6 15 minutes $ 30.01 24 Practitioner Level 4, In-Clinic H0031 U4 U6 15 minutes $ 20.30 24 Practitioner Level 5, In-Clinic H0031 U5 U6 15 minutes $ 15.13 24 Practitioner Level 2, Out-of-Clinic H0031 U2 U7 15 minutes $ 46.76 24 Practitioner Level 3, Out-of-Clinic H0031 U3 U7 15 minutes $ 36.68 24 Practitioner Level 4, Out-of-Clinic H0031 U4 U7 15 minutes _{$ 24.36} ₂₄ Practitioner Level 5, Out-of-Clinic H0031 U5 U7 15 minutes $ 18.15 24

Service Area = Service Plan Development

Mental Health Service Plan Development by a non-physician

Practitioner Level 2, In-Clinic H0032 U2 U6 15 minutes $ 38.97 24 Practitioner Level 3, In-Clinic H0032 U3 U6 15 minutes _{$ 30.01} ₂₄ Practitioner Level 4, In-Clinic H0032 U4 U6 15 minutes $ 20.30 24 Practitioner Level 5, In-Clinic H0032 U5 U6 15 minutes $ 15.13 24 Practitioner Level 2, Out-of-Clinic H0032 U2 U7 15 minutes $ 46.76 24 Practitioner Level 3, Out-of-Clinic H0032 U3 U7 15 minutes $ 36.68 24 Practitioner Level 4, Out-of-Clinic H0032 U4 U7 15 minutes $ 24.36 24 Practitioner Level 5, Out-of-Clinic H0032 U5 U7 15 minutes $ 18.15 24

Service Area = Diagnostic Assessment

Psychiatric Diagnostic Examination

Practitioner Level 1, In-Clinic 90801 U1 U6 1 episode $ 174.63 2 Practitioner Level 1, In-Clinic, Child Program 90801 HA U1 U6 1 episode $ 174.63 2 Practitioner Level 1, Out-of-Clinic 90801 U1 U7 1 episode $ 222.26 2 Practitioner Level 1, Out-of-Clinic, Child

Program

90801 HA U1 U7 1 episode $ 222.26 2 Practitioner Level 1, Via interactive audio and

video telecommunication systems

90801 GT U1 1 episode $ 174.63 2 Practitioner Level 1, Via interactive audio and

video telecommunication systems, Child Program

90801 GT HA U1 1 episode $ 174.63 2 Practitioner Level 2, In-Clinic 90801 U2 U6 1 episode $ 116.90 2 Practitioner Level 2, In-Clinic, Child Program 90801 HA U2 U6 1 episode $ 116.90 2 Practitioner Level 2, Out-of-Clinic 90801 U2 U7 1 episode $ 140.28 2 Practitioner Level 2, Out-of-Clinic, Child

Program

90801 HA U2 U7 1 episode $ 140.28 2

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Day

Practitioner Level 2, Via interactive audio and video telecommunication systems

video telecommunication systems, Child Program

90801 GT HA U2 1 episode $ 116.90 2 Practitioner Level 3, In-Clinic 90801 U3 U6 1 episode $90.03

2 Practitioner Level 3, In-Clinic, Child Program 90801 HA U3 U6 1 episode $90.03

2 Practitioner Level 3, Out-of-Clinic 90801 U3 U7 1 episode $110.04

2 Practitioner Level 3, Out-of-Clinic, Child

Program

90801 HA U3 U7 1 episode $110.04 2 Practitioner Level 3, Via interactive audio and

90801 GT HA U3 1 episode $ 90.03 2

Psychiatric Diagnostic Examination, Interactive

Practitioner Level 1, In-Clinic 90802 U1 U6 1 episode $ 174.63 2 Practitioner Level 1, In-Clinic, Child Program 90802 HA U1 U6 1 episode $ 174.63 2 Practitioner Level 1, Out-of-Clinic 90802 U1 U7 1 episode $ 222.26 2 Practitioner Level 1, Out-of-Clinic, Child

Program

90802 GT HA U1 1 episode $ 174.63 2 Practitioner Level 2, In-Clinic 90802 U2 U6 1 episode $ 116.90 2 Practitioner Level 2, In-Clinic, Child Program 90802 HA U2 U6 1 episode $ 116.90 2 Practitioner Level 2, Out-of-Clinic 90802 U2 U7 1 episode $ 140.28 ₂ Practitioner Level 2, Out-of-Clinic, Child

Program

video telecommunication systems, Child Program

90802 GT HA U2 1 episode $ 116.90 2 Practitioner Level 3, In-Clinic 90802 U3 U6 1 episode $90.03 2 Practitioner Level 3, In-Clinic, Child Program 90802 HA U3 U6 1 episode $90.03 2 Practitioner Level 3, Out-of-Clinic 90802 U3 U7 1 episode $110.04 2 Practitioner Level 3, Out-of-Clinic, Child

Program

90802 HA U3 U7 1 episode $110.04 2 Practitioner Level 3, Via interactive audio and

90802 GT U3 1 episode $ 90.03 2

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Day

Practitioner Level 3, Via interactive audio and video telecommunication systems, Child Program

90802 GT HA U3 1 episode $ 90.03 2

Psychological Testing – Psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology e.g. MMP, Rorschach, WAIS (per hour of psychologist’s or

physician’s time, both face-to-face with the patient and time interpreting test results and preparing the report)

Practitioner Level 2, In-Clinic 96101 U2 U6 1 hour $ 155.87 5 Practitioner Level 2, Out-of-Clinic 96101 U2 U7 1 hour $ 187.04 5

Psychological Testing – Psychodiagnostic assessment of emotionality, intellectual abilities,

personality and psychopathology e.g. MMP, Rorschach, WAIS) with qualified healthcare professional interpretation and report, administered by technician, per hour of technician time, face-to-face

Practitioner Level 3, In-Clinic 96102 U3 U6 1 hour $ 120.04 5 Practitioner Level 3, Out-of-Clinic 96102 U3 U7 1 hour $ 146.71 5 Practitioner Level 4, In-Clinic 96102 U4 U6 1 hour _{$ 81.18} 5 Practitioner Level 4, Out-of-Clinic 96102 U4 U7 1 hour $ 97.42 5

Service Area = Crisis Intervention Services

Crisis Intervention Services

Practitioner Level 1, In-Clinic H2011 U1 U6 15 minutes $ 58.21 48 Practitioner Level 2, In-Clinic H2011 U2 U6 15 minutes _{$ 38.97} ₄₈ Practitioner Level 3, In-Clinic H2011 U3 U6 15 minutes $ 30.01 48 Practitioner Level 4, In-Clinic H2011 U4 U6 15 minutes $ 20.30 48 Practitioner Level 5, In-Clinic H2011 U5 U6 15 minutes $ 15.13 48 Practitioner Level 1, Out-of-Clinic H2011 U1 U7 15 minutes $ 74.09 48 Practitioner Level 2, Out-of-Clinic H2011 U2 U7 15 minutes $ 46.76 48 Practitioner Level 3, Out-of-Clinic H2011 U3 U7 15 minutes $ 36.68 48 Practitioner Level 4, Out-of-Clinic H2011 U4 U7 15 minutes $ 24.36 48 Practitioner Level 5, Out-of-Clinic H2011 U5 U7 15 minutes $ 18.15 48

Service Area = Psychiatric Treatment

Individual Psychotherapy, insight oriented, behavior-modifying and/or supportive in an office or outpatient facility, approximately 20-30 minutes face-to-face with patient with medical evaluation and management services.

Practitioner Level 1, In-Clinic 90805 U1 U6 20-30 minutes $ 97.02 1 Practitioner Level 1, In-Clinic, Child Program 90805 HA U1 U6 20-30 minutes $ 97.02 1 Practitioner Level 1, Out-of-Clinic 90805 U1 U7 20-30 minutes $ 123.48 1 Practitioner Level 1, Out-of-Clinic, Child

Program

90805 HA U1 U7 20-30 minutes $ 123.48 1 Practitioner Level 2, In-Clinic 90805 U2 U6 20-30 minutes $ 64.95 1 Practitioner Level 2, In-Clinic, Child Program 90805 HA U2 U6 20-30 minutes $ 64.95 1 Practitioner Level 2, Out-of-Clinic 90805 U2 U7 20-30 minutes $ 77.93 1

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Day

Practitioner Level 2, Out-of-Clinic, Child Program

90805 HA U2 U7 20-30 minutes $ 77.93 1

Individual Psychotherapy, insight oriented, behavior-modifying and/or supportive in an office or outpatient facility, approximately 45-50 minutes face-to-face with patient with medical evaluation and management services.

Practitioner Level 1, In-Clinic 90807 U1 U6 45-50 minutes $ 174.63 1 Practitioner Level 1, In-Clinic, Child Program 90807 HA U1 U6 45-50 minutes $ 174.63 1 Practitioner Level 1, Out-of-Clinic 90807 U1 U7 45-50 minutes $ 222.26 1 Practitioner Level 1, Out-of-Clinic, Child

Program

90807 HA U1 U7 45-50 minutes $ 222.26 1 Practitioner Level 2, In-Clinic 90807 U2 U6 45-50 minutes $ 116.90 1 Practitioner Level 2, In-Clinic, Child Program 90807 HA U2 U6 45-50 minutes $ 116.90 1 Practitioner Level 2, Out-of-Clinic 90807 U2 U7 45-50 minutes $ 140.28 1 Practitioner Level 2, Out-of-Clinic, Child

Program

90807 HA U2 U7 45-50 minutes $ 140.28 1

Pharmacological Management

Practitioner Level 1, In-Clinic 90862 U1 U6 1 episode $ 58.21 1 Practitioner Level 1, In-Clinic, Child Program 90862 HA U1 U6 1 episode $ 58.21 1 Practitioner Level 1, Via interactive audio and

90862 GT HA U1 1 episode $ 58.21 1 Practitioner Level 1, Out-of-Clinic 90862 U1 U7 1 episode $ 74.09 1 Practitioner Level 1, Out-of-Clinic, Child

Program

90862 HA U1 U7 1 episode $ 74.09 1 Practitioner Level 2, In-Clinic 90862 U2 U6 1 episode $ 38.97 1 Practitioner Level 2, In-Clinic, Child Program 90862 HA U2 U6 1 episode $ 38.97 1 Practitioner Level 2, Via interactive audio and

90862 GT U2 1 episode

$ 38.97 1 Practitioner Level 2, Via interactive audio and

90862 GT HA U2 1 episode

$ 38.97 1 Practitioner Level 2, Out-of-Clinic 90862 U2 U7 1 episode $ 46.76 1 Practitioner Level 2, Out-of-Clinic, Child

Program

90862 HA U2 U7 1 episode

$ 46.76 1

Service Area = Nursing Assessment and Care

Nursing Assessment/ Evaluation

Practitioner Level 2, In-Clinic T1001 U2 U6 15 Minutes $ 38.97 16 Practitioner Level 3, In-Clinic T1001 U3 U6 15 Minutes _{$ 30.01} ₁₆ Practitioner Level 4, In-Clinic T1001 U4 U6 15 Minutes $ 20.30 16 Practitioner Level 2, Out-of-Clinic T1001 U2 U7 15 Minutes _{$ 46.76} ₁₆

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Day

Practitioner Level 3, Out-of-Clinic T1001 U3 U7 15 Minutes $ 36.68 16 Practitioner Level 4, Out-of-Clinic T1001 U4 U7 15 Minutes $ 24.36 16

RN Services, up to 15 minutes

Practitioner Level 2, In-Clinic T1002 U2 U6 15 Minutes $ 38.97 16 Practitioner Level 3, In-Clinic T1002 U3 U6 15 Minutes $ 30.01 16 Practitioner Level 2, Out-of-Clinic T1002 U2 U7 15 Minutes $ 46.76 16 Practitioner Level 3, Out-of-Clinic T1002 U3 U7 15 Minutes $ 36.68 16

LPN/LVN Services, up to 15 minutes

Practitioner Level 4, In-Clinic T1003 U4 U6 15 Minutes _{$ 20.30} ₁₆ Practitioner Level 4, Out-of-Clinic T1003 U4 U7 15 Minutes $ 24.36 16

Health and Behavior Assessment, Face-to-Face with the Patient, Initial Assessment

Practitioner Level 2, In-Clinic 96150 U2 U6 15 Minutes _{$ 38.97} ₁₆ Practitioner Level 3, In-Clinic 96150 U3 U6 15 Minutes $ 30.01 16 Practitioner Level 4, In-Clinic 96150 U4 U6 15 Minutes $ 20.30 16 Practitioner Level 2, Out-of-Clinic 96150 U2 U7 15 Minutes $ 46.76 16 Practitioner Level 3, Out-of-Clinic 96150 U3 U7 15 Minutes $ 36.68 16 Practitioner Level 4, Out-of-Clinic 96150 U4 U7 15 Minutes $ 24.36 16

Health and Behavior Assessment, Face-to-Face with the Patient, Reassessment

Practitioner Level 2, In-Clinic 96151 U2 U6 15 Minutes $ 38.97 16 Practitioner Level 3, In-Clinic 96151 U3 U6 15 Minutes $ 30.01 16 Practitioner Level 4, In-Clinic 96151 U4 U6 15 Minutes $ 20.30 16 Practitioner Level 2, Out-of-Clinic 96151 U2 U7 15 Minutes $ 46.76 16 Practitioner Level 3, Out-of-Clinic 96151 U3 U7 15 Minutes $ 36.68 16 Practitioner Level 4, Out-of-Clinic 96151 U4 U7 15 Minutes $ 24.36 16

Health and Wellness Supports (Behavioral Health Prevention Education Service (Delivery Of Services With Target Population To Affect Knowledge, Attitude And/Or Behavior)

Practitioner Level 2, In-Clinic 96151 U2 U6 15 Minutes $ 38.97 16 Practitioner Level 3, In-Clinic H0025 U3 U6 15 minutes $ 30.01 6 Practitioner Level 4, In-Clinic 96151 U4 U6 15 Minutes $ 20.30 16 Practitioner Level 2, Out-of-Clinic 96151 U2 U7 15 Minutes $ 46.76 16 Practitioner Level 3, Out-of-Clinic H0025 U3 U7 15 minutes $ 36.68 6 Practitioner Level 4, Out-of-Clinic 96151 U4 U7 15 Minutes $ 24.36 16

Service Area = Detoxification Services

Alcohol and/or drug services, Ambulatory Detoxification

Practitioner Level 2, In-Clinic H0014 U2 U6 15 Minutes $ 38.97 32 Practitioner Level 3, In-Clinic H0014 U3 U6 15 Minutes _{$ 30.01} 32 Practitioner Level 4, In-Clinic H0014 U4 U6 15 Minutes $ 20.30 32

Alcohol and/or drug services; Sub-acute Detoxification (Residential Addiction Program Outpatient)

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Day

Level II H0012 TG 1 day $38.58 1

Alcohol and/or drug services; Acute Detoxification (Residential Addiction Program Outpatient)

Level III H0013 1 day $209.22 1

Service Area = Individual Outpatient Services

Individual Psychotherapy, insight oriented, behavior-modifying and/or supportive in an office or outpatient facility, approximately 20-30 minutes face-to-face with patient

Practitioner Level 2, In-Clinic 90804 U2 U6 20-30

minutes $ 64.95 2 Practitioner Level 3, In-Clinic 90804 U3 U6 20-30

minutes $ 25.21 2 Practitioner Level 2, Out-of-Clinic 90804 U2 U7 20-30

minutes $ 30.25 2

minutes $ 54.46 2

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Day

minutes $ 90.76 2

Individual psychotherapy, interactive, using play equipment, physical devises, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20-30 minutes face-to-face with patient

minutes $ 30.25 2

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Day

Practitioner Level 2, Out-of-Clinic 90812 U2 U7 45-50

minutes $ 54.46 2

minutes $ 90.76 2

Service Area = Family Outpatient Services

Family – Behavioral health counseling and therapy (without client present)

Practitioner Level 2, In-Clinic H0004 HS U2 U6 15 minutes $ 38.97 16 Practitioner Level 3, In-Clinic H0004 HS U3 U6 15 minutes $ 30.01 16 Practitioner Level 4, In-Clinic H0004 HS U4 U6 15 minutes $ 20.30 16 Practitioner Level 5, In-Clinic H0004 HS U5 U6 15 minutes $ 15.13 16 Practitioner Level 2, Out-of-Clinic H0004 HS U2 U7 15 minutes _{$ 46.76} ₁₆ Practitioner Level 3, Out-of-Clinic H0004 HS U3 U7 15 minutes $ 36.68 16 Practitioner Level 4, Out-of-Clinic H0004 HS U4 U7 15 minutes _{$ 24.36} ₁₆ Practitioner Level 5, Out-of-Clinic H0004 HS U5 U7 15 minutes $ 18.15 16

Family -- Behavioral health counseling and therapy (with client present)

Practitioner Level 2, In-Clinic H0004 HR U2 U6 15 minutes $ 38.97 16 Practitioner Level 3, In-Clinic H0004 HR U3 U6 15 minutes $ 30.01 16 Practitioner Level 4, In-Clinic H0004 HR U4 U6 15 minutes $ 20.30 16 Practitioner Level 5, In-Clinic H0004 HR U5 U6 15 minutes $ 15.13 16

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Day

Practitioner Level 2, Out-of-Clinic H0004 HR U2 U7 15 minutes $ 46.76 16 Practitioner Level 3, Out-of-Clinic H0004 HR U3 U7 15 minutes $ 36.68 16 Practitioner Level 4, Out-of-Clinic H0004 HR U4 U7 15 minutes $ 24.36 16 Practitioner Level 5, Out-of-Clinic H0004 HR U5 U7 15 minutes $ 18.15 16

Family Psychotherapy without the patient present (appropriate license required)

Practitioner Level 2, In-Clinic 90846 U2 U6 15 minutes _{$ 38.97} ₁₆ Practitioner Level 3, In-Clinic 90846 U3 U6 15 minutes $ 30.01 16 Practitioner Level 4, In-Clinic 90846 U4 U6 15 minutes $ 20.30 16 Practitioner Level 5, In-Clinic 90846 U5 U6 15 minutes $ 15.13 16 Practitioner Level 2, Out-of-Clinic 90846 U2 U7 15 minutes $ 46.76 16 Practitioner Level 3, Out-of-Clinic 90846 U3 U7 15 minutes $ 36.68 16 Practitioner Level 4, Out-of-Clinic 90846 U4 U7 15 minutes $ 24.36 16 Practitioner Level 5, Out-of-Clinic 90846 U5 U7 15 minutes $ 18.15 16

Conjoint Family Psychotherapy with the patient present (appropriate license required)

Practitioner Level 2, In-Clinic 90847 U2 U6 15 minutes $ 38.97 16 Practitioner Level 3, In-Clinic 90847 U3 U6 15 minutes _{$ 30.01} ₁₆ Practitioner Level 4, In-Clinic 90847 U4 U6 15 minutes $ 20.30 16 Practitioner Level 5, In-Clinic 90847 U5 U6 15 minutes _{$ 15.13} ₁₆ Practitioner Level 2, Out-of-Clinic 90847 U2 U7 15 minutes $ 46.76 16 Practitioner Level 3, Out-of-Clinic 90847 U3 U7 15 minutes $ 36.68 16 Practitioner Level 4, Out-of-Clinic 90847 U4 U7 15 minutes $ 24.36 16 Practitioner Level 5, Out-of-Clinic 90847 U5 U7 15 minutes $ 18.15 16

Family - Skills training and development

Practitioner Level 4, In-Clinic, without client present

H2014 HS U4 U6 15 minutes

$ 20.30 16 Practitioner Level 5, In-Clinic, without client

present

$ 15.13 16 Practitioner Level 4, Out-of-Clinic, without

client present

$ 18.15 16 Practitioner Level 4, In-Clinic, with client

present

H2014 HR U4 U6 15 minutes

present

$ 15.13 16 Practitioner Level 4, Out-of-Clinic, with client

present

$ 18.15 16

Service Area = Group Outpatient Services

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Day

Practitioner Level 2, In-Clinic H0004 HQ U2 U6 15 minutes $ 8.50 20 Practitioner Level 3, In-Clinic H0004 HQ U3 U6 15 minutes $ 6.60 20 Practitioner Level 4, In-Clinic H0004 HQ U4 U6 15 minutes $ 4.43 20 Practitioner Level 5, In-Clinic H0004 HQ U5 U6 15 minutes $ 3.30 20 Practitioner Level 2, Out-of-Clinic H0004 HQ U2 U7 15 minutes $ 10.39 20 Practitioner Level 3, Out-of-Clinic H0004 HQ U3 U7 15 minutes $ 8.25 20 Practitioner Level 4, Out-of-Clinic H0004 HQ U4 U7 15 minutes $ 5.41 20 Practitioner Level 5, Out-of-Clinic H0004 HQ U5 U7 15 minutes $ 4.03 20 Practitioner Level 2, In-Clinic, Multi-family

group, with client present

H0004 HQ HR U2 U6

15 minutes

$ 8.50 20 Practitioner Level 3, In-Clinic, Multi-family

H0004 HQ HR U3 U6

15 minutes

H0004 HQ HR U4 U6

15 minutes

H0004 HQ HR U5 U6

15 minutes

$ 3.30 20 Practitioner Level 2, Out-of-Clinic, Multi-family

H0004 HQ HR U2 U7

15 minutes

H0004 HQ HR U3 U7

15 minutes

H0004 HQ HR U4 U7

15 minutes

H0004 HQ HR U5 U7

15 minutes

group, without client present

H0004 HQ HS U2 U6

15 minutes

H0004 HQ HS U3 U6

15 minutes

H0004 HQ HS U4 U6

15 minutes

H0004 HQ HS U5 U6

15 minutes

H0004 HQ HS U2 U7

15 minutes

H0004 HQ HS U3 U7

15 minutes

H0004 HQ HS U4 U7

15 minutes

H0004 HQ HS U5 U7

15 minutes

$ 4.03 20

Group Psychotherapy other than of a multiple family group (appropriate license required)

Practitioner Level 2, In-Clinic 90853 U2 U6 15 minutes $ 8.50 20 Practitioner Level 3, In-Clinic 90853 U3 U6 15 minutes $ 6.60 20 Practitioner Level 4, In-Clinic 90853 U4 U6 15 minutes $ 4.43 20

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Day

Practitioner Level 5, In-Clinic 90853 U5 U6 15 minutes $ 3.30 20 Practitioner Level 2, Out-of-Clinic 90853 U2 U7 15 minutes $ 10.39 20 Practitioner Level 3, Out-of-Clinic 90853 U3 U7 15 minutes $ 8.25 20 Practitioner Level 4, Out-of-Clinic 90853 U4 U7 15 minutes $ 5.41 20 Practitioner Level 5, Out-of-Clinic 90853 U5 U7 15 minutes $ 4.03 20

Group – Skills training and development

Practitioner Level 4, In-Clinic H2014 HQ U4 U6 15 minutes $ 4.43 20 Practitioner Level 5, In-Clinic H2014 HQ U5 U6 15 minutes $ 3.30 20 Practitioner Level 4, Out-of-Clinic H2014 HQ U4 U7 15 minutes _{$ 5.41} ₂₀ Practitioner Level 5, Out-of-Clinic H2014 HQ U5 U7 15 minutes $ 4.03 20 Practitioner Level 4, In-Clinic, with client

present

H2014 HQ HR U4 U6

15 minutes

present

H2014 HQ HR U5 U6

15 minutes

present

H2014 HQ HR U4 U7

15 minutes

present

H2014 HQ HR U5 U7

15 minutes

present

H2014 HQ HS U4 U6

15 minutes

present

H2014 HQ HS U5 U6

15 minutes

client present

H2014 HQ HS U4 U7

15 minutes

client present H2014 HQ HS U5 U7 15 minutes $ 4.03 20

Service Area = Intensive Family Intervention

Intensive Family Intervention

Practitioner Level 3, In-Clinic H0036 U3 U6 15 minutes $ 30.01 48 Practitioner Level 4, In-Clinic H0036 U4 U6 15 minutes $ 22.14 48 Practitioner Level 5, In-Clinic H0036 U5 U6 15 minutes $ 16.50 48 Practitioner Level 3, Out-of-Clinic H0036 U3 U7 15 minutes _{$ 41.26} ₄₈ Practitioner Level 4, Out-of-Clinic H0036 U4 U7 15 minutes $ 27.06 48 Practitioner Level 5, Out-of-Clinic H0036 U5 U7 15 minutes $ 20.17 48 Service Area = Medication Administration

Comprehensive Medication Services

Practitioner Level 2, In-Clinic H2010 U2 U6 Per contact $ 33.40 1 Practitioner Level 3, In-Clinic H2010 U3 U6 Per contact _{$ 25.39} ₁ Practitioner Level 4, In-Clinic H2010 U4 U6 Per contact $ 17.40 1 Practitioner Level 5, In-Clinic H2010 U5 U6 Per contact _{$ 12.97} ₁

(16)

Day

Practitioner Level 2, Out-of-Clinic H2010 U2 U7 Per contact $ 42.51 1 Practitioner Level 3, Out-of-Clinic H2010 U3 U7 Per contact $ 33.01 1 Practitioner Level 4, Out-of-Clinic H2010 U4 U7 Per contact $ 22.14 1

Therapeutic, prophylactic or diagnostic injection

Practitioner Level 2, In-Clinic 96372 U2 U6 Per contact $ 33.40 1 Practitioner Level 3, In-Clinic 96372 U3 U6 Per contact $ 25.39 1 Practitioner Level 4, In-Clinic 96372 U4 U6 Per contact $ 17.40 1 Practitioner Level 2, Out-of-Clinic 96372 U2 U7 Per contact $ 42.51 1 Practitioner Level 3, Out-of-Clinic 96372 U3 U7 Per contact $ 33.01 1 Practitioner Level 4, Out-of-Clinic 96372 U4 U7 Per contact $ 22.14 ₁

Alcohol, and/or drug services, methadone administration and/or service (provision of the drug by a licensed program)

Practitioner Level 2, In-Clinic H0020 U2 U6 Per contact $ 33.40 1 Practitioner Level 3, In-Clinic H0020 U3 U6 Per contact _{$ 25.39} ₁ Practitioner Level 4, In-Clinic H0020 U4 U6 Per contact $ 17.40 1

Service Area = Psychosocial Rehabilitation

Psychosocial Rehabilitation

Practitioner Level 4, Group, In-Clinic H2017 HQ U4 U6 1 hour $ 17.72 5 Practitioner Level 5, Group, In-Clinic H2017 HQ U5 U6 1 hour $ 13.20 5 Practitioner Level 4, Group, Out-of-Clinic H2017 HQ U4 U7 1 hour _{$ 21.64} ₅ Practitioner Level 5, Group, Out-of-Clinic H2017 HQ U5 U7 1 hour $ 16.12 5 Practitioner Level 4, In-Clinic H2017 U4 U6 15 minutes _{$ 20.30} ₄₈ Practitioner Level 5, In-Clinic H2017 U5 U6 15 minutes $ 15.13 48 Practitioner Level 4, Out-of-Clinic H2017 U4 U7 15 minutes $ 24.36 48 Practitioner Level 5, Out-of-Clinic H2017 U5 U7 15 minutes $ 18.15 48

Service Area = Community Support Services

Community Support Services

Practitioner Level 4, In-Clinic H2015 U4 U6 15 minutes $ 20.30 48 Practitioner Level 5, In-Clinic H2015 U5 U6 15 minutes $ 15.13 48 Practitioner Level 4, Out-of-Clinic H2015 U4 U7 15 minutes _{$ 24.36} ₄₈ Practitioner Level 5, Out-of-Clinic H2015 U5 U7 15 minutes $ 18.15 48 Practitioner Level 4, In-Clinic, Collateral

Contact

H2015 UK U4 U6 15 minutes

$ 20.30 48 Practitioner Level 5, In-Clinic, Collateral

Contact

$ 15.13 48 Practitioner Level 4, Out-of-Clinic, Collateral

Contact

$ 24.36 48 Practitioner Level 5, Out-of-Clinic, Collateral

Contact

(17)

Day

Service Area = Addictive Disease Support Services

Community Support Services

Practitioner Level 4, In-Clinic H2015 HF U4 U6 15

minutes $ 20.30 48 Practitioner Level 5, In-Clinic H2015 HF U5 U6 15

minutes $ 15.13 48 Practitioner Level 4, Out-of-Clinic H2015 HF U4 U7 15

minutes $ 24.36 48 Practitioner Level 5, Out-of-Clinic H2015 HF U5 U7 15

minutes $ 18.15 48 Practitioner Level 4, In-Clinic, Collateral

Contact

H2015 HF UK U4 U6 15

Contact

H2015 HF UK U5 U6 15

minutes $ 15.13 48 Practitioner Level 4, Out-of-Clinic, Collateral

Contact

H2015 HF UK U4 U7 15

Contact

H2015 HF UK U5 U7 15

minutes $ 18.15 48

Service Area = Case Management Support Services

Case Management

Practitioner Level 4, In-Clinic T1016 U4 U6 15

minutes $ 20.30 24 Practitioner Level 5, In-Clinic T1016 U5 U6 15

minutes $ 15.13 24 Practitioner Level 4, Out-of-Clinic T1016 U4 U7 15

minutes $ 24.36 24 Practitioner Level 5, Out-of-Clinic T1016 U5 U7 15

Contact T1016 UK U4 U6

15

minutes $ 18.15 24 Practitioner Level 4, In-Clinic T1016 HK U4 U6 15

minutes $ 20.30 24 Practitioner Level 5, In-Clinic T1016 HK U5 U6 15

minutes $ 15.13 24 Practitioner Level 4, Out-of-Clinic T1016 HK U4 U7 15

minutes $ 24.36 24 Practitioner Level 5, Out-of-Clinic T1016 HK U5 U7 15

Contact T1016 HK UK U4 U6

15

minutes $ 20.30 24 Practitioner Level 5, In-Clinic, Collateral T1016 HK UK U5 U6 15 $ 15.13 24

(18)

Day

Contact minutes

Practitioner Level 4, Out-of-Clinic, Collateral

15

minutes $ 18.15 24

Service Area = Peer Supports

Self Help/Peer Services Practitioner Level 4, Group, In-Clinic H0038 HQ U4 U6 1 hour $ 17.72 5 Practitioner Level 5, Group, In-Clinic H0038 HQ U5 U6 1 hour $ 13.20 5 Practitioner Level 4, Group, Out-of-Clinic H0038 HQ U4 U7 1 hour $ 21.64 5 Practitioner Level 5, Group, Out-of-Clinic H0038 HQ U5 U7 1 hour _{$ 16.12} 5 Practitioner Level 4, In-Clinic H0038 U4 U6 15 minutes $ 20.30 48 Practitioner Level 5, In-Clinic H0038 U5 U6 15 minutes _{$ 15.13} ₄₈ Practitioner Level 4, Out-of-Clinic H0038 U4 U7 15 minutes $ 24.36 48 Practitioner Level 5, Out-of-Clinic H0038 U5 U7 15 minutes _{$ 18.15} 48 Practitioner Level 4, Group, In-Clinic H0038 HF HQ U4

U6

1 hour

$ 17.72 5 Practitioner Level 5, Group, In-Clinic H0038 HF HQ U5

U6

1 hour

$ 13.20 5 Practitioner Level 4, Group, Out-of-Clinic H0038 HF HQ U4

U7

1 hour

$ 21.64 5 Practitioner Level 5, Group, Out-of-Clinic H0038 HF HQ U5

U7

1 hour

$ 16.12 5 Practitioner Level 4, In-Clinic H0038 HF U4 U6 15 minutes $ 20.30 48 Practitioner Level 5, In-Clinic H0038 HF U5 U6 15 minutes _{$ 15.13} ₄₈ Practitioner Level 4, Out-of-Clinic H0038 HF U4 U7 15 minutes $ 24.36 48 Practitioner Level 5, Out-of-Clinic H0038 HF U5 U7 15 minutes _{$ 18.15} 48

Health and Wellness Supports (Behavioral Health Prevention Education Service (Delivery Of Services With Target Population To Affect Knowledge, Attitude And/Or Behavior)

Practitioner Level 4, In-Clinic H0025 U4 U6 15 minutes _{$ 20.30} 6 Practitioner Level 5, In-Clinic H0025 U5 U6 15 minutes $ 15.13 6 Practitioner Level 4, Out-of-Clinic H0025 U4 U7 15 minutes _{$ 24.36} 6 Practitioner Level 5, Out-of-Clinic H0025 U5 U7 15 minutes $ 18.15 6

Service Area = Assertive Community Treatment

Assertive Community Treatment

Practitioner Level 1, In-Clinic H0039 U1 U6 15 minutes $ 32.46 60 Practitioner Level 2, In-Clinic H0039 U2 U6 15 minutes $ 32.46 60 Practitioner Level 3, In-Clinic H0039 U3 U6 15 minutes $ 32.46 60 Practitioner Level 4, In-Clinic H0039 U4 U6 15 minutes $ 32.46 60 Practitioner Level 5, In-Clinic H0039 U5 U6 15 minutes $ 32.46 60

(19)

Day

Practitioner Level 1, Out-of-Clinic H0039 U1 U7 15 minutes $ 32.46 60 Practitioner Level 2, Out-of-Clinic H0039 U2 U7 15 minutes $ 32.46 60 Practitioner Level 3, Out-of-Clinic H0039 U3 U7 15 minutes $ 32.46 60 Practitioner Level 4, Out-of-Clinic H0039 U4 U7 15 minutes $ 32.46 60 Practitioner Level 5, Out-of-Clinic H0039 U5 U7 15 minutes $ 32.46 60 Practitioner Level 1, Via interactive audio and

H0039 GT U1 15 minutes $ 32.46 60 Practitioner Level 1, Via interactive audio and

H0039 GT U2 15 minutes $ 32.46 60 Practitioner Level 3, Group, In-Clinic H0039 HQ U3 U6 15 minutes $ 6.60 20 Practitioner Level 4, Group, In-Clinic H0039 HQ U4 U6 15 minutes $ 4.43 20 Practitioner Level 5, Group, In-Clinic H0039 HQ U5 U6 15 minutes $ 3.30 20 Multidisciplinary Team Meeting H0039 HT 15 minutes $ 0.00 60 Practitioner Level 3, In-Clinic H0039 TN U3 U6 15 minutes $ 30.01 60 Practitioner Level 4, In-Clinic H0039 TN U4 U6 15 minutes $ 20.30 60 Practitioner Level 5, In-Clinic H0039 TN U5 U6 15 minutes $ 15.13 60 Practitioner Level 3, Out-of-Clinic H0039 TN U3 U7 15 minutes $ 36.68 60 Practitioner Level 4, Out-of-Clinic H0039 TN U4 U7 15 minutes $ 24.36 60 Practitioner Level 5, Out-of-Clinic H0039 TN U5 U7 15 minutes $ 18.15 60

Service Area = Community Living Supports

Level I H0019 TG 1 day $99.23 1

Level II H0019 TF 1 day $64.13 1

Level III H0019 1 day $46.43 1

Level IV H2021 15 minutes $13.96 10

Service Area = Task-Oriented Services

Practitioner Level 4, Out-of-Clinic H2025 U4 U7 15 minutes $ 24.36 8 Practitioner Level 5, Out-of-Clinic H2025 U5 U7 15 minutes $ 18.15 8

(20)

designated by law and on behalf of the State Medicaid agency, will require that the entity

furnish to the Medicaid agency on an annual basis the following:

a. data, by practitioner, on the utilization by Medicaid beneficiaries of the services

included in the unit rate; and

b. cost information by practitioner type and by type of service actually delivered within

the service unit.

The Medicaid Agency will base future rates on information obtained from the providers.

With respect to Community Living Supports (CLS), there are four intensity levels of service

delivery. No rate includes any room and/or board. Rates use the detail stated earlier in this

document specific to Practitioner Costs and Service Costs as a base and then are calculated

on the assumptions below to create units for each level:

CLS Level I is intensive and provides 24/7/365 awake staff support generally in a

licensed community-living setting (in no case exceeding 16 beds). In order to directly

support the individual, there will be a minimum of five hours weekly of skills training,

community integration activities, and/or personal services provided to the person if

indicated on the individual supports plan. This skills training is provided by one or

more Community Living Supports specialists who may be practitioner Level 3, 4 or 5.

CLS Level II is intensive and provides 24/7/365 staff support generally in a licensed

community-living setting (in no case exceeding 16 beds). In order to directly support

the individual, there will be a minimum of five hours weekly of skills training,

community integration activities, and/or personal services provided to the person if

indicated on the individual supports plan. This skills training is provided by one or

more Community Living Supports specialists who may be practitioner Level 3, 4 or 5.

CLS Level III is semi-independent support which provides 36 hours per week staff

support generally in a licensed community-living setting (in no case exceeding 16

beds). In order to directly support the individual, there will be a minimum of three

hours per week of skills training, community integration activities, and/or personal

services provided to the person if indicated on the individual supports plan. This skills

training is provided by one or more Community Living Supports specialists who may

be practitioner Level 4 or 5.

CLS IV is support to provide a minimum of one face-to-face contact and an average of

10 15-minute units per week of skills training, community integration activities, and/or

personal services provided to the person as indicated on the individual supports plan. A

Community Living Supports specialist is a practitioner Level 5 operating on 65%

productivity and is on call and available to consumers 24/7/365.

(21)

(22)

The covered Community Behavioral Health Rehabilitation Services will be available to all

Medicaid eligibles with mental illness and substance abuse disorders and who are medically

determined to need rehabilitative/prevention services. These services must be ordered by a

physician or other licensed practitioner within the scope of his/her practice under state law

and furnished by or under the direction of a physician or other practitioners operating within

the scope of applicable state law, to:

promote the maximum reduction of symptoms; and/or

restore the recipient to his/her best possible functional level; and/

prevent the escalation of a problem into a crisis situation or into a

chronic/significantly disabling disorder.

When services/supports are provided under the direction of a physician or other practitioners

operating within the scope of applicable state law, the practitioner will provide clinical

direction by:

assuming professional responsibility for the services provided under his/her

direction and monitors the need for continued services;

directly overseeing services to ensure beneficiaries are receiving services in a safe

and efficient manner in accordance with accepted standards of practice;

ensuring that individuals working under his/her direction have contact

information to permit them direct access to clinical direction as necessary during

the course of treatment; and

maintaining documentation supporting the oversight of services and ongoing

involvement in the treatment.

The covered Community Behavioral Health Rehabilitation Services are reimbursed when

delivered by enrolled agencies meeting the requirements listed herein. The State does not

arbitrarily limit Medicaid Provider Agencies. The State enrolls any willing Provider Agency

that meets the qualifications required to be a Provider Agency as outlined in the Policies and

Procedures Manual that is made available to all interested Provider Agencies. Individual

practitioners are not enrolled in this program. NOTE: The term ―practitioner‖ is used to

denote an individual who provides direct services/supports under the auspices of a Provider

Agency. Provider agency qualifications to provide these services are ensured by Provider

Agency compliance with requirements and standards of The Joint Commission (TJC),

Commission on Accreditation for Rehabilitation Facilities (CARF), Council on Accreditation

of Services for Children and Families, Inc. (COA), Council on Quality Leadership (CQL),

and/or State certification. Additionally, where agencies provide services in a residential

setting, required state licensure is verified through the provider application and enrollment

process. Individual practitioners working within these provider agencies are required to meet

(23)

The participants are given freedom of choice to choose a qualified, enrolled Provider Agency

and practitioner within that agency. A toll-free access number provides information regarding

the available services and providers to participants and family members seeking behavioral

healthcare services. The Department of Behavioral Health & Developmental Disabilities

regional and central offices are also available to provide information to individuals seeking

behavioral healthcare services through this program and participants may also access services

by directly contacting providers of their choice.

Table of Practitioners Employed by Provider Agencies:

Professional

Title

Minimum Level of

Education/Degree/

Experience Required

License/

Certification

Required

Supervision

State

Code

Physician Graduate of medical or

osteopathic college Licensed by the Georgia Composite Board of Medical Examiners

No. Additionally, can

supervise others 43-34-20 to 43-34-37 Psychiatrist Graduate of medical or

osteopathic college and a residency in psychiatry approved by the American Board of Psychiatry and Neurology

Licensed by the Georgia Composite Board of Medical Examiners

supervise others 43-34-20 to 43-34-37

Physician’s Assistant

(PA) Completion of a physician’s assistant training program approved by the Georgia Composite Board of Medical Examiners

-- at least 1 year of experience in behavioral healthcare required to supervise CPRP, CPS, or PP staff

Licensed by the Georgia Composite Board of Medical Examiners Physician delegates functions through Board-approved job description. 43-34-100 to 43-34-108 Advanced Practice Registered Nurse (APRN): Clinical Nurse Specialist/Psychiatric-Mental Health (CNS-PMH) and Nurse Practitioner (NP)

R.N. and graduation from a post-basic education program for Nurse Practitioners Master’s degree or higher in nursing for the CNS/PMH -- Nurse Practitioners must have at least 1 year of experience in behavioral healthcare to supervise CPRP, CPS, or PP staff Current certification by American Nurses Association, American Nurses Credentialing Center or American Academy of Nurse Practitioners and authorized as an APRN by the Georgia Board of Nursing Physician delegates advanced practice functions through Board-approved nurse protocol agreements. 43-26-1 to 43-26-13, 360-32

(24)

internship and passed an examination.

Registered Nurse

(RN) Georgia Board of Nursing-approved nursing education program

-- at least 1 year of experience in behavioral healthcare required to supervise CPRP, CPS, or PP

Licensed by the Georgia

Board of Nursing Physician 43-26-1 to 46-23-13

Licensed Practical Nurse (LPN)

Graduation from a nursing education program approved by the Georgia Board of Licensed Practical Nursing.

Licensed by Georgia Board of Licensed Practical Nursing Physician or RN 43-26-30 to 43-26-43 Licensed Dietician

(LD) - Bachelor’s degree or higher with a degree in dietetics, human nutrition, food and nutrition, nutrition education or food systems management. - - Satisfactory completion of at

least 900 hours of supervised experience in dietetic practice

Licensed by Georgia Board of Licensed Dieticians No 43-11A-1 to 43-11A-19 Qualified Medication Aide (QMA) Completion of a prescribed course conducted by the Georgia Department of Technical and Adult Education and pass examination for qualified medication aides approved by the Georgia Board of Licensed Practical Nursing.

Certified by the Georgia Board of Licensed Practical Nursing Supervised by RN performing certain medication administration tasks as delegated by RN or LPN. 43-26-50 to 43-26-60

Psychologist Doctoral Degree Licensed by the Georgia Board of Examiners of Psychologists

supervise others 43-39-1 to 43-39-20 Licensed Clinical

Social Worker (LCSW)

Masters degree in Social Work plus 3 years’ supervised full-time work in the practice of social work after the Master’s degree.

Licensed by the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists

supervise others 43-10A

Licensed Professional Counselor (LPC)

Master’s degree Licensed by the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists

supervise others 43-10A

Licensed Marriage

(25)

and Family Therapists Licensed Master’s

Social Worker (LMSW)

Master’s degree in Social

Work Licensed by the Georgia Composite Board of Professional

Counselors, Social Workers, and Marriage and Family Therapists

Under direction and supervision of an appropriately licensed/credentialed professional. 43-10A Licensed Associate Professional Counselor (LAPC)

Under direction and supervision of an appropriately licensed/credentialed professional 43-10A Licensed Associate Marriage and Family Therapist (LAMFT)

Under direction and supervision of an appropriately licensed/credentialed professional 43-10A Certified Clinical Alcohol and Drug Counselor (CCADC)

Master’s degree;

Also requires minimum of 2 years or 4,000 hours experience in direct alcohol and drug abuse treatment with individual and/or group counseling and a total of 270 hours of addiction-specific education and 300 hours of supervised training.

Certification by the Alcohol and Drug Certification Board of Georgia; International Certification and Reciprocity Consortium / Alcohol and Other Drug Abuse (IC&RC)

Services limited to those practices sanctioned by the certifying board and shall in any event be limited to the provision of chemical dependency treatment 43-10A-7 Georgia Certified Alcohol and Drug Counselor Level III (GCADC III)

Master’s degree; Also must have been certified by a national organization and have taken a written and oral examination in the past and must have been continuously certified for a period of 2 years; Must meet the standards outlined in the Ga. Code rules posted on the licensing board website: Perform the 12 core functions; Education and training; Supervised practicum; Experience and supervision

Certification by the Alcohol and Drug Certification Board of Georgia (ADACB-GA)

Services limited to those practices sanctioned by the certifying board and shall in any event be limited to the provision of chemical dependency treatment 43-10A-7 Master Addiction Counselor (MAC) National Board of Certified Counselors (NBCC) Master’s Degree Documentation of a minimum of 12 semester hours of graduate coursework in the area of OR 500 CE hours Certification by the National Board of Certified Counselors (NBCC) Nationally Certified Counselor Services limited to those practices sanctioned by the certifying board and shall in any event be

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counselor at no fewer than 20 hours per week. Two of the three years must have been completed after the counseling master's degree was

conferred. A passing score on the Examination for Master Addictions Counselors (EMAC).

Board of Professional Counselors, Social Workers, and Marriage and Family Therapists

treatment

Master Addiction Counselor, (MAC) through National Association of Alcohol and Drug Counselors, (NAADC)

Master’s degree; 500 contact hours of specific alcoholism and drug abuse counseling training). Three years full-time or 6,000 hours of supervised experience, two years or 4,000 hours of which must be post master's degree award. Passing score on the national examination for the MAC

Certification by the National Association Alcohol & Drug Counselors’ Current state certification /licensure in alcoholism and/or drug abuse counseling. Passing score on the national examination for the MAC

Services limited to those practices sanctioned by the certifying board and shall in any event be limited to the provision of chemical dependency treatment

43-10A-7

Certified Alcohol and Drug Counselor (CADC)

Bachelor’s degree; Also requires minimum of 2 years or 4,000 hours experience in direct alcohol and drug abuse treatment with individual and/or group counseling and a total of 270 hours of addiction-specific education and 300 hours of supervised training

Certification by the Alcohol and Drug Certification Board of Georgia (ADACB-GA) International

Certification and Reciprocity Consortium / Alcohol and Other Drug Abuse (IC&RC)

Services limited to those practices sanctioned by the certifying board and shall in any event be limited to the provision of chemical dependency treatment 43-10A-7 Georgia Certified Alcohol and Drug Counselor II (GCADC II)

Bachelors degree; Must be certified by a national

organization and have taken a written and oral examination; Must have been continuously certified for a period of 2 years; Must meet the standards outlined in the Ga. Code rules posted on the licensing board website: Perform the 12 core functions; Education and training; Supervised practicum; Experience and supervision

Certification by the Alcohol and Drug Certification Board of Georgia (ADACB-GA)

Services limited to those practices sanctioned by the certifying board and shall in any event be limited to the provision of chemical dependency treatment 43-10A-7 Certified Addiction Counselor, Level II (CAC-II)

Bachelor’s degree; Requires 3 years of experience in practice of chemical

dependency/abuse counseling; 270 hours education in addiction field; and 144 hours

Certification by the Georgia Addiction Counselors’ Association Services limited to those practices sanctioned by the certifying board and shall in any event be limited to the

(27)

Certified Addiction Counselor, Level I (CAC-I)

High School

Diploma/Equivalent; Requires 2 years of experience in the practice of chemical

dependency/abuse counseling; 180 hours education in addiction field; and 96 hours clinical supervision. Certification by the Georgia Addiction Counselors’ Association Services limited to those practices sanctioned by the certifying board and shall in any event be limited to the provision of chemical dependency treatment, Under supervision of a Certified Clinical Supervisor 43-10A-7 Registered Alcohol and Drug Technician I, II, III

High school diploma or its equivalent and must be enrolled in a junior college, college or university. Must document a minimum of one (1) year or two thousand (2000) hours experience of direct service (alcohol and drug counseling). Once the RADT has completed 30 college credit hours he/she is eligible to take the ICRC written exam. Upon passing the ICRC Written exam, a RADT-II certificate is issued. Once the RADT-II has completed 60 college credit hours, he/she is eligible to take the oral case presentation. Upon successful completion of the oral case presentation, receives a RADT-III certificate is issued. Upon completion of BS degree and experience a CADC will be issued

Registered/certified by the Alcohol and Drug Certification Board of

Services limited to those practices sanctioned by the certifying board and shall in any event be limited to the provision of chemical dependency treatment, Under supervision of a Certified Clinical Supervisor; CADC; CCADC, LPC, LCSW 43-10A-7 Addiction Counselor

Trainees High school diploma/equivalent and actively pursuing certification as CAC-I, CAC-II, RADT I, II, III; CADC or CCADC or other addiction counselor

certification recognized by practice acts.

Employed by an agency or facility that is licensed to provide addiction counseling Under supervision of a Certified Clinical Supervisor (CCS); CADC; CCADC Certified Psychiatric Rehabilitation Professional (CPRP) High school diploma/equivalent, Associates Degree, Bachelor’s Degree,

Certified by the US Psychiatric Rehabilitation Under supervision of an appropriately licensed/credentialed

(28)

(varies by level and type of degree)

Certified Peer

Specialist (CPS) Self-identified consumers who are in recovery from mental illness and/or substance use disorders; and

High school diploma/equivalent

Certification by the Georgia Certified Peer Specialist Project Requires a minimum of 40 hours of Certified Peer Specialist Training (including, for examples, how to facilitate Recovery Dialogues and Utilize and teach problem solving techniques) and successful completion of a certification exam (which demonstrates competency in Recovery). A minimum of 6 hours of Continuing Education is required annually. Services shall be limited to those not requiring licensure, but are provided under the supervision of an appropriately licensed/credentialed professional. Paraprofessional

(PP) College training in one of the behavioral or social sciences, or completion of standardized training program for

paraprofessionals approved by the Department of Community Health.

Completion of a minimum of 40 hours of paraprofessional training and successful

completion of all written exams and competency-based skills demonstrations. Under supervision of an appropriately licensed/credentialed professional

Limitations

Rehabilitation services do not include reimbursement for room and board and reimbursement

will not be provided for services provided to individuals in an IMD. The covered services

are available only to Medicaid eligible recipients with a written service plan, which contains

medically necessary services ordered by a physician or other licensed practitioners operating

within the scope of state law. All treatment, rehabilitative, and prevention services are

focused on the Medicaid eligible individual. Any consultation or treatment involving

families or other persons is solely for the purpose of addressing the behavioral health needs

of the Medicaid recipient.

(29)

authorization period expires or maximum units have been reached, a request must be

submitted to the URAC-accredited External Review Organization to justify provision of

services based upon medical necessity of the service for the Medicaid recipient.

CBHRS do not include any of the following and FFP is not available for:

a. room and board services;

b. educational, vocational and job training services;

c. habilitation services;

d. services to inmates in public institutions as defined in 42 CFR §435.1010;

e. services to individuals residing in institutions for mental diseases as described in

42 CFR§435.1010;

f. recreational and social activities; and

(30)

The behavioral health assessment process consists of a face-to-face comprehensive clinical

assessment with the individual, which must include the individual’s perspective, and may

also include consumer-identified family and/or significant others as well as collateral

agencies/treatment providers. The purpose of the assessment process is to gather all

information needed to determine the individual's symptoms, strengths, needs, abilities and

preferences, to develop a social and medical history, to determine functional level and to

develop or review collateral assessment information. This service may be provided in a

clinic or outside the clinic setting in the community.

Distinct Billable Services:

Description Practitioners

Behavioral Health Assessment by a non-physician

Practitioner Level 2: Psychologist, APRN, PA Practitioner Level 3: LCSW, LPC, LMFT, RN Practitioner Level 4: LMSW; LAPC; LAMFT; Psychologist/LCSW/LPC/LMFT’s supervisee/trainee with at least a Bachelor’s degree in one of the helping professions such as social work, community

counseling, counseling, psychology, or criminology, functioning within the scope of the practice acts of the state; MAC, CAC-II, CADC, CCADC, GCADC (II, III); CAC-I or Addiction Counselor Trainees with at least a Bachelor’s degree in one of the helping professions such as social work, community counseling, counseling, psychology, or criminology (addictions counselors may only perform these functions related to treatment of addictive diseases).

Practitioner Level 5: CAC-I, RADT (I, II, or III), Addiction Counselor Trainees with high school diploma/equivalent (practitioners at this level may only perform these functions related to treatment of addictive diseases and under the supervision of one of the licensed/credentialed professionals above).