Members Qualifications Needed to Deliver the Service
Qualifications Done by Documentation Needed
Service Should be Provided
Populations Units number of units per client per day for this service Components Allowed Case Management H0006 Case Management via telemedicine H0006 GT
Medicaid Medicaid High School diploma -Plus- 2 years SA work experience in a substance abuse treatment program -Plus- Sign off by a LAC or LCAC counselor Approved Medicaid provider VO will review files for staff qualifications and billing documentation KCPC, case management plan, Progress notes, discharge plan
Specific start and end dates and times for the services For example: 6/18/08, 11:00 am to 11:15 am would equal 1 unit Can be used in outpatient or intensive outpatient modalities but must be face to face with the client present or telephonic on behalf of the client. Any Medicaid client. $12.50 per 15 minute increment 15 minutes = 1 unit 16 units Linking individuals to services needed to assist in recovery. For example, Housing, Financial, Vocational, Educational, Mental health, and Physical health.
Direct services such as:
Child care, Teaching (GED coaching, computer skills)
Job Skills, training Chores, Transportation, Parties, Movies, Dinner, AA/NA,
Meal planning, and Life skills group.
Members Qualifications Needed to Deliver the Service
Qualifications Done by Documentation Needed
Service Should be Provided
Populations Units number of units per client per day for this service Components Allowed Person Centered Case Management (PCCM) H0006 HV PCCM via telemedicine H0006 HV GT
Block Grant Block Grant
BA/BS degree
One year of experience in a substance abuse field may be used to substitute one year of education -Plus- PCCM training documentation Approved PCCM provider VO will review files for staff qualifications and billing documentation KCPC, Progress notes, based on a wellness plan and strengths based assessment, discharge plan
Specific start and end dates and times for the services For example: 6/18/08, 11:00 am to 11:15 am would equal 1 unit Can be used in outpatient or intensive outpatient modalities or as a stand-alone service but must be face to face with the client present or telephonic on behalf of the client. Block Grant priority populations - Plus- Adolescents -Plus- Homeless $13.25 per 15 minute increment 15 minutes = 1 unit 16 units Linking individuals to services needed to assist in recovery. For example, Housing, Financial, Vocational, Educational, Mental health, and Physical health.
Direct services such as:
Child care, Teaching (GED coaching, computer skills)
Job Skills, training Chores, Transportation, Parties, Movies, Dinner, AA/NA,
Meal planning, and Life skills group.
Service Funding Source Eligible Members Staff Qualifications Needed to Deliver the Service Program Qualifications Monitoring Done by Clinical Documentation Needed How the Service Should be Provided Target Populations Rates and Units Maximum number of units per client per day for this service Allowable Components What is not Allowed Support Services A0160
Block Grant Block Grant High School diploma or equivalent Approved Block Grant provider VO will review files for staff qualifications and billing documentation
Specific start and end dates and times for the services For example: 6/18/08,11:00 am to 12:00 pm would equal 1 unit Transportation logs Can be used for all modalities but must occur outside of the agency. Must be face to face with the client present.
Can be used for any Block Grant client $7.50 per 15 minute increment 15 minutes = 1 unit
32 units Occurs outside of the agency. For example, transportation to and from Court Appointments Pharmacy Emergencies (such as medical or mental health) Can be used to transport members to the appropriate facility for their level of care for access to care purposes. Transporting clients to SA appointments.
Can also be used to provide translation services for Deaf clients or clients who speak a language other than English.
Direct provision of services other than transportation or interpreter services.
Transportation that does not involve the member’s treatment or recovery. Transportation of family members.
Source Members Qualifications Needed to Deliver the Service
Qualifications Done by Documentation Needed
Service Should be Provided
Populations Units number of units per client per day for this service Components Allowed Peer Support Individual H0038 HF Peer Support Group H0038 HQ HF Peer Support Individual via telemedicine H0038 HF GT Peer Support Group via telemedicine H0038 HQ HF GT AAPS and Medicaid AAPS and Medicaid High School diploma -Plus- 24 months of clean time -Plus- Certification as a Peer Support Mentor (PSM) -Plus- No conviction of crimes against a person Approved PSM provider SRS will review files for licensing, including: assessment, tx plan, progress notes and discharge plan VO will review files for staff qualifications and billing documentation KCPC, peer support plan, Progress notes, discharge plan
Specific start and end dates and times for the services For example: 6/18/08, 11:00 am to 11:15 am would equal 1 unit Outpatient or intensive outpatient modalities or as a stand-alone service; but must be face to face with the client present or telephonic. Can be used individually or in a group. If used in a group, no more than 10 participants per PSM. Any Medicaid/AAPS client Individual -$14 for MCD and $10 for AAPS per 15 minute increment Group - $7 for MCD and $5 for AAPS per 15 minute increment 15 minutes = 1 unit
12 Units Provide and advocate for effective recovery-based services that allow people to thrive in their communities and access naturally occurring community supports. Services typically provided by a licensed drug and alcohol counselor, services typically provided by a sponsor, mental health counseling, or medication administration.
Service Funding Source Eligible Members Staff Qualifications Needed to Deliver the Service Program Qualifications Monitoring Done by Clinical Documentation Needed How the Service Should be Provided Target Populations Rates and Units Maximum number of units per client per day for this service Allowable Components What is not Allowed Crisis Intervention H0007 Crisis Intervention via telemedicine H0007 GT AAPS and Medicaid AAPS and Medicaid High School diploma -Plus- 2 years SA work experience in a substance abuse treatment program -Plus- Sign off by a LAC or LCAC counselor Approved Medicaid or AAPS provider SRS will review files for licensing, including: assessment, tx plan, progress notes and discharge plan VO will review files for staff qualifications and billing documentation Can only be used in an outpatient setting; but must be face to face with the client present or telephonic. Any Medicaid/AAPS client $32.50 for MCD and $16.50 for AAPS per 15 minute increment
4 units Crisis = it is not safe for the member to wait for a substance abuse group or individual session to take place. If someone is in need of crisis intervention more than two times a month, a different level of care or mental health evaluation should be considered. Individuals in crisis who require this service may be experiencing mental health symptoms during the crisis. Mental health issues should be recognized and addressed in an integrated fashion as it may add to the risk increasing the need for coordination of care. Billing for services not related to a crisis with a substance abuse component.
Source Members Qualifications Needed to Deliver the Service
Qualifications Done by Documentation Needed
Service Should be Provided
Populations Units number of units per client per day for this service Components Allowed Telemedicine GT Modifier added to services performed -Plus- Q3014 facility code AAPS and Medicaid AAPS and Medicaid AAPS and Medicaid Approved Medicaid or AAPS provider -Plus- Licensed or certified for the type of service performed
VO will review files for staff qualifications and billing documentation Notation in the KCPC and clinical record about the location of the member and why telemedicine was chosen as the service delivery method Can only be provided for outpatient treatment modalities not including IOP. The member and provider must be in separate secure locations. There must be a telephonic and visual component to the service (provider and member should be able to see one another). Any AAPS or Medicaid member who cannot participate in face to face treatment. The member should not be in the same city as the provider.
The rate for the service is the same as the
non-telemedicine rate. The rate for MCD is Q3014 = $5.00/15 minute increment. $40 /day maximum.
The rate for AAPS is Q3014 = $5.00/15 minute increment. $40 /day maximum. Maximum number of units dependent upon the care provided. There is a maximum daily allowable charge for telemedicine reimbursement for Q3014. IT security and telephonic infrastructure consistent with telemedicine standards Can be performed for outpatient modalities (such as individual or assessments) only. The same provider cannot bill for the same service on the same day if it is delivered via telemedicine and face to face.
Webcams Telephonic only services – There MUST be a visual component for service delivery. Telemedicine services for residential services such as Intermediate and Reintegration
If you have any questions about what can/can not be billed, please contact Sheree Marzka at [email protected]
Case Management (CM): member centered to assist individuals to become more self-sufficient through an array of services which assess, plan, implement, coordinate, monitor and evaluate the options and services to meet an individuals needs using communication and available resources to promote quality, cost effective outcomes. Services should address an individual’s major lifestyle, attitudinal and behavioral problems that have the potential to create barriers to the goals of treatment.
Person Centered Case Management (PCCM): available to eligible populations if delivered by a certified PCCM under the AAPS policy for PCCM. Services are provided from a person centered strength based approach. Services are based on barrier reduction for engagement, retention and recovery through the development of community support services. The delivery of services is guided by the member’s personal wellness plan and incorporates the process of structured engagement. For more information on how to become PCCM certified, please contact Charley Bartlett at [email protected]
for the financial reimbursement of services that the Block Grant and Medicaid funded providers perform outside of the agencies physical location to assist the client with the needed resources to facilitate access, engagement and retention in treatment and recovery services such as transportation. Support services are provided outside of the agency’s physical location.
