Behavioral Health

Prior Authorization Update: Effective immediately, we are no longer requiring a prior authorization for Assertive Community Treatment (ACT) Services CPT code H0040 for the initial 12 months. After 12 months, providers will submit a prior authorization for a medical necessity review.

Updated Medicaid Behavioral Health Provider Manual Issued For January 1, 2023

ODM has published an updated version of the Medicaid Behavioral Health Provider Manual including several changes that will become effective January 1, 2023. Version 1.25 of the BH provider manual contains the following updates:

• Revised Medicaid payment rates for the administration of the Child and Adolescent Needs Survey (CANS). (This change aligns with recent updates to OhioRISE provider guidance.)
• Clarification that Mobile Response Stabilization Service (MRSS) may not be billed for time spent administering the CANS assessment. (This change aligns with recent updates to OhioRISE provider guidance)
• Discontinuation of prolonged services codes (99354 and 99355) for psychotherapy services beginning January 1, 2023, and after. This follows the new CPT/HCPCS guidance from the American Medical Association (AMA) beginning January 1, 2023.
• Discontinuation of CPT code 99343, Evaluation & Management Home Visit, presenting problems moderate to high severity, typically 45 minutes. This change also follows guidance of the AMA.
• Codes added for several provider administered pharmaceuticals on Table 2-9

Questions regarding the Medicaid Behavioral Health Provider Manual may be submitted to the ODM Behavioral Health Policy mailbox, BH-Enroll@medicaid.ohio.gov.

“MITS BITS” is being replaced with “BH Bulletin” as the newsletter to Medicaid behavioral health provider agencies and stakeholders. The BH Bulletin will continue to be an “as needed” communication vehicle offering updates, policy clarification, technical assistance, and useful news to community behavioral health agencies and other stakeholders. Current MITS BITS subscribers will automatically receive the new BH Bulletin. New subscriptions may be requested at BH.Medicaid.ohio.gov.

ODM recently became aware of a MITS claims payment error that caused underpayments for some Medicaid service codes when a certain number of units were exceeded. This affected claims with dates of service on or after October 1, 2022. Behavioral health codes listed below were impacted when billed with more than the specified number of units.

Codes Impacted

Limits on the number of service units for these codes were implemented in error. MITS billing logic for fee-for-service (FFS) claims has been corrected to match ODM policy. ODM is working with Medicaid managed care organizations (MCO) to assess and correct any affected claims for MCO members. Agencies with affected FFS claims may void and resubmit the claims or submit claims adjustments. ODM has posted User guidance on how to void or adjust claims on the BH.Medicaid.Ohio.gov website. Agencies needing additional assistance may call the ODM Provider Call Center at 800-686-1516 Option 7 to speak with an agent.

Changes Made to ICD-10 Code Groups as of 10-1-22.

Notification for provider types 84 (Mental Health) and 95 (Substance Use Disorder) that the behavioral health policy team at the Ohio Department of Medicaid has made updates to the ICD-10 Diagnosis (DX) Code Group resource file in response to the annual 2023 ICD-10 Update. Here is an edit tracker for detailed information on the DX code updates as well.

A new version of the Behavioral Health Provider Manual is now available on https://bh.medicaid.ohio.gov

• Updates to version 1.24 of the provider manual include:
• Updates to provider enrollment references throughout given implementation of the Provider Network Management (PNM) module on October 1, 2022.
• Minor clarifications to MRSS section.

Updates to the Behavioral Health Website to Reflect Provider Network Management

Similar to the updates made to the provider manual, updates have been made to the BH website to reflect implementation of the PNM module which, alonwith Centralized Credentialing and the new Single Pharmacy Benefit Management system, was launched on October 1. More information on both initiatives is available on the Ohio Medicaid website.

Updated ICD-10 DX Code List Available

A new version of the ICD-10 DX Code List to reflect new codes effective October 1 is now available on the BH website and can be found under “Billing and IT Resources” at https://bh.medicaid.ohio.gov/manuals .

October SUD 1115 Waiver Stakeholder Advisory Meeting Cancelled

The October 18 meeting of our Stakeholder Advisory Committee (SAC) has been canceled. The next SAC meeting will take place December 20, 2022. For more information, visit the SAC website.

Buckeye will soon launch a new program, BuckeyeSpectrum, designed to enhance treatment of Schizophrenia Spectrum Disorders for its members. BuckeyeSpectrum is a first of its kind, collaborative program with partnership between Buckeye and community mental health providers. Buckeye has partnered with community mental health centers that use current evidence-based best practices for the treatment of schizophrenia spectrum disorders. These treatment modalities include interventions designed for implementation with first episode psychosis and interventions designed for ongoing schizophrenia.Combined therapies to target all areas affected by schizophrenia

In recent years, research has revealed effective methods for addressing all symptoms of schizophrenia spectrum disorders. First line treatment for schizophrenia has typically been administration of antipsychotic medications. While great strides have been made in the formulation of new medications to treat schizophrenia, these medications do little to address the negative symptoms (lack of motivation, lack of reported enjoyment of and quality of life, difficulty interacting socially) or cognitive dysfunction (difficulty with memory, executive function, attention) present in individuals with diagnoses of schizophrenia spectrum disorders. Research into and application of combined therapies to target all areas affected by schizophrenia has shown improved positive outcomes for individuals who live with schizophrenia.

Collaboration with community health centers

Buckeye has developed methods for working collaboratively with community mental health centers to enhance the therapeutic work that can be done with clients to improve their overall quality of and enjoyment of life. These community agencies are already utilizing the most recent evidence-based treatment methods in their work with individuals with diagnoses of schizophrenia.

BuckeyeSpectrum provides:

• regular communication and collaboration with the clinical treatment team for clients affected by schizophrenia
• the ability for clinicians at mental health centers to access consultation with entities such as Project ECHO without losing revenue from a client session or psychiatry appointment that would have taken place during the time of the consult.
  
• the ability to contribute to work those clients are doing related to development of social skills and improved quality of life.
• the ability for clients to have opportunities to participate in activities that allow them to practice social skills and allow them to experience an increased level of enjoyment in their day-to-day lives. The activities individuals with a diagnosis of schizophrenia can engage in as participants in BuckeyeSpectrum give them opportunities to employ the skills they are working on related to cognitive enhancement, memory and attention.
• the program will allow individuals’ treatment teams to assist in meeting basic social determinants of health needs that might be present for those individuals. The reduction of stress presented by financial, social, education, health care, and neighborhood conditions will allow individuals to focus on improvement of cognitive, social and employment skills without the barriers of social determinants of health challenges.
  

BuckeyeSpectrum is designed to enhance the ability of our community partners and our members to experience the best quality care for schizophrenia spectrum disorders.  By enhancing collaboration with community mental health clinicians, we provide high quality, state of the art, fully inclusive care to individuals with diagnoses of schizophrenia spectrum disorders. 

Readmission Recoupment Policy (PDF)

Behavioral Health Readmission Policy

Effective November 18, 2021, the Managed Care Entity (MCE) members of the Ohio Association of Health Plans (OAHP) received approval from the Ohio Department of Medicaid, to implement a single MCE standard 30-Day Behavioral Health Readmission Policy and associated claims and clinical review programing.

Background

Effective November 18, 2021, the Managed Care Entity (MCE) members of the Ohio Association of Health Plans (OAHP) received approval from the Ohio Department of Medicaid, to implement a single MCE standard 30-Day Behavioral Health Readmission Policy and associated claims and clinical review programing.

Summary

The policy and the associated claims and clinical review program reviews all qualifying behavioral health readmissions occurring within 30 days to determine if the readmission was a preventable clinically related readmission. The policy articulates the quality and documentation expectations for the roles and responsibilities of various entities involved in the treatment and discharge planning of an individual with a behavioral health concern who requires hospitalization.

Please note the following highlights from policy revisions:

• Reviews will be limited to readmissions to same facility as initial admission;
• Pertinent and complete medical records for both admissions must be included with the claim submission to determine if the admission(s) is appropriate or is considered a preventable clinically related readmission;
• Failure to provide complete medical records for a post-service clinical readmission review will result in an automatic administrative denial of the claim for the readmission
• Prior Authorization processes and determinations are separate from any readmission review processes and determinations.

Impact

Payments for readmissions determined to be a preventable clinically related readmission will be adjusted to collapse the admissions into a single DRG payment.

Questions

To review the full policy, including policy effective date, for each MCE, and for any questions, please navigate to the appropriate MCE’s policy website and/or outreach to the MCE’s Provider Service’s Department.

Ohio Managed Care Plans