RCPA - Rehabilitation and Community Providers Association


Medical Assistance Bulletin On Non-Fee Scheduled Behavioral Health Services Changes Time Frames
March 2, 1999

The bulletin Accessing Outpatient Behavioral Health Services Not Currently Included on the Medical Assistance Fee Schedule for Eligible Recipients Under 21 Years of Age, originally published on September 8, 1995 (Bulletin 1153-95-01), was reissued on December 31, 1998. There were a number of changes made to this bulletin which affect providers of service. PCPA has been alerted by members of rejections in claims because of changes, particularly in time limits to the psychological or psychiatric evaluation/re-evaluation.

1. The language in the December 31, 1998 bulletin regarding program exceptions and psychiatric evaluation or reevaluation reads: " A strengths based psychiatric or psychological evaluation or re-evaluation should determine specific elements of medical necessity and rule out the need for psychiatric hospitalization. Evaluations must be performed within 60 days prior to the initiation of services and must be updated every four months...." This change means 15 days less than were available previously to get the psychiatric or psychological evaluation. The previous bulletin allowed 45 days from submission of packet..

2. Language has been added to the plan of care summary section, articularly the language discussing the role of the prescribing clinician.

3. Attachment 2 of the reissued bulletin replaces the responsibility of the primary case manager and shifts the responsibility to the provider.

There are a number of language changes throughout the document; although it is unclear if these changes will affect services. Providers are encouraged to read the bulletin thoroughly.

Please contact Lisa M. Lowrie at the Association if there are any comments or questions.

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