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OMHSAS Eligibility Category Update
April 28, 2010

The Office of Mental Health and Substance Abuse Services (OMHSAS) has provided additional information about the OMHSAS EVS MHX Category. Any individual that receives base funded services will have MHX on the record. They may also be eligible for Medical Assistance (MA) services or they may not. If an individual is eligible for both base funded services and MA, he/she will have a case record number for MHX and one for MA. If only eligible for base funded services, then only an MHX case record number is assigned to the person.

In essence, if an individual is MA eligible and the service is covered by MA, then HealthChoices or PROMISe, as applicable, should be billed. If the service is not covered by MA, then the provider must follow the requirements of the county contract for base covered services. The county would submit data to OMHSAS through the new CCR process.

If an individual is not eligible for MA, then the provider follows the requirements of the county contract for base covered services. The services covered could include those that would otherwise have been covered if the individual was MA eligible, but since the individual is not MA eligible and is MHX only, the services are covered by base funding. Counties may modify the way that data is submitted.

OMHSAS reports that 18 counties are in Phase 1 of implementation and are either certified as ready for production submission of encounters or are testing for certification. Thirteen counties are enrolling individuals and will be ready for the PROMISe certification process later this year. Eighteen more will begin provider enrollment and training for consumer enrollment next week for a total of 49 participating counties. Eighteen more counties will be included in the future. Contact Betty Simmonds with questions.

 

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