RCPA - Rehabilitation and Community Providers Association


MR Bulletin for EPSDT Revises Procedures
February 29, 2000

A bulletin issued in December 1999 has revised the submission procedures for the 1150 waiver for mental retardation providers. The bulletin is entitled Procedures for Licensed, enrolled Mental Retardation Providers to Access and Submit Claims for Outpatient Behavioral Health Services for Individuals Under the Age of 21.

Effective February 29, Office of Mental Retardation Regional EPSDT Coordinators will no longer accept 1150 waiver requests for prior approval of MR Behavioral Health Services. There are new procedures are for all MR -licensed providers enrolled with MA as a Provider Type 50. Providers under the managed care delivery system must follow the procedures established by the managed care plan.

The bulletin allows providers to submit claims for Mobile Therapy and Behavioral Specialist Consultant directly from the MA Program Fee Schedule. In addition, newly initiated TSS services may also be billed directly from the fee schedule. As with all Behavioral Health Rehabilitation Services, limitations to the frequency and dollar amounts must be followed, as well as the requirements and procedures for services. The limitations and requirements are identified in MA Bulletin 01-94-01, 41-94-01, 49-94-01, and 50-94-01, effective January 1, 1994.

For a copy of the December 3, 1999 bulletin, which has a more detailed explanation for procedures, contact Lisa Lowrie at the Association.

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