907 KAR 15:025. Reimbursement provisions and requirements regarding behavioral health services provided by behavioral health service organizations

      Section 1. General Requirements. For the department to reimburse for a service covered under this administrative regulation, the service shall:

      (1) Meet the requirements established in 907 KAR 15:020; and

      (2) Be covered in accordance with 907 KAR 15:020.

 

      Section 2. Reimbursement. (1) One (1) unit of service shall be:

      (a) Fifteen (15) minutes in length; or

      (b) The unit amount identified in the corresponding:

      1. Current procedural terminology code; or

      2. Healthcare common procedure coding system code.

      (2) The rate per unit for a screening or for crisis intervention shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;

      4. Licensed marriage and family therapist; or

      5. Licensed professional art therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a billing supervisor;

      2. Licensed professional counselor associate working under the supervision of a billing supervisor;

      3. Licensed psychological associate working under the supervision of a billing supervisor;

      4. Certified social worker working under the supervision of a billing supervisor;

      5. Physician assistant working under the supervision of a billing supervisor;

      6. Licensed professional art therapist associate working under the supervision of a billing supervisor; or

      7. Certified alcohol and drug counselor working under the supervision of a billing supervisor.

      (3) The rate per unit for an assessment shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;

      4. Licensed marriage and family therapist;

      5. Licensed professional art therapist; or

      6. Licensed behavior analyst; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a billing supervisor;

      2. Licensed professional counselor associate working under the supervision of a billing supervisor;

      3. Licensed psychological associate working under the supervision of a billing supervisor;

      4. Certified social worker working under the supervision of a billing supervisor;

      5. Physician assistant working under the supervision of a billing supervisor;

      6. Licensed professional art therapist associate working under the supervision of a billing supervisor;

      7. Licensed assistant behavior analyst working under the supervision of a billing supervisor; or

      8. Certified alcohol and drug counselor working under the supervision of a billing supervisor.

      (4) The rate per unit for psychological testing shall be:

      (a) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a licensed psychologist;

      (b) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a licensed psychological practitioner; or

      (c) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a licensed psychological associate working under the supervision of a licensed psychologist.

      (5) The rate per unit for individual outpatient therapy, group outpatient therapy, or collateral outpatient therapy shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;

      4. Licensed marriage and family therapist;

      5. Licensed professional art therapist; or

      6. Licensed behavior analyst; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a billing supervisor;

      2. Licensed professional counselor associate working under the supervision of a billing supervisor;

      3. Licensed psychological associate working under the supervision of a billing supervisor;

      4. Certified social worker working under the supervision of a billing supervisor;

      5. Physician assistant working under the supervision of a billing supervisor;

      6. Licensed professional art therapist associate working under the supervision of a billing supervisor;

      7. Licensed assistant behavior analyst working under the supervision of a billing supervisor; or

      8. Certified alcohol and drug counselor working under the supervision of a billing supervisor.

      (6) The rate per unit for family outpatient therapy shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;

      4. Licensed marriage and family therapist; or

      5. Licensed professional art therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a billing supervisor;

      2. Licensed professional counselor associate working under the supervision of a billing supervisor;

      3. Licensed psychological associate working under the supervision of a billing supervisor;

      4. Certified social worker working under the supervision of a billing supervisor;

      5. Physician assistant working under the supervision of a billing supervisor;

      6. Licensed professional art therapist associate working under the supervision of a billing supervisor; or

      7. Certified alcohol and drug counselor working under the supervision of a billing supervisor.

      (7) Reimbursement for the following services shall be as established on the BHSO Non-Medicare Services Fee Schedule:

      (a) Mobile crisis services;

      (b) Day treatment;

      (c) Peer support services;

      (d) Parent or family peer support services;

      (e) Intensive outpatient program services;

      (f) Service planning;

      (g) Residential services for substance use disorders;

      (h) Screening, brief intervention, and referral to treatment;

      (i) Assertive community treatment;

      (j) Comprehensive community support services; or

      (k) Therapeutic rehabilitation services.

      (8)(a) The department shall use the current version of the Kentucky-specific Medicare Physician Fee Schedule for reimbursement purposes.

      (b) For example, if the Kentucky-specific Medicare Physician Fee Schedule currently published and used by the Centers for Medicare and Medicaid Services for the Medicare Program is:

      1. An interim version, the department shall use the interim version until the final version has been published; or

      2. A final version, the department shall use the final version.

      (9) The department shall not reimburse for a service billed by or on behalf of an entity or individual that is not a billing provider.

 

      Section 3. No Duplication of Service. (1) The department shall not reimburse for a service provided to a recipient by more than one (1) provider of any program in which the service is covered during the same time period.

      (2) For example, if a recipient is receiving a behavioral health service from an independent behavioral health provider, the department shall not reimburse for the same service provided to the same recipient during the same time period by a behavioral health services organization.

 

      Section 4. Not Applicable to Managed Care Organizations. A managed care organization shall not be required to reimburse in accordance with this administrative regulation for a service covered pursuant to:

      (1) 907 KAR 15:020; and

      (2) This administrative regulation.

 

      Section 5. Federal Approval and Federal Financial Participation. The department’s reimbursement for services pursuant to this administrative regulation shall be contingent upon:

      (1) Receipt of federal financial participation for the reimbursement; and

      (2) Centers for Medicare and Medicaid Services’ approval for the reimbursement.

 

      Section 6. Incorporation by Reference. (1) "BHSO Non-Medicare Services Fee Schedule", July 2014, is incorporated by reference.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at:

      (a) The Department for Medicaid Services, 275 East Main Street, Frankfort, Kentucky, Monday through Friday, 8:00 a.m. to 4:30 p.m.; or

      (b) Online at the department’s Web site at http://www.chfs.ky.gov/dms/incorporated.htm. (41 Ky.R. 700; Am. 1398; 1656; eff. 2-6-2015.)

Notation

      RELATES TO: KRS 205.520, 42 U.S.C. 1396a(a)(10)(B), 42 U.S.C. 1396a(a)(23)

      STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3)

      NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services, has a responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed or opportunity presented by federal law to qualify for federal Medicaid funds. This administrative regulation establishes the reimbursement provisions and requirements regarding Medicaid Program behavioral health services provided by behavioral health services organizations to Medicaid recipients who are not enrolled with a managed care organization.