405 IAC 5-21.5-4 - Behavioral health counseling and therapy
Authority: IC 12-15
Affected: IC 12-13-7-3; IC 25-23.6-10.5
Sec. 4.
(a) The
services reimbursable as individual or group behavioral health counseling and
therapy consist of a series of time-limited, structured, face-to-face sessions
that work toward the goals identified in the individualized integrated care
plan. The service must be provided at the member's home or at other locations
outside the clinic setting as follows:
(1)
Requirements for individual or group behavioral health counseling and therapy
services shall be as follows:
(A) Services may
be provided for members of all ages.
(B) Providers must meet the either of the
following qualifications:
(i) A licensed
professional, except for a licensed clinical addiction counselor, as defined
under IC 25-23.6-10.5.
(ii) A
QBHP.
(2)
Programming standards shall be as follows:
(A) The service requires face-to-face
contact.
(B) The member is the
focus of the service.
(C)
Documentation must support how the service benefits the member, including when
services are provided in a group setting.
(D) Services must demonstrate movement toward
or achievement of member treatment goals identified in the individualized
integrated care plan.
(E) Service
goals must be rehabilitative in nature.
(F) When provided in a group setting,
services must be provided in an age appropriate setting for a member less than
eighteen (18) years of age.
(3) Exclusions shall be as follows:
(A) Services provided in a clinic setting and
services provided as a part of school-based services are not billable under the
MRO program, and must be billed to the clinic option.
(B) Licensed clinical addiction counselors,
as defined under IC 25-23.6-10.5, may not provide this service.
(C) If medication management is a component
of the service session, then medication training and support may not be billed
separately for the same visit by the same provider.
(b) The services reimbursable as
family or couple behavioral health counseling and therapy consist of a series
of time-limited, structured, and face-to-face sessions, with or without the
member present, that work toward the goals identified in the individualized
integrated care plan. The face-to-face interaction may be with family members
or nonprofessional caregivers. The service must be provided at home or other
locations outside the clinic setting as follows:
(1) Requirements for family or couple
behavioral health counseling and therapy services shall be as follows:
(A) Services may be provided for members of
all ages.
(B) Providers must meet
either of the following qualifications:
(i) A
licensed professional, except for a licensed clinical addiction counselor, as
defined under IC 25-23.6-10.5.
(ii)
A QBHP.
(C) Services may
be delivered in an individual or group setting.
(2) Programming standards shall be as
follows:
(A) The service requires face-to-face
contact.
(B) The member is the
focus of the service.
(C)
Documentation must support how the service benefits the member, including when
the member is not present and when services are provided in a group
setting.
(D) Services must
demonstrate movement toward or achievement of member treatment goals identified
in the individualized integrated care plan.
(E) Service goals must be rehabilitative in
nature.
(F) When provided in a
group setting, services must be provided in an age appropriate setting for a
member less than eighteen (18) years of age.
(3) Exclusions shall be as follows:
(A) Services provided in a clinic setting and
service provided as a part of school-based services are not billable under the
MRO program, and must be billed to the clinic option.
(B) Licensed clinical addiction counselors,
as defined under IC 25-23.6-10.5, may not provide this service.
(C) If medication management is a component
of the service session, then medication training and support may not be billed
separately for the same visit by the same provider.
(D) Services may not be provided to
professional caregivers.
Notes
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No prior version found.