Payment shall be made for medically necessary behavioral
health services provided by a participating marital and family therapist,
independent social worker, master social worker, mental health counselor, or
certified alcohol and drug counselor within the practitioner's scope of
practice pursuant to state law and subject to the limitations and exclusions
set forth in this rule.
(1)
Limitations.
a. An assessment
and a treatment plan are required.
b. Services provided by a licensed master
social worker must be provided under the supervision of an independent social
worker qualified to participate in the Medicaid program.
(2)
Exclusions. Payment will
not be approved for the following services:
a.
Services provided in a medical institution.
b. Services performed without relationship to
a specific condition, risk factor, symptom, or complaint.
c. Services provided for nonspecific
conditions of distress such as job dissatisfaction or general
unhappiness.
d. Sensitivity
training, marriage enrichment, assertiveness training, and growth groups or
marathons.
(3)
Payment.
a. Payment shall be
made only for time spent in face-to-face consultation with the
member.
b. A unit of service is 15
minutes. Time spent with members shall be rounded to the quarter hour, where
applicable.
This rule is intended to implement Iowa Code section
249A.4.
Notes
Iowa Code r.
441-78.29
ARC 9649B, IAB
8/10/11, effective 8/1/11; ARC
8959C, IAB 2/19/25, effective 4/1/25
ARC 9649B, lAB 8/10/11,
effective 8/1/11
Amended by
IAB
February 19, 2025/Volume XLVII, Number 17, effective
4/1/2025
