331.397A Children’s behavioral health core services.
1. For the purposes of this section, unless the context otherwise requires, “domain” means a set of similar behavioral health services that can be provided depending on a child’s service needs.
2. a. (1) A region shall work with children’s behavioral health service providers to ensure that services in the required behavioral health core service domains in subsection 4 are available to children who are residents of the region, regardless of any potential payment source for the services.
(2) Subject to the available appropriations, the director of human services shall ensure the behavioral health core service domains listed in subsection 4 are covered services for the medical assistance program under chapter 249A to the greatest extent allowable under federal regulations. The medical assistance program shall reimburse Medicaid enrolled providers for Medicaid covered services under subsection 4 when the services are medically necessary, the Medicaid enrolled provider submits an appropriate claim for such services, and no other third-party payor is responsible for reimbursement of such services. Within the funds available, the region shall pay for such services for eligible children when payment through the medical assistance program or another third-party payment is not available, unless the child is on a waiting list for such payment or it has been determined that the child does not meet the eligibility criteria for any such service.
b. Until funding is designed for other service populations, eligibility for the service domains listed in this section shall be limited to such children who are in need of behavioral health services.
3. Pursuant to recommendations made by the state board, the department of human services shall adopt rules to define the services included in the core domains listed in this section. The rules shall provide service definitions, service provider standards, service access standards, and service implementation dates, and shall provide consistency, to the extent possible, with similar service definitions under the medical assistance program.
4. The children’s behavioral health core service domains shall include all of the following:
a. Treatment designed to ameliorate a child’s serious emotional disturbance, including but not limited to all of the following:
(1) Prevention, early identification, early intervention, and education.
(2) Assessment and evaluation relating to eligibility for services.
(3) Medication prescribing and management.
(4) Behavioral health outpatient therapy.
b. Comprehensive facility and community-based crisis services regardless of a diagnosis of a serious emotional disturbance, including all of the following:
(1) Mobile response.
(2) Crisis stabilization community-based services.
(3) Crisis stabilization residential services.
(4) Behavioral health inpatient treatment.
5. A region shall ensure that services within the following additional core service domains are available to children not eligible for the medical assistance program under chapter 249A or not receiving other third-party payment for the services, when public funds are made available for such services:
a. Treatment designed to ameliorate a child’s serious emotional disturbance including but not limited to behavioral health school-based therapy.
b. Support for community living including but not limited to all of the following:
(1) Family support.
(2) Peer support.
(3) Therapeutic foster care.
(4) Respite care.
c. Transition services for children to the adult mental health system providing an appropriate match with a child’s abilities based upon informed, person-centered choices made from an array of options including but not limited to all of the following:
(1) Day habilitation.
(2) Job development.
(3) Supported employment.
(4) Prevocational services.
(5) Educational services.
d. Service coordination including physical health and primary care that follow the principles of the system of care including but not limited to all of the following:
(1) Care coordination.
(2) Health homes.
2019 Acts, ch 61, §18; 2020 Acts, ch 1063, §178
Subsection 5, unnumbered paragraph 1 amended