RS 2162 - Specialized behavioral health rehabilitation services in the Louisiana medical assistance program
A. For purposes of this Section, the following definitions shall apply:
(1) "Behavioral health services provider" means a health care provider as defined in R.S. 40:2153.
(2) "CMS" means the Centers for Medicare and Medicaid Services.
(3) "Community psychiatric support and treatment services", hereinafter referred to as "CPST" services, means CMS-approved Medicaid mental health rehabilitation services defined as services associated with assisting individuals with skill building to restore stability, support functional gains, and adapt to community living, designed to focus on reducing the disability from mental illness, restoring functional skills of daily living, and building natural supports and solution-oriented interventions, or such other successor services or requirements subsequently approved by CMS or the department for CPST services for the Louisiana medical assistance program.
(4) "Department" means the Louisiana Department of Health.
(5) "Louisiana medical assistance program" means the Louisiana Medicaid program.
(6) "Preliminary accreditation" means accreditation granted by an accrediting body to an unaccredited program seeking full accreditation status.
(7) "Psychosocial rehabilitation services", hereinafter referred to as "PSR" services, means CMS-approved Medicaid mental health rehabilitation services defined as psycho-educational services provided to individuals with mental illness in order to assist with skill building, restoration, and rehabilitation, designed to assist the individual with compensating for or eliminating functional deficits and interpersonal or environmental barriers associated with mental illness, or such other successor services or requirements subsequently approved by CMS or the department for PSR services for the Louisiana medical assistance program.
B. Medicaid reimbursement to behavioral health services providers that provide PSR and CPST services in the Medicaid specialized behavioral health rehabilitation services program shall comply with the requirements of this Section, subject to any required CMS approval.
C. In order to be eligible to receive Medicaid reimbursement, all behavioral health services providers providing PSR or CPST services to Medicaid recipients shall meet all of the following requirements:
(1) Be licensed as a behavioral health services provider agency.
(2) Be accredited by a department-approved accrediting organization and meet the following conditions:
(a) The behavioral health services provider shall show proof of full accreditation or obtain preliminary accreditation prior to being contracted with a Medicaid managed care organization.
(b) The behavioral health services provider shall maintain proof of full accreditation or proof of preliminary accreditation.
(c) If not fully accredited on or before July 1, 2018, the behavioral health services provider shall attain full accreditation within eighteen months of its initial accreditation application date and shall provide proof of full accreditation to each managed care organization with which it is contracted.
(d) The behavioral health services provider shall maintain continuous full or preliminary accreditation.
(e) The cost of attaining and maintaining accreditation is the responsibility of the behavioral health services provider.
(f) The behavioral health services provider shall report any loss of accreditation, suspension of accreditation, reduction to a preliminary accreditation status, or any other action that could result in the loss of accreditation, to each managed care organization with which it is contracted, within twenty-four hours of receipt of notification from the accreditation body.
(3) Effective January 1, 2019, have a National Provider Identification number, hereinafter referred to as "NPI". The behavioral health services provider agency shall include its NPI number and the NPI number of the individual rendering the PSR or CPST services on its behalf on all claims for Medicaid reimbursement submitted for PSR or CPST services, for dates of service on or after January 1, 2019.
(4) Implement a member choice form to be signed by each recipient, or the legal guardian or representative of the recipient, receiving PSR or CPST in order to prevent or reduce duplication of services.
(5) Be credentialed and in the provider network of the managed care organization that the provider intends to submit claims for Medicaid services, unless the managed care organization has a single case agreement with a licensed and accredited provider agency not in its network.
(6) Meet any other requirements promulgated through rulemaking by the department to ensure the quality and effectiveness of services.
D. In order to be eligible to receive Medicaid reimbursement, all behavioral health services providers shall ensure that any individual rendering PSR or CPST services for the licensed and accredited provider agency meets all of the following requirements:
(1) Effective for services rendered on or after January 1, 2019, the individual rendering the PSR or CPST services for the licensed and accredited provider agency shall have an individual NPI number and that NPI number shall be included on any claim by that provider agency for reimbursement related to such services.
(2)(a) Any individual rendering PSR services for a licensed and accredited provider agency shall hold a minimum of one of the following:
(i) A bachelor's degree from an accredited university or college in the field of counseling, social work, psychology, sociology, rehabilitation services, special education, early childhood education, secondary education, family and consumer sciences, or human growth and development.
(ii) Any bachelor's degree from an accredited university or college with a minor in counseling, social work, sociology, or psychology.
NOTE: Subparagraph (D)(2)(b) eff. until Jan. 1, 2022. See Acts 2021, No. 433, §1.
(b) Any individual rendering PSR services who does not possess the minimum educational requirements provided for in this Paragraph, but who met all provider qualifications in effect prior to July 1, 2018, may continue to provide PSR services for the same provider agency. Prior to the individual rendering PSR services at a different provider agency, he shall comply with the provisions of this Section.
NOTE: Subparagraph (D)(2)(b) as amended by Acts 2021, No. 204, eff. Jan. 1, 2022.
(b) Any individual rendering PSR services who does not possess the minimum educational requirements provided for in this Paragraph, but who met all provider qualifications in effect prior to July 1, 2018, may continue to provide PSR services for any licensed and accredited provider agency.
(c) Any individual rendering any CPST services for a licensed and accredited provider agency shall hold a minimum of a bachelor's degree from an accredited university or college in the field of counseling, social work, psychology, or sociology.
(3)(a) The individual rendering PSR or CPST services for the licensed and accredited provider agency shall meet all other requirements set forth in Medicaid rules, regulations, provider manuals, and policies.
(b) Within thirty days of May 31, 2018, the department shall commence any actions that are required to amend any existing department rule or regulation that is in conflict with the requirements of this Section, including but not limited to any required approval by CMS.
E. The department shall maintain a facility need review program for behavioral health services providers that provide PSR or CPST services. No facility need review approval for a license to provide PSR or CPST services shall be granted to any applicant unless the department determines that the evidence and data submitted by the applicant establishes the probability of serious, adverse consequences to recipients' ability to access services if the provider is not allowed to seek licensure.
F.(1) In order to be eligible to receive Medicaid reimbursement, each behavioral health services provider that provides PSR or CPST services shall employ at least one full-time physician, or full-time licensed mental health professional as defined in R.S. 40:2153(7)(a), (b), (c), (d), (e), or (g), to serve as a full-time mental health supervisor to assist in the design and evaluation of treatment plans for PSR and CPST services. For the purposes of this Section the term "full-time" shall mean employment by the behavioral health services provider for at least thirty-five hours per week.
(2) Each unlicensed individual rendering PSR or CPST services for the licensed and accredited behavioral health services provider agency shall be required to receive at least one hour per calendar month of personal supervision and training by the provider agency's mental health supervisor.
G. The department shall implement a centralized credentialing verification organization, hereinafter referred to as "CVO", for the Medicaid specialized behavioral health rehabilitation services program. The CVO shall be certified as a CVO by the National Committee for Quality Assurance, hereinafter referred to as "NCQA". The CVO shall perform agency provider credentialing that meets the following criteria:
(1) NCQA standards.
(2) Verification of agency license.
(3) Verification of agency accreditation.
(4) Any additional requirements imposed by the department for becoming a Medicaid provider reimbursed under the Medicaid specialized behavioral health rehabilitation services program.
H.(1) Effective July 1, 2018, the Medicaid managed care organizations shall take appropriate actions to recoup Medicaid payments or funds from any behavioral health services provider that renders Medicaid services in violation of the provision of this Section.
(2) The department may refer noncompliant behavioral health services providers to the Louisiana Medicaid Fraud Control Unit within the Louisiana attorney general's office for further fraud investigation.
I. The department may promulgate any rules pursuant to the Administrative Procedure Act and may publish any Medicaid manuals or Medicaid policy to implement and enforce the provisions of this Section.
J. The legislative auditor may conduct performance audits of the department to ensure compliance with the provisions of this Section.
K. The department shall not take any final action that will result in the elimination of PSR or CPST services unless such action is affirmatively approved by the House Committee on Health and Welfare and the Senate Committee on Health and Welfare.
Acts 2018, No. 582, §1, eff. May 31, 2018; Acts 2021, No. 204, §1, eff. Jan. 1, 2022; Acts 2021, No. 433, §1.