Table Of Contents Dhhr Wv Gov-Books Pdf

TABLE OF CONTENTS dhhr wv gov
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521 PSYCHOLOGICAL SERVICES, 521 12 6 Neuropsychological Testing By Computer 17. 521 13 Psychotherapy 18, 521 13 1 Individual Psychotherapy 18. 521 13 2 Group Psychotherapy Other than of a multiple family group 20. 521 13 3 Non Methadone Medication Assisted Treatment Guidelines 21. 521 13 4 Psychotherapy for Crisis 23, 521 13 5 Family Psychotherapy without the patient present 26. 521 13 6 Family Psychotherapy with the patient present 26. 521 14 Service Limitations 27, 521 15 Service Exclusions 27. 521 16 Prior Authorization 28, 521 16 1 Prior Authorization Procedures 28.
521 16 2 Prior Authorization Requirements 28, 521 17 Documentation and Record Retention Requirements 29. 521 18 Billing Procedures 29, Glossary 29, Change Log 30. Appendix 521A Coordination of Care and Release of Information Form for Suboxone Subutex or. Vivitrol Providers, BMS Provider Manual Page 2, Chapter 521 Psychological Services Revised 4 1 2015. DISCLAIMER This chapter does not address all the complexities of Medicaid policies and procedures and must be. supplemented with all State and Federal Laws and Regulations Contact BMS Fiscal Agent for coverage prior. authorization requirements service limitations and other practitioner information. 521 PSYCHOLOGICAL SERVICES, BACKGROUND, The West Virginia Medicaid Program offers a comprehensive scope of medically necessary psychological. services to diagnose and treat eligible members Covered and authorized services must be rendered by. enrolled providers within the scope of their license and in accordance with all State and Federal. regulations Any service procedure item or situation not discussed in the manual must be presumed. non covered unless informed otherwise in writing by the West Virginia Bureau for Medical Services. This chapter sets forth BMS s requirements for payment of Psychological Services provided by. Psychological providers to eligible West Virginia WV Medicaid members. The policies and procedures set forth herein are promulgated as regulations governing the provision of. Psychological Services in the Medicaid Program administered by the West Virginia Department of Health. and Human Resources WVDHHR under the provisions of Title XIX of the Social Security Act and. Chapter 9 of the Public Welfare Law of WV, The Bureau for Medical Services has a joint goal with Medicaid Enrolled Providers to ensure effective.
services are provided to Medicaid Members, Medicaid Enrolled Providers should give priority to children that have been identified as being in the foster. care system To uphold our responsibility to children in foster care addressing children s needs must. begin at entry and by making these foster children a priority especially with the assessment services. stated in Section 521 11 and Section 521 12 of this manual Medicaid Enrolled Providers should make a. good faith effort to complete assessments in a timely manner as well as work with Bureau for Children. and Families BCF to ensure that information is shared in a timely manner with BCF court systems as. well as other entities involved in the care and treatment process of the foster child while conforming to. state and federal confidentiality requirements, All Medicaid Members have the right to freedom of choice when choosing a provider for treatment A. Medicaid Member may receive one type of service from one provider and another type of service from a. different provider Providers that are found to be inhibiting freedom of choice to Medicaid Members are in. violation of their provider agreement, All Medicaid Enrolled Providers should coordinate care if a Medicaid Member has different Medicaid. services at different sites with other providers to ensure that quality of care is taking place and that safety. is the forefront of the Member s treatment Appropriate Releases of Information should be signed in order. that Health Insurance Portability and Accountability Act HIPAA Compliant Coordination of Care takes. 521 1 MEMBER ELIGIBILITY, Psychological Services are available to all Medicaid members with a known or suspected behavioral. health disorder Each member s level of services will be determined when prior authorization for. Psychological Services is requested through the utilization management contractor UMC authorized by. BMS Provider Manual Page 3, Chapter 521 Psychological Services Revised 4 1 2015.
DISCLAIMER This chapter does not address all the complexities of Medicaid policies and procedures and must be. supplemented with all State and Federal Laws and Regulations Contact BMS Fiscal Agent for coverage prior. authorization requirements service limitations and other practitioner information. 521 PSYCHOLOGICAL SERVICES, BMS to perform administrative review The Prior Authorization process is explained in Section 521 16 of. this manual, 521 2 MEDICAL NECESSITY, All Psychological Services covered in this chapter are subject to a determination of medical necessity. defined as follows in the managed care position paper published in 1999 by the State of WV. Services and Supplies that are, 1 appropriate and necessary for the symptoms diagnosis or treatment of an illness. 2 provided for the diagnosis or direct care of an illness. 3 within the standards of good practice, 4 not primarily for the convenience of the plan member or provider and. 5 the most appropriate level of care that can be safely provided. Medical Necessity must be demonstrated throughout the provision of services For these types of. services the following five factors will be included as part of this determination. Diagnosis as determined by a physician or licensed psychologist. Level of functioning, Evidence of clinical stability.
Available support system, Service is the appropriate level of care. Providers rendering services that require prior authorization must register with BMS s UMC and receive. authorization before rendering such services Prior authorization does not guarantee payment for. services rendered See Section 521 16 1 Prior Authorization Procedures and Section 521 16 2 Prior. Authorization Requirements, 521 3 PROVIDER ENROLLMENT. In order to participate in the WV Medicaid Program and receive payment from BMS providers of. Psychological Services must meet all enrollment criteria as described in Chapter 300 Provider. Participation Requirements, 521 3 1 Enrollment Requirements Staff Qualifications. Services may be rendered to Medicaid members by a supervised psychologist under the supervision of a. licensed psychologist Documentation including required licenses certifications and proof of completion. of training must be kept on file at the psychological practice where the services are rendered Board. Approved Supervisors may only bill for the four 4 psychologists they are supervising Board Approved. Supervisors may not trade supervisees for billing Medicaid services. All further Staff Qualifications will be indicated under the service codes All documentation for staff. including college transcripts certifications credentials background checks and trainings should be kept. BMS Provider Manual Page 4, Chapter 521 Psychological Services Revised 4 1 2015. DISCLAIMER This chapter does not address all the complexities of Medicaid policies and procedures and must be. supplemented with all State and Federal Laws and Regulations Contact BMS Fiscal Agent for coverage prior. authorization requirements service limitations and other practitioner information. 521 PSYCHOLOGICAL SERVICES, in the staff s personnel file and may be reviewed at any time by BMS the Bureau s contractors or state.
and federal auditors, 521 4 FINGERPRINT BASED BACKGROUND CHECKS. All providers of psychological services and their staff that have direct contact with Medicaid members. must at a minimum have results from a state level fingerprint based background check This check must. be conducted initially and again every 3 years If the current or prospective employee within the past 5. years has lived or worked out of state or currently lives or works out of state an additional federal. background check must be conducted by the Agency through the West Virginia State Police upon hire. and every 3 years of employment thereafter Providers may do an on line preliminary check and use. these results for a period of 3 months while waiting for state and or federal fingerprint results to be. received Providers may only use on line companies that check counties in which the applicant has lived. and worked within the last 5 years An individual who is providing services or is employed by a provider. cannot be considered to provide services nor can be employed or continue to be employed if ever. convicted of the following, Any violent felony crime including but not limited to rape sexual assault homicide or felonious. Child adult abuse or neglect, Crimes which involve the exploitation including financial exploitation of a child or an. incapacitated adult, Any type of felony battery, Felony arson. Felony or misdemeanor crime against a child or incapacitated adult which causes harm. Felony drug related offenses within the last 10 years. Felony Driving Under the Influence DUI within the last 10 years. Hate crimes, Kidnapping, Murder homicide, Neglect or abuse by a caregiver.
Pornography crimes involving children or incapacitated adults including but not limited to use of. minors in filming sexually explicit conduct distribution and exhibition of material depicting minors. in sexually explicit conduct or sending distributing exhibiting possessing displaying or. transporting material by a parent legal representative or custodian depicting a child engaged in. sexually explicit conduct, Purchase or sale of a child. Sexual offenses including but not limited to incest sexual abuse or indecent exposure. Healthcare fraud and, Felony forgery, Fingerprint based background check results other than those listed above which may place a member at. risk of personal health and safety or have evidence of a history of Medicaid fraud or abuse must be. considered by the provider before placing an individual in a position to provide services to the member. BMS Provider Manual Page 5, Chapter 521 Psychological Services Revised 4 1 2015. DISCLAIMER This chapter does not address all the complexities of Medicaid policies and procedures and must be. supplemented with all State and Federal Laws and Regulations Contact BMS Fiscal Agent for coverage prior. authorization requirements service limitations and other practitioner information. 521 PSYCHOLOGICAL SERVICES, If aware of recent convictions or change in conviction status of an agency staff member providing. Psychological services the Psychological provider must take appropriate action including notification to. the BMS Program Manager for Psychological Services. The Federal Office of the Inspector General OIG List of Excluded Individuals and Entities LEIE must. be checked by the Psychological provider for every agency staff who provides Medicaid services prior to. employment and monthly thereafter Persons on the OIG Exclusion List cannot provide Medicaid. It is the responsibility of the employer to check the list of excluded individuals entities monthly at. LEIE at http exclusions oig hhs gov, Formerly EPLS https www sam gov.
A form may be printed from this website to verify that the check occurred Any document that has. multiple staff names may be kept in a separate file and made available to staff as needed and during. agency audits, The following web addresses are provided to assist the governing body or designee to check applicants. against the sex offender registries for West Virginia and the National sex offender registry upon hiring for. employment Results of this check must be present in the employee volunteer personnel file and available. for review upon request, West Virginia s state police offender registry is at http www wvsp gov. National sex offender registry is at http www nsopw gov. 521 5 METHODS OF VERIFYING BUREAU FOR MEDICAL SERVICES. REQUIREMENTS, Enrollment requirements as well as provision of services are subject to review by BMS and or its. contracted agents BMS contracted agents may promulgate and update utilization management. guidelines that have been reviewed and approved by BMS These approved guidelines function as. policy Additional information governing the surveillance and utilization control program may be found in. Chapter 100 General Administration and Information of the Provider Manual and are subject to review. by state and federal auditors, 521 6 PSYCHOLOGICAL PROVIDER REVIEW S. The primary means of monitoring the quality of psychological services is through provider reviews. conducted by the Contracted Agent as determined by BMS by a defined cycle The Contracted agent. performs on site and desk documentation provider reviews and face to face member legal representative. and staff interviews to validate documentation and address CMS quality assurance standards. Targeted on site psychological provider reviews and or desk reviews may be conducted by the. Contracted Agent in follow up to receipt of Incident Management Reports complaint data Plan of. Corrections POC etc, BMS Provider Manual Page 6, Chapter 521 Psychological Services Revised 4 1 2015.
DISCLAIMER This chapter does not address all the complexities of Medicaid policies and procedures and must be. supplemented with all State and Federal Laws and Regulations Contact BMS Fiscal Agent for coverage prior. 521 PSYCHOLOGICAL SERVICES BMS Provider Manual Page 3

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