PART I - Department of Behavioral Health and Developmental ...

StaffingRequirementsServiceAccessibilityAdditionalMedicaidRequirementsReporting andBillingRequirementsDBHDD's Office of Forensic Services and may submit proposed materials for review.)1. Training is provided by staff with a minimum education of bachelor’s degree.2. For Individual Interventions: Maximum consumer to staff ratio cannot be more than one consumer to one direct service staff.3. For Group Interventions: Maximum consumer to staff ratio cannot be more than 10 consumers to one direct service staff.4. Practitioners providing this service are expected to maintain knowledge and skills regarding group training and competency restoration.1. Consumers will be referred by the Director of Forensic Services or designee at the state hospital in the catchment area of the provider.2. The provider will notify the referring state hospital if the consumer appears to be competent, is not likely to ever become competent, or is in need of more intensiveservices.This is not a Medicaid reimbursable service.Provider shall report to DBHDD's Office of Forensic Services quarterly (March 31, June 30, September 30, and December 31) the names of consumers served and foreach consumer, the date and type of service (individual or group) and the number of 15-minute units delivered (e.g. 60 minute group = 4 units of S9446 H9)Medication AdministrationTransactionCodeCode Detail Code Mod Mod Mod Mod Rate Code Detail Code Mod Mod Mod Mod Rate1 2 3 41 2 3 4Practitioner Level 2, In-Clinic H2010 U2 U6 $33.40 Practitioner Level 2, Out-of-Clinic H2010 U2 U7 $42.51ComprehensiveMedicationServicesPractitioner Level 3, In-Clinic H2010 U3 U6 $25.39 Practitioner Level 3, Out-of-Clinic H2010 U3 U7 $33.01Practitioner Level 4, In-Clinic H2010 U4 U6 $17.40 Practitioner Level 4, Out-of-Clinic H2010 U4 U7 $22.14Practitioner Level 5, In-Clinic H2010 U5 U6 $12.97Therapeutic,prophylactic ordiagnosticinjectionPractitioner Level 2, In-Clinic 96372 U2 U6 $33.40 Practitioner Level 2, Out-of-Clinic 96372 U2 U7 $42.51Practitioner Level 3, In-Clinic 96372 U3 U6 $25.39 Practitioner Level 3, Out-of-Clinic 96372 U3 U7 $33.01Practitioner Level 4, In-Clinic 96372 U4 U6 $17.40 Practitioner Level 4, Out-of-Clinic 96372 U4 U7 $22.14For individuals who need opioid maintenance, the Opioid Maintenance service should berequestedAlcohol, and/or drug services, methadone administration and/or service (provision of the drug by a licensedprogram)Unit Value 1 encounter Maximum Daily Units 1 encounterInitialAuthorization*With the submission of MICP Registration - 6 units sharedWith the submission of MICP New Episode: H2010 & 96372= 60 units sharedRe-Authorization*H2010 & 96372= 60 units sharedFY2013 Provider Manual for Community Behavioral Health Providers Page 81