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

Medication Administrationliving.RequiredComponentsStaffingRequirementsClinicalOperationsAdditionalMedicaidRequirements1. There must be a physician’s order for the medication and for the administration of the medication. The order must be in the individual’s chart. Telephone/verbalorders are acceptable provided they are signed by the physician in accordance with DBHDD standards.2. Documentation must support that the individual is being trained in the risks and benefits of the medications being administered and that symptoms are beingmonitored by the staff member administering the medication.3. Documentation must support the medical necessity of administration by licensed/credentialed medical personnel rather than by the individual, family or caregiver.4. Documentation must support that the individual is being trained in the principle of self-administration of medication or that the individual is physically or mentally unableto self-administer. This documentation will be subject to scrutiny by the External Review Organization in reauthorizing services in this category.5. This service does not include the supervision of self-administration of medication.Qualified Medication Aides working in a Community Living Arrangement (CLA) may administer medication only in a CLA1. Medication administration may not be billed for the provision of single or multiple doses of medication that a consumer has the ability to self-administer, eitherindependently or with supervision by a caregiver, either in a clinic or a community setting. In a group home/CCI setting, for example, medications may be managed bythe house parents or residential care staff and kept locked up for safety reasons. Staff may hand out medication to the residents but this does not constituteadministration of medication for the purposes of this definition and, like other watchful oversight and monitoring functions, are not reimbursable treatment services.2. If consumer/family requires training in skills needed in order to learn to manage his/her own medications and their safe self-administration and/or supervision of selfadministration,this skills training service can be provided via the Community Support or Family/Group Training services in accordance with the person’s individualizedrecovery/resiliency plan.As in all other settings, the daily maximum within a CSU for Medication Administration is 1 unit/day.Nursing Assessment and Health ServicesTransactionCodeCode Detail Code Mod1Mod2Mod3Mod4Rate Code Detail Code Mod1Mod2Mod3Mod4RateNursingAssessment/EvaluationRN Services, upto 15 minutesPractitioner Level 2, In-Clinic T1001 U2 U6 $38.97 Practitioner Level 2, Out-of-Clinic T1001 U2 U7 $46.76Practitioner Level 3, In-Clinic T1001 U3 U6 $30.01 Practitioner Level 3, Out-of-Clinic T1001 U3 U7 $36.68Practitioner Level 4, In-Clinic T1001 U4 U6 $20.30 Practitioner Level 4, Out-of-Clinic T1001 U4 U7 $24.36Practitioner Level 2, In-Clinic T1002 U2 U6 $38.97 Practitioner Level 2, Out-of-Clinic T1002 U2 U7 $46.76Practitioner Level 3, In-Clinic T1002 U3 U6 $30.01 Practitioner Level 3, Out-of-Clinic T1002 U3 U7 $36.68FY2013 Provider Manual for Community Behavioral Health Providers Page 83