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

Pharmacy & LabServiceDefinitionPharmacy and Lab Services include operating or purchasing services to order, package, and distribute prescription medications. It includes provision of assistance toconsumers to access indigent medication programs, sample medication programs and payment for necessary medications when no other funding source is available.This service provides for appropriate lab work, such as drug screens and medication levels to be performed. This service is to ensure that necessary medication and labservices are not withheld or delayed to consumers based on inability to pay.AdmissionCriteriaContinuingStay CriteriaDischargeCriteriaRequiredComponentsAdditionalMedicaidRequirementsReporting andBillingRequirementsIndividual has been assessed by a prescribing professional to need a psychotropic, anti-cholinergic, addiction specific, or anti-convulsant (as related to behavioral healthissue) medication and/or lab work required for persons entering services, and/or monitoring medication levels.Individual continues to meet the admission criteria as determined by the prescribing professional1. Individual no longer demonstrates symptoms that are likely to respond to or are responding to pharmacologic interventions; or2. Individual requests discharge and individual is not imminently dangerous or under court order for this intervention.1. Service must be provided by a licensed pharmacy or through contract with a licensed pharmacy.2. Agency must participate in any pharmaceutical rebate programs or pharmacy assistance programs that promote consumer access in obtaining medication.3. Providers shall assist consumers who have an inability to pay for medications in accessing the local Division of Family & Children Services or the Social SecurityAdministration to explore options for Medicaid eligibility.Not a Medicaid Rehabilitation Option “service.” Medicaid recipients may access the general Medicaid pharmacy program as defined by the Department of CommunityHealth.The agency shall adhere to expectations set forth in its contract for reporting related information.Psychiatric TreatmentTransactionCodeIndividualPsychotherapy,insightoriented,~20-30 minutesCode Detail Code Mod1Mod2Mod3Mod4Rate Code Detail Code Mod1Practitioner Level 1, In-Clinic 90805 U1 U6 97.02 Practitioner Level 2, In-Clinic 90805 U2 U6 64.95Practitioner Level 1, Out-of-Clinic90805 U1 U7 123.48 Practitioner Level 2, Out-of-Clinic 90805 U2 U7 77.93Mod2Mod3Mod4RateFY2013 Provider Manual for Community Behavioral Health Providers Page 86