Licensed Mental Health PractitionersSection II
section ii - lICENSED MENTAL HEALTH PractitionersContents
200.000lICENSED MENTAL HEALTH Practitioners GENERAL INFORMATION
201.000Arkansas Medicaid Participation Requirements for Licensed Mental Health Practitioners - Licensed Certified Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPC) and Psychologist
201.100Certification Requirements for LCSW, LMFT and LPC Providers
201.110Licensed Certified Social Workers (LCSW)
201.120Licensed Marriage and Family Therapist (LMFT)
201.130Licensed Professional Counselors (LPC)
202.000Group Providers of Licensed Mental Health Practitioner Services
203.000Psychologists Practicing in Arkansas and Bordering States
203.100Routine Services Provider - Psychologists
203.200Non-Bordering States - Psychologists
203.300Limited Service Providers - Psychologists
204.000LCSW, LMFT and LPC Participating in Arkansas and Bordering States
205.000The Psychologist’s Role in the Child Health Services (EPSDT) Program
210.000PROGRAM COVERAGE
211.000Introduction
211.100Non-Refusal Requirement
211.200Primary Care Physician (PCP) Referral
211.210When the Child is Ineligible for Medicaid at Time of Service
211.220Renewal of PCP Referral
212.000Scope
212.100Treatment Plan Requirements
212.200Place of Service
212.300Hospital Visits
212.400RSPMI and Inpatient Psychiatric for Under Age 21
213.000Exclusions
214.000Covered Services
215.000Diagnosis and Clinical Impression
216.000Reserved
217.000Documentation
218.000Electronic Signatures
218.100Reserved
240.000PRIOR AUTHORIZATION
240.100Prior Authorization Information
250.000REIMBURSEMENT
251.000Method of Reimbursement
251.010Fee Schedules
251.100Billing for Fifteen Minute Units
252.000Rate Appeal Process
260.000BILLING PROCEDURES
261.000Introduction to Billing
262.000CMS-1500 Billing Procedures
262.100Licensed Mental Health Practitioner Procedure Codes
262.200National Place of Service Codes
262.300Billing Instructions – Paper Only
262.310Completion of CMS-1500 Claim Form
262.400Special Billing Procedures
200.000lICENSED MENTAL HEALTH Practitioners GENERAL INFORMATION201.000Arkansas Medicaid Participation Requirements for Licensed Mental Health Practitioners - Licensed Certified Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPC) and Psychologist / 7-1-05
In order to ensure quality and continuity of care, all mental health providers approved to receive Medicaid reimbursement for services provided to the under age 21 Medicaid population must meet specific qualifications for their services and staff.
Licensed Mental Health Practitioner providers must meet the Provider Participation and enrollment requirements contained within Section 140.000 of this manual as well as the following criteria to be eligible to participate in the Arkansas Medicaid Program:
A.For the LCSW, LMFT and LPC, a copy of the certification letter from the Division of Behavioral Health Services (DBHS) must accompany the provider application. Any changes or subsequent certifications must be furnished to Arkansas Medicaid when received. See Sections 201.100 through 201.130 for the DBHS certification requirements.
B.Providers of Licensed Mental Health Practitioner services have the option of enrolling in the Title XVIII (Medicare) Program.
Providers who have agreements with Medicaid to provide other services to Medicaid beneficiaries must submit a separate provider application and Medicaid contract to provide Licensed Mental Health Practitioner services. A separate provider number is assigned.
An LCSW may not be enrolled in both the Targeted Case Management (TCM) and the Licensed Mental Health Practitioner Medicaid Programs. He or she must choose the program in which he or she wishes to enroll.
201.100Certification Requirements for LCSW, LMFT and LPC Providers / 10-13-03Providers of LCSW, LMFT and LPC services must be certified by the Division of Behavioral Health Services (DBHS) in order to be eligible to participate in the Arkansas Medicaid Program. All Licensed Certified Social Workers, Licensed Marriage and Family Therapists and Licensed Professional Counselors must meet the following requirements for certification:
A.The provider must complete all necessary forms required by the Arkansas Medicaid Program for application for provider status.
B.In order to be approved as a provider of outpatient mental and behavioral health services, a provider must meet the following criteria.
1.The provider must submit his or her plan to provide:
a.MEDICATION MANAGEMENT - The LCSW, LMFT and LPC must provide proof of an affiliation agreement with a physician and/or psychiatrist who will provide prescription and management of any necessary psychotropic medications to adequately treat the diagnosis and symptoms of the Medicaid beneficiary.
b.PHYSICIAN BACK-UP - LCSW, LMFT and LPC providers must have physician back up for referral and consultation, as necessary. The provider's plan must include provisions for the Medicaid beneficiary to see a physician face-to-face within a specified time when mental health symptoms indicate potential benefit of medication to treat and/or stabilize symptoms.
c.24-HOUR AVAILABILITY - LCSW, LMFT and LPC providers must have an easily accessible system of mental health care seven days a week, 24-hours a day in order to assure Medicaid beneficiaries will receive adequate crisis services, if needed. The provider must be able to provide proof of a relationship with an entity capable of providing such crisis services and services that require a more intensive level of care and/or intervention (such as a hospital, community mental health center, etc.)
d.COLLABORATION - LCSW, LMFT and LPC providers will collaborate with other agencies and/or institutions involved in the beneficiary’s care to ensure continuity and quality of service delivery.
2.Services must be provided by a licensed, certified mental health professional, which by virtue of his or her licensure may practice independently and without supervision.
3.Documentation of services rendered must meet the requirements defined by Arkansas Medicaid guidelines.
4.The LCSW, LMFT and LPC provider must meet all certification requirements as established by the Division of Behavioral Health Services for each level of care and/or type of service they are applying to provide to the child/adolescent population. To request certification, Form DMS-633 - Mental Health Services Provider Qualification Form for LCSW, LMFT and LPC must be submitted to DBHS. View or print form DMS-633.
201.110Licensed Certified Social Workers (LCSW) / 10-13-03In order to receive certification from DBHS, an LCSW must meet the requirements outlined in Section 201.100 as well as the following:
A.The LCSW must have a master's degree in social work from a graduate school of social work accredited by the Council on Social Work Education (CSWE).
B.The LCSW must be state licensed and certified to practice as a licensed certified social worker (LCSW) in the State of Arkansas and in good standing with the Arkansas Social Work Licensing Board.
C.The LCSW must provide proof of two years’ post-licensure experience treating children and adolescents with mental illness.
D.The LCSW must possess professional liability coverage at a minimum level of $1,000,000.00 per episode and $1,000,000.00 aggregate. He or she must be able to provide proof of such coverage, with the applicant named on the policy as the insured.
E.The LCSW must be accessible 24 hours a day, seven days a week either directly or through a back-up plan approved by the Division of Behavioral Health Services at the time the provider enrollment application is submitted.
201.120Licensed Marriage and Family Therapist (LMFT) / 10-13-03In order to receive certification from DBHS, an LMFT must meet the requirements outlined in Section 201.100 as well as the following:
A.The LMFT must possess a master's degree in mental health counseling from an accredited college or university.
B.The LMFT must be licensed as a licensed marriage and family therapist and in good standing with the Arkansas Board of Examiners in Counseling.
C.The LMFT must meet all licensure requirements as held forth in Arkansas Law, Act 244 of 1997 for Licensed Professional Counselors (LPC) and Licensed Marriage and Family Therapists (LMFT).
D.The LMFT must provide proof of two years’ post-licensure experience treating children and adolescents with mental illness.
E.The LMFT must possess professional liability coverage at a minimum level of $1,000,000.00 per episode and $1,000,000.00 aggregate. He or she must be able to provide proof of such coverage, with the applicant named on the policy as the insured.
F.The LMFT must be accessible 24 hours a day, seven days a week either directly or through a back-up plan approved by the Division of Behavioral Health Services at the time the provider enrollment application is submitted.
201.130Licensed Professional Counselors (LPC) / 10-13-03In order to receive certification from DBHS, an LPC must meet the requirements outlined in Section 201.100 as well as the following:
A.The LPC must possess a master's degree in mental health counseling from an accredited college or university.
B.The LPC must be licensed as a licensed professional counselor and be in good standing with the Arkansas Board of Examiners in Counseling.
C.The LPC must meet all licensure requirements as held forth in Arkansas Law, Act 244 of 1997 for Licensed Professional Counselors (LPC) and Licensed Marriage and Family Therapists (LMFT).
D.The LPC must provide proof of two years’ post-licensure experience treating children and adolescents with mental illness.
E.The LPC must possess professional liability coverage at a minimum level of $1,000,000.00 per episode and $1,000,000.00 aggregate. He or she must be able to provide proof of such coverage, with the applicant named on the policy as the insured.
F.The LPC must be accessible 24 hours a day, seven days a week either directly or through a back-up plan approved by the Division of Behavioral Health Services at the time the provider enrollment application is submitted.
202.000Group Providers of Licensed Mental Health Practitioner Services / 10-13-03Group providers of Licensed Mental Health Practitioner services must meet the following criteria in order to be eligible for participation in the Arkansas Medicaid Program.
If a licensed mental health practitioner is a member of a group, each individual licensed mental health practitioner and the group must both enroll according to the following criteria:
A.Each individual licensed mental health practitioner within the group must enroll following the criteria established in Sections 201.000 through 204.000.
B.All group providers are “pay to” providers only. The service must be performed and billed by a Medicaid-enrolled licensed mental health practitioner within the group.
203.000Psychologists Practicing in Arkansas and Bordering States / 10-13-03Psychologists in Arkansas and the bordering states of Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas will be enrolled as routine services providers.
203.100Routine Services Provider - Psychologists / 10-13-03A.The provider will be enrolled in the program as a regular provider of routine services.
B.Reimbursement will be available for all LCSW, LMFT, LPC and Psychologist services covered in the Arkansas Medicaid Program.
C.Claims will be filed according to Section 260.000 of this manual.
203.200Non-Bordering States - Psychologists / 10-13-03Psychologists in non-bordering states may be enrolled only as limited-service providers.
203.300Limited Service Providers - Psychologists / 3-1-11Out-of-state psychologists may be enrolled in the Arkansas Medicaid program to provide emergency services or non-emergency services not available in Arkansas that are medically necessary and prior-authorized.
A.Non-emergency services not available in Arkansas that are medically necessary must be prior authorized. Each request for these services must be made in writing, forwarded to the Utilization Review Section and approved before the service is provided. View or print the Utilization Review Section contact information. An Arkansas Medicaid application and contract must be downloaded from the Arkansas Medicaid website and submitted to Arkansas Medicaid Provider Enrollment. A provider number will be assigned upon approval of the provider application and the Medicaid contract. View or print the provider enrollment and contract package (Application Packet). View or print Provider Enrollment Unit contact information.
B.“Emergency services” are defined as inpatient or outpatient hospital services that a prudent layperson with an average knowledge of health and medicine would reasonably believe are necessary to prevent death or serious impairment of health and which, because of the danger to life or health, require use of the most accessible hospital available and equipped to furnish those services.
Source: 42 U.S. Code of Federal Regulations §422.2 and §424.101.
Limited services provider claims will be manually reviewed prior to processing to ensure that only emergency or prior-authorized services are approved for payment. These claims should be mailed to the Division of Behavioral Health Services. View or print the Division of Behavioral Health Services contact information.
204.000LCSW, LMFT and LPC Participating in Arkansas and Bordering States / 9-1-14LCSW, LMFT and LPC providers must be located within the State of Arkansas. They will be enrolled as routine services providers.
A.The LCSW, LMFT and LPC must be enrolled in the program as a regular provider of routine services.
B.Reimbursement will be available for all LCSW, LMFT and LPC services covered in the Arkansas Medicaid Program.
C.Claims will be filed according to Section 260.000 of this manual. This includes ICD and HCPCS codes for all services rendered.
205.000The Psychologist’s Role in the Child Health Services (EPSDT) Program / 1-15-11The Arkansas Medical Assistance Program includes a Child Health Services (EPSDT) Program for eligible individuals under 21 years of age. The purpose of this program is to detect and treat health problems in their early stages and to provide well-child health care such as immunizations.
Child Health Services (EPSDT) providers must refer to the Child Health Services (EPSDT) manual for additional information.
Psychologists interested in the Child Health Services (EPSDT) Program should contact the Child Health Services Office. View or print the Child Health Services Office contact information.
Psychologists may bill Child Health Services (EPSDT) on the CMS-1500 claim using the proper Child Health Services (EPSDT) provider manual. See the EPSDT provider manual for information regarding EPSDT screenings. Ancillary charges, such as lab and X-ray, associated with Child Health Services (EPSDT) should be listed in the patient record. Providers may bill electronically for Child Health Services (EPSDT). View or print form CMS-1500.
210.000PROGRAM COVERAGE211.000Introduction / 7-1-17
Medicaid (Arkansas Medical Assistance Program) is designed to assist eligible Medicaid beneficiaries in obtaining medical care within the guidelines specified in Section I of this manual. Reimbursement will be made for allowed services rendered by a Medicaid enrolled provider within the Medicaid Program limitations as outlined in Section II of this manual.
The transition process to eliminate the Rehabilitative Services for Persons with Mental Illness (RSPMI) Program, Licensed Mental Health Practitioner (LMHP) Program and the Substance Abuse Treatment Services (SATS) Program is contingent upon the approval of the implementation of the Outpatient Behavioral Health Services Program. Clients currently served by the RSPMI, LMHP and SATS programs will begin transitioning to the Outpatient Behavioral Health Program starting July 1, 2017. RSPMI, LMHP and SATS will cease to exist on June 30, 2018 and no Arkansas Medicaid payments will occur to any RSPMI, LMHP or SATS provider for services provided after June 30, 2018.
211.100Non-Refusal Requirement / 10-13-03The licensed mental health practitioner may not refuse services to a Medicaid-eligible beneficiary under age 21 unless, based upon the primary mental health diagnosis, the provider does not possess the services or program to adequately treat the beneficiary’s mental health needs.
211.200Primary Care Physician (PCP) Referral / 7-1-05A primary care physician (PCP) referral is required for each Medicaid beneficiary under age 21 for outpatient mental health services. See Section 180.000 of this manual for the PCP procedures. A PCP referral is generally obtained prior to providing service to Medicaid eligible children. However, a PCP is given the option of providing a referral after a service is provided. If a PCP chooses to make a referral after a service has been provided, the referral must be received by the LMHP provider no later 45 calendar days after the date of service. The PCP has no obligation to give a retroactive referral.
The LMHP provider may not file a claim and will not be reimbursed for any services provided that require a PCP referral unless the referral is received.
211.210When the Child is Ineligible for Medicaid at Time of Service / 10-13-03A.When a child who is not eligible for Medicaid receives an outpatient mental health service, an application for Medicaid eligibility may be filed by the child or his or her representative.
B.If the application for Medicaid coverage is approved, a PCP referral is not required for the period prior to the Medicaid authorization date. This period is considered retroactive eligibility and does not require a referral.
C.A PCP referral is required no later than five (5) calendar days after the authorization date. If the PCP referral is not obtained within five (5) calendar days of the Medicaid authorization date, reimbursement will begin, if all other requirements are met, the date the PCP referral is received. To verify the authorization date, a provider may call the fiscal agent telephone number in this notice or call the local DHS Office.
211.220Renewal of PCP Referral / 10-13-03If a beneficiary continues to require outpatient mental health services for 6 months or more, the PCP referral must be renewed every 6 months.
212.000Scope / 10-13-03The program for Licensed Mental Health Practitioner – licensed certified social worker (LCSW), licensed marriage and family therapist (LMFT), licensed professional counselor (LPC) and Psychologist consists of a range of mental health diagnostic, therapeutic, rehabilitative or palliative services provided by a duly licensed LCSW, LMFT, LPC or Psychologist to Medicaid-eligible beneficiaries under age 21 suffering from psychiatric conditions as described in the American Psychiatric Association Diagnostic and Statistical Manual (DSM-IV) and subsequent revisions.
Medicaid covered Licensed Mental Health Practitioner services may be provided only when:
A.Referred, by a Medicaid-enrolled physician, in writing or orally. The referral must be renewed every six (6) months. The written referral or documentation of the oral referral must include:
1.The name of the referring Medicaid-enrolled physician,
2.The referring Medicaid-enrolled physician’s Medicaid identification number and
3.The date of the referral.
B.Provided to Medicaid beneficiaries under age 21;
C.Provided to outpatients;
D.Provided by a licensed mental health practitioner – LCSW, LMFT, LPC or psychologist;
E.When applicable, provided by a psychologist according to an Individualized Education Plan (IEP) and
F.Included in a treatment plan.
212.100Treatment Plan Requirements / 10-13-03An individualized, written treatment plan must be developed for each beneficiary receiving mental health services and included in the patient record. The treatment plan must be updated no less than every 90 days.