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Outpatient Behavioral Health
Services (OBH)-General
Information
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• Beneficiaries currently served by the RSPMI, LMHP, and SATS programs will
begin transitioning to the Outpatient Behavioral Health Program starting on 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 a service
provided after June 30, 2018.
• Current providers have to transition as an agency to OBH before providing any
new OBH/Tier services. Current LMHP and SATS providers will have to obtain
certification to provide OBH services as Independently Licensed Practitioners.
• Please note-as providers remain RSPMI/LMHP/SATS they will continue to meet
these requirements until fully transitioned. (MTP, TPR timeframes, etc)
General Information
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• Outpatient Behavioral Health Services Program- treatment and
services by a certified Behavioral Health Services provider to
Medicaid-eligible beneficiaries that have a Behavioral Health
diagnosis as described in the American Psychiatric Association
Diagnostic and Statistical Manual (DSM-IV and subsequent
revisions).
• Eligibility for services-depends on the needs of the beneficiary
• Counseling Level Services and Crisis Services can be provided to any
beneficiary as long as the services are medically necessary.
• Rehabilitative Level Services and Intensive Level Services eligibility is
based upon the results of an Independent Assessment performed by an
independent entity.
Scope and Eligibility of Services
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COUNSELING LEVEL SERVICES (Tier 1)• Time-limited behavioral health services provided by qualified licensed
practitioners
• Counseling Services settings are: a behavioral health clinic/office, healthcare
center, physician office, and/or school
• Can be provided to any beneficiary as long as medical necessity is
established
REHABILITATIVE LEVEL SERVICES (Tier 2)• Home and community based behavioral health services with care
coordination for the purpose of treating mental health and/or substance abuse
conditions
• Services shall be rendered and coordinated through a team based approach.
• A standardized Independent Assessment to determine eligibility and a
Treatment Plan is required
• Rehabilitative Level Services home and community based settings shall
include: beneficiary’s home, community, behavioral health clinic/ office,
healthcare center, physician office, and/ or school
New Levels of Service
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INTENSIVE LEVEL SERVICES (Tier 3)• The most intensive behavioral health services for the purpose of treating
mental health and/or substance abuse conditions
• Services shall be rendered and coordinated through a team based approach
• Eligibility for Intensive Level services will be determined by additional criteria
and questions on the Independent Assessment based upon the results from
the Independent Assessment to determine eligibility for Intensive Level
Services
• This level of care will be based upon a referral from a Behavioral Health
Agency that is providing Rehabilitative Services to a beneficiary or the
Independent Care Coordination entity
• Residential treatment services are available—if deemed medically
necessary and eligibility is determined by way of the additional criteria and
questions on the standardized Independent Assessment
New Levels of Service
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• Current RSPMI providers will be “grandfathered” in to
Outpatient Behavioral Health certification
• Current LMHP and SATS providers will have to complete the
application/certification process for OBH
• The following services will require specialty certification to
provide:
• Dyadic Treatment
• Therapeutic Communities
• Acute Crisis Units
• Partial Hospitalization
Certifications
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New Certification requirements and forms effective July 1, 2017
• The Department of Human Services Division of Provider Services and Quality
Assurance will be responsible for certification of Medicaid Behavioral Health
Providers.
• Primary contacts for this Division:
Stephenie Blocker ([email protected])
Donna Hicks ([email protected])
• Applications for Behavioral Health Certification should continue to be sent to the
following:
Division of Behavioral Health Services Certification and Policy
305 South Palm Street, Little Rock, AR 72205
to the attention of Rachael Veregge
or via e-mail to [email protected]
• DBHS will continue to coordinate with this new Division to make this transition as
smooth as possible.
Certification
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PROVIDER TYPE LICENSES STATE CERTIFICATION REQUIRED SUPERVISION
Certified Peer Support
Specialist
N/A Yes, to provide services within a certified behavioral
health agency
Required
Certified Youth Support
Specialist
N/A Yes, to provide services within a certified behavioral
health agency
Required
Certified Family Support
Partner
N/A Yes, to provide services within a certified behavioral
health agency
Required
Qualified Behavioral Health
Provider – non-degreed
N/A Yes, to provide services within a certified behavioral
health agency
Required
Qualified Behavioral Health
Provider – Bachelors
N/A Yes, to provide services within a certified behavioral
health agency
Required
Independently Licensed
Clinicians –
Master’s/Doctoral
Licensed Clinical Social Worker (LCSW)
Licensed Marital and Family Therapist (LMFT)
Licensed Psychologist (LP)
Licensed Psychological Examiner – Independent
(LPEI)
Licensed Professional Counselor (LPC)
Yes, must be certified to provide services Not Required
Independently Licensed
Clinicians –
Parent/Caregiver & Child
(Dyadic treatment of
Children age 0-47 months &
Parent/Caregiver) Provider
Licensed Clinical Social Worker (LCSW)
Licensed Marital and Family Therapist (LMFT)
Licensed Psychologist (LP)
Licensed Psychological Examiner – Independent
(LPEI)
Licensed Professional Counselor (LPC)
Yes, must be certified to provide services Not Required
Staffing Requirements
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Independently Licensed
Clinicians –
Parent/Caregiver & Child
(Dyadic treatment of
Children age 0-47 months &
Parent/Caregiver) Provider
Licensed Clinical Social Worker (LCSW)
Licensed Marital and Family Therapist (LMFT)
Licensed Psychologist (LP)
Licensed Psychological Examiner – Independent
(LPEI)
Licensed Professional Counselor (LPC)
Yes, must be certified to provide
services
Not Required
Non-independently
Licensed Clinicians –
Master’s/Doctoral
Licensed Master Social Worker (LMSW)
Licensed Associate Counselor (LAC)
Licensed Psychological Examiner (LPE)
Provisionally Licensed Psychologist (PLP)
Yes, must be supervised by appropriate
Independently Licensed Clinician
Required
Non-independently
Licensed Clinicians –
Parent/Caregiver & Child
(Dyadic treatment of
Children age 0-47 months &
Parent/Caregiver) Provider
Licensed Master Social Worker (LMSW)
Licensed Associate Counselor (LAC)
Licensed Psychological Examiner (LPE)
Provisionally Licensed Psychologist (PLP)
Yes, must be supervised by appropriate
Independently Licensed Clinician and
must be certified to provide services
Required
Registered Nurse Registered Nurse (RN) No, must be a part of a certified agency Required
Advanced Practice Nurse
(APN)
Adult Psychiatric Mental Health Clinical Nurse
Specialist
Child Psychiatric Mental Health Clinical Nurse
Specialist
Adult Psychiatric Mental Health APN
Family Psychiatric Mental Health APN
No, must be part of a certified agency or
have a Collaborative Agreement with a
Physician
Collaborative Agreement
with Physician Required
Physician Doctor of Medicine (MD)
Doctor of Osteopathic Medicine (DO)
No, must provide proof of licensure Not Required
Staffing Requirements Continued
Outpatient Behavioral Health
Services (OBH)-Access and
Eligibility
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Eligibility depends on the needs of the beneficiary.
Counseling Level Services and Crisis Services:
Can be provided to any beneficiary as long as the
services are medically necessary.
Rehabilitative Level Services:
Eligibility will be based on the results of an Independent
Assessment performed by an independent entity.
Intensive Level Services:
Eligibility will be based on the results of an Independent
Assessment performed by an independent entity.
Eligibility
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Providers certified and eligible to provide Counseling Level
Services must have relationships with a physician licensed in
Arkansas in order to ensure psychiatric and medical conditions
are monitored and addressed by appropriate physician oversight.
Medical Supervision responsibility shall include, but is not limited
to, the following:
A beneficiary can receive three (3) Counseling Level Services before
a PCP/PCMH referral is necessary in the medical record (see
Section 217.100).
Medical responsibility will be vested in a physician licensed in
Arkansas who signs the PCP referral or PCMH approval for
Counseling Level Services of the Outpatient Behavioral Health
Services program.
Physician’s Role-Tier 1 Services
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Certified Behavioral Health Agencies which provide Tier 2 and
Tier 3 services are required to have relationships with a board
certified or board eligible psychiatrist who provides appropriate
supervision and oversight for all medical and treatment
services for beneficiaries with behavioral health needs.
A physician will supervise and coordinate all psychiatric and
medical functions as indicated in the Treatment Plan that is
required for beneficiaries receiving Rehabilitative Level
Services or Intensive Level Services
Medical responsibility shall be vested in a physician licensed in
Arkansas that signs the Treatment Plan of the beneficiary.
Physician’s Role-Tier 2 and Tier 3 Services
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• PCP referral is not required due to the Independent
Assessment and care coordination that will occur upon
transition. The Independent Assessment will determine
eligibility.
Primary Care Physician (PCP) Referral Tier 2 & Tier 3
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• A standardized Independent Assessment will determine eligibility for Rehabilitative
Level Services and Intensive Level Services (Tier 2 and Tier 3)
Transition Year
2017-2018
DHS will identify “blocks” of beneficiaries to be referred for an Independent Assessments
each month during this transition year.
Starting November 2017, approximately 4000 beneficiaries per month will be referred by
DHS to Optum to be assessed. (September and October will have smaller samples sent to
Optum)
Criteria for Presumptive Eligibility and Priority Populations for an Independent Assessment
will go into effect after the transitional year. (Excluding requests for Residential admissions
and the adult 911 populations)
Independent Assessments
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Beneficiaries referred for Residential treatment will be a Priority Population
effective October 1, 2017.
During this transition year:
1) Providers will continue to submit requests to Beacon for Residential
admissions.
2) When the beneficiary is currently in the home/community setting –
a) Beacon will place these requests for Residential admission on
hold and refer the beneficiary for an Independent Assessment.
b) Once the assessment has been completed the results will be
provided to Beacon.
c) Beacon physician will make CON determination on information
submitted as well as results of the Independent Assessment for
authorization.
Residential Admissions – U21
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3) When the beneficiary is currently in an Acute Hospital setting –
a) Beacon physician will review these requests for Residential
admission based on information provided. Beacon will make a
CON determination based on information provided.
b) If approved, Beacon will issue an authorization up to 14 days for
Residential Treatment.
c) Beneficiary will be referred for an Independent Assessment upon
receipt of request for admission.
d) Once assessment is completed, Beacon will be notified of the
results of the Independent Assessment.
e) Provider will submit a continuing stay request to Beacon at the
end of the initial authorization. Beacon will review the results of
the Independent Assessment as well as clinical documentation
provided to make a medical necessity determination for
continued stay in the facility.
Residential Admissions – U21 (cont.)
Outpatient Behavioral Health
Services (OBH)-Service Array
and PA/EOB
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Tier 1Clinic-Based
Individual behavioral health
counseling
Group behavioral health counseling
Marital/family behavioral health
counseling (Including Dyadic
Treatment for 0-47 mos)
Multi-family behavioral health
counseling
Psychoeducation
Mental health diagnosis
Interpretation of diagnosis
Substance abuse assessment
Psychological evaluation
Psychiatric assessment
Pharmacologic management
Tier Services
Tier 2
Home/Community-Based
▪ Master treatment plan
▪ Crisis stabilization intervention
▪ Home and community individual
psychotherapy
▪ Community group psychotherapy
▪ Home and community marital/family
psychotherapy
▪ Home and community family
psychoeducation
▪ Individual and group pharm
counseling by RN
▪ Partial hospitalization
▪ Peer support
▪ Family support partners
▪ Behavioral assistance
▪ Intensive outpatient substance abuse
treatment
▪ Adult rehabilitative day service
▪ Individual and group life skills
development
Child and youth support services
Clinic/Home/Community-Based
▪ Psychiatric diagnostic assessment
Tier 3
Home/Community-Based
▪ Therapeutic Communities
Residential
▪ Residential treatment unit and center
Independent Assessment to determine eligibility for:
Crisis Services Available to all Tiers
• Crisis Intervention
• Acute Psychiatric Hospitalization
• Acute Crisis Units
• Substance Abuse Detoxification
new services in red
existing services in blue
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• Beneficiaries receiving only Counseling Level Services do not
require a Treatment Plan
• The provider documents the medical necessity of Counseling
Level Services.
Documentation of medical necessity must:
• be made a part of the beneficiary’s medical record and
• be a written assessment that evaluates the beneficiary’s mental
condition and based on the beneficiary’s diagnosis, determines
whether treatment in the Outpatient Behavioral Health Services
Program is appropriate
Treatment Planning for Tier 1 Services
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• A Treatment Plan is required for beneficiaries who are determined
to be qualified for Tier 2 and Tier 3 services through the
standardized Independent Assessment.
• The Treatment Plan should build upon the information from any
Behavioral Health provider and information obtained during the
standardized Independent Assessment.
Periodic Review of the Master Treatment Plan:
• For all beneficiaries assessed to be qualified for and receiving Tier
2 or Tier 3 services the Treatment Plan must be periodically
reviewed at least every 180 calendar days
Treatment Planning for Tier 2 and Tier 3 Services
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• The Psychiatric Assessment is not required for beneficiaries
receiving only Counseling Level Services in the Outpatient
Behavioral Health Services program.
• The Psychiatric Assessment is required for beneficiaries
receiving Rehabilitative Level Services or Therapeutic
Communities in Intensive Level Services.
Psychiatric Assessment
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• Mental Health Paraprofessionals are Qualified Behavioral
Health Provider (QBHP) under OBH system
• Allowable services for QBHPs (Tier 2):
• Crisis Stabilization Intervention
• Behavioral Assistance (for children and youth)
• Adult Rehab Day
• Individual Life Skills Development (transitional youth age 16-20)
• Group Life Skills Development (age 16-20)
• Child and Youth Support Services
• Supportive Employment (adults)
• Supportive Housing (adults)
• Adult Life Skills Development
MHPP/QBHP
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MHPP Services under RSPMI:
Intervention, MHPP
Collateral Intervention, MHPP
Crisis Stabilization Intervention, MHPP
Rehabilitative Day Services
QBHP Services under Outpatient Behavioral Health (OBH):
Crisis Stabilization Intervention Supportive Employment
Behavioral Assistance Supportive Housing
Individual Life Skills Development Adult Life Skills Development
Group Life Skills Development Adult Rehab Day
Child and Youth Support Services
*new services only allowable once an agency transitions to OBH system
Allowable QBHP Services
Outpatient Behavioral Health
Services (OBH)-Next Steps
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On July 1, 2017, the new Reintegration Management
program began:
• The Reintegration Management Team will contact
guardians and providers to assist with navigating the
behavioral health system with a focus on the discharge
planning process while completing inpatient review
requests
• Discharge planning and community reintegration are the
focus
Introducing Reintegration Management
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• Prior Authorization process will remain the same for those
continuing to provide RSPMI services
• 3 months authorizations in conjunction with Master Treatment Plan and
Periodic Review
• All RSPMI regulations still expected to be followed
• Inspections of Care and Retrospective Reviews will continue as well
• RSPMI/LMHP authorizations will no longer be available after June
30, 2018
Prior Authorization Process-RSPMI
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• As Providers transition to OBH services, prior authorization will continue
to be required. All new Tier level services are now available in
ProviderConnect
• Upon transition to OBH, authorizations will be reviewed for 6 month time frames.
• Treatment Planning documents will be required for authorization of Tier 2 and Tier 3
services
• Extension of Benefit is available for Tier 1 services
• Services will be authorized based on applicable certifications
• For example, Therapeutic Communities can only be requested by providers certified to
provide this service
• Requests for services should only be for the Tier Level services for which the beneficiary
has been deemed appropriate. Beacon will receive notification from the Independent
Assessor of Tier determination
Prior Authorization Process-OBH
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Clinical Services:
Melissa Ortega, Interim Vice President
Jennifer Brezee, Clinical Services Manager
Medical Director:
Dr. Nichole Bauknight, Medical Director
Dr. Kelly Hair, Associate Medical Director
Beacon Contact Information
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Beacon Contact Information
Provider Relations and Training Opportunities:
Kerri Brazzel, Project Director
Shelly Rhodes, Provider Relations Manager
Reintegration Management:
Jamie Ables, Clinical Services Manager
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Thank you
