Changes for Master’s-Level Psychotherapists

1 Update December 2010. No. 2010-114. Affected Programs: BadgerCare Plus Standard Plan, BadgerCare Plus Benchmark Plan, Medicaid To: Advanced Practice Nurse Prescribers, HealthCheck Other Services Providers, Intensive In-Home mental health and Substance Abuse Services for Children Providers, master 's Level Psychotherapists , Nurse Practitioners, Outpatient mental health Clinics, Outpatient Substance Abuse Clinics, Physician Clinics, Physicians, Psychiatrists, Psychologists, Substance Abuse Counselors, HMOs and Other Managed Care Programs Changes for master 's-Level Psychotherapists As a result of the 2009 Wisconsin Act 28 (the Budget allowed to render and submit claims to Medicaid Act), beginning in January 2011, the following types of independently for mental health services provided Medicaid-certified licensed mental health professionals outside a Medicaid-certified outpatient mental health will be allowed to render and bill for mental health clinic.

2 Services provided outside a Medicaid-certified clinic: Licensed clinical social workers. Licensed clinical social workers. Licensed professional counselors. Licensed professional counselors. Licensed marriage/family therapists. Licensed marriage/family therapists. In addition, Wisconsin Medicaid has established a new Licensed clinical social workers, licensed professional mental health and substance abuse specialty, which will counselors, and licensed marriage/family therapists who allow master 's-level Psychotherapists with a substance may render and submit claims independently for services abuse certification to be certified as such. Only will now be referred to as licensed Psychotherapists by Psychotherapists with a substance abuse specialty Wisconsin Medicaid. certified by the Wisconsin Department of Regulation and Licensing will be allowed to be reimbursed for both outpatient mental health services and outpatient All licensed Psychotherapists are required to be licensed substance abuse services.

3 By the Wisconsin Department of Regulation and Licensing (DRL). Any licensed psychotherapist who Overview wishes to render and submit claims for substance abuse For Medicaid reimbursement prior to January 2011, all services must also be Wisconsin DRL certified as a master 's-level Psychotherapists were required to work in substance abuse counselor or have a substance abuse a Medicaid-certified mental health clinic and were not specialty attached to his or her psychotherapist license. allowed to bill Medicaid independently. As a result of the 2009 Wisconsin Act 28 (the Budget Act), master 's- Licensed Psychotherapists who work in Medicaid- level Psychotherapists will be split into two groups: certified outpatient mental health clinics must continue licensed and certified. to follow the policies and procedures for those clinics. Licensed Psychotherapists Certified Psychotherapists Beginning in January 2011, the following types of For Medicaid reimbursement, the following mental Medicaid-certified, licensed Psychotherapists will be health professionals will continue to be certified as Department of health Services rendering-only providers and must continue to practice This new specialty is referred to as a licensed within a Medicaid-certified outpatient mental health psychotherapist with SAC or certified psychotherapist clinic: with SAC in the mental health and substance abuse Certified advanced practice social workers.

4 Certification materials. Certified independent social workers. Registered nurses (RNs) with a master 's degree in Licensed Psychotherapists with Substance psychiatric- mental health nursing or community Abuse Certification mental health nursing. Licensed Psychotherapists with SAC will be able to Other mental health practitioners, as defined by render and submit claims to Medicaid for outpatient DHS (10), Wis. Admin. Code. mental health services and/or outpatient substance abuse services in their private practice. Licensed Note: All three of the above provider types must have Psychotherapists with SAC may also render services in 3,000 hours of post- master 's supervised clinical an outpatient mental health and/or outpatient substance experience and must have an individual provider status abuse services clinic. Services rendered in an outpatient approval letter issued by the Department of health mental health and/or outpatient substance abuse clinic Services (DHS) Division of Quality Assurance (DQA) must be billed by the clinic.

5 Verifying that this requirement is met. Certified Psychotherapists with Substance The clinic is responsible for billing for all services Abuse Certification rendered by these providers. Policies and procedures for Certified Psychotherapists with SAC will be able to certified Psychotherapists and other treatment render both outpatient mental health services and professionals have not changed. outpatient substance abuse services in a Medicaid- certified outpatient mental health and/or outpatient Certified advanced practice social workers, certified substance abuse clinic. independent social workers, RNs with a master 's degree in psychiatric- mental health nursing or community Border Status Providers mental health nursing, and other mental health A provider whose practice address is in one of the states practitioners who can render services only will now be that border Wisconsin is considered a border-status referred to as certified Psychotherapists by Wisconsin provider.

6 For a licensed psychotherapist to be eligible as Medicaid. a border-status provider with Wisconsin Medicaid, the provider is required to hold a current Wisconsin DRL. New mental health and Substance Abuse license that permits the provision of psychotherapy and Specialty for master 's-Level applicable credentials to practice psychotherapy in the Psychotherapists with a Substance Abuse border state. For a licensed psychotherapist or licensed Certification psychotherapist with SAC to be eligible as a border- Wisconsin Medicaid has established a new mental health status provider with Wisconsin Medicaid, the provider is and substance abuse provider specialty, which will allow required to hold a current Wisconsin DRL license that master 's-level Psychotherapists with a Wisconsin DRL permits the practice of psychotherapy, a Wisconsin SAC. substance abuse certification (SAC) to be reimbursed for certification, and applicable credentials to provide both outpatient mental health services and outpatient psychotherapy and substance use treatment services from substance abuse services.

7 The border state. For Wisconsin, the SAC can be ForwardHealth Provider Information December 2010 No. 2010-114 2. attached to the DRL psychotherapist license or be a Notice contains identifying information about the separate license from Wisconsin DRL. provider who is required to complete recertification, the recertification deadline, and the application For a certified psychotherapist or a certified tracking number (ATN) assigned to the provider. psychotherapist with SAC to be eligible as a border- The ATN is used when logging in to the status provider with Wisconsin Medicaid, the provider is ForwardHealth Portal to complete recertification required to have a provider status approval letter issued and also serves as the tracking number when by the Wisconsin DHS DQA, a DRL certification as a checking the status of the provider's recertification. substance abuse counselor, and applicable credentials The personal identification number (PIN) letter.

8 From the border state in which he or she is rendering Providers will receive this notice a few days after the services for psychotherapy and substance abuse. Provider Recertification Notice. The PIN letter will contain a recertification PIN and instructions on Wisconsin Medicaid Will Recertify All logging in to the ForwardHealth Portal to complete master 's-Level Psychotherapists recertification. As a result of 2009 Wisconsin Act 28, all master 's-level Psychotherapists will need to be recertified beginning in The letters are sent to the mailing address on file with January 2011. This recertification will allow providers to Wisconsin Medicaid. Providers should read these letters update their information and provider specialty with carefully and keep them for reference. The letters Wisconsin Medicaid. contain information necessary to log in to the secure Recertification area of the ForwardHealth Portal to Providers who were newly certified by Wisconsin complete recertification.

9 If a provider needs to replace Medicaid prior to the recertification in January 2011 will one of the letters, the recertification process will be also be required to recertify. delayed. To maintain Wisconsin Medicaid certification, providers Logging in to the Secure Recertification are required to recertify online via the ForwardHealth Area of the ForwardHealth Portal Portal. For many providers, recertification is approved Once a provider has received the Provider immediately upon completion of the ForwardHealth Recertification Notice and PIN letter, the provider may Portal recertification process. log in to the Recertification area of the Portal at to begin the recertification Providers can prepare for the recertification by process. reviewing Attachment 1 of this ForwardHealth Update, which lists information that must be supplied or verified The Recertification area of the Portal is not part of a during the recertification process.

10 Secure Provider Portal account. Providers do not need a secure Provider Portal account to participate in Notification Letters Required for recertification via the Portal. Providers are not able to Recertification access the Recertification area of the Portal by logging in Providers undergoing recertification will receive two to a Provider Portal account; providers are required to important letters in the mail from ForwardHealth in use the ATN from the Provider Recertification Notice January: and the PIN from the PIN letter to log in to the The Provider Recertification Notice. This is the first Recertification area of the Portal. notice to providers. The Provider Recertification ForwardHealth Provider Information December 2010 No. 2010-114 3. Completing Recertification on the Date of Approval ForwardHealth Portal Reimbursement for services under a new provider The Portal will guide providers through the specialty will not occur until recertification for the new recertification process.