Crisis Intervention Services - Wisconsin

1 Department of Health and Family ServicesJuly 2006 ! No. 2006-55To : Crisis InterventionProvidersHMOs and OtherManaged CareProgramsCrisis Intervention ServicesThis Wisconsin Medicaid and BadgerCareUpdate consolidates all of theinformation for Crisis interventionservices. Providers should use thisUpdate in conjunction with the GeneralInformation section of the Mental Healthand Substance Abuse ServicesHandbook and the purpose of this Wisconsin Medicaid andBadgerCare Update is to consolidate all of theinformation for Crisis Intervention Services . ThisUpdate replaces the following crisisintervention Services publications: The October 2005 Update (2005-63), titled Rate Changes for Services ReceivingOnly Federal Funds. The March 2004 Update (2004-11), titled Billing policy change for Crisis interventionservices provided to recipients enrolled inthe Independent Care Health Plan andMedicaid-contracted HMOs.

2 The August 2003 Update (2003-82), titled Changes to local codes and paper claimsfor Crisis Intervention Services as a result ofHIPAA. The September 2000 Update (2000-40),titled Change to Crisis Intervention coveredservices. Part H, Division VI, the Mental HealthCrisis Intervention Services for Crisis StabilizationServicesWisconsin Medicaid is introducing guidelines forstabilization Services effective upon receipt ofthis guidelines were developed incollaboration with the statewide Crisis to Attachment 2 of this Update for State Share Paid by county /Tribal Social or Human Services AgencyThe county /tribal social or human servicesagency pays the nonfederal share for to s. (41), Wis. Stats., Wisconsin Medicaid may pay only county /tribalsocial or human Services agencies to providecrisis Intervention Services .

3 county /tribal socialor human Services agencies, or the agenciesInside This This Medicaid and BadgerCare Service-Specific Information ! July 2006 ! No. 2006-552with which they contract to actually providecrisis Intervention Services , must be certifiedunder HFS 34, Wis. Admin. of Disability and Elder ServicesCertificationTo be reimbursed for providing this benefit toMedicaid recipients, a provider is first requiredto be certified by the Department of Health andFamily Services (DHFS), Division of Disabilityand Elder Services (DDES), Bureau of QualityAssurance (BQA) for Crisis Intervention underHFS 34, Subchapter III, Wis. Admin. Code. Forinformation regarding this certification,providers may contact the DHFS, DDES bytelephone at (608) 243-2025 or by mail at thefollowing address:Division of Disability and Elder ServicesBureau of Quality AssuranceProgram Certification Unit2917 International Ln Ste 300 Madison WI 53704A provider meeting DHFS, DDES certificationmay apply for Medicaid Medicaid CertificationAgencies should complete the WisconsinMedicaid Mental Health/Substance AbuseAgency Certification Packet.

4 Refer toAttachment 1 for Medicaid certificationrequirements and provider numbers assignedfor agencies providing Crisis county /tribal social or human Services agencywishing to receive Medicaid reimbursement forcrisis Intervention is required to obtain anagency resolution. The resolution must statethat the county /tribal social or human servicesagency agrees to make available the nonfederalshare needed for Medicaid reimbursement ofcrisis Intervention Services . Agency resolutions,such as or human Services boardresolutions, meet this may initiate Medicaid certification forcrisis Intervention by doing one of the following: Downloading the Wisconsin MedicaidMental Health/Substance Abuse AgencyCertification Packet from the MedicaidWeb site at Calling Provider Services at(800) 947-9627 or (608) 221-9883.

5 Writing to the following address: Wisconsin MedicaidProvider Maintenance6406 Bridge RdMadison WI 53784-0006 Refer to the General Information section of theMental Health and Substance Abuse ServicesHandbook for more information about providercertification, provider numbers, and for Crisis InterventionServicesA Medicaid-certified Crisis Intervention provider,as part of its certification under HFS 34,Subchapter III, Wis. Admin. Code, may contractwith other qualified providers for any part of itscrisis Intervention service. However, theMedicaid-certified provider retains all legal andfiscal responsibility for the Services provided Medicaid sends provider materials toMedicaid-certified providers only. It is thecertified provider s responsibility to ensure thatthe contractor is qualified and provides servicesand maintains records in accordance with theMedicaid requirements for the provision of crisisintervention Services .

6 For more information ondocumentation as it relates to Crisis interventionservices, refer to Attachment Medicaid-certified crisisinterventionprovider, as part ofits certificationunder HFS 34,Subchapter III, Code, maycontract with otherqualified providersfor any part of itscrisis Medicaid and BadgerCare Service-Specific Information ! July 2006 ! No. 2006-553 The Medicaid-certified provider is responsiblefor ensuring that its contractors do thefollowing: Meet all program requirements. Receive copies of Medicaid the contracted Crisis interventionagency may submit claims to WisconsinMedicaid using the certified provider sMedicaid number if the provider has authorizedthis, Wisconsin Medicaid payment is made onlyto the certified and Nonbilling Provider NumbersWhen the county is the Crisis interventionagency, a billing/performing provider number isissued to the county that is used to submitclaims to Wisconsin Medicaid, and no additionalprovider number is required on the claim providing Services within the crisisintervention agency do not need to beindividually that have been assigned more thanone Crisis Intervention billing provider numberprior to this Update may submit claims asnormal.

7 No other counties will be assigned morethan one billing provider number for crisisintervention Eligibility for CrisisIntervention ServicesInitial Contact and AssessmentWisconsin Medicaid covers an initial contactand assessment for any recipient contacting thecrisis Intervention provider. For recipients not incrisis, the length of the assessment must be nolonger than what is necessary to determine thatno Crisis or emergency exists and to makeappropriate referrals, when Other Crisis Intervention ServicesWisconsin Medicaid covers all other crisisintervention Services only if the providerdocuments that both of the following are true: The recipient is in a Crisis or situation thatmay develop into a Crisis if professionalsupports are not provided. The provider can expect to reduce theneed for institutional treatment or improvethe recipient s level of in Certified CommunitySupport ProgramsWisconsin Medicaid covers Crisis interventionservices for recipients receiving Medicaid-funded community support program (CSP) Services when any of the following is true: The Crisis Intervention program has aformal arrangement with the CSP toprovide Crisis Services to CSP enrollees.

8 The Crisis Intervention Services aredelivered according to a Crisis plandeveloped by the Crisis interventionprogram and the CSP. The Crisis Intervention Services do notduplicate CSP Crisis Intervention program may not claimMedicaid reimbursement if reimbursement forthe Crisis Intervention Services is claimedthrough the in Nursing FacilitiesRecipients in nursing facilities are eligible for allcrisis Intervention covered an initialcontact andassessment forany recipientcontacting thecrisis Medicaid and BadgerCare Service-Specific Information ! July 2006 ! No. 2006-554 Recipients Being Discharged from aHospital or Residential Care Centers forChildren and YouthRecipients being discharged from a hospital orresidential care center are eligible for crisisintervention Services only if the providerdocuments the following in the recipient srecords: Why the recipient is likely to experience anemergency or a Crisis if the crisisintervention Services are not provided.

9 Why other Services , which might maintainthe recipient in the community, are notavailable and when such Services are likelyto be following are the only covered crisisintervention Services for recipients in aninpatient hospital or a residential child carecenter: Development of a Crisis plan. Services to assist the recipient in makingthe transition to the least restrictive level Recipients Are Ineligible for CrisisIntervention ServicesRecipients are not eligible for any Medicaidservices, including Crisis Intervention , duringperiods of time when they are in jail or securedetention. This includes when recipients receivea day or overnight pass from these , recipients between ages 21 and 64 arenot eligible for any Medicaid Services whilethey are in an institution that is deemed an institute for mental disease (IMD).

10 Providersmay provide Services during these periods;however, they are not Medicaid Enrolled in State-ContractedManaged Care OrganizationsWisconsin Medicaid and BadgerCare recipientsenrolled in state-contracted managed careorganizations may receive Crisis interventionservices on a fee-for-service basis. Theseservices are not part of the HMO s capitationrate. If a recipient is in need of crisisintervention Services , recipients should bereferred to their county /tribal social or humanservices agency that may provide theseservices on a fee-for-service a recipient enrolled in Children Come First orWraparound Milwaukee is in need of crisisintervention, the recipient may receive theservice on a fee-for-service basis since thisservice is not part of the capitation should be referred to their county /tribal social or human Services agency that mayprovide this service on a fee-for-service Medicaid uses the followingdefinitions from HFS 34, Wis.