Behavioral Health Updates
Most recent updates from Managed Care Organizations
PerformCare Intensive Behavioral Health Services (IBHS) Provider notice dated 6/16/2021
IBHS 21 104 IBHS Updates (performcare.org): states that as of 8/1/2021, they will authorize all individual, Applied Behavioral Analysis (ABA), IBHS for 12 months. All other Evidence Based Practices (EBP’s) and other individual services will remain the same. Clarification of what the assessment should contain as well as the written order for IBHS is included. Expectations of completion of Child and Adolescent Needs and Strengths (CANS) for IBHS (for the Capital contract ) is also stipulated in this update. PerformCare has reformatted IBHS written order form as seen here: Intensive Behavioral Health Services (IBHS) Written Order Form – PerformCare
Community Behavioral Health (CBH) Provider Notice: Intensive Behavioral Health Services Increase in Behavioral Health Technician Daily Maximum Units
CBH is issuing this Notice to inform providers of a change in the maximum daily units billable for Behavioral Health Technician (BHT) services in Intensive Behavioral Health Services (IBHS). The daily maximum billable units for BHT services has been increased from 32 to 64 15-minute units. This applies to three BHT Levels of Care: 425-17 BHT, 425-18 BHT Specialized, and 425-31 BHT ABA.
Community Behavioral Health (CBH) Provider Notice: Pay-for-Performance for Behavioral Health Screening Events
CBH and Department of Behavioral Health and Intellectual Disability Services (DBHIDS) encourage Mental Health Outpatient and Drug & Alcohol Outpatient providers to actively connect with the community by hosting community-based screening events. This allows CBH in-network providers to earn pay-for-performance awards and gives the community an opportunity to get help early. Any CBH in-network provider of 300- or 350-levels of care is eligible for this award if the provider submitted a claim for those services during calendar year 2020. One of the criteria to receive the award is to attend a virtual orientation. Complete criteria for pay-for-performance credit, as well as best practices for hosting an event, will be reviewed during the orientation. The next event will be held on July 23, 2021, from 9:30 to 11:30 a.m.
Community Behavioral Health (CBH) Provider Notice: Case Management Transition
In response to state recommendations, utilization management activities for Medicaid enrolled members seeking case management services will be standardized with other community-based services authorized by CBH. This will include an increase in Clinical Care Management (CCM) interaction with Assertive Community Treatment (ACT) teams and eventually Non-Fidelity ACT teams. This transition will also require adjustments to the authorization and referral process of case management services for providers.
Magellan Behavioral Health medical necessity criteria updates to occur in October 2021
The 2021-2022 Magellan Care Guidelines (MCG) will become effective Oct. 11, 2021. This is a delay from the regularly scheduled update on July 1 (previously postponed until Sept. 2). STay tunes to the provider website, MagellanProvider.com, for its release. The 2020-2021 Magellan Care Guidelines will remain in effect until Oct. 10. 2021 this year.
Magellan uses the most recent edition of the MCG Guidelines® (“MCG”) in addition to Magellan’s proprietary clinical criteria (“Magellan Healthcare Guidelines”) as the primary decision support tools for its Utilization Management Program.
Note that criteria for some levels of care, plans and states differ. Please visit our Medical Necessity Criteria webpage for more information.