RE: MOBILE CRISIS AND CRISIS RESIDENCE AUTHORITY AND REIMBURSEMENT CHANGES
IMPACTED PLANS: MAINSTREAM MEDICAID PLANS, HEALTH AND RECOVERY PLANS (HARPS), HIV- SNP PLANS, AND MEDICAID ADVANTAGE PLUS (MAP) PLANS
TO: BEHAVIORAL HEALTH PARTICIPATING AND NON-PARTICIPATING PROVIDERS
NYS has received approval from CMS for the Crisis Intervention State Plan Amendment (SPA #22-0026) with a retroactive date of April 1, 2022.
In relation to the update from, NYS Office of Mental Health (OMH) and the NYS.
Department of Health (DOH), MetroPlusHealth will implement Mobile Crisis and Crisis Residence program and billing changes to effectuate the Crisis Intervention for adults and children effective March 1, 2024.
Coverage date not yet determined – NYS will notify MMCPs when to begin coverage of the Crisis Stabilization Center services in the Medicaid Managed Care benefit package.
Crisis Intervention Benefits – Background
- The Crisis Intervention benefit, including Mobile Crisis services implemented in 2019; and Crisis Residence services implemented in 2020; was authorized under NYS’ 1115 waiver as a demonstration benefit for adults aged 21 and older.
- Mobile Crisis and Crisis Residence services for children up to age 21 were developed under the Children and Family Treatment and Support Services (CFTSS) and implemented through the Children’s Medicaid Transformation. These services will remain State Plan services.
- Effective January 1, 2023, MAP members are already covered for the Crisis Intervention benefit for adults 21 and older.
- MAP Members under the age of 21 years can access coverage for Children’s Crisis Residence provided through Medicaid FFS.
- Effective May 1st, 2023, Comprehensive Psychiatric Emergency Program (CPEP) providers were approved to provide and be reimbursed for all Mobile Crisis services for adults and children under the Crisis Intervention SPA.
Coverage Changes With CMS Approval of Crisis Intervention SPA
- The previously separate Medicaid billing rates and rate code structures for children and adult Mobile Crisis and Crisis Residence services will be consolidated under this SPA authority.
- The mobile crisis telephonic response and triage service is already available to members 21 years and older. Effective March 1, 2024, MetroPlusHealth will cover Mobile Crisis services for members under the age of 21 years.
- Previously Intensive Crisis Residence and Residential Crisis Support programs followed 1115 waiver requirements for individuals 21 and older and CFTSS requirements for individuals 18-20. Retro-effective April 1, 2022, there are no longer different requirements for individuals 18-20.
BILLING AND REIMBURSEMENT POLICY CHANGES
MetroPlusHealth will adjust paid claims at the newly effective rates for dates of service beginning April 1, 2022. However, for MAP, the adjustment to paid claims will be retroactive back to January 1, 2023.
EXCLUSION OF RATE CODES AND FEDERAL INFORMATION PROCESSING STANDARDS (FIPS)
- Effective May 1, 2024, Providers may no longer bill with these Rate Codes and the associated Procedure Codes and Modifier Combinations for:
- The children’s Crisis Intervention Mobile Crisis rate codes (7906 – 7910; 7936 -7942) will be discontinued.
- The Crisis Residence rate codes (7943 – 7945) and their associated procedure codes and modifier combinations will be discontinued.
- Effective May 1, 2024, as a result of the termination of the above listed rate codes. Providers will no longer be required to include the FIPS code and a proxy locator code for children’s Mobile Crisis billing.
Mobile Crisis Services
Effective March 1, 2024, providers delivering adult and children’s Mobile Crisis services may continue to bill using the same rate codes (4609 – 4624), associated procedure codes, and modifier combinations, which were previously only used for the adult 1115 Waiver Crisis Intervention Mobile Crisis services.
TELEPHONIC CRISIS TRIAGE AND RESPONSE
| Rate Code Description | Rate Code | Procedure Code | Modifier(s) | Unit Measure | Unit Limit/Day |
|---|---|---|---|---|---|
| Professional | 4609 | H2011 | GT | 15 Minutes | Up to 90 minutes (6 Units) |
| Telephonic crisis response (up to 90 min) | 4610 | H2011 | GT, HO | 15 Minutes | Up to 90 minutes (6 Units) |
| Licensed Professional | 4611 | S9485 | GT | Per Diem | 90 minutes-3 hours (1 Unit) |
| Telephonic crisis response (Above 90 min – 3 hours) | 4612 | S9485 | HO | Per Diem | 90 minutes-3 hours (1 Unit) |
TELEPHONIC CRISIS FOLLOW-UP SERVICES
| Rate Code Description | Rate Code | Procedure Code | Modifier(s) | Unit Measure | Unit Limit/Day |
|---|---|---|---|---|---|
| Licensed Professional | 4613 | H2011 | TS, GT | 15 Minutes | Up to 60 minutes (4 Units) |
| Unlicensed/Certified Peer | 4614 | H2011 | TS, HM | 15 Minutes | Up to 60 minutes (4 Units) |
MOBILE CRISIS RESPONSE
| Rate Code Description | Rate Code | Procedure Code | Modifier(s) | Unit Measure | Unit Limit/Day |
|---|---|---|---|---|---|
| One-person response: Licensed | 4615 | H2011 | HE | 15 Minutes | Up to 90 minutes (6 Units) |
| Two-person response: Licensed and Unlicensed/Certified Peer | 4616 | H2011 | HK | 15 Minutes | Up to 90 minutes (6 Units) |
| Two-person response: Both Licensed | 4617 | H2011 | HE, HK | 15 Minutes | Up to 90 minutes (6 Units) |
| Two-person response: Licensed and Unlicensed/ Certified Peer | 4618 | S9485 | HE, U5 | Per Diem | 90 – 180 minutes (1 Unit) |
| Two-person response: Both Licensed | 4619 | S9485 | HE, HK, U5 | Per Diem | 90 – 180 minutes (1 Unit) |
| Two-person response: Licensed and Unlicensed/ Certified Peer | 4620 | S9485 | HE | Per Diem | At minimum 3 hours of face-to-face contact (1 Unit) |
| Two-person response: Both Licensed | 4621 | S9485 | HE, HK | Per Diem | At minimum 3 hours of face-to-face contact (1 Unit) |
MOBILE CRISIS FOLLOW-UP SERVICES
| Rate Code Description | Rate Code | Procedure Code | Modifier(s) | Unit Measure | Unit Limit/Day |
|---|---|---|---|---|---|
| One-person face-to-face response: Licensed | 4622 | H2011 | TS | 15 minutes | Up to 90 minutes (6 Units) |
| One-person face-to-face response: Unlicensed Bachelors/Certified Peer | 4623 | H2011 | TS, HE | 15 minutes | Up to 90 minutes (6 Units) |
| Two-person face-to-face response: Licensed and Unlicensed Bachelors/ Certified Peer | 4624 | H2011 | TS, SC | 15 minutes | Up to 90 minutes (6 Units) |
MOBILE CRISIS FOLLOW-UP SERVICES
Effective March 1, 2024, Crisis Residence rate codes (4625 – 4627) and their associated procedure codes and modifier combinations will be used for both adults and children.
CRISIS RESIDENCE SERVICES
| Rate Code Description | Rate Code | Procedure Code | Modifier(s) | Unit Measure | Unit Limit/Day |
|---|---|---|---|---|---|
| Residential Crisis Support (RCS) | 4625 | T2034 | HE | Per Diem | 28 days per admission |
| Intensive Crisis Residence (ICR) | 4626 | T2034 | ET | Per Diem | 28 days per admission |
| Children’s Crisis Residence Program (Up to age 21) | 4627 | T2034 | HK | Per Diem | 28 days per admission unless approved by MMCP/OMH |
If you have any questions or concerns, please feel free to reach out to MetroPlusHealth at 800.303.9626, Monday through Friday, 8am to 6pm.