"Interview Screening Forms - PowerPoint"
Psychological Services for Children with Medicaid in the Schools Department of Medical Assistance Services October, 2006 www.dmas.virginia.gov PRESENTATION OBJECTIVES • Understand the relationship between the school’s Special Education process and Virginia Medicaid • Identify the already utilized Psychological Services that can be billed within the schools • Recognize those persons who can provide billable Psychological Services in the schools • Learn how to easily incorporate current documentation into appropriate necessary Medicaid-compliant documentation. Service Providers Must hold a license from the Board of Psychology as one of the following: • Clinical Psychologist • School Psychologist • School Psychologist-limited (a special license category for school personnel only) OR Must hold a license from the Board of Medicine as a Psychiatrist 3 School Psychologist-Limited “… The Board of Psychology shall license, as school psychologists-limited, persons licensed by the Board of Education with an endorsement in psychology and a master’s degree in psychology. The Board of Psychology shall issue licenses to such persons without examination, upon review of credentials and payment of an application fee in accordance with the regulations of the Board for school psychologists-limited. … shall practice solely in public school divisions; … “ 4 Psychological Services in the Schools • Do not require pre-authorization • Do not require a referral by a physician, but shall be “medically prescribed” with active written plan designed and signature-dated by a Board of Psychology approved provider 5 Who is Eligible to Receive Medicaid Services in the School? Eligible for and enrolled in Medicaid Receiving special education services or Determined eligible for special education services 6 Current School Health Psych Services regulations 12 VAC30-50-229.1 – School Health Services Psychiatric and Psychological services - “Evaluations and therapy services shall be covered when rendered by individuals who are licensed by the Board of Medicine and practice as psychiatrists or by psychologists licensed by the Board of Psychology as clinical psychologists or by school psychologists limited licensed by the Board of Psychology” 7 Psychiatric and Psychological Services • School-based providers of psychological & psychiatric services are to follow the guidelines listed in the Psychiatric Services Manual • Chapter IV - Covered Services • Chapter VI - Utilization Review 8 Psychological Services that can be Billed to Medicaid • Initial evaluations (90801) • Re-evaluations • Extensive record reviews (90885) – as part of an evaluation – in place of a re-evaluation • Psychological Testing (96101-96103) • Individual and group counseling/therapy as a related service (codes vary) 9 Thinking “Privately” • Requires a paradigm shift • “Translate” terms and processes from a medical model to a special education model • Not always easy or comfortable 10 IDEA Special Ed The Process Medicaid Screening Assessment Eligibility Psychological Diagnostic Initial Interview Testing Interview Mental Status 96101 90801 DSM-IV-TR Records Review 90801 90885 Using the Forms • Diagnostic Clinical Interview (90801, 90802) • Psychological Evaluation (96101, 96102, 96103) • Neuropsychological Evaluation (96116, 96118, 96119, 96120) • Evaluative Review of Records (90885) • Therapy Progress Notes – Individual/Play (90804-90815, 90845) – Group (90853, 90857) – Family (90846, 90847) 12 Screening • Reason for referral or presenting problems • Background information – School/educational history – Medical history – Family history – Previous psychological treatment • Information fits on Diagnostic Clinical Interview form 13 Assessment • Conduct a personal interview • Continue completion of Diagnostic Clinical Interview Form • Relevant Family/Medical information • Include behavioral observations • Conduct a diagnostic clinical interview 14 Diagnostic Clinical Interview • Mental Status Exam – Similar to behavioral observations and interview – Done all the time during an assessment, but may not call it this Appearance Responsiveness Attitude Thought process Eye contact Judgment Mood, affect Insight Speech, vocabulary Suicidal/homicidal 15 Diagnostic Clinical Interview (cont’d) • Diagnostic Impression: DSM-IV-TR or ICD-10 classification • For DSM-IV-TR Multiaxial System*: – Axis I: Clinical Disorder – Axis II: Personality Disorder/Mental Retardation – Axis III: General Medical Conditions – Axis IV: Psychosocial & Environmental Problems – Axis V: Global Assessment of Functioning (GAF) *Only need Axis I/II and Axis V (GAF) –Treatment plan or recommend- ations 16 Using Diagnosis Codes in the Schools • Common diagnostic classification system (DMS-IV-TR or ICD-10) • Get comfortable “translating” educational terms into psychological terms that are required for Medicaid billing • Used in schools only for Medicaid documentation • Does not have to be used in any school reporting 17 Translating to “Medicaid-Friendly” Terms Specific Learning Disabilities = Learning Disorders – in Reading = Reading Disorder (315.00) – in Math = Mathematics Disorder(315.1) 18 Translating to “Medicaid- Friendly” Terms (cont’d) Mental Retardation = Mental Retardation – Educable = Mild Mental Retardation (317) – Trainable = Moderate Mental Retardation (318) – Severe & Profound = Severe (318.1) Profound (318.2) 19 Translating to “Medicaid- Friendly” Terms (cont’d) • Medicaid file NOT part of student record in school • Psychologists maintain forms in files in their office • Diagnosis must be “current” (i.e. within the past year) • Need Global Assessment of Functioning (GAF) 20 GAF Scale • Psychologist’s judgment of student’s overall level of functioning • Rated in respect to psychological, social and school functioning from 0 to 100 • 10 ranges of functioning (0-10, 11-20, etc.) • Two components – severity of symptoms – functioning level 21 GAF Scale: School Examples • 30 & below: hospitalized, residential treatment, specialized programs • 30 -40: violent, acting out • 40 - 60: self-contained class, non- violent acting out, social problems • 60 - 70: resource/itinerant services • 70+ : adjustment issues, probably not special education; guidance counseling 22 Evaluative Review of Records 90885 • Used to review student’s cumulative folder as part of evaluation process • Can be used for re-evaluation screening to determine need for further assessment • As of January 1, 2007, 90885 will be a non-covered service. Non covered services include interpretation of examinations, procedures, and data, and the preparation of reports. 23 Psychological Evaluation Form • Behavioral observations • Tests administered • Medication at time of testing • Plan of treatment or interventions recommended 24 Psychological Counseling • Service is related to IEP • Follows related service procedures for adding to IEP • Medicaid process: – Diagnostic Clinical Interview – GAF – Treatment Plan – Therapy Progress Note 25 Service Limits No more than a grand total of three of any in this list in a seven-day period • Individual psychotherapy – Once per day (medical/record evaluation & management is included in the psychotherapy code and should NOT be billed separately) 26 Service Limits (cont’d) • Group psychotherapy – Once per day – 10 (max) per group – No sensory stimulation, recreational activities, art classes, excursions, eating together counted • Family psychotherapy – Once per day 27 Service Limits (cont’d) EXCLUSIONS • Multiple-family group psychotherapy • Hypnotherapy • Environmental intervention • Interpretation of examinations, procedures & data • Preparations of reports 28 Non-Covered Psychiatric/Psychological Services • Broken appointments • Remedial education • Day care 29 Non-Covered Psychiatric/Psychological Services (cont’d) • Teaching “grooming” skills, monitoring activities of daily living, bibliotherapy, reminiscence therapy, or social interaction • Telephone consultations • Mail order prescriptions • Substance abuse services (May be accessed through EPDST for under age 21) 30 Differential Reimbursement Fees For the stated reimbursement amount: • Psychiatrists – 100% • Clinical Psychologists – 90% • School Psychologists or School Psychologist-Limited – 75% of the 90% • School district (the provider) gets the federal share of the reimbursed fee (currently 50% for Medicaid /65% for Medicaid expansion) 31 For Example ……….. A School Psychologist-Limited provider conducts a psychological evaluation – 90801 ($102.75) – receives 75% of the 90% (Clinical Psychologist’s full fee) = $69.36 – school district would receive the federal share of the stated reimbursement amount (50% = $34.68 or 65% = $45.08) 32 Conclusion Medicaid-required documentation readily fits into the current Special Education process we now follow. Forms can easily be adapted to be used to take notes during screening and during the assessment. Record keeping is kept to a minimum. Forms can be hand-written and information briefly stated. Additional training may be needed. 33 Contact Us Department of Medical Assistance Services www.dmas.virginia.gov Department of Education www.pen.k12.va.us 34