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					Department of
Public Health
and Human


Comprehensive School and
  Community Treatment
    Program Training
       Fall 2007
  Department of
  Public Health
  and Human

   What We Will Learn Today
•About the CSCT Program
•How to Bill
•How to Document
•More Information
      Department of
      Public Health
      and Human

    History of Medicaid in Schools
•Schools have been billing
Medicaid for over 10 years
•2001 MT Legislature issued a
directive to allow for increased
Federal Spending
                           The CSCT program was reinstated
                           into the school based services and
                           enacted in the fall of 2003
    Department of
    Public Health
    and Human

  Why Schools Can Bill Medicaid
•Title XIX (19) of the Social Security Act
   –Oversight is done by Centers for Medicare/Medicaid
   –Includes Early Periodic Screening, Diagnostic & Treatment
   Program (EPSDT)
•Medicare Catastrophic Coverage Act makes the
connection to Individual Education Plans (IEP)
•Individuals with Disabilities in Education Act (IDEA)

 CSCT Services can be provided for students without an
     this is different from all other School-Based
                  services in Montana
  Department of
  Public Health
  and Human

  Why is the CSCT Program a
    School-Based Service
•Helps to eliminate the risk of removing
students from home and school
•Program is operated by the school through a
contract with a mental health center
•Source of funding makes this available only
thru school programs
    Department of
    Public Health
    and Human

            Reimbursable Services

•Code H0036- Community psychiatric supportive
treatment, face-to-face, per 15 minutes (Medicaid
•Includes individual, family and group counseling
•Behavioral interventions with student (minimum of 8
minutes for one 15 minute unit)
•Direct Crisis intervention when student is present in
a school-owned or operated facility
•Services need to correspond with a students'
Individual Treatment Plan (ITP)
    Department of
    Public Health
    and Human

   Non-Reimbursable Activities

•Observation & monitoring/supervision
•Non face to face service
•Time in meetings
•More than 720 units of service per month per team
•Educational/Academic assistance with schoolwork
•Watching movies—attending assemblies---fieldtrips
•Less than 8 minutes of service in the 15 minute unit
that is billable
     Department of
     Public Health
     and Human

             Provider Requirements
•Services must be provided by at least two program
•Caseload for program cannot exceed 720 units (15
minutes each) per month per team
•At least one of the two staff must be:
   –Licensed Psychologist
   –Licensed Clinical Social Worker
   –Licensed Professional Counselor
   –An In-training licensed professional can be employed with
   the approval of the Children’s Mental Health Bureau at the
   state department
  Department of
  Public Health
  and Human

           Service Requirements
•Does not require Passport approval
and can only be provided to children
with Severe Emotional Disturbances
(SED) found in ARM 37.86.3702
•Does not have to be included on IEP
  –Services not specified on the IEP must
  be provided and billed to ALL children
  who require services
•Free Care rule applies with non-IEP
     Department of
     Public Health
     and Human

                     Free Care Rule
•Services must be made available to all children,
not just Medicaid eligible recipients
•All recipients must be billed, not just Medicaid
•To meet this rule CSCT programs must:
   –Establish sliding fee schedule
   –Determine third party liability (other insurance
   if any)
   –Bill recipients for cost of service

  StudentS with iep’S are exempt from the “free
      Care rule” in regard to CSCt ServiCeS
       Department of Public
       Health and Human

                Part time Staff
     37.106.1960 MENTAL HEALTH CENTER:
(5) This rule is not intended to prevent the use of part-time staff to provide
CSCT services throughout the year, including school vacation periods. If a
child or adolescent receives CSCT services during time periods when school
is not regularly in session, then part-time staff may be used and billed as set
forth in ARM 37.86.2225.
    Department of
    Public Health
    and Human

Administrative Rule for Prior Authorization
   of Outpatient Therapy with CSCT
  health services for a medicaid recipient under the
Montana medicaid program will be reimbursed only if
    the following requirements are met: . . .(c) prior
     authorization has been obtained for outpatient
 therapy services that are provided concurrently with
   comprehensive school and community treatment
      (CSCT) program services described at ARM
        37.106.1955, 37.106.1956, 37.106.1960,
       37.106.1961, 37.106.1965 and 37.86.2225;
  Department of
  Public Health
  and Human

Program Requirements/Approval
•Provided by a licensed mental health center
•Program is approved with a CSCT area of
endorsement by Quality Assurance Division
(QAD) at the state department
  –Information can be found in Appendix C of
  School Based Provider Manual
•Students with SED’s are served
•Certification of match is completed by
schools at the end of the year
  –For federal match requirements to obtain these
  dollars for reimbursement.
   Department of
   Public Health
   and Human

                   Provider Approval

•Individual provider/staff approval is generally
not required
•Expectation is that CSCT staff are available
throughout each day to work with children as
•CSCT programs can use Pre-Licensed
Professionals on an infrequent basis
   –Contact Diane White, Clinical Program Officer for
   Children’s Mental Health @ 406-444-1535 for approval of
   in-training staff personnel (this could be changing)
    Department of
    Public Health
    and Human

 Students with SED’s Served
•Services can only be provided to students
with serious emotional disturbances (ARM
37.86.3702, rule at end) regardless of
whether the child is eligible for Special
Education services
•Program not intended for children with
functional limitations that require activities of
daily living (ADL)
   –These services are covered by other Medicaid
   services like paraprofessional staff
Department of
Public Health
and Human

          Certification Of Match

The Federal government requires an
 annual certification of non-federal
  expenditures to cover the costs
  associated with CSCT services
   Individual schools are responsible for this
 match worksheet that is kept on file at the
     Department of
     Public Health
     and Human

    Provider Enrollment with MT
•Provider Notice for School Based Service
dated March 7, 2007
  –Schools re-enrollment and National Provider
  Identification Number (NPI)
  –Mental Health Centers need to work with
  schools to get the CSCT program staff (teams)
  enrolled and identified as TEAM 01 and so on
•Important and needs to be done before
billing for service’s (October 1, 2007)
  Department of
  Public Health
  and Human

        How to Bill for Services
•Details can be found in the School
Based Services Manual
•Only use H0036 code
•Field 19 on CMS-1500 is location for
―TEAM 01‖ etc.
•WINASAP 2003 is available from ACS
and is HIPPA compliant for use in
electronic billing
  –Contact Tom Keith @ 406-451-9532
           Department of
           Public Health
           and Human

Documentation Requirements
(1) All providers of service must maintain records which fully
   demonstrate the extent, nature and medical necessity of services
   and items provided to Montana Medicaid recipients. The records
   must support the fee charged or payment sought for the services
   and items and demonstrate compliance with all applicable
   requirements. . . .
(b) When reimbursement is based on the length of time spent in
   providing the service, the records must specify the time spent or
   the time treatment began and ended for each procedure billed to
   the nearest minute. Total time billed using one or multiple
   procedure codes may not exceed the total actual time spent with
   the Medicaid client.
           Department of
           Public Health
           and Human


  (2) "Serious emotional disturbance (SED)" means with respect to a youth from the
  age of six through 17 years of age that the youth meets requirements of (2)(a) and
             (a) The youth has been determined by a licensed mental health
  professional as having a mental disorder with a primary diagnosis falling within one
  of the following DSM-IV (or successor) classifications when applied to the youth's
  current presentation (current means within the past 12 calendar months unless
  otherwise specified in the DSM-IV) and the diagnosis has a severity specifier of
  moderate or severe:
             (i) childhood schizophrenia (295.10, 295.20, 295.30, 295.60, 295.90);
             (ii) oppositional defiant disorder (313.81);
             (iii) autistic disorder (299.00);
             (iv) pervasive developmental disorder not otherwise specified (299.80);
             (v) asperger's disorder (299.80);
             (vi) separation anxiety disorder (309.21);
             (vii) reactive attachment disorder of infancy or early childhood (313.89);
(viii) schizo affective disorder (295.70);
(ix) mood disorders (296.0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x,
296.7, 296.80, 296.89);
 (x) obsessive-compulsive disorder (300.3);
 (xi) dysthymic disorder (300.4);
 (xii) cyclothymic disorder (301.13);
 (xiii) generalized anxiety disorder (overanxious disorder) (300.02);
 (xiv) posttraumatic stress disorder (chronic) (309.81);
(xv) dissociative identity disorder (300.14);
 (xvi) sexual and gender identity disorder (302.2, 302.3, 302.4, 302.6,
302.82, 302.83, 302.84, 302.85, 302.89);
 (xvii) anorexia nervosa (severe) (307.1);
 (xviii) bulimia nervosa (severe) (307.51);
 (xix) intermittent explosive disorder (312.34); and
 (xx) attention deficit/hyperactivity disorder (314.00, 314.01, 314.9) when
accompanied by at least one of the diagnoses listed above
b) As a result of the youth's diagnosis determined in (2)(a) and for a period of at least
   six months, or for a predictable period over six months the youth consistently and
   persistently demonstrates behavioral abnormality in two or more spheres, to a
   significant degree, well outside normative developmental expectations, that cannot
   be attributed to intellectual, sensory, or health factors:
          (i) has failed to establish or maintain developmentally and culturally
   appropriate relationships with adult care givers or authority figures;
           (ii) has failed to demonstrate or maintain developmentally and culturally
    appropriate peer relationships;
           (iii) has failed to demonstrate a developmentally appropriate range and
    expression of emotion or mood;
           (iv) has displayed disruptive behavior sufficient to lead to isolation in or
    from school, home, therapeutic or recreation settings;
           (v) has displayed behavior that is seriously detrimental to the youth's
    growth, development, safety or welfare, or to the safety or welfare of others; or
           (vi) has displayed behavior resulting in substantial documented disruption
    to the family including, but not limited to, adverse impact on the ability of family
    members to secure or maintain gainful employment.
(c)   Serious emotional disturbance (SED) with respect to a youth under six years of
      age means the youth exhibits a severe behavioral abnormality that cannot be
      attributed to intellectual, sensory, or health factors and that results in
      substantial impairment in functioning for a period of at least six months and
      obviously predictable to continue for a period of at least six months, as
      manifested by one or more of the following:
         (i) atypical, disruptive, or dangerous behavior which is aggressive or self-
      (ii) atypical emotional responses which interfere with the
      child's functioning, such as an inability to communicate emotional needs and to
      tolerate normal frustrations;
         (iii) atypical thinking patterns which, considering age and developmental
      expectations, are bizarre, violent, or hypersexual;
         (iv) lack of positive interests in adults and peers or a
      failure to initiate or respond to most social interaction;
         (v) indiscriminate sociability (e.g., excessive familiarity with strangers) that
      results in a risk of personal safety of the child; or
         (vi) inappropriate and extreme fearfulness or other distress which does not
      respond to comfort by care givers.
(3) A youth must be reassessed annually by a licensed mental health
professional, as to whether or not they continue to meet the criteria for having a
serious emotional disturbance. For the initial or for an annual reassessment, the
clinical assessment must document how the youth meets the criteria for having a
serious emotional disturbance.
   Department of
   Public Health
   and Human

  More Information & Contacts
School–Based Services Program Provider
       Download a copy from
       Also found at Web site is Provider Notices, Fee
       Schedules, Forms and HIPAA information
DPHHS Contact:
       Rena Steyaert             Diane White
       Program Officer           Clinical Program
       School Based              Officer Children’s
       Services                  Mental Health
       (406)-444-4066            (406)-444-1535