Psychological Services for Children with Medicaid in the Schools

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Psychological Services for Children with
Medicaid in the Schools

• Department of Medical Assistance Services
• October, 2006

www.dmas.virginia.gov
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PRESENTATION OBJECTIVES

• Understand the relationship between the schools
  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.

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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

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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 masters 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

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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

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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

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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

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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

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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)

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Thinking Privately

• Requires a paradigm shift
• Translate terms and processes from a medical
  model to a special education model
• Not always easy or comfortable

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The Process
IDEA Special Ed
Medicaid
Screening
Assessment
Eligibility
Diagnostic Interview 90801
Psychological Testing 96101 Records Review 90885
Initial Interview Mental Status DSM-IV-TR 90801
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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)

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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

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Assessment

• Conduct a personal interview
• Continue completion of Diagnostic Clinical
  Interview Form
• Relevant Family/Medical information
• Include behavioral observations
• Conduct a diagnostic clinical interview

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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
• Attitude
• Eye contact
• Mood, affect
• Speech, vocabulary

• Responsiveness
• Thought process
• Judgment
• Insight
• Suicidal/homicidal

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Diagnostic Clinical Interview (contd)

• 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

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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

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Translating to Medicaid-Friendly Terms

• Specific Learning Disabilities Learning
  Disorders
• in Reading Reading Disorder (315.00)
• in Math Mathematics Disorder(315.1)

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Translating to Medicaid-Friendly Terms
(contd)

• Mental Retardation
• Mental Retardation
• Educable Mild Mental Retardation (317)
• Trainable Moderate Mental Retardation (318)
• Severe Profound
• Severe (318.1)
• Profound (318.2)

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Translating to Medicaid-Friendly Terms
(contd)

• 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)

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GAF Scale

• Psychologists judgment of students 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

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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

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Evaluative Review of Records90885

• Used to review students 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.

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Psychological Evaluation Form

• Behavioral observations
• Tests administered
• Medication at time of testing
• Plan of treatment or interventions recommended

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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

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No more than a grand total of three of any in
this list in a seven-day period
Service Limits

• Individual psychotherapy
• Once per day (medical/record evaluation
  management is included in the psychotherapy code
  and should NOT be billed separately)

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Service Limits (contd)

• 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

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Service Limits (contd)

• EXCLUSIONS
• Multiple-family group psychotherapy
• Hypnotherapy
• Environmental intervention
• Interpretation of examinations, procedures data
• Preparations of reports

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Non-Covered Psychiatric/Psychological Services

• Broken appointments
• Remedial education
• Day care

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Non-Covered Psychiatric/Psychological Services
(contd)

• 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)

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Differential Reimbursement Fees

• For the stated reimbursement amount
• Psychiatrists 100
• Clinical Psychologists 90
• School Psychologists or School Psychologist-Limite
  d 75 of the 90
• School district (the provider) gets the federal
  share of the reimbursed fee (currently 50 for
  Medicaid /65 for Medicaid expansion)

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For Example ..

• A School Psychologist-Limited provider conducts
  a psychological evaluation 90801 (102.75)
• receives 75 of the 90 (Clinical Psychologists
  full fee) 69.36
• school district would receive the federal share
  of the stated reimbursement amount (50 34.68
  or 65 45.08)

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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.

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Contact Us

• Department of Medical Assistance Services
• www.dmas.virginia.gov
• Department of Education
• www.pen.k12.va.us