2011 Session

Budget Amendments - SB800 (Committee Approved)

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Independent Assessment of Children's MH Services (language only)

Item 297 #15s

Item 297 #15s

Health And Human Resources
Medical Assistance Services, Department of

Page 267, strike lines 41 through 53, and insert:
"OOOO.  Effective July 1, 2011, the Department of Medical Assistance Services shall amend the State Plans under Title XIX and XXI of the Social Security Act to require an independent assessment of children or adolescents who
may be in need of intensive in-home, therapeutic day treatment, residential levels A and B services, and mental health support services.  Independent assessments shall be conducted by a licensed or licensed–eligible mental health professional, who will not directly provide or supervise the direct service provision of the recommended service, or shall be conducted by a qualified employee of the Community Services Board or Behavioral Health Authority (CSB/BHA) serving the locality where the child resides.  If the CSB/BHA performing the assessment will also provide the service, the person performing the assessment cannot be the direct service provider or the supervisor of the direct service provider.  If a child or adolescent is already involved with a Family Assessment and Planning Team (FAPT), the FAPT team’s referral, where appropriate, may be used in lieu of an independent assessment.  If the child or adolescent is a member of a Medicaid-contracted managed care organization, that organization shall provide for the assessment with appropriately credentialed personnel, which may include public or private providers. These services, other than case management, shall not be provided until the assessment is completed and determined that the individual meets the medical necessity criteria for the service(s).  This process shall also include the following principles:
1) The independent assessment shall establish medical necessity of the individual for services listed herein. The assessment shall, at a minimum, contain standardized elements as determined by the Departments of Medical Assistance Services and Behavioral Health and Developmental Services in consultation with stakeholders.
2) Service providers seeking prior authorization for services listed herein will no longer be required to provide evidence of previous behavioral interventions to the Department of Medical Assistance Services or its authorizing agent.  
3) The Department of Medical Assistance Services, in consultation with stakeholders,  shall develop a variance process if there is no independent assessor available to conduct a timely assessment.  This variance process will define what is a timely assessment, what constitutes written justification for the variance, and will allow a Licensed Mental Health Professional (LMHP) or LMHP eligible clinician working for a service provider to conduct the assessment and still allow the service provider to render services to the individual.
4) If the independent assessor determines a child/youth qualifies for the services listed herein, the independent assessor shall inform the child/youth and family of available service options.  Once the family chooses the service option, the assessor will also provide a choice of service providers.  The family shall make a choice of service providers.  Both service and provider choice shall be documented in writing.
5) Subsequent re-evaluations to determine continued medical necessity for the service shall be conducted by the service provider.
6) The Departments of Medical Assistance Services and Behavioral Health and Developmental Services, in consultation with stakeholders shall create outcome measures that will ensure value and quality.
7)  The Department of Medical Assistance Services and the Department of Behavioral Health and Developmental Services, in consultation with stakeholders, shall establish a training process for independent assessors.  The department shall have the authority to implement necessary changes upon federal approval and prior to the completion of any regulatory process undertaken to effect such change."

(This amendment replaces language included in the proposed amendment requiring all children to receive an assessment before receiving community-based mental health rehabilitative services. The amendment defines who will be responsible for the independent assessment. The amendment also lays out principles regarding independent assessments for the Department of Medical Assistance Services and Department of Behavioral Health and Developmental Services to work out in consultation with stakeholders.)