016.06.08 Ark. Code R. 007

Current through Register Vol. 49, No. 10, October, 2024

Rule 016.06.08-007 - Rehabilitative Services for Persons with Mental Illness Update Transmittal #100

SECTION II -REHABILITATIVE SERVICES FOR PERSONS WITH MENTAL ILLNESS (RSPMI)

218.000 Treatment Plan 5-1-08

For each beneficiary entering the RSPMI Program, the treatment team must develop an individualized treatment plan. This consists of a written, individualized plan to treat, ameliorate, diminish or stabilize or maintain remission of symptoms of mental illness that threaten life, or cause pain or suffering, resulting in diminished or impaired functional capacity. The treatment plan goals and objectives must be based on problems identified in the intake assessment or in subsequent assessments during the treatment process. The treatment plan must be included in the beneficiary records and contain a written description of the treatment objectives for that beneficiary. It also must describe:

A. The treatment regimen-the specific medical and remedial services, therapies and activities that will be used to meet the treatment objectives;

B. A projected schedule for service delivery-this includes the expected frequency and duration of each type of planned therapeutic session or encounter;

C. The type of personnel that will be furnishing the services and

D. A projected schedule for completing reevaluations of the patient's condition and updating the treatment plan.

The RSPMI treatment plan must be completed by a mental health professional and approved by a psychiatrist or physician, within 14 calendar days of the individual's entering care (first billable service). Subsequent revisions in the treatment plan will be approved in writing (signed and dated) by the psychiatrist or physician verifying continued medical necessity.

218.001 Participation of Families and Children in the Development of the 5-1-08 Treatment Plan for Children Under Age 21

The treatment plan should be based on the beneficiary's (or the parents' or guardians' if the beneficiary is under the age of 18) articulation of the problems or needs to be addressed in treatment. Each problem or need must have one or more clearly defined behavioral goals or objectives that will allow the beneficiary, family members, provider agency staff and others to assess progress toward achievement of the goal or objective. For each goal or objective, the treatment plan must specify the treatment intervention(s) determined to be medically necessary to address the problem or need and to achieve the goal(s) or objective(s).

The treatment plan must specify the beneficiary's and family's strengths and natural supports that will be the foundation for the treatment plan. The beneficiary, parent or guardian must be provided an opportunity to express comments about the treatment plan and a space on the treatment plan form to record these comments. The treatment plan must be signed by the MHP who drafted the plan, the physician authorizing and supervising the treatment, agency staff members who will provide specific treatment interventions, the beneficiary (unless clinically or developmentally contra-indicated) and, for beneficiaries under the age of 18, a parent or legal guardian.

218.100 Periodic Treatment Plan Review 5-1-08

The RSPMI treatment plan must be periodically reviewed by the treatment team in order to determine the beneficiary's progress toward the rehabilitative treatment and care objectives, the appropriateness of the rehabilitative services provided and the need for the enrolled beneficiary's continued participation in the RSPMI Program. The reviews must be performed on a regular basis (at least every 90 calendar days), documented in detail in the enrolled beneficiary's record, kept on file and made available as requested for state and federal purposes. If provided more frequently, there must be documentation of significant acuity or change in clinical status requiring an update in the beneficiary's treatment plan. The clock for the 90-day review begins to run on the earliest date set forth on the form that contains the treatment plan.

218.101 Participation of Families and Children in the Periodic Review of the 5-1-08

Treatment Plan for Children Under Age 21

The review of the treatment plan must reflect the beneficiary's, or in the case of a beneficiary under the age of 18, the parent's or guardian's, assessment of progress toward meeting treatment goals or objectives and their level of satisfaction with the treatment services provided. Problems, needs, goals, objectives, strengths and supports should be revised based on the progress made, barriers encountered, changes in clinical status and any other new information. The beneficiary, the parent or the guardian must be provided an opportunity to express comments about the treatment plan and a space on the treatment plan form to record these comments and their level of satisfaction with the services provided. The review of the plan of care must be signed by the MHP who drafted the plan, the physician authorizing and supervising the treatment, agency staff members who will provide specific treatment interventions, the beneficiary (unless clinically or developmentally contra-indicated) and a parent or legal guardian for beneficiaries under the age of 18.

224.000 Physician's Role

224.100 Physician's Role for Adults Age 21 and Over 5-1-08

RSPMI providers are required to have a board certified or board eligible psychiatrist who provides appropriate supervision and oversight for all medical and treatment services provided by the agency. A physician will supervise and coordinate all psychiatric and medical functions as indicated in treatment plans. Medical responsibility shall be vested in a physician licensed in Arkansas, preferably one specializing in psychiatry. If medical responsibility is not vested in a psychiatrist, then psychiatric consultation must be available on a regular basis. For RSPMI enrolled adults, age 21 and over, medical supervision responsibility shall include, but is not limited to, the following:

A. For any individuals certified as being Seriously Mentally III (SMI), the physician will see and evaluate the individual the earlier of 45 days of the individual's entering care or 45 days from the effective date of certification of serious mental illness. This evaluation is not required if the beneficiary discontinues services prior to calendar day 45. The SMI/SED beneficiary must be re-evaluated directly by a physician within one year after the date of the examination and at least every year thereafter.

B. For individuals not certified as having a Serious Mental Illness or Serious Emotional Disturbance, the psychiatrist or physician may determine through review of beneficiary records and consultation with the treatment staff that it is not medically necessary to directly assess and interview the enrolled beneficiary. By calendar day 45 after entering care, the physician must document in the beneficiary's record that it is not medically necessary to provide the beneficiary a physician assessment. If the beneficiary continues to be in care for more than six months after program entry, the psychiatrist/physician must conduct a Psychiatric Diagnostic Assessment of the individual directly by the end of six months, initially, then at least every year, thereafter.

C. The physician will review and approve the enrolled beneficiary's RSPMI treatment plan and document approval in the enrolled beneficiary's record. If the treatment plan is revised prior to each 90 day interval, the physician must approve the changes within 14 calendar days, as indicated by a dated signature on the revised plan.

D. Approval of all updated or revised treatment plans must be documented by the physician's dated signature on the revised document. The new 90-day period begins on the date the revised treatment plan is completed.

224.200 Physician's Role for Children Under Age 21 5-1-08

RSPMI providers are required to have a board certified or board eligible psychiatrist who provides supervision and oversight for all medical and treatment services provided by the agency. A physician will supervise and coordinate all psychiatric and medical functions as indicated in treatment plans. Medical responsibility shall be vested in a physician licensed in Arkansas, preferably one specializing in psychiatry. If medical responsibility is not vested in a psychiatrist, then psychiatric consultation must be available on a regular basis. For RSPMI enrolled children, underage 21, medical supervision responsibility shall include, but is not limited to, the following:

A. For any individuals underage 18, certified as being Seriously Emotionally Disturbed (SED) or individuals age 18 through age 20 certified as Seriously Mentally III (SMI), the physician will conduct a psychiatric Diagnostic Assessment of the individual the earlier of 45 days of the individual's entering care or 45 days from the effective date of certification of serious mental illness/serious emotional disturbance. This evaluation is not required if the beneficiary discontinues services prior to calendar day 45. The SMI/SED beneficiary must be evaluated again directly by the physician within one year after the date of the examination and at least every year thereafter.

B. For individuals not certified as having a Serious Mental Illness or Serious Emotional Disturbance, the physician may determine through review of beneficiary records and consultation with the treatment staff that it is not medically necessary to directly see the enrolled beneficiary. By calendar day 45 after entering care, the physician must document in the beneficiary record that it is not medically necessary to see the beneficiary. If the beneficiary continues to be in care for more than six months after program entry, the psychiatrist/physician shall see and evaluate the individual directly by the end of six months, initially, then at least every year, thereafter.

C. The physician will review and approve the enrolled beneficiary's RSPMI treatment plan and document the approval in the enrolled beneficiary's record. If the treatment plan is revised prior to each 90 day interval, the physician must approve the changes within 14 calendar days, as indicated by a dated signature on the revised plan.

D. Approval of all updated or revised treatment plans must be documented by the physician's dated signature on the revised document. The new 90-day period begins on the date the revised treatment plan is completed.

224.201 Psychiatric Diagnostic Assessment 5-1-08

The purpose of this service is to determine the existence, type, nature, and most appropriate treatment of a mental illness or emotional disorder as defined by DSM-IV or ICD-9. This face to face psychodiagnostic process must be conducted by an Arkansas licensed physician, preferably one with specialized training and experience in psychiatry (child and adolescent psychiatry for beneficiaries under age 18). The process must include:

A. An interview with the beneficiary, which covers the areas outlined below. The psychiatric diagnostic assessment may build on information obtained through other assessments reviewed by the physician and verified through the physician's interview. The interview should obtain or verify:

1. The beneficiary's understanding of the factors leading to the referral,

2. The presenting problem,

3. Relevant life circumstances and psychological factors,

4. Current symptoms and functional impairments,

5. History of problems,

6. Symptoms and functional impairments,

7. Treatment history,

8. Response to prior treatment interventions and

9. Medical history (and examination as indicated).

B. The assessment must include:

1. A mental status evaluation (a developmental mental status evaluation for beneficiaries underage 18) and

2. A complete multi-axial diagnosis.

C. For beneficiaries under the age of 18, the psychiatric diagnostic assessment must also include an interview of a parent (preferably both), the guardian (including the responsible DCFS caseworker) and/or the primary caretaker (including foster parents) in order to:

1. Clarify the reason for referral,

2. Clarify the nature of the current symptoms and functional impairments and

3. To obtain a detailed medical, family and developmental history.

The diagnostic assessment must contain sufficient detailed information to substantiate all diagnoses specified in the assessment and treatment plan, all functional impairments listed on SED or SMI certifications and all problems or needs to be addressed on the treatment plan. The Psychiatric Diagnostic Assessment must be updated every 12 months at a minimum.

240.000REIMBURSEMENT 5-1-08

Reimbursement is based on the lesser of the billed amount or the Title XIX (Medicaid) maximum allowable for each procedure.

Reimbursement is contingent upon eligibility of both the recipient and provider at the time the service is provided and upon accurate completeness of the claim filed for the service. The provider is responsible for verifying that the recipient is eligible for Medicaid prior to rendering services.

A. Outpatient Services

Fifteen-Minute Units

RSPMI services are billed on a per unit basis. A unit of service for an outpatient service is fifteen (15) minutes unless otherwise stated. Any unit less than five (5) minutes in duration is not considered a valid length of service and should not be submitted to Medicaid for payment. To determine how many units should be submitted on the claim, follow these steps. Begin by totaling the number of minutes of service rendered and divide by fifteen (15). If the remainder is five (5) or greater, round up to the next highest unit, but if the remainder is less than five (5), the quotient will be the valid units of service.

Providers may collectively bill for a single date of service but may not collectively bill for spanning dates of service. For example, an RSPMI service may occur on behalf of a recipient on Monday and then again on Tuesday. The RSPMI provider may bill for the total amount of time spent on Monday and the total amount of time spent on Tuesday but may not bill for the total amount of time spent both days as a single date of service. The maximum allowable for a procedure is the same for all RSPMI providers.

Documentation in the recipient's record must reflect exactly how the number of units is determined.

B. Inpatient Services

The length of time and number of units that may be billed for inpatient hospital visits are determined by the description of the service in Current Procedural Terminology (CPT).

252.110 Non-Restricted Outpatient Procedure Codes 5-1-08

National Code	Required Modifier	Local Code	Definition	Max Units Per Day for Services Not Requiring PA
92506	HA	Diagnosis: Speech Evaluation 1 unit = 30 minutes Maximum units per state fiscal year (SFY) = 4 units	4
90801	HA, Ul	Z0560	Diagnosis The purpose of this service is to determine the existence, type, nature and most appropriate treatment of a mental illness or related disorder as described in DSM-IV. This psychodiagnostic process must be provided by a Mental Health professional and must be supervised by a physician, as indicated by the physician's dated, signed approval of the related treatment plan. It may include, but is not limited to, a psychosocial and medical history, a mental status examination, diagnostic findings and initial treatment plan. This service may be billed for face-to-face contact as well as for time spent obtaining necessary information for diagnostic purposes and formulating the initial treatment plan. Note: Telemedicine POS 99	8
90801	Z0560	Diagnosis: Use the above description Additional requirement: 90801 with no modifier is for service provided via telemedicine only.	8
96101	HA, UA	Z0561	Diagnosis - Psychological Test 1 Evaluation This service allows for the administration of a single diagnostic test to a client by a Psychologist or Psychological Examiner. This procedure should reflect the mental abilities, aptitudes, interests, attitudes, motivation, emotional and personality characteristics of the client as prescribed by the purpose of the evaluation.	8
96101	HA, UA, UB	Z0562	Diagnosis - Psychological Testing Battery This service allows for the administration of two (2) or more diagnostic tests to a client by a Psychologist or Psychological Examiner. This battery should assess the mental abilities, aptitudes, interests, attitudes, emotions, motivation and personality characteristics of the client.	8
90885	HA, U2	Z0563	Treatment Plan The plan of treatment for Medicaid beneficiaries who are not SMI or SED is to be developed by a Mental Health Professional at the direction of the responsible physician in accordance with DBHS program standards and Section 224.000 of this manual. It must include short- and long-term goals for treatment of the beneficiary's mental health needs and must be reviewed every ninety (90) days.	2 May be billed 1 time upon entering care
90885	HA	Z1578	Periodic Review of Treatment Plan The periodic review and revision of the treatment plan by a mental health professional to determine the beneficiary's progress toward the treatment plan objectives, efficacy of the services provided and need for the enrolled beneficiary's continued participation in the RSPMI program. This service must be completed every 90 days at a minimum. If performed more frequently, there must be documentation of significant acuity or change in clinical status (e.g., onset of psychotic symptoms or suicidal feelings) requiring an update in the beneficiary's treatment plan.	2
90885	HA, U1	Z1578	Periodic Review of Treatment Plan Apply the above description. Additional information: 90885 plus modifier "U1" is for this service when provided by a non-physician.	2
90887	HA, U2	Z0564	Interpretation of Diagnosis This is a direct service provided by a Mental Health Professional for interpreting the results of diagnostic activities to the beneficiary and/or significant others. If significant others are involved, appropriate consent forms may need to be obtained. Note: Telemedicine POS 99	4
90887	U3	Z0564	Interpretation of Diagnosis Use above description Additional information: 90887 plus modifier "U3" is for service provided via telemedicine only. Note: Telemedicine POS99	4
H0004	HA	Z0568	Individual Outpatient - Therapy Session Scheduled individual outpatient therapy provided by a Mental Health Professional to a beneficiary for the purposes of treatment and remediation of a condition described in DSM-IV and subsequent revisions. Individual therapy services will not be authorized for beneficiaries under the age of three except in documented exceptional cases.	4
H0004	Z0568	Individual Outpatient - Therapy Session Use above description. Additional information: H0004 with no modifier is for ages 21 and over.	4
H0004	Z0568	Individual Outpatient -Therapy Session Use above description. Additional information: H0004 with no modifier is for services provided via telemedicine only.	4
90846	HA, U3	Z0571	Marital/Family Therapy - Beneficiary is not present Marital/Family Therapy shall be treatment provided by a mental health professional to member(s) of a family in the same session. The purpose of this service is to treat the symptoms of the mental illness or emotional disturbance of the identified beneficiary by improving the functional capacity of the beneficiary within marital/family relationships. Documentation to support the appropriateness of excluding the identified beneficiary must be maintained in the beneficiary's record.	6
90846	Z0571	Marital/Family Therapy - Beneficiary is not present Use the above description. Additional information: 90846 with no modifier is for ages 21 and over.	6
90846	U5	Z0571	Marital/Family Therapy - Beneficiary is not present Use the above description. Additional information: 90846 with the modifier "U5" is for a service provided via telemedicine only.	6
90847	HA, U3	Z0571	Marital/Family Therapy - Beneficiary is present Marital/Family Therapy shall be treatment provided by a mental health professional to more than one member of a family in the same session. The purpose of this service is to treat the symptoms of the mental illness or emotional disturbance of the identified beneficiary by improving the functional capacity of the beneficiary within marital/family relationships. Additional information: 90847 plus modifiers "HA U3" is for under age 21.	6
90847	Z0571	Marital/Family Therapy - Beneficiary is present Use the above description. Additional information: 90847 with no modifier is for ages 21 and over.	6
90847	U5	Z0571	Marital/Family Therapy - Beneficiary is present Use the above description. Additional information: 90847 with the modifier "U5" is for a service provided via telemedicine only.	6
92507	HA	Z1926	Individual Outpatient - Speech Therapy, Speech Language Pathologist	4
Scheduled individual outpatient care provided by a licensed speech pathologist supervised by a physician to a Medicaid-eligible beneficiary for the purpose of treatment and remediation of a communicative disorder deemed medically necessary. See the Occupational, Physical and Speech Therapy Program Provider Manual for specifics of the speech therapy services.
92507	HA, UB	Z2265	Individual Outpatient - Speech Therapy, Speech Language Pathologist Assistant	4
Scheduled individual outpatient care provided by a licensed speech pathologist assistant supervised by a qualified speech language pathologist to a Medicaid-eligible beneficiary for the purpose of treatment and remediation of a communicative disorder deemed medically necessary. See the Occupational, Physical and Speech Therapy Program Provider Manual for specifics of the speech therapy services.
92508	HA	Z1927	Group Outpatient - Speech Therapy, Speech Language Pathologist	4
Contact between a group of Medicaid-eligible beneficiaries and a speech pathologist for the purpose of speech therapy and remediation. Seethe Occupational, Physical and Speech Therapy Provider Manual for specifics of the speech therapy services.
92508	HA, UB	Z2266	Group Outpatient - Speech Therapy, Speech Language Pathologist Assistant	4
Contact between a group of Medicaid-eligible beneficiaries and a speech pathologist assistant for the purpose of speech therapy and remediation. See the Occupational, Physical and Speech Therapy Provider Manual for specifics of the speech therapy services.
90853	HA, U1	Z0574	Group Outpatient - Group Therapy A direct service contact between a group of beneficiaries and one or more Mental Health Professionals for the purposes of treatment and remediation of a psychiatric condition. This procedure does not include psychosocial group activities.	6
90853	Z0574	Group Outpatient - Group Therapy Apply the above description. Additional information: 90853 with no modifier is for ages 21 and over.	6
H2012	HA	Z0577	Therapeutic Day/Acute Day Treatment - 8 units minimum See Section 219.110 for service description.	32
H2012	UA	Z0577	Therapeutic Day/Acute Day Treatment - 8 units minimum H2012 with modifier "22" is for ages 21 and over. See Section 219.110 for service description.	32
H2011	HA, U7	Z1536	Crisis Intervention The purposes of this service are to prevent an inappropriate or premature more restrictive placement and/or to maintain the eligible beneficiary in an appropriate outpatient modality. This procedure is an unscheduled direct service contact occurring either on- or off-site between an eligible beneficiary with a diagnosable psychiatric disorder and a mental health professional.	8
H2011	U4	Z1536	Crisis Intervention Apply the above description. Additional information: H2011 plus modifier "U4" is for service provided via telemedicine only.	8
99201 99202 99203 99204 99212 99213 99214 99215	HA, UB HA, UB HA, UB HA, UB HA, UB HA, UB HA, UB HA, UB	Z1544	Physical Examination - Psychiatrist or Physician A direct service contact provided to an enrolled RSPMI beneficiary by a psychiatrist or a physician to review a beneficiary's medical history and to examine the beneficiary's organ and body systems functioning for the purpose of determining the status of the beneficiary's physical health. This procedure may occur either on- or off-site and may be billed only by the RSPMI provider. The physician may not bill for an office visit, nursing home visit or any other outpatient medical services procedure for the same date of service.	3
90862	HA	Z1545	Medication Maintenance by a Physician Pharmacologic management, including prescription, use and review of medication with no more than minimal medical psychotherapy.	2
90862	HA, HQ	Z0575	Group Outpatient - Medication Maintenance by a physician Group outpatient care by a licensed physician involving evaluation and maintenance of the Medicaid-eligible beneficiary on a medication regimen with simultaneous supportive psychotherapy in a group setting.	6
90862	Z1545	Medication Maintenance by a Physician Apply description above. Additional information: 90862 with no modifier is for ages 21 and over.	2
90862	Z1545	Medication Maintenance by a Physician Apply description above. Additional information: 90862 with no modifier is for services provided via telemedicine only.	2
90862	HA, UB	-	Pharmacologic Management	2
Psychiatric Mental Health Clinical Nurse Specialist or Psychiatric Mental Health Advanced Nurse Practitioner
36415	HA	Z1913	Routine Venipuncture for Collection of Specimen	Per routine
Inserting a needle into a vein to draw the specimen with a syringe or vacutainer.
90887	HA	Z1547	Collateral Intervention, Mental Health Professional	4
An on-site or off-site, face-to-face service contact by a mental health professional with caregivers, family members, gatekeepers, or other parties on behalf of an identified beneficiary to obtain or share relevant information necessary to the enrolled beneficiary's assessment, treatment plan and/or rehabilitation.
Contact between individuals in the employ of RSPMI facilities is not a billable collateral intervention.
90887	U1	Z1547	Collateral Intervention, Mental Health Professional	4
Apply the above description.
Additional information: 90887 plus modifier "U1" is for service provided via telemedicine only.
90887	HA, UB	Z1548	Collateral Intervention, Mental Health Paraprofessional	4
An on-site or off-site, face-to-face service contact by a mental health paraprofessional with caregivers, family members, gatekeepers, or other parties on behalf of an identified beneficiary to obtain or share relevant information necessary to the enrolled beneficiary's assessment, treatment plan and/or rehabilitation.
Contact between individuals in the employ of RSPMI facilities is not a billable collateral intervention.

252.120 Restricted Outpatient Procedure Codes 5-1-08

The following restricted services may be provided only to Medicaid eligible beneficiaries determined to be SMI or SED.

National Code	Required Modifier	Local Code	Definition	Max Units Per Day
T1023	HA, U1	Z1537	Assessment and Treatment Plan/Plan of Care The purpose of this service is to certify the enrolled recipient eligible for RSPMI restricted services based on diagnosis, past psychiatric history, level of functioning and present support needs, and to delineate the rehabilitative treatment and care to be provided during the certification period. This procedure must be completed by a Mental Health Professional and includes the initial assessment of rehabilitative care needs and the development of an individual treatment plan/plan of care for a recipient. Treatment plan is not complete until signed and dated by the physician.	Billed as 1 unit Maybe billed 1 time, upon admission to RSPMI services
T1023	Z1537	Assessment and Treatment Plan/Plan of Care Apply the above description. T1023 with no modifier is for services provided via telemedicine only.	Billed as 1 unit Maybe billed 1 time, upon admission to RSPMI services
H2011	HA, U6	Z1538	Crisis Stabilization Intervention, Mental Health Professional A scheduled direct service contact between an enrolled beneficiary and a mental health professional or paraprofessional for the purpose of ameliorating a situation which places the beneficiary at risk of 24-hour inpatient care or other more restrictive 24-hour placement. The service may be provided within the beneficiary's permanent place of residence, temporary domicile or on-site.	12
H2011	U2	Z1538	Crisis Stabilization Intervention, Mental Health Professional Apply the above description. Additional information: H2011 plus modifier "U2" is for ages 21 and over.	12
H2011	HA, U5	Z1539	Crisis Stabilization Intervention, Mental Health Para professional A scheduled direct service contact between an enrolled beneficiary and a mental health professional or paraprofessional for the purpose of ameliorating a situation which places the beneficiary at risk of 24-hour inpatient care or other more restrictive 24-hour placement. The service may be provided within the beneficiary's permanent place of residence, temporary domicile or on-site.	12
H2011	U1	Z1539	Crisis Stabilization Intervention, Mental Health Paraprofessional Apply the description above. Additional information: H2011 plus modifier"U1" is forages 21 and over	12
H2015	HA, U5	Z1540	On-Site Intervention, Mental Health Professional A direct, face to face, service contact occurring on-site between a MHP and a beneficiary that involves one or more specific therapeutic interventions specified on the treatment plan as medically necessary to address a problem or need specified on the treatment plan and designed to accomplish a specific goal or objective listed on the treatment plan.	6
H2015	U6	Z1540	On-Site Intervention, Mental Health Professional Apply the above description. Additional information: H2015plus modifier "U6" is for ages 21 and over.	6
H2015	U7	Z1540	On-Site Intervention, Mental Health Professional Apply the above description. Additional information: H2015plus modifier "U7" is for services provided via telemedicine only.	6
H2015	HA, U1	Z1541	On-Site Intervention, Mental Health Paraprofessional A direct, face to face, service contact occurring on-site between a MHPP and a beneficiary that involves one or more specific therapeutic interventions specified on the treatment plan as medically necessary to address a problem or need specified on the treatment plan and designed to accomplish a specific goal or objective listed on the treatment plan.	6
H2015	U2	Z1541	On-Site Intervention, Mental Health Paraprofessional Apply the above description. Additional information: H2015plus modifier "U2" is for ages 21 and over	6
H2015	HA, U8	Z1542	Off-Site Intervention, Mental Health Professional A direct, face to face, service contact occurring off-site between a MHP and a beneficiary that involves one or more specific therapeutic interventions specified on the treatment plan as medically necessary to address a problem or need specified on the treatment plan and designed to accomplish a specific goal or objective listed on the treatment plan.	6
H2015	U9	Z1542	Off-Site Intervention, Mental Health Professional Apply the above description. Additional information: H2015plus modifier "U9" is for ages 21 and over.	6
H2015	HA, U3	Z1543	Off-Site Intervention, Mental Health	6
Paraprofessional
A direct, face to face, service contact occurring off-site between a MHPP and a beneficiary that involves one or more specific therapeutic interventions specified on the treatment plan as medically necessary to address a problem or need specified on the treatment plan and designed to accomplish a specific goal or objective listed on the treatment plan.
H2015	U4	Z1543	Off-Site Intervention, Mental Health Paraprofessional	6
Apply the above description.
Additional information: H2015plus modifier "U4" is for ages 21 and over.
H2017	HA, U1	Rehabilitative Day Service, 192 units per week maximum	None
A direct service for enrolled beneficiaries who have psychiatric symptoms that require medical rehabilitation in a more structured form of care than outpatient care for the purposes of maximum reduction of psychiatric symptoms, increased functioning and eventual assimilation into the community. This service is provided primarily in a day program setting by a mental health professional or a mental health paraprofessional. Services may be provided off-site when necessary as a part of the treatment program.
H2017	-	Z1549	Rehabilitative Day Service, 192 units per week maximum	None
Apply the above description.
Additional information: H2017 with no modifier is for ages 21 and over.

016.06.08 Ark. Code R. 007

4/8/2008