Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Transmittal Letter EIP-18 June 2009 TO: Early Intervention Programs Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Early Intervention Program Manual (Changes to Professional Staff for Whom Early Intervention Service Providers Can Bill MassHealth and Revisions to Service Codes and Descriptions) Changes in who can provide EI services MassHealth regulations currently allow early intervention (EI) providers to claim payment from MassHealth for EI services furnished by the following professional staff: a nurse, an occupational therapist, a physical therapist, a speech/language pathologist, a social worker, or a psychologist. Currently, EI providers may also claim payment from MassHealth for intake, screening, evaluation, and assessment furnished by developmental specialists working in conjunction with one of the professional staff identified above. Effective for dates of service on or after July 1, 2009, EI providers may claim payment from MassHealth for MassHealth-reimbursable EI services when furnished by developmental specialists, including child visits, center-based individual visits, group visits, parent-focused group sessions, assessments, evaluations, screenings, and intakes. Developmental specialists may not provide EI services that are outside the scope of their discipline or that would require the knowledge and skills of a licensed clinician. EI developmental specialists must meet all requirements under Department of Public Health (DPH) Operational Standards, and must be certified by DPH to provide EI services. In addition, effective for dates of service on or after July 1, 2009, EI providers may claim payment from MassHealth for MassHealth-reimbursable EI services furnished by physical therapy assistants (PTAs) and occupational therapy assistants (OTAs). OTAs and PTAs providing EI services must have current licensure from, and be in good standing with, the Massachusetts Board of Registration in Allied Health Professions. OTAs and PTAs furnishing EI services must also meet all requirements under the DPH EI Operational Standards, may provide only those services within the scope of their licensure, and must receive supervision from a licensed occupational therapist or physical therapist in accordance with the requirements of the Board of Registration. Please Note: MassHealth does not pay for EI services provided by speech/language pathology assistants. Revisions to service codes and descriptions EI providers are required to enter the HN modifier with the appropriate service code when submitting claims to MassHealth for services furnished by developmental specialists. MassHealth has revised its Subchapter 6 for early intervention services to include the HN modifier for all service codes. MassHealth will be amending its regulations to reflect these changes. If you have any questions about the information in this transmittal letter please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) Early Intervention Program Manual Pages 6-1 and 6-2 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Early Intervention Program Manual Pages 6-1 and 6-2 — transmitted by Transmittal Letter EIP-16 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6. Service Codes and Descriptions Page 6-1 Early Intervention Program Manual Transmittal Letter EIP-18 Date 06/01/09 601 Service Codes and Descriptions Service Code-Modifier Service Description H2015-AH Comprehensive community-support services, per 15 minutes (use for individual child visits, not center-based); services provided by clinical psychologist H2015-AJ services provided by clinical social worker H2015-GN services provided by speech/language therapist H2015-GO services provided by occupational therapist H2015-GP services provided by physical therapist H2015-TD services provided by registered nurse H2015-TE services provided by licensed practical nurse H2015-HN services provided by developmental specialist T1015-TL Clinic visit/encounter, all-inclusive (one encounter is defined as a 15-minute unit) (use for individual child visits, center-based) T1023-AH Screening to determine the appropriateness of consideration for individual for participation in a specified program, project, or treatment protocol, per encounter (one encounter is defined as a 15-minute unit) (use for screening/intake); services provided by clinical psychologist T1023-AJ services provided by clinical social worker T1023-GN services provided by speech/language therapist T1023-GO services provided by occupational therapist T1023-GP services provided by physical therapist T1023-TD services provided by registered nurse T1023-TE services provided by licensed practical nurse T1023-HN services provided by developmental specialist T1024-AH Evaluation and treatment by an integrated specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (one encounter is defined as a 15-minute unit) (use for EI assessments); services provided by clinical psychologist T1024-AJ services provided by clinical social worker T1024-GN services provided by speech/language therapist T1024-GO services provided by occupational therapist T1024-GP services provided by physical therapist T1024-TD services provided by registered nurse T1024-TE services provided by licensed practical nurse T1024-HN services provided by developmental specialist T1027-TL Family training and counseling for child development, per 15 minutes (use for parent- focused group session, per member) 96153-U1 Health and behavior intervention, each 15 minutes, face-to-face; group (two or more patients) (use for EI-only child group, including only those children who are enrolled in EI) 96153-U2 group (two or more patients) (use for community child group, for groups of children that include both children enrolled in EI and those not enrolled in EI) Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6. Service Codes and Descriptions Page 6-2 Early Intervention Program Manual Transmittal Letter EIP-18 Date 06/01/09 This page is reserved.