Commonwealth of Massachusetts Executive Office of Health and Human Services Division of Medical Assistance 600 Washington Street Boston, MA 02111 MassHealth Home Health Agency Bulletin 36 March 2000 TO: Home Health Agencies Participating in MassHealth FROM: Mark E. Reynolds, Acting Commissioner RE: Behavioral Health Services Reminder This bulletin is a reminder that all behavioral health (mental health and substance abuse) services for members enrolled in the Division's Behavioral Health Program are reimbursed solely by the Division's behavioral health contractor in accordance with the contractor's service authorization and billing policies. See the Division's regulations at 130 CMR 450.105 and 450.124 for more information about this requirement. Behavioral health services include skilled nursing services provided with a treating diagnosis of any of the following ICD-9-CM codes: 291 through 316, excluding 294.1, 310, 310.0, 310.1, 310.2, and 310.8. Providers should refer members who are enrolled in the Behavioral Health Program and need behavioral health services to: Massachusetts Behavioral Health Partnership (the Partnership) at 1-800-495-0086. Recipient Eligibility Verification System You must check the Recipient Eligibility Verification System (REVS) to determine if a member is eligible for MassHealth and enrolled in the Behavioral Health Program. If the member is enrolled in the Behavioral Health Program, that member must be referred to the Partnership for behavioral health services. All members enrolled in the Primary Care Clinician (PCC) Plan are enrolled in the Behavioral Health Program. Some MassHealth members who are not enrolled in the PCC Plan are also enrolled in the Behavioral Health Program. Transition If you are currently providing behavioral health services to a MassHealth member who is enrolled in the Behavioral Health Program, the Division will allow payment for up to four medically necessary skilled nursing visits for each member, between March 1, and March 31, 2000. continued on back MassHealth Home Health Agency Bulletin 36 March 2000 Page 2 Transition (cont.) Any claims submitted to Unisys for skilled nursing services provided after March 31, 2000, with a treating diagnosis of any of the above behavioral health diagnosis codes will be denied. The error code for these denials will be 557 (services covered by behavioral health contractor). You may refer your MassHealth members who are enrolled in the Behavioral Health Program and who need behavioral health services to one of the Partnership's providers on the attached list. This is a partial list of the Partnership's network providers, by region. You may also refer these members directly to the Community Relations Department at the Partnership at 1-800-495-0086. Recovery The Division reserves the right to recover any overpayments, pursuant to 130 CMR 450.235 et seq. Questions If you have any questions about this bulletin, please contact the Unisys Provider Services Department at (617) 628-4141 or 1-800-325-5231. Commonwealth of Massachusetts Executive Office of Health and Human Services Division of Medical Assistance 600 Washington Street Boston, MA 02111 March 3, 2000 Dear Home Health Agency Provider, Attached to this letter is a list of MassHealth members who are enrolled in the Behavioral Health Program, and who have been identified through your claims since October 1, 1999, as having received behavioral health services from your agency. We are also notifying these members that they must obtain all necessary behavioral health services through the Massachusetts Behavioral Health Partnership (the Partnership). Please check your records carefully to make sure that you are not providing behavioral health services to other MassHealth members enrolled in the Behavioral Health Program, whom we may not have identified yet. Please refer to Home Health Agency Bulletin 36 for more information about behavioral health services. Sincerely, Elizabeth Greene Assistant Commissioner