Behavioral Health Residential Facilities
Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Mercy Care DCS CHP, and Mercy Care DD
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Care and services provided in a Behavioral Health Residential Facility (BHRF) are based on a per diem rate (24-hour day), require prior and continued authorization and do not include room and board.
According to AMPM 320-V -Behavioral Health Residential Facilities, services deemed medically necessary through the assessment and/or CFT/ART/TRBHA/Tribal ALTCS which are not offered at the BHRF, shall be documented in the Service Plan and documentation shall include a description of the need, identified goals and identification of Provider meeting the need. The following services shall be made available and provided by the BHRF and cannot be billed separately unless otherwise noted below:
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Counseling and Therapy (group or individual): Note: Group Behavioral Health Counseling and Therapy may not be billed on the same day as BHRF services unless specialized group behavioral health counseling and therapy have been identified in the Service Plan as a specific member need that cannot otherwise be met as required within the BHRF setting,
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Skills Training and Development:
- Independent Living Skills (e.g. self-care, household management, budgeting, avoidance of exploitation/safety education and awareness),
- Community Reintegration Skill building (e.g. use of public transportation system, understanding community resources and how to use them), and
- Social Communication Skills (e.g. conflict and anger management, same/opposite-sex friendships, development of social support networks, recreation).
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Behavioral Health Prevention/Promotion Education and Medication Training and Support Services including but not limited to:
- Symptom management (e.g. including identification of early warning signs and crisis planning/use of crisis plan),
- Health and wellness education (e.g. benefits of routine medical check-ups, preventive care, communication with the PCP and other health practitioners),
- Medication education and self-administration skills,
- Relapse prevention,
- Psychoeducation Services and Ongoing Support to Maintain Employment Work/Vocational skills, educational needs assessment and skill building,
- Treatment for Substance Use Disorder (e.g. substance use counseling, groups), and
- Personal Care Services (see additional licensing requirements in A.A.C. R9-10-702, R9-10-715, R9-10-814).
Services inappropriately billed that should be included in the per diem will be denied.
Thanks for all you do!
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