[PC-BH-Integration] PC-BH-Integration Digest, Vol 30, Issue 1

Mon Apr 9 14:56:46 EDT 2007

The key to this issue is (for everybody) that each state has a Medicaid 
authority that is allowed to  set standards around payment, credentialing, 
service provision, benefits, etc.  Most states' Medicaid programs (and 
private insurers/payers) take their cue from Medicare on quite a bit related 
to billing and coding, etc. ...but as the saying goes "if you know Medicaid 
in one state, you know Medicaid in one state."

So the Medicaid payment issue continues to be a state-by-state phenomena 
with a state-by-state resolution around topics like who provides the 
service, what settings, what codes are allowed, and so forth.  Sure wish 
there could be a push from the feds around the primary/behavioral health 
integration topic (there's been plenty of conversation...) so that the 9615x 
codes could be accepted, and a re-definition of credentialing could be 
considered and expanded.

Best wishes as you proceed.  Just because it isn't easy doesn't mean that 
you're not on the right track!

Sarah B. Bannon, MSW, LMSW, ACSW
Work: (517) 927-3916
Fax: (517)669-5532

>From: "Shelly Burke" <sburke at swcmhc.org>
>Reply-To: pc-bh-integration at lists101.his.com
>To: <pc-bh-integration at lists101.his.com>
>Subject: Re: [PC-BH-Integration] PC-BH-Integration Digest, Vol 30, Issue 1
>Date: Thu, 5 Apr 2007 17:05:32 -0600
>
>I just want to clarify then - does the State licensing and standards
>apply for reimbursement under a FQHC which is a federally designated
>clinic?
>
>We are looking at integration with primary care and exploring the option
>of reorganizing as an FQHC and including primary care as an offering.
>
>Shelly Burke
>Chief Financial Officer
>Southwest Colorado Mental Health Center, Inc.
>
>
>-----Original Message-----
>From: pc-bh-integration-bounces at lists101.his.com
>[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Bill
>Rosenfeld
>Sent: Thursday, April 05, 2007 10:13 AM
>To: pc-bh-integration at lists101.his.com
>Subject: Re: [PC-BH-Integration] PC-BH-Integration Digest, Vol 30, Issue
>1
>
>Arizona State Medicaid included LPC's and LMFT's under the reimbursable
>provider type umbrella...  We employ both and are receiving payment for
>the 9615X codes.
>
>-----Original Message-----
>From: pc-bh-integration-bounces at lists101.his.com
>[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of
>McGlathery, Michael
>Sent: Wednesday, April 04, 2007 2:19 PM
>To: pc-bh-integration at lists101.his.com
>Subject: Re: [PC-BH-Integration] PC-BH-Integration Digest, Vol 30, Issue
>1
>
>Hi Wendy; I noticed that you are an LPC. Are your clinics FQHC's? The
>reason why I am asking is the limitation of provider degree with FQHC's
>(LCSWs or Psychologists) and if that is a problem. I would love to hire
>MFTs or LPCs. Thanks. Michael McGlathery, Ph.D.
>
>-----Original Message-----
>From: pc-bh-integration-bounces at lists101.his.com
>[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of
>Bradley, Wendy D
>Sent: Tuesday, April 03, 2007 5:51 PM
>To: pc-bh-integration at lists101.his.com
>Subject: Re: [PC-BH-Integration] PC-BH-Integration Digest, Vol 30, Issue
>1
>
>We average between 6-12 encounters per day at approximately 15-25 min
>per visit. We also are available for "curbside consults" for providers.
>We are available by pagers. Our ratio is about 1 Behavioral Health
>Consultant per 5 provider teams (1 doctor 1 nurse case manager and 1
>CMA). Currently, there are 9 BHCs. We are located in the offices with
>the Primary Care Providers. We have been able to reduce high utilization
>by about 33% in the clinic, so in some ways that pays for out positions.
>
>Thank you,
>Wendy D. Bradley LPC
>729-3378
>
>
>-----Original Message-----
>From: pc-bh-integration-bounces at lists101.his.com
>[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of
>Kessler, Rodger S.
>Sent: Monday, April 02, 2007 12:46 PM
>To: pc-bh-integration at lists101.his.com;
>pc-bh-integration at lists101.his.com
>Subject: Re: [PC-BH-Integration] PC-BH-Integration Digest, Vol 30, Issue
>1
>
>  8 encounters of what length? how is 10 encounters in an integrated
>model determined?? Rodger Kessler Ph.D.
>
>________________________________
>
>From: pc-bh-integration-bounces at lists101.his.com on behalf of
>pc-bh-integration-request at lists101.his.com
>Sent: Mon 4/2/2007 12:00 AM
>To: pc-bh-integration at lists101.his.com
>Subject: PC-BH-Integration Digest, Vol 30, Issue 1
>
>
>
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>Today's Topics:
>
>    1. Re: Patient Visits (McGlathery, Michael)
>
>
>----------------------------------------------------------------------
>
>Message: 1
>Date: Thu, 22 Mar 2007 09:02:17 -0700
>From: "McGlathery, Michael" <MMcGlathery at solanocounty.com>
>Subject: Re: [PC-BH-Integration] Patient Visits
>To: <pc-bh-integration at lists101.his.com>,
>         <pc-bh-integration at nccbh.net>
>Message-ID:
>         <DB954945ED624248B5E05CF7904BB33E0362DE8F at EXCVJ01.Solano.Sol>
>Content-Type: text/plain;       charset="us-ascii"
>
>It sounds like you have a co-located mental health department. I have
>social workers working for me who average about 8 encounters a day,
>sometimes less but mostly more. The standard is 10 encounters a day in a
>fully integrated primary care model. Michael Mcglathery,PhD
>
>-----Original Message-----
>From: pc-bh-integration-bounces at lists101.his.com
>[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Susan
>Markley
>Sent: Wednesday, March 21, 2007 10:38 AM
>To: pc-bh-integration at lists101.his.com; pc-bh-integration at nccbh.net
>Subject: Re: [PC-BH-Integration] Patient Visits
>
>We are currently struggling with this issue as well.  If anyone has more
>concrete information of what has worked for the practice in making it a
>viable financial entity, that would be very helpful.
>
>Susan Markley
>
>-----Original Message-----
>From: pc-bh-integration-bounces at lists101.his.com
>[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Esther
>Lwanga
>Sent: Wednesday, March 14, 2007 11:01 AM
>To: pc-bh-integration at nccbh.net
>Subject: [PC-BH-Integration] Patient Visits
>
>
>
>Hello,
>
>I've been following the discussion thread regarding patient visits, and
>had some more specific questions. We are trying to determine effective
>utilization practices. If anyone could answer any of the following as
>relates to their practice, or generally held views:
>
>- Average number of encounters/visits per child psychiatrist per year
>- Average number of encounters/visits per adult psychiatrist per year
>- Average number of encounters/visits per psychologist per year
>- Time used for initial evaluation/psychiatric consultation
>- Time used for psychotherapy (i.e. 20-30??? 40-50mins)
>- Time used for group sessions?
>
>
>Thank you
>
>
>
>
>Esther Lwanga, MPH
>Community Development Manager
>Mid-Atlantic Association of Community Health Centers
>4483 B Forbes Blvd
>Lanham, MD 20706
>Phone: (301) 577-0097  Fax (301) 577-4789
>
>
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>------------------------------
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>End of PC-BH-Integration Digest, Vol 30, Issue 1
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