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II. E. Crisis Intervention Services General Definition Crisis intervention services provided by a mobile team or individual who travels to the place where the person is having the crisis (e.g., person’s place of residence, emergency room, jail, community setting). Crisis intervention services include risk analysis, assessment, and crisis counseling services, de-escalation, critical incident debriefing, and consultation, if necessary with a higher-level behavioral health professional. Depending on the situation, the person may be transported to a more appropriate facility for further care. (e.g., a crisis services center)
Service Standards/Provider Qualifications Crisis intervention services must be provided by agencies that have an OBHL license.
Coverage and Payment for Emergency Behavioral Health Services: Behavioral health crisis intervention services provided to Title XIX and Title XXI members are always the responsibility of the T/RBHA ... For persons who are enrolled with a T/RBHA, the T/RBHA is responsible to pay for psychiatric or psychological consults provided in an emergency room.
Release date September 1, 2001 Applicable for Services Provided on 10/03/01 or later Version 5.2 Revision Date July 1, 2004
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II. E. CRISIS INTERVENTION SERVICES ...........................107 II. E. 1. Crisis Intervention Services (Mobile)..............................109 II. E. 2. Crisis Intervention Services (Stabilization) ......................112 II. E. 3. Crisis Intervention (Telephone) ......................................115 Behavioral Health Services Guide IndexH2011 Procedure and Transportation Codes Billing Limitations Pages 5-6 ADHS/DBHS Allowable Procedure Code Matrix
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BILLING FOR PROFESSIONAL SERVICES AHCCCS FFS Provider Manual Page 8
Covered Services Guide Page 16 Behavioral Health Services Guide Index
Arizona_MCO_Crosswalk Page 3 Code H2011
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Contract Management Specialist/Buyer: Hannah Wright Lucas REGIONAL BEHAVIORAL HEALTH AUTHORITY SERVICES
1. Amendment Begin Date: July 01, 2004 2. Amendment End Date: June 30, 2005 SECTION 13. CRISIS SERVICES: The Contractor shall maintain a 24-hour, seven day a week crisis response service for eligible and enrolled persons that meets all the timeline requirements and has an adequate array of providers to provide all services identified in the ADHS Provider Manual and Paragraph 3, Covered Services of this contract. Emergency medical services (e.g. crisis services) do not require prior authorization but shall be delivered in compliance with R9-22-210, R9-31-210, R9-22-1205 and R9-31-1205 and the ADHS/DBHS Provider Manual. a. Coverage and Payment for Emergency Behavioral Health Services: i. The Contractor must ensure coverage and payment for emergency medical services for Title XIX/Title XXI eligible and enrolled persons regardless of whether the provider that furnishes the service has a contract with the Contractor or a subcontracted provider. iii. The Contractor cannot deny payment for treatment obtained under either of the following circumstances: (1) An eligible or enrolled person had an emergency medical condition, including cases in which the absence of medical attention would not have resulted in the outcomes identified in the definition of emergency medical condition found in 42 CFR 438.114; or (2) A representative of the Contractor or a subcontracted provider instructs the eligible or enrolled person to seek emergency medical services. iv. The Contractor or its subcontracted provider may not: (1) Limit what constitutes an emergency medical condition as defined in 42 CFR 438.114, on the basis of lists of diagnoses or symptoms; (2) Refuse to cover emergency medical services based on the failure of the subcontracted provider, other provider, hospital or fiscal agent to notify the Contractor or its subcontracted providers of the eligible or enrolled person’s screening and treatment within 10 calendar days of presentation for emergency services. This notification stipulation is only related to the provision of emergency services in an inpatient hospital emergency room. v. An eligible or enrolled person who has an emergency medical condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the patient. vi. The attending emergency physician, or the provider actually treating the eligible or enrolled person, is responsible for determining when the person is sufficiently stabilized for transfer or discharge, and such determination is binding on the Contractor and its subcontractors. vii. When Title XIX and Title XXI members present in an emergency room setting, the member's AHCCCS acute care health plan is responsible for all emergency medical services including triage, physician assessment and diagnostic tests. The Contractor is responsible for psychiatric and/or psychological consultations provided to Title XIX and Title XXI ADHS enrolled members in emergency room settings.
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RESPONSIBILITIES OF MEDICARE PARTICIPATING
Page 11: "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in: o Placing the health of the individual (or, with respect to a pregnant woman, the health of a woman or her unborn child) in serious jeopardy; o Serious impairment to any bodily functions; o Serious dysfunction of any bodily organ or part; or o With respect to a pregnant woman who is having contractions: --That there is inadequate time to effect a safe transfer to another hospital before delivery, or --That the transfer may pose a threat to the health or safety of the woman or the unborn child.
Psychiatric hospitals that provide emergency services are obligated under these regulations to respond within the limits of their capabilities.
Some intoxicated individuals may meet the definition of "emergency medical condition" because the absence of medical treatment may place their health in serious jeopardy, result in serious impairment of bodily functions, or serious dysfunction of a bodily organ. Further, it is not unusual for intoxicated individuals to have unrecognized trauma.
Likewise, an individual expressing suicidal or homicidal thoughts or gestures, if determined dangerous to self or others, would be considered to have an emergency medical condition.
Sanctions: Medicaid MCOs that fail to cover emergency screening or stabilization services may be subject to intermediate sanctions or termination. Section 1932(e) of the Act authorizes States to use intermediate sanctions if an MCO fails substantially to provide medically necessary items and services that are required (under law or under the organization's contract with the State) to be provided to an enrollee covered under the contract. HCFA may also impose sanctions under 1903(m)(5)(A) of the Act if the failure to cover emergency services as required under 1932(b)(2) of the Act adversely affects (or has a substantial likelihood of adversely affecting) a Medicaid beneficiary. Contract termination may also be imposed for any violation of the requirements in sections 1903(m) and/or 1932 of the Act. http://cms.hhs.gov/states/letters/bba2208c.asp
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