Time Sensitive Announcement from DHHS regarding incident to billing model

Time Sensitive Announcement from the Department of Health and Human Services

The Department of Health and Human Services (DHHS) has heard the concerns expressed regarding the change in billing for provisionally licensed clinicians announced on June 2, 2008 in Implementation Update # 44.

In order to address the concerns, DHHS is announcing today a change in that policy. The Department will implement the changes to the Medicaid "incident to" policy outlined in Implementation # 44; however, DHHS is removing the prohibition against Local Management Entities (LMEs) continuing to bill on behalf of agencies employing or contracting with provisionally licensed clinicians.

Effective July 1, 2008, the services of provisionally licensed clinicians may be billed to Medicaid and Division of Mental Health, Developmental Disabilities, and Substance Abuse Services funds in three ways: 1) when those clinicians are engaged in providing enhanced services, such as Intensive In-Home, Substance Abuse Intensive Outpatient, Assertive Community Treatment Team, etc.; 2) when they provide outpatient therapy under the revised "incident to" policy and their services are billed under the supervising physician’s provider number; and 3) when they provide outpatient therapy and the services are billed through the LMEs using "H" billing codes.

http://www.ncdhhs.gov/mhddsas/announce/provisionallylicensed6-24-08memo.pdf