Mercy Care has been evaluating services provided by BHRFs. This notice shall serve as both a notice of change to the BHRF authorization and billing process as well as a reminder of the types of services that should be provided within the BHRF environment.
BHRF requirements
:
- BHRF is a 24-hour therapeutic living environment.
- Under the 24-hour treatment umbrella it is expected that there is counseling, groups, or other therapeutic activities. The members should not be simply present. This is a therapeutic setting and treatment should be occurring at the facility site. Please note that AHCCCS AMPM 320-V notes the following services as required to be made available and provided by the BHRF:
- Counseling and therapy (group and individual).
- Skills training and development.
- Behavioral health prevention/promotion and medication training and support services.
- There may be special circumstances/occasions where treatment may need to be provided by another agency but this should be a rare occurrence and the need should be noted within the treatment plan to describe why the facility in which the member is placed cannot provide what the member needs. This should not be the routine or normal process for any BHRF.
- There should be documentation for the entire 24-hour period the member is present in the facility and this includes time the member is sleeping. Documentation is expected to be present for the entire 24-hour period to note the member’s presence in the facility. Any time in which the member is inpatient, has gone AWOL or is otherwise not present, this should be documented for coordination of care purposes. As a reminder, dates on which the member is inpatient, AWOL or has been discharged are not billable.
- Billing should be based on where the member is at 11:59 p.m. Regardless of the time of placement or return to the facility, the day is billable if the member is present at 11:59 p.m. The discharge day is not billable as the member is not there for the full day. This mechanism provides a fair way to bill as there may be days for which you get credit when the member is not there for a full day.
- Start and stop times are required to be present on all documents including notes for therapeutic services occurring in the facility. This is helpful in determining the total time members are spending in therapeutic activities during the day and is important for coordination of care purposes.
- Documentation of services should be thorough including appropriate dates of service and staff signatures. Documentation is often found to be insufficient or illegible on review. Please ensure that documentation is thorough and accurately describes the behavioral health services provided and the member’s response to those services.
Room and Board
:
Members with income may be billed for room and board in accordance with Mercy Care Room and Board Agreement for Behavioral Health Residential Facilities. The remaining balance of room and board may be billed to Mercy Care (this only applies to MCCC, Mercy DD and Mercy RBHA). Effectively immediately Mercy Care will be implementing the following requirements for all BHRFs:
- Providers must develop a policy on room and board. The policy must::
- State the method for determining member’s income.
- State the methodology for determining how much is collected from the member.
- State how the room and board is collected and recorded.
- State how the room and board collected from the members is tracked to ensure that Mercy Care is not also billed.
- Be in accordance with 9 A.C.C 10 Article 7 -711 Resident Rights B. 1.I.
- Discharge or transfer, or threat of discharge or transfer, for reasons unrelated to the resident’s treatment needs, except as established in a fee agreement signed by the resident or the resident’s representative.
- Please provide a copy of your developed room and board policy to your PRL by 8/1/20.
- Mercy Care will continue to monitor room and board billing.
- Behavioral Health Residential Facility providers are responsible for verification of benefits monthly and coordination with Outpatient clinical teams to pursue eligibility and financial benefits.
Personal Care Services (PCS)
Some BHRFs may be licensed to provide personal care services in accordance with 9 A.C.C. 10 Article 7 as part of the BHRF treatment. Please see
AHCCCS AMPM Policy 320-V
for examples of the types of activities included in personal care. BHRFs providing the added personal care service need to be aware of the following requirements:
- The provider must be licensed to provide the personal care.
- Services are captured by appending modifier TF (effective for dates of service 10/1/19 forward).
- The TF modifier beginning 8/1/2020 for PCS services must be authorized by Mercy Care Utilization Management or MCLTC Case Manager and is not to be appended to every member simply because the provider is licensed to provide personal care.
- The member’s needs that require additional assistance via personal care must be documented in the member’s treatment plan.
Complex/high level care is also noted to have been billed for multiple BHRFs
with either the TF or TG modifier
.
This modifier should be billed only when Mercy Care Utilization Management (for MCCC, Mercy DD and Mercy RBHA) or the Case Manager (MCLTC) has received a request and prior authorized the use of the TF or TG modifier and the clinical team and facility treatment provider has documented the need for a higher level of care. This must be noted in the treatment plan.
Note:
These cases will be reviewed at the intensity determined by Mercy Care Utilization Management.
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