Certified Peer Specialist Services. The HMO may elect to provide an enhanced behavioral health benefit to eligible members through the use of Certified Peer Specialist providers. This benefit is available for BadgerCare Plus and/or Medicaid SSI HMO enrolled adults (18 years and older) with a mental health and/or substance abuse diagnosis, especially members with a co-morbid diagnosis, who are at risk of hospitalization or who may have been hospitalized. Peer Specialists will be supervised by the HMO rendering provider, who must be a qualified mental health professional. Peer Specialists will be certified and trained by the Department’s Division of Care and Treatment Services (DCTS). DTCS maintains oversight of the training, certification and supervision requirements for peer specialist providers eligible for providing this benefit to HMO members. Peer specialist services will be billed under their supervising clinician’s NPI, using HCPCS code H0038 – Self-help/peer services. Up to 16 units may be billed per week. A unit is 15 minutes. Travel time to and from the member visits may not be billed separately, this time considered covered within the direct time reimbursement.
Certified Peer Specialist Services. Amend the first sentence to read: The HMO may elect to provide a behavioral health benefit in lieu of crisis stabilization, therapy services, and/or institutional placement to eligible members through the use of Certified Peer Specialist providers. Article VI, H.2 – Payment(s) for Ventilator Dependent Members, Medicaid SSI Criteria Effective on October 1, 2015, amend to read: The member had an inpatient stay for a minimum of four days or lesser length if the member died while on total respiratory support with one of the following qualifying LTC-DRG codes and the qualifying ICD-10-PCS procedure code where applicable: 870 - Septicemia or severe sepsis W MV 96+ hours, or 927 - Extensive third degree burn with skin graft and with ICD-10-PCS procedure code 5A1955Z (Respiratory ventilation, Greater than 96 Consecutive Hours), effective 10/1/15, or 933 - Extensive third degree burn without skin graft and with ICD-10-PCS procedure code 5A1955Z (Respiratory ventilation, Greater than 96 Consecutive Hours), effective 10/1/15, or 003 - Tracheostomy with mechanical ventilation 96+ hours or principle diagnosis except xxxx, xxxx and mouth diagnosis with major OR procedure, or 004 - Tracheostomy with mechanical ventilation 96+hours or principle diagnosis except xxxx, xxxx and mouth diagnosis without major OR procedure, or 207 - Respiratory system diagnosis with ventilator support 96+ hours. The need for total respiratory support must be supported by a copy of the UB-04 or a copy equivalent to the UB-04 with at least one of the LTC-DRG codes listed above with the designated ICD-10-PCS procedure code or a copy of the member’s admission history and physical exam, discharge summary, physician and nurse’s notes that pertain to the member’s ventilator use. Documentation must be submitted at the same time as the quarterly reports as specified in Article VII, K. The Department may approve additional DRGs if the medical records and ICD-10-PCS procedure code documents that the member was on continuous mechanical ventilation for 96 or more continuous hours and had an inpatient stay for a minimum of four days or lesser length if the member died while on total respiratory support. Addendum IV, L – Summary of the Maternity Kick Payment Report for Newborns to Department of Health Services Effective October 1, 2015, amend to read:
