Social Security Mental Disorders Rule Update

Mental Disorders Rule Update

Woman with documents sitting on the deskOn Monday, September 26, Social Security will publish a final rule to update the criteria we use to evaluate disability claims involving mental disorders. This rule, “Revised Medical Criteria for Evaluating Mental Disorders,” is the most comprehensive revision to the criteria since 1985.

Upon publishing this final rule, our standards and terminology for evaluating claims involving mental disorders reflect information from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition — the mental health profession’s current standard classification of mental disorders.

While updating this rule, the public had questions about our criteria for evaluating intellectual disability. From childhood onward, people with intellectual disabilities experience deficits in intellectual functioning and lack many basic daily practical and social skills. We decided it was critical to ensure these individuals receive necessary assistance as soon as possible. Therefore, we updated the diagnostic and functional criteria for this disorder and are using IQ test score criteria to identify quickly people who may qualify for disability benefits based on an intellectual disability.

Besides reflecting comments from members of the public, the rule reflects the expertise of disability policy experts, adjudicators, psychiatric professionals, and vocational experts.

During the careful, considered process of updating the rule, we’ve engaged with stakeholders, including: disability beneficiaries and their family members; psychiatrists, psychologists, and other mental health treatment providers; and advocacy groups for those with mental disorders. We also solicited, responded to, and incorporated public comments, and considered an intellectual disability report we commissioned from the National Academy of Sciences.

People with mental disorders are some of the most vulnerable members in our society, and we take our duty to provide them with effective service and support seriously. Publishing this rule is just one way we’re meeting our priority to secure today and tomorrow for millions throughout life’s journey.

You can learn more about the rule here.

Important Message from TRICARE: Network Provider Application & Contract from ValueOptions Federal Services

Value optionstricare

DATE  04/15/2016
As you may be aware, our military family population is about to double (approximately 6 million) as we optimistically await award of the 2017 TRICARE® contract. In our work with TRICARE currently we are responding to the results of over ten years of active warfare, where military members and their families have endured the emotional whiplash of combat deployments coupled with brief respites and redeployments. Now, as we face the predicted mental health consequences, your clinical skill and expertise has never been more needed by your country.

Our Federal Network of mental health professionals has played a key role in the provision of world-class mental health and substance abuse services to the men and women of our military for nearly three decades. We see you as a critical partner and not simply a name on a provider directory. To that end, we will have provider representatives who can assist with any questions or issues you may have in order to minimize administrative burden for your staff. As a network provider, you will receive priority with regard to referrals so that you can maintain a patient/client base that meets your professional needs. You will have easy access to cutting-edge trainings, many of which will include free continuing education units. But most importantly, you will be part of a cadre of professionals who have vowed to make a difference for America.

We understand that there are innumerable competing priorities for your services, and that a professional practice requires a level of cash flow to meet those needs. Being fully aware of the necessity of payer mix, we only ask that you consider setting aside a small percentage of your practice time to help these people who have sacrificed so much for all of us.

ValueOptions® Federal Services is dedicated to providing quality customer service to our members and our network providers. An adequate network of dedicated professionals providing much-needed care is therefore critical. We need Your Help, and extend an invitation for you to join the provider network for TRICARE, assuming you meet requisite licensing and credentialing requirements in the state where service is to be rendered. Once TRICARE announces the award of the 2017 contract, you will be credentialed by ValueOptions Federal Services. After credentialing has been completed in full, you will be a TRICARE network provider and eligible for TRICARE referrals at the start of health care delivery.

Below are links for the ValueOptions Federal Services/TRICARE Provider application, agreement and Fee Schedule. Click to open for review and signature.

CLICK HERE FOR APPLICATION

CLICK HERE FOR FEE SCHEDULE

 CLICK HERE FOR TRICARE AGREEMENT
Should a disqualifying issue occur in credentialing it may affect the agreement for TRICARE, but will have no effect on your other agreements with ValueOptions and Beacon Health Options. Please return as soon as possible by email toServingOurMilitary@valueoptions.com. If email is inconvenient, you can fax the agreement back to: 1-855-745-9579. Lastly, if your preference is to mail the agreement back, please mail to:

ValueOptions Federal Services, Inc.

Attn: TRICARE Provider Relations

1434 Crossways Boulevard Ste. 150

Chesapeake, Virginia 23320

Should you have any questions, please contact us atServingOurMilitary@valueoptions.com.

Your service is greatly needed and we thank you for your dedication to our military men and women. We are ready and willing to assist you.

Blue Cross Blue Shield of Michigan (BCBSM) & Blue Care Network (BCN) direct reimbursement available for Licensed Professional Counselors

After years of collaborative efforts, Licensed Professional Counselors (LPCs) are now eligible to begin the BCBSM and BCN paneling process beginning October 1, 2015 and reimbursement for services rendered will begin January 1, 2016.

LPCs will have the opportunity to participate in Blue Cross Blue Shield of Michigan’s Traditional, TRUST (PPO) and Mental Health and Substance Abuse Managed Care networks (BCN). Participating LPCs will receive direct reimbursement for covered mental health services that fall within their scope of practice/licensure (which includes any service an LPC has formally/ethically received training, i.e. see MCA/MMHCA scope of practice document).

Covered mental health services will be reimbursed at 80 percent of the Traditional, TRUST and MHSAMC doctoral level practitioner fee schedule, less any member deductibles and copayments. Additional provisions for expanded coverage continue and will be made available for dissemination as they become active, i.e. reimbursement parity for doctoral level LPCs, etc.

Note: Not all BCBSM plans (i.e. Self-Funded Plans) will cover LPC services or services billed directly by an LPC. However, services may still be billed on an “incident to” basis for both LPCs and LLPCs until these plans adopt coverage for LPCs. As additional Self-Funded Plans become eligible for contract renewal, it is expected they too will adopt LPCs as covered providers under their respective plans. To find out if a subscriber has coverage, check web-DENIS for member benefits and eligibility or call PARS at 1-800-344-8525. Also, if an LPC registers as a ‘nonparticipating’ provider for Traditional BCBSM plans, payments for covered services will be sent directly to the member.

Beginning October 1, 2015, LPCs can find the Traditional, TRUST and MHSAMC practitioner agreements and enrollment forms on bcbsm.com. To find enrollment information, click on Providers, and then on Join the Blues Network and Enrollment and Changes. Specific qualification requirements are identified within each agreement. Qualified LPCs may apply for a BCBSM provider identification number by completing the enrollment applications available on this site.

Beginning February 1, 2016, LPCs (or any provider type) will not be able to enroll in BCN until the next enrollment period which is October 1, 2016 through January 31, 2017.

All interested LPCs must be registered with a National Provider Identification (NPI) number, as well as a Council for Affordable Quality Healthcare (CAQH) number. Additional information on how to obtain these numbers are available online to members of Michigan Mental Health Counselors Association (MMHCA).

For more information, contact Provider Inquiry, your BCBSM provider consultant, or MMHCA.

Thank you to all that participated in this awaited accomplishment.

Donald E. Deering, Ph.D., LPC, NCC

President, Michigan Mental Health Counselors Association

AMHCA, ACES, and NBCC Jointly Endorse Plan for Counselor Licensure Portability.

The American Mental Health Counselors Association (AMHCA), the Association for Counselor Education and Supervision (ACES), and the National Board for Certified Counselors (NBCC) have jointly endorsed a plan for counselor licensure portability. This plan from leading counselor organizations establishes a regulatory platform allowing licensed counselors to move between and practice in multiple states.

The AMHCA-ACES-NBCC portability plan is built on sound principles of quality assurance and national standards. The plan will promote acceptance of a license from another state when the individual holds a degree from a clinically focused counselor preparation program accredited by the Council for Accreditation of Counseling & Related Educational Programs (CACREP), holds certification as a National Certified Counselor, or meets standards adopted by the state board of counseling.

Dr. Keith Mobley, president of AMHCA, states: “The AMHCA leadership commends the efforts of NBCC and ACES for collaborating on this agreement, as it demonstrates strides toward professional unification and portability of licensure. It has been the long-standing goal of AMHCA to seek consistently high standards among credentials for clinical mental health counselors so that our profession may benefit by achieving status equivalent to other practitioners in federally funded programs and gain license portability among states.”

The sentiments are echoed by ACES President Dr. Tarrell Portman, who says: “the counseling profession has too long suffered from inconsistency in education and training standards. These varying requirements have hampered the growth of the profession and the ability of counselors to move across state lines. ACES is excited to be part of this strategic partnership to establish a national education and training standard for licensure portability.”

“This portability plan is a tremendous step forward for the counseling profession,” says NBCC’s Board Chair, Dr. Kylie Dotson-Blake. “The adoption of a CACREP degree or the NCC will give licensure boards the quality control they need to recognize out-of-state licensees. NBCC applauds the AMHCA and ACES leadership for uniting behind this pioneering plan.”

Dr. Mobley summarizes the views of all the organizations when he says, “We are grateful for the collaboration and shared vision for licensed professional mental health counselors and invite other organizations and leaders of our profession to participate.”

 

Sincerely,

Dr. Keith Mobley
President

American Mental Health Counselors Association

Sincerely,

Dr. Tarrell Portman
President

Association for Counselor Education and Supervision

 

Sincerely,

Dr. Kylie Dotson-Blake
Chair

National Board for Certified Counselors

About the Organizations

The American Mental Health Counselors Association (AMHCA) is the leading national organization for licensed clinical mental health counselors.
The Association for Counselor Education and Supervision (ACES) is the premier organization dedicated to quality education and supervision of counselors in all work settings.
The National Board for Certified Counselors is the premier certification organization for the counseling profession.

Final TRICARE Rule

NBCC announces that the Department of Defense released the final rule establishing standards for counselor participation in the TRICARE program today.

This final rule follows the previous interim final rule (IFR), which was released in December 2011 and created the initial criteria for counselor independent practice under TRICARE. The final rule modifies the IFR in response to comments and concerns expressed by the public.

NBCC has been an active proponent of independent practice rights for counselors in TRICARE for over a decade, and this rule is the culmination of that effort. The IFR granted independent practice authority to counselors, but contained a number of burdensome limitations.

NBCC believes the final rule is a significant improvement over the IFR and is pleased to see many of our recommendations were incorporated. The entirety of the rule can be read here; the highlights of the changes include the following:

  • Extension of the transition period to 2017
    • Previously, the IFR was scheduled to end December 31, 2014, but the final rule extends the transition period for two years, until January 1, 2017. Additionally, TRICARE clarified that any counselor meeting the transition criteria before January 1, 2017, could apply at any time under those standards (including after the transition period closes). Many organizations, including NBCC, have advocated for a longer transition period.  With this extension, the transition period is five years.

      The transition period educational and test requirements include:

      • Possession of a master’s degree or higher from a mental health counseling program accredited by the Council for Accreditation of Counseling & Related Education Programs and passage of the National Counselor Examination for Licensure and Certification (NCE)OR
        Possession of a master’s degree or higher in counseling from a regionally accredited institution and passage of the National Clinical Mental Health Counseling Examination (NCMHCE).
  • Indefinite continuation of the supervised counselor status
    • The IFR allowed counselors to continue to practice under physician supervision as supervised mental health counselors (SMHCs) until January 1, 2015. After that date, the SMHC status would no longer be reimbursed. The final rule removes the expiration date and extends the SMHC status indefinitely. Consequently, counselors currently practicing under supervision may continue to do so for the foreseeable future.

The final rule will take effect on August 18, 2014.

 

NCCs interested in more information can review the final rule or contact the Behavioral Health Branch at 703-681-0064703-681-0064. NBCC is pleased with the positive improvements to the TRICARE standards found in the final rule, particularly those requirements broadening inclusion, extending the transition period and expanding access to counselors for TRICARE beneficiaries.

Consultation Center, Sturgis Medical Group Begin New Collaboration

Sturgis Medical Group and Sturgis Consultation Center are partnering to provide integrated behavioral health care to patients of SMG, on site, at The Sturgis Medical Commons I.

Integrated behavioral health care involves the patient, the physician and the counselor.  There are numerous models for integrated behavioral health care andSMGandSCCare working to accommodate both the physicians and the patients.

As state by the Integrated Behavioral Health Project, iphp.org, “Integrated behavioral care acknowledges the mind’s inextricable connection to the body and fully recognizes that what happens to one, profoundly impacts the other.”

According to IBHP some physical conditions may be addressed by behavioral health counselors in a primary care setting. Behavioral counselors can teach relaxation techniques and counsel patients how to reduces or avoid stressors that can exacerbate asthma, hypertension and coronary artery disease as well as anxiety and depression.  Other behaviors that may affect physical health and can be modified with behavioral counseling are: smoking, drug abuse, alcohol consumption, poor nutrition, obesity, difficulty sleeping, compliance with physician prescribed medical plans and others.

A physician may offer the patient the option to meet briefly with the behavioral counselor right in the exam room where a short assessment may take place and a future appointment with the counselor discussed.  Because the behavioral health counselor is on site, the patient experiences the benefits of having two professionals working together to provide quality care.

Another benefit to the patient is the convenience of multiple services at one location or, “one-stop shopping.”  A patient can access behavioral, emotional and mental health care in a setting that is familiar and easily accessible.

Many physicians recognize the need for and benefits of behavioral counseling for the patients.  There are commonly five levels of integrated behavioral health care: 1. The primary care physician refers a patient to an outside provider. 2. The primary care physician and the outside provider communicate about the patient.  3. The primary care physician and behavioral health counselor have separate systems but share a physical location. 4. Close collaboration in a partly integrated system 5. Close collaboration in a fully integrated system where a conscious effort toward a team approach is in place.

The goal of Sturgis Medical Group andSturgisConsultationCenteris to provide fully integrated or level 5, services for patients.  We are very excited to offer these innovative services to the Sturgis Medical Group population.

Article contributed by Jennifer Colberg who is on staff at Sturgis Consultation Center in Sturgis.

 

 

Why does MMHCA Sponsor Supervisor Training?

By James Blundo

Often I am asked, “Why does MMHCA sponsor supervisor training?” I want to take this opportunity to answer that question.

MMHCA sponsors supervisor training because we believe the role of supervisors is so important. Supervisors are the leaders of our profession in Michigan and help to shape our profession in our state. This is why it is so important that Michigan supervisors have a good understanding of our law, its history, and the unique challenges we face as Licensed Professional Counselors in Michigan. We guarantee that our MMHCA sponsored program offered by the Mentoring Institute provides this information in a way that a discounted, out-of-state program cannot.

Dr. Sara Sue Schaeffer, LPC, LMFT, ACS, one of the co-leaders of our training, served for many years as the Licensure Chair for the Michigan Counseling Association and as the first Chair of the Michigan Board of Counseling. She currently serves as Co-Chair of the MMHCA Licensure Committee along with Dr. Irene Mass Ametrano, LPC, ACS, past Co-Chair of the Michigan Board of Counseling. Dr. Schaeffer and Dr. Ametrano helped write our law, were instrumental in writing the first set of Administrative Rules to implement the law, and currently work intensely with MMHCA to protect our scope and right to practice. The MMHCA-sponsored training includes their book and DVD which are not available in any other training program.

I need to share one last important reason why your support of our supervisor training program is so critical. We currently face serious challenges to our scope of practice and ability to collect third-party reimbursement which has the potential to affect every LPC in Michigan. MMHCA is working diligently on your behalf to address these challenges. Every MMHCA member who signs up for our MMHCA-sponsored training program receives a discount on the training, and your membership in MMHCA helps us fund the efforts to defend your right to practice. In addition, we are currently offering a one-time only discount that makes this program more affordable than others.

If you are currently a LLPC Supervisor, please share this information with your colleagues who aspire to become supervisors. If you are looking for a quality supervisor training program that also supports your profession and right to practice, please sign up for our MMHCA-sponsored training program offered by The Mentoring Institute. The next program is beginning right now, but it is not too late to register.  For more information, contact Dr. Sara Sue Schaeffer at 269-327-6030.

14 Insurance Companies Will Look to Gain Business in Michigan

Fourteen different health insurers, some of which are run by health systems, have applied to sell health plans on Michigan’s health insurance exchange, according to a Detroit News report.

The 14 insurance companies will look to gain business among Michigan’s 1.3 million uninsured people. Enrollment for exchange plans begins in October and goes into effect Jan. 1. The following insurers have applied to sell plans but still must be approved by state and federal officials:

•    Alliance Health and Life Insurance Co.
•    Blue Care Network of Michigan
•    Blue Cross Blue Shield of Michigan
•    Consumers Mutual Insurance of Michigan, which is a CO-OP
•    Health Alliance Plan
•    Humana Medical Plan of Michigan
•    McLaren Health Plan
•    Meridian Health Plan of Michigan
•    Molina Healthcare of Michigan
•    Physicians Health Plan
•    Priority Health
•    Priority Health Insurance Co.
•    Total Health Care USA
•    United Healthcare Life Insurance Co.

BCBS of Michigan has sent out a request for proposal to hospitals and physician practices who are interested in being in the provider network of two of its exchange plans, according to a Crain’s Detroit Business report.

More Articles on Hospitals and Health Insurance:
UnitedHealthcare to Double Value-Based Contracts With Providers by 2017
Covenant Health, Tennova Sign Deal With Tennessee’s CO-OP
University of Iowa Health Alliance Partners With Multistate CO-OP 

Electronic Communication in Counseling

The question of the use of electronic communication in counseling practices has been on member’s minds for some time. There does not appear to be an explicit mention of this in the Michigan Rules. In ACA and AMHCA guidelines, the need to ensure that appropriate counseling practices are followed is clear. At present, this would appear to mean that Licensed Counselors be clear to any clients in their practice agreements that telephone , including Skype, and email communications are not absolutely confidential. It does not currently appear to be legal for Michigan Licensed professionals to counsel clients in states outside of Michigan unless they are also licensed in those states.

 

Article by Eric Blumberg, PhD, LPC, CAADC

MMHCA Legislative Chair

Current Procedural Terminology (CPT) Codes

 

As you probably know, beginning January 1, 2013 there are new AMA directives regarding Current Procedural Terminology (CPT) codes.  The following are the new codes for licensed professional counselors.  These new codes must be used for all billing statements.

 

Old          New          New Description

90801      90791       Diagnostic interview examination including history, mental status, disposition provided by a non-physician

90804      90832       Individual psychotherapy 30 minutes (16-37 minutes)

90806      90834       Individual psychotherapy 45 minutes (38-55 minutes)

90808      90837       Individual psychotherapy 60 minutes

 

Crisis Management

90839       Intervention for the first 30 to 74 minutes

90840       Intervention for each additional 30 minutes

 

These codes remain unchanged:

90846                       Family psychotherapy (without patient present)

90847                       Family psychotherapy (conjoint psychotherapy)

90849                       Multi-family group psychotherapy

90853                       Group psychotherapy (other than of a multiple-family group)

 

Here’s a web site you may want to access for more information.

http://www.valueoptions.com/providers/Files/pdfs/CPT_Code_Changes_Presentation_Slides.pdf