Rule 132 Overview, Medicaid Mental Health Services

Rule 132 Overview, Medicaid Mental Health Services

Rule 132 Training

  • Medicaid Mental Health Services

Available on DHS website

Rule 132 Requirements

  • Certification
  • Eligible Individual
  • Qualified Staff
  • Service Provision that is Medically Necessary
  • Documentation

Provider Certification

  • Certification reviews conducted by DHS Bureau of Accreditation, Licensure and Certification
  • Only certified providers may bill for delivery of Rule 132 services
  • Certified providers may not bill for services provided by other providers

Certification Details

  • On-Site Reviews
  • Notice of Deficiencies
  • Plans of Correction
  • Follow up Reviews Depending on Level
    • Level 1
    • Level 2
    • Level 3
    • Level 4

Some reminders about certification

  • Certified by service
    • Provider can only bill for services for which it is certified
  • Certified by site
    • May only bill for services provided at approved sites unless service is legitimately provided off site

Eligible Individual

  • Medicaid eligible
  • Diagnosis of mental illness
  • Requires medically necessary treatment

Staff qualifications

  • As defined and recognized in Rule 132
    • Licensed Practitioner of the Healing Arts (LPHA)
    • Qualified Mental Health Professional (QMHP)
    • Mental Health Professional (MHP)
    • Rehabilitative Services Associate (RSA)
  • Certified Recovery Support Specialist (CRSS)/Certified Family Partnership Professional (CFPP) = MHP

Required Documentation

  • Rule 132 requires specific documentation for each billed service
  • This documentation is subject to annual post payment review as well as certification surveys and potential Federal Centers for Medicare and Medicaid Services (CMS) audits

National Accreditation

  • DMH requires providers to be nationally accredited in behavioral health
  • Providers may choose to be accredited by one of the following:
    • The Joint Commission
    • CARF, The Accreditation Commission
    • The Council on Accreditation
    • Healthcare Facilities Accreditation Program

National Accreditation (Cont.)

  • Providers must become accredited when their billing for Rule 132 services reaches $200,000 annually
  • Providers must become accredited within one year of reaching that threshold and then maintain accreditation