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2019-25: Behavioral Health Alternate Payment Methodology In FQHCs And RHCs

Date: 04/18/19

Louisiana Healthcare Connections wants to ensure that our valued federally qualified health center (FQHC) and rural health clinic (RHC) partners are aware of recent changes to the alternative payment methodology (APM). LDH released Health Plan Advisory 19-7, establishing for Medicaid an APM for behavioral health services with dates of service beginning April 1, 2019. The APM applies to services provided by one of the following practitioners:

  1. Physicians with a psychiatric specialty
  2. Nurse practitioners or clinical nurse specialists with a psychiatric specialty
  3. Licensed clinical social workers
  4. Clinical psychologists

The APM allows reimbursement for behavioral health services equal to the all-inclusive prospective payment system rate on file for the date of service. This reimbursement will be in addition to any all-inclusive rate on the same date for medical and dental services. FQHC and RHC providers will use HCPCS Code H2020 for billing of the APM rate. Providers must submit the HCPCS Code H2020 on the first line of the claim submission and include detail lines for all services rendered along with the usual or customary charges or zero.
 
Louisiana Healthcare Connections is in the process of updating its system to accommodate the alternative payment methodology.  
 
Provided below are the billing options for current claims until the system configuration is in place on May 31, 2019:

  1. Providers can hold their current claims and then submit on or after May 31, 2019.
  2. Providers can bill their current claims with the APM code and receive claim denials. Shortly after configuration is in place, claims will be reprocessed requiring no further action on the provider’s part.

Louisiana Healthcare Connections is working with LDH to ensure this transition is as seamless as possible for our FQHC and RHC providers.