Louisiana Behavioral Health Partnership (LBHP) Ser

Bobby Jindal

GOVERNOR

Bruce D. Greenstein

SECRETARY

Department of Health and Hospitals

Office of Behavioral Health

December 29, 2011

Dear Community Leaders, Stakeholders, and Providers:

The Louisiana Department of Health and Hospitals (DHH) and Office of Behavioral Health (OBH

) are

pleased to release the initial version of the Louisiana Behavioral Health Partnership (LBHP) Services

Manual for Magellan Health Services (Magellan). This manual is being provided to the public and

providers for informational purposes only. The release of this manual is not intended to be nor should it

be interpreted to be a call for public comment for revisions.

Enclosed, you will find the initial version of the LBHP Service Definitions Manual that OBH has provided

to Magellan Health Services as a technical document to construct their clinical guidelines for the LBHP.

After March 1, 2012, providers will need to be enrolled in Magellan’s network and receive authorization

prior to providing care for adults and children needing behavioral health services. Once the LBHP is

implemented on March 1, 2012, Magellan Health Services will pay providers for behavioral health

services. Prior to the implementation of the LBHP, Magellan Health Services will provide additional

information for providers regarding the provider enrollment process, service authorizations, and billing

procedures.

This manual was developed by DHH and is intended for use by Magellan Health Services and is provided

to the public for information only. Magellan Health Services of Louisiana will provide additional

information and handbooks in the future to help direct providers and recipients to provider network

organizations, behavioral health services, and direct care clinics. Any questions from providers are to be

addressed to the following email address: **************************************.

All providers should enroll with Magellan and follow authorization and billing guidance issued by them.

DHH Office of Behavioral Health and Bureau of Health Services Financing (BHSF)/Medicaid Vendor

Administration (MVA) have worked in collaboration with stakeholders and the State Governing Body

(SGB) for the Coordinated System of Care (

CSoC) to

develop this statewide services manual for

Magellan’s use in the LBHP initiative with the goal and purpose of restructuring and expanding

behavioral health services in Louisiana to better serve the needs of our citizens. The enclosed manual

describes LBHP services and basic requirements that Magellan must at a minimum require for any entity

or individual that is interested in providing behavioral health services within Louisiana’s public

behavioral health system. These entities may include:

 CSoC entities, including Wraparound Agencies, Family Support Organizations;

 State entities providing behavioral health services, including mental health and/or addictive

disorder services;

 Behavioral health contracted and non-contracted providers, including those that provide

emergency and post-stabilization services;

 Hospitals providing specialized behavioral health services;

Bienville Building ▪ 628 N. 4

th

Street ▪ P.O. Box 4049 ▪ Baton Rouge, Louisiana 70821-4049

Phone #: 225/342-2540 ▪ Fax #: 225/342-3875 ▪

“An Equal Opportunity Employer”

 Licensed residential and inpatient facilities providing mental health and/or addictive disorder

clinical services

 Licensed Clinicians in Private Practice

 School-based behavioral health providers (note: arrangements for claims and payment will be

developed in separate agreement between Magellan and DOE).

Within the enclosed LBHP Services Manual, you will find information regarding services that are

allowable and reimbursable through the LBHP as approved by the CMS authorities. The information in

the enclosed manual, including service definitions, service requirements, and reimbursement rates, are

reflective of the authorities documents that have been submitted to CMS for approval and have been

developed in accordance with Medicaid policies and protocols

Within the enclosed LBHP Services manual, you will find the following information outlined from DHH to

Magellan:

1. Services Definitions & Descriptions

2. Provider Qualifications

3. Eligibility Criteria

4. Limitations/Exclusions

5. Allowed Modes of Delivery

6. Additional Service Criteria

7. Practitioner Type allowed to provide each service

8. Reimbursement Rate per Unit for children’s services

- Note: Please be advised that reimbursement rates for adult services will be established and

developed by Magellan Health Services and released at a later date. The reimbursement

rates attached to this service manual are for children’s services only.

Overview of LBHP

The LBHP is the behavioral health program managed by the Department of Health and Hospitals (DHH) -

Office of Behavioral Health (OBH) for children, youth and adults. The LBHP is designed to serve the

needs of individuals who comprise one of the following target populations:

1. Children with extensive behavioral health needs either in or at-risk of out-of-home placement;

2. Medicaid-eligible children with medically necessary behavioral health needs who need

coordinated care;

3. Adults with severe mental illness and/or addictive disorders who are Medicaid eligible; and,

4. Non-Medicaid children and adults who have severe mental illness and/or addictive disorders.

The DHH Office of Behavioral Health and Bureau of Health Services Financing (BHSF)/Medicaid Vendor

Administration (MVA) are collaborating with the Department of Children and Family Services (DCFS), the

Office of Juvenile Justice (OJJ), and the Department of Education (DOE) to restructure behavioral health

services in Louisiana. Pending approval from the Centers for Medicare & Medicaid Services (CMS),

Magellan Health Services will:

a. Manage care for eligible children/youth in need of MH and AD services, including children

eligible for the CSoC, utilizing Medicaid, DCFS, DHH-OBH, DOE, and OJJ State General Funds

(SGF) and federal block grant financing.

b. Manage behavioral health services for Medicaid adults with addictive disorders as well as adults

with functional behavioral health needs, including: persons with acute Stabilization Needs;

Persons with SMI (federal definition of Serious Mental Illness); Persons with Major Mental

LBHP Services Manual Introduction: Page 2 of 4

Disorders (MMD); and adults who have previously met the above criteria and need subsequent

medically necessary services for stabilization and maintenance;

c. Manage MH and AD services for adults funded through state general funds (SGF), and the MH

and the Substance Abuse Prevention and Treatment (SAPT) Block Grant will also be managed by

the SMO under terms in the contract.

The Louisiana Behavioral Health Partnership (LBHP) is scheduled for implementation on March 1, 2012,

pending the approval of Medicaid state plan amendments and waivers submitted to the Centers for

Medicare & Medicaid Services (CMS).

The LBHP will be administered by Magellan, which is the Statewide Management Organization (SMO

)

procured

via the State’s request for proposals (RFP) process to administer the LBHP.

Magellan has

demonstrated experience and success in providing managed behavioral health care services within

complex, publicly-funded behavioral health programs.

Magellan will manage behavioral health services for Medicaid and Non-Medicaid eligible populations

including those Medicaid eligible children who will need coordination of services provided by multiple

agencies including OBH, DCFS, OJJ and DOE, or funded through state general funds and block grants,

including services for individuals with co-occurring mental health and addictive disorders. Providers will

need to enroll with Magellan, obtain authorizations for care and submit claims to Magellan in order to

obtain payment beginning on March 1, 2012.

Magellan has the experience to assist with the State's system reform goals to:

1. Foster individual, youth, and family-driven behavioral health (BH) services.

2. Increase access to a broader array of evidence-based home- and community-based services that

promote hope, recovery, and resilience.

3. Improve quality by establishing and measuring outcomes.

4. Manage costs through effective utilization of State, federal, and local resources.

5. Foster reliance on natural supports that sustain individuals and families in homes and

communities.

The Louisiana Department of Health and Hospitals (DHH) strives to make the information in this manual

as accurate, complete, reliable and as timely as possible for Magellan’s use. This is the most current

version of the Louisiana Behavioral Health Partnership (LBHP) Services Manual, which is being released

as an informational and educational tool; however, this manual is subject to change and future revisions

as the implementation and operations of the LBHP initiative continue to develop. This manual is

intended solely as an informational and educational resource for providers intending to participate in

the Louisiana Behavioral Health Partnership and for the public. As stated above, the release of this

manual is not intended to be nor should it be interpreted to be a call for public comment for revisions.

All providers should enroll with Magellan and follow authorization and billing guidance issued by them.

The DHH Office of Behavioral Health and Bureau of Health Services Financing (BHSF)/Medicaid Vendor

Administration (MVA) have worked in collaboration with stakeholders and the SGB for CSoC to develop

this statewide services manual for the LBHP initiative with the goal and purpose of restructuring and

expanding behavioral health services in Louisiana to better serve the needs of our citizens. The enclosed

manual describes LBHP services, requirements to provide these services for any entity or individual that

currently provides behavioral health services within Louisiana’s public behavioral health system or an

Bienville Building ▪ 628 N. 4

th

Street ▪ P.O. Box 4049 ▪ Baton Rouge, Louisiana 70821-4049

Phone #: 225/342-2540 ▪ Fax #: 225/342-3875 ▪

“An Equal Opportunity Employer”

entity or individual that is interested in providing behavioral health services within Louisiana’s public

behavioral health system.

DHH is grateful for the interest you have expressed in the LBHP. We look forward to working with you

as we move forward toward implementation of LBHP and improving the provision of behavioral health

services to those we serve.

LEGAL DISCLAIMER

The Louisiana Department of Health and Hospitals (DHH) strives to make the information in this manual as

accurate, complete, reliable and as timely as possible. However, DHH makes no claims, promises or

guarantees about the accuracy, completeness or adequacy of this information. This is the most current

version of the Louisiana Behavioral Health Partnership (LBHP) Services Manual, which is being released as an

informational and educational tool; however, this manual is subject to change and future revisions as the

implementation and operations of the LBHP continue to develop.

DHH, its employees, agents, or others who provide the answers will not be liable or responsible to you for

any claim, loss, injury, liability, or damages related to your use of or reliance upon this information.

This manual is intended solely as an informational and educational resource for providers intending to

participate in the Louisiana Behavioral Health Partnership and for the public. This information is not

intended to be a substitute for professional legal, financial or business advice. This manual does not create,

nor is it intended to create, an attorney-client relationship between you and DHH. You are urged to consult

with your attorney, accountant or other qualified professional if you require advice or opinions tailored to

your specific needs and circumstances.

LBHP Services Manual Introduction: Page 4 of 4