OMHSAS Releases IBHS Code Clarification and MA FFS Rate Schedule

The Office of Mental Health and Substance Abuse Services (OMHSAS) has released a bulletin today outlining Intensive Behavioral Health Services (IBHS) code clarification, rates, and MA Fee For Service (FFS) rates.

The bulletin outlines the IBHS overview, including the procedure codes for Individual Services, Applied Behavior Analysis (ABA) Services, and Group Services. In addition to the rate fee schedule is language on prior authorization for services.

OMHSAS cites the following fiscal impact overview: the fiscal impact estimated for Fiscal Year (FY) 2019–20 is $11.1 million ($5.3 million in State funds). The estimated fiscal impact for FY 2020–21 is $38.5 million ($18.4 million in State funds). The estimated fiscal impact for FY 2021–22 is $45.8 million ($21.9 million in State funds).

RCPA recommends you review the rate schedule in accordance with your service delivery continuum as part of your implementation planning. RCPA will be reviewing the bulletin and working with RCPA members, OMHSAS, and the BH-MCOs on the fiscal and operational implementation of the IBHS regulations.

There will be a public comment period, whereby interested persons are invited to submit written comments regarding the changes to the MA Program Fee Schedule to the Department of Human Services, Office of Mental Health and Substance Abuse Services, c/o Deputy Secretary’s Office, Attention: Regulations Coordinator, 11th Floor, Commonwealth Towers, 303 Walnut Street, Harrisburg, PA 17120.

Comments may also be emailed. Comments received will be reviewed and considered for any subsequent revisions to the MA Program Fee Schedule. Please forward comments and feedback to RCPA Children’s Division Director Jim Sharp as part of your OMHSAS response.

The RCPA IBHS work group will have its regularly scheduled meeting this week and report out as per process. Please contact Jim Sharp with any questions or feedback.