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The 1915(i) Behavioral Health state plan amendment (SPA), which runs concurrently with an 1115 Behavioral Health demonstration for managed care, will be extended for one year. The 1915(i) serves individuals with serious emotional disturbances and intellectual and developmental disabilities.
CMS is introducing a new RESTRICTED-BENEFIT-CODE (ELG097) value to identify individuals dually eligible for Medicare/Medicaid who are enrolled in the Medicare Part B immunosuppressive drug (ID) benefit coverage.
Proposes to update the effective date for the SPA that establishes the Alternative Benefit Plan MI uses to implement requirements of the Healthy Michigan Plan.
The SPA revises the maximum fee rates for substance use disorder (SUD) health home rates. Two new billing tiers have been added to the per-member-per-month reimbursement rate that providers receive for administering the six core health home services. The billing requirements to qualify for tiers of reimbursement will no longer be determined by direct time (time spent with the member in-person or via telehealth) but rather by delivery of core service time.