IssuedJanuary 31, 2020

Effective February 1, 2020, providers may begin submitting Service Authorization Requests (SARs) for Community Support Team (CST) under the Definitions List “Community Support Team” and Services Code List “All Services”.  SARs may be submitted for members with either Medicaid or State-funded services.

The following CST codes and modifiers will be included in the “All Services” bundled list:

  • H2015 HT U1 – CST Peer Support Specialist
  • H2015 HT U1 DJ – CST DOJ Peer Support Specialist
  • H2015 HT HM – CST Paraprofessional
  • H2015 HT HM DJ – CST DOJ Paraprofessional
  • H2015 HT HN – CST Qualified Professional/Associate Professional
  • H2015 HT HN DJ – CST DOJ Qualified Professional/Associate Professional
  • H2015 HT HF – CST Substance Use Counselor (LCAS, LCAS-A, CCS, CSAC) *specific per service definition
  • H2015 HT HF DJ – CST DOJ Substance Use Counselor (LCAS, LCAS-A, CCS, CSAC) *specific per service definition
  • H2015 HT HO – CST Licensed Team Lead
  • H2015 HT HO DJ – CST DOJ Licensed Team Lead

Both Medicaid and State funded  members may receive CST beyond six months of services if they have a Comprehensive Clinical Assessment (CCA) Addendum or new CCA that recommends that the member continue CST after six months of service. The CCA Addendum may be completed by any licensed clinician at the provider agency.

A new Service Order is NOT required at or after six months of service. A new Service Order should be completed annually

Community Support Team Retroactive Service Authorization Requests:

Partners Utilization Management (UM) will allow the submission of retroactive SARs for Medicaid-funded CST for review back to December 16, 2019. In the case of  members seeking stable housing, providers MUST identify when the member started Permanent Supportive Housing Services. All retroactive SARs must be submitted to Partners UM by February 29, 2020. This does not apply to members receiving State-funded services.

Partners Benefit Plan for Medicaid and State Funded Members receiving Community Support Team:

Service Description

Benefit Limit

Level of Care

Source

Documentation Requirements

Community Support Team:

H2015 HT U1 – CST Peer Support Specialist

H2015 HT HM – CST Paraprofessional

H2015 HT HN – CST Qualified Professional/Associate Professional

H2015 HT HF – CST Substance Use Counselor (LCAS, LCAS-A, CCS, CSAC) * specific per service definition

H2015 HT HO – CST Licensed Team Lead

 

Department of Justice Members:

H2015 HT U1 (DJ) – CST Peer Support Specialist

H2015 HT HM (DJ) – CST Paraprofessional

H2015 HT HN (DJ) – CST Qualified Professional/Associate Professional

H2015 HT HF (DJ) – CST Substance Use Counselor (LCAS, LCAS-A, CCS, CSAC) * specific per service definition

H2015 HT HO (DJ) – CST Licensed Team Lead

Initial: Pass-through of 36 units for 30 days only once per treatment episode, once per fiscal year.

 

First Concurrent: Up to 128 units per 60 days. For those seeking permanent supportive housing, up to 420 units for 60 days.

 

 

Second Concurrent: Up to 192 units per 90 days. For those seeking permanent supportive housing, up to 630 units for 90 days.

LOCUS: 2-4

ASAM:  1-2.5

8A-6 Notification SAR is Required for Pass-through on Initial Service Authorization Request (SAR)

 

First Concurrent:  Comprehensive Clinical Assessment (CCA), Person Centered Plan (PCP) and Comprehensive Crisis Plan. Service Order is also required and is due on or before the first date of service. For those seeking permanent supportive housing, a housing goal must be included on the PCP.

 

Second Concurrent: Updated PCP.

New CCA or CCA Addendum needed if request exceeds six months per calendar year. For those seeking permanent supportive housing, a housing goal must be included on the PCP.

 

If you have any additional questions, please contact the Mental Health/Substance Use (MHSU) UM Workgroup at 704-842-6436.