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The purpose of this bulletin is to provide information about the transition process and requirements for service authorizations for Medicaid members and providers affected by the July 1, 2021 implementation of the enhanced services through Project BRAVO.  These transitions include:

• Intensive Community Treatment (H0039) transitioning to Assertive Community Treatment (H0040)
• Day Treatment/Partial Hospitalization (H0035 HB) transitioning to Mental Health Partial Hospitalization Program (H0035)
• Therapeutic Day Treatment (H0035, all modifiers) transitioning to a new procedure code H2016

The transitions for Intensive Community Treatment fall into several categories and guidance for each is listed below:

• Intensive Community Treatment (H0039) Service Authorizations that end on 06/30/2021:
  • The provider must submit a new initial Assertive Community Treatment (H0040) service request authorization, individual service plan (ISP) and the most recently updated assessment if the individual requires continued services beyond 6/30/2021.
• Intensive Community Treatment (H0039) Service Authorizations that extend beyond 06/30/2021 for Assertive Community Treatment providers that have become licensed by the Department of Behavioral Health and Developmental Services (DBHDS) and credentialed with the MCOs/BHSA:
  • The existing service request authorization will be administratively transferred to the new code for Assertive Community Treatment (H0040) by the Managed Care Organization (MCO) or Behavioral Health Services Administrator (BHSA) for the duration of the original authorization.
  • However, the provider must submit a new initial Assertive Community Treatment (H0040) service request authorization, ISP and the most recently updated assessment no sooner than 14 calendar days (MCO) or 30 days (BHSA) before the end of their original service authorization end date in order to request continued service.

For Example: A provider has a current ICT authorization from March 1, 2021 through August 31, 2021. The MCO or the BHSA will end date the ICT authorization for 06/30/2021 and start an ACT authorization from 07/01/2021 through 08/31/2021.  The provider will not need to submit any additional paperwork for the ICT authorization to transfer to an ACT authorization.  The provider will be notified by the MCO/BHSA of the new ACT authorization. The provider would need to submit a new initial ACT service request authorization to the MCO/BHSA and complete a new ISP and updated assessment in order to request that ACT services continue beyond 08/31/2021.

• Intensive Community Treatment (H0039) Service Authorizations if the provider has not been licensed by the Department of Behavioral Health and Developmental Services for Assertive Community Treatment (H0040) and contracted with the MCO/BHSA by 07/01/2021:
  • The service request authorizations that extend beyond 6/30/2021 will expire and cannot be billed against. The MCOs/BHSA will identify affected members, coordinate with service providers and either transition the individual to a licensed/contracted ACT provider or plan for alternate wrap around services as established in an active plan of care.

The following guidance is for the transition of Day Treatment / Partial Hospitalization to the new Mental Health Partial Hospitalization Service:

• Day Treatment/Partial Hospitalization (H0035 HB) Service Authorizations that end on 06/30/21:
  • The provider must submit a new initial Mental Health Partial Hospitalization Program (H0035) service request authorization, ISP and the most recently updated assessment if the individual requires continued services beyond 6/30/2021.
• Day Treatment/Partial Hospitalization (H0035 HB) Service Authorizations that extend beyond 6/30/21:
  • The service request authorization will be transferred to the new code for Mental Health Partial             Hospitalization Program (H0035) for the duration of the original authorization.
  • The provider must submit a new initial Mental Health Partial Hospitalization Program (H0035) service request authorization, individualized service plan and updated assessment prior to the end of their original service authorization end date in order to request continued service.

The following guidance is for the transition of Therapeutic Day Treatment services to the new procedure code H2016. There is no change in the service description, provider qualifications, or medical necessity criteria for Therapeutic Day Treatment services; this service is simply undergoing a code change to assure that the codes DMAS assigns are aligned with correct coding based on national definitions.

• Therapeutic Day Treatment Service (H0035 HA, UG, U7) Authorizations that end on 06/30/21:
  • The provider must use and submit the new Community Mental Health Rehabilitation Services continued stay service authorization request form with the new procedure code for Therapeutic Day Treatment (H2016) if the individual requires continued services beyond 6/30/2021.
• Therapeutic Day Treatment Service (H0035 HA, UG, U7) Authorizations that extend beyond 6/30/21:
  • The service request authorization will be administratively transferred to the new code for             Therapeutic Day Treatment (H2016) by the MCOs/BHSA for the duration of the original authorization.

All forms can be found here on the DMAS website: https://www.dmas.virginia.gov/for-providers/behavioral-health/training-and-resources/

For questions, please email: enhancedbh@dmas.virginia.gov

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