Therapeutic services are primarily intended to provide mental health assessments, psychological testing and treatment to children and families not otherwise eligible, covered, or receiving the specific mental health services by another entity.

The following should be considered prior to authorizing services under this contract:

• All children with an open foster care or adoption case must use a Medicaid provider for any type of behavioral health services. This includes individual and family counseling, testing and assessment, etc.
• If a non-Medicaid provider serves the client(s), a bill that includes CPT (current procedural terminology) codes must be submitted with the payment request. The CPT codes will be used to determine the amount that Medicaid would have paid. This is the maximum amount that will be paid for that service.
• Adult clients are not eligible for counseling under straight Medicaid. If they do belong to a Managed Care plan, they are eligible for counseling services, but only through the plan network. Staff should be sure to explore all these options before authorizing counseling through CTS.
• If counseling services are court ordered, workers still MUST use either a Medicaid provider or a provider who has a CTS contract to provide the specific service needed. Most court orders do not specify which provider is to be used. If a provider is used who does not have a CTS contract, payment will be denied or reduced to the current rate paid under Medicaid.
• The client receiving the counseling must have active/open CA/N, case management, or adoption involvement with the Division.

Therapeutic Services include the following:

• Assessment: The assessment is usually the first stage of a treatment process, but mental health assessments may also be used for other varying purposes. The assessment includes social and biographical information, direct observations, and data from specifically administered tests. An assessment is most commonly carried out for clinical and therapeutic purposes, to establish a diagnosis and formulation of the individual’s needs, to plan the individual’s care and treatment. Assessments may be performed in an in-patient, out-patient, or community setting.

• Specialized Clinical Assessment/Psycho-Sexual Evaluation: This is a specialized clinical assessment of adult and juvenile sex offenders, which are also referred to as a psycho-sexual evaluation. These assessments are generally performed by a psychiatrist or a psychologist; however may be performed by a Licensed Professional Counselor (LPC).       Psycho-Sexual Evaluations are generally court ordered and may be utilized for either an adult or juvenile sex offender (client) where the court is trying to determine any of the following:

  •  
    • Risk of repeat behavior;
    • Interventions;
    • Specific risk factors;
    • Client’s willingness to participate in recommended treatments and/or interventions;
    • Identifying factors that may prevent engagement in treatment and/or interventions; or
    • Identifying strengths and protective factors

  Psycho-Sexual Evaluations may be used by judges and/or other parties to make informed decisions regarding the following:

  • Pre-sentencing in Adult or Juvenile Criminal Court;
  • Custody disputes in Family Court; or
  • Child Protection Cases

  Psycho-Sexual Evaluations shall not be used to determine the following:

  • Guilt or innocence;
  • Whether or not a client is a sex offender; or
  • Whether or not a client meets the profile of a sex offender.
• Behavioral Health Services: Behavioral Health Services is a clinical and/or therapeutic service provided to a client to meet their behavioral health needs which exceed the maximum allowable units provided by MO HealthNet. Behavioral Health Services are intended to help the child acquire functional skills in their community placement, to prevent hospitalization or placement disruption. The service is intended to address serious behavioral concerns including severe aggression and self-injury that traditional therapeutic techniques have been unsuccessful in treating. Behavioral Health Services may include but not be limited to:
  • Creating a behavior support plan, including the collection and analysis of data related to the child’s behavior.
  • Behavioral modification strategies to assist the child and family (teaching/modeling);
  • Development of coping strategies aimed at keeping the child in the foster/relative/kinship or adoptive/guardianship home; and,
  • Development of appropriate communication skills between the child and the parent/guardian.

• Crisis Intervention: Crisis intervention may be provided to a client in order to alleviate or diffuse a situation of immediate crisis. The situation must be of significant severity to pose an imminent threat to the client’s well-being or of such severity that the client poses a danger to others. Crisis intervention may be accessed when a family crisis is occurring which may result in child maltreatment.

• Family Therapy: The focus of this service is to correct family dysfunction so that the children of the family may remain in their home rather than being placed in alternative care or, if in placement, be reunited with the family. The service should be of limited duration, generally three (3) to six (6) months. Services shall include group therapy with the family, with the child present, as authorized, and occasional individual therapy sessions if recommended, including structured interaction led by the provider, communication exercises, role playing, task assignment and analysis, and parenting skills training.

• Group Therapy: This service is group therapy in the form of guidance and instruction through therapeutic interaction between the provider and a group consisting of at least three (3) but no more than ten (10) individuals, who are not all members of the same family.

• Individual Therapy: Individual Therapy is an intensive level of client specific therapeutic treatment services. Th focus of individual therapy is to correct client dysfunction so that the children of the family may remain in their home rather than being placed in alternative care or, if in placement, be reunited with the family.

• Speech Therapy: Speech Therapy is for clients who have speech, language or hearing impairments. The client’s need for this therapy must be determined in a speech/language evaluation conducted by a certified audiologist or a state certified speech therapist. Speech/language therapy (ST) is the evaluation and provision of treatment for the remediation and development of age appropriate speech, expressive and receptive languages, oral motor and communication skills. Speech therapy includes activities that stimulate and facilitate the use of effective communication skills. Speech/language therapy includes treatment in one or more of the following areas: articulation, language development, oral motor/feeding, auditory rehabilitation, voice disorders, and augmentative communication modes. Speech Therapy is a client specific treatment modality.

• Testing: Testing services include the administration and interpretation of an individual battery of one or more psychological/psychiatric tests appropriate to the needs of the client, the submission of a written report that includes the test results, a professionally appropriate analysis and interpretation of the result of the tests, and a recommendation for treatment. Though often performed directly following the completion of a mental health assessment, psychological/psychiatric testing services may be provided in lieu of or in addition to previously completed mental health assessments as warranted on a case specific basis. Testing services are often utilized to rule various mental health/personality disorders in or out and/or to reach a diagnostic determination.

• Vision Therapy: Vision Therapy is an individualized, supervised, treatment program designed to correct visual-motor and/or perceptual cognitive deficiencies. Vision Therapy sessions include procedures designed to enhance the brain’s ability to control:
  • Eye alignment;
  • Eye teaming;
  • Eye focusing abilities;
  • Eye movements; and
  • Visual processing.

Visual-motor skills and endurance are developed through the use of specialized computer and optical devices, including therapeutic lenses, prisms and filters. During the final stages of Vision Therapy, the clients newly acquired visual skills are reinforced and made automatic through repetition and by integration with motor and cognitive skills.

Related Practice Points and Memos:

1-10-20 – CD20-05 – Children’s Treatment Services

9-22-20 = CD20-45- Medical Record Fees