DHS Publishes New Increased Outpatient Behavioral Health Rates

December 21, 2017

The Department of Health Services (DHS) formally published new Medicaid reimbursement changes for outpatient behavioral health services in the December 2017 ForwardHealth Update No. 2017-41. Gov. Scott Walker and DHS Secretary Linda Seemeyer announced in October an approximately $17 million investment, including $7 million in state funding, to raise Medicaid reimbursement rates for professionals providing outpatient mental health and substance use disorder services.  

Effective for dates of services on and after January 1, 2018, the December ForwardHealth Update makes three changes to current Medicaid reimbursement for outpatient mental health and substance abuse services:

  • Reimbursement Rates - New higher Medicaid reimbursement rates are listed for those services outlined in the Outpatient Mental Health and Outpatient Substance Abuse service areas of the Forward Health Online Handbook.
  • Rate Structure – There will be two sets of fees per procedure depending upon the provider’s professional licensure rather than four sets of fees per procedure.  For example, previously, psychotherapy services provided by a physician psychiatrist were paid at a higher rate than a Ph.D. psychologist; under the new rate structure, services provided by a physician psychiatrist and a Ph.D. psychologist are paid the same rate.
  • New Substance Abuse Claims Submission Requirements – Under the Update, certain substance abuse codes will now represent 15 minutes of service per one unit rather than 60 minutes of service per one unit.

The ForwardHealth Update did not include any reimbursement changes for evaluation and management (E/M) codes now commonly used by psychiatrists and APNP-psych providers following national coding standard changes in 2013 that deleted dedicated psychiatric evaluation codes. In comments submitted by WHA to DHS in November, WHA noted member feedback that E/M codes now make up at least 80 percent of psychiatrists’ outpatient visits for Medicaid visits and recommended that DHS include E/M codes used by psychiatrists and APNP-psych providers in its outpatient behavioral health reimbursement increase.  

“WHA applauds Governor Walker’s leadership in making investments in Medicaid reimbursement rates to make outpatient behavioral health services more financially sustainable and accessible,” said Eric Borgerding, WHA president/CEO.  “Increasing the Medicaid reimbursement rate for outpatient behavioral health services billed as E/M codes by psychiatrists will be a priority for WHA, and we look forward forward to working with DHS, the administration, and legislators in that effort.”

This story originally appeared in the December 21, 2017 edition of WHA Newsletter