SLS 18RS-1409 ORIGINAL
2018 Regular Session
SENATE BILL NO. 519
BY SENATOR LUNEAU
HEALTH CARE. Provides relative to behavioral health services providers. (gov sig)
1 AN ACT
2 To enact R.S. 40:2153 (15), (16), (17), and (18) and R.S. 40:2155.1, relative to behavioral
3 health services providers; to provide relative to psychosocial rehabilitation and
4 community psychiatric supportive treatment and reimbursement for behavioral
5 health services; to provide conditions that shall be met by provider agencies; to
6 provide for audits and facility need review; to provide for a certification review
7 process; to require recoupment of Medicaid funds under certain circumstances; to
8 provide for the promulgation of rules and regulations; and to provide for related
9 matters.
10 Be it enacted by the Legislature of Louisiana:
11 Section 1. R.S. 40:2153 (15), (16), (17), and (18) and R.S. 40:2155.1 are hereby
12 enacted to read as follows:
13 §2153. Definitions
14 For the purposes of this Part, and subject to the provisions of R.S. 40:2154,
15 unless the context otherwise clearly indicates, the following terms shall have the
16 following meanings:
17 * * *
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1 (15) "Certified mental health professional" means an individual who
2 meets both of the following qualifications:
3 (a) Holds a bachelor's degree from an accredited university or college in
4 the field of counseling, social work, or psychology.
5 (b) Has obtained any required license or certification to render and
6 provide mental health rehabilitation services in this state.
7 (16) "Community psychiatric supportive treatment", hereinafter
8 referred to as "CPST", means goal-directed supports and solution-focused
9 interventions intended to achieve identified goals or objectives as set forth in the
10 individual's individualized treatment plan. CPST is a face-to-face intervention
11 with the individual present. A minimum of fifty-one percent of CPST contacts
12 must occur in community locations where the person lives, works, attends
13 school, or socializes.
14 (17) "Mental health rehabilitation" means outpatient behavioral health
15 services which are medically necessary to reduce the disability resulting from
16 mental illness and assist in the recovery and resiliency of the recipient. These
17 services are home- and community-based and are provided on an as-needed
18 basis to assist recipients in coping with the symptoms of their illness.
19 (18) "Psychosocial rehabilitation", hereinafter referred to as "PSR",
20 means services designed to assist the individual with compensating for or
21 eliminating functional deficits and interpersonal or environmental barriers
22 associated with mental illness. PSR activities shall be intended to achieve the
23 identified goals or objectives as set forth in the individual's individualized
24 treatment plan. The intent of PSR is to restore the fullest possible integration
25 of the individual as an active and productive member of his family, community,
26 and culture with the least amount of ongoing professional intervention. PSR is
27 a face-to-face intervention with the individual present. Services may be
28 provided individually or in a group setting. A minimum of fifty-one percent of
29 PSR contacts must occur in community locations where the person lives, works,
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1 attends school, or socializes.
2 * * *
3 §2155.1. Psychosocial rehabilitation; community psychiatric supportive
4 treatment
5 A. Only the following individuals may provide and be reimbursed by the
6 department for certain behavioral health services:
7 (1) Psychosocial rehabilitation services, hereinafter referred to as
8 "PSR", shall be provided by one of the following:
9 (a) A certified mental health professional.
10 (b) An individual who does not satisfy the definition of a certified mental
11 health professional, but who met all of the provider qualifications and has been
12 providing PSR services on a full time basis for a period of at least one year
13 before August 1, 2017.
14 (2) Community psychiatric supportive treatment, hereinafter referred
15 to as "CPST", shall be provided by a certified mental health professional who
16 has attained a master's or doctorate degree in counseling, social work, or
17 psychology from an accredited university or college. The reimbursement rate
18 for any CPST services provided by a certified mental health professional
19 without a master's or doctorate degree in counseling, social work, or psychology
20 from an accredited university or college shall be the same as that provided for
21 similar PSR services.
22 B. The following conditions must be met by all provider agencies,
23 certified mental health professionals, or individuals referred to in Subsection
24 (A)(1)(b) of this Section in order to receive Medicaid reimbursement for PSR
25 or CPST services:
26 (1) Have a National Provider Identification number, hereinafter referred
27 to as "NPI", by January 1, 2019. The NPI shall be included on all claims for
28 reimbursement submitted for PSR or CPST services. Any claims for
29 reimbursement for PSR or CPST services provided after December 31, 2018,
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1 which do not include an NPI for both the provider agency and the authorized
2 individual rendering services shall be denied.
3 (2)(a) Be fully accreditated by a nationally recognized accrediting
4 organization, as designated by the department.
5 (b) Provisional accreditation shall not prevent reimbursement if it is
6 issued by the accrediting organization until full accreditation is obtained.
7 (c) Providers shall be re-accredited every three years after being fully
8 accredited.
9 (d) The cost of accreditation or re-accreditation shall be the
10 responsibility of the mental health rehabilitation services provider seeking
11 Medicaid reimbursement.
12 (e) The department shall audit, at least annually, the accreditation status
13 of mental health rehabilitation services providers seeking Medicaid
14 reimbursement to ensure that accreditation status is current and in compliance
15 with the provisions of this Section.
16 (3) Be licensed by the department pursuant to the provisions of this Part
17 and, in the case of an authorized individual, by any licensing and regulatory
18 board regulating that individual. After licensing a provider pursuant to the
19 provisions of this Part , the department shall take appropriate action to ensure
20 that the licensed provider is in full compliance with any and all applicable laws,
21 rules, and regulations, including but not limited to the requirement prohibiting
22 the operation of any offsite facilities that are not located in the same parish or
23 in an adjacent parish of the provider's primary facility.
24 (4) Be credentialed by and in the network of the Medicaid managed care
25 organization in which the provider intends to submit claims for service.
26 C. The department shall implement a facility need review, hereinafter
27 referred to as "FNR", for behavioral health services providers that are licensed
28 to provide PSR or CPST. Facility need review shall not be granted unless the
29 department determines there is a need for new PSR or CPST providers in a
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1 certain geographical area. The department shall exempt from the FNR
2 regulations any provider that has received a license from the department to
3 provide PSR or CPST services on or before April 1, 2018.
4 D.(1) On or before January 1, 2019, each mental health rehabilitation
5 services provider that provides PSR or CPST services shall employ at least one
6 full-time mental health supervisor to assist in the design and evaluation of
7 treatment plans for PSR and CPST services.
8 (2) In order to comply with the provisions of this Subsection, the mental
9 health supervisor shall be an individual as defined in R.S. 40:2153(7)(b), (c), (d),
10 or (e) and shall be employed by the behavioral health services provider as a
11 full-time employee for at least forty hours per week.
12 (3) Each certified mental health professional shall be required to receive
13 at least one hour per month of personal supervision and training by a mental
14 health supervisor. If a certified mental health professional has not provided
15 home- and community-based services for at least three consecutive months, he
16 shall be required to receive at least one hour of training at least twice per
17 calendar month until such time as he has provided home- and community-based
18 services for three consecutive months.
19 E.(1)The department shall develop and implement an internal certified
20 mental health professional certification review process to review at least
21 annually the qualifications of individuals providing mental health rehabilitation
22 services and ensuring that all rules, regulations, and written guidance regarding
23 mental health rehabilitation services are clear and consistent with this Part.
24 (2) The review process provided for in this Subsection shall include the
25 process for investigation of complaints, a procedure to conduct disciplinary or
26 investigative hearings in accordance with the Administrative Procedure Act,
27 imposition of sanctions, and recoupment of funds.
28 F.(1) The department shall recoup funds from any provider who received
29 Medicaid funds for the performance of PSR or CPST services in violation of the
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1 provisions of this Section.
2 (2) The department may refer noncompliant providers to the Louisiana
3 Medicaid Fraud Control Unit within the Louisiana attorney general's office for
4 further fraud investigation.
5 G. The department shall promulgate all rules necessary to implement the
6 provisions of this Section on or before January 1, 2019.
7 H. The Louisiana legislative auditor shall conduct performance audits
8 of the department to ensure compliance with the provisions of this Part.
9 Section 2. This Act shall be referred to as the "Behavioral Health Services Provider
10 Licensing Reform Law".
11 Section 3. This Act shall become effective upon signature by the governor or, if not
12 signed by the governor, upon expiration of the time for bills to become law without signature
13 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
14 vetoed by the governor and subsequently approved by the legislature, this Act shall become
15 effective on the day following such approval.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 519 Original 2018 Regular Session Luneau
Present law provides for licensing of behavioral health services providers by the Louisiana
Department of Health. Present law provides for definitions. Proposed law adds definitions
for certified mental health professionals, community psychiatric supportive treatment
(CPST), mental health rehabilitation, and psychosocial rehabilitation (PSR) to the definition
provisions of present law.
Present law provides licensure requirements. Proposed law provides for additional
requirements for providers of CPST and PSR services that must be met in order to be
reimbursed by the department for providing the services.
Proposed law provides that only a certified mental health professional or an individual who
is not certified, but who met present law criteria for providing PSR services and did so on
a full time basis for a year prior to August 1, 2017, may provide PSR services and be
reimbursed by the department for providing the services.
Proposed law provides that CPST shall be provided by a certified mental health professional
with a master's or doctorate in counseling, social work, or psychology from an accredited
university or college.
Proposed law provides that in order to receive Medicaid reimbursement for CPST or PSR
services, the provider agency, certified mental health professional, or other individuals
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allowed by law, shall have a national provider identification number, be fully accredited by
a nationally recognized accrediting organization, be licensed by the department, and be
credentialed by the Medicaid managed care organization in which the provider intends to
submit claims for services.
Proposed law establishes a facility need review process to assess the need in a geographical
area for new providers of CPST or PSR before a license is granted.
Proposed law requires mental health rehabilitation providers to employ a full-time mental
health supervisor on or before January 1, 2019. Proposed law requires the mental health
supervisor to assist in the design and evaluation of CPST and PSR services. Proposed law
requires certified mental health professionals to receive at least one hour per month or
personal supervision and training by the mental health supervisor.
Proposed law requires the department to develop an annual review of certified mental health
professionals, including ensuring certification has been attained and a process for
investigations and hearings.
Proposed law provides for recoupment of Medicaid funds paid to a provider who is not in
compliance with proposed law. Proposed law provides for referral to the Medicaid Fraud
Control Unit of the attorney general's office for further action.
Proposed law provides for rulemaking.
Proposed law provides for an audit of the department by the Louisiana legislative auditor.
Proposed law shall be referred to as the "Behavioral Health Services Provider Licensing
Reform Law".
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Adds R.S. 40:2153 (15), (16), (17), and (18) and R.S. 40:2155.1)
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