Medicaid Independent Enrollment of Licensed Mental Health Professionals

Senate File 89, now Senate Enrolled Act 49, was passed during the 2014 Legislative Budget Session amending current Medicaid statute 42-4-103. The revised statute removes existing supervision requirements for licensed mental health professionals providing behavioral health services to Medicaid clients. The effective date of this legislative change is March 11, 2014. Information regarding these changes can be found on the Senate Enrolled Act 49 web page on the Medicaid website.

Effective July 1, 2014 the following licensed mental health professionals (LMHPs) may enroll with Medicaid as independently practicing providers:

  • Licensed Addictions Therapist (LAT)
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Professional Counselor (LPC)

It is essential that LMHPs review and understand the provider responsibilities as outlined in the following:

  • The Medicaid Provider Agreement
  • The Medicaid Provider Certification
  • The CMS-1500 Provider Manual
    • Chapter 1-5 – Provider Responsibilities
    • Chapter 6 – Billing
    • Chapter 7 – TPL
    • Chapter 8 & 9 – Electronic Data Interchange (EDI) and Wyoming Specific HIPAA 5010 Electronic Specifications
    • Chapter 10 – Medicaid Covered Services
    • Appendices

The CMS-1500 Provider Manual will reflect the change after July 1, and a specific set of services that may be provided by LMHPs has been added to the Psychiatric & Mental Health Services Section (10.15.18) in Chapter 10.

Review the following web pages for specific information.

  • The Senate Enrolled 49 (General information regarding change)
  • CMS Re-Enrollment (Provides the CMS Rule, frequently asked questions, enrollment/re-enrollment requirements (providers to re-enroll every 5 years), general enrollment information, bulletins)
  • Provider Enrollment (To begin enrollment)

Licensed mental health professionals who rendered services prior to July 1, 2014 enrollment may submit claims with dates of service between March 11, and the July 1 enrollment with their enrollment packet, and request a retroactive enrollment date that coincides with the earliest date of service between the March 11 and July 1, 2014 dates.

 Lisa Brockman, RN

Division of Healthcare Financing-Medicaid

 

Wyoming Department of Health

 

6101 Yellowstone Rd., Suite 210

 

Cheyenne, WY  82002

 

 

 

(307)777-7531-Front Desk

 

Janet de Vries

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