Covered services of the PNMI Per-Diem rate (the fee paid, per recipient day, to a PNMI Provider) includes a spectrum of mental health care services. Designated Agencies/Specialized Services Agencies may deliver Service Planning and Coordination or Community Supports for discharge planning/transition/aftercare coordination (see sections 3.6 & 3.7 for requirements). 1.6 Provider Eligibility Provider numbers are issued for the provision of specific types of services such as mental health services, developmental services, services in a detoxification facility, neurological services or general medical services. Only services specifically allowed under a given provider number will be reimbursed. In cases where multiple provider numbers are issued to a DA, DMH staff will have access to settlement sheets documenting payments under each number. Ongoing Medicaid review activities by DMH will include verification that double payments are not made under multiple provider numbers for the same service. 1.6.1 Staff Qualifications Specific staff requirements for services will be included in the appropriate section. Staff qualifications also apply to contracted employees, interns, and sub-contracted entities. 1.7 Documentation Standards Documentation of services provided must be legible, of sufficient clarity, and sufficient clinical content (minimum required content is specified for each service) to ensure eligibility for payment. Auditors must be able to read the service documentation. All clinical and support notes must include: Identification of the individual served The date the service was rendered The specific or code of the service rendered Location in which the service occurred The amount of time it took to deliver the service Reference to the treatment goal for the service Summary of the service rendered with appropriate clinical content (refer to specific service documentation requirements)
Covered services of the PNMI Per-Diem rate (the fee paid, per recipient day, to a PNMI Provider) includes a spectrum of mental health care services. Designated Agencies/Specialized Services Agencies may deliver Service Planning and Coordination or Community Supports for discharge planning/transition/aftercare coordination (see sections 3.6 & 3.7 for requirements). 1.6 Provider Eligibility Provider numbers are issued for the provision of specific types of services such as mental health services, developmental services, services in a detoxification facility, neurological services or general medical services. Only services specifically allowed under a given provider number will be reimbursed. In cases where multiple provider numbers are issued to a DA, DMH staff will have access to settlement sheets documenting payments under each number. Ongoing Medicaid review activities by DMH will include verification that double payments are not made under multiple provider numbers for the same service. 1.6.1 Staff Qualifications Specific staff requirements for services will be included in the appropriate section. Staff qualifications also apply to contracted employees, interns, and sub-contracted entities. 1.7 Documentation Standards Documentation of services provided must be legible, of sufficient clarity, and sufficient clinical content (minimum required content is specified for each service) to ensure eligibility for payment. Auditors must be able to read the service documentation. All clinical and support notes must include: Identification of the individual served The date the service was rendered The specific or code of the service rendered Location in which the service occurred The amount of time it took to deliver the service Reference to the treatment goal for the service Summary of the service rendered with appropriate clinical content (refer to specific service documentation requirements)
DMH_Medicaid_FFS_Manual_Draft_for_Comments_2017-04-14.docx