Section 441.78.29. Behavioral health services.

Payment shall be made for medically necessary behavioral health services provided by a participating marital and family therapist, independent social worker, master social worker, mental health counselor, or certified alcohol and drug counselor within the practitioner’s scope of practice pursuant to state law and subject to the limitations and exclusions set forth in this rule.

       78.29(1) Limitations.

        a.           An assessment and a treatment plan are required.

        b.           Services provided by a licensed master social worker must be provided under the supervision of an independent social worker qualified to participate in the Medicaid program.

       78.29(2) Exclusions. Payment will not be approved for the following services:

        a.           Services provided in a medical institution.

        b.           Services performed without relationship to a specific condition, risk factor, symptom, or complaint.

        c.           Services provided for nonspecific conditions of distress such as job dissatisfaction or general unhappiness.

        d.           Sensitivity training, marriage enrichment, assertiveness training, and growth groups or marathons.

       78.29(3) Payment.

        a.           Payment shall be made only for time spent in face-to-face consultation with the member.

        b.           A unit of service is 15 minutes. Time spent with members shall be rounded to the quarter hour, where applicable.

This rule is intended to implement Iowa Code section 249A.4.

[ARC 9649B, IAB 8/10/11, effective 8/1/11]