Behavioral Health

Here you can find Applied Behavior Analysis forms and resources:

• Board-Certified Behavior Analyst/Agency Network Participation Request Formopen_in_new
  
• Applied Behavior Analysis ABA Treatment Request Form - Online versionopen_in_new
• Roster Template for non-licensed clinician loading

• LOCUS Training Dates open_in_new- via Deerfield
• LOCUS Online Brochureopen_in_new
• CASIIopen_in_new – through AACAP
• ECSIIopen_in_new – through AACAP

• DSNP 2024 - DSNP Member Rights and Assisting DSNP Members with Accessing Grievances & Appealsopen_in_new

• Psych. Testing Request Formopen_in_new
• TMS Authorization Request Formopen_in_new
• STAR UMopen_in_new

The Washington state legislature recently passed a bill that will change Apple Health’s policies for mental health evaluations for children from birth to age 5, now known as the Mental Health Assessment for Young Children (MHAYC).

Changes under the new MHAYC policy include:

• Reimbursement for up to 5 sessions
• Reimbursement to health care professional travel costs for assessments performed in home or community settings
• Apple Health mental health professionals conducting a mental health assessment from child birth to 5 are required to use the DC:0-5open_in_new

Travel reimbursement details

Travel for in-network health care professionals will be reimbursed in accordance with your contract if these qualifications are met:

• Conducting a mental health assessment for children from birth through age five in the home or in a community setting. The following information must be present on any submitted claims to qualify the claims for provider travel reimbursement. 
  • CPT®/HCPCS Code (90791, 90792, H0031) 
• Client age (0 years up until 6th birthday)
  • Place of service code (03: School, 04: Homeless Shelter, 12: Home, 99: Other Place of Service) 
• Claims with a U8 modifier, which identify services provided to Wraparound Intensive Services (WISe) participants by qualified WISe practitioners, are NOT eligible for MHAYC provider travel reimbursement. 
• Provider travel will be reimbursed by mileage. Current mileage reimbursement rates can be found on the Office of Financial Management's accounting resource page regarding travel.

To request reimbursement, you need to complete the Community Plan of Washington MHAYC Provider A-19 Vendor Invoice Voucher Form, including:

• The service date of the assessment
• The ProviderOne client ID
• Addresses of starting and ending point
• Miles from starting point to ending point
• Mileage rate (prepopulated on the form)
• Submit invoices to wa_imc_finance@uhc.com. The invoices will be confirmed to claims based on the eligibility requirements for reimbursed outlined here. If all requirements are not met, UnitedHealthcare can’t adjudicate the claim.

Please submit the invoices no later than 60 days from an adjudicated supporting claim.

Questions:  Please submit any questions or concerns to wa_imc_finance@uhc.com

Resources

• Free DC:0-5 training for Apple Health providers is available through the Infant-Early Childhood Mental Health Workforce Collaborativeopen_in_new (IECMH-WC). 
• The HCA MHAYC webpageopen_in_new provides guidance on billing and clinical policy for MHAYC, including regular billing webinarsopen_in_new and more. 
• The HCA IECMH webpage provides additional guidance on billing and clinical policy for infant-early childhood mental health (IECMH) services, including quarterly IECMH Office Hoursopen_in_new, the IECMH Services toolkitopen_in_new and more. 
• Mental Health Services Billing Guide (wa.gov)open_in_new