Circumstance whereby Complex Trauma Assessment by identified Licensed Professional may be Billed
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| *Under what circumstances can Complex Trauma identified Licensed Professionals bill Medicaid for Assessments See below for the Complex Trauma Exposure Assessment (CTEA) for Health Homes Serving Chidlren determination of eligibility |
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| https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/final_complex_trauma_exposure_assessment.pdf | |||||
| Licensed Professionals that can complete the Complex Trauma Exposure Assessment (CTEA) for Health Home Serving Children determination of eligibility | LPs that can bill Medicaid Today for Assessments (* indicates under certain circumstances) | Article 28 Clinics | Article 31 Clinics | Article 32 Clinics | Article 16 Clinics |
| Licensed Master Social Worker (LMSW) | *Yes | LMSWs are not enrolled in FFS Medicaid as billing providers.The A-28 clinic that employs the LMSW bills Medicaid for services rendered by the LMSW. Note: FFS will only reimburse LMSW services provided to enrollees up to the age of 21 y.o. and pregnant women up to 60 days postpartum. In an FQHC, these limitations (age and postpartum) do not apply. | *Everyone on the list can provide assessments. | *All of the individuals identified (Licensed practioners) should be able to conduct an assessment that is billable in an Article 32 clinic for complex trauma, assuming that they have appropriate experience and serve the population in question. (not all OASAS article 32 clinics serve children). | UNDER APPROPRIATE SUPERVISION LMSWs shall provide services under the supervision of a licensed clinical social worker, psychologist or psychiatrist. Services shall be provided to persons with a diagnosis of developmental disability. See link for additional information. |
| Licensed Clinical Social Worker (LCSW) | *Yes | LCSWs are not enrolled in FFS Medicaid as billing providers. The A-28 clinic that employs the LCSW bills Medicaid for services rendered by the LCSW. Note: FFS will only reimburse LCSW services provided to enrollees up to the age of 21 y.o. and pregnant women up to 60 days postpartum. In an FQHC, these limitations (age and postpartum) do not apply. | *Everyone on the list can provide assessments. | *All of the individuals identified (Licensed practioners) should be able to conduct an assessment that is billable in an Article 32 clinic for complex trauma, assuming that they have appropriate experience and serve the population in question. (not all OASAS article 32 clinics serve children). | Services provided by the LCSW are covered in A16. Services shall be provided to persons with a diagnosis of developmental disability. |
| Licensed Psychologist | Yes | The services provided by a licensed psychologist are covered in an A-28 clinic. | *Everyone on the list can provide assessments. | *All of the individuals identified (Licensed practioners) should be able to conduct an assessment that is billable in an Article 32 clinic for complex trauma, assuming that they have appropriate experience and serve the population in question. (not all OASAS article 32 clinics serve children). | Services provided by the Licensed Psychologist are covered in A16. Services shall be provided to persons with a diagnosis of developmental disability. |
| Licensed Psychiatrist | Yes | The services provided by a licensed psychiatrist are covered in an A-28 clinic. | *Everyone on the list can provide assessments. | *All of the individuals identified (Licensed practioners) should be able to conduct an assessment that is billable in an Article 32 clinic for complex trauma, assuming that they have appropriate experience and serve the population in question. (not all OASAS article 32 clinics serve children). | Services covered by the Licensed psychiatrist are covered in A16. Services shall be provided to persons with a diagnosis of developmental disability. |
| Licensed Psychiatric Nurse Practitioner (LNPP) | Yes | The services provided by a psychiatric nurse practitioner are covered in an A-28 clinic. | *Everyone on the list can provide assessments. | *All of the individuals identified (Licensed practioners) should be able to conduct an assessment that is billable in an Article 32 clinic for complex trauma, assuming that they have appropriate experience and serve the population in question. (not all OASAS article 32 clinics serve children). | Services covered by the licensed psychiatric nurse practitioner are covered in A16. Services shall be provided to persons with a diagnosis of developmental disability. |
| Licensed Marriage and Family Therapist (LMFT) | No | The services provided by a licensed marriage and family therapist are not covered by Medicaid in an A-28 clinic. | *Everyone on the list can provide assessments. | *All of the individuals identified (Licensed practioners) should be able to conduct an assessment that is billable in an Article 32 clinic for complex trauma, assuming that they have appropriate experience and serve the population in question. (not all OASAS article 32 clinics serve children). | Not provided in A16. |
| Licensed Mental Health Counselor (LMHC) | No | The services provided by a licensed mental health counselor are not covered by Medicaid in an A-28 clinic. | *Everyone on the list can provide assessments. | *All of the individuals identified (Licensed practioners) should be able to conduct an assessment that is billable in an Article 32 clinic for complex trauma, assuming that they have appropriate experience and serve the population in question. (not all OASAS article 32 clinics serve children). | Not provided in A16. |
| Pediatrician/Family Medicine Physician or Internist with specialization in Behavioral Health | Yes | The services of a pediatrician/family medicine physician or internist with specialization in behavioral health are covered in an A-28 clinic. | *Everyone on the list can provide assessments. | *All of the individuals identified (Licensed practioners) should be able to conduct an assessment that is billable in an Article 32 clinic for complex trauma, assuming that they have appropriate experience and serve the population in question. (not all OASAS article 32 clinics serve children). | These services are covered in an A16 Clinic. Services shall be provided to persons with a diagnosis of developmental disability. |
| Services shall be provided to persons with a diagnosis of developmental disability please see 14CRR-NY 679 regulations for more information. | |||||
