Addition of Multisystemic Therapy (MST) for Intensive In-home Service
Effective Jan. 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) will cover the first evidence-based practice for intensive in-home service delivery, MST, through the Medicaid State Plan. The Rehabilitative Behavioral Health Services (RBHS) Manual will be updated by Jan. 1, 2024, to reflect the addition of this service.
MST
MST is an intensive, evidence-based family and community-based treatment that addresses the externalizing behaviors of youth who have significant clinical impairment in disruptive behavior, mood and/or substance use. MST is provided using a home-based model of service delivery for youth and their families. MST focuses on youth between 11 and 18 years-old who are at high risk of out-of-home placement or may be returning home from a higher level of care.
MST is a short-term rehabilitative service that may serve as a step-down or diversion from higher levels of care. MST is typically completed in approximately four months of treatment and 60 hours of service delivery on average during that period. MST seeks to understand and intervene with youth within their networks, including family, peers, school and neighborhood/community.
Fidelity measures for MST are required components for all licensed MST teams. Quality assurance support activities focus on monitoring and enhancing program outcomes through increasing therapist adherence to the MST treatment model.
MST providers are available for crisis intervention 24 hours per day, seven days per week and provide scheduled interventions at times and locations convenient to the youth’s family.
Fidelity Requirements
MST teams must be trained and licensed by MST Services, Inc. or an MST Provider Network partner. To be reimbursed by Healthy Connections Medicaid, MST teams must deliver services with fidelity to the model. This includes completing initial training, ongoing booster training and participating in MST professional consultation.
Rates for MST
MST services will be reimbursed with a bundled per diem rate. The service limits are designed to enhance provider flexibility and increase access to care. Therefore, in lieu of prior authorization, each service is structured to have a standard number of encounters and length of time to utilize those encounters. This represents the basic frequency and intensity of services for the duration of the model’s average episode of care, shown below.
| Service | Procedure Code | Service Limits | Unit Rate |
|---|---|---|---|
| MST | H2033 | 48 encounters over a period of 120 days; one encounter may be billed per member, per day | $309.56 per diem |
Encounters may be used in any frequency combination to meet the intensity required based on the medical necessity of the youth and needs of the family. Any additional units required beyond the service limit listed above must be authorized by the SCDHHS Office of Behavioral Health after submission of documentation substantiating medical necessity. Documentation must be attached to the next claim submitted after 48 encounters; claims with attachments must be submitted via the Medicaid webtool.
South Carolina’s Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members who are enrolled in an MCO.
Providers should direct questions related to this bulletin to the Provider Service Center (PSC) at (888) 289-0709 or to behavioralhealth004@scdhhs.gov. The PSC’s hours of operation are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.
Resources Providers Can Use to Help with Medicaid Member Annual Reviews
As SCDHHS continues its federally required review of Medicaid member eligibility, a process frequently referred to as “unwinding,” it is reminding providers of resources available to them that can help with this process. SCDHHS has produced several member-facing communications and marketing items and is encouraging providers to post its “submit your review, when it’s time to renew” flyer in patient-facing areas. The flyer is available for download from SCDHHS’ website in English and in Spanish along with other provider resources on SCDHHS’ annual reviews website.
The Centers for Medicare and Medicaid Services have also produced outreach and educational resources about this process that are available on their website.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.