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MST - Funding & Medicaid Standards

Downloadable documents discussed on the web page are listed below for your convenience.

  • Position statement on Medicaid Funding for MST Programs
  • MST Preferred Service Description
  • Sample MST Preferred Service Description Rating Form
  • Multisystemic Therapy H2033 HCPCS code
  • Draft MST RFP Template
  • MST Services' position on Medicaid funding for MST programs sums up our current “lessons learned” regarding the strengths and challenges of using Medicaid funding to support MST implementation. Medicaid funding has emerged as an important facilitator in the growth of MST and it is playing a critical role in the financial sustainability of many MST programs across the United States.  However, we caution stakeholders against viewing Medicaid as a “silver bullet” solution to their funding troubles due to the potential challenges of using Medicaid funds to support the model-adherent implementation of MST. For the full “Position Statement on Medicaid Funding for MST Programs” click here.

    The standards and service descriptions for Medicaid or other funding sources for MST of various states are summarized below. Information on each state's MST standards is provided as well as an assessment of how consistent these standards are with MST. Suggested elements to be included in an MST Medicaid Standard are presented in the MST Preferred Service Description document. For an example of how states can be rated using this preferred service description, review our Sample MST Preferred Service Description Rating Form.

    While some states use the current Multisystemic Therapy H2033 HCPCS code (see page eight) for Medicaid billing, many states have created MST funding mechanisms under other HCPCS codes or have chosen to use pre-existing Medicaid codes such as those for “Intensive In-home Services”. In the table below, rating information is provided on how consistent each state's standards are with the MST evidence base.

    These state Medicaid standards are rated by placing them in one of four categories (i.e., Highly Consistent, Consistent, Mostly Consistent, or Minimally Consistent) by comparing them to the list of recommended program practices and requirements presented in the MST Preferred Service Description document. These recommended program practices and requirements have been developed to replicate the characteristics of clinicians, training, clinical supervision, consultation, monitoring and program support provided in the successful clinical trials of MST and have been refined through extensive experience with MST program replications throughout the United States and in growing a number of sites internationally.

    The goals of MST programs include providing clinically effective, family-based services with high levels of provider accountability for outcome. Thus, the functional mission and current service array of the MST host agency must be examined for compatibility with the MST treatment approach.  The Success of MST depends on the provision and proper management of these necessary resources.

    For those individuals interested in assistance with RFP development, please refer to Draft MST RFP Template. This file is helpful in writing an RFP as it contains the elements that should be included in the RFP for MST.

    For technical assistance in developing funding or Medicaid standards for MST, please contact Melanie Duncan, Project Manager, at melanie.duncan@mstservices.com. For other technical assistance  in the planning and implementation of financing and management of other human services and mental health treatments not specific to MST, contact John Morris (jmorris@tacinc.org) from the Technical Assistance Collaborative (TAC) at www.tacinc.org.

    STATE / COUNTY
    SERVICE DESCRIPTION MEDICAID / FUNDING STANDARD
    LEVEL OF CONSISTENCY W/ MST EVIDENCE BASE
    PUBLISHED RATE INFORMATION* (see footnote about activities allowed for billiing)
    ADDITIONAL INFORMATION /         COMMENTS                                      
    Alabama
    No MST standard has been identified
    N/A
    N/A
    Alaska
    No licensed MST teams operating
    N/A
    N/A
    Arizona
    The accepted definition of MST is:
    Consistent - This standard is consistent with the MST evidence base due to the requirement that the "contractor will implement the MST service in strict adherence to the Blueprints Project MST model".
    This state standard is silent in many critical areas including, quality assurance practices and staff training, program staffing and program operational requirements. The main strength is the requirement of implementation to be in strict adherence to the Blueprints Project MST model.
    Arkansas
    No licensed MST teams operating
    N/A
    N/A
    California
    Copy of standard not obtained Outpatient Mental Health Services - Medi-Cal
    N/A
    Colorado
    Federal H2033 Multisystemic Therapy
    Not Consistent - This standard does not provide adequate specification of the MST model. CO - MST Service Description Rating
    No published state-wide rate. Each provider negotiates rates with each BHO.
    This standard fails to provide adequate specification of the service to insure adherent implementation of the MST model and gives almost no guidance regarding critical implementation requirements and target population criteria.
    Connecticut
    Review under development
    Delaware
    N/A
    District of Columbia
    Copy of standard not obtained Community Based Intervention (CBI) Level I
    N/A
    Florida
    No MST standard has been identified
    N/A
    N/A
    Georgia
    No MST standard has been identified
    N/A
    N/A
    Hawaii
    Mostly Consistent - This standard is mostly consistent with the MST evidence base. Fortunately the HI MST system has practice standards that demand adherence to the MST model in areas where this standard is silent (e.g. QA, MST licensure, etc.). HI - MST Service Description Rating
    No rate published
    Idaho
    No licensed MST teams operating
    N/A
    N/A
    Illinois
    No MST standard has been identified
    N/A
    N/A
    Indiana
    No licensed MST teams operating
    N/A
    N/A
    Iowa
    No licensed MST teams operating
    N/A
    N/A
    Kansas
    No licensed MST teams operating
    N/A
    N/A
    Kentucky
    No licensed MST teams operating
    N/A
    N/A
    Louisiana
    Consistent- This standard is consistent with the MST evidence base.

    The rate for MST ranges $36.01* (minimum for MA-level therapist) - $30.23* (minimum for BA-level therapist) per 15-minute unit set by LA Medicaid (H2033).

    https://www.lamedicaid.com/prov web1fee_schedules/Multi_Fee.pdf
     
     

     

    The standard requires that "The provider agency must have a current license issued by the MST Services." Almost all recommended criteria are specified in standard; however, program financial stability may be an issue due to the fact that phone and collateral contacts (even when clinically appropriate) have been disallowed as a billable activity.

    Maine
    Highly Consistent- This standard is highly consistent with the MST evidence base.

    The rate for MST is $31.07* per 15 minute increment as published here: 

    https://www.maine.gov/dhhs/audit/ rate-setting/documents/S65Behavio ral Health2-23-15.pdf
     
     

     

    The Children's Home and Community Based Treatment Services rule within the Mainecare Behavioral Services Medicaid Assistance Program is inclusive of MST.
    Maryland
    MST Medicaid standard under development
    Review under development
    N/A
    Massachusetts
    No MST standard has been identified
    N/A
    N/A
    Michigan
    Federal H2033 Multisystemic Therapy
    Mostly Consistent - This standard is mostly consistent with the MST evidence base due to the requirement that the "Master's level clinician who is a CMHP, certified by MST Services", even though it does not provide adequate specification of the MST model. MI-MST Service Description Rating
    No rate published
    While most MST criteria are not specified in this standard should be met "de facto" as licensure by MST Services is required. A weakness of the rate structure is that is only direct services, face-to-face with consumer or family members are billable.
    Minnesota
    No MST standard has been identified
    N/A
    N/A
    Mississippi
    No MST standard has been identified
    N/A
    N/A
    Missouri
    No MST standard has been identified
    N/A
    Montana
    No licensed MST teams operating
    N/A
    N/A
    Nebraska
    NE MST Medicaid Standard Document

    Federal H2033 Multisystemic Therapy

    Highly Consistent- This standard is highly consistent with the MST evidence base.

    The rate for MST is $38.24* per 15 minute increment is published on page 14 of the document found here:

    http://dhhs.ne.gov/Documents/471-000-532.pdf

    The standard requires agency to "be trained and certified in MST as defined by the institute of MST." Almost all recommended criteria are specified in standard and those not specified in the standard, should be met "de facto."

    Nevada
    No MST standard has been identified
    N/A
    N/A
    New Hampshire
    No licensed MST teams operating
    N/A
    N/A
    New Jersey
    Not Consistent- This standard is not specific to MST and is reported to be administered in such a way as to hinder the delivery of MST.
    The rate for MST is set contract pricing as published on page 283 of this document:

    https://www.hdismedicaid.com/files/ NJ%202016.pdf

    N/A
    New Mexico
    Highly Consistent - This standard is highly consistent with the MST evidence base although it lacks specifying the significant exclusionary criteria for standard MST. NM - MST Service Description Rating

    The rate for MST is $37.50 (for Masters, or Higher, Level), - 35.00* (for Bachelors Level) per 15 minute increment service (under H2033 code), but can be negotiated per provider, as published here: 

    http://www.hsd.state.nm.us/uploads/ FileLinks/e7cfb008157f422597cccdc 11d2034f0Behavioral_Health_Fee_ Schedule_Effective_8_1_2014_ corrected.pdf
     

     

    New York
    No MST standard has been identified
    N/A
    N/A
    North Carolina
    NC MST Medicaid Standard Federal H2033 Multisystemic Therapy (MST) code NC LME Standards
    Consistent - This standard is consistent with the MST evidence base. While this  standard is intended to fund the use of MST within the evidence-based referral range of youth 12-17 years old, it was written with a broader age range of 7- 17 to enable the formal evaluation of using MST with youth down to an age of 7 years old in hopes of facilitating further development of the MST evidence base.
    No rate published. Rates are negotiated with MCOs, no set state-wide rate.
    Provider organizations must demonstrate that they meet these standards by being endorsed by the LME.
    North Dakota
    No licensed MST teams operating
    N/A
    N/A
    Ohio
    OH Intensive Home Based Treatment Service Description Intensive Home Based Treatment (IHBT) Service
    This standard is not specific to MST and has not been reviewed.
    The Intensive Home-Based Treatment rule is inclusive of MST.
    Oklahoma
    Federal H2033 Multisystemic Therapy
    Not Consistent - This standard does not provide adequate specification of the MST model. OK - MST Service Description Rating
    This standard fails to provide adequate specification of the service to insure adherent implementation of the MST model and gives almost no guidance regarding critical implementation requirements and target population criteria.
    Oregon
    No MST standard has been identified
    N/A
    N/A
    Pennsylvania
    Mostly Consistent - This standard is mostly consistent with the MST evidence base. Fortunately the system has practice standards to the MST model in areas where this standard is silent (e.g. QA continued stay, discharge criteria, etc.). PA - MST Service Description Rating
    Rates are negotiated with MCOs, no set state-wide rate. There are weekly rates for some providers.
    N/A
    Rhode Island
    No MST standard has been identified.
    N/A
    All MST providers are funded through two "Networks" of child-serving agencies contracted with the state Department of Children, Youth, and Families to provide services to Department-involved youth (including juvenile justice). MST services are Medicaid reimbursable for the state through "Costs not otherwise matchable" (CNOM) under the Rhode Island Global Consumer Choice, Section 1115(a), Demonstration Waiver.
    South Carolina
    Mostly Consistent - While this standard is not specific to MST it is mostly consistent with the MST evidence base.  Fortunately the SC MST system has practice standards that demand adherence to the MST model in areas where this standard is silent (e.g. QA, staff training, etc.). SC - MHS-NOH Service Description Rating
    No rate published
    N/A
    South Dakota
    No licensed MST teams operating
    N/A
    N/A
    Tennessee
    No MST standard has been identified
    N/A
    N/A
    Texas
    No MST standard has been identified
    N/A
    N/A
    Utah
    No licensed MST teams operating
    N/A
    N/A
    Vermont
    No licensed MST teams operating
    N/A
    N/A
    Virginia
    No MST standard has been identified
    N/A
    N/A
    Washington

    Washington State MST Pilot Project Medicaid Standard

    Federal H2033 Multisystemic Therapy

    This standard was established for a specific pilot project and does not provide full specification of the MST model and therefore has not been reviewed.
    This standard was created for a limited pilot program which does not fully specify the service but does state it will fund “MST services as defined by MST, Inc.”
    West Virginia
    No licensed MST teams operating
    N/A
    N/A
    Wisconsin
    No licensed MST teams operating
    N/A
    N/A
    Wyoming
    No MST standard has been identified
    N/A
    N/A

     

     * Footnote regarding activities allowed for billing. The range of activities that are ‘Allowable’ for billing generally varies greatly state by state and across Managed Care Organizations (MCOs) within states. As a result, the total number of 15-minute units that are billed for a single case of MST will be dramatically different in accordance to what is allowed to be billed as a reimbursable activity. These differences in the definitions of Allowable / Billable activities is a large contributor to why the 15-minute unit rates for MST vary so much across systems. An additional significant contributor to rate differentials is regional variation in staff salaries.