Outpatient Changes for Contracted Behavioral Health Providers

Transcription

1 Outpatient Changes for Contracted Behavioral Health Providers New Roster Requirement for Non-Licensed Providers of Mental Health Rehabilitation Services and Evidence Based Practices

2 Today s speakers Kendell Andrus, Network Trainer Behavioral Health Dan Schroer, Sr. Project Manager Optum 2

3 Today s agenda Why are we implementing these changes? What are the new requirements for Non-licensed Clinicians rendering Mental Health Rehabilitation (MHR) Services and Evidence-Based Practices (EBP)? How will this affect billing? How will UnitedHealthcare Community Plan implement these changes? 3

4 Why the changes? The state has requested that UnitedHealthcare Community Plan begin requiring non-licensed staff, rendering Mental Health Rehabilitation Services; to obtain and submit National Provider Identification(NPI)numbers to ensure appropriate payment. 4

5 What are the new requirements? Beginning January 1, 2019, UnitedHealthcare Community Plan (UHCCP) will require unlicensed staff rendering and receiving reimbursement for MHR services, to obtain and submit NPI numbers to UHCCP, prior to reimbursing agencies for services provided by these staff. This includes Evidence-Based Practice (EBP) MHR services. UHCCP will also require documentation verifying that non-licensed staff meet all qualifications and requirements for providing MHR Services. 5

6 ACT 582: Legislation Summary This piece of legislation, now law, affects Behavioral Health Services Providers (BHSPs) who provide Psychosocial Rehabilitation (PSR) or Community Psychiatric Supportive Treatment (CPST) to Medicaid recipients. More specifically, it changed the law regarding several requirements for provider agencies and individuals providing services within those agencies. 6

7 Provider Agency Requirements In order to be eligible to receive Medicaid reimbursement, BHSPs providing PSR or CPST to Medicaid recipients must meet all of the following requirements: Be Licensed as a BHSP Agency Be accredited by a department-approved accrediting organization The BHSP must show proof of full accreditation or obtain preliminary accreditation* prior to being contracted with a Medicaid MCO The BHSP must maintain proof of continuous full or preliminary accreditation* If not fully accredited on or before July 1, 2018, the BHSP must attain full accreditation within 18 months of its initial accreditation application date and must provide proof of full accreditation to each MCO with which it is contracted. * Note: The requirement for obtaining preliminary accreditation, if not fully accredited, requires CMS approval. 7

8 Provider Agency Requirements (continued) Have a National Provider Identification Number (NPI) The regulation goes into effective January 1, 2019, each BHSP must include its NPI number and the NPI number of the individual rendering PSR or CPST services on all PSR and CPST claims submitted for Medicaid reimbursement for dates of service on or after January 1, Implement a Member Choice Form The form must be signed by each recipient or legal guardian or representative of the person receiving PSR or CPST. 8

9 Provider Agency Requirements (continued) Be Credentialed The BHSP must be credentialed and in the provider network of the MCO for which the provider intends to submit claims for Medicaid services, unless the MCO has a single case agreement with the provider agency. In such single case agreements, the BHSP agency must be both licensed and accredited. 9

10 Provider Agency Requirements (continued) Employ at least 1 full-time physician or Licensed Mental Health Professional (LMHP) to supervise. Full-time means they must work at least 35 hours/week for the agency. This physician or LMHP will serve as a full-time mental health supervisor to assist in the design and evaluation of treatment plans. For purposes of this requirement, LMHP is defined as one of the following fully licensed practitioner types able to practice independent of supervision: Medical Psychologist Licensed Psychologist Licensed Clinical Social Worker (LCSW) Licensed Professional Counselor (LPC) Licensed Marriage and Family Therapist (LMFT) Licensed Advanced Practice Registered Nurse (APRN) 10

11 Agency Requirements (continued) Provide Supervision for Unlicensed Individuals The BHSP shall ensure each unlicensed individual rendering PSR or CPST services for their agency receives at least 1 hour a month of personal supervision and training by the agency s mental health supervisor. 11

12 Provider Agency Requirements (continued) Meet other Requirements This legislation summary is not an all-inclusive list of requirements for providing PSR or CPST services, nor for receiving Medicaid reimbursement. The requirements noted in this legislation summary establish minimum standards for a limited number of requirements. The department may establish additional requirements, and may strengthen standards of requirements noted in this legislation summary. Providers must meet all requirements in statute, in rule, and in the Medicaid Behavioral Health Services Provider Manual. Providers should refer to the Medicaid Behavioral Health Services Provider Manual accessible via to find more information about standards, qualifications and requirements established to provide PSR or CPST services to Medicaid recipients. 12

13 Individuals Providing Services Requirements In order to be eligible to receive Medicaid reimbursement, BHSPs must ensure that any individual rendering PSR or CPST services for their agency meets all of the following requirements: Have a National Provider Identification Number (NPI) Effective for services rendered on or after January 1, 2019, the individual rendering the PSR or CPST services for the licensed and accredited provider agency must have an individual NPI number, and that number must be included on any PSR or CPST claim submitted by that provider agency for Medicaid reimbursement (in addition to the agency NPI number). Important Note! Beginning December 14, 2018, please begin submitting claims with the rendering NPI number in Box 24J 13

14 Individuals Providing Services Requirements (continued) Have a bachelor s degree to provide PSR services * Individuals rendering PSR services must have the minimum of a bachelor s degree from an accredited university or college in the specific field of counseling, social work, psychology, or sociology. Grandfather clause: individuals who do not possess the minimum bachelor s degree required per Act 582, but who meets all other provider qualifications and requirements in effect prior to January 1,2019, may continue to provide PSR services for the same provider agency, where they were employed prior to January 1, However, before the individual may render PSR services for a different provider agency, he/she must comply with the degree requirements established by Act 582. * Note: The requirement relating to qualifications of individuals providing PSR services requires CMS approval. 14

15 Individuals Providing Services Requirements (continued) Have a bachelor s degree to provide CPST services* Individuals rendering CPST services must have a minimum of a bachelor s degree in the specific field of counseling, social work, psychology, or sociology. There is no grandfather provision for individuals providing CPST services. * Note: The requirement relating to qualifications of individuals providing CPST services requires CMS approval. 15

16 Claims Information CMS 1500 Paper Claim HCFA 1500 Electronic Claim Other Claims Related Information 16

17 Claims form Form

18 Form-1500 Provider Section Box 24J: Licensed Mental Health Professionals and Non-Licensed Mental Health Professionals*, who render services enter their NPI number in the non-shaded portion. * New Requirement for Licensed & Non-licensed Mental Health Professionals

19 Form-1500 Provider Section (continued) Box 31: Licensed Mental Health Professionals (LMHPs) who render services enter their name and licensure in Box 31. Box 31: Non-licensed providers who render services will now be required to enter their name and licensure in Box 31 blank.* *New Requirement for Licensed and Non-Licensed Providers 19

20 Form-1500 Provider Section (continued) Box 33: Agency name, address, and phone number Box 33a: Agency NPI number 20

21 1500 HCFA Electronic Claim Image 21

22 Other Claims Related Information Existing Licensed and Non-Licensed Mental Health Providers Go Live is December 14, Continue billing with the Agency NPI in Box 33A and leaving Box 24J blank, through December 13, Beginning December 14, 2018, please begin submitting claims with the identified codes including the rendering NPI number in Box 24J. The identified codes are: H0036, H2011, H2017, H2033 and S9485. Please note these important dates!! 22

23 Roster Implementation Roster Form Location Roster Form Information 23

24 How will these changes be implemented? Effective January 1, 2019, UnitedHealthcare Community Plan will begin requiring unlicensed staff, rendering Mental Health Rehabilitation Services; to obtain and submit NPI numbers to ensure appropriate payment. Beginning December 14, 2018, please begin submitting claims with the identified codes including the rendering NPI number in Box 24J. On an ongoing basis, groups will also be contacted periodically with formal requests to review and update comprehensive, pre-populated group rosters for the purpose of maintaining accurate directory data. Some groups have already been contacted for this purpose, and going forward, those rosters will include data requested for unlicensed staff. Note: This roster submission is for this implementation. There are still other roster submission validation requirements that you need to follow outside of this implementation. 24

25 Non-Independently Licensed Clinician Roster Form The Healthy LA Non-Independently Licensed Clinicians Roster Form will be located on the Louisiana page of Provider Express. To access the roster form go to: providerexpress.com > Our Network > Welcome to the Network > Louisiana 25

26 The Louisiana Page on Provider Express 26

27 Important Note! The roster registration form can be submitted now, however; do not start billing with your individual NPI numbers until December 14,

28 Non-Independently Licensed Clinician Roster Form Roster Form Components Instructions Important Reminders New Provider Additions Providers Who Have Left 28

29 Instructions and Important Reminders Instructions This section will provide you with an overview of the template and helpful instructions on how to complete the roster form. Important Reminders Important information for Supervising Clinicians and Non-Licensed Staff requirements.! Please review these sections before completing the roster form. 29

30 New Provider Additions and Leaving Providers New Provider Additions In this section, you will enter the Non-Independently Licensed Clinician information Please review the Instructions and Important reminders before completing Providers Who Have Left Here you will provide information about providers who have left your organization. Note: Please submit your entire roster within one week of attending this training. 30

31 New Provider Additions and Leaving Providers Preventing Duplicates If you are adding a new provider to your roster, please do not submit the same names from the previous roster submission. We only need the new provider(s) who have joined your organization. This will prevent duplicates that may delay your roster submission. Removing a provider from your roster If you are removing a provider from your roster, please submit only the provider(s) who are leaving your organization. 31

32 Roster Template Form Information Group/Agency Information 32

33 Roster Template Form Information (continued) Provider Information Important Note: Name Consistency Please ensure that the name you will be submitting on claims, the name provided for the roster loading and the name you entered in NPPES are all EXACTLY the same. If the names are not in alignment, there is a risk your claims may deny. 33

34 Roster Template Form Information (continued) Provider Information (continued) 34

35 Roster Template Form Information (continued) Provider Information (continued) We are requesting the Individual Rostered Clinician s Medicare and/or Medicaid ID Number (s), not the agency s information 35

36 Roster Template Form Information (continued) Provider Information (continued) 36

37 Roster Template Form Information (continued) Provider Information (continued) 37

38 Roster Template Form Information (continued) TYPES OF SERVICES OFFERED BY NON-LICENSED PROVIDER 38

39 Roster Template Form Information (continued) PROVIDER PRACTICE ADDRESS(ES) Instructions: Enter one row per address where each provider practices, and If there are multiple practice addresses for a provider, designate one as the 'primary' in column AA and duplicate 'Provider Information' fields for each row 39

40 Roster Template Form Information (continued) PROVIDER PRACTICE ADDRESS(ES) (continued) 40

41 Roster Template Form Information (continued) PROVIDER PRACTICE ADDRESS(ES) (continued) 41

42 Roster Template Form Information (continued) Attestation 42

43 How do I submit my Roster Form? Go to : providerexpress.com > Our Network > Welcome to the Network > Louisiana Download the Roster Template form on the LA Page of Provider Express. After completing the roster template, save the document to your computer. Then send it as an attachment to networkse@optum.com Please include LA: NILC Agency/Group Name in the Subject Line of the . 43

44 UnitedHealthcare Provider Website UHCprovider.com LINK Prior Authorization and Notification Tool 44

45 UHCprovider.com: LINK 45

46 Access all of these online tools and resources in a single website: UHCprovider.com eligibilitylink claimslink Benefits and eligibility information Claim status and payment determination/ remediation Link dashboard Electronic Payments & Statements Document Vault Electronic Payments and Statements Contains commercial claim letters, UHCWest and UHCOnline reports Paperless Delivery Options Turn off paper letters Prior Authorization and Notification referrallink PreCheck MyScript Prior authorization determination Referral determination and submission Run a pharmacy trial claim and get real-time prescription coverage detail for your patients 46

47 LINK Dashboard 47

48 Prior Authorization and Notification Tool Resources Live Training Sessions UHCprovider.com > Menu > Resource Library > Training > Prior Authorization and Notification Overview UHC On Air UHCprovider.com > Menu > Resource Library > UHC On Air Other Training Resources UHCprovider.com > Menu > Prior Authorization and Notification > Prior Authorization and Notification Tool > Quick Reference Guides, Videos and Training Tools 48

49 49

50 Where do I find the roster form? The Louisiana Page on Provider Express 50

51 When do I submit my roster form? Within one week of attending this training Please submit your entire roster with one submission 51

52 If a non-licensed provider leaves our organization or joins our organization, how long do we have to update the roster template? Please update your rosters in a timely fashion to prevent claim denials. 52

53 How will we be notified when our roster is completed? Providers will receive a notification, confirming that the roster has been completed. Please ensure your contact information is correct and up to date on the roster template. 53

54 Where do I check my prior authorization online? UHCprovider.com The Prior Authorization and Notification Tool via Link 54

55 How do I request an NPI number? For the most efficient application processing and the fastest receipt of NPIs, use the web-based application process. Simply go the National Plan and Provider Enumeration System (NPPES) website and apply on line. 55

56 UnitedHealthcare Community Plan Provider Call Center or 56