BHSD SAPT Block Grant and State General Funding Completion of Service Registration Discharge for Consumers

Transcription

1 BHSD SAPT Block Grant and State General Funding Completion of Service Registration Discharge for Consumers FREQUENTLY ASKED QUESTIONS 1. Question: What providers are subject to the Provider Alert dated January 23, 2011 entitled SUBSTANCE ABUSE PROVIDER MANDATORY BHSD WEBEX TRAINING ON SERVICE REGISTRATION DISCHARGE COMPLETION? Answer: All ISATS providers who receive Substance Abuse Prevention Treatment (SAPT) Block Grant and/or State General Funds Substance Abuse (SGF:SA) funding from the State that treated consumers for substance abuse (residential, Intensive Out patient, or Outpatient). I-SATS stands for Inventory of Substance Abuse Treatment Services providers. An ISATS provider is a facility that directly provides substance abuse treatment or is registered on the National Directory of Drug and Alcohol Abuse Treatment Programs. Treatment includes any of the following services or programs: Inpatient or residential rehabilitation services Outpatient rehabilitation services Detoxification services Opioid Treatment Programs (methadone / LAAM maintenance) DUI / DWI programs that include treatment Halfway house services that include treatment These treatment services may be provided in a private or publicly owned/operated facility in any setting, including the following: Hospital Residential facility Outpatient facility Mental health facility with substance abuse treatment program Other kind of clinic or facility with substance abuse treatment program 2. Question: Does SAPT Block Grant funding apply only to Substance Dependence clients or does the funding include payment for the Substance Abuse diagnosis? Answer: Both SAPT Block Grant and State General Fund Substance Abuse funding pays for substance abuse treatment services for consumers with substance dependence and substance abuse diagnoses including disorders identified in the DSM- IV under the categories: Alcohol Related disorders, Amphetamine Related disorders, Cannabis-Related disorders; Cocaine-Related Disorders, Hallucinogen Related

2 disorders; Inhalant Related disorders; Opioid Related Disorders; Phencyclidine Related disorders; Sedative, Hypnotic or Anxiolytic Related disorders; and, polysubstance abuse. 3. Question: Does the SAPT Block Grant funding pay for treatment services provided to co-occurring (mental illness and substance use) consumers? Answer: Yes. SAPT Block Grant and SGF:SA funding pays for substance abuse treatment for consumers diagnosed with co-occurring mental illness and substance use. 4. Question: Is completing discharge information for a consumer a new requirement? Answer: No this is not a new requirement. Providers receiving State General Substance Abuse and/or SAPT Block Grant funding are required to complete the discharge data since it is a requirement of the federal funding to the State. The statewide providers rate of completion for consumer discharge data for CY2010 is very low. Since the completion of discharge data is a federal contracting requirement for ISATS providers, providers' failure to compete this data jeopardizes the federal funding to the State and prevents OHNM's reporting of this data to the State. See previous Provider Alert dated June 29, 2010 second paragraph. 5. Question: Does a provider have to complete a Service Registration discharge for a consumer that the provider has also completed the ecert Clinical Notification Discharge Form? Answer: Yes. Providers subject to the ecertification filing for a consumer must also complete that consumer's Service Registration discharge information. Providers who are delivering services for which prior authorizations have been obtained must complete the ecert Clinical Notification Discharge Form according to applicable procedures related to those services, and also must complete the discharge information in the Service Registration until further notice. 6. Question: What date should be inserted into the Start Date (Step 5 in the Power Point)? Answer: For calendar year 2010, the provider should use the date the provider is completing the registration for the Start Date to avoid any timely filing issues. For example, if the consumer service registration is from March of 2010, and the provider completed the discharge service registration on February 4, 2011, the Start Date would be February 4, Please use the above strategy until timely filing is no longer an issue. Thereafter, use the discharge date for current and future service registration updates

3 7. Question: If we discharge a consumer via service registration and we need to enter an additional charge that occurred prior to discharge date how do we insure we get paid for the additional service rendered? Answer: For FY11, all claims billed are subject to timely filing and other claims requirements. The completion of service registration discharge information does not change the provider s ability to claim for services rendered to the consumer prior to the discharge date entered in to the service registration subject to claim filing requirements. 8. Question: If a provider s allocation of SAPT Block Grant and/or State General Substance Abuse funds is exhausted, is the provider still required to enter the consumer service registration discharge data? Answer: Yes. The T1007 claims will be paid out of the provider s existing SAPT Block Grant and/or State General Substance Abuse funding until exhausted by the provider. The provider has been and is required to complete consumer discharge information for consumers treated using these two funding streams whether or not their funding is exhausted. All BHSD program funding is subject to the availability of funds from the New Mexico State legislature and the federal government. 9. Question: What Date Discharged from Services should be used? Answer: The Date Discharged from Services is the date the provider determines that the consumer dropped out/completed/finished the span of treatment, level of care, or the treatment episode that occasioned the treatment. If the consumer was transferred to another provider or internally to another group within the provider for a different level of care or for a different treatment, then a transfer should be indicated in the service registration. If the consumer has dropped out/completed/finished the span of treatment after transfer within the provider then a service registration discharge must be completed. 10. Question: When a consumer has multiple registrations, which one do we use? Answer: The provider must complete service registration discharge information for each span of treatment, treatment episode, and/or level of care completed for the consumer. If the consumer has three different episodes of treatment over the course of 12 months resulting in three corresponding services registrations, then discharge information should be completed for each respective treatment episode conclusion

4 11. Question: Can a copy of the Power Point presentation used in the provider training in February be made available? Answer: Yes. The Power Point presentation has been posted to the Provider Portal under the heading Service Registration Discharge Documentation Requirements: SAPT Block and SGF: SA. 12. Question: There are some consumers that are seen every 3 to 6 months. In these instances, will a provider be required to discharge the consumer and reenroll them for this cycle of treatment? Answer: Not necessarily, this is a clinical judgment. It depends on whether the provider determines if that consumer has completed/finished the span of treatment, level of care, or the episode of care that occasioned the treatment. If the provider does not complete the service registration discharge for a consumer then the assessment and/or treatment plan(s) including updates should have the appropriate notes and explanation as to how the 3 to 6 months contact is clinically appropriate so the consumer is not subject to the 60 day discharge rule. 13. Question: Are we required to discharge consumers from all services or just CCSS? Answer: The provider must complete service registration discharge information for each span of treatment, treatment episode, and/or level of care for all consumers treated using the BHSD SAPT Block Grant Funding and State General Fund Substance Abuse Funding. Other requirements affecting these and other funding streams including treatment requirements, prior authorizations, and reporting obligations have not changed, and are not changed by this requirement. 14. Question: How does this affect patients that are registered for Psych Emergency Service consumers? Are we required to register the patient and then discharge them immediately after a visit? Answer: Neither SAPT Block Grant nor SGF:SA funds should be paying for Psyche Emergency Services. These above funding streams are specifically to fund substance abuse treatment. 15. Question: Is there a report available for providers identifying which records need to be updated? Answer: The provider can run the standard Service Registration Report which shows the effective and expiration dates of the service registration for the providers case loads. Please call the IT help desk in Albuquerque at (505) for further help with the report

5 Separately, OHNM is working on a report for each provider that will list the provider s consumers that have had no treatment activity for more than 60+ days. OHNM hopes to distribute this report by COB February 11, Question: How does the No Eject policy for CSAs relate to discharging a consumer? Answer: If a CSA adult consumer member voluntarily exits their treatment program, or the consumer s treatment episode, level of care, or treatment span has ended, completing the discharge information regarding the completion of a treatment episode is not in violation of the No Reject/No Eject for CSAs. If however, the adult consumer re-presents for services, the CSA should undertake service if the consumer continues to meet all eligibility criteria. 17. Question: What Service Registration Discharge fields are required to be completed using the T1007? Answer: Under the special arrangement with Behavioral Health Services Division (BHSD) for CY10 and thereafter, the following fields whether previously required or optional are now required to be filled out using the best data available: Date of Discharge Reason for Discharge, Transfer or Discontinuance of Treatment. Note: consumers who drop out of treatment for unknown reason and consumers who have not received treatment for some time and are discharged for administrative reasons are included in the code left against professional advice. Do not use Unknown Date of Birth Sex Race Ethnicity DSM IV Diagnosis and Axis I-V Problem Substance(s) at Discharge Frequency of Use of Problem Substance(s) at Discharge Living Arrangement at Discharge Employment Status at Discharge Not In Labor Force at Discharge (only fill out when Not in Labor Force is answered in the Employment Status field) Number of Arrests in 30 Days prior to Discharge Frequency of Attendance in Self Help Programs in 30 days prior to Discharge Pregnancy Status if consumer has become pregnant during treatment, and Name of Agency Discharging Consumer If the consumer requiring a discharge from Substance Abuse treatment is a consumer who was receiving services for the mentally ill and also has to be discharged from Mental Health services, the following additional fields should be filled out: Living Situation

6 18. Question: Will the provider need to send a claim in order to get the T1007 payment for completing the discharge or will OHNM be sending the payment automatically based on the discharges that are completed? Answer: The provider must submit a claim to be paid after the consumer discharge has been properly completed subject to funding availability. Payment for the final T1007 for the treatment cycle requires the completion of the treatment/service plan modification/update that is placed in the file. The final T1007 shall include documentation of: Date of discharge. Implementation of the discharge plan Goals met and progress towards goals met in which outcomes identified by the change over time from admission registration to discharge registration are documented here (See Answer to Question 17 above) Aftercare services to which the individual was referred. 19. Question: Will there be a modifier for the T1007 code for consumer discharges in the future? Answer: BHSD and OHNM are working together to introduce for FY12 a T1007 HV modifier. This means that BHSD will develop a Service Definition for the T1007 HV modifier and OHNM will create this modifier for T1007 for providers use in FY Question: What is the definition of Discharge again? Answer: For the purposes of the Collaborative s Letter Of Direction, this reporting activity, the Service Registration, and ISATS' provider training on the Service Registration required, the definition of "Discharge" means either, (i) Outpatient - the consumer has not been treated for sixty (60) days since the last treatment service date, or (ii) Intensive Outpatient (IOP) - the consumer has not been seen in seven (7) days since the last treatment service date; or (iii) Residential the consumer has not been seen in one (1) day. 21. Question: What do I do if the consumer is Medicaid Eligible for reporting and billing purposes? Answer: Completion of consumer discharge information using the T1007 is funded only by BHSD and not by Medicaid. To use the T1007 on the service registration, you will need to: Clone the original service registration that showed the correct SAPT Block Grant and/or SGF:SA funding, Use the current date for the date of the service registration for timely filing purposes, and Use the actual discharge date, name of provider and reason for discharge

7 22. Question: What do I do if the Discharge Service Registration does not fund and therefore I cannot click Submit? Answer: Please call the provider line at press 3 then press 2. For more information please call either the provider line at press 3 then press 2 or the Claims Funding Specialist in your region: OHNM Claims Funding Specialists Phone Numbers: Region 1 Rebecca Griffin Region 2 Anna Annon Region 3 Michelle Rosales Region 4 Tracy English-Brown Region 5 Delia Bueno Region 6 Rebecca Griffin / Anna Annon For more information about the SAPT Block Grant, federal reporting requirements and other related information, please visit the Substance Abuse and Mental Health Services Administration at