CHILDREN S FULL SERVICE PARTNERSHIP (FSP) FREQUENTLY ASKED QUESTIONS

Transcription

1 CHILDREN S FULL SERVICE PARTNERSHIP (FSP) FREQUENTLY ASKED QUESTIONS Q: ARE AGENCIES ALLOWED TO DO OUTREACH AND ENGAGEMENT OR START FSP SERVICES IF THEY HAVE NOT YET SIGNED THE AMENDMENT? A: Contract amendments must be signed before FSP services or billing can begin. Q: WHAT SHOULD NAVIGATORS DO WITH REFERRALS THAT COME IN BEFORE AMENDMENTS ARE SIGNED? A: Navigators should hold onto referrals locally until contract amendments are signed and FSP programs are operational. The navigators will be updated on a regular basis as to the status of amendments in their respective Service Areas. Q: ARE OUTREACH AND ENGAGEMENT SERVICES TO BE DIRECTED ONLY AT REFERRED CLIENTS TO GET THEM ENGAGED IN SERVICES RATHER THAN TO THE FULL COMMUNITY TO IDENTIFY AND SECURE CLIENTS FOR ENROLLMENT? A: The answer to this question is really both. Efforts should be made to identify unserved clients in the community as well as to engage clients referred for services prior to enrollment. Q: CAN A PROVIDER THAT HAS BOTH OUTPATIENT AND FSP PROGRAMS BILL FOR COS OUTREACH AS THEY TRY TO ENGAGE AN EXISTING CLIENT FOR WHOM THEY ARE BILLING OUTPATIENT SERVICES? A: COS funds are intended for Mental Health Promotion and Outreach to new clients and not for existing outpatient clients. For clients with an open case through outpatient services, outreach and engagement for FSP can be billed through collateral sessions with the parent/caregiver, or can be considered part of treatment planning under EPSDT. Q: WHAT PERCENTAGE OF ALLOCATED FSP SLOTS CAN BE FILLED BY TRANSFERRING FROM EXISTING CASES? A: Up to 20% of the total allocated FSP slots can be filled by transferring existing cases. Ten percent of these transfer cases must be reserved for indigent clients, with the balance going to EPSDT-funded clients. For example, if Frequently Asked Questions 1 of 6

2 an agency has been allocated a total of 26 slots, up to 5 existing cases (26 x.20 = 5.2, rounds to 5) can be transferred to the FSP program. One case will be reserved for an indigent client (10% of the 5 cases is 0.5, so this is rounded up to 1) and 4 cases will go to EPSDT-funded clients. The transfer cases need to meet the underserved or inappropriately served criteria. When clients from existing caseloads are referred to the FSP program, they will require a strong written justification explaining why the services currently being provided are inadequate to meet the treatment goals. Q: HOW SHOULD PROVIDERS HANDLE A NEW CONSUMER WHO CLEARLY MEETS CRITERIA FOR FSP BUT NEEDS SERVICES IMMEDIATELY AND CANNOT WAIT FOR THE AUTHORIZATION, EVEN IF IT IS AS SHORT AS TWO DAYS? A: We would expect that a client requiring immediate services be served by the agency. The FSP authorization process, however, cannot be waived. These clients should be served by opening an outpatient episode. Their episode can then be closed and reopened to FSP once the authorization is provided. What constitutes a transfer would be assessed on a case-by-case basis and would take into account the length of time elapsed between when the outpatient episode was opened and when the FSP referral was submitted. To avoid complications, it is advisable that the FSP referral be submitted to the Impact Unit before, or while, opening the outpatient episode. Q: DO THE 24/7 SERVICES REQUIRE THE FUNDED AGENCY TO RESPOND 100% OF THE TIME TO CLIENT NEEDS? A: Yes. Responding does not mean that you must immediately go out to the client s home every time you get a call. It does mean, however, that you must respond and connect with that particular client in order to assess the situation and determine the appropriate response to their current situation. Q: IF A PROVIDER ENROLLS A CHILD WHO HAS EPSDT, DO THEY BILL MHSA FUNDS OR EPSDT? A: The provider should bill Medi-Cal (EPSDT is no longer a plan in the IS). The MHSA funds should be preserved for those clients that do not have any other payer source. Q: SHOULD PROVIDERS BILL ALL OTHER PAYER SOURCES FOR FSP CLIENTS BEFORE THEY BILL MHSA? A: Providers should bill to the client s payer source only if it is included in their FSP contract. The children s contracts were set up 90% Medi-Cal, 10% indigent. No other payer sources are funded at this time, but we hope to add Healthy Families funding in early Frequently Asked Questions 2 of 6

3 Q: ARE PARENT PARTNERS ALLOWED TO BILL? A: Parent Partners are able to bill if they meet criteria for approved staffing and meet the criteria specified in the in the DMH Rehabilitation Option Manual. Q: CAN FAMILY SUPPORT SERVICES DOLLARS BE USED TO PAY FOR PARENT PARTNER POSITIONS? A: Some of these dollars can be used toward covering the Parent Partner position, but the bulk of the funds should be used for the direct delivery of mental health services to the parent/guardians/families of the child enrolled in the FSP. Q: ARE THE FLEX FUNDS (AKA FAMILY SUPPORT SERVICES) ALLOCATED FOR THE YEAR OR ARE THEY GIVEN TO THE PROVIDER IN MONTHLY INSTALLMENTS BASED ON THE NUMBER OF SLOTS FILLED? A: Flex funds are Client Supportive Services, not Family Support Services. Both are allocated for the year. Family Support Services are units of service-based and will be billed to MHSA Plan lll in the IS. They are reimbursed according to the terms of the provider s contract. Flex funds are cost reimbursement and will require the agency to invoice DMH for qualified expenditures. Q: CAN THE FAMILY SUPPORT SERVICES PER SLOT AMOUNT OF $650 BE POOLED FOR USE AS NEEDED BY INDIVIDUAL CLIENTS? FOR INSTANCE, ONE CLIENT NEEDS $1000 IN CLIENT SUPPORT AND ANOTHER NEEDS ONLY $200? A: The Family Support Services allocation is $2,200 per year. The Client Supportive Services (flex funds) allocation is $650 per year. The allocations may be pooled and used depending on the need of each client and family. Q: ARE THESE SUPPORTIVE COSTS JUST ESTIMATES OR ARE WE CONTRACTUALLY OBLIGATED TO SET ASIDE OR RESERVE THESE AMOUNTS FOR USE BY CLIENTS? A: Yes, the supportive costs are estimates. Contractually, providers are obligated to reserve the Family Support Services funds primarily to provide eligible parents and caregivers with a full array of clinical services, including individual therapy, couples therapy, group therapy, psychiatry/medication support, crisis intervention, case management/linkage, parenting education, and services for substance abuse and domestic violence. Providers are contractually obligated to use the Client Supportive Services (flex funds) to provide for a variety of non-clinical services and supports to individuals and their families in need of assistance with housing, personal, vocational and program/socialization, as well as outreach and engagement to potential FSP clients. Frequently Asked Questions 3 of 6

4 Q: CAN MOMMY AND ME OR A THERAPEUTIC DOMESTIC VIOLENCE GROUP BE PAID OUT OF THE FAMILY SUPPORT SERVICES FUND? A: These types of groups are appropriate as long as they are clinically indicated and the information is appropriately documented in the chart. Q: HOW WILL GIFT CARDS BE ACCOUNTED FOR WHEN INVOICING FLEX FUNDS? A: The agency must submit an invoice for the gift cards when they are purchased indicating which stores they were purchased from, the dollar amounts of the cards and the total amount purchased per store. When the cards are disbursed, the DMH Central Unit will need an accounting of who received the cards, the dollar amount of the cards, and the reason they were given. Q: OUR AGENCY PUT A VAN LEASE IN OUR FSP PROGRAM. WE WANT TO MAKE SURE THAT THIS CAN BE CONSIDERED A PROGRAM EXPENSE UNDER MEDI-CAL SINCE IT IS NOT A PURCHASE. A: The lease amount for the portion of the time the vehicle is used for the Medi- Cal program is chargeable to Medi-Cal. Q: CAN A CHILD CURRENTLY ENROLLED IN AN INTENSIVE MENTAL HEALTH PROGRAM, SUCH AS SOC, WRAPAROUND, INTENSIVE IN-HOME MENTAL HEALTH SERVICES/FOSTER CARE BE TRANSFERRED TO RECEIVE FSP SERVICES? A: No, children currently enrolled in intensive mental health programs are not eligible for FSP. Q: WHOSE SUPERVISORY DISTRICT SHOULD BE USED IN DOCUMENTATION, THE CHILD S RESIDENCE OR THE PROVIDER S? A: The Supervisorial District in which the FSP provider is located should be used. Q: ON THE REFERRAL FORM FOR CHILDREN, IT INDICATES THAT ONE OF THE FOCAL POPULATIONS IS "PRE-NATAL TO 5." DOES THIS MEAN THAT AN UNBORN CHILD COULD BE ENROLLED AS A CLIENT? The term pre-natal in the focal population sub-category Pre-natal to five has been changed to zero so the sub-category now reads Zero to five (0-5). This change was influenced by the need to maintain consistency with the Community Services and Supports (CSS) Plan and the Mental Health Services Act (MHSA) Frequently Asked Questions 4 of 6

5 age group categories, as defined by the Stakeholders. All references to Prenatal have been deleted from the children s FSP documents. Q: IF A 14-YEAR-OLD FEMALE MEETS CRITERIA, BUT IS PREGNANT AND WILL SOON DELIVER, IS IT POSSIBLE THAT BOTH SHE AND HER BABY COULD BE ENROLLED SEPARATELY AS CLIENTS IN AN FSP PROGRAM? A: It is possible that a mother and child could be enrolled separately in a FSP. However, it will depend on the issues surrounding the case and whether the child and mother meet the 0-5 focal population criteria. Another important factor is that the child be referred to a provider with expertise on the 0-5 population. Q: WE DID NOT THINK THAT PARENTS/CAREGIVERS NEEDED TO BE SERIOUSLY MENTALLY ILL ENOUGH TO QUALIFY FOR ADULT MENTAL HEALTH SERVICES UNDER FAMILY SUPPORT SERVICES, EVEN IF THEY HAD MEDI-CAL. IS THAT CORRECT? A: It is correct that the parents/caregivers receiving Family Support Services (FSS) do not have to meet Medi-Cal medical necessity criteria (unless Medi-Cal is being billed). Q: WHAT ARE THE AUDIT PLANS FOR FAMILY SUPPORT SERVICES BILLING? A: Because FSP has required so much work, we have not yet developed specific eligibility and documentation standards for Family Support Services (FSS), but we intend to do so. Regardless, documentation standards for FSS should be on par with existing state and county DMH standards. Lastly, we don t know what the state intends to do with regard to auditing the MHSA dollars, but we (children s MHSA central admin.) intend to review MHSA Plan III (FSS) services and expenditures. Q: OUR UNDERSTANDING IS THAT FAMILY SUPPORT SERVICES MUST BE IN SUPPORT OF THE CHILD'S MENTAL HEALTH TREATMENT GOALS BUT COULD INCLUDE COUNSELING FOR PARENTS, SUBSTANCE ABUSE TREATMENT, JOB TRAINING, ETC. THESE WOULD NOT MEET THE TYPICAL STANDARDS FOR BILLING ADULT MENTAL HEALTH. WHAT CODES WOULD WE USE FOR BILLING? A: Family Support Services are intended to provide eligible parents and caregivers with a full array of clinical services, including individual therapy, couples therapy, group therapy, psychiatry/medication support, crisis intervention, case management/linkage, parenting education, and services for substance abuse and domestic violence. These will typically be adults who do not meet medical necessity criteria and/or have no insurance benefits to pay for the cost of care. These dollars are NOT intended to be used for job training, which should come out of the flexible funds (Client Supportive Services). There Frequently Asked Questions 5 of 6

6 are no new billing codes. The children s FSP providers will have MHSA Plan III (C-02) added to their provider file on the IS. Mode 15 Service Function Codes are included for Targeted Case Management, Mental Health Services (individual, group, collateral), Medication Support and Crisis Intervention. Q: I AM CONCERNED THAT IN OUR PERFORMANCE STANDARDS WE ARE SUPPOSED TO SERVE 25% UNINSURED OR UNDERINSURED AT INTAKE YET WE ARE VERY LIMITED ON MHSA DOLLARS THAT WOULD FUND THE UNINSURED CLIENTS. HOW WILL THIS WORK IN TERMS OF HOLDING US ACCOUNTABLE FOR MEETING THE UNINSURED GOAL YET NOT HAVING ENOUGH DOLLARS TO SERVE THEM TO THE SAME STANDARD AS EPSDT CLIENTS? A: The performance standards state that at admission 15% uninsured and 10% underinsured shall be enrolled in the FSP. The expectation is NOT that the agency will serve 25% un- or underinsured ongoing. The expectation is that, of the combined 25%, 10% are UNINSURABLE (for which the indigent funds are to be used) and that the other 15% are eligible for benefits that the agency is responsible for helping them to establish. Frequently Asked Questions 6 of 6