Inpatient IOC Checklist Clinical Record Review
|
|
- Jane Blair
- 5 years ago
- Views:
Transcription
1 Date of Review Reason for Review: Inspection of Care Action Plan Follow-up (Focus of Follow-up: ) Beneficiary Record ID: Beneficiary Age: Custody: DCFS DYS Provider Name: Acute RTC PRTF Date of Admission: Reviewer/Credentials: 1. Is there documentation of a PCP referral, for beneficiaries under age 21, for inpatient psychiatric services made prior to the provision of services or there is a retroactive PCP referral covering the service and received no more than 45 calendar days after the date of the service (or the date of Medicaid authorization)? PCP NA, if any of the following: 1) Beneficiary is 21 years of age or older; 2) Admission was an emergency admission; 3) Admission was a non-emergency admission and less than 45 days since date of admission. CON 2. Is there a PCP referral renewal prior to the expiration of previous referral or every six months (whichever is first)? NA, if any of the following: 1) Beneficiary is 21 years of age or older; 2) Admission is less than 6 months 3. Is there is a written Certificate of Need (CON) in the beneficiary record that states the individual is or was in need of inpatient psychiatric services for emergency admissions and non-emergency admissions? 4. Is there a written Certificate of Need made at the time of admission for acute admissions and prior to admission for non-emergency admissions? ADMISSION EVALUATIO 5. Were the parents/legal guardians informed and given a copy of restraints and seclusion policy upon beneficiary s admission to the facility? 6. Is there documentation of a Social Evaluation conducted by professional staff? Adopted in compliance with Ark. Code Ann Page 1 of 6
2 7. Is there documentation of a Social Evaluation conducted within 60 hours of admission by professional staff? 8. Is there documentation of a Psychiatric Evaluation conducted by professional staff? 9. Is there documentation of a Psychiatric Evaluation conducted within 60 hours of admission by professional staff? 10. Is there documentation of a Medical Evaluation conducted by a physician? 11. Is there documentation of a Medical Evaluation conducted by a physician within 60 hours of admission? 12. Does the Medical Evaluation include symptoms, complaints and complications indicating the need for admission? 13. Does the Medical Evaluation include a medical history? Medical Evaluation 14. Does the Medical Evaluation include a summary of present medical findings? 15. Does the Medical Evaluation include a diagnosis? 16. Does the Medical Evaluation include a mental and physical functional capacity of the beneficiary? 17. Does the Medical Evaluation include a prognosis? PLAN OF CARE 18. Is there is an Individual Plan of Care developed by the facility-based team (physician and MHP)? 19. Is the Individual Plan of Care completed no later than 14 days after the admission? 20. Is the Individual Plan of Care developed in consultation with the recipient and his or her parent(s), legal guardian(s), or others in whose care he or she will be released after discharge? Adopted in compliance with Ark. Code Ann Page 2 of 6
3 21. Does the Plan of Care include diagnoses? 22. Does the Plan of Care include symptoms, complaints and complications indicating the need for admission? 23. Does the Plan of Care state treatment objectives? Plan of Care Review 24. Does the Plan of Care state any orders for medications, diet, treatments, restorative and rehabilitative services or special procedures recommended for the health and safety of the recipient? 25. Does the Plan of Care contain an integrated program of therapies, social services, activities and experiences designed to meet the treatment objectives? 26. Does the Plan of Care include discharge plans and, at an appropriate time, post-discharge plans, and also include the coordination of inpatient services with partial discharge plans and related community services to ensure continuity of care in the recipient s family, school and community upon discharge? 27. Is the Individual Plan of Care designed to improve the recipient s condition to the extent that inpatient psychiatric services will no longer be necessary and to achieve the recipient s discharge from inpatient status at the earliest possible time? 28. Is the Individual Plan of Care based on a diagnostic evaluation that includes examination of the medial, social, psychological, behavioral and developmental aspects of the recipient s situation and reflects the need for inpatient psychiatric services? Dates of Plan of Care Reviews reviewed: list all reviewed 29. Is the Plan of Care reviewed by the facility based team every 30 calendar days? 30. Does the plan of care review determine whether services being provided are or were required on an inpatient basis? 31. Does the plan of care review recommend changes in the plan as indicated by the recipient s overall adjustment as an inpatient? Adopted in compliance with Ark. Code Ann Page 3 of 6
4 32. Was there documentation that the attending physician reviews the prescribed medications at least every 30 days? (b) (1) Has there been any use of restraints or seclusion for this beneficiary? Please list dates and times: informational only SECLUSION AND RESTRAINT 33. Was there a physician order specific to the acute incident requiring the use of restraints or seclusion and no standing/prn order? 34. Was the intervention conducted within the time limitations for the beneficiary s specific age? Was the date and time that the order was obtained documented? 36. Were the start and stop times of the emergency safety intervention documented? 37. If there was harm or injury to the beneficiary as a result of the intervention, was medical treatment immediate? Was there a face-to-face assessment within one hour of initiation of the intervention? 39. The restraint or seclusion intervention was not used as a means of coercion, discipline, convenience or retaliation? 40. Was the parent/guardian notified of the intervention within 24 hours after the occurrence? Adopted in compliance with Ark. Code Ann Page 4 of 6
5 41. Is there documentation of a face to face post intervention debriefing within 24 hours after the use of restraint or seclusion with staff involved and beneficiary? Is there documentation of a post intervention debriefing within 24 hours after the use of restraint or seclusion with all staff involved including appropriate supervisory and administrative staff? 43. Was the documentation of the intervention completed by the end of the staff s shift? 44. Was the purpose of therapeutic leave days clearly documented in the beneficiary s record? Therapeutic Leave Documentation 45. Did the therapeutic leave evaluation documentation provide support to the plan of care objectives and goals? 46. Was there documentation of staff contact with beneficiary and person(s) responsible for the beneficiary for therapeutic leave in excess of 72 consecutive hours? 47. Were there progress notes that provide statements that track the beneficiary s actions and reactions and clearly reveal the beneficiary s achievements or regressions while on therapeutic leave? 48. Did records document the specific service provided? Did records document the date and actual time the services were provided (Time frames may not overlap between services. All services must be outside the time frame of other services)? 50. Did records document the relationship of the services to the treatment regimen described in the plan of care? 51. Did records document updates describing the patient s progress? Were records legible and concise? Did records document reflect the name and title of the person providing the service as being at the appropriate professional level? Adopted in compliance with Ark. Code Ann Page 5 of 6
6 Medical Necessity 54. Are inpatient services medically necessary for this beneficiary based upon documentation in the clinical record of the beneficiary s severity of illness (i.e., diagnosis, current condition, symptoms, response to treatment, etc.)? * Acute Only Adopted in compliance with Ark. Code Ann Page 6 of 6
Inpatient Psychiatric Services for Under Age 21 Arkansas Medicaid Regulations and Documentation
Inpatient Psychiatric Services for Under Age 21 Arkansas Medicaid Regulations and Documentation Presented by: Shelly Rhodes Shelly.Rhodes@beaconhealthoptions.com Disclaimer Disclaimer: This presentation
More informationALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-5 PSYCHIATRIC FACILITIES FOR INDIVIDUALS 65 OR OVER TABLE OF CONTENTS
Medicaid Chapter 560-X-5 ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-5 PSYCHIATRIC FACILITIES FOR INDIVIDUALS 65 OR OVER TABLE OF CONTENTS 560-X-5-.01 560-X-5-.02 560-X-5-.03 560-X-5-.04
More informationAcute Crisis Units. Shelly Rhodes, Provider Relations Manager
Acute Crisis Units Shelly Rhodes, Provider Relations Manager Shelly.Rhodes@beaconhealthoptions.com Training Agenda Agenda: Transition and Certification Coverage of Services Service Code Definition Documentation
More informationBEHAVIORAL HEALTH Section 13. Introduction. Behavioral Health Benefit Overview
Introduction Ohana Health Plan s Clinical Services Program is designed to coordinate medically necessary care at the most appropriate level of service. The goal is to provide the right service in the right
More informationElectronic Medical Records (EMR) and Individualization of Documentation
Electronic Medical Records (EMR) and Individualization of Documentation 1 Individualization of treatment and beneficiary-specific documentation in beneficiary records is required under Arkansas Medicaid
More informationALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-41 PSYCHIATRIC TREATMENT FACILITIES TABLE OF CONTENTS
ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-41 PSYCHIATRIC TREATMENT FACILITIES TABLE OF CONTENTS 560-X-41-.01 560-X-41-.02 560-X-41-.03 560-X-41-.04 560-X-41-.05 560-X-41-.06 560-X-41-.07
More informationTreatment Planning. General Considerations
Treatment Planning CBH Compliance has been tasked with ensuring that our providers adhere to documentation standards presented in state regulations, bulletins, CBH contractual documents, etc. Complying
More informationPrior Authorization and Continued Stay Criteria for Adult Serious Mentally Ill (SMI) Behavioral Health Residential Facility
Prior Authorization and Continued Stay Criteria for Adult Serious Mentally Ill (SMI) Behavioral Health Residential Facility AUTHORIZATION CRITERIA FOR BEHAVIORAL HEALTH RESIDENTIAL FACILITY, ADULT Title
More informationFlorida Medicaid. Statewide Inpatient Psychiatric Program Coverage Policy
Florida Medicaid Statewide Inpatient Psychiatric Program Coverage Policy Agency for Health Care Administration December 2015 Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority...
More informationFlorida Medicaid. State Mental Health Hospital Services Coverage Policy. Agency for Health Care Administration. January 2018
Florida Medicaid State Mental Health Hospital Services Coverage Policy Agency for Health Care Administration Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions...
More informationIntensive In-Home Services (IIHS): Aligning Care Efficiencies with Effective Treatment. BHM Healthcare Solutions
Intensive In-Home Services (IIHS): Aligning Care Efficiencies with Effective Treatment BHM Healthcare Solutions 2013 1 Presentation Objectives Attendees will have a thorough understanding of Intensive
More informationArkansas Department of Human Services
Arkansas Department of Human Services Stakeholder Webinar May 31, 2018 Agenda OBH Certification Update Billing Update ConnectCare Services Transition Plan Tier 2 and Tier 3 New Services Q&A OBH CERTIFICATION
More informationPsychiatric Services Provider Manual 10/9/2007. Covered Services and Limitations CHAPTER IV COVERED SERVICES AND LIMITATIONS. Manual Title.
Subject Revision Date CHAPTER COVERED SERVICES AND LIMITATIONS Subject Revision Date i CHAPTER TABLE OF CONTENTS Inpatient Psychiatric Services (Acute Hospital and Residential) 1 Acute Care Hospitals 1
More informationChapter 1 Section 5.1. Requirements For Documentation Of Treatment In Medical Records
Administration Chapter 1 Section 5.1 Requirements For Documentation Of Treatment In Medical Records Issue Date: June 1, 1999 Authority: 32 CFR 199.2; 32 CFR 199.6(b); 32 CFR 199.7(b), and (b)(1) 1.0 ISSUE
More information- The psychiatric nurse visits such patients one to three times per week.
Community mental health community psychiatry Definition: Community psychiatry can be defined as the provision of psychiatric services to the patient within their community environment with an aim to achieve
More informationRULES OF DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES DIVISION OF MENTAL HEALTH SERVICES
RULES OF DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES DIVISION OF MENTAL HEALTH SERVICES CHAPTER 0940-3-9 USE OF ISOLATION, MECHANICAL RESTRAINT, AND PHYSICAL HOLDING RESTRAINT TABLE OF CONTENTS
More informationBenefit Criteria for Outpatient Observation Services to Change for Texas Medicaid
Benefit Criteria for Outpatient Observation Services to Change for Texas Medicaid Information posted on October 8, 2010 Effective for dates of service on or after December 1, 2010, the benefit criteria
More informationClinical Utilization Management Guideline
Clinical Utilization Management Guideline Subject: Therapeutic Behavioral On-Site Services for Recipients Under the Age of 21 Years Status: New Current Effective Date: January 2018 Description Last Review
More informationTo Access Community Center Rehabilitative Behavioral Health Services (RBHS)
To Access Community Center Rehabilitative Behavioral Health Services (RBHS) I. Who Can Make Referrals Representatives from the following South Carolina State agencies may make referrals/authorize Rehabilitative
More informationService Review Criteria
Client Name: SAR#: Administrative Review Process notes: When documenting call outs to provider, please document the call in a patient note in Alpha the day the call is made. tes should be coded as Care
More informationPatient s Bill of Rights (Revised April 2012)
Patient s Bill of Rights (Revised April 2012) TIRR Memorial Hermann recognizes the rights of human beings for independence of expression, decision, and action and will protect these rights of all patients,
More informationChapter 7 Inpatient and Outpatient Hospital Care
7 Inpatient & Outpatient Hospital Care ACUTE INPATIENT ADMISSIONS All elective and emergent admissions require prior authorization and/or notification for all Health Choice Generations Member admissions.
More informationMedical Management Program
Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent Fraud, Waste and Abuse in its programs. The Molina
More informationThe Oregon Administrative Rules contain OARs filed through December 14, 2012
The Oregon Administrative Rules contain OARs filed through December 14, 2012 OREGON HEALTH AUTHORITY, ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES 309-016-0605 Definitions DIVISION 16
More informationArkansas Provider E-News
Arkansas Provider E-News This Issue: August 2018 This newsletter alerts providers to upcoming changes and other information or procedural updates. Evidenced-Based Treatment Practices Independent Assessment
More informationComprehensive Community Services (CCS) File Review Checklist Comprehensive
This is a sample form developed by the "CCS Statewide QA/QI Work Group", and is available to CCS sites as a sample for consideration of use, modification, and customization. There is no implicit or explicit
More informationProvider Evaluation of Performance. Plan. Tennessee
Provider Evaluation of Performance Plan Tennessee 2018 Executive Summary UnitedHealthcare Community Plan is committed to ensuring the services members receive from network providers meet the requirements
More informationA SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS
A SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS This tool is intended to provide a broad overview of common Medicaid (MA) requirements in relation to COA s Standards. While there are specific
More informationGUIDELINES FOR SCORING INDIVIDUAL RECORDS. Y = Meets Standard N = Does Not Meet Standard. N/A = Not Applicable
QUALITY OF DOCUMENTATION PHP GUIDELINES FOR SCORING INDIVIDUAL RECORDS Y = Meets Standard N = Does Not Meet Standard N/A = Not Applicable GUIDELINES FOR DETERMINING PROGRAM COMPLIANCE WITH STANDARDS Programs
More informationSection 7. Medical Management Program
Section 7. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.
More informationGUIDELINES FOR SCORING INDIVIDUAL RECORDS. Y = Meets Standard N = Does Not Meet Standard. N/A = Not Applicable
QUALITY OF DOCUMENTATION IOP GUIDELINES FOR SCORING INDIVIDUAL RECORDS Y = Meets Standard N = Does Not Meet Standard N/A = Not Applicable GUIDELINES FOR DETERMINING PROGRAM COMPLIANCE WITH STANDARDS Programs
More informationProvider Treatment Record Audit Tool
Provider Treatment Record Audit Tool Provider Name: Discipline: Practice Name: Solo Group Provider ID Number: Provider Location: Address: Suite: (City) Phone Number: (State) Enrollee ID: Age: Diagnosis
More informationFlorida Medicaid. Therapeutic Group Care Services Coverage Policy
Florida Medicaid Therapeutic Group Care Services Coverage Policy Agency for Health Care Administration July 2017 Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal
More informationInstitutional Handbook of Operating Procedures Policy Responsible Vice President: Executive Vice President and CEO, Health System
Section: Clinical Subject: General Policies Institutional Handbook of Operating Procedures Policy 09.13.06 Responsible Vice President: Executive Vice President and CEO, Health System Responsible Entity:
More informationOutpatient Behavioral Health Services (OBH)-General Information
Outpatient Behavioral Health Services (OBH)-General Information 1 General Information Beneficiaries currently served by the RSPMI, LMHP, and SATS programs will begin transitioning to the Outpatient Behavioral
More informationStandards For Inpatient Rehabilitation And Partial Hospitalization For The Treatment Of Substance Use Disorders
Chapter 11 TRICARE Policy Manual 6010.57-M, February 1, 2008 Providers Addendum F Standards For Inpatient Rehabilitation And Partial Hospitalization For The Treatment Of Substance Use Disorders 1.0 ORGANIZATION
More informationINFORMED CONSENT FOR TREATMENT
INFORMED CONSENT FOR TREATMENT I (name of patient), agree and consent to participate in behavioral health care services offered and provided at/by Children s Respite Care Center, a behavioral health care
More informationWHAT DOES MEDICALLY NECESSARY MEAN?
WHAT DOES MEDICALLY NECESSARY MEAN? Your Primary Care Provider (PCP) will help you get the services you need that are medically necessary as defined below. Medically Necessary means appropriate and necessary
More informationPartial Hospitalization. Shelly Rhodes, LPC
Partial Hospitalization Shelly Rhodes, LPC Shelly.Rhodes@beaconhealthoptions.com Transition and Certification 2 Transition and Certification Current Rehabilitative Services for Persons with Mental Illness
More informationChapter 6: Medical Necessity Criteria Introduction
Chapter 6: Medical Necessity Criteria Introduction Preamble "Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in
More informationResidential Treatment Services Manual 6/30/2017. Utilization Review and Control UTILIZATION REVIEW AND CONTROL CHAPTER VI. Page. Chapter.
1 UTILIZATION REEW AND CONTROL CHAPTER 2 CHAPTER TABLE OF CONTENTS PAGE Financial Review and Verification... 3 Utilization Review (UR) - General Requirements... 3 Appeals... 4 Documentation Requirements
More informationMEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE
MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE SUBJECT BY NUMBER: ISSUE DATE: September 8, 1995 EFFECTIVE DATE: September 8, 1995 Mental Health Services Provided
More informationPatient Rights and Responsibilities
Developed / Edited By: UNION HOSPITAL Reviewed By: Approved By: Policy Number: AG-245 Elkton, Maryland Effective Date: 11/2009 Hospital Policies and Procedures Patient Rights and Responsibilities Departments
More informationTraumatic Brain Injury Rights Project
Traumatic Brain Injury Rights Project 1 B E T H K A R P I A K E Q U A L J U S T I C E W O R K S F E L L O W S P O N S O R E D B Y G R E E N B E R G T R A U R I G A N D WA L G R E E N S D I S A B I L I
More informationInteractive Voice Registration (IVR) System Manual WASHINGTON STREET, SUITE 310 BOSTON, MA (800)
Interactive Voice Registration (IVR) System Manual 1000 WASHINGTON STREET, SUITE 310 BOSTON, MA 02118-5002 (800) 495-0086 www.masspartnership.com TABLE OF CONTENTS INTRODUCTION... 3 IVR INSTRUCTIONS...
More informationPsychiatric Residential Treatment Facility (PRTF) Prior Authorization Request
MIS# Name: Address: City/State/Zip: Phone #: Fax #: Client Information: Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Request Clinical Contact Information * * * * Attachments *
More informationInteractive Voice Registration (IVR) System Manual WASHINGTON STREET, SUITE 310 BOSTON, MA
Interactive Voice Registration (IVR) System Manual 1000 WASHINGTON STREET, SUITE 310 BOSTON, MA 02118-5002 1-800-495-0086 www.masspartnership.com TABLE OF CONTENTS INTRODUCTION... 3 IVR INSTRUCTIONS...
More informationBEHAVIORAL HEALTH SERVICES PROVIDER MANUAL Chapter Two of the Medicaid Services Manual
BEHAVIORAL HEALTH SERVICES PROVIDER MANUAL Chapter Two of the Medicaid Services Manual Issued March 14, 2017 State of Louisiana Bureau of Health Services Financing LOUISIANA MEDICAID PROGRAM ISSUED: 12/13/17
More informationCoding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care
P R A C T I C E R E S O U R C E A P R I L 2015 NO.2 Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care By Margaret McManus, MHS The National Alliance to Advance Adolescent
More informationOUTPATIENT BEHAVIORAL HEALTH CSHCN SERVICES PROGRAM PROVIDER MANUAL
OUTPATIENT BEHAVIORAL HEALTH CSHCN SERVICES PROGRAM PROVIDER MANUAL APRIL 2018 CSHCN PROVIDER PROCEDURES MANUAL APRIL 2018 OUTPATIENT BEHAVIORAL HEALTH Table of Contents 29.1 Enrollment......................................................................
More informationState of Alaska Department of Health and Social Services. Behavioral Health Inpatient Psychiatric Review Provider Manual
State of Alaska Department of Health and Social Services Behavioral Health Inpatient Psychiatric Review Provider Manual Revised October 2015 Alaska Medicaid Inpatient Psychiatric Review Provider ManualTable
More informationEmergency Use of Manual Restraints Policy
Emergency Use of Manual Restraints Policy It is the policy of this DHS licensed provider, Companion Linc, to promote the rights of persons served by this program and to protect their health and safety
More informationTennessee Health Link Guidelines: Adults Medical Necessity Criteria
Tennessee Health Link Guidelines: Adults Medical Necessity Criteria https://providers.amerigroup.com Program description The Health Link service model is a program created to address the diverse needs
More informationIntensive In-Home Services Training
Intensive In-Home Services Training Intensive In Home Services Definition Intensive In Home Services is an intensive, time-limited mental health service for youth and their families, provided in the home,
More informationBEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care
BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care Acute Inpatient Hospitalization I. DEFINITION OF SERVICE: Acute Inpatient Psychiatric Hospitalization is a 24-hour secure and protected, medically
More informationTransitional Care Management JANET BEASY, CPC, CPCO, CMC, CMOM PRACTICE EDUCATION CONSULTANT
1 Transitional Care Management JANET BEASY, CPC, CPCO, CMC, CMOM PRACTICE EDUCATION CONSULTANT Initial Requirements 2 Services required when patient returns to community after discharge from specified
More informationCMHC Conditions of Participation
CMHC Conditions of Participation Mary Rossi-Coajou Center for Clinical Standards and Quality/Clinical Standards Group The Centers for Medicare and Medicare Services March 4,2014 Key Themes The CMHC NPRM
More informationALABAMA STATEWIDE TRANSITION PLAN SYSTEMIC ASSESSMENT FEBRUARY 29, 2016
ALABAMA STATEWIDE TRANSITION PLAN PLAN FOR ACHIEVING AND MAINTAINING COMPLIANCE WITH THE HCBS SETTINGS FINAL RULE CMS 2249 F and CMS 2296 F SYSTEMIC ASSESSMENT FEBRUARY 29, 2016 ALABAMA STATEWIDE TRANSITION
More informationStandards For Residential Treatment Centers (RTCs) Serving Children And Adolescents
Chapter 11 TRICARE Policy Manual 6010.60-M, April 1, 2015 Providers Addendum H Standards For Residential Treatment Centers (RTCs) Serving Children And Adolescents Revision: 1.0 ORGANIZATION AND ADMINISTRATION
More informationRyan White Part A. Quality Management
Quality Management Mental Health Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part A grant
More informationChapter 2 Provider Responsibilities Unit 6: Behavioral Health Care Specialists
Chapter 2 Provider Responsibilities Unit 6: Health Care Specialists In This Unit Unit 6: Health Care Specialists General Information 2 Highmark s Health Programs 4 Accessibility Standards For Health Providers
More informationUTILIZATION MANAGEMENT AND CARE COORDINATION Section 8
Overview The focus of WellCare s Utilization Management (UM) Program is to provide members access to quality care and to monitor the appropriate utilization of services. WellCare s UM Program has five
More informationOutpatient Wellness Clinic
Outpatient Wellness Clinic Patient Name: Date of Birth: Address: Phone: Email: Emergency Contact: Relationship: Phone: What is the reason for the appointment? Who were you referred by? (Physician, agency/
More informationSherri Proffer, RN, Program Manager. Dorothy Ukegbu, RN Coordinator, 02/20/2014 1
Sherri Proffer, RN, Program Manager Dorothy Ukegbu, RN Coordinator, 02/20/2014 1 Procedures for Determination of Medical Need for Nursing Home Services I. Medical Need Assessments A. Nursing Facility Procedures
More informationUnitedHealthcare Guideline
UnitedHealthcare Guideline TITLE: CRS BEHAVIORAL HEALTH HOME CARE TRAINING TO HOME CARE CLIENT (HCTC) PRACTICE GUIDELINES EFFECTIVE DATE: 1/1/2017 PAGE 1 of 14 GUIDELINE STATEMENT This guideline outlines
More informationBenefits. Benefits Covered by UnitedHealthcare Community Plan
Benefits Covered by UnitedHealthcare Community Plan As a member of UnitedHealthcare Community Plan, you are covered for the following MO HealthNet Managed Care services. (Remember to always show your current
More informationFlorida Medicaid. Behavior Analysis Services Coverage Policy
Florida Medicaid Behavior Analysis Services Coverage Policy Agency for Health Care Administration Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Florida Medicaid Policies... 1 1.2 Statewide
More informationPEDIATRIC DAY HEALTH CARE PROVIDER MANUAL
PEDIATRIC DAY HEALTH CARE PROVIDER MANUAL Chapter 45 of the Medicaid Services Manual Issued December 1, 2011 Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable
More informationEPSDT and Inpatient Psychiatric Care
EPSDT and Inpatient Psychiatric Care Federal Mandate for Mental Health Services for Youth Under 21 EPSDT services: such other necessaryhealth care, diagnostic services, treatment, and other measures to
More informationOptum - Behavioral Network Services ABA RECORD AUDIT TOOL
December-16 Optum - Behavioral Network Services ABA RECORD AUDIT TOOL Facility Name: Reviewer Name: Date of Facility Review: Rating Scale: NA = Not Applicable Y = Yes N = No Y N NA General Documentation
More informationMedicaid Covered Services Not Provided by Managed Medical Assistance Plans
Medicaid Covered Services Not Provided by Managed Medical Assistance Plans This document outlines services not provided by MMA plans, but are available to Medicaid recipients through Medicaid fee-for-service.
More informationInpatient and Residential Psychiatric Treatment Services. October 2017
Inpatient and Residential Psychiatric Treatment Services October 2017 Overview Provider Participation Requirements Member Eligibility Service Authorization Evaluation, Certificate of Need and Plan of Care
More informationState of Montana. Department of Public Health and Human Services CHILDREN S MENTAL HEALTH BUREAU PROVIDER MANUAL AND CLINICAL GUIDELINES
State of Montana Department of Public Health and Human Services CHILDREN S MENTAL HEALTH BUREAU PROVIDER MANUAL AND CLINICAL GUIDELINES FOR UTILIZATION MANAGEMENT January 31, 2013 Children s Mental Health
More informationINTRODUCTION TO CARE COORDINATION FOR PPEC PROVIDERS April 2014
INTRODUCTION TO CARE COORDINATION FOR PPEC PROVIDERS April 2014 1 eqhealth Solutions eqhealth Solutions is the Agency for Health Care Administration s (AHCA) contracted quality improvement organization
More information907 KAR 10:014. Outpatient hospital service coverage provisions and requirements.
907 KAR 10:014. Outpatient hospital service coverage provisions and requirements. RELATES TO: KRS 205.520, 42 C.F.R. 447.53 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3), 205.560, 205.6310,
More informationSoonerCare Medical Necessity Criteria for Inpatient Behavioral Health Services
SoonerCare Medical Necessity Criteria for Inpatient Behavioral Health Services OKLAHOMA HEALTH CARE AUTHORITY Updated: May 14, 2018 PURPOSE OF MANUAL... 3 OHCA INPATIENT REVIEW REQUEST LINE... 4 TELEPHONIC
More informationSUBJECT: PATIENT RIGHTS AND RESPONSIBILITIES REFERENCE # PAGE: 1 DEPARTMENT: AMBULATORY SURGERY OF: 5 EFFECTIVE:
PAGE: 1 PURPOSE: To ensure all Center for Pain Management staff and contract staff shall observe these patients rights. POLICY: The Center for Pain Management has adopted the Statement of Patient Rights,
More informationCODES: H0045-U4 = Individual Respite H0045-HQ-U4 = Group Respite T1005-TD-U4 = Nursing Respite-RN T1005-TE-U4 = Nursing Respite-LPN
CODES: H0045-U4 = Individual Respite H0045-HQ-U4 = Group Respite T1005-TD-U4 = Nursing Respite-RN T1005-TE-U4 = Nursing Respite-LPN (b)(3) Respite Children MH/ID/DD/SUD and Adults with Developmental Disabilities
More informationStatewide Inpatient Psychiatric Programs Admission Process and Level of Care Criteria. Effective August 1, 2014
Statewide Inpatient Psychiatric Programs Admission Process and Level of Care Criteria Effective August 1, 2014 1 Table of Contents Florida Medicaid Handbook... 3 Clinical Practice Guidelines... 3 Description
More informationAPPENDIX B TRICARE/CHAMPUS STANDARDS FOR RESIDENTIAL TREATMENT CENTERS SERVING CHILDREN AND ADOLESCENTS (RTCS)
TRICARE/CHAMPUS POLICY MANUAL 6010.47-M JUNE 25, 1999 APPENDIX B TRICARE/CHAMPUS STANDARDS FOR RESIDENTIAL TREATMENT CENTERS SERVING CHILDREN AND ADOLESCENTS (RTCS) I. ORGANIZATION AND ADMINISTRATION A.
More informationNO Tallahassee, December 15, Mental Health/Substance Abuse RECOVERY PLANNING AND IMPLEMENTATION IN MENTAL HEALTH TREATMENT FACILITIES
CFOP 155-16 STATE OF FLORIDA DEPARTMENT OF CF OPERATING PROCEDURE CHILDREN AND FAMILIES NO. 155-16 Tallahassee, December 15, 2017 Mental Health/Substance Abuse RECOVERY PLANNING AND IMPLEMENTATION IN MENTAL
More informationPlace of Service Code Description Conversion
Place of Conversion CMS Place of Code Place of Name The place of service field indicates where the services were performed Possible values include: Code Description Inpatient Outpatient Office Home 5 Independent
More informationPsychology Externship Information
November 20, 2017 Psychology Externship 2018-2019 Information Contact information for externship: o Address: 720 N St. Asaph St. Alexandria, VA 20314 o Psychology Externship director: Kirimi Fuller, Psy.D.;
More informationPrimary Care Setting Behavioral Health Billing Codes
Primary Care Setting s Medicaid Medicare Third Eligible Documentation Assessment 90792 Psychiatric Prescribers only (MD, NP, PA, APRN) Psychiatric diagnostic evaluation with medical services. Medical though
More informationMichelle P Waiver Training
Michelle P Waiver Training Presented by Department for Medicaid Services and Department for Mental Health, Developmental Disabilities and Addiction Services 1 Workshop Outline I. History and Overview of
More informationState of Montana. Department of Public Health and Human Services CHILDREN S MENTAL HEALTH BUREAU PROVIDER MANUAL AND CLINICAL GUIDELINES
State of Montana Department of Public Health and Human Services CHILDREN S MENTAL HEALTH BUREAU PROVIDER MANUAL AND CLINICAL GUIDELINES FOR UTILIZATION MANAGEMENT October 1, 2012 Children s Mental Health
More informationTitle 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 07 Medical Day Care Services Authority: Health-General Article, 2-104(b), 15-103, 15-105, and 15-111, Annotated
More informationMississippi Medicaid Autism Spectrum Disorder Services for EPSDT Eligible Beneficiaries Provider Manual
Mississippi Medicaid Services for EPSDT Eligible Beneficiaries Provider Manual Effective Date: July 1, 2017 Services for Introduction: eqhealth Solutions Services (ASD) Utilization Management Program includes
More information907 KAR 15:080. Coverage provisions and requirements regarding outpatient chemical dependency treatment center services.
907 KAR 15:080. Coverage provisions and requirements regarding outpatient chemical dependency treatment center services. RELATES TO: KRS 205.520, 42 U.S.C. 1396a(a)(10)(B), 1396a(a)(23) STATUTORY AUTHORITY:
More informationMEDICAL ASSISTANCE BULLETIN
MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE ISSUE DATE EFFECTIVE DATE NUMBER September 8, 1995 September 8, 1995 1153-95-01 SUBJECT Accessing Outpatient Wraparound
More informationMEMBER WELCOME GUIDE
2015 Dear Patient; MEMBER WELCOME GUIDE The staff of Scripps Health Plan and its affiliate Plan Medical Groups (PMG), Scripps Clinic Medical Group, Scripps Coastal Medical Center, Mercy Physician Medical
More informationMental Health Medi-Cal: Service Definitions for "Outpatient Bundle"
Mental Health Medi-Cal: Service Definitions for "Outpatient Bundle" 1. Assessment 2. Plan Development 3. Therapy 4. Rehabilitation 5. Collateral 6. Targeted Case Management 7. Crisis Intervention 8. Medication
More informationThe policy applies to all SHS employees involved in direct patient care and medical staff.
Restraints Use of Violent - System Introduction Restraints, Use of Violent System Introduction SCOPE The policy applies to all SHS employees involved in direct patient care and medical staff. Implementation
More informationSite: Lovelace Health System Title: PATIENT CARE - Restraints Approved Date: 08/28/2015 Effective Date: TBD
Approved Date: 08/28/2015 Effective Date: TBD 08/01/2018 Document Number P-NS-1063.6 Document Type: Policy Page 1 of 11 1. Policy: All patients have the right to be free from physical or mental abuse,
More informationTips for Successful Completion of a Continued Stay Request. Clinical Webinars for Therapy February 2012
Tips for Successful Completion of a Continued Stay Request Clinical Webinars for Therapy February 2012 Goals 1. Describe the continued stay process. 2. Describe key elements that are needed to successfully
More informationReimbursement Policy. Subject: Consultations Effective Date: 05/01/05
Reimbursement Policy Subject: Consultations Effective Date: 05/01/05 Committee Approval Obtained: 06/06/16 Section: Evaluation and Management *****The most current version of the Reimbursement Policies
More informationThe Medicare Hospice Benefit. What Does It Mean to You and Your Patients?
The Medicare Hospice Benefit What Does It Mean to You and Your Patients? The Medicare Hospice Benefit By the time Congress established the Medicare Hospice Benefit in 1982, hundreds of organizations in
More information[ ] POSITIVE SUPPORT STRATEGIES AND EMERGENCY MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
Sec. 4. [245.8251] POSITIVE SUPPORT STRATEGIES AND EMERGENCY MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS. Subdivision 1. Rules. The commissioner of human services shall, within 24 months of enactment
More informationName: Intensive Service Array Responsible Department: Lane County Health and Human Services- Trillium Behavioral Health
Procedure Name: Responsible Department: Lane County Health and Human Services- Trillium Behavioral Health Plans: Medicaid Medicare Marketplace PEBB Current Effective Date: 1-26-16 Scheduled Review Date:
More informationMedicaid Benefits at a Glance
Medicaid Benefits at a Glance Mountain Health Trust Benefits Children (0 up to 21 years) Ambulatory Surgical Center Services Any distinct entity that operates exclusively for the purpose of providing surgical
More information