Arkansas Department of Human Services

Transcription

1 Arkansas Department of Human Services Stakeholder Webinar May 31, 2018

2 Agenda OBH Certification Update Billing Update ConnectCare Services Transition Plan Tier 2 and Tier 3 New Services Q&A

3 OBH CERTIFICATION UPDATE Division of Provider Services and Quality Assurance Dept. of Licensure and Certification Sherri Proffer, RN May 24, 2018

4 Should you have any questions, please contact: Sherri Proffer, RN Assistant Director Division of Provider Services and Quality Assurance PO Box 8059, Slot 408 Little Rock, AR Or Cindy Corbitt Licensure and Certification Unit Division of Provider Services and Quality Assurance PO Box 8059, Slot 408 Little Rock, AR

5 RSPMI/OBHS Providers Billing Update Broadcast Message June 4, 2018

6 Current policy requires rendering providers to be Fully enrolled as a credentialed provider. Fully enrolled, credentialed providers must bill using their NPI in the rendering provider field. These providers are certified and considered medical professionals who have an independent license (e.g. Physician, Psychologist, LCSW, LPC). OR A registered, non-credentialed provider. Non-credentialed providers must use a Practitioner Identification Number (PIN) in the rendering provider field. These providers are mental health para professionals, peer specialists, RNs, and behavioral health counselors who do not have an independent license (e.g. LMSW, LAC) June 4,

7 Action needed from RSPMI Providers RSPMI providers have been able to bill without entering the NPI or PIN in the rendering provider field. Effective immediately, enrolled RSPMI providers must: Use the rendering provider NPI or PIN Non-enrolled RSPMI providers must: Prepare for this policy to be enforced in claims processing Enroll your rendering providers today! During this time period it is important to ensure the integrity of the program. Compliance will be monitored by a review of billing provider claims submissions. Billing providers that do not submit claims with current NPI for professionals may be subject to audits of professional service claims. June 4,

8 Compliance During this time period it is important to ensure the integrity of the program. Compliance will be monitored by a review of billing provider claims submissions. Billing providers that do not submit claims with current NPI for professionals may be subject to audits of professional service claims. June 4,

9 Rendering Provider Enrollment The first step to ensure correct claims processing is to confirm that rendering providers are enrolled. For detailed information on how to determine if your rendering provider needs an NPI or a PIN, please refer to Section Staff Requirements of the RSPMI provider manual. All enrollment applications for rendering providers must be received by August 1, 2018 to ensure they receive a PIN or provider ID prior to the policy being enforced in claims processing. We are requesting a staggered approach to enable targeted technical assistance with the process. By June 30: Submit PIN requests for behavioral health counselors who do not have an independent license for processing prior to the August 1, 2018 deadline. All requests can be submitted prior to June 30, 2018 to identify any issues in July. June 4,

10 Credentialed Fully Participating Providers To enroll as a rendering provider: Must first have an NPI Then complete the web-based Arkansas Medicaid enrollment application to receive an Arkansas Medicaid provider ID. The application can be found on the HealthCare Provider Portal at Ensure that information is complete, accurate and that ALL requested information is attached or uploaded to the portal. A rendering provider who is currently enrolled, but has not reported their NPI to Arkansas Medicaid, should complete the NPI Reporting form and return to DXC for processing - June 4,

11 Non-Credentialed Providers (PIN) To enroll for a Practitioner Identification Number (PIN): Complete DMS Practitioner Identification Number Request form at Return the completed form to DXC for processing. The form must be completed in its entirety for DXC to expedite processing and issue a PIN. A completed sample form for reference can be found at Non-credentialed providers are NOT required to have an NPI. If your non-credentialed rendering provider has an NPI, it cannot be linked to a PIN and you will not be able to bill using this NPI. June 4,

12 OBHS (former RSPMI) Billing September 1, 2018, all OBHS (former RSPMI) providers must bill using a valid rendering provider ID or PIN. While NPI numbers can be entered in the rendering provider field on ANY system, Practitioner Identifier Numbers cannot be submitted in the rendering provider field if you use a vendor system (billing company or clearing house). For the proper location of the PIN when using a vendor system, the following information must be communicated to your vendor: Loop: 2310B Segment: REF REF*G2* (Provider ID) Identifier: G2 If PINs are billed in any other location, your claim will deny indicating that a rendering provider is needed. Please note: Each detail of a claim must indicate the appropriate rendering provider. Only details with the same rendering provider can have spanned dates of service. June 4,

13 ConnectCare and Primary Care Physicians Sheryl Hurt, PCMH CCE, CPHIMS Manager, Outreach Services Medicaid Provider Relations AFMC

14 Who is considered a PCP and what are they responsible for? A PCP contracts with DMS to provider primary care, health education and case management for his or her enrollees. The PCP is responsible for referring enrollees to specialists and other providers; therefore, he or she is responsible for deciding whether a particular referral is medically necessary. A PCP may make such decisions in consultation with physicians or other professionals as needed and in accordance with his or her medical training and experience; however, a PCP is not required to make any referral simply because it is requested. A PCP coordinates his or her enrollees medical and rehabilitative services with the providers of those services. Medical and rehabilitative professionals to whom a PCP refers a patient are required to report to or consult with the PCP so that the PCP can coordinate care and monitor an enrollee s status, progress and outcomes.

15 What is ConnectCare? ConnectCare is the Arkansas Medicaid Primary Care Case Management (PCCM) system. In ConnectCare, a Medicaid beneficiary selects and enrolls with a primary care physician (PCP) that has contracted with DMS to be responsible for managing the health care of a limited number (specified by the PCP) of Medicaid enrollees.

16 Who can contact ConnectCare? Parent or legal guardian Beneficiary Providers can not make this selection for the beneficiaries. Providers can assist the beneficiary with contacting ConnectCare.

17 Hours of operation ConnectCare Monday through Friday 8 a.m. 4:30 p.m. Toll-free (TDD: )

18 ConnectCare website Website of information available for beneficiaries o List of providers o List of charitable dental clinics o Other great resources and contacts

19 Beneficiary education Teaches new Medicaid enrollees about their benefits and the services they can receive. They also help new enrollees choose their primary care physician (PCP). Their mission is to improve beneficiary health and lower Medicaid costs. There are several ways they do this: o Teaching about tools and services that keep beneficiaries healthy o Helping to choose a PCP (if they don t have one already) o Showing beneficiaries common health risks o Encouraging beneficiaries to tell their PCP about their health o Teaching about when beneficiaries shouldn t visit the emergency room For more information on these classes contact: Kimbra Butler: kbutler@afmc.org or Gloria Boone: gboone@afmc.org

20 Tools for beneficiaries ConnectCare Newsletter ConnectCare brochures Beneficiary education postcards and flyers

21 Contact information Sheryl Hurt Manager, Outreach Services AFMC

22 TIER II AND TIER III Patricia Gann, LPC Arkansas Department of Human Services

23 RSPMI to OBHS Transition Beacon will begin generating confirmation numbers for half of the benefits package for services contained in Tier II for all those beneficiaries who have received a tier determination of Tier II or Tier III and forward those confirmation numbers to the providers holding the current prior authorization for RSPMI services so that these beneficiaries have access to care beginning on July 1, If beneficiaries transfer to another provider, the confirmation number will follow the beneficiary during this transition period.

24 RSPMI to OBHS Transition Tier III services contained in the OBHS manual are Therapeutic Communities and Community Reintegration Program and the providers of those services will follow a separate process. In addition, confirmation numbers for partial hospitalization services will need to be obtained through submission of a treatment plan.

25 RSPMI to OBHS Transition Providers may submit an extension of benefits request for additional services as medically necessary. Please note the following services are contained in Tier II but are outside of the benefits package: intensive outpatient substance abuse treatment, supportive employment, and supportive housing and will require submission of treatment plan and prior authorization request.

26 Psychiatric Assessment Transition Existing beneficiary: The current psychiatric assessment will be in effect until the expiration date. For example: The psychiatric assessment was completed on April 4, The continuing care psychiatric assessment will be due on April 4, 2019.

27 Psychiatric Assessment Transition New beneficiary (Tier I) Provider should evaluate the need for a psychiatric assessment for those beneficiaries entering care prior to July 1, If the beneficiary will not be referred for an independent assessment, a psychiatric assessment is not required however may be completed if medically necessary. A psychiatric diagnostic assessment is not be required after July 1, 2018 for those beneficiaries receiving Tier I services.

28 Psychiatric Assessment New beneficiary If the beneficiary is referred for an independent assessment and is determined to be Tier II or Tier III, the psychiatric assessment must be completed within 45 days of eligibility determination.

29 Treatment Plans Treatment plans for existing beneficiaries may be completed at any time after the Tier II or Tier III results are received. The effective date of the treatment plan should be the date of the provider transition to OBHS, either on July 1, 2018 or earlier if transitioning prior to July 1, Treatment plan will be in effect until December 31, A transition plan will be developed for the January 1, 2019 transition when the PASSE assumes full risk.

30 Treatment Plans Under OBHS Medicaid Provider Manual A Treatment Plan is required for beneficiaries who are determined to be qualified for Rehabilitative Level Services or Therapeutic Communities/Planned Respite in Intensive Level Services. The Treatment Plan must reflect services to address areas of need identified during the standardized Independent Assessment. The Treatment Plan must be included in the beneficiary s medical record and contain a written description of the treatment objectives for that beneficiary. Providers are responsible for updating treatment plans to reflect the new services they will be providing to each client

31 PCP Referrals July 1, 2018 PCP referrals will be required for all Tier I, Counseling Level beneficiaries after 3 sessions. (Children, Youth, and Adults) Current PCP referrals will continue to be in effect until the expiration date, but should reflect an order for services. The PCP referral is the prescription for Tier I services. PCP referrals will be required every six months or less as prescribed by the physician. Physicians may require providers to submit diagnostic information, treatment summaries, etc. in order to renew the PCP referral. Though the PCP may approve up to six months of services, it is at their discretion and PCP referrals may be for shorter periods of time.

32 Benefits Limits Benefits limits are cumulative and do not reset at tier determination. For example: A beneficiary enters care on July 7, 2018 and is seen for a Mental Health Diagnosis and for 4 of the 12 Individual Behavioral Health Counseling encounters. Beneficiary is referred for an independent assessment after an acute inpatient admission and is determined to meet criteria for Tier II on September 10, Beneficiary now has 22 Individual Behavioral Health Counseling encounters remaining of the 26 in benefits limit before extension of benefits is required.

33 Rehabilitative Level Services Home and community based behavioral health services with care coordination for the purpose of treating mental health and/or substance abuse conditions. Services shall be rendered and coordinated through a team based approach. A standardized Independent Assessment to determine eligibility and a Treatment Plan is required. Rehabilitative Level Services home and community based settings shall include services rendered in a beneficiary s home, community, behavioral health clinic/ office, healthcare center, physician office, and/ or school, etc.

34 Tier II Services Provider Type: Where: Certified Behavioral Health Agencies Home and community based setting such as home, school, clinic, PCP office, etc. based on certification manual. Access: Services require Independent Assessment and Tier II or Tier III determination. Purpose: Add targeted behavioral health services to specific population of high need beneficiaries. Define the broad Intervention Service to better target specific behaviors and interventions to include supportive services and life skills development to improve outcomes. 34

35 Tier II Services (Annual Benefit) Current Services Mental Health Diagnosis 1 encounter Psychiatric Diagnostic Assessment (required) 1 encounter Treatment Plan (required every 180 days) 4 units (30 minute) Interpretation of Diagnosis 2 encounters Crisis Stabilization Intervention MHP and QBHP 72 units (15 minute) Individual Behavioral Health Counseling 26 encounters Group Behavioral Health Counseling 104 encounters Marital/Family Behavioral Health Counseling 30 encounters Pharmacological Management 12 encounters Psychological Evaluation 8 (60 minute unit) Adult Rehabilitative Day Services 90 units per quarter (60 minute) Extension of benefits allowed based on medical necessity. 35

36 Tier II Services (Annual Benefit) New Services Substance Abuse Assessment 1 encounter Multi-Family Behavioral Health Counseling 12 encounters Psychoeducation 48 units (15 minute) Behavioral Assistance 292 units (15 minutes) Child and Youth Support Services 60 units (60 minutes) per quarter Individual and Group Pharmacological Counseling (RN) 12 encounters Individual and Group Life Skills Development 292 units per service ( 16 to 20 year old) (QBHP) per year (15 minute) Adult Life Skills Development 292 units ( 15 minutes) Peer Support 120 units (15 minutes) Family Support Partners 120 units (15 minutes) Partial Hospitalization 40 days (per diem) Extension of benefits allowed based on medical necessity. 36

37 Tier II Services Services Requiring Prior Authorization Intensive Outpatient Substance Abuse Treatment Supportive Employment Supportive Housing

38 Intensive Level Services The most intensive behavioral health services for the purpose of treating mental health and/or substance abuse conditions. Services shall be rendered and coordinated through a team based approach. Eligibility for Intensive Level services will be determined by additional criteria and questions on the Independent Assessment based upon the results from the Independent Assessment to determine eligibility for Intensive Level Services. This level of care will be based upon a referral from a Behavioral Health Agency that is providing Rehabilitative Services to a beneficiary or the Independent Care Coordination entity. Residential treatment services are available if deemed medically necessary and eligibility is determined by way of the additional criteria and questions on the standardized Independent Assessment.

39 Tier III Services Provider Type: Access: Licensed Residential Facility Certified Therapeutic Community Provider Certified Community Reintegration Provider Services require Independent Assessment and Tier III determination. Service Type: Therapeutic Communities (Adults) Level 1 and Lever 2 Community Reintegration Program (Children and Youth) Must be referred by DCFS 39

40 Crisis Services Crisis Services available to ALL tiers Crisis Intervention (Mental Health Professional) Acute Psychiatric Hospitalization Acute Crisis Units Substance Abuse Detoxification 40

41 July 1, 2018 and Beyond All beneficiaries who have not completed an Independent Assessment are eligible to receive Counseling Level Services. Crisis services are available to all Tiers.

42 Myth Beneficiaries may only receive one Individual Behavioral Health Counseling session per month. Services should be provided at frequencies and duration deemed to be medically necessary and clinically appropriate based on clinical assessment. Extension of benefits is available based on documentation of medical necessity.

43 Myth I will have to completed new treatment plans on all of the Tier II and Tier III beneficiaries on January 1, 2019 when the PASSE takes full risk. A transition plan to address the transition from OBHS fee for services to PASSE will be developed and communicated to providers.

44 Questions?