BH Medical Group Providers IEHP Provider Relations Date: January 16, 2014 Subject: Expanded Mental Health Benefits
|
|
- Logan Malone
- 6 years ago
- Views:
Transcription
1 To: From: BH Medical Group Providers IEHP Provider Relations Date: Subject: Expanded Mental Health Benefits The New Year has begun and the expanded mental health benefit for IEHP Medi-Cal Members is in full swing. We are pleased to be referring Medi-Cal Members to you and want to make sure you understand how your authorizations and claims payment will work. Attached is the previous letter announcing the expanded programs for 2014 for your reference. The key elements you may be concerned about are: Your contract now covers all IEHP Lines of Business in order to incorporate Medi-Cal Members in addition to the Medicare DualChoice Members you have been serving. Authorizations, payment rates, Web Forms and claims submission are all the same; you will receive the same Medicare based payment rate regardless of whether the Member is Medicare DualChoice or Medi-Cal. If you currently receive referrals from the County to treat Medi-Cal Members who meet Specialty Mental Health Criteria you will continue to work with the County and now will also receive IEHP Medi-Cal referrals for Members who do not meet Specialty Mental Health Criteria from IEHP. IEHP will directly authorize and pay you for treating these Medi-Cal Members who do not qualify for services within the County Mental Health program. If you are not working with the County Medi-Cal program you will receive Medi-Cal referrals from IEHP and your contract with IEHP enables you to treat these Members like you currently treat our Medicare DualChoice Members. Please schedule these new Medi-Cal referrals that you will receive from IEHP as you would our Medicare DualChoice referrals. We are expecting a substantial increase in referrals as Members learn of the newly available benefit that provides access to mental health professionals for mild and moderate mental health conditions. Substance Abuse treatment for Medi-Cal Members will continue to be provided through the County Drug Medi-Cal program. The BH Care Management Team will be screening Members to determine if they need Specialty Mental Health services through the County Mental Health Programs due to more severe impairment and we will do our best to refer Members to you who do not need this Specialty Mental Health level of care. However, our screening is not perfect and you may occasionally evaluate a Member who turns out to meet Specialty Mental Health criteria. In such cases, you are asked to describe the Member s condition and request that the IEHP BH Care Management Team transition the Member to the appropriate County Mental Health Program. Your authorization will continue to cover the additional treatment you provide until the Member is fully transitioned as you will have to provide for continuity of care to prevent patients you have evaluated from experiencing a preventable lapse in medically necessary care. You can document the Members Specialty Mental Health condition on your initial Coordination of Care Web form and we will handle the initiation of Specialty Mental Health Services through the County. You are encouraged to also
2 Page 2 of 5 call the IEHP BH Care Management Team and we will assist the Member in getting to the appropriate level of care. A description of Specialty Mental Health criteria is attached for you to use as a reference guide when you come across those Members that present more severe mental health conditions. All Medi-Cal Members needing psychiatric hospital care will be referred immediately to a County contracted facility because all psychiatric inpatient services remain the responsibility of the County Mental Health program. We are excited about being able to offer a full range of mental health services to our 680,000 (and growing) Medi-Cal Members and to be able to maintain the same level of payment for our providers as we have for our Medicare population. Please feel free to call us at (909) if you have any questions or concerns. Enclosure: 2013 BH Amendment Specialty Mental Health Criteria
3 Page 3 of 5 September 26, 2013 Dear Behavioral Health Provider: IEHP is working on preparing our Behavioral Health Network for the current changes in the benefits we will be providing to our Members in First, we are pleased to announce that as of January 1, 2014, IEHP will be providing a full range of mental health services to our Medi-Cal Members (estimated population of 700,000 in February 2014) who do not meet the severity criteria for treatment within the County Mental Health Departments. Based on the needs of these Members we are anticipating a 500% increase in referrals to our directly contracted Behavioral Health Network starting in January of 2014 for mild behavioral health conditions. Additionally, as of April 1, 2014 IEHP will begin enrolling dual eligible Medicare/Medi Cal Members as the Coordinated Care Initiative is launched in California. Our projections indicate over the subsequent 12 months we will see a three-fold increase in the Behavioral Health Services IEHP is directly managing and referring to you, our directly contracted BH providers. Rather than create two rate schedules, one for the Medi Cal and one for the Medi/Medi membership, IEHP has decided to have one rate schedule for all lines of business which will be based on the higher Medicare fee schedule. For this reason, and to make sure we have updated our contract with you we are sending you the enclosed revisions to your contract. As you may recall, a couple of State level changes occurred in the year 2013 that may have directly impacted your practice in relationship to your business with the Inland Empire Health Plan (IEHP). The year began with a change in the CPT codes behavioral health providers can bill for services rendered. In addition, another change was IEHP s 58,000 Health Families Members had their healthcare benefits switched to Medi-Cal. This makes IEHP s behavioral network primarily focused on providing services to our Medicare DualChoice Members. Therefore, IEHP is updating its behavioral agreement to reflect the CPT codes which you can bill and a corresponding reimbursement methodology based on Medicare rates. Enclosed please find a new agreement for your review. Please contact your Contract Manager with comments and/or questions. We would appreciate receiving your signed agreement by October 07, Sincerely, David Carrish Peter Currie, Ph. D. Director of Provider Contracting Clinical Director of Behavioral Health
4 Page 4 of 5 Specialty Mental Health Criteria IEHP Medi-Cal Members must meet the following Specialty Mental Health criteria to be eligible to receive MH services through County Behavioral/Mental Health. This criteria should be used by all IEHP BH providers when evaluating Members to ensure they receive treatment in the correct system of care. All THREE CRITERIA (A, B, and C) MUST BE MET! A: Diagnosis: Included Diagnosis: Pervasive Developmental Disorders, except Autistic Disorders Disruptive Behavior and Attention Deficit Disorders Feeding and Eating Disorders of Infancy and Early Childhood Elimination Disorders Other Disorders of Infancy, Childhood, or Adolescence Schizophrenia and other Psychotic Disorders, except Psychotic Disorders due to a General Medical Condition Mood Disorders, except Mood Disorders due to a General Medical Condition Anxiety Disorders, except Anxiety Disorders due to a General Medical Condition Somatoform Disorders Factitious Disorders Dissociative Disorders Paraphilias Gender Identity Disorder Eating Disorders Impulse-Control Disorders Not Elsewhere Classified Adjustment Disorders Personality Disorders, excluding Antisocial Personality Disorder Medication-Induced Movement Disorders related to other included diagnosis An Included Diagnosis when an Excluded Diagnosis is also Present Excluded Diagnosis: (Not Eligible for Specialty Mental Health Services thru County MH) Autistic Disorder Learning Disorders Motor Skills Disorder Community Disorders Autistic Disorder Other Pervasive Developmental Disorders are Included Tic Disorders Delirium, Dementia, Amnesic, and Other Cognitive Disorders Mental Disorders Due to a General Medical Condition Substance-Related Disorder Sexual Dysfunction Sleep Disorders
5 Page 5 of 5 Antisocial Personality Disorder Other Conditions That May be a Focus of Clinical Attention, Except Medication Induced Movement Disorders Which are Included Mental Retardation B. Impairment Criteria: A beneficiary may receive services for an included diagnosis when an excluded diagnosis is also present. Must have one of the following as a result of the mental disorder(s) identified in the diagnostic criteria. A significant impairment in an important area of life functioning. A probability of significant deterioration in an important area of life functioning. Children also qualify if there is a probability the child will not progress developmentally as individually appropriate. C. Intervention-Related Criteria: Must have all of the following: The focus of proposed intervention is to address the condition identified in impairment criteria. It is expected the beneficiary will benefit from the proposed intervention by significantly diminishing the impairment, or preventing significant deterioration in an important area of life functioning, and/or for children it is probable the child will progress developmentally as individually appropriate. The condition would not be responsive to physical healthcare-based treatment.
Basic Training in Medi-Cal Documentation
Basic Training in Medi-Cal Documentation Sara Kashing, J.D. Staff Attorney The Therapist May/June 2012 Since 1998, Medi-Cal mental health services have been provided through county-based Mental Health
More informationPresenters. Kathy Hughes President/Chief Executive Officer, ChildNet Youth and Family Services
Intensive Treatment Foster Care, Intensive Services Foster Care and Therapeutic Foster Care ITFC, ISFC and TFC Differences in Policies and Practices (September 6, 2017, 4:00 5:30) Presenters Kathy Hughes
More informationMedi-Cal Managed Care CBAS Program Transition
Medi-Cal Managed Care CBAS Program Transition Presented to: The Sacramento Medi-Cal Managed Care Stakeholder s Advisory Committee By: the Sacramento GMC Plans Revised 01/25/13 1 Outline What is CBAS? Who
More informationSolano County Mental Health Managed Care Provider Manual August 2011
Solano County Health & Social Services Solano County Mental Health Managed Care Provider Manual August 2011 Revised August 2011 Revised August 2011 This page left blank intentionally Table of Contents
More informationGUIDE TO Medi-Cal Medi-Cal M ental Health Mental Health S ervices Services Updated 2010
GUIDE TO Medi-Cal Mental Health Services Updated 2010 Disponible en Español What Is A Mental Health Emergency? An emergency is a serious mental or emotional problem, such as: When a person is a danger
More informationUpdate June, 2013 Medi-Cal Mental Health Services General Statewide Information Why Is It Important To Read This Booklet? The first section of this booklet tells you how to get Medi-Cal mental
More informationMEMBER GRIEVANCE FORM
MEMBER GRIEVANCE FORM Please Return: Partnership HealthPlan of California Attention: Grievance Unit 4665 Business Center Drive Fairfield, CA 94534 Phone: (800) 863-4155 Fax: (707) 863-4351 Partnership
More informationINPATIENT OPERATIONS HANDBOOK
INPATIENT OPERATIONS HANDBOOK County of San Diego Health & Human Services Agency Behavioral Health Services Updated September 2012 2 TABLE OF CONTENTS Page Overview..5 1. General Guidelines 6 2. Notification
More informationWHAT YOU NEED TO KNOW ABOUT INSTITUTES OF MENTAL DISEASE AND NURSING FACILITIES IN NEBRASKA
Ascend Management Innovations 1 WHAT YOU NEED TO KNOW ABOUT INSTITUTES OF MENTAL DISEASE AND NURSING FACILITIES IN NEBRASKA PRESENTATION BY NANCY SHANLEY VP OF CONSULTING AND POLICY ANALYSIS ASCEND MANAGEMENT
More informationBeacon Health Strategies Primary Care Provider Training
Beacon Health Strategies Primary Care Provider Training REFERRAL AND RESOURCE GUIDE Updated June 2015 BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 15, 2015 1 Agenda 1. Review Medi-Cal Managed
More informationSanta Clara County, California Medicare- Medicaid Plan (MMP)
Santa Clara County, California Medicare- Medicaid Plan (MMP) Behavioral health overview topics Topics covered: o Behavioral health (BH) covered services overview o BH noncovered services o Early and Periodic
More informationIn Arkansas 02/20/2014 1
In Arkansas 02/20/2014 1 Procedures for Determination of Medical Need for Nursing Home Services I. Medical Need Assessments A. Nursing Facility Procedures B. OLTC Procedures II. Pre-Admission Screening
More informationFamily Medicine Residency Behavior Medicine Rotation Elly Riley, DO
Family Medicine Residency Behavior Medicine Rotation Elly Riley, DO Rotation Goal The teaching of Human Behavior and Psychiatry at the UT Family Medicine Center (UTFPC) is divided into several discreet
More informationWest Coast University Course Syllabus Revision Date: April 2010
Section B: Course Outline Class objectives reflect the teaching activities that, if engaged in, are intended to lead to specific, measurable student learning outcomes as identified in Section A. Content
More informationApplicant Name Last, First Social Security Number Date of Birth. Applicant s Address City State Zip Code
MAP-409 COMMONWEALTH OF KENTUCKY DEPARTMENT FOR MEDICAID SERVICES PRE-ADMISSION SCREENING AND RESIDENT REVIEW (PASRR) NURSING FACILITY IDENTIFICATION SCREEN (LEVEL I) Revised March 2007 Applicant Name
More informationNew Online Features Enhance the Initial Health Assessment Roster
Staff Newsletter #19 IEHP Now Covers Care for Autism Spectrum Disorder Page 3 New Prior Authorization Forms Page 4 What's New with the Flu Page 5 Summer Fall 2014 2012 New Online Features Enhance the Initial
More informationPASRR LEVEL I INSTRUCTIONS FOR OHCA FORM LTC-300A PURPOSE
PLEASE READ THE FOLLOWING INSTRUCTIONS THOROUGHLY. IF YOU HAVE ANY QUESTIONS OR IF ANY PART IS NOT UNDERSTOOD, PLEASE CONTACT OHCA/LOCEU. PURPOSE The LTC-300A is used to meet Federal requirements for PASRR
More informationGP SERVICES COMMITTEE Mental Health INCENTIVES. Revised January 2018
GP SERVICES COMMITTEE Mental Health INCENTIVES Revised January 2018 COMMUNITY-BASED MENTAL HEALTH INITIATIVE The following incentive payments are available to B.C. s eligible family physicians. The purpose
More informationMedi-Cal Managed Care Advisory Committee Split Benefit Overview
Medi-Cal Managed Care Advisory Committee Split Benefit Overview Division of Mental Health Services Stephanie Kelly, MS, LMFT October 23, 2017 1 Molina Anthem Blue Cross Health Net Kaiser Permanente United
More informationLibrary of Congress Cataloging-in-Publication Data
Library of Congress Cataloging-in-Publication Data Names: Johnson, Kathryn, 1947-, author. Vanderhoef, Dawn, author. Nursing Knowledge Center, publisher. Title: Psychiatric-mental health nurse practitioner
More informationCMHPSM Organizational Credentialing/Re-credentialing Application Instructions
CMHPSM Organizational Credentialing/Re-credentialing Application Instructions Overview The CMHPSM credentialing/re-credentialing form is to be used for initially applying to become a CMHPSM Mental Health
More informationSan Diego County Funded Long-Term Care Criteria
San Diego County Funded Long-Term Care Criteria Prepared By: 6/23/16 Table of Contents San Diego County Funded Long Term Care Criteria... 2 Referral Criteria by Level of Care: Institute of Mental Disease
More informationEducation & Training Plan
Ed4 (Created 9-10-15) AUBURN O FFICE OF P ROFESSIONAL AND CONTINUING EDUCATION Office of Professional & Continuing Education 301 OD Smith Hall Auburn, AL 36849 http://www.auburn.edu/mycaa Contact: Shavon
More informationThree World Concept of Behavioral Health and Primary Care Integration Part 3 The Clinician Perspective
Three World Concept of Behavioral Health and Primary Care Integration Part 3 The Clinician Perspective Colorado Behavioral Health Association October 3, 2010 Three World Model C. J. Peek suggests that
More informationMild-to-Moderate Mental Health Coverage in Medi-Cal: The Challenge and Promise of Coordination between Counties and Health Plans
Advancing innovations in health care delivery for low-income Americans Mild-to-Moderate Mental Health Coverage in Medi-Cal: The Challenge and Promise of Coordination between Counties and Health Plans December
More informationDEPARTMENT OF PUBLIC HEALTH SPECIALTY MENTAL HEALTH SERVICES DOCUMENTATION REQUIREMENTS AT A GLANCE
1 DEPARTMENT OF PUBLIC HEALTH SPECIALTY MENTAL HEALTH SERVICES DOCUMENTATION REQUIREMENTS AT A GLANCE A DESK REFERENCE FOR BASIC STATE DOCUMENTATION REQUIREMENTS Inside Page 1 List of Medi Cal Reimbursable
More informationBehavioral Health Outpatient Authorization Request Self Service. User Guide
Behavioral Health Self Behavioral Health Outpatient Authorization Request Self Service User Guide Introduction Tufts Health Plan Network Health has created this user guide to illustrate how to navigate
More informationCoordination of Physical and Mental Health Care SECTION 11: COORDINATION OF PHYSICAL AND MENTAL HEALTH CARE
SECTION 11: COORDINATION OF PHYSICAL AND MENTAL HEALTH CARE 11.0 CalViva Health Medi-Cal Managed Care Plan 11.0.1 Referral for Mental Health Services A CalViva Health Medi-Cal beneficiary of Fresno County
More informationThe following benefit is being added: Behavioral health treatment applied behavior analysis (ABA)
Customer No.: Dear , Thank you for your business. We re writing to let you know of changes to
More information#14 AUTHORIZATION FOR MEDI-CAL SPECIAL TY MENTAL HEAL TH SERVICES (OUTPATIENT)
COUNTY OF SANTA BARBARA ALCOHOL, DRUG AND MENTAL HEAL TH SERVICES Section - Policy- QUALITY ASSURANCE #14 AUTHORIZATION FOR MEDI-CAL SPECIAL TY MENTAL HEAL TH SERVICES (OUTPATIENT) Director's /{A A.. \
More informationDivision of Mental Health, Developmental Disabilities & Substance Abuse Services NC Mental Health and Substance Use Service Array Survey
Table 1 Service Name Include any subcategories of service on a separate line In Table 2, please add service description and key terms Outpatient Treatment Behavioral Health Urgent Care (a type of outpatient)
More informationAmerican Health Quality Association Sept Baltimore Maryland Managing Behavioral Health Problems and Solutions
American Health Quality Association Sept 9 2015 Baltimore Maryland Managing Behavioral Health Problems and Solutions Meeting the Challenges of Behavioral Health Integration IBHI IS: 501C3 Organization
More informationPrimary Care/Behavioral Health INTEGRATION. Neal Adams, MD MPH Deputy Director California Institute for Mental Health
Primary Care/Behavioral Health INTEGRATION Neal Adams, MD MPH Deputy Director California Institute for Mental Health Why Integrate BH & PC? BH disorder burden is great BH and physical health problems are
More informationCLINICAL DOCUMENTATION GUIDE
CLINICAL DOCUMENTATION GUIDE 2016 YOLO COUNTY MENTAL HEALTH PLAN TABLE OF CONTENTS Chapter 1: Introduction/Compliance 3 1.1 Why Do We Have This Manual? 1.2 Compliance Chapter 2: General Principals of Documentation.6
More informationFOR BCBSTX Providers Only
Integrated Behavioral Health Program Updates Frequently Asked Questions For BCBSTX Providers Only Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes to the Behavioral Health Program*.
More informationI. Coordinating Quality Strategies Across Managed Care Plans
Jennifer Kent Director California Department of Health Care Services 1501 Capitol Avenue Sacramento, CA 95814 SUBJECT: California Department of Health Care Services Medi-Cal Managed Care Quality Strategy
More informationMental Health Liaison Group
Mental Health Liaison Group The Honorable Nancy Pelosi The Honorable Harry Reid Speaker Majority Leader United States House of Representatives United States Senate Washington, DC 20515 Washington, DC 20510
More informationThe Budget: Maximizing Federal Reimbursement For Parolee Mental Health Care Summary
The 2013-14 Budget: Maximizing Federal Reimbursement For Parolee Mental Health Care MAC Taylor Legislative Analyst MAY 6, 2013 Summary Historically, the state has spent tens of millions of dollars annually
More informationI. General Instructions
Contra Costa Behavioral Health Services Request for Proposals (RFP) Outpatient Mental Health Services September 30, 2015 I. General Instructions Contra Costa Behavioral Health Services (CCBHS, or the County)
More informationFacility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By
Policy Number 2016RP505A Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date 09/30/2016 Approved By Optum Behavioral Reimbursement Committee IMPORTANT NOTE
More informationSANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery .,-~ ,
SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery Page 11 of 7 Departmental Policy and Procedure Section Sub-section Policy Clinical Documentation Mental Health Client
More informationFrom Triage to Intervention: A Crisis Care Model for Persons with IDD. Alton Bozeman, Psy.D., Clinical Psychologist Amanda Willis, LCSW-S
From Triage to Intervention: A Crisis Care Model for Persons with IDD Alton Bozeman, Psy.D., Clinical Psychologist Amanda Willis, LCSW-S Examples of Barriers Lack of information Access to professionals
More informationAffiliate Provider Application Instructions and Check Sheet
WellSpan EAP P.O. Box 1827 York, PA 17405 1827 Phone: 866 227 6527 Fax: (717) 851 4493 Affiliate Provider Application Instructions and Check Sheet Enclosed is an Affiliate Provider Application for your
More informationUnit 4 Diagnosis and Outcome Development
Unit 4 Diagnosis and Outcome Development Introduction Learning Outcomes Resources Information Instructional Activities Resources COPYRIGHT and Acknowledgements Copyright 2014 Registered Nurses Professional
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 information1. SMHS Section of CCR Title 9 (Division 1, Chapter 11): this is the regulation created by the California Department of Health Care Services (DHCS).
Clinical Documentation Tool This tool compares the definitions of outpatient Specialty Mental Health s (SMHS) that appear in two different sources: 1. SMHS Section of CCR Title 9 (Division 1, Chapter 11):
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 informationCMS-0044-P; Proposed Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Stage 2
May 7, 2012 Submitted Electronically Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building
More informationTemplate Language for Memorandum of Understanding between Duals Demonstration Health Plans and County Behavioral Health Department(s)
Template Language for Memorandum of Understanding between Duals Demonstration Health Plans and County Behavioral Health Department(s) Updated Draft February 14, 2013 In the duals demonstration, participating
More informationExam Blueprint and Specialty Competencies
Exam Blueprint and Specialty Competencies Introduction Blueprint for the Psychiatric and Mental Health Nursing Certification Exam The primary function of the blueprint for the CNA Psychiatric and Mental
More informationEVALUATION OF THE CARE MANAGEMENT OVERSIGHT PROJECT. Prepared By: Geneva Strech, M. Ed., MHR Betty Harris, M. A. John Vetter, M. A.
University of Oklahoma College of Continuing Education EVALUATION OF THE CARE MANAGEMENT OVERSIGHT PROJECT June 30, 2011 Prepared By: Geneva Strech, M. Ed., MHR Betty Harris, M. A. John Vetter, M. A. Funding
More informationSTROKE REHAB PROGRAM
STROKE REHAB PROGRAM Allied Rehab Hospital is part of Allied Services Integrated Health System, the premier post-acute health-care system in Northeast Pennsylvania, and is the region s leading provider
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 informationUNDER SECRETARY OF DEFENSE 4000 DEFENSE PENTAGON WASHINGTON, DC
~ ' UNDER SECRETARY OF DEFENSE 4000 DEFENSE PENTAGON WASHINGTON, DC 20301-4000 PERSONNEL AND READINESS The Honorable Carl Levin Chairman Committee on Armed Services United States Senate Washington, DC
More informationCOMPLIANCE. Behavioral Health Compliance Office Compliance Corner. October Defining Healthcare Compliance. A culture that promotes:
Behavioral Health Compliance Office Compliance Corner October 2018 COMPLIANCE Defining Healthcare Compliance Healthcare compliance can be defined as the ongoing A culture that promotes: process of meeting
More informationEVALUATION OF THE CARE MANAGEMENT OVERSIGHT PROJECT. June 30, 2011 Prepared By: Geneva Strech, M. Ed., MHR Betty Harris, M. A. John Vetter, M. A.
University of Oklahoma College of Continuing Education EVALUATION OF THE CARE MANAGEMENT OVERSIGHT PROJECT June 30, 2011 Prepared By: Geneva Strech, M. Ed., MHR Betty Harris, M. A. John Vetter, M. A. Funding
More informationRFS-7-62 ATTACHMENT E INDIANA CARE SELECT PROGRAM DESCRIPTION AND COVERED BENEFITS
The following services are covered by the Indiana Care Select Program. Dual-eligible members, those members eligible for both IHCP and Medicare, will not receive any benefits under Indiana Care Select,
More informationState of West Virginia DEPARTMENT OF HEALTH AND HUMAN RESOURCES Office of Inspector General Board of Review 1027 N. Randolph Ave.
Earl Ray Tomblin Governor State of West Virginia DEPARTMENT OF HEALTH AND HUMAN RESOURCES Office of Inspector General Board of Review 1027 N. Randolph Ave. Elkins, WV 26241 October 5, 2012 Rocco S. Fucillo
More informationCHILDREN'S MENTAL HEALTH ACT
40 MINNESOTA STATUTES 2013 245.487 CHILDREN'S MENTAL HEALTH ACT 245.487 CITATION; DECLARATION OF POLICY; MISSION. Subdivision 1. Citation. Sections 245.487 to 245.4889 may be cited as the "Minnesota Comprehensive
More informationAlcohol Drug & Mental Health Services INPATIENT SERVICES
Alcohol Drug & Mental Health Services INPATIENT SERVICES WHEN MUST COUNTY FUND MENTAL HEALTH SERVICES? 2 INPATIENT INCREASES DRIVERS Lack of psychiatric beds state & nation Increase in patients Court Ordered
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 informationState of California Health and Human Services Agency Department of Health Care Services
State of California Health and Human Services Agency Department of Health Care Services JENNIFER KENT DIRECTOR EDMUND G. BROWN JR. GOVERNOR DATE: December 3, 2015 ALL PLAN LETTER 15-025 (SUPERSEDES ALL
More informationDEPARTMENT OF COMMUNITY SERVICES. Services for Persons with Disabilities
DEPARTMENT OF COMMUNITY SERVICES Services for Persons with Disabilities Alternative Family Support Program Policy Effective: July 28, 2006 Table of Contents Section 1. Introduction Page 2 Section 2. Eligibility
More informationEnsuring safety: IHSS Caregiver Back-up System (BUS)
P a g e 1 Ensuring safety: IHSS Caregiver Back-up System (BUS) ABSTRACT OF THE PROGRAM The In-Home Supportive Services (IHSS) Caregiver Back-Up System (BUS) is an innovative, 24- hour, in-home emergency
More informationSpecialized Therapeutic Foster Care and Therapeutic Group Home (Florida)
Care1st Health Plan Arizona, Inc. Easy Choice Health Plan Harmony Health Plan of Illinois Missouri Care Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona OneCare (Care1st Health
More informationThe Future of Delivery System Reform in Medi-Cal: Moving Medi-Cal Forward
The Future of Delivery System Reform in Medi-Cal: Moving Medi-Cal Forward Cindy Mann Partner Manatt Health July 13, 2016 Agenda 2 Project Overview Medi-Cal Today Vision for the Future of Medi-Cal Near
More informationMHP Work Plan: 4-Behavioral health clinical care
PROGRAM INFORMATION: Program Title: School Based Metro (MHSA) Provider: Department of Behavioral Health The Department of Behavioral Health (DBH) Metro School Based Team (MSBT) is designed to deliver outpatient
More informationNovember 14, Chief Clinical Operating Officer Division of Medical Assistance Department of Health and Human Services
Department of Health and Human Services Division of Medical Assistance Response To Questions from the Adult Care Home Transition Subcommittee of the Blue Ribbon Commission November 14, 2012 Presenter:
More informationHCMC Outpatient Mental Health Programs. External Referral Form
HCMC Outpatient Mental Health Programs External Referral Form Thank you for your interest in the Day Treatment, Partial Hospital Program, or Dialectical Behavior Therapy Intensive Outpatient Program. All
More informationNASSAU COUNTY SINGLE POINT OF ACCESS (SPOA) CHILDREN S INTENSIVE MENTAL HEALTH PROGRAMS
NASSAU COUNTY SINGLE POINT OF ACCESS (SPOA) CHILDREN S INTENSIVE MENTAL HEALTH PROGRAMS Date of Referral: Child s Name: Date of Birth: Gender: Social Security Number: Age: Address: Town: Zip: Phone: Legal
More informationBackground to HoNOS (extract from Trust website) Page 2. How to Rate HoNOS Page 2. The Mental Health Clustering Tool Page 3
HOW TO..HoNOS and RiO Contents: Background to HoNOS (extract from Trust website) Page 2 How to Rate HoNOS Page 2 The Mental Health Clustering Tool Page 3 How to use HoNOS process flow For teams using RiO
More informationSpecialty Behavioral Health and Integrated Services
Introduction Behavioral health services that are provided within primary care clinics are important to meeting our members needs. Health Share of Oregon supports the integration of behavioral health and
More informationBehavioral Health Redesign Timeline. John B. McCarthy, Director Ohio Department of Medicaid September 17, 2015
John B. McCarthy, Director Ohio Department of Medicaid September 17, 2015 Ohio s Priorities for Behavioral Health (BH) Redesign 1915(i) Program for Adults With SPMI» Ensure continued access to care for
More informationFlorida Medicaid. Community Behavioral Health Services Coverage and Limitations Handbook. Agency for Health Care Administration
Florida Medicaid Community Behavioral Health Services Coverage and Limitations Handbook Agency for Health Care Administration UPDATE LOG COMMUNITY BEHAVIORAL HEALTH SERVICES COVERAGE AND LIMITATIONS HANDBOOK
More informationTitle. Clinical Documentation Training: Mental Health Medi-Cal Specialty Mental Health Services. Subtitle
Clinical Documentation Training: Mental Health Medi-Cal Specialty Mental Health Services Outpatient Behavioral Health Services Provided by Medical Staff 1 Title Subtitle October 2016 San Francisco Department
More informationIndividual Applicant Information Practices with 5 or more counselors should call (651) for further instruction.
Individual Applicant Information Practices with 5 or more counselors should call (651) 383-8473 for further instruction. Group Practice Name Office Location to Add to Personal Demographics First Name Last
More informationPENNSYLVANIA PREADMISSION SCREENING RESIDENT REVIEW (PASRR) IDENTIFICATION LEVEL I FORM (Revised 9/1/2018)
PENNSYLVANIA PREADMISSION SCREENING RESIDENT REVIEW (PASRR) IDENTIFICATION LEVEL I FORM (Revised 9/1/2018) This process applies to all nursing facility (NF) applicants, regardless of payer source. All
More informationServices and Supports for People with Dual Diagnosis
RIGHTS UNDER THE LAN TERMAN ACT Services and Supports for People with Dual Diagnosis Chapter 10 This chapter explains: - Dual diagnosis - Mental health services and supports - Regional Center responsibilities
More informationMental Health Board Member Orientation & Training
1 Mental Health Board Member Orientation & Training See Tab 1 Mental Health Timeline 1957 Sources: California Legislative Analyst Office & California Department of Health Care Services to Prior to 1957
More informationALL MENTAL HEALTH AND SUBSTANCE USE DISORDER PROGRAMS MUST INCLUDE PSYCHOSOCIAL AND PSYCHIATRIC EVALUATIONS
COUNTY of NASSAU DEPARTMENT OF HUMAN SERVICES Office of Mental Health, Chemical Dependency and Developmental Disabilities Services 60 Charles Lindbergh Boulevard, Suite 200, Uniondale, New York 11553-3687
More informationSeptember 27, RE: Medicaid Primary Care Rate Increase. Dear Administrator Tavenner:
September 27, 2013 Marilyn Tavenner, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445 G, Hubert H. Humphrey Building 200 Independence Avenue SW Washington,
More informationNursing: Mental Health and Community Concepts
Western Technical College 10543110 Nursing: Mental Health and Community Concepts Course Outcome Summary Course Information Description Career Cluster Instructional Level Total Credits 2.00 This course
More informationMEDI-CAL MANAGED CARE OVERVIEW
MEDI-CAL MANAGED CARE OVERVIEW September 2016 Sandy Damiano, PhD Deputy Director DHHS Primary Health Eligibility & Enrollment Open year round Based on income and family size Simplified procedures Income
More information17. MEMBER TRANSFERS AND DISENROLLMENT. A. Primary Care Physician (PCP) Transfers 1. Voluntary
A. Primary Care Physician (PCP) Transfers 1. Voluntary APPLIES TO: A. This policy applies to all IEHP Medi-Cal Members. POLICY: A. IEHP makes best efforts to accommodate Member requests for transfer of
More informationPRE-ADMISSION SCREENING AND RESIDENT REVIEW (PASRR) LEVEL I SCREEN
NEW JERSEY DEPARTMENT OF HUMAN SERVICES PRE-ADMISSION SCREENING AND RESIDENT REVIEW (PASRR) LEVEL I SCREEN Please print and complete all questions. This form must be completed for all applicants PRIOR
More informationBehavioral Health Services
Behavioral Health Services Substance Use Disorder Services and RFP 26-2016: Substance Abuse Disorder Treatment Services and Support. February 6, 2018 1 Introduction Today is the fourth in a series of overview
More informationProvider Responsibilities: Health Assessments
Provider Responsibilities: Health Assessments 1 This section includes information about the two categories of providers who may render Child Health and Disability Prevention (CHDP) services, outlines the
More informationThe Way Forward. Towards Recovery: The Mental Health and Addictions Action Plan for Newfoundland and Labrador
The Way Forward Towards Recovery: The Mental Health and Addictions Action Plan for Newfoundland and Labrador 2 Table of Contents Introduction... 2 Background... 3 Vision and Values... 5 Governance... 6
More informationLOUISIANA MEDICAID PROGRAM ISSUED: 08/24/17 REPLACED: 07/06/17 CHAPTER 2: BEHAVIORAL HEALTH SERVICES APPENDIX B GLOSSARY/ACRONYMS PAGE(S) 5 GLOSSARY
GLOSSARY The following is a list of abbreviations, acronyms and definitions used in the Behavioral Health Services manual chapter. Ambulatory Withdrawal Management with Extended On-Site Monitoring (ASAM
More informationClinical Documentation Training: Mental Health Medi-Cal Specialty Mental Health Services
Clinical Documentation Training: Mental Health Medi-Cal Specialty Mental Health Services Child, Youth and Family System of Care Outpatient Behavioral Health Services October 2016 San Francisco Department
More informationPersonal Long-Term Care Plan Long-Term Care Insurance. Plan Benefits First-Occurrence Nursing Home Assisted-Living Home Care
Personal Long-Term Care Plan Long-Term Care Insurance Plan Benefits First-Occurrence Nursing Home Assisted-Living Home Care Form A27075BNJ IC(7/05) Aflac s Personal Long-Term Care Insurance Plan Policy
More informationMental Health and Substance Abuse Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE
Mental Health Substance Abuse Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE NUMBER: OMHSAS 01-01 ISSUE DATE: 2-01-01 EFFECTIVE DATE: Immediately SUBJECT BY Nursing Home Reform Implementation
More informationOptum. Clinical Expertise Checklist
Optum Clinical Expertise Checklist To add or modify your area(s) of expertise and/or attested specialty(ies): Complete and sign this form Fax completed form and any requested supportive documents to Network
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 informationObservation Care Evaluation and Management Codes Policy
Policy Number Observation Care Evaluation and Management Codes Policy 2017R0115A Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible
More informationIowa PASRR for Providers. A brief introduction to
Iowa PASRR for Providers A brief introduction to Iowa s PASRR process 1 Why are PASRR Level I screens and Level II evaluations important? Mental health services in nursing facilities make a difference
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 informationPaula Stone Deputy Director, DMS, DHS
Paula Stone Deputy Director, DMS, DHS 1 Outpatient mental health services available to AR Medicaid beneficiaries include: Individual, family and group counseling services provided in an outpatient agency
More informationContemporary Psychiatric-Mental Health Nursing Third Edition. Comprehensive Assessment. Psychiatric History* 10/9/2014.
Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 11 Psychiatric- Mental Health Assessment Comprehensive Assessment Enables nurse to: Make sound clinical judgments Plan appropriate interventions
More informationA. Utilization Management Delegation and Monitoring
A. Utilization Management Delegation and Monitoring APPLIES TO: A. This policy applies to all IEHP DualChoice Cal MediConnect Plan (Medicare Medicaid Plan) Members. POLICY: A. As of October 1, 2015, IEHP
More information