Outpatient Behavioral Health Services (OBH)-General Information

Transcription

1 Outpatient Behavioral Health Services (OBH)-General Information 1

2 General Information Beneficiaries currently served by the RSPMI, LMHP, and SATS programs will begin transitioning to the Outpatient Behavioral Health Program starting on July 1, RSPMI, LMHP and SATS will cease to exist on June 30, 2018; and no Arkansas Medicaid payments will occur to any RSPMI, LMHP, or SATS provider for a service provided after June 30, Current providers have to transition as an agency to OBH before providing any new OBH/Tier services. Current LMHP and SATS providers will have to obtain certification to provide OBH services as Independently Licensed Practitioners. Please note-as providers remain RSPMI/LMHP/SATS they will continue to meet these requirements until fully transitioned. (MTP, TPR timeframes, etc) 2

3 Scope and Eligibility of Services Outpatient Behavioral Health Services Program- treatment and services by a certified Behavioral Health Services provider to Medicaid-eligible beneficiaries that have a Behavioral Health diagnosis as described in the American Psychiatric Association Diagnostic and Statistical Manual (DSM-IV and subsequent revisions). Eligibility for services-depends on the needs of the beneficiary Counseling Level Services and Crisis Services can be provided to any beneficiary as long as the services are medically necessary. Rehabilitative Level Services and Intensive Level Services eligibility is based upon the results of an Independent Assessment performed by an independent entity. 3

4 New Levels of Service COUNSELING LEVEL SERVICES (Tier 1) Time-limited behavioral health services provided by qualified licensed practitioners Counseling Services settings are: a behavioral health clinic/office, healthcare center, physician office, and/or school Can be provided to any beneficiary as long as medical necessity is established REHABILITATIVE LEVEL SERVICES (Tier 2) 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: beneficiary s home, community, behavioral health clinic/ office, healthcare center, physician office, and/ or school 4

5 New Levels of Service INTENSIVE LEVEL SERVICES (Tier 3) 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 5

6 Current RSPMI providers will be grandfathered in to Outpatient Behavioral Health certification Current LMHP and SATS providers will have to complete the application/certification process for OBH The following services will require specialty certification to provide: Dyadic Treatment Therapeutic Communities Acute Crisis Units Partial Hospitalization Certifications 6

7 Certification New Certification requirements and forms effective July 1, 2017 The Department of Human Services Division of Provider Services and Quality Assurance will be responsible for certification of Medicaid Behavioral Health Providers. Primary contacts for this Division: Stephenie Blocker Donna Hicks Applications for Behavioral Health Certification should continue to be sent to the following: Division of Behavioral Health Services Certification and Policy 305 South Palm Street, Little Rock, AR to the attention of Rachael Veregge or via to DBHS will continue to coordinate with this new Division to make this transition as smooth as possible. 7

8 Staffing Requirements PROVIDER TYPE LICENSES STATE CERTIFICATION REQUIRED SUPERVISION Certified Peer Support Specialist N/A Yes, to provide services within a certified behavioral health agency Required Certified Youth Support Specialist N/A Yes, to provide services within a certified behavioral health agency Required Certified Family Support Partner N/A Yes, to provide services within a certified behavioral health agency Required Qualified Behavioral Health Provider non-degreed N/A Yes, to provide services within a certified behavioral health agency Required Qualified Behavioral Health Provider Bachelors N/A Yes, to provide services within a certified behavioral health agency Required Independently Licensed Clinicians Master s/doctoral Licensed Clinical Social Worker (LCSW) Licensed Marital and Family Therapist (LMFT) Licensed Psychologist (LP) Yes, must be certified to provide services Not Required Licensed Psychological Examiner Independent (LPEI) Licensed Professional Counselor (LPC) Independently Licensed Clinicians Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months & Parent/Caregiver) Provider Licensed Clinical Social Worker (LCSW) Licensed Marital and Family Therapist (LMFT) Licensed Psychologist (LP) Licensed Psychological Examiner Independent (LPEI) Licensed Professional Counselor (LPC) Yes, must be certified to provide services Not Required 8

9 Staffing Requirements Continued Independently Licensed Clinicians Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months & Parent/Caregiver) Provider Licensed Clinical Social Worker (LCSW) Licensed Marital and Family Therapist (LMFT) Licensed Psychologist (LP) Licensed Psychological Examiner Independent (LPEI) Licensed Professional Counselor (LPC) Yes, must be certified to provide services Not Required Non-independently Licensed Clinicians Master s/doctoral Licensed Master Social Worker (LMSW) Licensed Associate Counselor (LAC) Licensed Psychological Examiner (LPE) Yes, must be supervised by appropriate Independently Licensed Clinician Required Provisionally Licensed Psychologist (PLP) Non-independently Licensed Clinicians Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months & Parent/Caregiver) Provider Licensed Master Social Worker (LMSW) Licensed Associate Counselor (LAC) Licensed Psychological Examiner (LPE) Provisionally Licensed Psychologist (PLP) Yes, must be supervised by appropriate Independently Licensed Clinician and must be certified to provide services Required Registered Nurse Registered Nurse (RN) No, must be a part of a certified agency Required Advanced Practice Nurse (APN) Adult Psychiatric Mental Health Clinical Nurse Specialist Child Psychiatric Mental Health Clinical Nurse Specialist No, must be part of a certified agency or have a Collaborative Agreement with a Physician Collaborative Agreement with Physician Required Adult Psychiatric Mental Health APN Family Psychiatric Mental Health APN Physician Doctor of Medicine (MD) No, must provide proof of licensure Not Required Doctor of Osteopathic Medicine (DO) 9

10 Outpatient Behavioral Health Services (OBH)-Access and Eligibility 10

11 Eligibility Eligibility depends on the needs of the beneficiary. Counseling Level Services and Crisis Services: Can be provided to any beneficiary as long as the services are medically necessary. Rehabilitative Level Services: Eligibility will be based on the results of an Independent Assessment performed by an independent entity. Intensive Level Services: Eligibility will be based on the results of an Independent Assessment performed by an independent entity. 11

12 Physician s Role-Tier 1 Services Providers certified and eligible to provide Counseling Level Services must have relationships with a physician licensed in Arkansas in order to ensure psychiatric and medical conditions are monitored and addressed by appropriate physician oversight. Medical Supervision responsibility shall include, but is not limited to, the following: A beneficiary can receive three (3) Counseling Level Services before a PCP/PCMH referral is necessary in the medical record (see Section ). Medical responsibility will be vested in a physician licensed in Arkansas who signs the PCP referral or PCMH approval for Counseling Level Services of the Outpatient Behavioral Health Services program. 12

13 Physician s Role-Tier 2 and Tier 3 Services Certified Behavioral Health Agencies which provide Tier 2 and Tier 3 services are required to have relationships with a board certified or board eligible psychiatrist who provides appropriate supervision and oversight for all medical and treatment services for beneficiaries with behavioral health needs. A physician will supervise and coordinate all psychiatric and medical functions as indicated in the Treatment Plan that is required for beneficiaries receiving Rehabilitative Level Services or Intensive Level Services Medical responsibility shall be vested in a physician licensed in Arkansas that signs the Treatment Plan of the beneficiary. 13

14 Primary Care Physician (PCP) Referral Tier 2 & Tier 3 PCP referral is not required due to the Independent Assessment and care coordination that will occur upon transition. The Independent Assessment will determine eligibility. 14

15 Independent Assessments A standardized Independent Assessment will determine eligibility for Rehabilitative Level Services and Intensive Level Services (Tier 2 and Tier 3) Transition Year DHS will identify blocks of beneficiaries to be referred for an Independent Assessments each month during this transition year. Starting November 2017, approximately 4000 beneficiaries per month will be referred by DHS to Optum to be assessed. (September and October will have smaller samples sent to Optum) Criteria for Presumptive Eligibility and Priority Populations for an Independent Assessment will go into effect after the transitional year. (Excluding requests for Residential admissions and the adult 911 populations) 15

16 Residential Admissions U21 Beneficiaries referred for Residential treatment will be a Priority Population effective October 1, During this transition year: 1) Providers will continue to submit requests to Beacon for Residential admissions. 2) When the beneficiary is currently in the home/community setting a) Beacon will place these requests for Residential admission on hold and refer the beneficiary for an Independent Assessment. b) Once the assessment has been completed the results will be provided to Beacon. c) Beacon physician will make CON determination on information submitted as well as results of the Independent Assessment for authorization. 16

17 Residential Admissions U21 (cont.) 3) When the beneficiary is currently in an Acute Hospital setting a) Beacon physician will review these requests for Residential admission based on information provided. Beacon will make a CON determination based on information provided. b) If approved, Beacon will issue an authorization up to 14 days for Residential Treatment. c) Beneficiary will be referred for an Independent Assessment upon receipt of request for admission. d) Once assessment is completed, Beacon will be notified of the results of the Independent Assessment. e) Provider will submit a continuing stay request to Beacon at the end of the initial authorization. Beacon will review the results of the Independent Assessment as well as clinical documentation provided to make a medical necessity determination for continued stay in the facility. 17

18 Outpatient Behavioral Health Services (OBH)-Service Array and PA/EOB 18

19 Tier Services new services in red existing services in blue Independent Assessment to determine eligibility for: Clinic-Based Tier 1 Individual behavioral health counseling Group behavioral health counseling Marital/family behavioral health counseling (Including Dyadic Treatment for 0-47 mos) Multi-family behavioral health counseling Psychoeducation Mental health diagnosis Interpretation of diagnosis Substance abuse assessment Psychological evaluation Psychiatric assessment Pharmacologic management Tier 2 Home/Community-Based Master treatment plan Crisis stabilization intervention Home and community individual psychotherapy Community group psychotherapy Home and community marital/family psychotherapy Home and community family psychoeducation Individual and group pharm counseling by RN Partial hospitalization Peer support Family support partners Behavioral assistance Intensive outpatient substance abuse treatment Adult rehabilitative day service Individual and group life skills development Child and youth support services Clinic/Home/Community-Based Psychiatric diagnostic assessment Tier 3 Home/Community-Based Therapeutic Communities Residential Residential treatment unit and center Crisis Services Available to all Tiers Crisis Intervention Acute Psychiatric Hospitalization Acute Crisis Units Substance Abuse Detoxification 19

20 Treatment Planning for Tier 1 Services Beneficiaries receiving only Counseling Level Services do not require a Treatment Plan The provider documents the medical necessity of Counseling Level Services. Documentation of medical necessity must: be made a part of the beneficiary s medical record and be a written assessment that evaluates the beneficiary s mental condition and based on the beneficiary s diagnosis, determines whether treatment in the Outpatient Behavioral Health Services Program is appropriate 20

21 Treatment Planning for Tier 2 and Tier 3 Services A Treatment Plan is required for beneficiaries who are determined to be qualified for Tier 2 and Tier 3 services through the standardized Independent Assessment. The Treatment Plan should build upon the information from any Behavioral Health provider and information obtained during the standardized Independent Assessment. Periodic Review of the Master Treatment Plan: For all beneficiaries assessed to be qualified for and receiving Tier 2 or Tier 3 services the Treatment Plan must be periodically reviewed at least every 180 calendar days 21

22 Psychiatric Assessment The Psychiatric Assessment is not required for beneficiaries receiving only Counseling Level Services in the Outpatient Behavioral Health Services program. The Psychiatric Assessment is required for beneficiaries receiving Rehabilitative Level Services or Therapeutic Communities in Intensive Level Services. 22

23 MHPP/QBHP Mental Health Paraprofessionals are Qualified Behavioral Health Provider (QBHP) under OBH system Allowable services for QBHPs (Tier 2): Crisis Stabilization Intervention Behavioral Assistance (for children and youth) Adult Rehab Day Individual Life Skills Development (transitional youth age 16-20) Group Life Skills Development (age 16-20) Child and Youth Support Services Supportive Employment (adults) Supportive Housing (adults) Adult Life Skills Development 23

24 Allowable QBHP Services MHPP Services under RSPMI: Intervention, MHPP Collateral Intervention, MHPP Crisis Stabilization Intervention, MHPP Rehabilitative Day Services QBHP Services under Outpatient Behavioral Health (OBH): Crisis Stabilization Intervention Behavioral Assistance Individual Life Skills Development Group Life Skills Development Supportive Employment Supportive Housing Adult Life Skills Development Adult Rehab Day Child and Youth Support Services *new services only allowable once an agency transitions to OBH system 24

25 Outpatient Behavioral Health Services (OBH)-Next Steps 25

26 Introducing Reintegration Management On July 1, 2017, the new Reintegration Management program began: The Reintegration Management Team will contact guardians and providers to assist with navigating the behavioral health system with a focus on the discharge planning process while completing inpatient review requests Discharge planning and community reintegration are the focus 26

27 Prior Authorization Process-RSPMI Prior Authorization process will remain the same for those continuing to provide RSPMI services 3 months authorizations in conjunction with Master Treatment Plan and Periodic Review All RSPMI regulations still expected to be followed Inspections of Care and Retrospective Reviews will continue as well RSPMI/LMHP authorizations will no longer be available after June 30,

28 Prior Authorization Process-OBH As Providers transition to OBH services, prior authorization will continue to be required. All new Tier level services are now available in ProviderConnect Upon transition to OBH, authorizations will be reviewed for 6 month time frames. Treatment Planning documents will be required for authorization of Tier 2 and Tier 3 services Extension of Benefit is available for Tier 1 services Services will be authorized based on applicable certifications For example, Therapeutic Communities can only be requested by providers certified to provide this service Requests for services should only be for the Tier Level services for which the beneficiary has been deemed appropriate. Beacon will receive notification from the Independent Assessor of Tier determination 28

29 Beacon Contact Information Clinical Services: Melissa Ortega, Interim Vice President Jennifer Brezee, Clinical Services Manager Medical Director: Dr. Nichole Bauknight, Medical Director Dr. Kelly Hair, Associate Medical Director 29

30 Beacon Contact Information Provider Relations and Training Opportunities: Kerri Brazzel, Project Director Shelly Rhodes, Provider Relations Manager Reintegration Management: Jamie Ables, Clinical Services Manager 30

31 Thank you 31