BEHAVIORAL HEALTH REHABILITATION SERVICES

Transcription

1 BEHAVIORAL HEALTH REHABILITATION SERVICES

2 TODAY S AGENDA New Developments Update on PA of TSS Highlights of Draft Regulations

3 CORRECTIVE ACTION WORKGROUP In response to: Ever Increasing Utilization Complaints Providers Consumers Counties Other Departmental Agencies On-Site Reviews by BPI

4 CORRECTIVE ACTION WORKGROUP Purpose: To develop and implement a comprehensive corrective action plan to address: Treatment Issue Documentation Issue System/Billing Issue

5 CORRECTIVE ACTION WORKGROUP Members: Department of Public Welfare Office of Medical Assistance Programs Office of Mental Health and Substance Abuse Services (OMHSAS) Office of Mental Retardation (OMR) Office of Children, Youth and Families (OCY&F) Office of the Medical Director Department of Health

6 CORRECTIVE ACTION WORKGROUP Issued MA Bulletins: Accurate Billing for Units of Service Based on Units of Time Change in Procedure for Requesting and Billing Therapeutic Staff Support (TSS) Services Change in Billing Procedures for Behavioral Health Services Prior Authorization of TSS Services MR Licensed Providers Rendering Behavioral Health Services to Children Under 21 Years of Age Freedom of Choice New Types of Service Codes Summer Therapeutic Activity Program

7 DRAFT BULLETINS & REGULATIONS Draft Bulletin: Provision Of Mobile Therapy (Mt), Therapeutic Staff Support (TSS) and Behavioral Specialist Consultant (BSC) Services for Children and Adolescents issued for comment much of content used for Chapter 1154 Chapter 1154: Outpatient Behavioral Health Rehabilitation Services being developed

8 CHANGES TO BHR SERVICE DELIVERY SYSTEM Timeframe for Prompt Service Delivery Need for ISPT Meeting TSS Staffing Qualifications TSS Training TSS Supervision Reporting

9 TIMEFRAME FOR PROMPT SERVICE DELIVERY Services delivered as authorized within 60 days of request for service to A county OR BH-MCO OR BHRS provider

10 TIMEFRAME FOR PROMPT SERVICE DELIVERY 60-DAY TIMEFRAME INCLUDES Evaluation ISPT Meeting Authorization Delivery

11 TIMEFRAME FOR PROMPT SERVICE DELIVERY SERVICES DELIVERED AS AUTHORIZED All services delivered as authorized within 60 days OR Services offered as authorized but family delays start of service OR Amount of services offered less than authorized but family agrees appropriate

12 NEED FOR ISPT MEETING WHEN SERVICES ARE FIRST PRESCRIBED ANNUALLY THEREAFTER UNLESS: Any member of ISPT requests a meeting sooner, based on needs of child OR Child is receiving services from three or more service systems ISPT INPUT WHEN NEW SERVICE IS PRESCRIBED

13 TSS QUALIFICATIONS BACHELOR S DEGREE IN HUMAN SERVICES FIELD; OTHER BACHELOR S DEGREE or LICENSED REGISTERED NURSE + 1 year paid work experience with children or adolescents; ASSOCIATE S DEGREE or 60 COLLEGE CREDITS or LICENSED PRACTICAL NURSE + 3 years paid work experience with children or adolescents

14 TSS TRAINING INITIAL TRAINING FOR TSS WORKERS WITH NO EXPERIENCE: At least 15 hours before working alone Additional 24 hours within first six months ONGOING TRAINING FOR ALL TSS WORKERS: 20 hours per year after first year

15 TSS SUPERVISION INITIAL SUPERVISION TSS WORKERS WITH LESS THAN 6 MONTHS TSS EXPERIENCE: At least 6 hours on-site before working alone ALL NEWLY HIRED TSS WORKERS: At least 3 hours on-site before working alone

16 TSS SUPERVISION NEW PROCEDURE CODE FOR INITIAL SUPERVISION PROVIDER BILLS FOR BOTH TSS WORKER AND SUPERVISOR

17 TSS SUPERVISION ONGOING SUPERVISION For TSS workers who work 20 hours or more, at least 1 hour per week For TSS workers who work less than 20 hours, at least ½ hour per week

18 REPORTING NEW FORM TO REPORT: Time within which services are delivered Whether services were delivered at level authorized

19 REPORTING IN FFS SYSTEM Provider to submit form with prior authorization requests IN MANAGED CARE SYSTEM Provider to submit form to BH-MCO

20 IMPROVING ACCESS TO BHR SERVICES DEPARTMENT DESIGNEES TO RECEIVE COMPLAINTS ASSOCIATED WITH ACCESS TO SERVICES

21 PRIOR AUTHORIZATION OF THERAPEUTIC STAFF SUPPORT SERVICES

22 SUPPORTING DOCUMENTATION MA-97 REQUEST FORM PSYCHIATRIC OR PSYCHOLOGICAL EVALUATION DOCUMENTATION OF INTERAGENCY SERVICE PLANNING TEAM MEETING TREATMENT PLAN PLAN OF CARE SUMMARY SUBCONTRACTING FORM (AS NEEDED)

23 MA-97 REQUEST FORM BOX 1: PRIOR AUTHORIZATION BOX 3: 10 DIGIT RECIPIENT NUMBER BOX 8: PROVIDER TYPE BOX 9: PROVIDER MAID NUMBER BOX 10: ADDRESS CODE

24 MA-97 REQUEST FORM BOX 12: ONLY IF DIFFERENT PAYEE BOX 21: DSM DIAGNOSIS BOX 25: TSS BOX 25-B: TS BOX 25-C: Y9607 BOX 25-E: TOTAL # OF ½ HOUR UNITS PER MONTH

25 MA-97 REQUEST FORM BOX 31-B: DATE SERVICE INITIALLY RENDERED (HISTORICALLY) BOX 31-C: BEGINNING DATE OF SERVICE FOR THIS REQUEST PERIOD BOX 34: NARRATIVE DESCRIPTION: CONTACT PERSON & PHONE NUMBER BOXES 38 & 39: DATE AND SIGNATURE OF PARENT OR GUARDIAN BOXES 40 & 41: DATE AND SIGNATURE OF PRESCRIBER

26 EVALUATION Identifying Information Treatment History Mental Status Exam Child and Family Strengths Current Services Diagnosis Recommendations

27 IDENTIFYING INFORMATION NAME, AGE, SEX, RACE FAMILY MEMBERS PLACE OF RESIDENCE OTHER SYSTEM INVOLVEMENT SCHOOL INFORMATION DEVELOPMENTAL HISTORY

28 TREATMENT HISTORY WHETHER OR NOT ANY PREVIOUS TREATMENT WAS RECEIVED DESCRIPTION OF PREVIOUS TREATMENTS RESPONSE TO TREATMENT

29 MENTAL STATUS EXAM HOMICIDAL/SUICIDAL IDEATION, PLAN SELF-INJURIOUS BEHAVIOR PSYCHOSIS IMPAIRED THINKING: MR, ORGANIC INVOLVEMENT, DEVELOPMENTAL DELAYS ORIENTATION MANNER OF RELATING GOALS, IDEAS, UNDERSTANDING

30 CHILD & FAMILY STRENGTHS CHILD AND FAMILY STRENGTHS AND RESOURCES SITUATIONS, TIMES, AND PLACES CHILD FUNCTIONS EFFECTIVELY WITHOUT SUPPORT FAMILY MEMBER S ABILITY TO SUPPORT EACH OTHER AND THE CHILD FAMILY INTER-RELATIONSHIPS OTHER COMMUNITY SUPPORTS

31 CURRENT SERVICES TYPE OF SERVICE ALL SERVICES SETTINGS GOALS, OBJECTIVES RELATIONSHIP OF SERVICES TO EACH OTHER MEDICATION EFFECTIVENESS (MOVEMENT TOWARD GOALS)

32 DIAGNOSIS AXIS I AXIS II AXIS III AXIS IV AXIS V

33 RECOMMENDATIONS PRESCRIPTION TYPE OF SERVICE(S) NUMBER OF HOURS / WEEK MEDICALLY NECESSARY SETTINGS GOALS & INTERVENTIONS OTHER RECOMMENDATIONS

34 TREATMENT PLAN BASED ON EVAL & DIAGNOSIS SPECIFIC GOALS MEASURABLE/OBSERVABLE OBJECTIVES WITH TARGET DATES SPECIFIC INTERVENTIONS IDENTIFYING RESPONSIBLE PERSON SETTINGS

35 TREATMENT PLAN REVIEW & UPDATE OF PREVIOUS PLANS MONITORS CLINICAL IMPROVEMENT SIGNATURE OF PARENT / GUARDIAN SIGNATURE OF CHILD IF 14 YEARS OF AGE OR OLDER

36 COORDINATION OF CARE COLLABORATION OF MULTIPLE SYSTEMS AIMING FOR LEAST RESTRICTIVE, LEAST INTRUSIVE, AND MOST APPROPRIATE SERVICE ALL REPRESENTATIVES HELP DEVELOP GOALS

37 COORDINATION OF CARE ISPT MEETING (IF REQUIRED) WITHIN 60 DAYS OF START DATE AGREEMENT / DISAGREEMENT OF ISPT MEMBERS SIGNATURE OF ISPT MEMBERS IDENTIFICATION OF CONTACT PERSON FOR EACH SYSTEM

38 INCORRECT OR INCOMPLETE REQUESTS ADDITIONAL INFORMATION MUST BE RECEIVED WITHIN AGREED TIME IF RECEIVED TIMELY, CONTINUES THROUGH REVIEW PROCESS 21 DAY CLOCK CAN T BE STOPPED IF NOT RECEIVED IN TIME, DENIED AND NEW REQUEST MUST BE SUBMITTED

39 CHAPTER 1154 DEFINITIONS COVERED AND NONCOVERED SERVICES PROVIDER RESPONSIBILITIES QUALIFICATIONS FOR MT, TSS, & BSC TRAINING FOR MT, TSS, & BSC SUPERVISION FOR MT, TSS, & BSC

40 OMAP WEBSITE