Arkansas Provider E-News

Transcription

1 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 Referral Prior Authorization Recent Provider Alert OBHS Certification Contacts OBHS Resources Inspection of Care Educational Opportunities Beacon Health Options Blog Upcoming Webinars Front Line Optum Arkansas Independent Assessment Contact Information Beacon Health Options 400 West Capitol Avenue Suite 1754 Little Rock, AR (Phone) Toll Free Phone: (General Fax) Website: Evidenced-Based Treatment Practices The National Alliance on Mental Illness defines evidence-based practices, also known as EBPs, as treatments that have been researched academically or scientifically, been proven effective, and replicated by more than one investigation or study. This model integrates medically researched evidence with individual patient values and the clinical experience of the provider. Evidence-based treatment practices are meant to make treatment more effective for more people by using scientifically proven methods and research. Most agree that there are six steps for the provider in the evidence-based practice treatment process: Assess the patient and discover their clinical needs; ask the right questions. Acquire relevant research and look into all investigations or studies. Appraise the applicability, validity and quality of the knowledge to the patient s case. Discuss results of research with client and determine integration with their individual values, needs and goals. Apply the knowledge by collaboratively developing a shared plan of action between the provider and patient. Implement the plan. Some professionals also include a seventh step in which the clinician evaluates their own performance on each case-bycase basis. Arkansas Provider E-News August

2 Benefits of EBP Evidence-based practices generally work because they have been proven. Studies have already been conducted most likely in large-scale clinical trials that involve thousands of patients. Scientific evidence is plentiful and risk factors have already been assessed. The results of extensive research are usually used to produce a plan that is replicable and standardized. Many EBPs have thorough written instructions and the necessary tools needed to implement them. EBP treatments may also be less expensive than traditional therapy as well. Clinicians providing evidence-based practices are typically highly and specially trained and use tools and therapies to help individuals become more self-reliant and improve their quality of life. The Journal of Psychiatric Services published that evidence-based practices work above and beyond traditional health care, encouraging patients to improve their lifestyles, relationships and become independent. EBPs are meant to work with patients in recovery in tandem instead of against the grain. Recovering addicts, for example, are encouraged to seek peer and family support, learn their social and environmental triggers, and work to avoid relapse. Along with detoxification and sometimes medication, group and individual therapy is employed. The focus for addicts is on lifestyle changes and behavioral modification and not just detox. The evidence-based treatment method attempts to help recovering addicts improve in all aspects of their lives and not just treat the initial addiction. Many addicts also suffer from a mental health disorder, and there are EBPs, like Dialectical Behavior Therapy, that work to treat both the disorder and the addiction simultaneously, which seem to have the best results for the long term. For more information regarding Evidence Based Programs and Practices: SAMHSA NREPP Foundations Recovery Network Evidenced Based Mental Health SAMHSA EBP Web Guide *Excerpt from Foundation Recovery Network Evidence-Based Treatment Practices Arkansas Provider E-News August 2018 # 2

3 Beacon will not Beacon release will Tier not determinations release Tier determinations to providers. 5 Independent Assessment Referrals for Outpatient Behavioral Health The process for requesting an Independent Assessment for new beneficiaries at a Behavioral Health Agency is as follows: Submit a request in ProviderConnect Indicate Rehabilitative/Intensive Level as Type of Program and pick at least one (1) Tier 2 service Complete required fields marked with an asterisk (*) Enter the contact name in the Guardian Name field Self Guardian name Enter contact phone number in the Narrative Entry box No attachments are required For Optum to be able to contact the beneficiary/guardian, you must enter contact information in the Guardian Name field and Narrative Entry. Upon notification of a Tier determination, Beacon will: Notify provider that the request will be closed due to ineligibility for Tier 1 determinations. Issue a confirmation number and send to the provider via an approval letter with half of the benefit package indicated until 12/31/18 for Tier 2 or Tier 3 determinations. Prior Authorization and Extension of Benefits Tier 1 Prior Authorization is required for: Dyadic Treatment (under age 4) Provider must be an approved Dyadic Treatment provider Will be for 6 months Tier 2 Prior Authorization is required for: Supportive Employment Supportive Housing End date will be 12/31/18 Extension of Benefits An Extension of Benefits (EOB) can be requested once providers are within one to two weeks of exhausting the benefit limits or authorized units. Providers will need to submit the following documentation with the EOB: Assessment for Counseling level Services (Tier 1) Treatment Plan for Rehabilitative Level Services (Tier 2) or Intensive Level Services (Tier 3) Ongoing Behaviors and Symptoms that require additional time to stabilize and treat Arkansas Provider E-News July 2018 Arkansas Provider Arkansas E-News December Provider E-News 2016 August 2018 # 5 3

4 Recent Provider Alert Please find below helpful reminders for Entering OBH Requests in ProviderConnect: Indicate in the request the correct Program Type for the tier level of the beneficiary. Please ensure the provider is appropriately certified for the program type services requested: Counseling-Tier 1 Rehabilitative-Tier 2 Intensive-Tier 3 Counseling Level/Tier 1 Prior Authorized Services: Required for Dyadic Services Must meet the standards for Dyadic Services and be on the DAABHS Mental Health Therapist List Extension of Benefit: Submit EOB requests only when benefit has been exhausted and document this in the narrative entry box Document in the narrative entry box the medical necessity justification for needing to continue services. Please remember some services are now encounters, and request them accordingly for a 6-month time frame Rehabilitative Level/Tier 2 Independent Assessment Referrals: Continue to put contact phone number in the narrative entry box Confirmation number is generated once we receive the tier determination Only Tier 1 services should be provided until you receive the tier determination and confirmation number Confirmation Numbers: Please note in the narrative entry box if you are needing the confirmation number as it was not received on the spreadsheets that went out Please request the services needed as this will speed up the processing of these requests Extension of Benefit: Please indicate in the narrative if this is an EOB for certain services Please remember some services are encounter based, and request accordingly for the remainder of the year (ends 12/31/18) Arkansas Provider Arkansas E-News December Provider E-News 2016 August 2018 # 54

5 Outpatient Behavioral Health Services Certification Contacts The Department of Human Services Division of Provider Support and Quality Assurance will be responsible for certification of Medicaid Behavioral Health Providers. Contact: Applications for Behavioral Health Certification should to be sent to the following: Department of Human Services Division of Provider Support and Quality Assurance PO Box 1437, Slot S408 Little Rock, AR Sherri Proffer, RN Assistant Director Or New certification requirements and forms effective July 1, 2017 are available here. Independently Licensed Practitioners (ILPS) Independently Licensed Practitioner is an individual that is licensed to engage in private/independent practice by the appropriate State Board. The following licensure can qualify as Independently Licensed Practitioners: Licensed Certified Social Worker (LCSW) Licensed Marital and Family Therapist (LMFT) Licensed Psychologist (LP) Licensed Psychological Examiner Independent (LPEI) Licensed Professional Counselor (LPC) OBHS Resource Links Stay in the know with these helpful resources: Please visit Arkansas Medicaid for Provider Information, Outpatient Behavioral Health Medicaid Manual, Provider Enrollment, and other information including Frequently Asked Questions. Please visit Beacon Health Options Arkansas to get updated information on recent: Provider Alerts Provider Trainings Provider Newsletters Provider Forms and Reference Documents Please visit DBHS Publications and Manuals for the OBHS certification manuals. Arkansas Provider Arkansas E-News December Provider E-News 2016 August 2018 # 5

6 Outpatient Behavioral Health Services Onsite Inspection of Care/ Desk Review Please note the following about the Onsite Inspection of Care/Desk Review for Behavioral Health Agencies, Inpatient Providers, and Independently Licensed Practitioners. Outpatient Behavioral Health Agency Providers OBHA: What has not Changed: Decertification Process (provider will be notified upon completion of the Clinical Record Review) Right to request Reconsideration and Appeal Corrective Action Plan (CAP) submission within 30 calendar days of receipt of Report (unless a reconsideration is requested, which stops the 30-day requirement and begins again upon receipt of the results of the reconsideration) OBHA: What has Changed: Clinical Record Review Checklist Facility Review Checklist utilized No notification prior to On-Site Visit/Review Beacon Staff for On-Site Review One or two Beacon Reviewers may be on-site (may be a non-mhp, an MHP, or both) Clinical Record Review will usually occur via Desk Review after the On-Site Facility Review Clinical records for the Desk Review will be made available to Beacon via remote access to EMR, uploaded by the provider directly to ProviderConnect, or submitted by provider to Beacon via or fax. Records must be provided within 48 hours of request. [Note: Beacon will provide information/training to providers regarding this process, but will not upload/submit records] No requirement to provide evidence of CAP Implementation from last IOC/Desk Review No Exit Conference (unless the clinical records are all reviewed on-site) The Review Report will be submitted to the provider and the State within 30 days of receipt of all clinical records For the Clinical Record Review, corrective actions will be required only for deficiencies for specific, identified Elements (For other Elements, a deficiency will be considered a Clinical Observation and corrective action will not be required.) CAPs will be reviewed by DHS DPSQA (will not be reviewed by Beacon) Inpatient Providers IP: What has not Changed: Clinical Record Review Checklist Facility Review Checklist Decertification Process (provider will be notified upon completion of the clinical record review) Right to request Reconsideration and Appeal Requirement to provide evidence of CAP Implementation from last IOC/Desk Review (DR) Requirement for CAP submission for deficiencies found in the Review within 14 calendar days of receipt of Report (unless a reconsideration is requested, which stops the 14-day requirement; the 14-day requirement begins again upon receipt of the results of the reconsideration) IP: What has Changed: Beacon Staff for On-Site Review One or two Beacon Reviewers may be on-site (may be a non-mhp, an MHP, or both) Arkansas Provider Arkansas E-News December Provider E-News 2016 August 2018 # 56

7 Beacon Physician will not be on-site, but will be available for consultation and review of records during the Desk Review Clinical Record Review will usually occur via Desk Review after the On-Site Program Review Clinical records for the Desk Review will be made available to Beacon via remote access to EMR, uploaded by the provider directly to ProviderConnect, or submitted by provider to Beacon via or fax. Records must be provided within 48 hours of request Only 20 clinical records will be reviewed (or 100% if less than 20 beneficiaries) Lower percentage of personnel records will be reviewed 100% of beneficiaries will no longer be interviewed by a Beacon Physician; a percentage of beneficiaries will be interviewed by the On-Site Reviewer No Exit Conference (unless the clinical records are all reviewed on-site) and no Entrance Conference The Review Report will be submitted to the provider and the State within 30 days of receipt of all clinical records and evidence of CAP implementation Independently Licensed Practitioner Providers Notification of the actual On-Site Review: Beacon will send a notification letter via two business days prior to the actual On-Site Review, specifying the actual date that the On-Site Review will occur. Beacon will then contact the provider again by telephone for purposes of setting up the time and place for the On-Site Review and answer any further questions. Review Process: Beacon Staff for On-Site Review For most Reviews, only one Beacon Reviewer will be on-site (may be a non-mhp or an MHP) Facility Review will occur On-Site, with a specific Checklist utilized Clinical Record Review may occur on-site or via Desk Review after the On-Site Facility Review, with a specific Checklist utilized Clinical records for the Desk Review will be made available to Beacon via remote access to EMR, uploaded by the provider directly to ProviderConnect, or submitted by provider to Beacon via or fax. Records must be provided within 48 hours of request. [Note: Beacon will provide information/training to providers regarding this process, but will not upload/submit records] The Review Report will be submitted to the provider and the State within 30 days of receipt of all clinical records Providers have a right to request Reconsideration and Appeal Providers must submit a Corrective Action Plan (CAP) in response to deficiencies for specific, identified Elements in the Clinical Record Review and for deficiencies found in the Facility Review CAP submission within 30 calendar days (unless a reconsideration is requested, which stops the 30-day requirement; the 30 days begins again upon receipt of the results of the reconsideration) CAPs will be reviewed by DHS DPSQA Arkansas Provider E-News December 2016 August 2018 Arkansas Provider E-News # 7 5

8 Educational Opportunities The following is a list of available trainings offered by Beacon Health Options: Treatment Planning Consistency and Accuracy in Documenting Behavioral Health Diagnosis Corrective Action Plans - Development and Submission Inpatient Psychiatric Services for U21: Arkansas Medicaid Regulations and Documentation Medical Necessity Physician s Role in RSPMI Services and Psychiatric Diagnostic Assessments Provider Connect: How to Submit an Authorization Retrospective Review - Process and Content Use of Seclusion and Restraints Counseling Level Services (Tier 1) Qualified Behavioral Health Providers Therapeutic Communities Documenting a Thorough Mental Health Evaluation Acute Crisis Units Partial Hospitalization For more information or to schedule a training for your organization please contact Kerri Brazzel or Shelly Rhodes. We help people live their lives to the fullest potential. Beacon Health Options Blog: beaconlens The beaconlens is the blog from Beacon Health Options, the nation s pre-eminent behavioral health company. The blog s focus is on rapid response to the most pressing and controversial issues in behavioral healthcare today. The blog does not always reflect the settled thinking of Beacon but rather represents the voices of our professionals on topical discussions. To view recent posts including, Drug diversion: The crime that affects everybody please visit: beaconlens.com. Arkansas Provider E-News August 2018 # 8

9 Upcoming Webinars Outpatient Behavioral Health Services: Counseling Level Tier 1 This webinar will cover transition and certification, coverage of services, documentation and medical necessity, and provider reviews. Outpatient Behavioral Health Services: Counseling Level Tier 1 Wednesday, August 15, :00 4:00 Register Here! Qualified Behavioral Health Providers This webinar will cover training, certification, and supervision requirements, allowable services, and medical necessity and documentation. Qualified Behavioral Health Providers Wednesday, August 29, :00 4:30 Register Here! Front Line: Your Information Hub for the New MMIS Arkansas Medicaid implemented the new Medicaid Management Information System (MMIS) on November 1, Please check Front Line often for the latest alerts, details pertaining to billing, FAQ s, contact information, and other changes impacting providers. Front line can be found on the Arkansas Medicaid Providers website or by following this link. Optum Arkansas Independent Assessment AR Department of Human Services (DHS) and its contractor, Optum, have begun performing Independent Assessments of beneficiaries who receive behavioral health services. People you serve may soon receive a notification letter and phone calls to schedule the interview. More information and materials you can share with staff, beneficiaries, families and guardians are available at: For questions concerning the Independent Assessment process or scheduling, call Optum at The Behavioral Health Independent Assessment paper tool Optum uses to determine Tier Determination can be found here for your reference. Contact Optum For Providers and Beneficiaries with questions on the program, please call For more information from State of Arkansas, please visit the DHS Website For more information on Optum Corporate, please visit our Corporate site Arkansas Provider Arkansas E-News December Provider E-News 2016 August 2018 # 5 9

10 Important Contact Information Clinical Queue Toll Free Number Clinical Fax (Please use appropriate coversheet) EDI Helpdesk Division of Medical Services (DMS) toll-free numbers: Beneficiary Eligibility Beneficiary Coverage Medical Director Nichole Bauknight Office: Cell: Project Director Kerri Brazzel Office: Cell: Clinical Quality Advisor April Bale Cell: Supervisor of Clinical Services LaTosha Brown Office: Provider Relations Manager Shelly Rhodes Office: Clinical Services Manager JoVann Leek Office: Clinical Services Manager Janice Malone Office: Quality Management Specialist Retrospective Reviews Peggy Whitledge Office: Complaints Shelly Rhodes Office: Did you know our website is Network Specific? To visit our website please go to: beaconhealthoptions.com On our Network Specific website you will find forms tailored to fit the Arkansas provider, including: Provider Alerts Provider Forms Provider Newsletters Provider Training and Education Fraud and Abuse Information Reference Documents Retrospective Review Information Please feel free to share this newsletter. If you would like to receive the newsletter and other provider alerts, please Arkansas Provider E-News August 2018 # 10