FY16 BH-TEDS (SUD Admits (A) & Discharges (D) Record Clarification)

Transcription

1 ** When integrated services (both SUD and MH) are being provided within the same agency, the most primary issue(s) will determine the funding and therefore whether the BH-TEDS will follow SU or MH with regard to Admission and Discharge, or M, U, E respectively. This document refers only to how SU will be addressed with respect to BH-TEDS. ** READ CAREFULLY, reporting has changed since FY15. Discharges Detox Admissions must be discharged. If for whatever reason, a consumer admitted into detox or any residential service drops out of treatment, a discharge is required within 3 days with the discharge date being the last date of treatment. This is considered a Service End record (D). All other levels of care that a consumer may be admitted into, and drops out of treatment, a discharge is required within 30 days with the last date of treatment being the discharge date. However, if one knows the consumer is not coming back, or shows up elsewhere, discharge immediately. Consumers that are actively in treatment as of 10/1/2015 will only require the new BH-TEDS form when discharged (Service End record (D)) from a program. Discharge date is the last date of service for the treatment setting a consumer is being discharged from. The Service End Date may be the same as the Service Start Date, but cannot be sooner. Further instruction is comingled below, as appropriate. Reason for Service End Indicates the outcome of a treatment episode or reason for transfer/ discontinuance. Value Description Detail 01 Treatment Completed Substantially all parts of the treatment plan or program were completed. 02 Dropped Out of Treatment Individual chose not to complete treatment program. Includes individuals who drop out of treatment for unknown reasons, individuals with whom contact has been lost, individuals who fail to return from leave (i.e. AWOL), and individuals who have not attended for some time as identified by State guidelines. 03 Terminated by Facility Treatment terminated by action of the treatment facility, generally because of non-compliance with treatment or violation of rules, laws, policies, or procedures. 04 Transferring to Another Program or Facility/ Individual will transfer to another level of care, program, provider, or facility. 9/30/2015 Page 1 of 18

2 Completed Treatment Setting 05 Incarcerated or Released by Courts Individual s treatment is terminated because he/she has been subject to jail, prison, or house confinement or he/she has been released by or to the courts. 06 Death The death of the individual receiving behavioral health services. 07 Other Individual transferred or discontinued treatment because of change in life circumstances like extended illness, hospitalization, or placement, or change of residence out of the PIHP region. Admissions Special Circumstances for SU Opioid MAT Providers. ALL consumers that are actively admitted into your programs who are receiving dosing as of 10/1/2015, MUST have a new BH-TEDS Admission with the ORIGINAL Admission Date completed. **Note: PCE will convert the old to the new form, but Providers must complete these forms no later than 12/31/2015. For all other Admissions: The date of admission (A) record is the date of the first face-to-face service a consumer receives. If a consumer is admitted for only SUD, and then through the course of treatment it becomes apparent a consumer has a Mental Health issue(s): 1. Discharge the consumer from SUD only, with End (D) record. 2. Re-admit [(A) Service Start record] consumer with Mental Illness = Yes. 3. Add integration of care to the IPOS (Treatment Plan), carry on. From this point forward, all services will be tagged with the HH modifier when submitted to MDHHS. This will occur on the outbound Encounters by DWMHA. Regardless of current eligibility, if a Medicaid or MIChild ID exists, it must be reported on the Admission. Use the look-up buttons to determine. If neither exist, leave the fields blank. Validate self-reported Medicare ID via C-CSNAP, MPHI or similar eligibility verification system. If an individual refused to provide, but it is know from eligibility verification that person is Medicare eligible, enter the validated ID rather than leaving blank. If unknown, leave field blank. SDA can only be marked as YES if: 1. Consumer is older than 17yrs, and 2. Consumer is admitted into a residential program (detox, LT, ST), and 3. Consumer is admitted to an agency contracted for SDA, otherwise 4. SDA should be answered as No Date of Request/ First Contact, is the date consumer calls Pioneer asking for services, and no other date. 9/30/2015 Page 2 of 18

3 Time to Treatment, is the number of days from date of first contact to the first face-to-face service without any adjustments. Performance Indicators are not based off of this form. When treatment is immediately available, as in the case of walk-in services, the time to treatment is entered as 000. (This should automatically be calculated) Prior Treatment Episodes, still answers the question: How many times in the past have you tried to address? Codependent/Collateral Person Served 1. For DWMHA, Client should always be marked as (2) 2. For DWMHA, Codependent/collateral individual should NEVER be checked when SUD funds are paying for the services, because we currently are not funding such program. Referral Source [Best describes: Who referred you to this program? ] 1. (01) Individual is marked when: a. Client (self-referral), or b. Family member, or c. Any individual NOT included in categories (02-07), or d. Can include self-referral due to pending DWI/DUI. 2. (02) Alcohol/ Drug Abuse Care Provider when: a. Any program, or b. Any clinic, or c. Any health care provider: Whose principal objective is treating individuals with SUD or whose activities are related to SUD prevention and/ or education. This is not our Pioneer Access Center. 3. (03) Other Health Care Provider is: a. Physician, or b. Psychiatrist, or c. Nurse, or d. Other licensed health care professional, or e. General hospital, or f. Psychiatric hospital, or g. Mental health program, or h. Nursing home. 4. (04) School (Educational) is marked when referred by: a. School principal, or b. Counselor, or c. Teacher, or d. A student assistance program, or e. The school system, or 9/30/2015 Page 3 of 18

4 f. Any educational agency. 5. (05) Employer/ Employee is, an employee s supervisor or an employee counselor. 6. (06) Other Community Referral is marked when: a. Community or religious organization, or b. Any federal, state, or local agency that provides aid in the areas of poverty relief, unemployment, shelter, or social welfare, or c. Defense Attorney, or d. Self-help groups (AA, Al-Anon, and NA) 7. (07) Court/ Criminal Justice Referral/ DUI/ DWI is marked when: a. Police official, or b. Judge, or c. Prosecutor, or d. Probation officer, or e. Other person affiliated with a federal, state, or county judicial system including: i. Juvenile justice system, or ii. Drug Courts, or iii. Lieu of prosecution, or iv. Pretrial release, or v. Civil commitment When (07) is used, Detailed Criminal Justice Referral must have a value of, Detailed Criminal Justice Referral 1. (01) Federal/ State Court includes: a. Circuit, or b. District, or c. Probate 2. (02) Other Court includes: any not listed in 01 i.e. Municipal Court 3. (03) Probation/ Parole includes: a. Probation officer, or b. Parole officer 4. (04) Other Recognized Legal Entity includes: a. Law Enforcement, or b. Corrections, or c. Youth services, or d. Review board/ agency 5. (05) Diversionary Program when remanded treatment in lieu of jail/ prison 6. (06) Prison directed as condition of release or part of furlough program 7. (07) DUI/ DWI referred as part of disposition of DUI/DWI case. 8. (08) Other criminal justice referral not included in, (96) Not Applicable means, NOT referred by either Criminal Justice or Juvenile Justice System. 9/30/2015 Page 4 of 18

5 Type of Treatment Service Setting (equates to level of care) 1. (02) Detoxification, 24hr service, free-standing residential is, a non-hospital 24hr setting that provides for safe withdrawal and transition to ongoing SUD treatment. 2. (04) Rehabilitation/ Res-ST (30 days or less of SUD TX) 3. (05) Rehabilitation Res-LT (31 days or more of SUD TX, can include transitional housing. 4. (06) Ambulatory IOP, is non-acute care setting where treatment is less intensive than residential and more intensive than out patient. 5. (07) Ambulatory non-intensive OP, setting where individual, family, group, case management, and /or pharmacological therapies are used. I/DD (Intellectual/ Developmental Disability) Designation 1. IF a diagnosis is made by a licensed practitioner within the scope of his/her practice, and Provider has a copy of diagnosis in the client s chart, then mark, YES 2. Mark NO if client was evaluated and no diagnosis was given, otherwise 3. Not Evaluated, indicates client has not been evaluated to determine if he/she meets MI Mental Health Code Definition of Developmental Disability. MI or SED (Mental Illness or Serious Emotional Disturbance) Designation Identifies whether an individual has been evaluated and/or as a DSM MI diagnosis that is EXCLUSIVE of mental retardation, developmental disability, or SUD, OR if an individual has a serious emotional disturbance. 1. IF DSM diagnosis is made by a licensed practitioner operating within scope of practice and fits criteria above, then mark YES 2. Mark NO if there is no diagnosis that meets criteria in (identified above), otherwise 3. Not Evaluated, indicates individual has not been evaluated for MI or SED. Detailed SMI or SED Status Indicates individual IS receiving integrated treatment, has SMI (serious mental illness) or SED. 1. (1) SMI individual meets current MI MH Code Definition P.A. 500 of SMI regardless of whether receiving services from I/DD or MI service arrays. 2. (2) SED individual, UNDER 18yrs of age has SED as defined in current MI MH Code. 3. (4) Neither SMI nor SED individual does not meet current MI MH Code Definition P.A. 500 of SMI or have SED DSM dia. Integrated Treatment SUD Admits and Discharges, where individuals have mild to moderate MH diagnosis would be captured with response (4), Neither SMI nor SED. 4. (7) Not Evaluated or N/A individual has not been evaluated for SMI or SED and does not have an otherwise documented diagnosis of either, OR SUD is without integrated treatment. **In most instances, SUD will use either value 4 or 7** 9/30/2015 Page 5 of 18

6 Prior Treatment Episodes attempts to answer, How many times have you tried to address this problem with any treatment Provider? Gender Indicate the gender person identifies with EXCEPT when individual is pregnant, then field must be marked as Female. Pregnant on Service Start Date IF during treatment, it is determined individual was pregnant on date of admit (which is the first service date) and reported no at time of admission, the Admit must be edited to correct both this field and Gender if originally identified as Male and vice versa. IF individual becomes pregnant during treatment, the (A) record requires NO change. County of Residence Indicates where individual resides = City of Detroit, else = Wayne, (excluding City of Detroit) 3. IF consumer has no fixed address, use county of shelter or county where homeless. Race Enter value that corresponds to the race which the individual considers him/herself. 9/30/2015 Page 6 of 18

7 Ethnicity Currently in Mainstream Special Education Status For SUD, use 1 or 2 ONLY Education 1. Highest school grade completed IF no longer attending school 2. For individuals age 3-17 NOT protected by State of MI Special Ed Law, or 3. Current school grade or special education classroom status for ages 0-26 who are protected by State of MI Special Ed Law. For children less than 3yrs old NOT covered by State of MI Special Ed Law, use 00 If school recently ended for the year, enter level completed, NOT year to which child is advancing. For home-schooled children, OR in special education, but have been mainstreamed in regular school grates, report equivalent grade level. For individuals protected ty State of MI Special Ed Lay (age 0-26), in a specialized education setting that has an equivalent school grade level, report the school grade level. For individuals protected by State of MI Special Ed Law (age 0-26), in a special education class that does NOT have an equivalent school grade level, report (74). For children who spend part of their day in a self-contained special education class with no grade level equivalent and part of their day in a mainstream setting, report the code which reflects where they spend the majority of the day. For individuals who are no longer in school, report highest level completed. 9/30/2015 Page 7 of 18

8 Private homes in which primarily custodial care is provided is not considered a nursery school. Kindergarten may be full or half day. School Attendance Status For SUD, 7 & 8 do not apply For SUD, answer 1, 2 or 6 for which is applicable to the individual. Marital Status For SUD, 97 and 98 do NOT apply Veteran Status Value Description 1 Veteran 2 Not a Veteran 7 Not collected at this co-located services 8 Not collected for this crisis-only service For SUD, Only 1 and 2 apply Employment Status 1. (01) Full-time Competitive, Integrated Employment Individual working 35hrs or more per week, with or without supports, in a typical workplace setting, where the majority of persons employed are not persons with disabilities, earning wages consistent with those paid workers without disabilities in the community performing the same or similar work. The individual earns at least minimum wage and is paid directly by the employer. 9/30/2015 Page 8 of 18

9 2. (02) Part-time Competitive, Integrated Employment Individual working less than 35 hours per week, with or without supports, in a typical workplace setting, where the majority of persons employed are not persons with disabilities, earning wages consistent with those paid workers without disabilities in the community performing the same or similar work. The individual earns at least minimum wage and is paid directly by the employer. 3. (03) Unemployed Individual who has looked for work during the past 30 days or on a layoff from a job. 4. (04) No in Competitive, Integrated Labor Force An individual who has not looked for work in the past 30 days An individual whose current disability symptoms prevent him/her from competitively or non-competitively working An individual who is primarily a student, homemaker, retired, inmate of an institution An individual who works in a non-competitive or non-integrated environment. Individuals in this category are further described in Detailed Not in Labor Force. 5. (98) N/A Individual is under 16yrs of age IF individual is 15yrs or younger, (98) N/A MUST always be reported Minimum Wage defined by Public Act 138 of 2014, currently: i. $8.15 = minimum hourly wage ii. $3.10 = tipped employee hourly wage rate iii. $4.25 = training wage for first 90 days of employment of individuals 16-19yrs iv. $7.25 = minors (16-17) minimum hourly wage When an individual is engaged in two or more activities (has overlapping status) at the time of data collection, the Dept. of Labor prioritization system dictates which to choose. The department prioritizes labor force activities over non-labor-force activities, and working over, looking for work. i. A homemaker who works part-time in the competitive, integrated labor force is coded (02). ii. A full-time waiter looking for a new job as a receptionist is coded (01). iii. A student actively searching for work (includes sending out resumes, interviewing, etc.) is coded (03). 9/30/2015 Page 9 of 18

10 Reporting of an individual in an internship program: i. IF the internship is a school requirement, whether paid or not, the individual is considered a student, therefore is coded as (04). ii. IF the internship is not a school requirement, is an unpaid position, does not displace regular employees, or does not entitle the individual to a job at the end of the internship, code as (04). iii. IF the internship is not a school requirement, pays at least minimum wage, and the employer benefits from the intern s engagement in actual operations and performing productive work, then either (01) Full-time, or (02) Part-time is reported. Individuals 16yrs and older who are not in the Competitive Labor Force are further described in Detailed Not in Labor Force. Seasonal Workers are coded based on the employment status at the time of data collection. i. IF worker is earning at least minimum wage, working 35hrs or more per week at time of data collection, code as (01). ii. IF worker is earning at least minimum wage working less than 35hrs per week at time of data collection, code as (02). iii. IF worker earning less than minimum wage, or not working at time of data collection, code as (04). Detailed Not in Competitive, Integrated labor Force Explains in greater detail, those coded as (04) in Employment Status When an individual is 15yrs or younger, (98) must be reported. IF an individual was coded as (01, 02, or 03) in Employment Status, then (96) must be reported. Otherwise, (01-64) must be reported for those who were coded as (04) in Employment Status. Minimum Wage For SUD, (01-03), must be reported. Refer to current State of Michigan Wage defined by Public Act 139 of Current wages are referenced above in Employment Status guidelines. Total Annual Income Specifies individual s current Annualized income utilized in calculating his/her Ability to Pay (ATP). For SUD, ONLY report 6-digits with no commas or decimal points. 9/30/2015 Page 10 of 18

11 Children are typically reported on parent(s) tax return, thus the Total Annual Income of the parent(s) would be reported. i. IF child s income is used to determine ATP (i.e. Children s Waiver Program, SED Waiver Programs) the total annual income would reflect child s income ONLY. IF Employment Status reported is (01 or 02), then Annual Income MUST be greater than $0. Number of Dependents Specifies number of dependents utilized in calculating ATP. For SUD, ONLY report the number, do not use 97 or 98. Number of dependents must be 1 or greater (client is included). IF child is reported on parent(s) tax return, the number of dependents claimed on parent(s) tax return is reported. IF Children s Waiver or SED Waiver Programs are used to calculate ATP, report 1. 9/30/2015 Page 11 of 18

12 Substance Use Problem (Primary, Secondary, & Tertiary) For SUD, Primary should NEVER be (None), DWMHA currently does not fund codependent programs. Substance should reflect order in which substances are creating the most difficulty in an individual s life. Substance can only be identified once. In order to have a secondary, a primary must exist. In order to have a tertiary, a primary and secondary substance must exist. 9/30/2015 Page 12 of 18

13 Route of Administration (Primary, Secondary, & Tertiary) Identifies usual route of administration of the substance identified in Primary, Secondary, & Tertiary drug. Route should reflect most frequently used route of administration for each substance identified. Only report (20) - Other, when none of the other routes apply. ONLY use (96) when a substance is NOT identified. Frequency of Use (Primary, Secondary, & Tertiary) Identifies how often the identified substance was used. 1. For Admission (Service Start record), utilize the 30-day window when the individual last had the opportunity to use. 2. For Discharge (End record), utilize the past 30-days OR since Service Start (Admit date), whichever is shorter. Purpose of collecting for Admission, is to identify use pattern in last 30 days that individual had the ability to use (i.e. not incarcerated, hospitalized, or in residential treatment). Hence enter the value that best reflects the number of days that a 30-day window represents. Purpose of collecting for Discharge, is to identify use pattern since treatment began. ONLY use (96) when a substance has not been identified. 9/30/2015 Page 13 of 18

14 Age at First Use (Primary, Secondary, & Tertiary) Identifies newborn dependency, age of first intoxication, or age of first use for substance(s) identified. IF a substance is identified in Primary, Secondary, or Tertiary, then age must be (00-95). IF substance identified as 02-Alcohol, enter age of individual s first intoxication. IF substance is any drug other than 02-Alcohol, enter age of individual s first use. IF 01-None is identified as substance, 96 MUST be used. Medication-Assisted Opioid Therapy Identifies whether the use of opioid medications such as Methadone, Buprenorphine, Vivotrol, Suboxone, or Naltrexone will be part of an individual s treatment plan. IF 05-Heroin, 06-Non-prescription Methadone, or 07-Other Opiates and Synthetics is identified as a substance in Primary, Secondary, or Tertiary, then use (01 or 02) to report. Otherwise, report (06) if any other substance other than (05-07) is identified. **This means that even a Provider who is not licensed to dispense, but is aware this will be part of one s treatment administered elsewhere, then (01) should be reported** Integrated Substance Use and Mental Health Treatment Identifies whether the individual is receiving SU and MH treatment, managed by a single entity from an integrated team under an integrated treatment plan. For the dual-diagnosis individual receiving integrated treatment, the services appear seamless with a consistent approach. 9/30/2015 Page 14 of 18

15 For YES to be selected, the: 1. Treatment plan MUST be integrated, including SU and MH goals. 2. Clinical encounters occur at a single facility. 3. For an A record (Service Starting Admission), the program must have an Integrated Treatment Endorsement on its Outpatient License. When YES is selected, ALL fields of the BH-TEDS record are required. When YES is selected, ALL Encounters submitted to MDHHS, MUST have the HH modifier. When an individual moves from an integrated treatment plan to a non-integrated treatment plan, OR from a non-integrated treatment plan to an integrated treatment plan, the current treatment episode must be ended (D) and individual be re-admitted (A), so the integration change can be identified; as this only occurs on an (A) record for SUD. **NO longer, should a Provider edit the (A) admission record to reflect this change** Living Arrangements Identifies whether an individual is homeless, or describes the individual s residential situation or arrangement. Record Value Description Detail Type A, D 01 Homeless Individual having no fixed address. Includes homeless shelters A, D 02 Dependent Living Individual living in a supervised setting such as a residential institution, halfway house, transitional housing, recovery housing, or group home OR children (under age 18) living with parents, relatives or guardians or SUD individual in A, D 03 Independent Living foster care. Individual with a fixed address living alone, or with others in a private residence independently. Includes adult children (18yrs and older) living with parents and adolescents living independently. Also includes individuals living independently with case management or supported housing support. Detailed Residential Care Living Arrangement Provides greater detail about type of Residential Home in which an individual is living. For SUD, report 996 Not applicable; Living Arrangement was NOT 22-Residential Care. Number of Arrests in Past 30 Days Specifies number of separate arrests in the past 30 days, or since Service Start (A) record, whichever is sooner. On (A) Service Start, enter number of separate arrests individual had in past 30 days. On (D) End record, enter number of separate arrests individual in the past 30 days, OR since Service Start date, whichever is shorter. Never go back further than the Service Start Date when calculating this field for the (D) End record. 9/30/2015 Page 15 of 18

16 When individual is stepping up or down in a treatment setting, the full 30 days is looked at again. Corrections Related Status Specifies the individual s highest priority of corrections related status For SUD, (97-98) do NOT apply The list of reportable corrections-related statuses have been prioritized for MDHHS reporting (from highest = 01 to lowest = 11) Attendance at Substance Use or Co-dependent Self help Groups in past 30 Days Indicates the frequency of attendance at a self-help group in the past 30 days or since Service Start, whichever is most recent. For (A) records, timeframe is within past 30 days. For (D) records, timeframe is past 30 days or since Service Start (A), whichever is the shortest, of the two. Diagnostic Code Set Identifier Specifies which Diagnostic Code set is used in reporting the SUD Diagnosis on the Service Start (A) record. Value Description 3 ICD-10 9/30/2015 Page 16 of 18

17 ICD-10 is the preferred Diagnostic Code Set to be used in BH-TEDS, this is what DWMHA is mandating. Substance Use Diagnosis Specifies the individual s diagnosis used to identify the substance use problem that provides the reason for an encounter and treatment. ICD-10 will be utilized here. The diagnosis must be provide by a licensed clinician operating within his/her scope of practice. **NOTE: Billing prior to 10/1/2015 will still use ICD-9** Mental Health Diagnostic Code (One, Two, & Three) Must be sequenced in problematic priority. IF these don t exist, report No primary MH diagnosis has been determined. Fields cannot be left blank. Use DWM-IV Legal Status at Admission to State Hospital For SUD, (96) - Not Applicable, will always be used. 9/30/2015 Page 17 of 18

18 List of Acronyms 9/30/2015 Page 18 of 18