SED Registration Provider Orientation

Transcription

1 SED Registration Provider Orientation 1

2 Objectives Welcome and Introductions. Overview of BHM. Philosophy of BHM Program. SED Clinical Requirements. SED Registration Web Demo Questions and Answers. 2

3 3 Program Overview

4 Long Island Behavioral Health Management (BHM) Mission To improve the outcomes of those receiving mental health and substance abuse services within the region by: encouraging and facilitating region-wide multi-stakeholder collaboration/communication supporting the emergence of Health Homes in the region strengthening provider efforts toward more effective discharge planning reducing preventable readmissions encouraging the application of evidence based practices and quality improvement efforts collecting and reporting on data to inform and enhance local and state government regional planning efforts advancing the principles of recovery and resiliency preparing the region s public behavioral health care system, and relevant health and human services partners for the advent of responsively integrated managed health care reform in

5 Long Island Behavioral Health Management (BHM) Vision BHM is committed to supporting and advancing the development of an integrated, efficient, reliable and recovery-focused regional service delivery system that is flexible and innovative, assuring timely and appropriate access to the right service at the right time in order to responsively address the person-centered mental health and chemical dependency needs of those receiving services within the region. 5

6 Long Island Behavioral Health Management (BHM) Overview A partnership between ValueOptions and the North Shore LIJ Health System. Care management leadership to the Long Island Region for the treatment services and support required by Medicaid-eligible adults with serious mental illnesses and substance use disorders whose behavioral health needs are not covered by NYS Medicaid Health Plans, as well as children and youth diagnosed with a serious emotional disturbance. 6

7 Long Island Behavioral Health Management (BHM) Overview BHO initiative will include: Monitoring and improving the efficiency of inpatient services. Support and assistance to reduce avoidable readmissions and improve rapid linkage with required outpatient services postdischarge. Reduce regional service fragmentation through active outreach and communication with all components of the inpatient and outpatient behavioral health service delivery system. Systems advocacy efforts to focus on peer wellness and navigation services, particularly for high risk individuals who have fallen out of care and are at risk for emergency hospitalization or incarceration. Suicide prevention protocols into all aspects of clinical care management operations. 7

8 8 SED Registration Requirements

9 SED Registration Specialty Interim Clinics (SED) are required to report new admissions for all children with Medicaid Managed care who meet criteria for SED and for which SED rate codes are billed. Clinics that are licensed by OMH under Article 31 of the Mental Hygiene Law and designated as Specialty Clinics are required to notify BHM of each new episode of care for a child who is diagnosed as having a Serious Emotional Disturbance. Data that is required by OMH must include child identifiers, diagnosis, and functional impairments. BHM must report to OMH monthly and quarterly. The data will include the number of children newly diagnosed, member demographics, provider demographics, diagnosis, and identified functional limitations. 9

10 SED Registration Form Requirements Patient name: Last name, First Name, Middle initial (required) Medicaid id#: Unique Identifier (required) Date of Birth: MMDDYYYY (required) County of Residence: Select from pick-list (required): Gender: N/F/Unknown (required) Date of new admission to clinic: MMDDYYYY (required) Medicaid Managed Care Provider (from picklist required) 10

11 SED Registration Form Requirements Clinic Name (will be automatically populated based on login) Clinic id# (will be automatically populated) Clinic location code (will be automatically populated) Clinic address (will be automatically populated) BHO conducting the review: (will be automatically populated) Primary Mental Health Axis 1 Diagnosis #1(required) Primary Mental Health Axis 1 Diagnosis #2 DSM Axis 2 Diagnosis #1 DSM Axis 2 Diagnosis #2 11

12 SED Registration Form Requirements Does the patient have a functional limitation related to the ability to care for self? Y/N/NA (required) Does the patient have a functional limitation related to family life? Y/N/NA (required) Does the patient have a functional limitation related to social relationships? Y/N/NA (required) Does the patient have a functional limitation related to self direction/self control? Y/N/NA (required) Does the patient have a functional limitation related to ability to learn? Y/N/NA (required) Fax SED Admission Registration Form to

13 SED Registration via the Website Go to choose Providers. The following slides will demonstrate how to complete SED registration via the Website. 13

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17 SED Registration via the Website 17

18 SED Registration via the Website 18

19 19 Questions & Answers

20 20 Thank You