RSPMI Quarterly Training Presented by: ValueOptions /DMS/DBHS/HP 1
I. DBHS RSPMI CERTIFICATION POLICY Division of Behavioral Health Services 2
DBHS CONTACT INFORMATION Address: 305 South Palm Street Little Rock, AR 72205 Charlotte Carlson, M.Ed., M.S., J.D. Director of Policy and Certification Phone:(501) 683 6903 Email: Charlotte.Carlson@arkansas.gov Tullos (Tripp) Franks, LCSW Clinical Specialist of Policy and Certification Phone: (501) 683 6999 Email: Tullos.Franks@arkansas.gov 3
DBHS CERTIFICATION MANUAL 4
SIGNIFICANT CHANGES TRAINING OPPORTUNITIES See DBHS Policy VIII, A (page 8) OFF SITE SERVICE DELIVERY IN A 50 MILE RADIUS ACCREDITATION CHANGES See DBHS Policy V, H, 1 3 (pages 6 7) STAFF REQUIREMENTS (Designated positions and oversight) See DBHS Policy VIII, E (pages 9 14) PROGRAM REQUIREMENTS Disclosure of Treatment Programs See DBHS Policy VIII, J, (page 15) Emergency Responses See DBHS Policy, VIII, N (pages 16 17) Quality Assurance See DBHS Policy III, Z, (page 5) SUPERVISION REQUIREMENTS 5
TRAINING OPPORTUNITIES See DBHS Policy VIII, A (page 8) This presentation is the first of the trainings that is being presented Future trainings will be held quarterly 6
OFF SITE SERVICE DELIVERY IN A 50 MILE RADIUS DBHS RSPMI Manual III, T and CC The language for off site delivery is changed in the new manual to be: Mobile Care Delivered as specified in III, T (page 4) And delivered from a certified Site as in III, CC (page 5) 7
ACCREDITATION CHANGES Must post accreditation in a public area at each site Must recognize and include all the applicant s RSPMI programs, services and sites Initial accreditation must include an on site survey of each service site Accreditation documentation must include the applicant s governance standards and sufficiently define and describe all services the applicant intends to provide (i.e. outpatient treatment, therapeutic foster care, in home family counseling) Any outpatient behavioral health program associated with a hospital must have a free standing behavioral health outpatient program national accreditation Must have full accreditation by at least one of the following: CARF, TJC, COA. 8
STAFF REQUIREMENTS DBHS Policy VIII, E 9 14 Must designate a staff position/s to cover company functions New requirements are specified for: Clinical Director Corporate Compliance Officer/Privacy Officer/Quality Control Manger/ Grievance Officer/Medical Records Librarian 9
STAFF REQUIREMENTS The Medical Director position was enhanced to ensure medical oversight for RSPMI care planning, coordination, and delivery If the medical director is not a psychiatrist, a psychiatrist must serve as a consultant. If the provider serves clients under the age of 21, the medical director shall have access to a board certified child psychiatrist If the medical director is not a psychiatrist, then the medical director must contact a consulting psychiatrist within 24 hours in the following situations: When antipsychotic or stimulant medications are used in dosages higher than recommended in guidelines published by the Arkansas Department of Human Services Division of Medical Services When two or more medications from the same pharmacological class are used When there is significant clinical deterioration or crisis with enhanced risk of danger to self or others The consulting psychiatrist(s) shall participate in quarterly quality assurance meetings 10
PROGRAM REQUIREMENTS Disclosure of Treatment Programs DBHS Policy VIII,J (page 15) An effort to inform clients/families of services available and provided Emergency Responses DBHS Policy, VIII, N (pages 16 17) Clarifies the crisis services requirements & the accessing of acute care funds 11
QUALITY ASSURANCE CHANGES QA meetings must be held quarterly (every 3 months) Quality Improvement program must include: 1) evidence based practice 2) use of the YOQ 3) requirements for informing clients of rights 4) QA meetings that include: o Clinical records reviews of a minimum number of randomly selected charts (minimum number is defined as 10% of all charts open at any time during the past three months or a statistically valid sample yielding 95% confidence with a 5% margin error). The number of charts is cumulative. You can use staffing, peer reviews, supervision contacts and treatment plan reviews as part of the total number. So, if you have 9000 charts open, you must do clinical records review on a statistically valid sample or 900 charts every quarter (3 months). o Program and services reviews. These must include: 1) Did care meet client needs? 2) Were any unmet needs identified? 3) Was a plan identified to address any unmet needs? Did a psychiatrist(s) participate in the quality assurance meeting? Did the Quality Control Manager chair the QA committee? 12
QUESTIONS? 13
II. LICENSING REQUIREMENTS AND REFERRALS FOR CHILD CARE LICENSING STANDARDS, PROFESSIONAL LICENSES, PARAPROFESSIONAL CERTIFICATION, ETC. Child Care Licensing: DCCECE 14
CLARIFICATIONS FOR MONITORING RSPMI FACILITIES (Rehabilitative Services for persons with Mental Illnesses) The following clarifications are to be considered and applied as you monitor RSPMI facilities. The standard licensing requirements will apply to any areas and situations not covered by these clarifications. If the program is meeting basic licensing requirements but is not meeting RSPMI standards that exceed the licensing requirements, the Director or person in charge will be advised advised as a courtesy. 301 Staff/Child Ratios 2.d RSPMI programs meet a 1/10 ratio for kindergarten through school age. This exceed our ratios. A deficiency would be citied if the program failed to meet our Minimum requirements. 15
CLARIFICATIONS FOR MONITORING RSPMI FACILITIES (Rehabilitative Services for persons with Mental Illnesses) cont 302 Director 3. Directors who are licensed Mental Health Professional fully meet director requirements. 4. Specific New Director s Orientation sessions may be available for RAPMI Directors who represent newly licensed programs. (Check with Licensing Central Office for schedule.) 7. Directors or staff members who are Licensed Mental Health Professionals are already required to obtain continuing education credits which will count for the required training hours regardless of whether the subject matter is listed in this section or the licensing requirements. 303 Employee Requirements 4. In addition to the requirement for at least one staff to be present who is certified in CPR, RSPMI programs also require at least one staff member to be present who has been certified in a nationally recognized crisis prevention/management model. (This is not something that would be citied but would brought to the attention of the Director.) 16
CLARIFICATIONS FOR MONITORING RSPMI FACILITIES (Rehabilitative Services for persons with Mental Illnesses) cont 303 Employee Requirements 5. In addition to the basic orientation requirement, RSPMI employees who work in summer and or after school programs are required to receive training as Mental Health Paraprofessionals. (Again, this is not something we would we cite for failing to meet licensing requirements.) 304 Volunteers 2. RSPMI rules do not allow volunteers to have any supervisory or disciplinary control over children and volunteers are not to be counted in the staff/child ratio. (This exceeds our requirements for volunteers.) 505 Behavior Guidance 6. Some methods of behavior guidance are appropriate for use by RSPMI programs that might not be allowed in typical child care settings. Check with your supervisor before citing any non compliance in this area. Physical holds or time outs that require physical contact with a child are required to adhere to guidelines established through CARF, JCAHO or COA standards. 17
CLARIFICATIONS FOR MONITORING RSPMI FACILITIES (Rehabilitative Services for persons with Mental Illnesses) cont 601 Employee Records 7. RSPMI programs, as a part of the documented training requirement, also require documentation of MHPP certification and annual training requirements. (This exceeds licensing requirements and would not be cited.) 600 Child Records All requirements in this section apply to RSPMI programs with the possible exception of the requirements for immunizations. Programs serving only school age children are not required to verify immunizations. However, the immunization requirements would apply to programs serving pre school Children. (Pre school definition Children five years old or younger who are not yet attending kindergarten.) 18
DCCECE Contact Information Ratha Tracy Program Coordinator Toll free: 1 800 445 3316 Local: 501 682 8590 DCCECE Website: www.arkansas.gov/childcare/ 19
QUESTIONS? 20
MORE LICENSURE INFORMATION Professional Licenses: Presented by DBHS Paraprofessional Certification: Certification: Presented by ValueOptions & DMS Behavioral Unit Supervision: Presented by DBHS 21
PROFESSIONAL LICENSE Mental Health Practice Governed by 5 Professional Boards: Counseling Board: http://www.abec.arkansas.gov o LAC, LPC Medical Board: http://www.armedicalboard.org o M.D., D.O. Nursing Board: http://www.arsbn.arkansas.gov o LPN, RN, APN Psychology Board: http://www.arkansas.gov/abep o PhD, LPE, LPE I, Psy.D. and Ed.D. Social Work Board: http://www.arkansas.gov/swlb/ o BSW, LMSW, LCSW, PLMSW 22
SOCIAL WORK LICENSING BOARD REQUIREMENTS Assure services are provided within each practitioner s scope of practice under Arkansas law and under such supervision as required by law for practitioner's not licensed to practice independently (i.e. LMSWs, LACs, LPEs). Make sure supervision plans are in the personnel records of all professional not licensed to practice independently. 23
Paraprofessional Certification Audited in accordance with Arkansas Medicaid RSPMI Manual Regulation 213.100 40-hour initial training Certificate for 40-hour training 8 hours of annual training for every 12 months of employment Certificates are portable from one agency to another Copy of certifying test may be requested (to insure that all elements listed in regulation were included). 24
SUPERVISION REQUIREMENTS PER CERT POLICY Two Levels MHP Definition: see DBHS Policy III, S (page 4) Additional Certification Requirements: See DBHS Policy VIII,E,3 (page 10) Elements of Supervision: See DBHS Policy VIII,E, 3, b (page 10) MHPP Definition: See DBHS Policy III, R (page 3) Additional Certification Requirements See DBHS Policy VIII,E,4 (page 11) 25
SUPERVISION REQUIREMENTS (MHPPS) Must occur at least once every 14 days Must have at least 12 contacts within a 90 day period Must be face to face No time limit on the amount of time or the number of clients that must be discussed Must include all 8 elements (VIII;E,3,b) every 6 months Supervision must be documented (This can be done using a supervision log) Must include observation by a MHP at least once every 30 days. Again, no time limit on how this is accomplished. This must also be documented. Supervision can be accomplished in a number of different ways. (Groups, staffing, etc.) Part time MHPPs (defined as less than 20 hours a week) must have face to face contact with the MHP at least every 28 days and at least 6 contacts every 90 days. The observation requirement for a part time MHPP is at least once every 60 days. 26
SUPERVISION REQUIREMENTS FOR PROFESSIONAL LICENSE Board Specific Must be Provided by a Professional of Like License Must be documented in Provider s Records 27
QUESTIONS? 28
III. EXPECTATIONS FOR STANDARDS OF CARE (BEST PRACTICES AND SYSTEM OF CARE INFORMATION) DBHS 29
STANDARDS OF CARE Quality of Care Best Practices System of Care Requirements See DBHS Policy VIII,P, 1 & 2 (page 18) 30
ACT 1593 Created the Children s Behavioral Health Care Commission Mandated an assessment tool to guide service decisions and outcomes Authorized an outcomes based data system to support tracking, accountability, and decision making Encouraged family driven, child centered, youthguided services with families involved at all levels 31
YOQ There are 3 versions Parent version Youth version Young adult version Some of the questions will inform the clinician of current conditions in the child s or youth s life Others serve as potential predictors of treatment success Collect systematic information across agency and statewide and identify more intensive cases Refer to DMS Policy RSPMI Manual Section 217.101 & DBHS RSPMI Certification Manual Policy VIII, P,2 (page 18) YOQ website: https://www.oqarkansas.com/oqa/ 32
QUESTIONS? 33
IV. CORPORATE COMPLIANCE & ETHICS DBHS & ValueOptions 34
Reminders for: Outpatient Providers with Multiple Service Sites 35
36 The Arkansas Medicaid Manual requires enrollment for each site 202.200Providers with Multiple Sites11-1-08 Providers with multiple service sites must apply for enrollment for each site. A cover letter must accompany the provider application for enrollment of each site that attests to their satellite status and the name, address and Arkansas Medicaid number of the parent organization. A letter of attestation must be submitted to the Medicaid Enrollment Unit by the parent organization annually that lists the name, address and Arkansas Medicaid number of each site affiliated with the parent. The attestation letter must be received by Arkansas Medicaid no later than June 15 of each year beginning in June 2009. Failure by the parent organization to submit a letter of attestation by June 15 each year may result in the loss of Medicaid enrollment. The Enrollment Unit will verify the receipt of all required letters of attestation by July 1 of each year. A notice will be sent to any parent organization if a letter is not received advising of the impending loss of Medicaid enrollment.
37 What happens if services are provided via sites that have not been enrolled? Report made to DMS/DBHS Recoupment for any services performed via sites that have not been enrolled What if a provider has more than one site in the same town? Each site must be enrolled and have its own provider number
38 Ethical Considerations In Medical Necessity Denial of Coverage
39 Arkansas Medicaid Medical Necessity Definition (Section IV Glossary) All Medicaid benefits are based upon medical necessity A service is medically necessary if it is: o reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions that endanger life, cause suffering or pain, result in illness or injury, threaten to cause or aggravate a handicap or cause physical deformity or malfunction and if there is no other equally effective (although more conservative or less costly) course of treatment available or suitable for the beneficiary requesting the service For this purpose, a course of treatment may include mere observation or (where appropriate) no treatment at all The determination of medical necessity may be made by the Medical Director for the Medicaid Program or by the Medicaid Program Quality Improvement Organization (QIO). Coverage may be denied if a service: is not medically necessary in accordance with the preceding criteria or is generally regarded by the medical profession as experimental inappropriate or ineffective unless using objective clinical evidence that demonstrates circumstances making the service necessary
40 Areas for Statewide Improvement Family involvement in treatment Stage/age behaviors versus symptoms of mental illness Measurable goals and objectives Complete Psychiatric Diagnostic Assessments
CORPORATE COMPLIANCE Levels of Ethical Demonstration Professional Guidelines Practice Demonstrations Accrediting Bodies See DBHS Policy III, G (page 2) 41
ACCREDITING BODIES & ETHICS All three accrediting organizations have standards related to ethical practice TJC focuses on managing organizational relationships with clients and the public in an ethical manner. This encompasses consideration of the values and preferences of clients including the decision to discontinue care, helping clients understand and exercise their rights, informing clients of their responsibilities in care and recognizing the organization s responsibilities under the law. CARF s leadership standards include written ethical codes of conduct in business, marketing, service delivery, professional responsibility and human resources. COA s ethical practice standards stress open, transparent operations in addition to standards related to conflict of interest, fund raising, protection of reporters, professional conduct and research protections. 42
QUESTIONS? 43
V. MAINTENANCE OF DBHS CERTIFICATION DBHS 44
MAINTENANCE OF DBHS CERTIFICATION See DBHS Policy XIII (page 22) Maintain all Operational Policy Requirements Reporting Requirements See VI, H, a, i & ii (page 15) 45
MAINTENANCE OF CERTIFICATION Assure that DBHS certification information is current, and must notify DBHS within thirty (30) calendar days of any change affecting the accuracy of the provider s certification records. This includes changes in administrative staff including the Medical Director, CEO and Clinical Director. Furnish DBHS all correspondence in any form (e.g., letter facsimile, e mail) to and from the accrediting organization within thirty (30) calendar days of the date the correspondence was sent or received except: 1) as stated in XII (provider recertification) 2) correspondence related to any change in accreditation status, which providers must send to DBHS within three (3) calendar days of the date the correspondence was sent or received 3) Correspondence related to changes in service delivery, site location, or organizational structure, which providers must send to DBHS within ten (10) calendar days of the date the correspondence was sent or received Display the RSPMI certificate for each site at a prominent public location within the site 46
MAINTENANCE OF CERTIFICATION Providers must furnish annual reports to DBHS before July 1 of each year that the provider has been in operation for the proceeding twelve (12) months. Annual report shall be prepared by completing form provided by DBHS. The annual report form is available at www.arkanas.gov/dhs/dmhs and at Appendix 12 DBHS Form #6 By January 21, 2011, providers are to notify the Program Integrity Unit of the names of covered health care practitioners who are providing RSPMI services. MHPPs are not considered covered health care practitioners. On or before the 10 th (tenth) day of each month, providers must notify the Medicaid Program Integrity Unit of the names of covered health care practitioners who are providing RSPMI services and whose names were not previously disclosed. If no changes, no report is required. All providers are required to notify DBHS of all site relocations, openings, closings and transfers. All applicable forms are available in the appendix section of the RSPMI certification manual located at the DBHS website. 47
QUESTIONS? 48
VI. COMPLETION OF THE DISCLOSURE FORM HP Provider Enrollment & DMS Behavioral Unit 49
Provider Enrollment Disclosure Forms DMS 675 Ownership and Conviction Disclosure Form DMS 689 Disclosure of Significant Business Transactions Form Contract
Provider Enrollment The Ownership and Conviction Disclosure Form, Disclosure of Significant Business Transactions Form and the Contract are required for any provider enrolled in Arkansas Medicaid. If the provider enrolled after September 1, 2008, HP should already have a disclosure form on file. All providers who were enrolled in Medicaid before that date will be asked to complete disclosure forms along with a new contract at a later date. Disclosure forms are also required to be completed if there is a name change or re enrollment of the provider.
Provider Enrollment DMS 675 Ownership and Conviction Disclosure Form Must list any owner (direct/indirect) that has 5% or more interest with the required information o If individual owns, then list under section of individual with their home address, % of interest, DOB, SS# o If corporation, then list under section of Corporation with business address, % of interest, Tax ID and attach copy of SS4 Even if facility is non profit, list facility and attach 501(c)(3) in place of or with SS4 Must list managing employees. That includes any individual who signs any form within the application, individuals at the clinical level and if non profit, LLC, PLLC, Inc., etc. must also attach Board of Directors with the same required information o For the Board of Directors, not only do you list the officers but also the members with their information o For the LLC, PLLC, Inc., etc. that are not non profit, you must list the officers and owners along with any individual who signs forms with the application Disclose any bankruptcies, felony charges, etc. Sign and date 52
Provider Enrollment DMS 689 Disclosure of Significant Business Transactions Form List any individual or company: oif leasing a building, etc. from another Arkansas Medicaid provider oif purchasing supplies from another Arkansas Medicaid provider If not applicable, indicate not applicable, sign and date 53
Provider Enrollment All forms should be signed by one of the following: Owner, CEO, CFO, COO, President/Vice President of Facility, Director/Co Director of facility If the individual is not one of the above, you must also attach a copy of a letter from the CEO or minutes from the Board of Directors granting permission for the individual to sign off on all formal contracts with Arkansas Medicaid.
Provider Enrollment Applications are located on the Arkansas Medicaid website at https://www.medicaid.state.ar.us/. Click Provider at the top of the page or on the word Provider in the picture. Enrollment is on the left hand side of the screen. Click Provider Enrollment; then click Printable enrollment related forms. In the list of forms will be the Disclosure of Significant Business Transactions, the Ownership and Conviction Disclosure and the Contract that will also need to be signed and mailed with the disclosure forms.
Provider Enrollment 56
Provider Enrollment 57
Provider Enrollment 58
Provider Enrollment Contact Information Mailing Address: Provider Enrollment HP Enterprise Services PO Box 8105 Little Rock, AR 72203 Physical Address: Provider Enrollment HP Enterprise Services 500 President Clinton Ave, Suite 400 Little Rock, AR 72201 Phone Numbers: 800 457 4454 option 0, then 3 501 376 2211
Question & Answer
VIII. MEDICAID MANUAL: HP Provider Representatives and DMS Behavioral Unit 61
Medicaid Enrollment Process & Claims Processing (Referral Information for connecting with EDS) with HP Provider Enrollment, DMS Behavioral Unit & ValueOptions 62 62
Content Medicaid Provider Manuals Contents Electronic Billing vs. Paper claims Billing Tips Contacts Training 63
AR Medicaid Provider Manuals www.medicaid.state.ar.us Your manuals are found on the web site. There are 58 manuals available for the different Medicaid programs. You do not have to log on. Go the web site Click on provider On the left side of your monitor click on provider manuals, official notices, RA messages and available fee schedules. 64 64
AR Medicaid Provider Manuals Section 1 Basic Information that affects all Medicaid Provider types: Background and legal basis of Medicaid Beneficiaries eligibility Beneficiaries responsibilities Provider responsibilities Primary Care Case Management Sanctions and appeals 65
66 AR Medicaid Provider Manuals Section II Information about your specific program: Requirements to be a provider Whom do you serve in your program What services or procedures do you provide About prior authorizations How to bill your claims
AR Medicaid Provider Manuals Section III General billing information that affects all provider types: Electronic claim submission Contacts Timely filing requirements Understanding your Remittance and Status report 67 67
68 AR Medicaid Provider Manuals Section IV The glossary explaining the definitions and meanings of words, phrases and abbreviations commonly used throughout the Arkansas Medicaid manuals
AR Medicaid Provider Manuals Section V A listing of the forms and contacts: Form names and numbers required by Medicaid and where to get the forms Links to various Medicaid contacts that you may use 69 69
Electronic vs. Paper Claim Billing Vendor software Medicaid Web Page Provider Electronic Solutions (PES) Paper 70 70
Billing Tips Some Top 25 denial: Duplicate claims: EOB 470 duplicate of a paid claim and EOB 469 duplicate of an unpaid claim Most of the denials this year have been for duplicate billing. Providers pay 17 cents per claim, so when some providers had 100 denials for duplicate billing it cost them $17.00. 71
Billing Tips Some Top 25 denial: Unit limitations: the second highest incidence of denials for RSPMI and LMHP providers is billing for units in excess of authorized or allowable numbers of units. Remember the link to the RSPMI Web Inquiry for patient s units history: Log on to www.medicaid.state.ar.us It updates weekly but it shows only units paid, not submitted. 72 72
Billing Tips Some Top 25 denial: Incorrect PCP referral: The third highest incidence of denials this year has been the use of the wrong PCP ID number. When you check eligibility we indicate the PCP name and telephone number. That will be the PCP of record that our system will require to be shown on the claim. 73 73
Contacts Provider Assistance Center EDI Provider Enrollment Provider Representatives 74 74
HP Enterprise Services Monday through Friday (8 a.m. 5 p.m.) Toll free in Arkansas (800) 457 4454 Local or out of state (501) 376 2211 Then follow the phone tree Fax number (501) 374 0549 75
76
Questions 77 77
78 VII. UTILIZATION MANAGEMENT PROCESS ValueOptions & DMS Behavioral Unit
Utilization Management Process Presented by: ValueOptions & DMS Behavioral Unit 79
80 Arkansas Medicaid Medical Necessity Definition Section IV- Glossary All Medicaid benefits are based upon medical necessity. A service is medically necessary if it is: Reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions that endanger life, cause suffering or pain, result in illness or injury, threaten to cause or aggravate a handicap or cause physical deformity or malfunction. If there is no other equally effective (although more conservative or less costly) course of treatment available or suitable for the beneficiary requesting the service. For this purpose, a course of treatment may include mere observation or (where appropriate) no treatment at all. The determination of medical necessity may be made by the Medical Director for the Medicaid Program or by the Medicaid Program Quality Improvement Organization (QIO). Coverage may be denied if a service: is not medically necessary in accordance with the preceding criteria or is generally regarded by the medical profession as experimental inappropriate or ineffective using unless objective clinical evidence demonstrates circumstances making the service necessary.
81 Examples of Factors Considered in Determining Medical Necessity Is the beneficiary able to benefit from the treatment modality provided? Is progress documented? If no progress is being made, is there a change in treatment planning and/or approach? Does treatment correspond to beneficiary s age/psychosocial stage of development? Does treatment match diagnosis and active symptoms? Does the service rendered conform to the service definition as set forth in the Arkansas Medicaid RSPMI Manual? Is it delivered in conformance with 240.000 Reimbursement? Does it meet the criteria of the definition? -Who is providing the service? -Is the service performed in an authorized location? -Does the service as documented reflect the service definition?
82 Audit Process Provider Notification Outpatient ValueOptions notifies outpatient providers via e-mail two business days in advance Notification describes IOC process details and what is required of provider Following notification, ValueOptions gives outpatient providers a courtesy telephone call Inpatient No notification given
Purpose of On-Site Audits To assess medical necessity To examine regulatory compliance and quality of care To assess beneficiary satisfaction with care To assess if the care conforms to state and federal guidelines To determine areas for provider education To further develop standardized measurement methodologies across providers 83 83
84 Audit Process During the Audit Be sure to have all items listed on the Notification Letter immediately available to auditors upon their arrival (Failure to have required or requested items available in a timely manner may lead to an observation or deficiency in your audit report) Assign one specific person to be available to assist auditors where needed or requested in locating documents or other required items (Auditors record the person s name, items requested, and whether items were produced) Items or documents not delivered to the auditors prior to the beginning of the Exit Conference will be listed as absent or not made available in the audit report Even though certain documents may have been reviewed in previous audits at other sites (i.e., policy and procedure manuals, quality assurance meeting minutes, etc.) these documents must be made available to the auditors at the site currently being audited
85 Audit Process Exit Conference A brief, verbal summary of findings is provided by the auditors Specific findings are not detailed in the Exit Conference specifics will be detailed in audit report Information for provider training and assistance will be given during the Exit Conference Contact: Nelda Michael, Project Director for: Assistance in writing CAP nelda.michael@valueoptions.com Audit-specific training office: 501-707-0922 Topic-specific training cell: 501-747-3309 General provider training Concerns/questions regarding audit findings
86 Audit Process Audit Results Audit results electronically reported to DMS and provider within 14 calendar days of ending day of audit Summary of Findings Deficiency/C.A.P. Notification
87 Audit Process Corrective Action Plan (C.A.P) Due from provider to ValueOptions within 30 calendar days of date of Summary of Findings and Deficiency/C.A.P Notification If C.A.P is acceptable, ValueOptions notifies provider and forwards to DMS within 10 calendar days of receipt If C.A.P is unacceptable or not submitted by provider, ValueOptions sends provider C.A.P Insufficiency Notification
88 Audit Process Insufficient CAP Provider has 10 business days to submit/resubmit C.A.P ValueOptions notifies DMS if provider fails to comply
89 Tips for Submitting Your CAP See ValueOptions March newsletter article C.A.P article also available on ValueOptions website For each deficiency: -Briefly describe specific plan to address the deficiency -List the person/s responsible for implementing the specific plan -List the target completion date ***Provider opinions, explanations, or objections may be included, but do not take the place of the items required above.***
90 Audit Findings: Current Areas for Statewide Improvement Psychiatric Diagnostic Assessments Must contain all elements required in Arkansas Medicaid Manual Parent/guardian must be included in interview for children beneficiaries Measurable Objectives Behavior Reduction/Increase Over Time Measured Family Participation in Treatment Required in treatment planning Services must be provided as ordered on treatment plan Documentation of attempts to involve family Needed in all cases, absolutely essential for certain diagnoses Excluded Diagnoses *** ValueOptions provider seminars and trainings are available in all these areas
Questions? 91
92 ValueOptions ProviderConnect sm Overview
93 ValueOptions ProviderConnect sm ProviderConnect sm is an online tool that increases convenience & decreases administrative burden Free, secure, online application Easy access 24 hours a day, 7 days a week Complete multiple transactions in a single session
ValueOptions ProviderConnect sm With ProviderConnect sm, Arkansas providers can: Request Authorizations View Authorizations Authorization file download Submit inquiries to Customer Service Access and print forms 94
95 ProviderConnect sm Registration Providers may register for ProviderConnect sm by completing our online Services Account Request Form. This form is located on our website at http://arkansas.valueoptions.com under the Provider Section tab. Click on Provider Forms & Reference Documents and is located under Administrative forms. Providers may also register for ProviderConnect sm online by accessing the following link: https://www.valueoptions.com/pc/eprovider/providerregisterfromlogin.do
96 Contact Information: Provider Relations Manger Chepeka McKinney email: Chepeka.McKinney@valueoptions.com Phone: 501-707-0920
Questions? 97
Thank You! 98