Psychiatric Rehabilitation Services: Chapter 5230 Regulation Highlights

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1 Psychiatric Rehabilitation Services: Chapter 5230 Regulation Highlights Implementation Webinar Prepared by the Office of Mental Health and Substance Abuse Services June 2013

2 OMHSAS Policy & Operations Lead Staff Bill Boyer, Section Chief for Program Development OMHSAS Bureau of Policy, Planning and Program Development Elizabeth Ricker, OMHSAS - Harrisburg Field Office Virginia Dikeman, OMHSAS - Scranton Field Office Scott Ashenfelter, OMHSAS Southeast Field Office Lee Ann Kohler, OMHSAS - Pittsburgh Field Office 2

3 Housekeeping Electronic copies of sample forms can be found at (click on statewide initiatives, scroll to consumer driven programs/psychiatric Rehabilitation) Please feel free to send your questions electronically as we go along. We will answer written and verbal questions at the end of the presentation. 3

4 AGENDA Introduction Key Changes Development of Service Descriptions Licensing and Enrollment Training & Technical Assistance Questions 4

5 Approval of the Regulation The Final-Form was published 5/11/ Pa.Code Chapter 5230 Psychiatric Rehabilitation Services The Pennsylvania Bulletin 43 Pa.B Effective 90 days after publication : August 9,

6 Benefits of the Regulation Provides a unified set of standards in accordance with nationally-recognized practices Consistent with the principles established by USPRA Provides for a consistent level of quality PRS in PA Provides for the development of a professionally qualified and credentialed PRS workforce Protects consumer health and safety while receiving PRS 6

7 Licensed PRS providers in Pennsylvania have historically operated under the 2001 PRS Medical Necessity Criteria and Standards Rehab_Standards.pdf This presentation highlights major changes from the 2001 Standards that are found in Chapter

8 Scope Applies to all providers of PRS PRS Providers must have a license from DPW Providers that opt not to be licensed may not identify as PRS, and must update the epoms enrollment data to bill county base using social rehabilitation codes rather than PRS codes. Enrollment deadline: October 8,

9 Definitions PRS Agency: the organization PRS Facility: the premises where services are provided Evidence Based Practices: research/data based & proven effective Licensed Practitioner of the Healing Arts (LPHA): physician, physician s assistant, certified registered nurse practitioner, psychologist 9

10 Agency Records More specific requirements: Detailed Service Description Service delivery Policies & Procedures (P&Ps) HR P&Ps including staff work schedules and time sheets PRS daily schedules QI documents 10

11 Agency Service Description More specific 17 point outline provided All providers must submit a revised SD for OMHSAS review and approval prior to the August 9, 2013 effective date PRS approaches that offer both site based and mobile services are encouraged but not required (see Individual services and Group services) 11

12 Content of Individual Record More specific requirements Evidence that an individual has been given oral and written versions of the statement of rights Recommendation for PRS by an LPHA Documentation of coordination with other services and supports 12

13 Documentation Standards More specific requirements that mirror what is found in the DPW Payment regulations seen in the MA Manual under Chapters 1101 and Should help to ensure that PRS documentation meets MA standards for payment. 13

14 Access to Individual Record Requires the PRS provider to allow an individual to review the record and provide written comments Making written entries in the record is a consumer right, not a consumer requirement. Making written entries in the record is an agency requirement. 14

15 Admission, Continued Stay & Discharge Requirements Requires the PRS provider to obtain a recommendation for the service from an LPHA Provides for an exception by the LPHA ( rather than the funding source) when an individual clearly needs the service but does not have one of the SMI listed diagnoses (PTSD and other anxiety disorders commonly merit exceptions) 15

16 Rights Provides a specific statement of rights for individuals who use PRS Requires PRS agencies to notify individuals of rights verbally, in writing and by postings within the facility DPW will provide the PRS Statement of Rights as a published handbill 16

17 Staff Qualifications Provides a career ladder for staff working in PRS: PRS Assistant, PRS Worker, PRS Specialist, & PRS Director Requires PRS directors to have a bachelor s degree unless covered by the grandfather clause under 5230.(a) (3) Requires PRS directors and specialists to obtain CPRP certification within 2 years of hire 17

18 General Staffing Requirements Every PRS must employ a PRS director and a PRS specialist Requires PRS to maintain staff schedules that demonstrate adequate staffing based on utilization Requires PRS directors to be present at each facility an average of 7.5 hours per week in a calendar month A minimum of 25% of the FTE shall meet the qualification for PRS specialist A minimum of 25% of the FTE shall have CPRP within two years of initial licensing 18

19 Individual Services Group Services The PRS may provide individual services (1:1) in the facility or in the community The PRS may provide group services in the facility or in the community Group size is limited to 5 individuals when services are provided in the community ( no ratio no groups larger than 5) Group size in the facility is not limited to 10 individuals No limit on number of hours of PRS provided in the community. Community service delivery methods must be included in the IRP Confidentiality must be protected 19

20 Supervision A PRS specialist may provide supervision when designated as a supervisor in the job description Establishes minimum supervision requirements Individual face-to-face no less than twice a month Group supervision ( no minimum frequency) but methods are defined: monitoring active service delivery, discussing approaches (case reviews) & general staff meetings Requires an annual staff evaluation that is reviewed and approved by the PRS director 20

21 Assessment Requires an assessment prior to development of the IRP that includes: Functioning in the 4 domains Strengths & Needs of the individual Skills, supports & resources needed & preferred Cultural needs & preferences Signed by the individual & staff member Updated annually and when the individual requests update, completes the goal or is not making progress 21

22 Individual Rehabilitation Plan Requires an IRP that includes: Goal Method of service provision Responsibilities of individual & staff Action steps and time frame Expected frequency & duration of service Signed & dated by the individual, staff & PRS director Intended service location (facility, community) Completed by 20 th day of attendance, but not more than 60 calendar days after initial contact Updated every 90 calendar days and when individual requests update, completes the goal or is not making progress (same for facility and community services) 22

23 Individual Rehabilitation Plan, continued Requires a comprehensive narrative summary of progress that includes: A description of service in the context of the goal Documentation of individual participation & response to service Summary of progress or lack of progress toward the goal Summary of changes to the IRP Dated signature of the individual, staff & PRS director Documentation of the reason if the individual does not sign This summary is done every 90 days, along with the IRP update. This summary replaces the monthly note which is no longer required. 23

24 Daily Entry Requires a daily entry for the day of service that: Indicates the date, time, duration, location and type of interaction Documents service provided in context of goal Documents individual response to service Dated signature of the individual & staff Documentation of the reason if the individual does not sign This requirement is consistent with the MA payment regulations. 24

25 Discharge Requires attempts to re-engage when the discharge is due to disengagement Discharge Summary Detailed minimum requirements Completed within 30 days after date of discharge Reviewed and signed by the PRS director Offered to the individual for review, signature and the opportunity to comment 25

26 Quality Improvement Requires a written QI plan with specific methodologies Requires an annual report of findings Requires internal action plan to address report findings Available for public review Waiver Waiver requests may be submitted to DPW- OMHSAS Granted only in exceptional circumstances Granted only when health and safety of individual and quality of service are not adversely affected May be revoked if conditions required by the waiver are not met 26

27 Development of Service Descriptions Every licensed provider of PRS must submit a revised service description consistent with Target date is June 25, 2013 to allow OMHSAS time to review and approve The service description checklist that OMHSAS will use is available on line at Work with you regional field office lead for PRS to complete this process 27

28 Licensing & Enrollment PRS will continue to be enrolled as an MA funded Supplemental Service in HealthChoices PRS will continue to be available as a County base-funded service As a supplemental service under HC, there is no access requirement for choice of two providers Chapter 5230 does require a provider of PRS to become licensed 28

29 Licensing & Enrollment Under Chapter 5230 PRS agencies that are already licensed and enrolled in PROMISe as Supplemental Services will not need to re-enroll PRS agencies that are enrolled and billing County Base in epoms will need to be licensed by August 9, 2013 in order to continue to use the PRS billing codes PRS agencies that are enrolled and billing County Base in epoms who elect to not obtain a license can no longer identify as PRS and will need to amend the epoms enrollment to bill Social Rehabilitation codes. 60 day grace period to complete epoms changes ends 10/8/13 29

30 Licensing & Enrollment Under Chapter 5230 There will be less distinction between Mobile and Site-Based All licensed providers will be able to provide services in the community consistent with each person s individual rehabilitation plan Providers will be licensed according to an approved service description For PROMISe enrollment and billing purposes, the license will show whether the PRS is approved to provide Clubhouse, site-based, mobile or a combination of service types. 30

31 Implementation Chapter 5230 will take effect August 9, 2013 All PRS providers must be licensed regardless of payment source All licensed providers will be required to submit a revised program description consistent with the requirements in Chapter 5230 The field offices will review and approve the new service descriptions prior to the end of the 90 day window (August 9, 2013) Licensing visits will continue as scheduled with compliance required at the time of the visit. Enforcement of 5230 begins August 9,

32 Status of the Current PRS Delivery System in PA EXISTING PRS LICENSES AS OF 2/1/2013 REGION LICENSES FACILITIES SATELLITES SOUTHEAST the Current PRS Delivery So NORTHEAST CENTRAL WEST TOTALS

33 Training & Technical Assistance Technical Assistance has been provided to our 2-day PRS Orientation Training vendors to assure content is consistent with Chapter 5230 This is one of five regional webinars offered for providers, counties, & MCOs during June 2013 Technical assistance will be available through the regional field offices Sample documentation forms will be posted on 33

34 Questions? 34

35 Contact Information OMHSAS Policy staff Bill Boyer Tel: OMHSAS Field Office staff Western Region Lee Ann Kohler Tel: Central Region Beth Ricker Tel: Southeast Region Scott Ashenfelter Tel: Northeast Region Ginny Dikeman Tel:

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