Comprehensive School and Community Treatment Program. MSCA Spring Conference 2014

Transcription

1 Comprehensive School and Community Treatment Program MSCA Spring Conference 2014

2 Contact Information for Presenters Susan Bailey Anderson, OPI CSPD Coordinator Erin Butts, OPI School Mental Health Coordinator Sally Tilleman, CMHB CSCT Medicaid Program Officer

3 What is CSCT? CSCT = Comprehensive School and Community Treatment A medically necessary mental health service for seriously emotionally disturbed youth The source of funding for these services is federal Medicaid dollars matched with state funds (school matching funds). 1 CSCT team = 1 therapist (or in-training therapist with clinical supervisor) + 1 behavioral aide. Schools are Medicaid providers for CSCT services.

4 What CSCT is not A behavioral management tool Extra school staff A replacement for school counselors/psychologists A Tier 1 intervention

5 History of CSCT In Fall of 2003 and services were back dated to Jan. of 2003 CSCT began and was administered by School Based Services out of DPHHS Health Resources Division In August 2012, Comprehensive School and Community Treatment officially moved to CMHB from the Health Resources Division, where it was housed with other school-based Medicaid programs.

6 Why Schools can bill Medicaid Title XIX (19) of the Social Security Act Oversight is done by Centers for Medicare/Medicaid (CMS) Includes Early Periodic Screening, Diagnostic & Treatment Program (EPSDT) enacted in 1967 due to high rejection rates for military draftees due to childhood illness. Medicare Catastrophic Coverage Act of 1988 makes the connection to Individual Education Plans (IEP) Individuals with Disabilities in Education Act (IDEA) CSCT Services can be provided for students without an IEP; this is different from all other School-Based services in Montana

7 Why is CSCT School-based? Where are the kids that need help.at school. Helps to eliminate the risk of removing students from school and or home Program is operated by the school through a contract with a mental health center Source of funding changed when brought to School Based Services in 2003 (federal matching) makes this available only thru school programs.

8 Reimbursable Services For youth with SED: Code H0036- Community psychiatric supportive treatment, face-to-face, per 15 minutes (Medicaid specific) Behavioral interventions/redirection with student (minimum of 8 minutes for one 15 minute unit). Code is performed in place of service of school setting or clients home. Includes individual, family and group counseling The clinical assessment directs the Individual Treatment Plan (ITP); the ITP directs the service

9 Reimbursable Services For youth without SED (NEW): Code H2027- Assessment, intervention, and referral services Limited to 20 units per youth per state fiscal year (July1 to June 30) and part of your 720 team units

10 Non-Reimbursable Activities Documentation time doing reports and notes Observation & monitoring/supervision Non face-to-face service Time in meetings More than 720 units of service per month per team Educational/Academic assistance with schoolwork Watching movies attending assemblies---field trips (this includes summer programs and normal school vacation days) Less than 8 minutes of service in the 15 minute unit that is billable

11 Program requirements Services must be provided by at least two program staff Caseload for program cannot exceed 720 units (15 minutes each) per month per team At least one of the two staff must be: Licensed Psychologist Licensed Clinical Social Worker Licensed Professional Counselor An In-training practitioner can be employed. Services must be made available to all children, not just Medicaid eligible recipients. Each program manages this requirement differently.

12 Important Rule Changes Two EPSDT rules have been repealed and there are three new CMHB Rules. New Rule prescribes an order for considering referrals to the program as determined by acuity and need. 50% of the units billed by each team each month must be by the therapist. Coordination with outpatient therapists.

13 Rule Changes (cont d) New Rule requires a contract between the mental health center and school district, specifying: Details about services and staffing; What the school will provide in terms of space, technology, transportation, etc; The referral process to CSCT; There must be a PBIS in the school; Training offered by the school and mental health center (including to parents); Data to be shared; and Administrative requirements.

14 PBIS in rule Does my school need to be an MBI school? NO! But existing schools are not grandfathered in, either. Existing MBI schools must have a school MBI team, be collecting data, and are using a PBIS for behavior management, not just academics. New schools must have a written plan for implementation within two years. This needs to be concrete plan that would include having a dedicated MBI team, training, and a school-wide environmental scan.

15 New Documentation Requirements No more monthly summaries! Notes are completed on a daily basis by each staff person: (e) daily progress notes from each team member that document individual therapy sessions and other direct services provided to the youth and family throughout the day including: (i) when any therapy or therapeutic intervention begins and ends; and (ii) the sum total number of minutes spent each day with the youth. ( )

16 YOUTH MENTAL HEALTH SERVICES, SERIOUS EMOTIONAL DISTURBANCE CRITERIA 1) "Serious emotional disturbance (SED)" means with respect to a youth from the age of six through 17 years of age that the youth meets the requirements of (1)(a) and (1)(b). (a) The youth has been determined by a licensed mental health professional as having a mental disorder with a primary diagnosis falling within one of the following DSM-IV (or successor) classifications when applied to the youth's current presentation (current means within the past 12 calendar months unless otherwise specified in the DSM-IV) and the diagnosis has a severity specifier of moderate or severe: (i) childhood schizophrenia (295.10, , , , ); (ii) oppositional defiant disorder (313.81); (iii) autistic disorder (299.00); (iv) pervasive developmental disorder not otherwise specified (299.80);

17 (v) Asperger's disorder (299.80); (vi) separation anxiety disorder (309.21); (vii) reactive attachment disorder of infancy or early childhood (313.89); (viii) schizo affective disorder (295.70); (ix) mood disorders (296.0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x, 296.7, , ); (x) obsessive-compulsive disorder (300.3); (xi) dysthymic disorder (300.4); (xii) cyclothymic disorder (301.13); (xiii) generalized anxiety disorder (overanxious disorder) (300.02); (xiv) posttraumatic stress disorder (chronic) (309.81); (xv) dissociative identity disorder (300.14); (xvi) sexual and gender identity disorder (302.2, 302.3, 302.4, 302.6, , , , , ); (xvii) anorexia nervosa (severe) (307.1); (xviii) bulimia nervosa (severe) (307.51); (xix) intermittent explosive disorder (312.34); and (xx) attention deficit/hyperactivity disorder (314.00, , 314.9) when accompanied by at least one of the diagnoses listed above.

18 SED criteria (cont d) + Functional Impairment (see UR manual) CMHB Provider Manual and Guidelines for Utilization Management: Manual_and_Clinical_Management_Guideline a.pdf Youth under 6 have different criteria.

19 Where to go for more information CMHB Provider Manual and Guidelines for Utilization Management: ovider_manual_and_clinical_management_guideline a.pdf Youth Mental Health Services Manual: edicaid2011.pdf Children s Mental Health Bureau: Montana Medicaid Provider Information:

20 You can search by text, rule number or even chapter number. You can also get a table of contents listing.

21 Or you can contact me Sally Tilleman Program Officer for Comprehensive School and Community Treatment (CSCT) and Day Treatment 111 North Sanders/PO Box 4210 Helena, MT (406) (406) (f)

22 CSCT Tier 3 Graphic source: pbis.org Accessed June 17,2013