Placer County Systems of Care Mental Health Documentation, Auditing, and Compliance Training. Fall 2014

Transcription

1 Placer County Systems of Care Mental Health Documentation, Auditing, and Compliance Training Fall 2014

2 Please Note At the end of this training, you will be required to complete a post-test and attestation. Please follow the directions at the end of this training.

3 Training Goals To assist you in providing quality mental health services To familiarize you with clinical documents To clarify documentation requirements

4 What you will learn today: Features of quality documentation What Medical Necessity is The link between Assessment Service Plan Progress Notes Service definitions and billing codes Cultural Competency overview Audit Updates Auditing Responsibilities Compliance Guidelines Your Service Authorization and You Legislative Updates

5 Introduction The training today will familiarize you with concepts that you can take back with you to your job regardless of where you work or what kind of mental health services you provide to your clients. In general, Medi-Cal Regulations are written in such a way so they can be utilized by any county or mental health community based organization across the State.

6 Cultural Competency Making cultural accommodations Documenting those accommodations Using interpreters

7 Cultural Competency A set of congruent practice skills, knowledge, behaviors, attitudes, and policies that come together in a system, agency, or among consumer providers and professionals that enables that system, agency, or other professionals and consumer providers to work effectively in cross-cultural situations.

8 Cultural Competency Cultural/Linguistic Requirements DMH establishes standards and criteria through the Cultural Competence Plan. Each county must develop and submit a cultural competence plan consistent with these standards and criteria. These plans are updated yearly, with a new plan due to DMH every three years.

9 Cultural Competency Cultural Competence Plan Requirements These requirements include: The client s right to culturally/linguistically appropriate services Oral and written communication provided in the client s preferred language Documentation of attempts to accommodate the cultural/linguistic needs of the client

10 Cultural Competency Threshold Languages A threshold language is a primary language other than English spoken by 3,000 Medi-Cal beneficiaries or 5% of the population, whichever is lower, in an identified geographic area. Placer County has Spanish as its only threshold language (11.97%; 3,959 Beneficiaries) Russian is currently at 2.34% (775 Beneficiaries)

11 Medical Necessity What is Medical Necessity, and what do I need to know about it? In order for our services to be reimbursed through Medi-Cal, and to avoid recoupment from an audit, we must prove that the services we provided were medically necessary.

12 Medical Necessity There are 3 parts to Medical Necessity: Must have an included diagnosis Meet functional impairment criteria Be able to benefit from the intervention

13 Medical Necessity Diagnosis Diagnosis: Client must have a covered DSM IV or ICD-9-CM diagnosis The client s diagnosis is updated on the CARE 009 Progress Report/Request for Authorization MD, RN, Licensed Clinical Psychologist, LCSW, Registered ASW, MFT, Registered MFTI

14 UPDATE!!! By now, everyone is aware that the DSM V has been released. However, the Department of Health Care Services (DHCS), which is the single State intermediary responsible for the oversight of the Medicaid program in California, has informed counties to continue to use the DSM IV for diagnostic purposes and the ICD 9 for billing purposes. You will be informed when DHCS notifies counties to begin using the DSM V. Please continue to use the DSM IV until further notification for diagnostic purposes.

15 Medical Necessity Impairment Impairment: Significant impairment in an important area of life functioning, or Probability of significant deterioration in an important area of life functioning, or Probability a child will not progress developmentally as individually appropriate

16 Medical Necessity Intervention Intervention: Focus is to address the identified impairment Expected to diminish the impairment, or Expected to prevent significant deterioration in an important area of life functioning, or Allow the child to progress developmentally as individually appropriate Condition would not be responsive to physical health care based treatment

17 Medical Necessity Intervention In an audit, we are asked: How did this intervention ameliorate the mental health condition of the client? If we can not answer this question, the service that we billed to Medi-Cal will be recouped.

18 EXAMPLE RECOUPED NOTES Please refer to your handouts for notes that were recouped from an audit due to lack of documenting a mental health intervention.

19 Making it Work There is a disconnect between providing services that are client-centered, strengths-based and having to document those services in the language of diagnosis, symptoms, and impairment to meet Medi-Cal requirements. This training is designed to assist you in documenting the services you provide not only in a way that meets these requirements, but also respectful of the client and useful to other service providers.

20 Making it Work How we GO ABOUT doing our job in a Systems of Care environment is: Client centered Culturally competent Strength based Collaborative Comprehensive

21 Making it Work How we DOCUMENT these services must take into consideration: Regulations Included Diagnoses Medical Necessity Compliance

22 Making it Work Placer County Model of Providing Treatment Regulatory Oversight Client Centered Regulations Strengths- Based Collaborative Medical Necessity Diagnosis Comprehensive Integrated Culturally Competent Compliance Billing Codes Documentation

23 Making it Work And remember There are NO secret words or phrases that will magically make something Medi-Cal reimbursable. It s about learning how to document the services you are providing, and ensuring that you are ALWAYS documenting a Medi-Cal reimbursable service that is included in the client s treatment plan.

24 For Example In order to ameliorate the mental health condition of the client, I assisted him in buying some tennis shoes so he could play basketball with his brother. Client is diagnosed with depression, and playing basketball makes him feel better. This example does NOT document a Medi-Cal reimbursable service!!

25 ALWAYS REMEMBER Medi-Cal reimburses us for your INTERVENTIONS Buying tennis shoes, or any other non-behavioral health activity, is NOT an intervention!!

26 Assessment The Assessment begins to determine Medical Necessity by documenting a covered Medi-Cal diagnosis and the client s impairment. The Assessment also begins to name possible interventions to address the identified impairment. We refer to Assessments either as Biopsychosocial Assessments, or Psychological Evaluations.

27 Assessment The most important element of an Assessment is that it contains all of the required elements. Fill out the form COMPLETELY. Per Placer County policy, Assessments are completed every 3 years.

28 ASSESSMENT UPDATE!!! A change in Placer County policy regarding the frequency of Assessments will be forthcoming. You will be notified via when this change occurs.

29 ASSESSMENT UPDATE!!! You are required to ALWAYS have an updated client Assessment for your records. If you have been referred a client who does not have a current Assessment per Placer County policy, you must either request a copy from the referring Placer County worker, or ask for authorization to complete one. No exceptions.

30 Elements of a Clinical Assessment 1. Presenting problem: client chief complaint, history of presenting problem, current level of functioning, relevant family history and current family information 2. Documentation of relevant conditions and psychosocial factors affecting clients physical health and mental health, including living situation, daily activities, social support, cultural and linguistic factors, history of trauma or exposure to trauma.

31 Elements of a Clinical Assessment 3. Mental health history 4. Relevant physical health conditions as reported by client 5. Information about medications, including documentation of allergies or adverse reactions to medications

32 Elements of a Clinical Assessment 6. Substance exposure/substance use, including past and present use of tobacco, alcohol, caffeine, CAM (complementary and alternative medications), over-the-counter, and illicit drugs 7. Documentation of client strengths relevant to achieving client plan goals

33 Elements of a Clinical Assessment 8. Risks: Documentation of special status situations that present a risk to client or others, including past or current trauma 9. Mental status exam 10. Complete five axis diagnosis consistent with presenting problems, history, mental status exam and/or other clinical data

34 ASSESSMENT FORM! Please notice that there are different Assessment forms, depending on the age of the client: CARE 141e Child Biopsychosocial Assessment used for all clients aged under 18 (version dated ) CARE 015e Biopsychosocial Assessment used for all clients aged 18 and over (version dated ) All current Placer County forms can be located at:

35 Treatment Plan The Treatment Plan helps to determine Medical Necessity by outlining all of the services the interventions that will be provided by you on behalf of the client.

36 Treatment Plan The most important element of a Treatment Plan is that it contains all of the required elements. Fill out the form COMPLETELY. Per Medi-Cal regulation, Treatment Plans shall be updated at least annually. Per Medi-Cal regulation, Treatment Plans are due within 60 days of opening the case. The CARE 009 Progress Report/Request for Authorization has been formatted to be used as the client s Treatment Plan. However, the client must sign it.

37 Treatment Plan Required elements: Specific observable and/or specific quantifiable goals Goals are consistent in treating the documented diagnosis Proposed type and duration of intervention The focus of the intervention is consistent with the Treatment Plan goals

38 Treatment Plan Medi-Cal required signatures: LCSW or registered intern (ASW) MFT or registered intern (MFTI) MD or RN Licensed Psychologist Client signature, or there must be a non-signature explanation Client shall be given a copy of the Treatment Plan upon request

39 Treatment Plan Tips on how to write specific observable and/or specific quantifiable goals: Use phrases such as as evidenced by You should be able to answer the question, How will I know when the client has reached their goal? All goals and interventions must be linked to ameliorating the client s mental health condition

40 BOTTOM LINE ALL clients must have a Treatment PLAN in their chart! It authorizes the services we provide to our clients.

41 Treatment Plan UPDATE!!! Your service plans must indicate the interventions (i.e. individual therapy, rehabilitation, etc.) that you are performing with your client. The interventions on the service plan must then correspond to the interventions documented on your progress notes.

42 Progress Notes Next comes the Progress Notes Progress Notes document the interventions that you are performing with your client. Medi-Cal reimburses us for your interventions. Your interventions must relate directly to the goals stated on the client s Treatment Plan.

43 Progress Notes Elements Key topics discussed in the session Evidence of addressing culture, ethnicity, and language Type and effectiveness of therapeutic intervention and techniques How the intervention addressed the client s mental health condition Progress towards treatment goals

44 Progress Notes Elements Staff signature, including licensure or job title Date of service, referrals to community resources, follow-up care LEGIBLE

45 Progress Notes Important Aspects Progress Notes must address the mental health condition of the client. Do not write overly detailed Progress Notes document the clinical exchange and the interventions. Medi-Cal reimburses us for your mental health interventions.

46 Progress Notes Saying, Checked in with client is NOT an intervention! Document the clinical intervention that was used.

47 Progress Notes Be cautious when using the phrase I supported the client If you use this phrase, you must also ensure to document the intervention you used in behaviorally specific terms. The above phrase does not provide adequate documentation of the intervention provided for purposes of Medi-Cal reimbursement.

48 Assessment Treatment Plan Progress Notes Now to tie it all together

49 Assessment Treatment Plan Progress Notes Auditors want to see how the client s Assessment, Treatment Plan, and Progress Notes are related: The treatment goals stated in the Treatment Plan must be consistent in treating the documented diagnosis. The interventions documented on the Treatment Plan must be consistent in treating the client s treatment goals. The Progress Notes must document an intervention that directly relates to a treatment goal written in the Treatment Plan.

50 Assessment Treatment Plan Progress Notes VERY IMPORTANT ALL services documented in a Progress Note should DIRECTLY link to a treatment goal written in the Treatment Plan. This helps to prove that the service documented was necessary to ameliorate the mental health condition of the client.

51 Making it Work Assessment Strengths Diagnosis Impairment Service Plan Incorporate strengths to address impairment Progress Notes Document progress made on service plan goals

52 Assessment Treatment Plan Progress Notes Relate the client s PRESENTING CLINICAL SYMPTOMS to their MENTAL HEALTH IMPAIRMENT

53 Assessment Treatment Plan Progress Notes In order to qualify for Medi-Cal reimbursement for specialty mental health services, the client must present with a significant MENTAL HEALTH impairment in an important area of life functioning. For children, this may mean that a child has a condition that would not allow them to progress developmentally as individually appropriate.

54 Assessment Treatment Plan Progress Notes Important area of life functioning, for example: Living situation Daily activities Social supports Work/School

55 Assessment Treatment Plan Progress Notes In other words How are the clients CLINICAL SYMPTOMS impairing them from succeeding in an IMPORTANT AREA OF LIFE FUNCTIONING?

56 Assessment Treatment Plan Progress Notes Our role is outlined in the INTERVENTIONS in the client s Treatment Plan. All of the services we provide must relate back to the interventions listed in the client s Treatment Plan. Interventions are the things we say we are going to do with the client.

57 Assessment Treatment Plan Progress Notes The expectation is that the proposed intervention will: significantly diminish the mental health impairment, or prevent significant deterioration in an important area of life functioning, or Allow a child to progress developmentally as individually appropriate.

58 Assessment Treatment Plan Progress Notes We have come up with a phase that you may use to help you to make this link between Assessment, Treatment Plan, and Progress Notes. You may use the phrase on the following slide as an introduction to the client goals stated in your Treatment Plan. Please note that this phrase must still be followed by a specific observable/quantifiable goal.

59 Assessment Treatment Plan Progress Notes Bill/Billy s symptoms of (diagnosis), as manifested by (symptoms), are impairing his ability to (list important area of life functioning). Follow this phrase with the client s specific observable and/or specific quantifiable goal.

60 Service Definitions and Billing Codes Assessment Individual Therapy Group Therapy Family Therapy with client Collateral Rehabilitation H2017 Plan Development H0032 Targeted Case Management T1017 Family Therapy without client 90846

61 Service Definitions and Billing Codes See Handouts for examples of well-written progress notes

62 Service Definitions and Billing Codes Collateral A service activity to a significant support person in a client s life for the purpose of meeting the needs of the client in terms of meeting the goal s in the client s Treatment Plan. May include training the significant support person to help the client better utilize the services they are receiving. May include training the significant support person to better understand mental illness; and family therapy.

63 Service Definitions and Billing Codes Collateral Tips when billing for Collateral: If you find that you are communicating often with this person, they should be included in the client s Service Plan. Addressing the significant support person s mental health issues are not reimbursable by Medi-Cal.

64 Service Definitions and Billing Codes Rehabilitation H2017 Service activity which assists to improve, maintain, or restore a client s: Functional skills Daily living skills Social and leisure skills Grooming and personal hygiene skills Meal preparation skills Support resources Medication education (If provided by MD, RN, or LPT should be billed as Medication Support) Notes should reflect interventions, progress, and response to skill training.

65 Service Definitions and Billing Codes Tips when billing for Rehabilitation: Rehabilitation services are about teaching a client a skill be sure to include what this skill is, and how it addresses a goal in the client s service plan.

66 Service Definitions and Billing Codes Assessment A service activity designed to evaluate the current status of a client s mental, emotional, or behavioral health. Activities may include analysis of client s clinical history; analysis of relevant cultural issues and history; mental status determination; and diagnosis. Biopsychosocial Assessment

67 Service Definitions and Billing Codes Individual Therapy Focus is on reducing symptoms and impairment Provides intervention consistent with the diagnosis Provided by a licensed clinician or registered intern only

68 Service Definitions and Billing Codes Family Therapy 90846, Focus is to improve or maintain the mental health condition of the identified client Client may or may not be present for the activity Provided by a licensed clinician or registered intern only without the client present with the client present

69 Service Definitions and Billing Codes Psychotherapy Group Provided by a licensed therapist or intern only Must include the group billing formula A group note should include: Type or title of group Goal of today s group Client s receptivity or response in group

70 Service Definitions and Billing Codes Rehabilitation Group H2017 Skill development groups, including all groups by nonlicensed staff, e.g. social skills groups, daily living skills groups, etc. Must include the group billing formula A group note should include: Type or title of group Goal of today s group Client s receptivity or response in group

71 Service Definitions and Billing Codes Plan Development H0032 A service activity which may include: Development of client plans Approval of client plans Monitoring of client s progress Must clearly document steps for a planned intervention and follow-up

72 Service Definitions and Billing Codes Targeted Case Management T1017 Services that assist a client to access needed community services, i.e.: Medical Educational Social Prevocational Vocational Rehabilitative Or other community services

73 Service Definitions and Billing Codes Targeted Case Management T1017 Service activities may include: Communication, coordination, and referral Monitoring service delivery to ensure beneficiary access to service delivery system Monitoring of client s progress Placement services

74 Service Definitions and Billing Codes Targeted Case Management T1017 Setting a client up with a Network Provider, and any subsequent conversations with the Provider including writing a new authorization. Assisting the client in accessing community services including medical, educational, and social needs, and subsequent monitoring to ensure access to that service.

75 Service Definitions and Billing Codes Targeted Case Management T1017 Contacting a transportation agency on behalf of your client, and ensuring that your client is hooked up with that service. What are some other Targeted Case Management activities you think you may be providing?

76 Service Definitions and Billing Codes TBS TBS H2019 Therapeutic Behavioral Services What is TBS?

77 Service Definitions and Billing Codes TBS TBS is a short-term, one-to-one behavioral mental health service available to children/youth with serious emotional challenges. TBS can help children/youth and parents/caregivers, etc. learn new ways of reducing and managing challenging behaviors. TBS are designed to help children/youth and parents/caregivers (when available) manage these behaviors utilizing short-term, measurable goals based on the needs of the child/youth and family.

78 Service Definitions and Billing Codes TBS TBS arose from a class action lawsuit, commonly known as Emily Q., which strives for increased utilization of this service, and better outcomes for children/youth. The federal court ordered the State to increase TBS utilization, and appointed a Special Master to develop a plan to do this. Clients are eligible for TBS if they meet ALL of the following criteria:

79 Service Definitions and Billing Codes TBS Under 21 TBS Class Eligibility Criteria Full-scope Medi-Cal Serious emotional problems

80 Service Definitions and Billing Codes TBS Class Eligibility Criteria Live in a group home RCL 12 or above, or At risk of being placed in a group home RCL 12 + OR Has been hospitalized within the last 2 years for emergency mental health problems, or At risk of hospitalization (e.g. is being considered as part of a set of possible solutions to address the child/youth needs.)

81 Service Definitions and Billing Codes TBS TBS is an EPSDT reimbursable service activity. There are many other service requirements. Only certain providers may provide TBS. If you feel that you may have a client that could benefit from TBS, please contact our TBS Coordinator Candyce Skinner at (530)

82 Non-Billable Service Activities Filing Faxing Making an appointment Leaving a message/retrieving a message Studying or researching a topic No-shows Supervision Transportation Social service activity Payee related services

83 Non-Billable Service Activities PLEASE NOTE If the Progress Note does not mention an intervention that addresses the amelioration of the mental health condition of the CLIENT, then that Progress Note is not billable.

84 Auditing And compliance

85 AUDIT ALERT The EPSDT Audit for 2009 yielded 7 recoupments: 1 was for no progress note but it was for 270 minutes! (This note accounted for 2/3rds of the money recouped) 1 the client was psychiatrically hospitalized (21 minutes) (Lock-out, not eligible for Medi-Cal reimbursement) 4 were for progress notes that did not address the amelioration of the mental health condition of the client. (82 minutes) 1 was for visiting the school, but the child was not there (55 minutes) (Can not bill for missed appointments ) This audit looks at clients under the age of 21.

86 AUDIT ALERT The Medi-Cal Oversight Audit for 2009 yielded 23 recoupments: 17 were for Progress Notes that did not address the mental health impairment of the client 4 were for Progress Notes where the intervention was not related to the client s impairment 2 were for missing Progress Notes

87 AUDIT ALERT The Medi-Cal Oversight Audit for 2013 yielded a number of recoupments related to the treatment plan: It is imperative that the treatment plan is completed timely, as previously described. It is imperative that the signatures on the treatment plan also occur timely. Without all of the required signatures on the treatment plan, all services are at risk of recoupment.

88 IMPORTANT INFORMATION REGARDING AUDITS Placer County undergoes a variety of audits and reviews, both fiscal and programmatic. Oftentimes, there is very little heads-up that these audits are occurring. All providers are required to make their records available to Placer County in a timely manner within 24 hours, or less when requested.

89 IMPORTANT INFORMATION REGARDING AUDITS MHP Contract, Exhibit A, Attachment 1 (K) shall review it s providers for continued compliance with standards California Code of Regulations (b)(4) the MHP shall require that each individual or group provider maintain records in a manner that meets state and federal standards. California Code of Regulations (a)(3) provider shall make records available for authorized review for fiscal audits, program compliance, and beneficiary complaints.

90 IMPORTANT INFORMATION REGARDING AUDITS PLEASE NOTE If your notes are disallowed in an audit, you are responsible for the repayment of these services to the county.

91 Compliance Plan According to CFR 42 (Code of Federal Regulations) and Title 9 Section of the California Code of Regulations, it is required that all providers of mental health services verify that every service provided is accurately documented, signed, and billed appropriately. Assessments, client plans, and progress notes are required documentation.

92 Compliance Plan The following slides outline important aspects of Placer County s Compliance Plan that you should know and understand.

93 Compliance Plan Fraud: Intentional deception or misrepresentations made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or her self or some other person.

94 Compliance Plan Abuse: Provider practices that are inconsistent with sound fiscal, business, or medical practice, and result in an unnecessary cost to the Federal government, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for healthcare. Ethical staff make billing mistakes and errors through inadvertence or negligence. Innocent billing errors are a significant drain on the Federal Health care programs and must be corrected.

95 Compliance Plan EXPECTATIONS OF THE FEDERAL GOVERNMENT - RISK ASSESSMENT ELEMENTS Ineligible beneficiaries Services not reasonable and necessary Services not authorized Services with inadequate or no documentation Billing for services provided by unqualified or unlicensed clinical personnel Billing for services provided by sanctioned individuals Knowing misuse of provider ID numbers Lack of integrity in computer systems

96 ROLES AND RESPONSISBILITIES Follow the letter and spirit of the Code of Conduct Make a good faith effort to detect and prevent any wrongdoing in day-to-day activities before it happens Raise questions to Supervisors and Managers Use the resources available, such as the Compliance Hotline (530) , to report any inappropriate activity Participate in all required training programs Understand Medicare/Medi-Cal billing and documentation requirements Reviews, increased training, corrective action and discipline if necessary

97 Code of Conduct PCSOC provides guidance to covered individuals and off-site contract providers to carry out daily activities within appropriate ethical standards and applicable laws and regulations Covered Individuals: All PCSOC employees, contractors, and individuals with responsibility pertaining to the ordering, provision and documentation of billed services Off-site Contractor Providers: Individuals who contract with PCSOC, or who are employed by or subcontracted with a person or entity who contracts with PCSOC

98 Adhere to Laws and Regulations Comply with all applicable laws, rules, regulations and standards Do not engage in any practice that involves unethical or illegal activity Take reasonable precaution to ensure that billing and/or coding of claims are prepared and submitted accurately, timely and consistently with regulations Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement of any kind are submitted Bill only for eligible services actually rendered and fully documented Act promptly to investigate and correct problems if errors in claims or billings are discovered Voluntarily disclose to third party law enforcement or regulatory agencies violations of law, regulations or standards where appropriate and legally required

99 Records Maintenance Maintain complete, accurate and thorough records Comply with all laws governing the confidentiality of information Ensure that timesheets and other cost records and reports are complete and reflect accurate information

100 Responsibilities Comply with the Code of Conduct, policies, procedures, laws and regulations. Failure to comply may subject an employee to civil and criminal liability, sanctions, penalties or disciplinary action Help to create a culture within PCSOC that promotes the highest standards of ethics and compliance Employees and contract providers are obligated to report violations of the Code of Conduct, agency policies and procedures or laws and regulations. Depending on the circumstances, failure to report a known or suspected violation could subject an employee to disciplinary action.

101 Your Service Authorization and You

102 Network Provider Service Authorization Required to pay you for the services you provide Completed by a SOC case manager Work within the parameters of your authorization Please Note: Services provided by you to a client without prior authorization will not be reimbursed.

103 Network Provider Service Authorization Understand and ensure your authorization has: Accurate Provider name All services you intend to provide Total sessions/groups Period of authorization Please ensure not to exceed the number of sessions or period of authorization.

104 Network Provider Service Authorization If you ever have any questions regarding your service authorization, please contact the Placer County case worker that wrote it for you. Please notice that both the case manager s name and phone number, as well as the name and phone number of their supervisor, are printed on the bottom of your authorization.

105 Progress Report/Request for Reauthorization Also called the CARE 009 Complete front only for Progress Report Complete front and back for requesting a new authorization Documents medical necessity must document why the client requires ongoing treatment May be used as the client s Treatment Plan if the client signs it Complete when terminating treatment with a client

106 How do I bill for my services? Health Insurance Claim Form (CMS-1500) Purchase at local stationary supplier Required fields for CMS-1500 See Handout, required fields are highlighted

107 FORMS UPDATE!!! If you are referred a client for an Assessment, please ensure that you have completed and returned all of the forms located in the Provider Initial Assessment Forms Bundle located on our website at:

108 FORMS UPDATE!!! The forms in the Provider Initial Assessment Forms Bundle include: For Children: CARE010 Outcomes Screening Form-Child CARE015a CSI Info for Biopsychosocial CARE024 Periodic Information Sheet CARE036 Consent to Treat a Minor CARE141 Child/Youth Biopsychosocial Assessment HIPAA05 For Adults: CARE015a CSI Info for Biopsychosocial CARE024 Periodic Information Sheet CARE015 Biopsychosocial Assessment HIPAA05

109 FORMS UPDATE!!! Please ensure that you have completed all of the forms on the preceding page when completing an initial assessment, and return all of these forms to the case worker who wrote you the authorization. Information on these forms contain required client services information (CSI) that the County is required to submit to DHCS Thank you for your attention to this important matter.

110 Legislative Updates

111 Legislative updates Medi-Cal Managed Care Program Medi-Cal managed care is an organized system to help Medi-Cal beneficiaries find the physical and mental health services they need. In California, there are six models of Medi-Cal managed care: County Organized Health Systems (COHS); Geographic Managed Care; Two-Plan; Regional; Imperial; and San Benito.

112 Legislative updates Medi-Cal Managed Care Program Placer County employs the Regional Medi-Cal managed care model. The Regional model serves about 207,000 beneficiaries (July 2014 enrollment numbers) in 18 counties: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne, and Yuba. In Regional model counties, there are two Commercial Insurance Plans that contract with DHCS.

113 Legislative updates Medi-Cal Managed Care Program The two Commercial Insurance Plans, which we refer to as Managed Care Plans or MCPs, for the 18 Regional model counties are: California Health and Wellness (CAHW) and Anthem.

114 Legislative updates Medi-Cal Managed Care Program Placer County is currently in the process of finalizing its MOU s with the two MCPs. As more information becomes available, it will be passed on to you. More information regarding Medi-Cal managed care can be found on the DHCS website at:

115 Legislative updates The Department of Health Care Services (DHCS) has now assumed all regulatory oversight of all mental health and alcohol and other drug services. This was part of Governor Brown s 2012 realignment.

116 Legislative updates DSM V All California counties have received direction from DHCS to continue to use the DSM IV for diagnostic purposes, and to continue to crosswalk the DSM IV diagnosis to the appropriate ICD 9 code for billing purposes. You will be notified when DSM V codes will be required.

117 Legislative updates ICD 10 Many of you may have been hearing about the upcoming ICD-10 implementation. Due to feedback received, the federal Centers for Medicare & Medicaid Services (CMS) has now postponed the ICD-10 implementation until October For now, specialty mental health services must continue to be billed using ICD 9 codes.

118 Legislative updates Katie A. The term Katie A. refers to a complaint that was first filed in California in 2002, and subsequently certified as a class action lawsuit. Katie A. is to foster children much like Emily Q. was to at-risk Medi-Cal child beneficiaries.

119 Legislative updates Katie A. In 2009, a Special Master was appointed by the Court (much like Emily Q.) to help the parties reach a settlement agreement. As part of this agreement, a specific array of intensive services will be made available to Katie A. sub-class members.

120 Katie A. refers to a very specific class of children in California who: Are in foster care or are at imminent risk of foster care placement; who have a mental illness that has been documented (or would have been documented had an assessment been conducted); and who need intensive mental health services in the home or in a home-like setting, to treat or ameliorate their illness or condition.

121 Please note that Placer will be referring to Katie A. services as Dependency Mental Health. If you hear the phrase Dependency Mental Health, know that this relates to the services provided to the Katie A. subclass of children.

122 Legislative updates Katie A. If you are authorized to perform Katie A. services (IHBS, ICC), please work closely with the referring case worker. This does not apply to Network Providers. This applies to Organizational Providers only.

123 Legislative updates Katie A. DCHS has created two new treatment codes specifically for Katie A. services: In-Home Based Services (IHBS) IHBS services will be cross-walked and reimbursed at the same rate as Rehabilitation by DHCS. Intensive Case Coordination (ICC) ICC services will be cross-walked and reimbursed at the same rate as Targeted Case Management.

124 Legislative updates Katie A. Please note that your authorization may include language that indicates that the client is designated as Katie A. You may also receive a new authorization if a client you are treating becomes designated as a Katie A. client. This is required for our required reporting to DHCS of all services that Katie A. designated children receive. If you ever have any question regarding your authorization, please contact the worker you sent you your authorization.

125 Questions and Contacts For more information, see our website Placer County Behavioral Health Managed Care Unit Website: Systems of Care Quality Assurance Lynda Hughes, QI Manager, (530) Twylla Abrahamson, Assistant Director, CSOC Marie Osborne, Assistant Director, ASOC Derek Holley, Program Supervisor, CSOC