Kansas Positive Behavior Support Resource Training

Transcription

1 Kansas Positive Behavior Support Resource Training Webinar #2: Kansas PBS Medicaid Billing & Case Studies March 6, :30am-12:30pm Matt Enyart, Sara Quick, and Aaron Gates PROVIDED BY THE KANSAS INSTITUTE FOR POSITIVE BEHAVIOR SUPPORT UNIVERSITY OF KANSAS FUNDED BY KANSAS DEPARTMENT FOR AGING AND DISABILITY SERVICES

2 Agenda 2 11:30-11:35 Welcome 11:35-11:45 Kansas PBS Medicaid Services Process 11:45-11:55 Kansas PBS Medicaid Services Forms 11:55-12:25 Tele-Behavioral Health and Kansas PBS Medicaid Services 12:25-12:30 Question & Answer

3 Criteria Review 3 Medicaid Eligibility Significant Challenging Behaviors Health & Safety Access to Community Out of Home/Community Risk Medical Necessity

4 Service Considerations 4 Not in School Settings Not Billed with Other Medicaid Services Provider Cannot be Providing other Medicaid Services For Example Case Management and PBS Facilitator

5 5 Documents Submitted to MCO 1. Positive Behavior Support Referral of Services Form 2. KanCare Service Prior Authorization Form for PBS Services 3. MCO approves PA and sends to KDADS electronically for final approval and facilitator caseload documentation. Linda Blasi LMSW Children s Inpatient Systems Manager Community Services and Programs Commission Kansas Department for Aging and Disability Services New England Building 503 S. Kansas Ave. Topeka, Kansas [email protected] KDADS contacts MCO with final approval within 3 work days with approval.

6 Prior Authorization Form 6 Screen Consumer Qualifications Gather Behavioral Health Details Settings Severity Intensity Frequency Likert Scale (Consideration of Alternatives if Low Score)

7 Positive Behavior Support Referral Form 7 Physician or Licensed Professional PBS Education Website Organization Brochure Organization PPT PBS Brief

8 KIPBS Role 8 Prior Authorization Review Facilitator Eligibility Caseload Size Fidelity of Implementation Training Case First Billed Case Sampling Reviews Ongoing Technical Assistance Modules Coaching Case Studies

9 KIPBS Tools 9 45 Item Checklist FOLLOW PORTFOLIO Parent Interviews Surveys Satisfaction Contextual Fit PCP QOL

10 Billing 10 To access the PBS information for Providers: Go to Click on the Behavioral Health Services link, located under the Community Services and Programs Header (center column, top of the page). Click on Providers in the left-hand side navigation menu Click on PBS Providers in the list of links on the page. o Facilitator Forms include Positive Behavior Support Referral of Services KanCare Service Prior Authorization Form for PBS Services KanCare Prior Authorization of Termination of PBS Service form Kancare Institute for Positive Behavior Consent Form for Parent or Guardians Receiving KIPBS Services

11 Billing 11 Service Name Service Code Maximum Billing Allowed Reimbursement Rate PBS Environmental Assessment H Units (Unit = 15 min) $10 per unit (Maximum of $1,200) PBS Treatment H2027(U3) 240 Units (Unit = 15 min) $25 per unit (Maximum of $6,000 PBS Person-Centered Planning 90882(U3) 40 Hours (Unit 15 minutes) $10 per unit (Maximum of $1,600)

12 Oversight Responsibility 12 Oversight Systems MCOs --Referral Form PA Medical Necessity Billing KDADS PA Facilitator Caseload Size (6 Max) Child Yrs. Of Medicaid Eligibility (2 years) an exception can be requested for additional PBS services KIPBS Backup KDADS Information Pre/Post Global Risk Assessment 45 Item Checklist Termination Forms --Fidelity

13 KIPBS Facilitator Status 13 Endorsed and Practicing Endorsed and Practicing with Conditions Previously Endorsed but Not Active Endorsement Renewal Not Eligible w/o Conditions Not Permitted to Bill

14 Collaboration 14 Facilitator MCO KDADS PBS Teams CMHCs Regions Community Partners and Stakeholders

15 Case Study Initiation Case Studies Minimal 3 Billing (Support with Initial 3 Billing) Weekly Calls Onsites Additional Webinar Support Use of Ipad Applications Video Examples Ongoing Support

16 Question & Answer 16 Questions about Billing? Questions about Case Studies? Thank you for joining us today!