Summit Psychological Associates Inc State of Ohio Behavioral Health Redesign State will require changes as of January 1 2018 Managed Care changes will go into effect as of July 1 2018 SPA has already been implementing the changes since June 2017 so we can have a smooth transition ID: 698533
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Slide1
Overview of Behavioral Health Redesign
Summit Psychological Associates, Inc.Slide2
State of Ohio Behavioral Health Redesign
State will require changes as of January 1, 2018
Managed Care changes will go into effect as of July 1, 2018
SPA has already been implementing the changes since June 2017 so we can have a smooth transitionSlide3
Supervision Slide4
Supervision
Non-independently licensed Clinicians will continue to identify which supervisor was on site while the billable activity was performed.
The supervisor does not have to be in the room or free from another activity to be indicated as the supervisor. The supervisor must be”immediately available and interruptible” - accessible in person in case of an emergency. This does not mean accessible by phone or text only - it means the supervisor can be interrupted and walk over to assist in session if needed. For non-trainee clinicians this supervisor can change from week to week for a client.
This does not apply to case management services.
The supervisor who is identified as “direct supervisor” has to be sent any documents needing co-signed (DAs, DA Updates, ISPs, ISP reviews)Slide5
Supervision
On all of our
Carelogic
documents, clinicians complete the “Supervising/Ordering Entry Module”
If a supervisor was directly accessible and on site – the non independent clinician chooses the bullet for “Supervision” and indicates in the Staff field which supervisor was directly accessible. The supervisor just has to be available to choose “Supervision” – they don’t have to be utilized.
If a supervisor was not on site during the time of the activity then the non-independent clinician chooses the bullet “No Supervision” and does not choose a staff member. Choosing “No Supervision” does not mean the services were not supervised – it means general supervision was provided but no supervisor was directly available at the time of that service.Slide6
Supervision for Trainees
Trainees at SPA are the Psychology Interns and anyone completing a Field Placement through their school program
Trainees must have their supervisor meet a MCD client at the DA in addition to having the under supervision form completed. The supervisor that meets the client has to be the supervisor who is chosen for the supervisor each week the client attends sessions. If that supervisor is out of the building or on vacation, then the note for that client would say “No supervision.”
All documentation needs co-signed and has to be sent to the supervisor who met the client.
The supervisor will also be scheduled once a quarter to stop and see the client at the beginning of a session if they do not see them naturally in group or have met with them for another reason. For both the DA and quarterly meetings, the supervisor can stick her head in group and re-introduce herself.Slide7
Supervision for Trainees
DAs and Progress Notes will ask if the client is Medicaid – if the clinician responds yes, the prompt will come up to ask if the clinician is a trainee, if yes, it will ask which supervisor met with the client. On a progress note, it will ask if the supervisor met with the client that week (for the quarterly meeting) so we can track if a quarterly meeting has already occurred.
Psychology Interns will have a Message Board on the schedule under the client’s name that reminds them they are Medicaid and which supervisor is scheduled to meet with the client at the DA. This will also remind which supervisor to put in the supervision module and to which one all documentation should be sent for review.Slide8
Supervision Module for Independent Clinicians
Independently licensed clinicians will always choose “No supervision”
Non-independent clinicians will choose between “Supervision” and “No Supervision.”Slide9
Co-signing for Supervising Independent Clinicians
Clinicians have to complete and sign their documentation by the end of the next business day (with everything
statused
by the end of the day)
Supervisors must review and co-sign within 72 hours (business hours) of the supervisee’s signature. (If an intern signs on Monday, the psychologist has to sign by Thursday)
Nothing will be billed out until the supervisor has signed.Slide10
Supervision
The Dashboard on
Carelogic
will identify daily which supervisors are present at each location.
For psychology interns – the supervisor who met the client at the DA should be chosen for the supervision module and to co-sign the documentation.
For all non-independent clinicians in Akron, choose Dr. O’Bradovich as the supervisor if she is present and only the DAs would need to be cosigned by Dr. O’Bradovich and she can do this within the 72 hour time frame. Supervision toward licensure will still occur as normal and supervising all clinical cases should still be done with this supervisor even though SO might review the documentation and provide additional supervision.Slide11
Diagnostic AssessmentsSlide12
Diagnostic Assessment
Must be completed in one session with a focus on obtaining the necessary information to identify a diagnosis and treatment needs for the client. The DA will have to be completed and signed by the end of the next business day. Supervision and Peer Review will continue to reflect that the DA can only obtain a certain amount of information and that additional information to flush out diagnoses and further direction in treatment will be shown in subsequent treatment notes.
There will be no additional sessions for DAs unless a crisis occurs in the DA session. If a crisis occurs in the first session, then the process for a pre-authorization for a second DA session will be completed.
The second session progress note will allow clinicians to use the second session to complete the ISP and the orientation documentation with the client – including prompts for with the ISP being completed in the second session when treatment begins.Slide13
Diagnostic Assessment
The DA is not complete unless the medication section has been completed.
The clinician should list current medications in the medical section – however, the medications need entered into Dr. First by the support staff by the end of the next business day or the form cannot be signed.
Clinicians should immediately give the client form to their support staff upon ending the first DA session and verify that the medications are entered before signing.Slide14
Diagnostic Assessments
A diagnosis (or multiple) is still required with the one session DA.
A clinician can begin with a preliminary diagnosis and then clarify the diagnosis as treatment continues (which should be done anyway).Slide15
Crisis Sessions
Based on further clarification, SPA will not be billing under crisis sessions because we are not certified to provide crisis services.
QA will be identifying the requirements for obtaining certification as a crisis provider.
Currently, crisis will not be an option on the Additional Services Module for SPA.Slide16
Diagnoses and documentation
With BH redesign, clinicians have to be more deliberate in their documentation to connect the services provided to the diagnoses they are using.
Clinicians should link treatment provided to an ongoing diagnosis either in the treatment provided or in the response to treatment. If client has major depression – we need to link services to this diagnosis – “Practiced positive self talk to address negative self image” or personality disorder “Identified thinking errors related to getting needs met in relationship”
Diagnosis has to fit treatment - If have a chronic illness like Diabetes but go to the doctor for a sinus infection, the diagnosis for that visit would be “sinus injection” not “diabetes.” Slide17
Diagnoses and documentation
When managed care begins in July 2018, we will have limits on the length of time a client can have an unspecified diagnosis and authorizations for additional treatment (like testing) will not be approved with an unspecified diagnosis.
Need to further clarify unspecified diagnoses after the DA and need to move to a specified diagnosis if nothing else fits – “Personality Disorder with antisocial traits”Slide18
Interactive ComplexitySlide19
Interactive Complexity
Definition – Refers to specific communication factors that complicate the delivery of services and occur during the delivery of the service.
Common situations – difficult communication with discordant or emotional family members and engagement of verbally undeveloped or impaired clients.
Won’t be used frequently and cannot be used for only having an interpreter in the room – it cannot be just a time issue – that it takes more time (for instance someone who stutters) but for communication that makes the treatment more complex – reflects added intensity – not added time – is not meant to be used with every “difficult“ client.Slide20
Interactive Complexity
Interactive Complexity is included (and documented clearly) when at least one of the following is present during the visit:
The need to manage maladaptive communication(related to, e.g. High anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.
Caregiver emotions or behaviors that interfere with implementation of the treatment plan.
Evidence or disclosure of a sentinel event and mandated report to a third party (e.g. Abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with the patient and other visit participants.Slide21
Interactive Complexity
More often present with clients who:
Have other individuals legally responsible for their care, such as minors or adults with guardians
Requests others to be involved in their care during the visit, such as adults accompanied by one or more participating family members
Require the involvement of other third parties, such as child protective agencies, parole, probation officer or schools.
These are not billed just for having an interpreter present.Slide22
Interactive Complexity
The need to manage maladaptive communication(related to, e.g. High anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.
Examples
During court ordered therapy the client is angry and explosive throughout the session and refuses to engage or participate in the treatment plan
The participating spouse disagrees with the treatment plan because is in denial about the severity of the drug problem and suicidal ideation the client presentsSlide23
Interactive Complexity
Caregiver emotions or behaviors that interfere with implementation of the treatment plan.
Parent has significant anxiety over diagnosis and recommended treatment and is dealing with only feelings of guilt and anger that the treatment plan cannot be fully completed or explained to the parent.Slide24
Interactive Complexity
Evidence or disclosure of a sentinel event and mandated report to a third party (e.g. Abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with the patient and other visit participants.
Disclosure of child abuse/neglect, elder abuse, self harm or harm to others with discussion in session with client and other participantsSlide25
Interactive Complexity
These are not billed as Interactive Complexities:
Multiple participants in the session but communication is straightforward
Client attends session individually with no sentinel event or language barriers
Treatment plan is explained in session and understood without significant interference by caretaker emotions or behaviorsSlide26
Case management/cpst for cliniciansSlide27
Case management/cpst for clinicians
Case Management is for clients with Substance Abuse diagnoses receiving substance abuse treatment from SPA
CPST is for clients with mental health diagnosesSlide28
Case management/cpst for clinicians
This is not a substitute for clients that need traditional CM or CPST and those clients should be referred to case management.
Case Management and CPST can be billed by the a clinician in the following situations:
If Case Management/CPST is identified as an activity that can be done by the therapist on the ISP
If the activity supports the client in the obtainment of the ISP goals
If the activity lasts longer than 8 minutesSlide29
Case management/cpst for clinicians
Examples of clinician CM/CPST activities as long as meet earlier criteria:
Face to Face or phone consultation with primary care doctor or client’s psychiatrist
Phone contact with the client that works toward them attending sessions, identifying barriers (not just leaving a ‘where are you’ message)
Completing a monthly for the SSA detailing progress in treatment or barriers to progress
Phone consultation with SCCS regarding a client they referred
Attending a planning meeting for a client with DD
Consulting with a clinician who provides another form of treatment with that client (group leader, case manager) – only one clinician can bill for this activity – it cannot be both
Speaking with a PO regarding progress in treatment or barriers to progressSlide30
Case management/cpst for clinicians
Clinician will have to enter the CM/CPST activity into their schedule as a billable client activity (click on the C for adding a client activity). If marked a client as NS – it will open up that hour and CM/CPST can be completed in that time.
The activity should be set up for the actual time done (1:05 to 1:23 – for 18 minutes) and the activity should be kept.
The Activity to choose is either Case Management (
AoD
) for Clinician or CPST (MH) for ClinicianSlide31
Case management/cpst for clinicians
If client program does not pre-populate then have to choose between forensic, non-forensic or vivitrol.
If location does not pre-populate you choose “Office”
You can put a description in the box that will show up on the schedule but this is not required.Slide32Slide33
Case management/cpst for clinicians
The activity will be linked to a progress note and the clinician will choose either CM or CPST
Choosing these options will remove the sections not required for the CM/CPST note such as mental status or current dangerousness.
This should be
statused
by the end of the day and as with other documentation must be completed by the end of the next business day.
The note should reflect the amount of time spent in consulting or working with the client outside of session.Slide34
Psychological testingSlide35
Psychological Testing
Currently, psychological testing is a global activity that is billed regardless of the test that is given.
As of January 1, 2018, each psychological test will have its own activity – so a client will be scheduled for an MMPI rather than scheduled for psychological testing.
Clinicians can now bill for administration, interpretation and report writing time up to 12 hours for diagnostic testing and 10 hours for developmental testing per client per calendar year. Slide36
Psychological Testing
Testing will be administered by clinicians beginning in January and interpretation and report writing will be put in as a billable activity and tracked toward the allowed hours for Medicaid clients. Reports for these evaluations will be due ten days after the testing is completed.
Testing will be scheduled for Medicaid clients after the initial interview and a psychological testing order has to be completed by Dr. O’Bradovich prior to the client being seen for testing.Slide37
Prior Authorization Work Flow Overview
1. Clinician recognizes that a prior authorization is needed and completes a Prior Authorization Form. The form is turned in to their secretary for processing.
2. Secretary enters in the Prior Authorization information into MITS depending if this is a MH or
AoD
case
3. Secretary follows up on the status of the request. Medicaid processing can take 2-7 business days. Once the Prior Authorization has been processed, the secretary will update the clinician, enter the information into
CareLogics
and schedule any appointments that were pending the auth.
4. Clinician can check their caseload or client face sheets in
CareLogics
for the status
5. Secretary will notify clinician once approved.Slide38
Prior Authorization Process - Clinician
Clinician identifies need for pre-authorization
Clinician staffs the case with Dr. O’Bradovich in Akron, Star Jones in Canton, or Kristen
Kratzer
in Ravenna
3. Clinician completes the form
4. Leave the MMIS# blank
5. For the Primary Diagnosis –
ICD-10 Diagnosis MUST BE USED
6. Turn form into your secretary completed
7. Client cannot be seen for
this activity until
the form is either approved or denied. Denials can be appealed. Slide39Slide40Slide41Slide42
Treatment Groups
Mental Health Treatment Groups will only be authorized for one unit – one hour.
Mental Health Treatment Groups require two leaders if the number of group members is over 12
Due to contractual obligations, Federal SO groups will remain at 90 minutes.
New Foundations groups will not be able to go over 12 unless there is a co-lead.Slide43
Accounting of disclosures of PHI form
The accounting of disclosures of PHI form is used in
Carelogic
when information is disclosed to an agency or a person without a release of information – such as in the case of an ambulance having to be called because of a medical problem for a client or a disclosure to SCCS in the case of child abuse. Slide44Slide45
Uds collection for smart program
uds
orders
Medicaid will allow billing for UDS collection that is ordered by a physician
The case managers will be completing UDS orders for Dr.
McCluskey
to review and sign when a client begins the SMART program. These will be done at all offices and all sent to Dr.
McCluskey
.
UDS collection will have to be completed by clinical staff (case managers) in order to bill for the collection.
This is not impacting the Federal UDS program.