BH TEDS Solution Indicator 2b BH TEDS Solution 1 11152019 Directives for New or Amended Performance Indicators CMS and HSAG advised the Administration on the following Focus of performance indicators should be on performance and quality improvement ID: 778884
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Slide1
Timeliness to Substance Use disorder services and treatment
BH TEDS Solution
Indicator #2b BH TEDS Solution
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Slide2Directives for New or Amended Performance Indicators
CMS and HSAG advised the Administration on the following:
Focus of performance indicators should be on performance and quality improvementCurrent high scores shows that indicators are not informing quality improvement
Need to:Reduce or eliminate exceptions and exclusionsAbandon 95% normative standards created by edict rather than observation
Utilize existing data collection mechanisms to every extent possible (Encounters, BH TEDS, Critical Incidents, etc.)
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Slide3Using BH TEDS with 2B or (Not) 2B… That is the Question
Without Using BH TEDS
Using BH TEDS A Records
Reported Wait Times for Each Admission (Statistical Analysis)
No
Yes
Provider Level Detail
No
Yes
Proximity (County of Residence to County of Provider)
No
YesDemographics (Age, Gender, Race)NoYesSubstances Involved (Opiates vs. Methamphetamines vs. Alcohol)NoYesObserve Improvement Inside 14-Day Window (See next slides)NoYes
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Slide4Demonstrating Performance or process Improvement
By reporting aggregate counts, numerator & denominator, within 14 days:
Mean and median for time to treatment are unobservable
13-day wait times are treated equally to 1-day wait times
Improvements of wait times within 14 days are masked
For example, an improvement of moving from 11 day to 2 days will not be detected.
By using
Time to Treatment
already reported in BH TEDS one can:
show improvement in median or mean wait times, even if the 14-day percentages remain effectively unchanged
factor in all efforts to improve wait times, not just those from outside 14 days but also inside it
observe such things as percentage of admissions on the same day as the request.14-day window can elevate mediocrity and mask excellenceIndicator #2b BH TEDS Solution
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Slide5BH TEDS substance use disorder AdmissionsReportable Admissions
For this indicator, BHDDA will count the
number of Admissions for the quarter. Persons are admitted to each, distinct LARA-licensed site
Each provider will be held accountable for timely admissions, not just the one that happens to take place first chronologically“Failed Hand-offs” from one provider to the next, based on reported Reasons for Discharge of
Transfer/Continuing
, occur in nearly 40% of SUD episodes when a new provider is involved.
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Slide6Observations on BH-TEDS and Federal Time to Treatment Field
Time to Treatment
has been reported on all SUD TEDS admissions since 19921.45 million SUD TEDS records have this reported since FY2000Federally-required field that Michigan is held accountable for completeness and reasonableness in our SAMHSA award agreement
BH TEDS definition now matches 2B Indicator definition, which no longer includes exceptions or exclusions.Using BH TEDS is consistent with the goal/directive to use existing data collection sources whenever possible
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Slide7Benefits from Using BH TEDS
Eliminate redundant reporting
Simplify your reporting task for this IndicatorProvide additional information to facilitate quality improvement effortsEvaluate timeliness at each LARA-licensed SUD provider
Reinforce accurate BH TEDS reporting in field A013 (as stipulated in the SAMHSA Agreement with Michigan)
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Slide8Indicator #
new 2b
Current contract language for 2020
The percentage of new persons during the quarter receiving a face-to-face service for treatment or supports within 14 calendar days of a non-emergency request for service for persons with Substance Use Disorders.
No Standard for 1
st
year of implementation – will use information to determine baseline.Proposed approach for using BH TEDS to satisfy the requirements of this indicator…..
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Slide9Time to TreatmentBH TEDS (A013)
Definition from BH TEDS Coding instructions:Date of 1st face-to-face service (SUD treatment service); minus Date of 1st contact/request for service equals Time to treatment; or, (Date of 1st billable, non-brief-screening (H0002) face-to-face service) – (Date of 1st contact/request for service) = Time to Treatment.
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Slide10Contract Language
1.
# of New Persons Who Requested and Were
Approved for SUD Treatment or Supports
X1 = X1a +X1b
2.
# of Persons from column 1 Receiving a Service for Treatment or Supports within 14 calendar days of First Request
Y1
3.
% of Persons Requesting a Service who Received Treatment or Supports within 14 Days.
Y1/X1
BH TEDS Methodology
X1a. The count of BH TEDS SUD Admission records (Client Transaction Type = A) for the quarter.
X1b.
Expired Request
:
All SUD approved service requests during the quarter for which there is no BHTEDS admission record.
Based on the BHTEDS
Time to Treatment
field for Admissions counted in X1a.
BHDDA calculations
PIHP calculation
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Slide11Keys points - to Summarize
BH TEDS Methodology
The BH TEDS field Time to Treatment will be used by BHDDA to determine whether a service is provided within 14 days of the request.PIHPs will submit ‘expired requests’ to the state, outside of BH TEDS reporting.
The BH TEDS Admissions and the count of ‘expired’ requests will be summed for a total count of requests (the denominator, X1).The number of requests resulting in a service within 14 days will be divided by the total number of requests to calculate the percentage receiving a service within 14 days of the request.
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Slide12Another way to look at it –Need to Delineate three possible outcomes
Timely Admission
BH TEDS Admission with a Time to Treatment within 14 days of request.Untimely Admission
BH TEDS Admission with a Time to Treatment outside of 14 days of request.Expired Request
Approved Request that does not result in an Admission.
Will be reported by the PIHP outside of BH TEDS reporting process.
SUM
These three outcomes will be added together to create the total or the denominator, Column #1
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Slide13performance indicator instructions
implementation
Contract language: Cases selected for inclusion in Column 1 are those new persons, both Medicaid and non-Medicaid, who made a non-emergency request and were authorized for an SUD service during the quarter.
Cases selected for inclusion in Column 2 are those in Column 1 for which the service for treatment or supports took place within 14 calendar days following the first request.
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Slide14Indicator #2b BH TEDS Solution
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.
Terms to Address
BH TEDS Methodology
1. Include all Coverages
6. During the quarter, reporting quarter
2. Definition of a Request
7. Non-emergency
3. Determining Request Date
8. Expired Requests
4. Reporting time to treatment in BH TEDS
9. Counting Expired Requests
5. Counting BH TEDS Admissions
10. Expired Requests - Counting Days from Request
New PIHP Tasks
BHDDA Task
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Slide15Populations
Include all coverages
Medicaid
Healthy MichiganBlock Grant
General Fund
Individuals covered under the Medicaid autism benefit will be included.
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Slide16definition of a request
Definition of Request:
The initial telephone or walk-in request to a provider for non-emergency services bythe individual,
parent of minor child,legal guardian,
referral source (including other SUD providers)
A request occurs when:
The person or someone on their behalf makes a request at that provider.
And
The person has been approved for SUD treatments and supports at that provider.
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Slide17Example #1: If date of request and date for approval for services are not on the same day:
If the request date is 3/31/2020
The approval date is 4/1/2020
The request date is 3/31/2020.
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Determining the date of request
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Slide18Determining date of request (
con’t)
Example #2: Person difficult to reach after making request via phone, the date of the person’s first request is the request date.
1/1/2020 The person calls for the first time and leaves a message,
with name and call-back information
, requesting services.
1/1/2020 The access center
or provider calls the person back, is unable to reach them but leaves a message.1/15/2020 the person calls back to request services and receives approval for SUD services.
The request date is 1/1/2020.
Important to note – the request starts once the person provides their name and contact information.
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Slide19Determining date of request (con’t)
Example #3: Person receives referral from Provider A to Provider B. The request date is the date that Provider B receives the request to provide services to the person.
2/15/2020 The person starts outpatient services at Provider A
2/21/2020 Provider A contacts Provider B to ask to get the person into residential treatment.
2/23/2020 the person agrees to receive treatment from Provider B.
2/29/2020 the person starts services at Provider B.
The request date at Provider B is 2/21/2020.
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Slide20Determining date of request (con’t)
Example #4: Person is receiving treatment at a residential facility and receives referral from Provider B to Provider C. The request date is the date that the person is
discharged from Provider B.
4/7/2020 The person starts residential treatment at Provider B4/10/2020 Provider B contacts Provider C to ask to get the person into non-intensive outpatient services.
4/10/2020 the person agrees to receive services from Provider C.
4/14/2020 Person is discharged from Provider B residential facility.
4/15/2020 the person starts services at Provider C.
The request date is 4/14/2020 – the discharge date.
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Slide21Reporting Time to Treatment in BH TEDS
Start of SUD Services is the first face-to-face service for SUD treatments or supports at that provider.
An assessment (H0001 HF) can be counted as the first service. A screening is considered an administrative function and cannot be counted as a service.
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Slide22Reporting time to treatment in BH teds
For reporting
Time to Treatment in BH TEDS, the PIHPs should determine the request date as described in previous slides
Example #1:The date of the request is 3/31/2020
The date of approval for services is 4/1/2020
Person received first face-to-face service (e.g., H0001 HF) on 4/5/2020.
The request date is 3/31/2020
Time to Treatment is the number of days between 3/31/2020 and 4/5/2020Time to Treatment = 5 days.
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Slide23For Provider A:
A BHTEDS Admission Record will be reported with a Service Start Date of 4-5-2020 and Time to Treatment = 5 days.
Initial, Reportable Request
3/31/2020
SUD Admission
4-5-2020
SUD Provider A
5 Days
Approval for SUD services
4/1/2020
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Slide24For Provider B:
A BHTEDS Admission Record will be reported with a Service Start Date of 4-1-2020 and Time to Treatment = 6 days.
For Provider c:A BHTEDS Admission Record will be reported with a Service Start Date of 4-1-2020 and Time to Treatment = 0 days.
Initial, Reportable Request
4-1-2020
SUD Admission
4-7-2020
SUD Provider B 6 Days
Approval for SUD services
4-1-2020
Initial, Reportable Request
4-1-2020
Approval. Persons stays for appointment
4-1-2020
SUD Admission
4-1-2020
SUD Provider C 0 Days
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Slide25SUD Admission records will be counted for the indicator if:
The person has never received SUD services from the PIHP.
or
The person is not receiving services from this SUD provider. That is, the person does not have an open Admission at this provider.or
The person was discharged from this SUD provider more than 60 days ago.
Indicator #2b BH TEDS Solution
Counting BH TEDS Admissions
BHDDA calculation
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Slide26BH TEDS substance use disorder Admissions
Reportable AdmissionsBHDDA calculation
For this indicator, BHDDA will count the
number of Admissions for the quarter. Persons are admitted to each, distinct LARA-licensed site
Reminder - The State does not require you to admit and discharge between levels of care at same provider
Reporting changes in level of care at the same provider is a PIHP decision.
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Slide27Counting BH TEDS AdmissionsReporting Quarter
BHDDA will determine the reporting quarter for the BH TEDS Admission based on the BH TEDS Service Start Date.
Example #1:
The Service Start Date on the Admission Record is 4/5/2020BHDDA will count this Admission for 3rd quarter 2020.
Example #2:
The Service Start Date on the Admission Record is 9/30/2020
BHDDA will count this Admission for 4th quarter 2020.
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Slide28Non-emergency, non-urgent request
Contract Requirement
Emergency and urgent requests for SUD services are excluded from this indicator:
Pregnant womenPeople determined by the PIHP to need SUD services within 24 to 48 hours.
BH TEDS Methodology
Pregnant women
Whether a women is pregnant is collected on the BH TEDS Admission record.
BH TEDS Admissions for pregnant women will be excluded for this indicator.
Services needed within 24 to 48 hoursCurrently there is no information in BH TEDS as to whether the person is determined by the PIHP to need SUD services within 24 to 48 hours.
This information will be added to BH TEDS Admission record for 2021.
Once information is available these BH TEDS Admissions will be excluded for this indicator.
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Slide29Counting BH TEDS Admissions
Non-emergency, non-urgent request
Pregnant women
BHDDA will exclude BH TEDS Admissions for pregnant women for this indicator.Services needed within 24 to 48 hours
This information will be reported on the BH TEDS Admission record for 2021 as a new data element.
When information is available in 2021, BHDDA will exclude these BH TEDS Admissions for this indicator.
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Slide30Expired RequestsPIHP Calculation
These are approved requests at an SUD provider that do not result in a BH TEDS Admission.
Requests are expired if there is no service from this provider within 60 days of the request date.The PIHP will report the number of requests that expired during the quarter.
Will be reported to the State, outside of the BH TEDS reporting process.
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Slide31How to Count the number of days from the request
Expired Requests
Sixty days following the request date, the request will be expired.
Example #1Person requests services at Provider A on 1/1/2020.
Provider A approves the person for SUD services on 1/3/2020.
Request Date is 1/1/2020
.
If the person has not received services from Provider A by or on 3/1/2020
, the request is expired.
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Slide32how to count requests
expired Requests
The PIHP is to count ONLY those approved requests for services that are subsequent to one of the following conditions or situations:
The person has never received SUD services from the PIHPorThe person is not receiving services from
this
SUD provider
This is operationalized as the person does not have an open Admission at this provider
orThe person made an approved request to this SUD provider more than 60 days ago and has not yet received services (expired request)or
The person was discharged from this SUD provider more than 60 days ago.
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Slide33BH TEDS Methodology – this person will be reported as an expired request by the PIHP for 3
rd quarter 2020 (6-17-2020)
Decisions:
Initial, Reportable Request
4-18-2020
Yes, Start Count on 4-18-2020
6-17-2020
60 days since request on 4-18-2020
Subsequent Request
4-20-2020
Do not count this subsequent request
SUD Provider A – 60 Days
Expired Request
Yes = 1
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Slide34Expired RequestsReporting Quarter
The PIHP will determine the reporting quarter based on the expiration date of the request.
Example #1: Date of approved request is 3/31/2020.The expiration date of the request is 5/31/2020 (60 days since 3/31/2020).Person does not receive services and a BH TEDS Admission record is not submitted.This expired request will be included in the count submitted to the state for
3rd quarter 2020 which is due to BHDDA September 30th.
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Slide35Expired RequestsReporting Quarter
If a BH TEDS record has been submitted for a request for service, do not count as an expired request.
Example #2:Date of approved request is 4/23/2020.
The expiration date of this request is 6/22/2020 (60 days since 4/23/2020).Person receives services on 6/30/2020 in response to the request from 4/23/2020.PIHP submits BH TEDS Admission with:
Services Start Date = 6/30/2020
Time to Treatment = 68 days.
PIHP
does not count this as an Expired Request since a BH TEDS Admission has been reported to the state.
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Slide36March 2020 Request at Provider A:
PIHP would report the expired request for 3rd quarter 2020 (Expiration Date 5-18-2020)May 2020 Request at Provider A:
PIHP would report the expired request for 3rd quarter 2020 (expiration date 7-19-2020)
Initial, Reportable Request
3-19-2020
No SUD Admission in 60 days
5-18-2020
SUD Provider A
Reportable Request
5-19-2020
SUD Provider A
No SUD Admission in 60 days
7-19-2020
Expired Request
Yes = 1
60 days
Yes, Start Count
Yes, Start Count
60 days
Expired Request
Yes = 1
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Slide37Non-emergency, non-urgent request
Expired Requests
Pregnant women
For the PIHPs aggregate count of expired requests, requests for service from pregnant women will be excluded.Services needed within 24 to 48 hours
For 2020 the PIHP will include these requests in the aggregate count of expired requests submitted to the state.
Will be consistent with BH TEDS data.
Once information is available in BH TEDS, the PIHPs will exclude requests for services needed with 24 to 48 hours.
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