1. Welcome to NJSAMS 3.4 New Jersey Substance Abuse Monitoring System Brian Regan – Assistant Director (OIS) Nitin Garg – IT Manager Kyu Kyu Hlaing– Research Scientist 1 Chandra Akenapalli – Application Architect Release Date – MAY 24 2016

2. NJSAMS 3.4 INTRODUCTION The IME will serve as a single point of entry for those seeking treatment for substance use disorders and will ensure that individuals are receiving the right level of care for the right duration at the right intensity for IME managed initiatives. IME will use ASAM criteria to approve addiction treatment placements and continuing care stays for individuals being served through IME managed state initiatives and Medicaid covered services and providers. 2

3. NJSAMS 3.4 Flowchart for May 24 th Release 3

4. New terminologies in NJSAMS 3.4 release 4  Clinical authorization :  Authorization obtain by IME is called as Clinical authorization.  Its is relevant to IME managed initiatives funding source only  Providers will submit request to IME for clinical authorization with the exception of standard outpatient and OPIOID maintenance outpatient.  Clinical authorization comprises of two steps: o Clinical approval: Where DSM-5 and LOCI-3 report will be reviewed by IME. o Treatment authorization : Where IME will obtain authorization number from fiscal entity.  Extension request will follow the clinical authorization process  Admin authorization:  Authorization obtain by provider, without IME intervention is called as admin authorization.  Its is relevant to both IME managed and non IME managed initiatives funding source.  All authorization for Drug court, SBP and DOC are considered as admin authorization.  Authorization, for IME managed initiatives, after clinical authorization and prior to extension request limits are considered as admin authorization.

5. New Core Features 5  Admission Module:  Client funding source has moved to the beginning of the admission process.  Fee for Service initiatives are categorized as Managed and non-managed initiatives  A significant change in client admission statuses. As the admission moves through, the client status will be changed according to the client funding source and IME approval.  Authorization :  Service providers send clinical/financial request to IME  Clinical requests approval by IME  Securing financial treatment authorization by IME after clinical approval  Obtaining admin treatment authorizations by service provider for Managed Initiatives  Extensions:  ERL for Non-managed Initiatives and for Managed Initiatives  Miscellaneous:  All authorizations are admin authorization for non-managed initiatives and service providers will secure them.  Various ad-hoc reports for IME

6. Admission (Funding Source Selection)  Completing client’s admission is a prerequisite to proceed to a treatment authorization for both Managed and Non- Managed initiatives. All required information must be entered in admission module. The required fields and validations are the same as in current NJSAMS 3.3.  In admission module funding source selection has been moved from seventh accordion to first accordion.  New funding source screen in admission module : 6

7. Funding Source Categories  In NJAMS 3.4 release, funding sources are categorized as, 7 Managed Initiatives ( Medicaid, DUII, SJI and MATI ) Non-Managed Initiatives (DC,SPB,DOC) Other public funding Other non- public funding Service provider is required to send a request to IME for clinical approval Service providers can secure authorization by themselves No Clinical Approval is required and no request need to send to IME. ( Women Set a Side, MATI-MMU enhanced services can be requested by providers)

8. Funding Source Categories  Managed Initiatives: Medicaid, DUII, SJI and MATI.  If client’s funding source is chosen as one of those initiatives in first accordion of admission section and entered all required fields then client admission status will be updated to “Admission – Pending Submission to IME” and Button “Clinical Authorization” will be enabled.  Service provider is required to send a request to IME for clinical approval and IME will secure financial authorization for service provider after clinical request has been approved.  “Treatment Authorization” button will be enabled to secure enhancement services and subsequent admin authorizations at provider’s end once clinical authorization has been obtained by IME.  Non-Managed Initiatives: Drug Court (DC), Stare Parole Board (SPB) and Department of Corrections (DOC).  Non-managed initiatives have higher priority in terms of initiative eligibility over managed initiatives and other funding source.  If client’s funding source is chosen as one of the non-managed initiatives and entered all required fields in admission section then client admission status will be changed to “Admitted”.  “Treatment Authorization” button will be enabled at left navigation for all admitted clients so service providers can secure treatment authorization.  Service providers can secure authorization by themselves.  Other public funding: General DAS slot, Women Set a Side, MATI-MMU, County Funding, Chapter 51, Youth Service Commission, PIP, SAMHSA – General, MATOP, Medicare, WFNJ  Client’s funding source is chosen as other than managed and non-managed (E.g. Self pay, private insurance, County Funding etc.) and entered all required fields in admission section then client admission status will be changed to “Admitted”. No Authorization is required and no request need to sent to IME.  Other non-public funding: Self/Family pay, Private insurance. No fee/No payer/ charity  Client’s funding source is chosen as other than managed and non-managed (E.g. Self pay, private insurance etc..) and entered all required fields in admission section then client admission status will be changed to “Admitted”. No Authorization is required and no request need to sent to IME. 8

9. Client Admission Statuses 9  There are significant changes in client admission statuses as compared to NSJAMS previous versions. In previous version, if all required fields are entered in admission section then client status will be updated to “Admitted”, whereas in NJSAMS 3.4, client’s admission status depends on Client Payer Source and IME approval.  Below are various admission statuses in NJSAMS 3.4 :  Admission in Progress: First accordion saved and remaining required fields in admission section are incomplete.  Admission – Pending Submission to IME: Required fields in admission section are completed and selected funding source is Managed (Client is ready to send IME for clinical approval).  Admission - Clinical Approval Pending: Funding is Managed and request has been sent to IME for approval  Admission - Clinically Denied: Funding source is managed; clinical request has been reviewed and denied with a reason by IME.  Admission - Clinically Approved: Funding is Managed, Request has been reviewed and approved (No authorization has been secured yet).  Admission – Care coordination: Funding is managed; Request has been reviewed and approved but unable to secure an authorization. Agency can change the client funding source if any other funding is available (other than non-managed).

10. Admission Status Continue.. 10 Admission in Progress Admission – Pending Submission to IME Admission - Clinical Approval Pending Admission - Clinically Denied Admission - Clinically Approved Admission – Care coordination Client’s admission started but required fields in admission section are incomplete. Required fields in admission section are completed and selected funding source is managed Funding source is managed and request has been sent to IME for approval Funding source is managed; clinical request has been reviewed and denied with a reason by IME. Funding source is managed; Request has been reviewed and approved (No authorization has been secured yet). Request has been approved but IME unable to secure an authorization (various reasons)

11. Admission Status Continue.. 11  Admitted : If Client meets any one of the below criteria  If funding is managed and authorization has been secured  If funding is not managed and required fields are entered in admission section.  Disregarding of funding source if level of care is standard outpatient and OPIOID maintenance outpatient and required fields are entered in admission section.  Admitted – Pending Submission to IME : Funding is managed; client is receiving treatment and requires another clinical approval after subsequent admin authorizations (When funding source change during the treatment).  Admitted – Subsequent Clinical Approval Pending : Funding is managed, client is receiving treatment and a clinical request has been sent to IME for another clinical approval after subsequent admin authorizations (When funding source change during the treatment).  Admitted – Subsequent Clinical Request Denied : Funding is managed, Client is receiving treatment and a request has been sent to IME for another clinical approval but request has been denied.  Admitted – Subsequent Clinical Request Approved : Funding is managed, Client is receiving treatment and a request has been sent and was approved by IME

12. Admission Status Continue.. 12 Admitted Admitted – Pending Submission to IME Admitted – Subsequent Clinical Approval Pending Admitted – Subsequent Clinical Request Approved If funding source is managed and authorization has been secured Funding Source is managed; Client is receiving treatment and client’s funding source was changed. Funding Source is managed and Clinical request has been sent to IME for another clinical approval. Request has been sent to IME for another clinical approval but request has been denied. Request has been sent to IME for another clinical approval and request has approved If funding is not managed and required fields are entered in admission section Admitted – Subsequent Clinical Request Denied

13. Clinical Review Request to IME (Providers) 13  Service providers must send a request to IME for clients who need clinical/financial authorization for approval.  Click on “Clinical Authorization” button from left side navigation from DASIE Client Search which will display two tabs, Clients Require Authorization and Sent Requests. (OR Click on “Clinical Authorization” button from left side navigation from Client Quick Links to get screen specific to that client)  Clients Require Authorization: All clients that require Clinical approval will be listed here. (including clients whose request was denied after review by IME)

14. Request To IME continue.. (Providers) 14  On clicking “Request to IME” button system redirects to a new screen where agency can enter Authorization start date and Send Request to IME for clinical/financial approval. Validation: Authorization start date cannot be before admission date, Future authorization date is allowed (up to seven days from current date)

15. Clinical Review Request to IME continue.. (Providers) 15  Clients sent for clinical Review : All clients sent to IME for clinical review will be listed in this list. Until the request has been reviewed the status will display as “Pending Review”. Once reviewed by IME, appropriate status will be displayed. Click to see more information

16. Cancel The Request (Providers) 16  A request can be cancelled if a request has been sent in error before it is reviewed by IME (by clicking on the “Cancel Request” button)

17. Funding Source Change (Providers) 17  Any change in funding source during the treatment, then current active authorization (if any) must be cancelled before changing to new funding source. System will give a prompt message to cancel authorization if any active authorization is found.  Client admission status will change to “Admitted – Pending Submission to IME” if funding source changes to managed initiative after admission.  If Client status is “Admission - Clinical Approval Pending /Admitted – Subsequent Clinical Approval Pending” or “Admission - Clinical Approved/Admitted - Subsequent Clinical Request Approved “ then “Change Funding Source” button will be disabled in admission module.

18. Clinical Request Review by IME (IME) 18  IME must review clinical/financial requests received from service providers. When IME logs in, a button “Clinical Authorization” will appear on left navigation.  Clients To Be Reviewed : A list of clients requires clinical approval will be listed in a grid in the order they were received by date.

19. Review By IME continue.. (IME) 19  On clicking “Review” button system redirects to a new screen where IME can update the status (Approve or Deny) after reviewing DSM-5 and LOCI-3 reports.

20. Review By IME continue.. (IME) 20  If clinical request is “Approved” then client’s admission status will change to “Admission - Clinically Approved”  There are two ways to access the “Treatment Authorization” module by IME.  First, from Clinical Authorization Screen, On clicking “ Go To Treatment Authorization ”button system redirects users to treatment authorization module.  Second, on clicking “Treatment Authorization “ button in Client’s Quick Links.

21. Review By IME continue.. (IME) 21  At the bottom section page will display History of Clinical authorization for this client. Hover on review status, tool tip should be displayed with Comments and deny reason (if request was clinically denied by IME)  If clinical request is “Denied” then client’s admission status will be “Admission - Clinically Denied”. Denial reason must be selected from dropdown list if request is denied. A comments box is also available for IME to communicate to providers on any information related to clinical request  Denial Reason :  If a clinical request is denied then service providers may update either DSM-5 or LOCI-3 or both as per denial reason given by IME reviewers and re-submit clinical request to IME for approval.

22. Review By IME continue.. (IME) 22  Clinical Requests Reviewed: All clinical requests that have been reviewed by IME will be listed here.

23. Treatment Authorization/Financial Authorization 23  Treatment Authorization Module for IME:  In previous versions, Service providers are the only authorized users to access treatment authorization module, now IME staff also will have the access to treatment authorization module for managed initiatives.  “Treatment Authorization” link will be enabled for IME only if the client is clinically approved. IME UM role is the only authorized users for this module.  Change/confirm initiative and site license number by IME: In treatment authorization module, IME has the ability to override client initiative and site license number before securing financial authorization from CSC.

24. Medicaid Authorization 24  IME will enter Medicaid authorization number, Service start and End dates in NJSAMS application if client is eligible for Medicaid.  If a client is eligible for Medicaid and IME approves Medicaid funding source then a message will be given to IME to enter Medicaid authorization number.

25. Summary of Benefits Report 25

26. Extension Request 26  Extension Request LOCI (ERL) is the process to allow the Fee for Service client to continue in current treatment beyond pre-defined treatment days for an initiative and level of care (other than Outpatient). Agency required to re-evaluate client’s complete LOCI and provides counselor interventions to support client’s stay in current treatment episode.  Client requires an extension request to continue in current treatment level of care beyond number of days before extension is needed. Clients due for ERL will listed in "Clients due for ERL". Search client in ERL due list, if found click on “Start New ERL” button next to client name in the grid which will allows to complete a new LOCI and flagged to identify as an extension request LOCI.  Complete regular/OTP LOCI and counselor intensions to support client’s continuing stay in current treatment level of care. Enter number of days required, check client consent to continue in treatment and “Save and Send For Review”.  Agency can secure admin authorizations until number of days before extension is reached and Extension Request LOCI (ERL) is required.

27. Extension Request continue.. 27

28. Maintenance Release for LOCI3 28  COWS, CIWA-Ar, Blood Pressure (BP) added to the first dimension of Regular LOCI

29. Maintenance Release for LOCI3 29  “No Level of Care is Indicated” option is available for selection of Level of Care Indicated in LOCI-3 on LOCI-3 Summary section.

30. Maintenance Release for LOCI3 30  LOCI-3 type selection section is redesigned.

31. NJSAMS 3.4 - Flowchart 31

32. Afternoon Session 32  Sending Clinical Request to IME (Approval) Step 1: Select DUII and IOP level of care and complete required fields in Admission module Step 2: Find Client in “Clients Require Clinical Authorization” tab Step 3: Click on the link “Request to IME” Step 4: Enter Authorization Start Date and Click on “Send Request” button to Send a request to IME Step 5: Check the status of the request in “Sent Request” tab Step 6: Client admission status will change to “Admitted” after obtaining treatment authorization Step 6: Click on “Treatment Authorization” button to add enhanced Services

33. Afternoon Session continue.. 33  Sending Clinical Request to IME (Denial) Step 1: Select DUII and IOP level of care and complete required fields in Admission module Step 2: Find Client in “Clients Require Clinical Authorization” tab Step 3: Click on the link “Request to IME” Step 4: Enter Authorization Start Date and Click on “Send Request” button to Send a request to IME Step 5: IME denies the clinical request with a reason Step 6: Check the status of the request in “Sent Request” tab. Click on “Details” link to see comments entered by IME Step 7: Re-evaluate DSM-5 and/or LOCI-3 as requested by IME Step 8: Re-Submit clinical request to IME

34. Afternoon Session continue.. 34  Cancel a Clinical Request Step 1: Select DUII and IOP level of care and complete required fields in Admission module Step 2: Find Client in “Clients Require Clinical Authorization” tab Step 3: Click on the link “Request to IME” Step 4: Enter Authorization Start Date and Click on “Send Request” button to Send a request to IME (Request sent in error) Step 5: Click on button “Cancel Request” Step 6: Find Client in “Clients Require Clinical Authorization” tab Step 7: Complete all the information that require to send to IME Step 8: Re-Submit clinical request to IME

35.  Thank You !!! - NJSAMS OIS TEAM 35