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Training presented May 20071 Rule 132 Medicaid Community Mental Health Service Program.

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Presentation on theme: "Training presented May 20071 Rule 132 Medicaid Community Mental Health Service Program."— Presentation transcript:

1 Training presented May Rule 132 Medicaid Community Mental Health Service Program

2 Training presented May History and development process Why changes: – Shift focus to recovery and resiliency – Conform to CMMS requirements – Continue efforts started in 2004 to improve rule How changes made: Establish System Restructuring Initiative (SRI) Establish workgroup on each new service Review and incorporate other state experiences Research evidence-based practices/best practices Review recent CMMS audits and actions

3 Training presented May Underlying Vision of Recovery and Resilience Fundamental components and role of services in supporting recovery and resilience can be found at

4 Training presented May Objectives for today – Understand why and how Rule 132 was amended – Understand how Rule 132 services support the fundamental principles of recovery and resilience – Understand general changes in Rule 132 – Understand changed requirements of existing Rule 132 services – Understand requirements of new and substantially changed services in Rule 132 – Understand general billing changes – Understand transition requirements – Present questions

5 Training presented May Handouts and Reference Materials Handouts: – Agenda – PowerPoint presentation – Question cards – Evaluation Reference Materials: Found at Adopted Rule 132 Crosswalk (now known as Service Definition and Reimbursement Guide) Guidelines, Instructions and Checklist Summary of rule changes

6 Training presented May Certification Process All currently certified providers will receive new certificates Process for adding new services Providers now certified for therapeutic behavioral services or skills training and development will be automatically certified for community support individual and group

7 Training presented May Certification Process (cont.) If now certified for skills training and development or therapeutic behavioral services and have CILA (620), supervised residential (830) or crisis residential (860) – will be automatically certified for community support residential If now certified for therapeutic behavioral services and comprehensive services – will be automatically certified for community support residential

8 Training presented May Transition Issues Rule allows three month transition period for documentation Treatment plans that currently have therapeutic behavioral service or skills training and development (ind/group) identified have until 9/30/07 to modify plans to community support (individual or group). Providers may bill for CSI or CSG during these three months Effective 7/1/07 services provided must meet CSI and CSG definition and service notes must indicate CSI or CSG

9 Training presented May Transition (cont.) Mental health assessments – must be updated by 6/30/2008 Treatment Plans – Must be updated by 9/30/07 – May be updated with signed & dated modification – 7/1/07 – provision, billing & documentation of services must be for revised rule services even when not yet in ITP

10 Training presented May Topics for future and separate discussions DCFS specific transition DHS/DMH contract requirements

11 Training presented May Rates, Billing and Coding Changes Rates – Minor rate changes for services unaffected by the revisions to Rule 132 – Rates for community support (group and individual) and psychosocial rehabilitation (group and individual) based on the rendering provider (RSA, MHP, QMHP) – Rates for community support team and evidence-based assertive community treatment based upon interdisciplinary teams – Rates for transition ACT are current rates

12 Training presented May Rates, Billing and Coding Changes (cont.) General billing issues – Bills with dates of service on or after 7/1/2007 will be rejected for: Day treatment Activity therapy Skills training and development Therapeutic behavioral services – Bills for these services with earlier dates of service will still be processed

13 Training presented May Rates, Billing and Coding Changes (cont.) Coding changes – DHS activity codes and HIPAA standard procedure codes are in the Services Definition and Reimbursement Guide (www.dhs.state.il.us/revisedRule132/)www.dhs.state.il.us/revisedRule132/ – Each state agency has more specific instructions on billing and payment to be addressed in later training

14 Training presented May Training Follow-up and Next Steps Moderated conference calls – Billing and Coding, May 29, 10 am – noon 1(800) Passcode: – Non-Medicaid Vocational Service – Non-Medicaid Outreach & Engagement Technical assistance – ACT/CST decision support tools – PSR decision support tool Q & A via

15 Training presented May General Changes Definition of Licensed Clinician Definition of MHP Definition of QMHP (still includes LPHA) Definition of off-site Medicare certification status Consequence of Medicare decertification Plan for clinical supervision of all non-licensed staff

16 Training presented May Summary of Service Changes Mental health assessment Treatment plan development, review and modification Therapy/counseling Skills training and development

17 Training presented May Summary of Service Changes (cont.) Therapeutic behavioral services Mental health day treatment Mental health intensive outpatient Activity therapy Intensive family-based services

18 Training presented May Changes to Mental Health Assessment ( a) Client preferences Name and contact information for primary care physician Completion within 30 days of first face-to- face contact Annual update MHAs must be updated by 6/30/08 Medical necessity documentation

19 Training presented May Changes to Treatment Plan Development, Review and Modification ( c) Progress note if no client signature Frequency of services – included by 9/30/07 Six month review includes review of goals for continuing care with client or guardian Must be updated by 9/30/07 – may be done with a signed and dated modification Before providing new services – must be in ITP

20 Training presented May Changes to Therapy/Counseling ( e) Strengthen definition to distinguish focus on psychodynamic approach as opposed to skills development that is community support or psychosocial rehabilitation Examples of therapy/counseling: – Cognitive behavioral therapy – Functional family therapy – Motivational enhancement therapy – Trauma counseling – Anger management – Sexual offender treatment

21 Training presented May Skills Training and Development Service components now part of community support services and psychosocial rehabilitation Service name deleted and will not be paid for if delivered beginning 7/1/2007 Automatically certified to provide community support individual and group effective 7/1/2007

22 Training presented May Therapeutic Behavioral Services Service components now part of community support services and psychosocial rehabilitation Service name deleted and will not be paid for if delivered beginning 7/1/2007 Automatically certified to provide community support individual and group effective 7/1/2007

23 Training presented May Mental Health Day Treatment Service no longer in treatment taxonomy Service name deleted and will not be paid for if delivered beginning 7/1/2007 Providers encouraged to become certified to provide psychosocial rehabilitation and community support (individual & group)

24 Training presented May Activity Therapy Service no longer in treatment taxonomy Service name deleted and will not be paid for if delivered beginning 7/1/2007 Providers encouraged to become certified to provide community support (individual & group)

25 Training presented May Intensive Family- Based Services Service no longer in Medicaid state plan or treatment taxonomy Service name deleted and will not be paid for if delivered on or after July 1, 2007 Activities provided under this service may be billable as other rule 132 services

26 Training presented May Changes to Mental Health Intensive Outpatient ( l) May be provided to clients at risk of hospitalization

27 Training presented May Questions

28 Training presented May New or Substantially Changed Services Case Management – Mental Health Community support – individual Community support – group Community support – residential Community support – team Assertive community treatment Psychosocial rehabilitation

29 Training presented May Unless otherwise specified, providers must apply for certification of all new and substantially changed services, with the exception of case management, in order to provide them effective 7/1/2007.

30 Training presented May Changes to Case Management Services ( ) Definition narrowed – active intervention components moved to community support Case management: Identifies resource needs Facilitates access/linkage Advocates Coordinates Does not include provision of rehabilitation services

31 Training presented May Changes to Case Management (cont.) Case management may be provided for 30 days immediately preceding completion of the mental health assessment Includes administering of LOCUS – DHS only

32 Training presented May Case Management (cont.) Case management vs. Community support: – Case management does for the client – Community support teaches the client how to do for self

33 Training presented May Community Support Necessary mental health rehabilitation intervention and supports: – To build capacity with the person to achieve their self- identified rehabilitative, resiliency and recovery goals – Designed to meet the following types of treatment support needs of the person: EducationalVocational ResidentialMental health Co-Occurring DisordersFinancial SocialOthers

34 Training presented May Community Support – Individual ( f) Provided face-to-face, by telephone or video conference At least 60% delivered in natural settings Delivered by at least RSA Not provided to clients receiving community support team or assertive community treatment except during transition If now certified for skills training and development or therapeutic behavioral services – will be automatically certified for community support individual

35 Training presented May Community Support – Group ( g) Provided face-to-face in group settings ranging in size from 2 to 15 At least 60% delivered in natural settings Delivered by at least RSA Not provided to clients receiving assertive community treatment except during transition If now certified for skills training and development or therapeutic behavioral services – will be automatically certified for community support group

36 Training presented May Community Support – Residential ( h) Provided face-to-face, by telephone or video conference in group or individual settings Provided only to clients in public payer designated residential settings This services must be provided in the residential setting Services in other settings may be billable, but not as CSR Delivered by at least RSA

37 Training presented May Community Support – Residential (cont.) If now certified for skills training and development or therapeutic behavioral services and have CILA (620), supervised residential (830) or crisis residential (860) – will be automatically certified for community support residential If now certified for therapeutic behavioral services and comprehensive services – will be automatically certified for community support residential

38 Training presented May Community Support – Team ( i) Provided face-to-face, by telephone or video conference to client or family member At least 60% delivered in natural settings Client-to-staff ratio - 18 to 1 in program not in any specific group No group rate – participation in group activities may be community support group More than one staff member of the team engaged in direct service to client

39 Training presented May Community Support – Team (cont.) Client must meet at least three eligibility criteria in i)4) Delivered by a team of no fewer than 3 staff: team leader who is a QMHP & two other staff of which one is preferably someone in recovery Service must be provided and billed only by one of the clients team members at any given time Not provided to clients receiving assertive community treatment or community support individual except during transition

40 Training presented May Questions

41 Training presented May Assertive Community Treatment ( j) Definition ACT services must be prior authorized Provided face-to-face, by telephone or video conference 75% of service provided out of office Clients 18 or older Not provided in combination with other 132 services except: – During transition to another level of care – To client in Crisis residential

42 Training presented May Assertive Community Treatment (cont.) Crisis services for clients in ACT must be provided by ACT team Client in ACT cannot receive services from any staff outside ACT team except during transition Available 24 hours/day, 7 days/week

43 Training presented May Assertive Community Treatment (cont.) Provided by at least 6 person interdisciplinary team led by licensed clinician Team must include psychiatrist, nurse, program assistant and staff: – With special training & certification in substance abuse treatment and/or co-occurring mental health and substance abuse disorders – In recovery – With special training in rehabilitation counseling

44 Training presented May Assertive Community Treatment (cont.) Team shall include a total complement of members; if any team member resigns or is on leave, the team will be considered incomplete if the team member is not replaced within 31 days If team is not complete on the 32 nd day: – Other services may be provided to the client per her/his ITP – Bills for ACT will not be acceptable

45 Training presented May Planning for New Assertive Community Treatment By 6/30/07 providers must declare intent to convert to evidenced-based ACT & projected date for recertification (no later than 9/30/07) New clients entering effective 7/1/07 must meet new requirements ACT must be re-certified and services must be authorized as meeting new requirements

46 Training presented May Converting an Assertive Community Treatment Team By 6/30/07 providers must declare intent to convert existing team to another service (conversion must be no later than 9/30/07) No new clients will be added to existing teams who plan to convert to another service(s) Between 7/1/07 and the conversion date, provider may bill at current ACT rate

47 Training presented May Other ACT Conversion Issues Region offices will create register of existing ACT clients prior to 6/30/07 Region offices will authorize ACT services compliant with new rule BALC will recertify ACT when compliant with new rule Current rates will apply to service provided prior to recertification date

48 Training presented May Questions

49 Training presented May Psychosocial Rehabilitation ( k) Definition Clients 18 or older Facility based – no off-site billing Available at least 25 hours/week at least 4 days/week Adjunct service to community support All providers certified for PSR must also be certified for community support

50 Training presented May Psychosocial Rehabilitation (cont.) Program director must be at least QMHP Delivered by at least an RSA Staff to client ratio shall not exceed 1 to 15 May not be provided in combination with assertive community treatment (except during transition to ACT), intensive outpatient or hospital-based psychiatric services type A Document each session of service

51 Training presented May Questions

52 Training presented May Vocational Engagement Definition Provided face to face, by telephone or video conference in individual or group settings Minimal staff requirement – RSA Provided to adults and adolescents age 14 & over Goal for employment or preparation for employment must be on ITP Does not include provider-based pre-vocational programs or educational programs that do not result in credentials recognized by an employer Activities related to employment that may be viewed in terms of the clients broader rehabilitative or social functioning skills & are not job specific should be expressed in those terms and billed as Medicaid- covered services

53 Training presented May Vocational Assessment Definition Provided face to face, by telephone or video conference Minimal staff requirement – RSA Provided to adults and adolescents age 14 & over Clients vocational goals should be integrated in the treatment plan Does not include pre-vocational work experiences or simulated/situational work experiences at the providers site

54 Training presented May Job Finding Supports Definition Provided face to face, by telephone or video conference in individual or group settings At least 40% delivered in natural settings Minimal staff requirement – RSA Provided to adults and adolescents age 14 & over This does not include general job development

55 Training presented May Job Retention Supports Definition Provided face to face, by telephone or video conference in individual or group settings At least 40% delivered in natural settings Minimal staff requirement – RSA Provided to adults and adolescents age 14 & over Interventions must be specific to work and the job Therapeutic supports to help individuals manage symptoms as they work toward achieving recovery goals should be distinguished from this service

56 Training presented May Job Leaving/Termination Supports Definition Provided face to face, by telephone or video conference in individual or group settings Minimal staff requirement – RSA Provided to adults and adolescents age 14 & over Job loss is not a reason to discontinue participation in supported employment

57 Training presented May Outreach and Engagement & Stakeholder Education

58 Training presented May Outreach and Engagement & Stakeholder Education No prior authorization needed Funded with state dollars only No new contract dollars involved Target adults, children or SASS Not for PATH or federally funded projects Limited to 1% of contract billable total Billing beyond 1% with written approval from region office

59 Training presented May Outreach and Engagement Definition Provided face to face, by telephone or video conference in individual or group settings Minimal staff requirement – RSA 75% out of office Service go to reach people with SMI/SMD on streets, in shelters, in jail or prison, or isolated due to refugee status, language, cultural, social barriers Staff Dyad can be used for offsite activity

60 Training presented May Stakeholder Education Definition Provided face-to-face or by video conference to individual to groups Minimal staff requirement – RSA Service goal to support collaboration between DMH providers and community stakeholders, fight stigma and promote innovative access strategies Staff Dyad permitted when second staff person in person in recovery Must be delivered in prepared event/session

61 Training presented May Questions


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