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Rule 132 Medicaid Community Mental Health Service Program

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Presentation on theme: "Rule 132 Medicaid Community Mental Health Service Program"— Presentation transcript:

1 Rule 132 Medicaid Community Mental Health Service Program
Training presented May 2007

2 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 Training presented May 2007

3 Underlying Vision of Recovery and Resilience
Fundamental components and role of services in supporting recovery and resilience can be found at Training presented May 2007

4 Training presented May 2007
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 Training presented May 2007

5 Handouts and Reference Materials
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 Training presented May 2007

6 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 Training presented May 2007

7 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 Training presented May 2007

8 Training presented May 2007
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 Training presented May 2007

9 Training presented May 2007
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 Training presented May 2007

10 Topics for future and separate discussions
DCFS specific transition DHS/DMH contract requirements Training presented May 2007

11 Rates, Billing and Coding Changes
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 Training presented May 2007

12 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 Training presented May 2007

13 Rates, Billing and Coding Changes (cont.)
DHS activity codes and HIPAA standard procedure codes are in the Services Definition and Reimbursement Guide (www.dhs.state.il.us/revisedRule132/) Each state agency has more specific instructions on billing and payment to be addressed in later training Training presented May 2007

14 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 Training presented May 2007

15 Training presented May 2007
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 Training presented May 2007

16 Summary of Service Changes
Mental health assessment Treatment plan development, review and modification Therapy/counseling Skills training and development Training presented May 2007

17 Summary of Service Changes (cont.)
Therapeutic behavioral services Mental health day treatment Mental health intensive outpatient Activity therapy Intensive family-based services Training presented May 2007

18 Changes to Mental Health Assessment (132.148a)
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 Training presented May 2007

19 Training presented May 2007
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 Training presented May 2007

20 Changes to Therapy/Counseling (132.150e)
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 Training presented May 2007

21 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 Training presented May 2007

22 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 Training presented May 2007

23 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) Training presented May 2007

24 Training presented May 2007
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) Training presented May 2007

25 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 Training presented May 2007

26 Changes to Mental Health Intensive Outpatient (132.150l)
May be provided to clients at risk of hospitalization Training presented May 2007

27 Training presented May 2007
Questions Training presented May 2007

28 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 Training presented May 2007

29 Training presented May 2007
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. Training presented May 2007

30 Changes to Case Management Services (132.165)
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 Training presented May 2007

31 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 Training presented May 2007

32 Case Management (cont.)
Case management vs. Community support: Case management does for the client Community support teaches the client how to do for self Training presented May 2007

33 Training presented May 2007
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: Educational Vocational Residential Mental health Co-Occurring Disorders Financial Social Others Training presented May 2007

34 Community Support – Individual (132.150f)
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 Training presented May 2007

35 Community Support – Group (132.150g)
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 Training presented May 2007

36 Community Support – Residential (132.150h)
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 Training presented May 2007

37 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 Training presented May 2007

38 Community Support – Team (132.150i)
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 Training presented May 2007

39 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 client’s team members at any given time Not provided to clients receiving assertive community treatment or community support individual except during transition Training presented May 2007

40 Training presented May 2007
Questions Training presented May 2007

41 Assertive Community Treatment (132.150j)
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 Training presented May 2007

42 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 Training presented May 2007

43 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 Training presented May 2007

44 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 32nd day: Other services may be provided to the client per her/his ITP Bills for ACT will not be acceptable Training presented May 2007

45 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 Training presented May 2007

46 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 Training presented May 2007

47 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 Training presented May 2007

48 Training presented May 2007
Questions Training presented May 2007

49 Psychosocial Rehabilitation (132.150k)
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 Training presented May 2007

50 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 Training presented May 2007

51 Training presented May 2007
Questions Training presented May 2007

52 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 client’s broader rehabilitative or social functioning skills & are not job specific should be expressed in those terms and billed as Medicaid-covered services Training presented May 2007

53 Vocational Assessment
Definition Provided face to face, by telephone or video conference Minimal staff requirement – RSA Provided to adults and adolescents age 14 & over Client’s vocational goals should be integrated in the treatment plan Does not include pre-vocational work experiences or simulated/situational work experiences at the provider’s site Training presented May 2007

54 Training presented May 2007
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 Training presented May 2007

55 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 Training presented May 2007

56 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 Training presented May 2007

57 Outreach and Engagement & Stakeholder Education
Training presented May 2007

58 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 Training presented May 2007

59 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 Training presented May 2007

60 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 Training presented May 2007

61 Training presented May 2007
Questions Training presented May 2007


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