Mental Health Support Services (MHSS) Department of Medical Assistance Services Mental Health Support Services (MHSS) H0046 2013 www.dmas.virginia.gov 1

Department of Medical Assistance Services Disclaimer These slides contain only highlights of the Virginia Medicaid Community Mental Health Rehabilitative Services Manual (CHMRS) and are not meant to substitute for the comprehensive information available in the manual or state and federal regulations. *Please refer to the manual, available on the DMAS website portal, for in-depth information on Community Mental Health Rehabilitative Services criteria. Providers are responsible for adhering to related state and federal regulations. www.vita.virginia.gov www.dmas.virginia.gov 2

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Objectives of this Training Are: To define the criteria of Mental Health Support Services To identify staff qualifications; To clarify eligibility criteria; To identify required activities; To review limitations of the service; To outline service units and reimbursement; and To review service authorization requirements. www.vita.virginia.gov www.dmas.virginia.gov 3

MHSS Service Definition Department of Medical Assistance Services MHSS Service Definition H0046 www.dmas.virginia.gov 4

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Mental Health Support Services (MHSS) are training and supports to enable individuals with significant psychiatric functional limitations to achieve and maintain community stability and independence in the most appropriate, least restrictive environment. This is not a substitute for mental health counseling or psychotherapy. This service is to provide training in or reinforcement of functional skills and appropriate behavior related to the individual’s health and safety, ADLs, and use of community resources; assistance with medication management, and monitoring health, nutrition and physical condition. www.vita.virginia.gov www.dmas.virginia.gov 5

MHSS Licensing Department of Medical Assistance Services H0046 www.dmas.virginia.gov 6

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Mental Health Support Services providers must be licensed by the Department of Behavioral Health and Developmental Services (DBHDS) as a provider of Supportive In-Home Services, Intensive Community Treatment, or as a Program of Assertive Community Treatment. www.vita.virginia.gov www.dmas.virginia.gov 7

MHSS Staff Qualifications Department of Medical Assistance Services MHSS Staff Qualifications H0046 www.dmas.virginia.gov 8

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Providers of MHSS must be a: Licensed Mental Health Professional (LMHP) or LMHP Supervisee or Resident Qualified Mental Health Professional-Adult (QMHP-A) or QMHP-Eligible (QMHP-E) Qualified Paraprofessional (QPP) * Qualification definitions may be found in Chapter II of the CMHRS Manual www.vita.virginia.gov www.dmas.virginia.gov 9

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS The LMHP, LMHP Supervisee or Resident or QMHP will supervise the care if delivered by the qualified paraprofessional. Paraprofessionals, who do not meet the experience requirement may provide services for Medicaid reimbursement if they are working directly with a qualified paraprofessional on-site and supervised by a QMHP, LMHP or LMHP Supervisee or Resident. www.vita.virginia.gov www.dmas.virginia.gov 10

MHSS Eligibility Criteria Department of Medical Assistance Services MHSS Eligibility Criteria H0046 www.dmas.virginia.gov 11

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS For individuals up to age 21 Effective July 18, 2011, an Independent Clinical Assessment must be conducted by the CSB/BHA prior to the authorization of new requests for MHSS services. New services are defined as services for which the individual has been discharged from or never received prior to July 17, 2011. Upon discharge from Level A, B or C residential care facility or psychiatric hospitalizaiton, the Independent Clinical Assessment will not be required for the first 30 days post discharge. The Independent Clinical Assessment will be required for any subsequent reauthorization. www.vita.virginia.gov www.dmas.virginia.gov 12

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Individuals qualifying for this service must demonstrate a clinical need for the service due to mental, behavioral, or emotional illness that results in significant functional impairments in major life activities. Services are provided to individuals who without these services would be unable to remain in the community. Individuals must meet at least two of the following criteria on a continuing or intermittent basis: Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of psychiatric hospitalization, homelessness, or isolation from social supports. www.vita.virginia.gov www.dmas.virginia.gov 13

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Exhibit such inappropriate behavior that repeated interventions by the mental health, social services, or judicial system are necessary. Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or recognize significantly inappropriate social behavior. Require help in basic living skills, such as maintaining personal hygiene, preparing food and maintaining adequate nutrition, or managing finances to such a degree that health or safety is jeopardized. www.vita.virginia.gov www.dmas.virginia.gov 14

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Individuals eligible for this service may have a dual diagnosis of either mental illness and intellectual disability or mental illness and substance abuse disorder. If an individual has co-occurring mental health and substance abuse disorders, integrated treatment for both disorders is allowed within Mental Health Support Services as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition. The impact of the substance abuse condition on the mental health condition must be documented in the service specific provider assessment, the ISP, and the progress notes. www.vita.virginia.gov www.dmas.virginia.gov 15

MHSS Required Activities Department of Medical Assistance Services MHSS Required Activities H0046 www.dmas.virginia.gov 16

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS For individuals up to age 21 The provider must maintain a copy of the entire Independent Clinical Assessment in each individual’s file. After the Independent Clinical Assessment and prior to admission, a face-to-face service-specific provider assessment must be conducted and documented. The service-specific provider assessment must not be completed more than 30 days prior to the initiation of services. www.vita.virginia.gov www.dmas.virginia.gov 17

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS For all individuals receiving MHSS The initial service-specific provider assessment must be done face-to-face by an LMHP or LMHP Supervisee or Resident. The service-specific provider assessment must not be completed more than 30 days prior to the initiation of services. Continuation of services may be approved at six-month intervals following a face-to-face reassessment conducted by an LMHP or LMHP Supervisee or Resident that documents the need for the continuation of services. www.vita.virginia.gov www.dmas.virginia.gov 18

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS A new service specific-provider assessment is also required following any break in service greater than 30 days or if the case is closed and re-opened. This service is to provide training in or reinforcement of functional skills and appropriate behavior related to the individual’s health and safety, ADLs, and use of community resources; assistance with medication management, and monitoring health, nutrition and physical condition. An Individual Service Plan (ISP) developed by at least a QMHP must be fully completed within 30 days of the initiation of services and indicate the specific supports and services to be provided and the goals and objectives to be accomplished. www.vita.virginia.gov www.dmas.virginia.gov 19

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Every three months, the LMHP, LMHP Supervisee or Resident, QMHP-A or QMHP-E must review, modify as appropriate, and update the ISP. If the QMHP-A or QMHP-E reviews the ISP it must be discussed face-to-face with the LMHP or LMHP Supervisee or Resident. Such reviews must be documented in the individual service record. The ISP must be rewritten at least annually. www.vita.virginia.gov www.dmas.virginia.gov 20

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Only direct face-to-face contacts and services to the individual are reimbursable. Individuals employed or contracted to provide mental health support services must have training in the characteristics of mental illness and appropriate interventions, training strategies, and support methods for persons with mental illness and functional limitations. An LMHP, LMHP Supervisee or Resident, QMHP-A, or QMHP-E must supervise the care of services if delivered by a qualified paraprofessional. www.vita.virginia.gov www.dmas.virginia.gov 21

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Minimally, documentation and description of services through a daily log of the time as well as a weekly summary note is required. If the individual is receiving case management there must be coordination with the case management agency. The service provider must notify the primary care provider of the individual’s receipt of this community mental health rehabilitative service. www.vita.virginia.gov www.dmas.virginia.gov 22

MHSS Limitations and Supervision Department of Medical Assistance Services MHSS Limitations and Supervision H0046 www.dmas.virginia.gov 23

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Any services provided to the individual that are strictly academic in natures will not be reimbursed. These include, but are not limited to, such basic educational programs as instruction in reading, science, math, or GED prep. Any services provided to individuals that are strictly vocational in natures will not be reimbursed. However, support activities and activities directly related to assisting an individual to cope with a mental illness to the degree necessary to develop appropriate behaviors for operating in an overall work environment will be billable. www.vita.virginia.gov www.dmas.virginia.gov 24

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Room and board, custodial care, and general supervision are not components of this service. This service is not billable for individuals who reside in facilitates where staff are expected to provide such services under the facilities licensure requirements. Staff travel time is excluded. www.vita.virginia.gov www.dmas.virginia.gov 25

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Supervision of a qualified paraprofessional by the QMHP, LMHP, or LMHP Supervisee or Resident is demonstrated by a review of progress notes, the individual’s progress toward achieving ISP goals and objectives, and recommendations for change based on the individual’s status. Supervision must occur monthly and documentation of this occurrence must be in the individual’s clinical record and signed by the QMHP, LMHP, or LMHP Supervisee or Resident. Individual, group, or a combination of the individual and group supervision conducted by the QMHP, LMHP or LMHP Supervisee or Resident with the paraprofessional is acceptable. www.vita.virginia.gov www.dmas.virginia.gov 26

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Paraprofessionals who do not meet the experience requirements listed in Ch. II of the Community Mental Health Rehabilitative Service Manual may provide services for Medicaid reimbursement if they are working directly with a qualified paraprofessional on-site and supervised by a QMHP, LMHP, or LMHP Supervisee or Resident. Supervision must include on-site observation, face-to-face consultation, a review of progress notes, the individual’s progress toward achieving ISP goals and objectives, and recommendations for change based on the individual’s status. Supervision must occur and be documented in the clinical record at least monthly. www.vita.virginia.gov www.dmas.virginia.gov 27

MHSS Units and Reimbursement Department of Medical Assistance Services MHSS Units and Reimbursement H0046 www.dmas.virginia.gov 28

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Mental Health Support Services (H0046) requires service authorization before any services (beyond the service- specific provider assessment) are reimbursed. The service limit for service-specific provider assessments is 2 per provider per individual per fiscal year. This allows each provider to bill 2 service specific-provider assessments for each individual from July 1 – June 30 of every year. The service-specific provider assessment code (H0032, modifier U8) must be billed before the service treatment (H0046) will pay in the Medicaid Management of Information System (MMIS) claims system. www.vita.virginia.gov www.dmas.virginia.gov 29

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS For individuals new to service and under the age of 21 the provider’s service-specific provider assessment must not occur prior to the Independent Clinical Assessment or there will be post payment retractions. The unit of service for MHSS are: One unit = 1 to 2.99 hours per day Two units = 3 to 4.99 hours per day Three units = 5 to 6.99 hours per day Four units = 7+ hours per day Time may be accumulated to reach a billable unit. Service delivery time must be added consecutively to reach a billable unit of service. www.vita.virginia.gov www.dmas.virginia.gov 30

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS A maximum of 372 units of Mental Health Support Services may be authorized annually with coverage under the State Plan Option. The MMIS claims payment system will stop payment for State Plan Option Services when claims exceed the 372 units of service limit allowed in the regulations. • The annual treatment (fiscal) year for all individuals is defined as the period July 1 through the following June 30. Each July 1 all service limits will be set to zero. www.vita.virginia.gov www.dmas.virginia.gov 31

MHSS Service Authorization Department of Medical Assistance Services MHSS Service Authorization H0046 www.dmas.virginia.gov 32

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS KePRO is the DMAS contractor for Service Authorization (SA). For questions go to the SA website: DMAS.KePRO.org and click on Virginia Medicaid Phone: 1-888-VAPAUTH or 1-888-827-2884 Fax: 1-877-OKBYFAX or 1-877-652-9329 Web: ProviderIssues@KePRO.com www.vita.virginia.gov www.dmas.virginia.gov 33

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Submitting a request The preferred method is through the Atrezzo® web-based program Registration is required Information on Atrezzo is available on the KePRO website, or call 1-888-827-2884 or (804) 622-8900 or mail to: KePro 2810 North Parham Rd, Suite 305 Henrico, Virginia 23294 www.vita.virginia.gov www.dmas.virginia.gov 34

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Initial review is required to be submitted to the SA contractor at admission. Continued stay reviews are required to be submitted to the SA contractor prior to, however not more than 30 days before, the end of the current approval. Clinical information is needed from the provider for review for medical necessity criteria. A checklist for both the initial and continued stay review is located at dmas.kepro.org. Requests are authorized for up to 6 months at one time. www.vita.virginia.gov www.dmas.virginia.gov 35

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS For Individuals under age 21 In addition to information required for all MHSS authorization requests, providers must also indicate the following information: Whether an Independent Clinical Assessment (ICA) was completed through the CSB/BHA The date of the assessment The name of the CSB/BHA that completed the ICA What services were recommended by the ICA Whether the member has been discharged from a Level A, B, or C facility or psychiatric hospitalization within the past 30 days and the date of discharge.** ** Juvenile Detention is NOT a Level A, B, or C facility. www.vita.virginia.gov www.dmas.virginia.gov 36

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS All Service Authorization Requests should include: Provider name and contact information A DSM diagnosis (V codes are not acceptable as stand alone diagnosis); If there is a dual diagnosis of mental health and substance abuse, services must be integrated; A description of symptoms/severity of illness; and Documentation of clinical necessity for the service with specific examples of how the individual meets each of the eligibility criteria due to their mental health symptoms. www.vita.virginia.gov www.dmas.virginia.gov 37

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS For continued stay submissions, examples of clinical necessity must document how the individual continues to meet the medical necessity (eligibility) criteria due to their mental health symptoms. For individuals under age 21 that did not require an ICA, due to residential placement discharge, for the initial review indicate that an ICA was completed and the date of the assessment. Use of the KePRO checklist helps to ensure that all required information is submitted and expedites review by reducing the need for requests to be pended for additional information. www.vita.virginia.gov www.dmas.virginia.gov 38

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Helpful Resources: 12VAC30-50-226 - Emergency Regulations for Community Mental Health Services Virginia Medicaid Web Portal link www.virginiamedicaid.dmas.virginia.gov DMAS Office of Behavioral Health: Email Address CMHRS@dmas.virginia.gov DMAS Helpline: 804-786-6273 Richmond Area 1-800-552-8627 All other www.vita.virginia.gov www.dmas.virginia.gov 39

Mental Health Support Services - MHSS Department of Medical Assistance Services Mental Health Support Services - MHSS Thank you for attending this training and helping to serve Virginia’s Medicaid Recipients. www.vita.virginia.gov www.dmas.virginia.gov 40