1. DHCS CSI and DCR Data Quality Improvement Project Mode 05 Services
Mental Health Data Alliance, LLC
(MHData)
March 8, 2018

2. Project Goals
Support the ability to submit good data to the current state CSI and DCR mental health data systems
Close the feedback loop for counties to validate that they have good data in the CSI and DCR state mental health data systems
Improve the value of state CSI and DCR mental health data systems for counties, the state and stakeholders

3. Approach
Over 1.5 years:
Provided counties with 2 reports which provide an overview of current data and errors for CSI and DCR
Met with counties to review reports and identify potential causes of data patterns and inconsistencies
Work with counties and DHCS to improve processes to submit data to DCR and CSI
Provide counties with 2 reports which provide an overview of improved data for CSI and DCR

4. Mode 05 Services 24 Hour Services: Adult Crisis Residential
Adult Residential
Hospital Administrative Day
Hospital Inpatient
IMD Basic (No Patch)
IMD With Patch
Independent Living
Jail Inpatient
Mental Health Rehab Center
Psychiatric Health Facility (PHF)
Residential – Other
SNF Intensive
Semi-Supervised Living

5. Who had CSI issues with Mode 05 Services?

6. General Mode 05 Issues in CSI
Issues with Mode 05 service reporting are common.
Many submitting entities have challenges with reporting or understanding their Mode 05 services. There were 111 Mode 05 related issues for 50 of 58 counties identified for further research. Some of these issues relate to out‐of‐county services. Submitting entities are not able to retrieve data from CSI on services provided which are submitted to CSI from out‐of‐county. In the next phase, this project will produce a supplemental out‐of‐county service report. Additional Mode 05 issues relate to barriers in EHRs to set up Mode 05 services for reporting, as well as in‐county Mode 05 services which are reported directly to the state for Medi‐Cal billing and never captured in the submitting entities EHR, rendering such services unavailable for reporting to CSI.
Mode 05 dates overlap
Several submitting entities experienced an error that Mode 05 service dates in record overlapped with a previous record. Overlapping dates can occur when a client is discharged from one Mode 05 facility and admitted to another on the same day. Submitting entities are requesting further instruction from DHCS with regard to reporting data in these circumstances.
Anasazi holds all Mode 05 records in suspension when a client is discharged from one facility and admitted to another on the same day as this causes a CSI error with regard to overlapping dates of Mode 05 service.

7. General Mode 05 Issues in CSI
Providers not Set up in Provider file for that service.
Many Mode 05 fatal errors occur when provider is not set up in Provider File to report those services
When billing is behind CSI reporting, the services may never get reported.
Some providers have trouble reporting services to county.
Some reports from providers to the county must be entered manually into the EHR by county staff, and this requires process monitoring and staff training.
Some provider bill the state directly and don’t report service detail to county (just length of placement)
Some Mode 05 services are stored in a system separate from the CSI reporting EHR and therefore cannot be included in the CSI data extract from the EHR.
Better definitions are needed for the categories of services which are coded and reported to CSI.

8. General Mode 05 Issues in CSI
The Services are in the EHR, but they are not set up to report to CSI.
Some Mode 05 services are not reported to CSI by counties because they are not billed to Medi-Cal, and assumed to be non-reportable overall
All services provided by the county which fit into the CSI types of services are required to be reported to CSI, regardless of funding stream.
The Data Quality Report does not show services provided out of county.
Many Mode 05 services are provided out of county, and the initial report only included services reported by the serving county.
A supplemental report for out of county services has been created and will be released shortly to counties.

9. Who had Mode 05 Services provided Out-of-County (OOC)?

10. Out-of-County (OOC) Supplemental Report

11. Who Served my OOC Clients?

12. Specific Mode 05 Issues Alameda
Mode 05 Hospital Administrative Day sometimes has 0 values and large variability to low numbers some months.
Mode 05 IMDs reported in CSI are likely lower than actually served. There was a drop in clients in July 2009.
Amador
Mode 05 Hospital Inpatient numbers were low for FY 2015/16, with no data after April after Monthly counts seem low. Might have been behind in billing.
Calaveras
Mode 05 Hospital Inpatient numbers were low. Perhaps the non-billing units and subunits are not being reported to CSI.
Mode 05 IMDs should have data and has never been reported but should have been.
Mode 05 Mental Health Rehab Center has never been reported but should have been.
Mode 05 Psychiatric Health Facility service unit numbers were low as some months had no days of PHF services.

13. Specific Mode 05 Issues Contra Costa Mode 05 IMD clients are low.
Mode 05 SNF Intensive clients dropped significantly in July of 2011.
El Dorado
For Mode 05 PHF, there was a dip in clients between August and December of There may have been a switch in the PHF admission process because of a switch in providers to Telecare.
Fresno
Mode 05 Adult Crisis Residential stopped being reported with the switch to NetSmart Avatar in 2009, even though these services are still provided. Not set up to report as a CSI service in EHR.
Mode 05 IMDs stopped being reported with the switch to NetSmart Avatar in 2009, even though these services are still provided. Not set up to report as a CSI service in EHR.
Mode 05 Mental Health Rehab Center stopped being reported with the switch to NetSmart Avatar in 2009, even though these services are still provided. Not set up to report as a CSI service in EHR.
Mode 05 SNF Intensive stopped being reported with the switch to NetSmart Avatar in 2009, even though these services are still provided. Not set up to report as a CSI service in EHR.

14. Specific Mode 05 Issues Inyo Kern Humboldt
Some Mode 05 services (Hospital Inpatient, IMD, MHRC, and SNF Intensive) have high level of fatal errors. Mode 05 service dates in record overlap with previous record.
Imperial
Mode 05 IMD records are experiencing high rates of fatal errors.
Inyo
Mode 05 IMDs have a large proportion of errors in FY 2015/16. Possibly related to date of service out of range with the provider start and end date in the provider system.
Kern
Mode 05 Hospital Inpatient services have high level of fatal errors in FY 2015/16. Mode 05 service dates in record overlap with previous record.
There is a dip in clients for Mode 05 Hospital Inpatient in November of 2016 and other earlier months. One potential issue is that Cerner Anasazi suspends records when a client is discharged and readmitted on the same day because rule 520 in the CSI will cause a fatal error. This happens when clients are moved between hospitals or subunits. The vendor believes that this rule is a CSI issue.

15. Specific Mode 05 Issues Kings Lake Lassen Los Angeles
The Mode 05 Mental Health Rehab Center service pattern has many months of no data in certain years.
For Mode 05 PHF, there are clients place out-of-county which are not showing in the report.
Lake
Mode 05 Hospital Inpatient represent only about 1/5 in FY 2009/10 of clients likely due to the Cerner Anasazi issue related to the "single contact".
Some Mode 05 services (Hospital Inpatient, IMD, MHRC, and SNF Intensive) are being suspended by EHR because they would otherwise cause a fatal error in CSI. Cerner Anasazi suspends records when a client is discharged and readmitted on the same day because rule 520 in the CSI will cause a fatal error. This happens when clients are moved between hospitals or subunits. The vendor believes that this rule is a CSI issue.
Lassen
Lassen County has never reported Mode 05 services. Mode 05 services are not set up in EHR (Echo) to report, and all Mode 05 clients are sent out-of-county.
Los Angeles
Mode 05 IMDs, MHRCs and SNFs have not been reported since FY 2008/09. Mode 05 Adult Crisis Residential, Adult Residential, Hospital Administrative Day, Hospital Inpatient, Jail Inpatient, PHF, Residential - Other , Semi-Supervised Living services experience variability.

16. Specific Mode 05 Issues Madera Marin Mariposa
Mode 05 Hospital Inpatient data has not been submitted since FY 2013/14. The services are not being reported accurately.
Mode 05 IMDs is not being reported. The services are not being reported accurately.
Mode 05 Mental Health Rehab Center clients are low. These services are not being reported accurately.
Mode 05 PHF clients are low. These services are not being reported accurately.
Marin
Mode 05 Adult Residential services have not been reported since FY 2004/05, although they are still provided.
Mode 05 Hospital Inpatient services units drop in FY 2014/15 and forward.
Mode 05 IMDs have not been reported on recently.
Mode 05 Independent Living dropped with the switch to Echo ShareCare in FY 2010/11.
Mariposa
Mode 05 IMDs are being used out-of-county but not showing on report. Project will supply a supplemental report for out-of-county services.

17. Specific Mode 05 Issues Mendocino Merced Mono Monterey Napa
Mode 05 PHF are being used but not showing on report. PHF clients dropped in FY 2008/09 and declined forward. Reviewing our historical data shows some Providers used with Mode 05 were not in our Provider file.
Merced
One third of Mode 05 Mental Health Rehab Center service records have unresolved fatal errors in FY 2013/14 through FY 2015/16. The fatal error codes were likely that the service function was not in the Provider File.
Mode 05 PHF was not reported as delivered for a period after the switch to Cerner Anasazi from July 2010 through April These services were not set up to report in Cerner Anasazi at first.
Mono
There are no Mode 05 Services showing for Mono, which are all out-of-county.
Monterey
Mode 05 Services were not being reported regularly since the switch to NetSmart Avatar. It could be because there is a treatment registry setting in the EHR such that a program must be set up as 'outpatient' In order to be reported as inpatient.
Napa
Mode 05 Hospital Inpatient dropped by more than half in FY 2015/16.There is a strange pattern that year: in July of 2015, the clients drop to 0 and then jump to 17 in September and then back to 0 in October.

18. Specific Mode 05 Issues Nevada Orange Placer
Mode 05 Hospital Inpatient are sent out-of-county.
Orange
For Mode 05 Adult Residential, there was a down month of days in July of 2016.
Mode 05 Hospital Inpatient there was a dramatic reduction in reported clients starting in September of 2015 forward. One of the providers is having trouble entering their service information into the system.
Mode 05 Residential - Other represents Children's Crisis Residential and clients appear to have dropped unexpectedly in FY 2015/16. There was a down month in December of 2016 where there were only about half clients. There was an increase in days of this service despite the drop in clients. The county increased beds.
Placer
Mode 05 Adult Crisis Residential is showing a strange pattern in that monthly clients drop to single digits or to 0 some months. There was an old provider that had difficulty reporting data, and we have since switched to a new provider.
Mode 05 Hospital Inpatient, provided by Telecare, are not being reported to CSI. Many Mode 05 services are not being reported to CSI. Many inpatient services go into TARS and not in Avatar, which are not reported to CSI. If information is in Avatar, they are stored as non-reportable because they are not billed to Medi-Cal.

19. Specific Mode 05 Issues Plumas Riverside Sacramento San Benito
There have been no Mode 05 Hospital Inpatient Services showing since April of 2014, which are all out-of-county.
There have been no Mode 05 IMD Services showing since November of 2011, which are all out-of-county.
Riverside
Mode 05 Hospital Inpatient clients dropped in FY 2014/15.
Mode 05 IMDs dropped to 0 clients in July and August to Services exist in Riverside's EHR system and are setup to report to CSI.
Mode 05 Residential - Other dropped in clients with the switch to Avatar in June of is likely that some programs or services were not set up in EHR to report to CSI.
Sacramento
Services were no longer reported after switch to NetSmart Avatar on May of There services or programs might not be set up to report in EHR.
San Benito
Mode 05 Hospital Inpatient clients appear lower than expected. There is a lot of variability in units each month, with 0 days being reported for many months.
Not all programs or services are bring reported to CSI. Some may be out-of-county.

20. Specific Mode 05 Issues San Bernardino San Diego
When trying to sent a Mode 05 discharge record, the system gives an error that the system cannot find the associated admission record, even though the county knows that it is there. Report problem to DHCS.
Mode 05 Hospital Inpatient clients dropped from ~350 down to single digits in November 2015 through March of This was likely due to fatal errors or suspended records due to potential errors with the switch to ICD-10.
San Diego
A large proportion of Mode 05 Jail Inpatient and Mode 05 Hospital Administrative Day service records had fatal errors.
Mode 05 Hospital Administrative Day clients declined significantly beginning in July of 2015.
For the Mode 05 IMDs, very few of these services are reported to the CSI. The client numbers dropped in December of These providers bill the state directly, and therefore the county does not collect detail about these services, just the length of placement.
Mode 05 Mental Health Rehab Center clients declined in FY 2014/15 and in FY 2015/16. The reporting is very spotty with 0 reported in some months.
For Mode 05 PHF, very few of these services are reported to the CSI. These providers bill the state directly, and therefore the county does not collect detail about these services, just the length of placement.

21. Specific Mode 05 Issues San Francisco San Joaquin San Luis Obispo
Mode 05 Adult Residential clients dropped with the switch to Avatar. There services or programs might not be set up to report in EHR.
Mode 05 Hospital Administrative Day dropped with the switch to Avatar. There services or programs might not be set up to report in EHR.
Mode 05 Hospital Inpatient dropped with the switch to Avatar. There services or programs might not be set up to report in EHR.
San Joaquin
Mode 05 Mental Health Rehab Center code was no longer reported beginning in FY 2010/11.
Mode 05 PHF client dropped in half beginning in FY 2011/12 forward.
San Luis Obispo
Mode 05 Administrative Days might be missing. Admin days are not claimable for PHF and are not set up to report. However, all services should be set to be reported to CSI.
Mode 05 IMDs stopped being reported with the switch to Anasazi in 2011.
IMDs do not bill through Anasazi, so their service data is not entered into our EHR.
Mode 05 PHF fell with the switch to Anasazi. Units are also declining over time. It could be related to AB109 change or could be related to coding for non-Medi-Cal- billed services not being reported. The current mobile crisis provider diverts a higher percentage of clients or facilitates direct admission to out-of-county facilities.

22. Specific Mode 05 Issues San Mateo Santa Barbara Santa Clara
Mode 05 Hospital Administrative Day clients and units dropped with the switch to Avatar. Unknown why, but Mode 05 Hospital Inpatient days did rise at the same time.
Mode 05 SNF Intensive clients dropped with the switch to Avatar.
Santa Barbara
Mode 05 Adult Crisis Residential stopped being reported after FY 2014/15 and should still be showing.
Mode 05 IMDs are being used out-of-count but not showing on report.
Mode 05 Semi-Supervised Living - County has Room & Board, but unsure if they would be picked up by this code. Better definitions are needed for the categories of services which are coded and reported to CSI. Some of the facilities are community care licensing and are not getting any funding from the county, therefore may not be reported.
Santa Clara
Mode 05 IMDs clients appear to be declining, but unfortunately should be increasing.
Mode 05 Jail Inpatient stopped reporting, but not being reported now. County not sure who was reporting it.
Mode 05 PHF is not being reported regularly. These services might be captured in Epic Healthlink, which does not report to CSI.

23. Specific Mode 05 Issues San Cruz Shasta Sierra Solano
Mode 05 Adult Crisis Residential has unrealistic variation. This is likely related to a setup issue in the EHR.
Mode 05 Adult Residential has unrealistic variation with several years of no clients with a big drop in May of This is likely related to a setup issue in the EHR.
Mode 05 Mental Health Rehab Center has unrealistic variation with several months with no clients. This is likely related to a setup issue in the EHR.
Shasta
Mode 05 IMDs clients have a variable pattern with some months reporting no clients.
Sierra
There are no Mode 05 Services showing for Sierra which are all out-of-county.
Solano
Mode 05 Adult Crisis Residential is no longer reported after the switch to NetSmart Avatar.
EHR was likely not set up to report this service.
Mode 05 IMDs are not showing in the report. County does not know how these would get reported. Service coding groups are poorly defined.
Mode 05 Mental Health Rehab Center services are missing in FY 2013/14 with the switch to NetSmart. The pattern thereafter is unrealistically variable with many months reporting no clients. EHR was likely not set up to report this service accurately.
Mode 05 SNF Intensive services are missing in FY 2013/14 with the switch to NetSmart.

24. Specific Mode 05 Issues Sonoma Stanislaus Sutter-Yuba
Mode 05 Services have not been submitted since FY 2012/13 with the switch to Avatar.
Stanislaus
Most 24-hour services are out-of-county or contracted out and not collected in the county's EHR. These services used to be reported for over a thousand clients and now there are only a hundred or so clients. County does submit information for contracted services. County did confirm that there are two services codes setup incorrectly and causing 200 services to not be submitted to CSI. County will be meeting with our Quality Services Department to ensure these services are setup correctly and that should be submitted to CSI. County also confirmed that there are services on suspense for 777 clients since June of 2016 and will be addressing the issues shortly and submitting.
Sutter-Yuba
Mode 05 Hospital Inpatient clients are reported with a strange pattern with no clients reported in some months. These are out-of-county services and county is unsure of how these are reported from the EHR. Also, there are unresolved fatal errors for this service type.
Mode 05 IMD clients are reported with a strange pattern with no clients reported in some months. These are out-of-county services and county is unsure of how these are reported from the EHR. Also, there are unresolved fatal errors for this service type.
Mode 05 Services are often out-of-county and not showing fully in this report.
Mode 05 SNF Intensive clients and units have a variable pattern with no clients reported some months.

25. Specific Mode 05 Issues Tehama Tri-City Trinity Tulare
There are no Mode 05 Services showing for Tehama which are all out-of-county.
Tri-City
There are no Mode 05 Services showing for Tri-City which are all out-of-county.
Trinity
Some hospitals they use do direct billing to DHCS and others invoice Trinity and we upload the claims. This can cause extreme variation.
Mode 05 Mental Health Rehab Center are used out-of-county, but are not showing on the report.
Tulare
Mode 05 Hospital Inpatient clients drop from over 800 in FY 2013/14 to 25 in FY 2014/15. It stopped being reported in July of The county instituted some changes to reduce hospital inpatient services, but this drop seems too extreme.
Mode 05 IMDs are not showing in the report after FY 2013/14. It is a staff training issue. Since moving to the EHR, this reporting process hasn’t been monitored properly.
Mode 05 Mental Health Rehab Center fell to 0 in FY 2014/15 forward. This requires staff to manually enter which days the client is in the facility.
All Mode 05 Services seem to be down in FY 2014/15 forward, unexpectedly. This requires staff to manually enter which days the client is in the facility.

26. Specific Mode 05 Issues Tuolumne Ventura Yolo
Mode 05 Services are out-of-county and are not showing on the report.
Ventura
Mode 05 Hospital Administrative Day has a variable pattern.
Mode 05 Hospital Inpatient clients are decreasing year on year unexpectedly.
Some Mode 05 Services stopped being reported after 2009, in including Mode 05 Adult Residential, Mode 05 IMDs. Some contracted providers bill directly to state and the services are not captured in county’s EHR. In other cases, the programs are in the EHR, but reporting seems to have stopped after the switch to NetSmart Avatar. Some of these services are out-of-county.
Yolo
Mode 05 IMD Services experience a large proportion of fatal errors each year.
For Mode 05 Hospital Inpatient, it is likely that not all are being reported to CSI. Only those providers with provider numbers in CSI are billed to CSI. Non-contracted inpatients are not given a CSI number.
Mode 05 IMDs clients might be low. This depends on the setup in NetSmart Avatar.

27. Next Steps
DHCS should identify how direct billed services should be reported by counties if counties do not collect information about the services themselves
DHCS should investigate option to provide additional definitions for Mode 05 service categories
DHCS should investigate and address fatal error for overlapping dates when client is discharged from one facility and readmitted to another facility on the same day.
This is a realistic occurrence and should be accepted by the CSI
Oversight in current business rules
DHCS should devise a way to report back OOC services to fiscally responsible county

28. Next Steps
Counties to ensure that all providers are set up in Provider file for appropriate services.
Counties to investigate what happens when billing is behind and make sure that late reported records get reported to CSI.
Counties to provide technical assistance to providers who have trouble reporting services to county.
Counties to identify process to oversee manual entry to Mode 05 services in EHR.
Counties to identify which Mode 05 services are stored in a system separate from the CSI and alert DHCS that while they provide these services, they cannot report these types of services at this time.
County to ensure that all Mode 05 services in the HER are set up to report to CSI.

29. Next Steps
DHCS to post Data Quality Supplemental Report for OOC Services on ITWS/BHIS
Counties to review new Data Quality Supplemental Report for OOC Services and plan to attend the May 17 webinar on OOC services
Register here:
MHDATA to follow up with counties to see if their Mode 05 issues have been addressed/resolved.

30. Discussion Other issues? Comments? Next Steps? Email Support

31. DHCS CSI and DCR Data Quality Improvement Project
Mental Health Data Alliance, LLC
(MHData)