Rule 132 Medicaid Community Mental Health Service Program

1
Rule 132 Medicaid Community Mental Health
Service Program
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

3
Underlying Vision of Recovery and Resilience

• Fundamental components and role of services in
  supporting recovery and resilience can be found
  at www.dhs.state.il.us/revisedRule132/

4
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
Handouts and Reference Materials

• Handouts
• Agenda
• PowerPoint presentation
• Question cards
• Evaluation
• Reference Materials
• Found at www.dhs.state.il.us/revisedRule132/
• Adopted Rule 132
• Crosswalk (now known as Service Definition and
  Reimbursement Guide)
• Guidelines, Instructions and Checklist
• Summary of rule changes

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

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

8
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
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
Topics for future and separate discussions

• DCFS specific transition
• DHS/DMH contract requirements

11
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
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
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/revisedRu
  le132/)
• Each state agency has more specific instructions
  on billing and payment to be addressed in later
  training

14
Training Follow-up and Next Steps

• Moderated conference calls
• Billing and Coding, May 29, 10 am noon
• 1(800)640-9765
• Passcode 17862946
• Non-Medicaid Vocational Service
• Non-Medicaid Outreach Engagement
• Technical assistance
• ACT/CST decision support tools
• PSR decision support tool
• Q A via dhsmh_at_dhs.state.il.us

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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
Summary of Service Changes

• Mental health assessment
• Treatment plan development, review and
  modification
• Therapy/counseling
• Skills training and development

17
Summary of Service Changes (cont.)

• Therapeutic behavioral services
• Mental health day treatment
• Mental health intensive outpatient
• Activity therapy
• Intensive family-based services

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

19
Changes to Treatment Plan Development, Review and
Modification (132.148c)

• 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
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

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

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

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)

24
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
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
Changes to Mental Health Intensive Outpatient
(132.150l)

• May be provided to clients at risk of
  hospitalization

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Questions
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

29

• 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
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

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

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

33
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

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

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

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

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

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

39
Community Support Team (cont.)

• Client must meet at least three eligibility
  criteria in 132.150i)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
Questions
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

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

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

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

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

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

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

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Questions
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

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

51
Questions
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 clients broader
  rehabilitative or social functioning skills are
  not job specific should be expressed in those
  terms and billed as Medicaid-covered services

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
• 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
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
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
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

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• Outreach and Engagement
• Stakeholder Education

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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
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
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
Questions