dhcs dmc-ods regulatory and compliance...program integrity requirements, quality management, state...
TRANSCRIPT
DHCS DMC-ODS regulatory and compliance
Masonic Center
Nov 288:30-11:30 or 1:00-4:00
Substance Use Treatment Services
Nov 278:30-11:30 or 1:00-4:00
Register: SCCLearnwww.scclearn.sccgov.org
DMC-ODS
NOVEMBER 2018
Tianna D. Nelson, Ph.D., L.M.F.T. Behavioral Health Division Director
Steve Lownsbery, L.M.F.T.SUTS Clinical Standards Coordinator
2
DMC-ODS Documentation TrainingAM session PM session
8:00 Registration 12:30
8:30 Regulatory statutes and compliance issues 1:00
9:00 Assessment 1:309:30 Treatment Planning 2:00
10:00 Progress Notes 2:30
10:30 Clinical Justification for Services 3:0011:00 Discharge Planning and Continuing Care 3:30
11:30 Questions 4:00
Sign out and certificates
3
4
Primary Sources
• Intergovernmental Agreement (IA) (also known as the SUTS contract with DHCS)
Disclaimer: The material on the IA is presented for the purposes of familiarizing the audience with its key features. The presentation does not cover the entire IA and does not claim to be comprehensive.
5
Primary Source - IA• Preamble• Federal requirements• Program Specifications
• Includes covered services, access to services, coordination and continuity of care, authorization of services, continued certification of providers, defines the DMC-ODS modalities, case management, recovery services, cultural competency, describes the beneficiary problem resolution process, program integrity requirements, quality management, state monitoring, contractor monitoring and reporting requirements, training program mandates, compliance records, program complaints, correction action plans, individual quality improvement programs and utilization management and performance measures.
6
Foundations of the new world of MCP
• Provider Staff – Counselors, Licensed Practitioners of the Healing Arts (LPHAs), & Medical Director
• Substance Use Disorder Diagnosis & Medical Necessity
• Treatment Modalities
• Documentation Requirements
• Resources7
8
9
10
11
12
13
Regulation Compliance Clinical
14
15
Licensed Practitioner of the Healing ArtsLPHAs include:
• Physician • Nurse Practitioners • Physician Assistants• Registered Nurses• Registered Pharmacists • Licensed Clinical Psychologists• Licensed Clinical Social Worker • Licensed Professional Clinical Counselor • Licensed Marriage and Family Therapists • License Eligible Practitioners working under the supervision of licensed clinicians 16
The Role of the Medical Director/Physician
• Develop & Implement Medical Policies & Standards
• Ensure Physicians & LPHAs • trained to perform diagnosis & determine medical
necessity, within scope• receive five hours of continuing education related to
addiction medicine annually
• Physicians do not delegate their duties to non-physician personnel 17
Medical Necessity Criteria
• Beneficiaries must have one SUD diagnosis from the DSM
• Must meet the ASAM Criteria definition of medical necessity
for services based on the ASAM Criteria
18
• Place appropriate limits on a service - On the basis of criteria applied under the State plan, such as medical
necessity; or
• For the purpose of utilization control, provided that - The services furnished can reasonably achieve their purpose
- Must ensure that the services are sufficient in amount, duration or scope to reasonably achieve the purpose for which the services are furnished.
Medical Necessity Criteria42 CFR 438.210(a)(4)
19
Determination of Services Must be Medically Necessary
42 CFR 438.210(a)(4)
• Intake Assessments• ASAM – 6 Dimensions• DSM Criteria• 42 CFR 438.210(a)(4) (Adults)• 22 CCR § 51303 (Adolescents)
By – Medical Director or LPHA
Required professional reviews the initial treatment plan to determine whether the services are medically necessary. Shall type or legibly print name, sign & date treatment plan within 15 days of the therapist or counselor or within 30 days from admission, whichever comes first. 20
Substance Use Disorder Diagnosis
• Counselor – LPHA or Medical Director• required face-to-face review
• Medical Director or LPHA (working within their scope of practice)• SHALL document the basis of the diagnosis based on DSM criteria
21
Reg
ulat
ion
Intake and Assessment
22
Reg
ulat
ion
Intake and AssessmentPhysical Exam(PE): a) completed by M.D. / LNP / PA within 30 days of admit b) provides proof a PE done within the last 12 months c) Obtaining a PE is a Treatment Plan goal
HSQ and determination of medical eligibility w/in 30d of admit signed by MD w/lic, #, & dated
ASAM biopsychosocial assessment is completed within 30 days of admit
Documentation of the face-to-face/telehealth chart review by the counselor & LPHA
LPHA determines and provides justification for DSM5 diagnosis and appropriate Level of Care 23
Com
plia
nce
Intake and Assessment
Beneficiary Record shall include:Identifier (i.e., name, number)BirthdayGenderRace and/or Ethnic BackgroundAddressTelephone numberNext of Kin or Emergency Contact
24
Com
plia
nceIntake and Assessment
Documentation of all client demographics and emergency phone numberMonthly Medi-Cal eligibility is documentedYOUTH - Parental/guardian’s involvement in treatment is justified, sign & datedALOC reflects appropriate LOC for the treatment modality & is signed and datedALOC is completed at the "Intake" counseling session- ALOC reflects appropriate LOC, is signed & dated with QI authorizationConsent to Treatment is signed and datedThere is a written consent for psychiatric medications 25
Com
plia
nceIntake and Assessment
Admission Agreement is signed and datedProgram Rules are signed and datedAppropriate Release of Information (ROI) are completed, signed and datedBeneficiary Handbook given & Ack of Receipt of Grievance process signed & datedBeneficiary's Fair Hearing Rights are signed and datedBeneficiary's preferred language for treatment is documentedInterpretation services are documented when preferred language is not EnglishIdentifies client's strengths
26
Com
plia
nce
Intake and Assessment
Financial, educational, employment and legal history is documentedIndividual and family substance use history documentedFamilial, cultural and social factors are identifiedCase Management issues are summarizedDocumentation of coordination of care with other providersAdmit to Recovery Services is conditional on previously completing OS treatmentASAM biopsychosocial assessment is completed within 30 d of admitDiagnosis is supported by current symptoms and behaviorsMedical necessity is stated as a significant impairment or distress in life functioning 27
Clin
ical
Chapter 1 p. 63Chapter 2 pp. 11 & 13Chapter 3 p. 13Chapter 4 pp. 20, 23, 24 & 25Chapter 4 pp. 23 & 24 Chapter 5 p. 4 Chapter 5 p. 27 Chapter 6 p. 32Chapter 6 p. 34Chapter 8 p. 38
Intake and Assessment
28
Reg
ulat
ion
Treatment Plan Timeline and Requirements
Initial:• 30 calendar days from admission
–Counselor/LPHA–Beneficiary
• 15 calendar days from Counselor signature date
• Or within 30 days from admission, if documenting MN by approving the TP –Medical Director/LPHA 29
Reg
ulat
ion • Problem Statements
• Goals• Action Steps• Target Dates• Description of Service; type and
frequency
Treatment Plan
30
Reg
ulat
ion • Assignment of Primary Counselor
• Beneficiary’s Diagnosis• Physical Examination Goals• Significant Illness• Assignment of primary counselor / LPHA
Treatment Plan
31
Reg
ulat
ion
Treatment Plan
LPHA name is printed, signed, license & # and dated
Client’s goal to obtain a PE is on the Treatment Plan (as needed)Plan has modality of SUD services and frequency
Problem statements identify areas of impairment or distress of SUD
32
Reg
ulat
ion
Treatment Plan
Goals and Action Steps have target dates
Client has name printed, signed and dated
Notation client was offered a copy of the TP
Primary Counselor's name is printed, signed, license & # and dated w/in 30d of admit
LPHA name printed, signed, license & # and dated w/in 15 days of counselor 33
Com
plia
nce
1. Interventions are clinically appropriate to reduce impairment, restore functioning or prevent significant deterioration
2. Problem Statements are correctly matched with the appropriate dimension
3. Case Management (CM) identifies specific linkage services4. Case Management (CM) is stated with range of frequency
5. Stage of Change is correctly matched with appropriate Problem
6. Goal(s) relate to the Problem Statement & match the Stage of Change
Treatment Plan
34
Com
plia
nce
a. Action Steps\Interventions are strength-basedb. Action Steps are stated in measurable terms (S.M.A.R.T.)c. Action Steps help achieve the Goal(s)d. Action Steps are strength-based
e. WM Care Plan signed by LPHA, license & # and dated w/in 48h of admit
f. PHS/RES - TP signed, by LPHA license & # and dated w/in 10 days of admit
g. OS/IOS/RS TP printed, signed by LPHA, lic & # and dated w/in 30d of admit
Treatment Plan
35
Clin
ical
Chapter 2 p. 15Chapter 3 pp. 20, 21, 22 & 23
Chapter 4 p. 23, 25, Chapter 5 p. 26, 28 & 30
Chapter 6 p. 32 & 34
Chapter 7 pp. 35, 36, &37
Chapter 9 pp. 40, 41, 42 & 45
Treatment Plan
36
Reg
ulat
ion
Progress Note• Topic of session OR purpose of the service• Actual treatment service or counseling session time is noted
distinctly from the documentation and travel time
• Description of progress OR lack of progress on treatment plan
• Attendance – date, actual start & end times– If break is provided, must document
• Identify if services were provided in-person, by telephone, or by telehealth
• If provided in the community, identify location and how the provider ensured confidentiality 37
Reg
ulat
ion
Progress NoteDescription of type and summary of services provided
Location, if out of office
Each session has date and start & end time
Services are individualized based on the TP
CM services connected to the TP Goals
Counselor’s intervention(s) are stated with client’s response38
Reg
ulat
ion
Progress Note
Completed within 7 days of the session
Counselor’s name is printed, signed, license & #, and datedIOS - Adult - minimum of 9 hrs/wk / Youth - minimum of 6 hrs/wk
IOS - Breaks are separated from the hourly listing of service
39
Reg
ulat
ion
Progress Note
Reflects treatment progress or lack thereof based on TP goals
IOS - Youth sessions correspond to a minimum of 6 hours per week
IOS - Adult sessions correspond to a minimum of 9 hours per week
40
Reg
ulat
ion
Signature RequirementsLPHA or counselor shall:
Type or legibly print their name
Sign and date the progress note within 7 calendar days of the counseling session or treatment service
Counselor’s name is printed, signed, license & #, and dated
Signature shall be adjacent to the typed or legibly printed name
Progress Note
41
Reg
ulat
ion
Case Management
Beneficiary’s name
The purpose of the service
Narrative summary
Date, start & end times
How confidentiality was insuredIdentify if the service was provided in-person, by phone, by telehealth or in the community
Progress Note
42
Reg
ulat
ion
Case Management
Beneficiary’s name
The purpose of the service
Narrative summary
Date, start & end times
How confidentiality was insuredIdentify if the service was provided in-person, by phone, by telehealth or in the community
Progress Note
43
Com
plia
nce
1. No show or cancelations are documented
2. Services are individualized based on the TP3. Counselor's interventions reflect EBPs used
4. CM/phone - Has justification / rationale of treatment services
5. CM services are connected to the TP Goals, and Action Steps
6. CM field sessions have an explanation of how confidentiality is protected
Progress Note
44
Com
plia
nce
Progress Notea. OS & RS - completed within 48 hrs of the sessionb. IOS / PHS / WM / RES - DAILY documentation of
activities, services and sessionsc. PHS – treatment services correspond to a
minimum of 20 hours/weekd. RS - Minimum 1x monthly (face-to-face, telephone
or telehealth) e. RES - Bed census correspond to Treatment
services documented 7d/wkf. RES documentation of all treatment and activities
are a minimum of 20 hrs/wk 45
Com
plia
nce
i. Family therapy and/or family counseling appropriately claimed
ii. Notation if treatment services were provided in their preferred language
iii. Evidence of coordination of care with client's PCP
iv. Documentation of coordination of care with other providers
Progress Note
46
Clin
ical
Chapter 1 p. 13Chapter 2 p. 15Chapter 4 pp. 20, 22,23 & 24Chapter 6 p. 32Chapter 7 p. 37Chapter 9 pp. 42 & 43Chapter 9 p. 43Chapter 10 p. 5
Progress Note
47
Reg
ulat
ion
Group - Sign-In Sheets
• Establish and maintain a sign in sheet for every group counseling session to include:
• Typed or legibly printed name of LPHA and/or counselor and beneficiary
• Date of session• Topic of session• Start and end time of session
For IOS and Residential:– Provider shall have a sign-in sheet for patient education
and structured activities 48
Reg
ulat
ion
Group - Sign-In Sheets
Group sign-in sheet lists between 2-12 participants
Group sign-in sheet has topic and date
Sign-in sheet has client's notation of start and end time Client’s name is printed and signed with time signed in to the group session
Counselor’s name printed, signed, license & # and dated 49
Com
plia
nce
Justification of a cofacilitator is noted
Group notes documented separately by a cofacilitator
Group
50
Reg
ulat
ion
• 90 calendar days –From initial or prior treatment plan
• Unless there is… –A change in treatment modality –Or a significant event necessitating
a new TP (clinical justification)• Whichever occurs first
Updated Treatment Plan
51
Reg
ulat
ion
Updated Treatment PlanPlan has modality of SUD services, frequency, amount & target dates
Problem statement identifies areas of impairment or distress of SUD
Client’s name is printed, signed and dated
Primary Counselor's name is printed, signed, license & # and dated w/in 90d of previous TP
LPHA name printed, signed, license & # and dated w/15 days of counselor by day 90
Notation TP copy given to client 52
Com
plia
nce
1. Problem Statements identifies areas of impairment or distress of SU
2. 1st Problem Statements are correctly matched with the appropriate dimension
3. Stage of Change is correctly matched with appropriate problem(s)
4. Goal(s) relate to the Problem Statement & match the Stage of Change
5. Action Steps are stated in measurable terms (S.M.A.R.T.)6. Action Steps help achieve the Goal (s)
Updated Treatment Plan
53
Clin
ical
Chapter 2 p. 15
Chapter 4 p. 21 & 23
Updated Treatment Plan
54
Reg
ulat
ion
Continuing Services Justification (CSJ)
• Outpatient Services
• Intensive Outpatient Services
• Case Management
• Naltrexone Treatment
• Btwn 5th - 6th month from admin or last CSJ
55
Reg
ulat
ion
Continuing Services Justification• LPHA/counselor shall review
– Document recommendation of continuation of services • Determination of continued medical necessity shall be
documented by medical director or LPHA• Review and consideration of the following shall be
documented:− Beneficiary’s personal, medical, substance use history− Most recent physical exam− Progress notes & treatment plan goals− LPHA/counselor’s recommendation− Beneficiary’s prognosis
56
Reg
ulat
ion
Continuing Services Justification
Justification of Clinical Services describes treatment outcomes
Counselor/LPHA gives prognosis
Counselor’s name is printed, signed, license & #, dated
LPHA has narrative clinical justification for medical necessity for this LOC
57
Reg
ulat
ion
Continuing Services Justification
YOUTH - Notice of Parental/guardian’s is updated, justified, signed & dated
Signed by LPHA between the 5th & 6th / 11th & 12th month
LPHA name printed, signed, license & # and dated
58
Com
plia
nce
i. Describes treatment outcomeii. Counselor/LPHA gives prognosisiii. Counselor’s name is printed, signed, license & # and datediv. LPHA has narrative clinical justification for medical
necessity for this LOC v. YOUTH - Notice of Parental/guardian’s is updated, justified,
signed & datedvi. Signed by LPHA between the 5th & 6th / 11th & 12th month vii. LPHA name printed, signed, license & # and dated
Continuing Services Justification
59
Clin
ical
Chapter 4 p. 21
Continuing Services Justification
60
Reg
ulat
ion – Within 30 days of last face-to-face service
• Required elements:– List of relapse triggers– Plan for avoiding relapse when faced with triggers– Support plan - how to assist / avoid
• People• Organizations
• During last face-to-face, LPHA/counselor and beneficiary, shall type or legibly print printed, signed, license & # and dated on the discharge plan
• A copy must be provided to beneficiary & documented
Discharge Plan
61
Reg
ulat
ion
Discharge Plan
1. Detailed progress and goals (achieved or not)
2. Details client’s Continuing Care Support Plan
3. Has client’s name printed, signed and dated
4. Client notification of a NOADB - IF Involuntarily terminated given 10 day prior to D/C
62
Com
plia
nce
Discharge Plan
1. Notes either reason of Voluntary or Involuntary discharge2. Detailed progress and goals (achieved or not)
3. Details client’s Continuing Care Support Plan4. States value and referral to Recovery Services5. Treatment / Residential / Recovery Services Plan is current
at discharge
6. Client notification of a NOADB - IF Involuntarily terminated given 10 day prior to D/C
63
Reg
ulat
ion • Required for an unexpected lapse in treatment services for
30+ days
• Completed by LPHA/counselor within 30 days of last face-to-face
• Required elements:– Duration of the treatment episode– Reason for discharge– Narrative summary of the treatment episode– Prognosis
Discharge Summary
64
Com
plia
nce
Discharge Summary
Involuntarily terminated client’s Fair Hearing Rights are advised
Client notification of a NOADB - IF Involuntarily terminated is given 10 day prior
65
Clin
ical
Discharge Summary
Chapter 4 pp. 21, 23, & 24 & 26
66
Regulation Compliance Clinical
67
SUTS System of Care audits• Contract Monitoring
• Fiscal• Personnel• Facilities
• Intergovernmental Agreement• Drug MediCal-ODS
• Clinical 68
69
70
SUBSTANCE USE TREATMENT SERVICES
UTILIZATION REVIEW PROCESS 1. U.R. will take place quarterly on the last Monday of the month. In the event of a holiday it will
occur on the 3rd Monday of the month.
2. Although there is no State ADP requirement, Medi-Cal charts will typically be brought on a random basis, having a 10% sample of the total number of open charts of the site to be reviewed quarterly.
3. Clinicians will be notified one week prior to the U.R. process in order to allow time for them to
complete the top portion of the U.R. “Quarterly Chart Review” prior to bringing the chart to U.R. 4. The “Period Reviewed” will be the three-month period prior to the U.R. as per the State
calendar. 5. Clinicians conducting the U.R. are expected to review content for any disallowances related to
provider services. (i.e. medical review, meeting target dates, individual/group progress notes match type of service provided; assessment is complete; all consent forms are signed etc.)
DISALLOWANCES
A. A disallowance will occur for the following reasons: 1. Physical Exam documentation does not occur prior to the 30 day window of Treatment Plan
(TP) development. 2. OR Physical Exam, as a client’s goal, is not documentation the TP.
3. TP is not developed within 30 days or 5th visit from admission.
4. M.D. does not sign the TP within 15 days after Counselor’s signature 5. A Request for the Six Month Extension of Treatment is prior to the fifth or after the sixth
71
UTILIZATION REVIEW (UR)
SANTA CLARA COUNTY DRUG MEDI-CAL
Client: ID #: Counselor: PROGRAM: Diagnosis: ,
Admit Date: 9/1/18 Discharge Date: 10/1/18 REVIEWED From: Date: 10/31/18 to Date: 10/31/18
DRUG MEDI-CAL - DISALLOWANCE COMPLIANCE ISSUE Intake and Assessment P NP P NP
Physical Exam a) completed by MD/LNP/PA within 30 days of admission date b) proof a PE done within the last 12 months
YOUTH Notice of parental/guardian’s involvement in treatment is justified
Admission Agreement/Program Rules are included and signed Health screen (HSQ) done within / 30 days of Admit
Date:
HSQ signed by M.D. Date: 5/1/15
ASAM assessment is completed within 30 days of Admit ASAM assessment is Signed by MD
Primary Counselor of Medi-Cal services is noted Substance Use Disorder criteria is delineated
Initial Treatment Plan P NP P NP Initial Treatment Plan (TP) is submitted within 30 Date: 5/1/15
days of Admission date Client physical health issues as noted per the HSQ (Dim 2) are on
the Treatment Plan
States a Substance Use Disorder diagnosis Short and long term goals noted
Lists SUD treatment services, frequency and target dates Action steps are clearly defined and measurable
Client’s name is printed, signed and dated
Counselor’s name printed, signed, & dated within 30 days of Date: ____________ Admit
M.D. name printed, signed, and dated within 15 days of Date: ____________ counselor
Progress Note P NP P NP Has counselor’s signature and
date Time and Duration
Completed within 7 days of the counseling session Progress or lack of per TP goals Crisis session is substance use related and justified Counselor’s intervention noted
Second Service Same Day is documented per DMC standard Client’s response stated Second Service Same Day DHCS MC 6700 form is completed & in
the chart Stage of change recorded
IOP Sessions correspond to a minimum of 3 days a week 3 hours each day per week
Collateral is with a nonprofessional IOP Second Service Same Day is ONLY a Crisis and is
documented per DMC standard
72
SUTS
73
SUTS
74
75
Primary Sources - Regulatory authority citations• IA - Intergovernmental Agreement for Santa Clara County• STC - Standard Terms and Conditions• AOD Cert. Standards - Alcohol and/or Other Drug Program Certification
Standards (May 1, 2017) Alcohol and/or Other Drug Program Certification Standards• DMC - Drug Medi-Cal Certification Standards for Substance Abuse Clinics (July
1, 2004• DTS - Standards for Drug Treatment Programs (September 1982)• Title 9 - California Code of Regulations, • Title 9 - Narcotic Treatment Programs• Title 22 - California Code of Regulations • Title 22 - Drug Medi-Cal (as amended by Emergency Regulations)• WIC - Welfare and Institutions Code• Perinatal Service Network Guidelines 2016-2017• SUTS CPM - Substance Use Treatment Services Clinical Performance
Measures76
does not address • How to fill out a GRS, RRS, TRS or a CRS
• an ALOC• CalOMS – Clinician's Guide to CalOMS• Admit paperwork
• Billing Procedures - SUTS Biz Ops or DHCS Billing Manual • HIPAA or 42CFR, CFR 45 or 438• Beneficiary Rights and Grievance procedures • Beneficiary Handbook• SUTS Clinical Documentation Manual• Client Satisfaction Survey• Title 9 NTP/OTP or MAT
• Other specific clinical trainings, eg., ALOC, DSM5 diagnostic differentials, Stages of Change, Treatment planning, or use of EBPs77
SCCo SUTS Contract with DHCS
• Changes the terms and conditions of SUTS relationship with DHCS
• By signing the contract SUTS agrees to take on a dual role:• Operating an organized delivery system (ODS) • Functioning as a managed care plan (MCP)
• Signing the contract makes SUTS contractually obligated to comply with IA terms
The Intergovernmental Agreement (IA)
78
The IA – SCCo SUTS Contract with DHCS
• The IA is composed of two main sections; a general section and a county-specific section
• The provisions in the general section applies to all waiver opt-in counties
• The general section contains 28 different provisions and a 29th
section that defines key terms in the IA• The general IGA provisions are based mainly on 42 CFR Part
438, which regulates the operation of managed care plans
79
County – specific provisions in the IA
• Provisions of Section 30 are unique to each county’s waiver proposal submitted to DHCS
• Section 30 lists key elements of SUTS waiver proposal submitted to & accepted by DHCS (& CMS)
• SUTS is contractually obligated to provide services proposed in the waiver plan
80
FEDERAL REQUIREMENTS• 42 CFR Part 2
– Confidentiality of Alcohol and Drug Abuse Patient Records• https://www.gpo.gov
• 42 CFR Part 438– Managed Care Subparts A-J
• https://www.gpo.gov/fdsys/granule/CFR-2011-title42-vol4/CFR-2011-title42-vol4-part438/content-detail.html
• 45 CFR– HIPAA Privacy Rule
• https://www.hhs.gov/hipaa/for-professionals/privacy/index.html81
DMC-ODS RESOURCES • FAQs, Fact Sheets & Information Notices• Special Terms and Conditions• Technical Assistance• Webinars
• DMCODS webpage: – (http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-
Delivery-System.aspx)
• Submit a form for all DMC-ODS Waiver questions:– (http://www.dhcs.ca.gov/services/adp/Pages/DMC-Answers.aspx)
82
DHCS Additional Resources
• MHSUDS Information Notices–http://www.dhcs.ca.gov/formsandpubs/Pages/M
HSUDS-Information-Notices.aspx
• State Health Information Guidance (SHIG)–http://www.chhs.ca.gov/ohii/pages/shig.aspx
83
• SUD County Complaint• [email protected]• Required within 2-business days of completing the investigation.
• Program/Counselor Complaints• http://www.dhcs.ca.gov/individuals/Pages/Sud-Complaints.aspx• Public Number: (916) 322-2911• Toll Free number: (877) 685-8333
• Certifying Organization Complaints• [email protected] 84
COMPLAINTS
• Certifying Organizations
• http://www.dhcs.ca.gov/provgovpart/Pages/CounselorCertificationOrganizations.aspx
• Counselor Certification• DHCS Revoked and/or Suspended Counselor List• http://www.dhcs.ca.gov/provgovpart/Pages/CounselorCertification.aspx
• Licensed Professionals• http://www.mbc.ca.gov/Breeze/License_Verification.aspx
85
CERTIFICATIONS & LICENCE
• DHCS Medi-Cal Fraud Website• http://www.dhcs.ca.gov/individuals/Pages/StopMedi-
CalFraud.aspx
• 1-800-822-6222
• [email protected]• Medi-Cal Fraud Complaint – Intake Unit
Audits and InvestigationsPO Box 997413, MS 2500Sacramento, CA 95899-7413
86
Medi-Cal Fraud
SUD Medical Directors are required to take 5 hours of continuing in “addiction medicine” annually.
Medical Directors also have required Continued Medical Education (CMEs) credits either online or in person.
Additional websites that provide information on physician Continuing Medical Education (CME):• http://cmelist.com/addiction-substance-abuse-cme.htm• http://www.audio-digest.org/CME-Series-Specials/substance-abuse• http://www.abam.net/become-certified/earning-cme-for-the-2014-
examination-application/• http://www.csam-asam.org/online-cme• http://psychiatry.ufl.edu/education/addiction-medicine-cme-program/ 87
Medical Director required training Resources
• California Association of DUI Treatment Programs (CADTP)• Website: http://www.cadtp.org/
• California Consortium of Addiction Programs and Professionals (CCAPP)
• Website: https://www.ccapp.us/
• DHCS Certifying Organization (CO) Webpage• http://www.dhcs.ca.gov/provgovpart/Pages/CounselorCertificat
ionOrganizations.aspx88
Certifying Organizations
• Counselor/Registrant• Certifying Organization Website – Registry• DHCS Revoked and/or Suspended Counselor List • DHCS Counselor Certification Page
http://www.dhcs.ca.gov/provgovpart/Pages/CounselorCertification.aspx
• Licensed Professionals• Department of Consumer Affairs (BreEZe)
http://www.mbc.ca.gov/Breeze/License_Verification.aspx
89
License Status Verification
QUESTIONS?
90