documentation best practices for family peer support ... · part 1: agenda quality documentation....
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Documentation Best Practices for Family Peer Support Providers: Part 1YVETTE KELLY, CTACANNE KUPPINGER, CTAC
October 16, 2019
Please Note‣Refer to state guidance documents for official guidance.‣Providers should follow internal agency policy and
procedures in alignment with state issued guidance and manuals.‣ Information is current as of the date of the presentation.‣Slides and recording will be posted to the CTAC website.
Part 1: AgendaQuality Documentation
Pathways to Care
Working with the Family for the Benefit of the Child
Service Authorizations
Q&A and Resources
State Guidance Documents
CFTSS Health Record Documentationhttps://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/cftss_prov_guide_hlth_rec_doc.pdf
Child and Family Treatment and Support Services Provider Manualhttps://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/updated_spa_manual.pdf
Qua
lity
Docu
men
tatio
n
Quality Documentation
Multi-System
Community Based
Culturally Competent
Least Restrictive
Family Focused
Child Centered
CFTSS Core Principles
Documentation Reflects PrinciplesPrinciples guide your work
+ Evident in your documentation
Example: David NoteReviewed LPHA recommendation regarding David’s school issues with his father. School does not understand impact of David’s social issues. FPA will attend the next CSE meeting with father to address a) child’s lack of friends which is impacting his attendance and b) need for reading assistance. Referral made to parent support group so father can meet other parents whose children have similar needs.
Example: David Better NoteFPA and David’s father discussed the LPHA recommendation. Father understands the CSE process but has been frustrated that the “school isn’t doing all they can do because David is quiet and not a problem.” FPA helped the father chose two priority issues a) David’s lack of friends which his father feels is impacting his attendance and b) need for reading assistance. FPA offered to attend CSE with father who stated he will consider that. FPA explained about a support group in town and, at the father’s request, and will check to see if any other fathers attend.
Example: Nina Note Recommendation indicated that Nina is not getting enough sleep which is having a negative impact on her behavior. Nina’s mother shared that she is not following the pediatrician’s recommendation. FPA and mother discussed possible changes to routine to increase Nina’s sleep. Referral made to County Mental Health for clinic services due to Nina’s nightmares.
Example: Nina Better NoteRecommendation indicated that Nina is not getting enough sleep which is having a negative impact on her behavior. Nina’s mother shared she arrives home late and wants time with her daughter. FPA helped the mother brainstorm possible changes to their routine that could give them time, but also get Nina more sleep. Nina’s mother also shared that Nina has been having nightmares since moving to this country. FPA explained some options for getting Nina some support to cope with her fears which included some in-home services as the family is concerned about what others might think.
Path
way
s to
Car
e
Who can make a CFTSS referral?Anyone can make a referral to CFTSS!
Parents, youth, pediatricians, care managers, schools, clinicians, childcare providers, and others.
Once a referral is made, a Licensed Practitioner of the Healing Arts (LPHA) will need to assess the child, document medical necessity and write a recommendation.
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Important to Note about CFTSSFamily Peer Support Services (FPSS) is one of six CFTSS services. ‣A child does not need to be enrolled in a Health Home to
receive CFTSS ‣A child does not need to meet HCBS eligibility in order to
receive CFTSS‣There are Medical Necessity Criteria for Family Peer
Support Services. A recommendation is needed to establish Medical Necessity.
Sample Recommendation FormRecommendations must: • Be in writing • Be signed and dated• Include an explanation of the medical
need for the service• Have the NPI# of the LPHA, if an
enrollable practitioner type; if not, the NPI# of the employing agency of the LPHA
The sample LPHA Recommendation Form can be found here.
Sample Recommendation FormBasic Information • Including Medicaid #
Diagnoses and Symptoms
Areas of Functioning• Self-Direction/Control • Self-Care • Family Life • Social Relationships • Symptom Management
Recommended CFTSS Services and Needed Interventions
Reason for Recommendation
LPHA Signature and Date
When is a New Recommendation Needed?‣ The recommending LPHA must have current knowledge of the
child, their functioning and needs, and diagnosis‣ If a child’s needs change significantly and they need additional
CFTSS, they will need a new recommendation‣ This does NOT mean a new recommendation is needed in
order to update the FPSS treatment plan as this will be done on an ongoing basis
Before Seeking Medicaid ReimbursementCheck to be sure that:
Child has a recommendation for FPSS
Child is currently enrolled in Medicaid
Your agency is in the child’s MMCPs Network
Check with the family, HH and MMCP to determine what services the child is receiving to improve coordination and prevent duplication.
Wor
king
with
the
Pare
nt
for t
he B
enef
it of
the
Child
Impact on Documentation• In Medicaid, the child or youth is the beneficiary.
• The parent/caregiver(s) are a critical resource for the child and the family well-being matters to child outcomes.
• The work you do with parents needs to be defined and described by clearly connecting your work to the child’s goals and objectives.
Additional Assessment by FPSS Provider‣Explain FPSS to the family and discuss parent’s interest in FPSS‣Discuss the parent’s areas of strength and where they need
support in relationship to their child’s goals. ‣Some providers use the Family Assessment of Needs and
Strengths (FANS) as the basis for a conversation to identify how to work together, but this is not required
RECOMMENTATION + FPSS ASSESSMENT = BASIS FOR TREATMENT PLAN
Components of FPSSEngagement, Bridging and
Transition Support
Self-Advocacy, Self-Efficacy
and Empowerment
Parent Skill Development
Community Connections and Natural
Supports
How can I support you
...to learn how the system works
...to build up your support system
...to figure out what works
...to feel strong
...to navigate big transitions
...to advocate for what they need
...to understand their diagnoses
...to learn new parenting strategies
....to support your child!
Serv
ice
Auth
oriz
atio
n
Medical Necessity and Utilization Management
Medical Necessity answers the question: Is this service appropriate and necessary?
Utilization Management (UM) is: Set of procedures MMCPs use to monitor or evaluate clinical necessity, appropriateness, efficacy, or efficiency of behavioral health care services.
Service Authorization Basics
The first 3 service visits with FPSS do
not require authorization,
however providers should notify MMCPs
before providing services to ensure proper and timely
payment.
If more services are needed MMCPs
perform concurrent review and if service is deemed medically necessary, authorize
further services. MMCPs must provide
a minimum of 30 service visits as part of this authorization.
Plans are not required to perform concurrent review. However, if they choose to, they
cannot do before the 4th visit.
Initial Treatment PlanBy the 4th session or no more than 30 days after the first face-to-face with the parent/caregiver:
• An assessment of the parent/caregiver’s needs and strengths should be completed
• A FPSS Treatment Plan is developed to assist the parent/caregiver in meeting the needs of the child (based on the LHPA recommendation)
• FPSS Treatment Plan must be signed by the parent/caregiver, FPA and FPA’s supervisor
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Medical Necessity Criteria
1. Admission
2. Continued Stay
3. Discharge
1. FPSS Admission Criteria‣ Behavioral Health diagnosis or evidence of skills lost or underdeveloped
due to a physical health diagnosis ‣ Likely to benefit from services to prevent symptoms from developing or
getting worse‣ Family is available, receptive and demonstrates need for services to help
in areas such as: building skills in the family to benefit the child, promoting empowerment, strengthening supports in the child’s environment.
‣ Treatment planning includes family/caregiver(s) and/or other support systems, unless not clinically indicated or relevant.
‣ Recommended by LPHAThis is a summary. For full admission, continued stay and discharge
criteria see official medical necessity guidance document.
1. Admission Documentation TipsYour documentation should show:• That a parent/caregiver is available and receptive to receiving the service.
• There is a need for services to help in areas within the scope of FPSS such as building skills in the family to benefit the child, promoting empowerment, strengthening supports in the child’s environment.
• How the parent/caregiver was involved in treatment planning.
Obviously, if the family is not interested in the service, you would note that and communicate with the recommending LPHA.
2. FPSS Continued Stay Criteria
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‣ The child/youth continues to meet admission criteria.‣ The child/youth is making progress but has not fully reached their goals
and additional services will be helpful.‣ Participation is contributing to the youth’s progress.‣ Additional services will contribute to the child/youth’s progress.‣ The child/youth does not require an alternative and/or higher, more
intensive level of care or treatment.‣ The child/youth is at risk of losing skills gained if the service is not
continued.‣ Treatment planning includes family/youth and other supports.
All must be met
2. Continued Stay Documentation Tips• Documentation must support ongoing need (medical necessity) to ensure services are reimbursable
• Track and note both progress AND remaining needs in progress notes
• Reference parent/child changes • Describe new interventions if progress is stalled• Be sure to describe FPA interventions• Update treatment plan as needed. If objectives are all met, but there is still work to do, update treatment plan.
3. FPSS Discharge Criteria
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‣ Child/youth no longer meets admission criteria‣ Child/youth has met goals‣ Family withdraws consent‣ Child/youth and/or family is not making/expected to make progress with
continued services‣ Child/youth and/or family is no longer engaged despite multiple,
reasonable efforts by providers‣ Child/youth and/or family no longer needs this services as they are
receiving similar benefit from other services
3. Discharge Documentation Tips‣Evidence goal/objectives have been met‣Explanation that progress is not be made and why‣ Include the plan for ongoing services and/or supports‣ For an unplanned discharge, document efforts to reconnect
with the family‣ If relevant, document why this service is no longer best to meet
the needs.
FPSS Documentation: Part 2
October 23, 2019 1:30-2:30 pmRegister here:
https://registration.nytac.org/event/?pid=1&id=874
Topics Include:Treatment Planning for FPSS
Progress Notes
Reso
urce
s
CTAC Online Learning ModuleQuality Documentation Series
PEP Online Training Modules
Documenting YourWork
Creating a Plan to Support Families
Measuring the Impact of Your Work with Families
Children’s Behavioral Health Transition to Managed Care
https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/index.htm
Family Assessment of Needs and Strengths (FANS)
https://www.ftnys.org/training-credentialing/family-needs-strengths-fans/
State MailboxesDivision of integrated Children and Family Services:[email protected]
NYS OMH Managed Care Mailbox:[email protected]
NYS OASAS Mailbox:[email protected]
NYSDOH Health Homes for Children:[email protected]
NYS OCFS Mailbox: [email protected]
Listservs
‣ Subscribe to the Children’s Managed Care Listservhttp://www.omh.ny.gov/omhweb/childservice/
‣ Subscribe to DOH Health Home Listservhttp://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/listserv.htm
‣ Health Home Bureau Mail Log (BML) https://apps.health.ny.gov/pubdoh/health_care/medicaid/program/medicaid_health_homes/emailHealthHome.action
Contact CTAC Please send questions to:
Logistical questions usually receive a response in 1 business day or less.
Longer & more complicated questions
can take longer.
We appreciate your interest and patience! Visit www.ctacny.org to view past
trainings, sign-up for updates and event announcements, and access resources
Please Note: ‣ It is important to note that this presentation provides
general guidance on documentation best practices. Please consult state guidance documents.‣The organization you work for will provide you with
agency-specific training on their documentation requirements and process.‣Documentation requirements may vary based on the
specific service, modality, and payor.
Thank You!Yvette Kelly Director of Children's Services and Healthcare Innovation CTAC/MCTAC
Anne KuppingerSenior Research Coordinator CTAC/MCTAC