training presented may 20071 rule 132 medicaid community mental health service program

Training presented May 2007 1

Rule 132 Medicaid Community Rule 132 Medicaid Community Mental Health Service ProgramMental Health Service Program


History and development History and development processprocess

Why changes:– Shift focus to recovery and resiliency– Conform to CMMS requirements– Continue efforts started in 2004 to improve ruleHow changes made:

Establish System Restructuring Initiative (SRI)Establish workgroup on each new serviceReview and incorporate other state experiencesResearch evidence-based practices/best practicesReview recent CMMS audits and actions


Underlying Vision of Recovery Underlying Vision of Recovery and Resilienceand Resilience

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


Objectives for todayObjectives 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


Handouts and Reference Handouts and Reference MaterialsMaterials

Handouts:– Agenda– PowerPoint presentation– Question cards– EvaluationReference 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


Certification ProcessCertification 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


Certification Process (cont.)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


Transition IssuesTransition 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


Transition (cont.)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


Topics for future and separate Topics for future and separate discussionsdiscussions

DCFS specific transitionDHS/DMH contract requirements


Rates, Billing and Coding Rates, Billing and Coding ChangesChanges

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


Rates, Billing and Coding Rates, Billing and Coding Changes (cont.)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


Rates, Billing and Coding Rates, Billing and Coding Changes (cont.)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/revisedRule132/)

– Each state agency has more specific instructions on billing and payment to be addressed in later training


Training Follow-up and Next Training Follow-up and Next StepsSteps

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 [email protected]


General ChangesGeneral 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


Summary of Service ChangesSummary of Service Changes

Mental health assessmentTreatment plan development, review and

modificationTherapy/counselingSkills training and development


Summary of Service Changes Summary of Service Changes (cont.)(cont.)

Therapeutic behavioral servicesMental health day treatmentMental health intensive outpatientActivity therapyIntensive family-based services


Changes to Mental Health Changes to Mental Health Assessment (132.148a)Assessment (132.148a)

Client preferencesName and contact information for primary

care physicianCompletion within 30 days of first face-to-

face contactAnnual updateMHAs must be updated by 6/30/08Medical necessity documentation


Changes to Treatment Plan Changes to Treatment Plan Development, Review and Development, Review and

Modification (132.148c)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


Changes to Therapy/CounselingChanges to Therapy/Counseling(132.150e)(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


Skills Training and Skills Training and DevelopmentDevelopment

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


Therapeutic Behavioral Therapeutic Behavioral ServicesServices

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


Mental Health Day TreatmentMental Health Day Treatment

Service no longer in treatment taxonomyService name deleted and will not be paid

for if delivered beginning 7/1/2007Providers encouraged to become certified to

provide psychosocial rehabilitation and community support (individual & group)


Activity TherapyActivity Therapy

Service no longer in treatment taxonomyService name deleted and will not be paid

for if delivered beginning 7/1/2007Providers encouraged to become certified to

provide community support (individual & group)


Intensive Family- Based Intensive Family- Based ServicesServices

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


Changes to Mental Health Changes to Mental Health Intensive Outpatient Intensive Outpatient

(132.150l)(132.150l)

May be provided to clients at risk of hospitalization


QuestionsQuestions


New or Substantially Changed New or Substantially Changed ServicesServices

Case Management – Mental HealthCommunity support – individualCommunity support – groupCommunity support – residentialCommunity support – teamAssertive community treatmentPsychosocial rehabilitation


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.


Changes to Case Management Changes to Case Management Services (132.165)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


Changes to Case Changes to Case Management (cont.)Management (cont.)

Case management may be provided for 30 days immediately preceding completion of the mental health assessment

Includes administering of LOCUS – DHS only


Case Management (cont.)Case Management (cont.)

Case management vs. Community support:– Case management does for the client– Community support teaches the client how to

do for self


Community SupportCommunity 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


Community Support – Community Support – Individual (132.150f)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


Community Support – Group Community Support – Group (132.150g)(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


Community Support – Community Support – Residential (132.150h)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


Community Support – Community Support – Residential (cont.)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


Community Support – Team Community Support – Team (132.150i)(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


Community Support – Team Community Support – Team (cont.)(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 client’s team members at any given time

Not provided to clients receiving assertive community treatment or community support individual except during transition


QuestionsQuestions


Assertive Community Assertive Community Treatment (132.150j)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


Assertive Community Assertive Community Treatment (cont.)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



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



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


Planning for New Assertive Planning for New Assertive Community TreatmentCommunity 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


Converting an Assertive Converting an Assertive Community Treatment TeamCommunity 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


Other ACT Conversion IssuesOther 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


QuestionsQuestions


Psychosocial Rehabilitation Psychosocial Rehabilitation (132.150k)(132.150k)

DefinitionClients 18 or olderFacility based – no off-site billingAvailable at least 25 hours/week at least 4

days/weekAdjunct service to community supportAll providers certified for PSR must also be

certified for community support


Psychosocial Rehabilitation Psychosocial Rehabilitation (cont.)(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


QuestionsQuestions


Vocational EngagementVocational 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

client’s broader rehabilitative or social functioning skills & are not job specific should be expressed in those terms and billed as Medicaid-covered services


Vocational AssessmentVocational Assessment

Definition Provided face to face, by telephone or video conference Minimal staff requirement – RSA Provided to adults and adolescents age 14 & over Client’s vocational goals should be integrated in the

treatment plan Does not include pre-vocational work experiences or

simulated/situational work experiences at the provider’s site


Job Finding SupportsJob 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


Job Retention SupportsJob 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


Job Leaving/Termination Job Leaving/Termination SupportsSupports


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


Outreach and Engagement

&

Stakeholder Education


Outreach and Engagement & Outreach and Engagement & Stakeholder EducationStakeholder 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


Outreach and EngagementOutreach and Engagement


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


Stakeholder EducationStakeholder 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


QuestionsQuestions

training presented may 20071 rule 132 medicaid community mental health service program

Documents

later training slide

services definition

training followup

revised rule services

group slide

csg slide

services unaffected

role of services