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Community Mental Health and Rehabilitative Services Overview

December 2017

DMAS Community Mental Health and Rehabilitative Services

• On January 1, 2018, DMAS will enact a benefit carve-in for Community Mental Health and Rehabilitation Services, referred to as CMHRS. This means that all CCC Plus health plans will assume responsibility for the administration of these services, which have historically been provided by our sister company, Magellan Healthcare of Virginia. DMAS is carving in these services in an effort to increase integration of physical and behavioral health services, and to leverage the care coordination model of the CCC Plus program.

• CMHRS are behavioral health interventions intended to provide clinical treatment to those individuals with significant mental illness or children with, or at risk of developing, serious emotional disturbances.

• These benefits are available to individuals who meet the service specific medical necessity criteria based on diagnoses made by Licensed Mental Health Professionals practicing within the scope of their licenses.

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• Day treatment/partial hospitalization

• Psychosocial rehabilitation

• Mental health skill-building

• Mental health peer supports/family supports

• Mental health case management

• Intensive community treatment

• Crisis intervention

• Crisis stabilization

• Intensive in-home services for children and adolescents.

• Therapeutic day treatment for children and adolescents.

• Behavioral therapy

DMAS Services included in the CMHRS

CMHR Services Descriptions

Services for Adults (and some older Adolescents)

Adult Day Treatment/Partial Hospitalization Programs:

• The interventions are more intensive than outpatient services and are in at least two consecutive hours.

• A multi-disciplinary team works to provide coordinated, comprehensive care to members to stabilize their psychiatric symptoms.

• The program assists with learning activities of daily living.

• Designed to help members change behaviors that are problematic in the community.

• This service may be used to prevent hospitalization for those at risk of hospitalization or as a bridge back to the community from hospitalization.

• Adult Day Treatment / PHP programs must be provided in group settings.

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Psychosocial Rehabilitation

• This service is provided in group setting.

• It is to educate members about their mental illness, provide information on the appropriate use of their medications, assist members to develop the skills needed to live independently, and help members increase their connections to their community.

• It is usually for members who have had repeated or long term psychiatric hospitalizations.

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Intensive Community Treatment (ICT)

• For members who need intensive support to live in the community.

• This service includes medical psychotherapy, psychiatric assessment, medication management, and case management activities.

• It is usually provided outside the clinic, hospital, or office setting.

• ICT utilizes a team of mental health professionals who are available either directly or on call 24 hours a day, seven days a week, 365 days a year.

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Mental Health Skill-building

• This service is intended to assist members with maintaining community stability and gaining independence.

• It helps the member remain in the most appropriate, least restrictive environment.

• Mental Health Skill-building works with member to improve functional skills.

• It helps coach members on how to complete activities of daily living and use of community resources and assists member with appropriate medication use.

• It also helps educate and model healthy living habits to maintain optimum physical health.

• It is provided on an individual basis.



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Mental Health Peer Supports

• Services provided by a person with lived experience [Peer Recovery Specialist (PRS)]

• Services assist with development of self-advocacy skills to achieve increased integration with natural support and community

• Empower people to realize their own wellness potential

• Assist with the acquisition of skills needed to engage in and maintain recovery

• This service may be provided individually or in a group setting

Services for Adults and Youth

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Services for Adults and Youth

Mental Health Case Management (also known as Targeted Case Management)

The mental health case manager assists individuals who live with severe and persistent mental health disorders in gaining access to needed services including:

• Behavioral health

• Medical

• Social

• Educational

• Other services as appropriate to the individual member

Case management does not include direct services to the member.

Mental Health Case Management can only be provided by the local CSB

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Crisis Intervention Services

• This is intended to be immediate mental health assistance available 24 hours a day, seven days a week for members experiencing acute mental health dysfunction which require immediate clinical attention. This service may include pre- admission screening activities by a community services board (CSB) or behavioral health authority (BHA).

Crisis intervention is provided to:

• Prevent symptoms from worsening.

• Prevent injury to the member or someone else.

• Provide treatment in the least restrictive setting.

Crisis Services

Crisis Services

Crisis stabilization

• This service provides direct mental health care to non-hospitalized individuals in an acute psychiatric crisis

• It helps avoid psychiatric hospitalization or re-hospitalization, provides a safe environment, provides security for crisis intervention

• Helps to stabilize individuals in psychiatric crisis

• Crisis Stabilization can also mobilize the community support system, family members, and others to assist the member with ongoing recovery

• Crisis stabilization may be provided to members in their home or in a residential setting licensed by Department of Behavioral Health and Developmental Services (DBHDS) (Excluding institutions for mental disease)

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Peer Support Services

• Peer Support Services facilitate recovery from both serious mental health conditions and substance use disorders.

• Recovery is a process in which people are able to live, work, learn and fully participate in their communities.

• Peer Support Services are delivered by trained and certified peers who have been successful in the recovery process and can extend the reach of treatment beyond the clinical setting into an individual’s community and natural environment to support and assist an individual with staying engaged in the recovery process

• Peer Support Services are targeted towards those members 21 years of age and older

Peer Support Services and Family Support Partners

Peer Support Services and Family Support Partners

Family Support Partners

• Family Support Partner Services are rendered by a Peer Recovery Specialist (PRS) who is:

− A parent of a minor or adult child with a similar mental health or substance use disorder or co-occurring mental health and substance use disorder, or

− An adult with personal experience with a family member with a similar a mental health or substance use disorder or co-occurring mental health and substance use disorder with experience navigating substance use or behavioral health care services.

• Family Support Partner Services may be provided to eligible individuals under the age of 21 who have a mental health or substance use disorder or co-occurring mental health and substance use disorders

• This service, provided to the caregiver, must be directed exclusively toward the benefit of the member.

• Services are expected to improve outcomes for youth with complex needs who are involved with multiple systems. and increase the youth and family’s confidence and capacity to manage their own services and supports while promoting recovery and healthy relationships.

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Services for Youth and their Families

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Services for youth and their families

Intensive in-home services for children and adolescents are:

• Focused, time-limited behavioral health treatment related interventions.

• More intensive than outpatient clinic services.

• Take place primarily in the youth’s home.

• Address family dynamics and communication patterns.

• Intervene in problematic behaviors of the youth.

• Provide case management for the youth.

• Access to 24-hour emergency response resource for the family.

• At least one adult family member needs to be able to participate with the goal of keeping the child with the family.

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Therapeutic day treatment

• Includes psychotherapeutic interventions, medication education and mental health treatment.

• Works with families on the development and implementation of individual behavior plans.

• Responds to any on-site behavioral crisis.

• Operates a minimum of two hours per day either before, during, or after the normal school day.

• Provides two or more therapeutic activities per day are required.

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Behavioral Therapy

• Services are for youth under age 21 who cannot engage in traditional outpatient, TDT, IIH or other services designed to assist with insight development or increased self-awareness.

• Behavioral therapy is designed to enhance communication skills and decrease maladaptive patterns of behavior that could lead to more complex problems and the need for a greater or more restrictive level of care.

• Goal is to ensure the individual’s family/caregiver is trained to support the individual in the home and community

• A behavioral modification strategy (such as applied behavior analysis) that employs systematic interventions typically provided in the individual’s home.

• The family is trained to manage the individual’s behavior in the home using behavioral modification strategies.

• Direct family involvement in the treatment program is required.

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CMHRS Essentials for Providers

Authorization Process

MH Presentation Toolbox21

Submit Service Authorization/Registration Requests by Fax to MCC of VA:

• 1-866-210-1523

• Please fax all supporting documentation with the request

Utilization Management Decision Turnaround Standards:

• All MCOs will rely on contract standards of 3 business days or up to 5 business days if additional clinical information is required

Provider Authorization/Registration Request Timeframes for Submission to MCC of VA:

• CMHRS (excluding Crisis Intervention/Crisis Stabilization) is 7 business days

• Crisis Intervention/Crisis Stabilization is 48 hours

Providers will be notified of authorization approvals or denials by letter and/or phone

Note: For denials, a letter would be sent by MCC of VA to both the provider and member, to meet NCQA requirements.

Levels of Care: Registration vs. Authorization

The CMHRS levels of care are below. The levels of care with an “R” will have a registration required (i.e. no licensed clinician required to review request), while the “A” indicates an Authorization, meaning that a licensed clinician will need to review for MNC.

Community Mental Health Rehabilitation Services (CMHRS)Procedure

Code

Registration vs.

Authorization

INITIAL

Request

Registration vs.

Authorization

CONTINUED STAY

Request

Mental Health Case Management H0023 R R

Therapeutic Day Treatment (TDT) for Children H0035 HA A A

Day Treatment/ Partial Hospitalization for Adults H0035 HB A A

Crisis Intervention H0036 R N/A

Intensive Community Treatment H0039 A R

Mental Health Skill-building Services (MHSS) H0046 A A

Intensive In-Home H2012 A A

Psychosocial Rehab H2017 A A

Crisis Stabilization H2019 R N/A

(ABA) / Behavioral Therapy H2033 A A

Mental Health Peer Support Services – Individual H0025 R A

Mental Health Peer Support Services – Group H0024 R A

MCC of VA 2018 Prior Authorization List

MH Presentation Toolbox23

Beginning 1-1-18 Community Mental Health Rehabilitative Services

• Authorization of All Services: − Behavioral Therapy/Applied Behavioral Analysis (ABA)

− Day Treatment/Partial Hospitalization for Adults

− Psychosocial Rehabilitation

− Therapeutic Day Treatment for Children

− Mental Health Skill Building Services

− Intensive In-Home

• Authorization required and then continued stay request via registration after six months:− Intensive Community Treatment

• Registration required and then continued stay request is required after 12 days of care have been provided:− Mental Health Peer Support Services/Family Support Partners Individual and Group

• Registration only required:− Mental Health Case Management

− Crisis Stabilization

− Crisis Intervention

Continuity of Care

CCC Plus MCOs will:

1. Maintain the Member’s current CMHRS providers for up to 90 days; After 4-1-18, the continuity period changes to up to 30 days;

2. Honor service authorizations (SAs) issued prior to enrollment, including those with out of network providers, for up to 90 days until or until the authorization expires, whichever comes first; and After 4-1-18, the continuity period changes to up to 30 days or until the authorization expires,

whichever comes first;

3. Extend this time frame as necessary to ensure continuity of care pending the provider’s contracting with the health plan or the member’s safe and effective transition to a qualified provider within the MCO’s provider network or as authorized by the MCO out-of-network.

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• New members will be added to the CCC Plus population as of January 1, 2018. These members may also already be receiving CMHR Services.

• The Care Coordinator will work with the member’s service providers to complete the HRA and develop the ICP including the CMHR Services as indicated by the member’s needs and desires of the member and family as appropriate to the level of care needed.

• The same continuity of care parameters will be followed for members already enrolled in CCC Plus.

• Enrolled in another MCO? The provider will need to contact the MCO the member is enrolled in for assistance as each CCC Plus MCO is now supporting their own CMHRS calls

• Enrolled in Medicaid, but not CCC Plus? Magellan of VA will continue to assist Medicaid members that are not enrolled in CCC Plus with Behavioral Health Services

New Members to CCC Plus

Carved Out Behavioral Health Services

Behavioral Health Services that are still carved out of CCC Plus Plans and still managed by Magellan of Virginia (BHSA):

• Psychiatric Residential Treatment Facility (PRTF) [formerly called Residential Level C]: Any CCC+ member admitted to a PRTF is temporarily excluded from the CCC Plus program until they are discharged. They are covered by Fee For Service until discharged.

• Treatment Foster Care Case Management (TFC-CM): Members admitted to TFC-CM currently remain in CCC Plus. This service is managed by the BHSA, while the CCC+ Plans manage the other medical, ARTS, mental health, transportation and pharmacy services as needed.

• Therapeutic Group Home (TGH) [formerly called Residential A & B]: Members admitted to a Therapeutic Group Home will remain in CCC Plus but their TGH per diem service is managed by the BHSA. The CCC+ Plans work collaboratively with Magellan of Virginia (BHSA) to manage and coordinate the other medical, ARTS, mental health, transportation and pharmacy services as needed.

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Span Billing

Span Billing

• What is span billing?− Repetitive services that span multiple dates of service on a single claim. In other

words, this means that providers can submit one claim which includes multiple units for multiple days for that level of care.

• For example: − Intensive Community Treatment (ICT) is a level of care for which span billing is allowed

− If member received 3 units of ICT on 12/4/17, 2 units of ICT on 12/6/17 and 4 units of ICT on 12/7/17----instead of submitting 3 separate claims for those 3 dates (i.e. 3 units on 12/4/17; 2 units on 12/6/17; 4 units on 12/7/17) , DMAS allows the provider to submit for 9 units from 12/4/17-12/7/17 on one claim

• Do you do span billing?− Yes, we do!

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Contacting MCC of VA

Provider/Member Services Line

1-800-424-4524, TTY: 711

Additional Training will be provided.

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Visit MCCofVA.com

Questions?

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Confidentiality statement for educational presentations

By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment.

*If the presentation includes legal information (e.g., an explanation of parity or HIPAA), add this: The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors.

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Structure BookmarksSlideSpanFigureFigureCommunity Mental Health and Rehabilitative Services OverviewCommunity Mental Health and Rehabilitative Services Overview

December 2017December 2017

SlideSpanFigureFigureFigureFigureFigureDMAS Community Mental Health and Rehabilitative ServicesDMAS Community Mental Health and Rehabilitative Services

•On January 1, 2018, DMAS will enact a benefit carve-in for Community Mental Health and Rehabilitation Services, referred to as CMHRS. This means that all CCC Plus health plans will assume responsibility for the administration of these services, which have historically been provided by our sister company, Magellan Healthcare of Virginia. DMAS is carving in these services in an effort to increase integration of physical and behavioral health services, and to leverage the care coordination model of the CCC Pl•On January 1, 2018, DMAS will enact a benefit carve-in for Community Mental Health and Rehabilitation Services, referred to as CMHRS. This means that all CCC Plus health plans will assume responsibility for the administration of these services, which have historically been provided by our sister company, Magellan Healthcare of Virginia. DMAS is carving in these services in an effort to increase integration of physical and behavioral health services, and to leverage the care coordination model of the CCC Pl•On January 1, 2018, DMAS will enact a benefit carve-in for Community Mental Health and Rehabilitation Services, referred to as CMHRS. This means that all CCC Plus health plans will assume responsibility for the administration of these services, which have historically been provided by our sister company, Magellan Healthcare of Virginia. DMAS is carving in these services in an effort to increase integration of physical and behavioral health services, and to leverage the care coordination model of the CCC Pl•On January 1, 2018, DMAS will enact a benefit carve-in for Community Mental Health and Rehabilitation Services, referred to as CMHRS. This means that all CCC Plus health plans will assume responsibility for the administration of these services, which have historically been provided by our sister company, Magellan Healthcare of Virginia. DMAS is carving in these services in an effort to increase integration of physical and behavioral health services, and to leverage the care coordination model of the CCC Pl

•CMHRS are behavioral health interventions intended to provide clinical treatment to those individuals with significant mental illness or children with, or at risk of developing, serious emotional disturbances.•CMHRS are behavioral health interventions intended to provide clinical treatment to those individuals with significant mental illness or children with, or at risk of developing, serious emotional disturbances.

•These benefits are available to individuals who meet the service specific medical necessity criteria based on diagnoses made by Licensed Mental Health Professionals practicing within the scope of their licenses.•These benefits are available to individuals who meet the service specific medical necessity criteria based on diagnoses made by Licensed Mental Health Professionals practicing within the scope of their licenses.

SlideSpanFigureFigureFigureFigure•Day treatment/partial hospitalization•Day treatment/partial hospitalization•Day treatment/partial hospitalization•Day treatment/partial hospitalization

•Psychosocial rehabilitation•Psychosocial rehabilitation

•Mental health skill-building •Mental health skill-building

•Mental health peer supports/family supports •Mental health peer supports/family supports

•Mental health case management •Mental health case management

•Intensive community treatment •Intensive community treatment

•Crisis intervention•Crisis intervention

•Crisis stabilization•Crisis stabilization

•Intensive in-home services for children and adolescents. •Intensive in-home services for children and adolescents.

•Therapeutic day treatment for children and adolescents. •Therapeutic day treatment for children and adolescents.

•Behavioral therapy •Behavioral therapy

DMAS Services included in the CMHRSDMAS Services included in the CMHRS

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SlideSpanFigureFigureCMHR Services DescriptionsCMHR Services Descriptions

SlideSpanFigureFigureFigureFigureServices for Adults (and some older Adolescents)Services for Adults (and some older Adolescents)

Adult Day Treatment/Partial Hospitalization Programs: Adult Day Treatment/Partial Hospitalization Programs: •The interventions are more intensive than outpatient services and are in at least two consecutive hours. •The interventions are more intensive than outpatient services and are in at least two consecutive hours. •The interventions are more intensive than outpatient services and are in at least two consecutive hours.

•A multi-disciplinary team works to provide coordinated, comprehensive care to members to stabilize their psychiatric symptoms. •A multi-disciplinary team works to provide coordinated, comprehensive care to members to stabilize their psychiatric symptoms.

•The program assists with learning activities of daily living. •The program assists with learning activities of daily living.

•Designed to help members change behaviors that are problematic in the community. •Designed to help members change behaviors that are problematic in the community.

•This service may be used to prevent hospitalization for those at risk of hospitalization or as a bridge back to the community from hospitalization. •This service may be used to prevent hospitalization for those at risk of hospitalization or as a bridge back to the community from hospitalization.

•Adult Day Treatment / PHP programs must be provided in group settings. •Adult Day Treatment / PHP programs must be provided in group settings.


Psychosocial Rehabilitation Psychosocial Rehabilitation •This service is provided in group setting. •This service is provided in group setting. •This service is provided in group setting.

•It is to educate members about their mental illness, provide information on the appropriate use of their medications, assist members to develop the skills needed to live independently, andhelp members increase their connections to their community. •It is to educate members about their mental illness, provide information on the appropriate use of their medications, assist members to develop the skills needed to live independently, andhelp members increase their connections to their community.

•It is usually for members who have had repeated or long term psychiatric hospitalizations. •It is usually for members who have had repeated or long term psychiatric hospitalizations.

Figure


Intensive Community Treatment (ICT) Intensive Community Treatment (ICT) •For members who need intensive support to live in the community. •For members who need intensive support to live in the community. •For members who need intensive support to live in the community.

•This service includes medical psychotherapy, psychiatric assessment, medication management, and case management activities. •This service includes medical psychotherapy, psychiatric assessment, medication management, and case management activities.

•It is usually provided outside the clinic, hospital, or office setting. •It is usually provided outside the clinic, hospital, or office setting.

•ICT utilizes a team of mental health professionals who are available either directly or on call 24 hours a day, seven days a week, 365 days a year. •ICT utilizes a team of mental health professionals who are available either directly or on call 24 hours a day, seven days a week, 365 days a year.

Figure

SlideSpanFigureFigureFigureFigureMental Health Skill-buildingMental Health Skill-building•This service is intended to assist members with maintaining community stability and gaining independence.•This service is intended to assist members with maintaining community stability and gaining independence.•This service is intended to assist members with maintaining community stability and gaining independence.

•It helps the member remain in the most appropriate, least restrictive environment.•It helps the member remain in the most appropriate, least restrictive environment.

•Mental Health Skill-building works with member to improve functional skills.•Mental Health Skill-building works with member to improve functional skills.

•It helps coach members on how to complete activities of daily living and use of community resources and assists member with appropriate medication use.•It helps coach members on how to complete activities of daily living and use of community resources and assists member with appropriate medication use.

•It also helps educate and model healthy living habits to maintain optimum physical health.•It also helps educate and model healthy living habits to maintain optimum physical health.

•It is provided on an individual basis.•It is provided on an individual basis.

Services for Adults (and some older Adolescents)Services for Adults (and some older Adolescents)


Mental Health Peer SupportsMental Health Peer Supports•Services provided by a person with lived experience [Peer Recovery Specialist (PRS)]•Services provided by a person with lived experience [Peer Recovery Specialist (PRS)]•Services provided by a person with lived experience [Peer Recovery Specialist (PRS)]

•Services assist with development of self-advocacy skills to achieve increased integration with natural support and community •Services assist with development of self-advocacy skills to achieve increased integration with natural support and community

•Empower people to realize their own wellness potential•Empower people to realize their own wellness potential

•Assist with the acquisition of skills needed to engage in and maintain recovery•Assist with the acquisition of skills needed to engage in and maintain recovery

•This service may be provided individually or in a group setting•This service may be provided individually or in a group setting

Figure

SlideSpanFigureFigureServices for Adults and YouthServices for Adults and Youth

SlideSpanFigureFigureFigureFigureServices for Adults and YouthServices for Adults and Youth

Mental Health Case Management (also known as Targeted Case Management)Mental Health Case Management (also known as Targeted Case Management)The mental health case manager assists individuals who live with severe and persistent mental health disorders in gaining access to needed services including:•Behavioral health•Behavioral health•Behavioral health

•Medical•Medical

•Social•Social

•Educational•Educational

•Other services as appropriate to the individual member•Other services as appropriate to the individual member

Case management does not include direct services to the member.Mental Health Case Management can only be provided by the local CSB

SlideSpanFigureFigureFigureFigureCrisis Intervention Services Crisis Intervention Services •This is intended to be immediate mental health assistance available 24 hours a day, seven days a week for members experiencing acute mental health dysfunction which require immediate clinical attention. This service may include pre-admission screening activities by a community services board (CSB) or behavioral health authority (BHA). •This is intended to be immediate mental health assistance available 24 hours a day, seven days a week for members experiencing acute mental health dysfunction which require immediate clinical attention. This service may include pre-admission screening activities by a community services board (CSB) or behavioral health authority (BHA). •This is intended to be immediate mental health assistance available 24 hours a day, seven days a week for members experiencing acute mental health dysfunction which require immediate clinical attention. This service may include pre-admission screening activities by a community services board (CSB) or behavioral health authority (BHA).

Crisis intervention is provided to: •Prevent symptoms from worsening. •Prevent symptoms from worsening. •Prevent symptoms from worsening.

•Prevent injury to the member or someone else. •Prevent injury to the member or someone else.

•Provide treatment in the least restrictive setting. •Provide treatment in the least restrictive setting.

Crisis ServicesCrisis Services

SlideSpanFigureFigureFigureFigureCrisis ServicesCrisis Services

Crisis stabilization Crisis stabilization •This service provides direct mental health care to non-hospitalized individuals in an acute psychiatric crisis•This service provides direct mental health care to non-hospitalized individuals in an acute psychiatric crisis•This service provides direct mental health care to non-hospitalized individuals in an acute psychiatric crisis

•It helps avoid psychiatric hospitalization or re-hospitalization,provides a safe environment, provides security for crisis intervention•It helps avoid psychiatric hospitalization or re-hospitalization,provides a safe environment, provides security for crisis intervention

•Helps to stabilize individuals in psychiatric crisis •Helps to stabilize individuals in psychiatric crisis

•Crisis Stabilization can also mobilize the community support system, family members, and others to assist the member with ongoing recovery •Crisis Stabilization can also mobilize the community support system, family members, and others to assist the member with ongoing recovery

•Crisis stabilization may be provided to members in their home or in a residential setting licensed by Department of Behavioral Health and Developmental Services (DBHDS) (Excluding institutions for mental disease) •Crisis stabilization may be provided to members in their home or in a residential setting licensed by Department of Behavioral Health and Developmental Services (DBHDS) (Excluding institutions for mental disease)

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SlideSpanFigureFigureFigureFigurePeer Support ServicesPeer Support Services•Peer Support Services facilitate recovery from both serious mental health conditions and substance use disorders. •Peer Support Services facilitate recovery from both serious mental health conditions and substance use disorders. •Peer Support Services facilitate recovery from both serious mental health conditions and substance use disorders.

•Recovery is a process in which people are able to live, work, learn and fully participate in their communities. •Recovery is a process in which people are able to live, work, learn and fully participate in their communities.

•Peer Support Services are delivered by trained and certified peers who have been successful in the recovery process and can extend the reach of treatment beyond the clinical setting into an individual’s community and natural environment to support and assist an individual with staying engaged in the recovery process•Peer Support Services are delivered by trained and certified peers who have been successful in the recovery process and can extend the reach of treatment beyond the clinical setting into an individual’s community and natural environment to support and assist an individual with staying engaged in the recovery process

•Peer Support Services are targeted towards those members 21 years of age and older•Peer Support Services are targeted towards those members 21 years of age and older

Peer Support Services and Family Support PartnersPeer Support Services and Family Support Partners

SlideSpanFigureFigureFigureFigurePeer Support Services and Family Support PartnersPeer Support Services and Family Support Partners

Family Support PartnersFamily Support Partners•Family Support Partner Services are rendered by a Peer Recovery Specialist (PRS) who is: •Family Support Partner Services are rendered by a Peer Recovery Specialist (PRS) who is: •Family Support Partner Services are rendered by a Peer Recovery Specialist (PRS) who is:

−A parent of a minor or adult child with a similar mental health or substance use disorder or co-occurring mental health and substance use disorder, or −A parent of a minor or adult child with a similar mental health or substance use disorder or co-occurring mental health and substance use disorder, or −A parent of a minor or adult child with a similar mental health or substance use disorder or co-occurring mental health and substance use disorder, or

−An adult with personal experience with a family member with a similar a mental health or substance use disorder or co-occurring mental health and substance use disorder with experience navigating substance use or behavioral health care services. −An adult with personal experience with a family member with a similar a mental health or substance use disorder or co-occurring mental health and substance use disorder with experience navigating substance use or behavioral health care services.

•Family Support Partner Services may be provided to eligible individuals under the age of 21 who have a mental health or substance use disorder or co-occurring mental health and substance use disorders•Family Support Partner Services may be provided to eligible individuals under the age of 21 who have a mental health or substance use disorder or co-occurring mental health and substance use disorders

•This service, provided to the caregiver, must be directed exclusively toward the benefit of the member. •This service, provided to the caregiver, must be directed exclusively toward the benefit of the member.

•Services are expected to improve outcomes for youth with complex needs who are involved with multiple systems. and increase the youth and family’s confidence and capacity to manage their own services and supports while promoting recovery and healthy relationships. •Services are expected to improve outcomes for youth with complex needs who are involved with multiple systems. and increase the youth and family’s confidence and capacity to manage their own services and supports while promoting recovery and healthy relationships.

SlideSpanFigureFigureServices for Youth and their FamiliesServices for Youth and their Families

SlideSpanFigureFigureFigureFigureFigureServices for youth and their families Services for youth and their families

Intensive in-home services for children and adolescents are:Intensive in-home services for children and adolescents are:•Focused, time-limited behavioral health treatment related interventions. •Focused, time-limited behavioral health treatment related interventions. •Focused, time-limited behavioral health treatment related interventions.

•More intensive than outpatient clinic services. •More intensive than outpatient clinic services.

•Take place primarily in the youth’s home. •Take place primarily in the youth’s home.

•Address family dynamics and communication patterns. •Address family dynamics and communication patterns.

•Intervene in problematic behaviors of the youth. •Intervene in problematic behaviors of the youth.

•Provide case management for the youth. •Provide case management for the youth.

•Access to 24-hour emergency response resource for the family. •Access to 24-hour emergency response resource for the family.

•At least one adult family member needs to be able to participate with the goal of keeping the child with the family. •At least one adult family member needs to be able to participate with the goal of keeping the child with the family.

SlideSpanFigureFigureFigureFigureServices for youth and their families Services for youth and their families

Therapeutic day treatment Therapeutic day treatment •Includes psychotherapeutic interventions, medication education and mental health treatment. •Includes psychotherapeutic interventions, medication education and mental health treatment. •Includes psychotherapeutic interventions, medication education and mental health treatment.

•Works with families on the development and implementation of individual behavior plans. •Works with families on the development and implementation of individual behavior plans.

•Responds to any on-site behavioral crisis. •Responds to any on-site behavioral crisis.

•Operates a minimum of two hours per day either before, during, or after the normal school day. •Operates a minimum of two hours per day either before, during, or after the normal school day.

•Provides two or more therapeutic activities per day are required. •Provides two or more therapeutic activities per day are required.

SlideSpanFigureFigureFigureFigureServices for youth and their families Services for youth and their families

Behavioral TherapyBehavioral Therapy•Services are for youth under age 21 who cannot engage in traditional outpatient, TDT, IIH or other services designed to assist with insight development or increased self-awareness. •Services are for youth under age 21 who cannot engage in traditional outpatient, TDT, IIH or other services designed to assist with insight development or increased self-awareness. •Services are for youth under age 21 who cannot engage in traditional outpatient, TDT, IIH or other services designed to assist with insight development or increased self-awareness.

•Behavioral therapy is designed to enhance communication skills and decrease maladaptive patterns of behavior that could lead to more complex problems and the need for a greater or more restrictive level of care.•Behavioral therapy is designed to enhance communication skills and decrease maladaptive patterns of behavior that could lead to more complex problems and the need for a greater or more restrictive level of care.

•Goal is to ensure the individual’s family/caregiver is trained to support the individual in the home and community•Goal is to ensure the individual’s family/caregiver is trained to support the individual in the home and community

•A behavioral modification strategy (such as applied behavior analysis) that employs systematic interventions typically provided in the individual’s home.•A behavioral modification strategy (such as applied behavior analysis) that employs systematic interventions typically provided in the individual’s home.

•The family is trained to manage the individual’s behavior in the home using behavioral modification strategies.•The family is trained to manage the individual’s behavior in the home using behavioral modification strategies.

•Direct family involvement in the treatment program is required.•Direct family involvement in the treatment program is required.

SlideSpanFigureFigureCMHRS Essentials for ProvidersCMHRS Essentials for Providers

SlideSpanFigureFigureFigureFigureAuthorization ProcessAuthorization Process

Submit Service Authorization/Registration Requests by Fax to MCC of VA:Submit Service Authorization/Registration Requests by Fax to MCC of VA:•1-866-210-1523•1-866-210-1523•1-866-210-1523

•Please fax all supporting documentation with the request•Please fax all supporting documentation with the request

Utilization Management Decision Turnaround Standards:•All MCOs will rely on contract standards of 3 business days or up to 5 business days if additional clinical information is required•All MCOs will rely on contract standards of 3 business days or up to 5 business days if additional clinical information is required•All MCOs will rely on contract standards of 3 business days or up to 5 business days if additional clinical information is required

Provider Authorization/Registration Request Timeframes for Submission to MCC of VA:•CMHRS (excluding Crisis Intervention/Crisis Stabilization) is 7 business days•CMHRS (excluding Crisis Intervention/Crisis Stabilization) is 7 business days•CMHRS (excluding Crisis Intervention/Crisis Stabilization) is 7 business days

•Crisis Intervention/Crisis Stabilization is 48 hours•Crisis Intervention/Crisis Stabilization is 48 hours

Providers will be notified of authorization approvals or denials by letter and/or phone

Note:For denials, a letter would be sent by MCC of VA to both the provider and member, to meet NCQA requirements.Note:For denials, a letter would be sent by MCC of VA to both the provider and member, to meet NCQA requirements.

SlideSpanFigureFigureFigureFigureLevels of Care: Registration vs. AuthorizationLevels of Care: Registration vs. Authorization

The CMHRS levels of care are below. The levels of care with an “R” will have a registration required (i.e. no licensed clinician required to review request), while the “A” indicates an Authorization, meaning that a licensed clinician will need to review for MNC.The CMHRS levels of care are below. The levels of care with an “R” will have a registration required (i.e. no licensed clinician required to review request), while the “A” indicates an Authorization, meaning that a licensed clinician will need to review for MNC.

TableSpanCommunity Mental Health Rehabilitation Services (CMHRS)Community Mental Health Rehabilitation Services (CMHRS)Community Mental Health Rehabilitation Services (CMHRS)Community Mental Health Rehabilitation Services (CMHRS)

Procedure CodeProcedure CodeProcedure Code

Registration vs. AuthorizationRegistration vs. AuthorizationRegistration vs. AuthorizationINITIALRequest

Registration vs. AuthorizationRegistration vs. AuthorizationRegistration vs. AuthorizationCONTINUED STAYRequest

Mental Health Case ManagementMental Health Case ManagementMental Health Case ManagementMental Health Case Management

H0023H0023H0023

RRR

RRR

Therapeutic Day Treatment (TDT) for ChildrenTherapeutic Day Treatment (TDT) for ChildrenTherapeutic Day Treatment (TDT) for ChildrenTherapeutic Day Treatment (TDT) for Children

H0035 HAH0035 HAH0035 HA

AAA

AAA

Day Treatment/ Partial Hospitalization for AdultsDay Treatment/ Partial Hospitalization for AdultsDay Treatment/ Partial Hospitalization for AdultsDay Treatment/ Partial Hospitalization for Adults

H0035 HBH0035 HBH0035 HB

AAA

AAA

Crisis InterventionCrisis InterventionCrisis InterventionCrisis Intervention

H0036H0036H0036

RRR

N/AN/AN/A

Intensive Community Treatment Intensive Community Treatment Intensive Community Treatment Intensive Community Treatment

H0039H0039H0039

AAA

RRR

Mental Health Skill-building Services (MHSS)Mental Health Skill-building Services (MHSS)Mental Health Skill-building Services (MHSS)Mental Health Skill-building Services (MHSS)

H0046H0046H0046

AAA

AAA

Intensive In-HomeIntensive In-HomeIntensive In-HomeIntensive In-Home

H2012H2012H2012

AAA

AAA

Psychosocial RehabPsychosocial RehabPsychosocial RehabPsychosocial Rehab

H2017H2017H2017

AAA

AAA

Crisis StabilizationCrisis StabilizationCrisis StabilizationCrisis Stabilization

H2019H2019H2019

RRR

N/AN/AN/A

(ABA) / Behavioral Therapy(ABA) / Behavioral Therapy(ABA) / Behavioral Therapy(ABA) / Behavioral Therapy

H2033H2033H2033

AAA

AAA

Mental Health Peer Support Services –IndividualMental Health Peer Support Services –IndividualMental Health Peer Support Services –IndividualMental Health Peer Support Services –Individual

H0025H0025H0025

RRR

AAA

Mental Health Peer Support Services –GroupMental Health Peer Support Services –GroupMental Health Peer Support Services –GroupMental Health Peer Support Services –Group

H0024H0024H0024

RRR

AAA

SlideSpanFigureFigureFigureFigureMCC of VA 2018 Prior Authorization ListMCC of VA 2018 Prior Authorization List

Beginning 1-1-18 Community Mental Health Rehabilitative ServicesBeginning 1-1-18 Community Mental Health Rehabilitative Services•Authorization of All Services: •Authorization of All Services: •Authorization of All Services:

−Behavioral Therapy/Applied Behavioral Analysis (ABA)−Behavioral Therapy/Applied Behavioral Analysis (ABA)−Behavioral Therapy/Applied Behavioral Analysis (ABA)

−Day Treatment/Partial Hospitalization for Adults−Day Treatment/Partial Hospitalization for Adults

−Psychosocial Rehabilitation −Psychosocial Rehabilitation

−Therapeutic Day Treatment for Children−Therapeutic Day Treatment for Children

−Mental Health Skill Building Services−Mental Health Skill Building Services

−Intensive In-Home−Intensive In-Home

•Authorization required and then continued stay request via registration after six months:•Authorization required and then continued stay request via registration after six months:•Authorization required and then continued stay request via registration after six months:•Authorization required and then continued stay request via registration after six months:

−Intensive Community Treatment−Intensive Community Treatment−Intensive Community Treatment

•Registration required and then continued stay request is required after 12 days of care have been provided:•Registration required and then continued stay request is required after 12 days of care have been provided:

−Mental Health Peer Support Services/Family Support Partners Individual and Group−Mental Health Peer Support Services/Family Support Partners Individual and Group−Mental Health Peer Support Services/Family Support Partners Individual and Group

•Registration only required:•Registration only required:

−Mental Health Case Management−Mental Health Case Management−Mental Health Case Management

−Crisis Stabilization−Crisis Stabilization

−Crisis Intervention−Crisis Intervention

SlideSpanFigureFigureFigureFigureContinuity of CareContinuity of Care

CCC Plus MCOs will: CCC Plus MCOs will: 1.Maintain the Member’s current CMHRS providers for up to 90 days; 1.Maintain the Member’s current CMHRS providers for up to 90 days; 1.Maintain the Member’s current CMHRS providers for up to 90 days;

After 4-1-18, the continuity period changes to up to 30 days;After 4-1-18, the continuity period changes to up to 30 days;After 4-1-18, the continuity period changes to up to 30 days;

2.Honor service authorizations (SAs) issued prior to enrollment, including those with out of network providers, for up to 90 days until or until the authorization expires, whichever comes first; and 2.Honor service authorizations (SAs) issued prior to enrollment, including those with out of network providers, for up to 90 days until or until the authorization expires, whichever comes first; and 2.Honor service authorizations (SAs) issued prior to enrollment, including those with out of network providers, for up to 90 days until or until the authorization expires, whichever comes first; and

After 4-1-18, the continuity period changes to up to 30 days or until the authorization expires, whichever comes first;After 4-1-18, the continuity period changes to up to 30 days or until the authorization expires, whichever comes first;After 4-1-18, the continuity period changes to up to 30 days or until the authorization expires, whichever comes first;

3.Extend this time frame as necessary to ensure continuity of care pending the provider’s contracting with the health plan or the member’s safe and effective transition to a qualified provider within the MCO’s provider network or as authorized by the MCO out-of-network. 3.Extend this time frame as necessary to ensure continuity of care pending the provider’s contracting with the health plan or the member’s safe and effective transition to a qualified provider within the MCO’s provider network or as authorized by the MCO out-of-network.

SlideSpanFigureFigureFigureFigure•New members will be added to the CCC Plus population as of January 1, 2018. These members may also already be receiving CMHR Services.•New members will be added to the CCC Plus population as of January 1, 2018. These members may also already be receiving CMHR Services.•New members will be added to the CCC Plus population as of January 1, 2018. These members may also already be receiving CMHR Services.•New members will be added to the CCC Plus population as of January 1, 2018. These members may also already be receiving CMHR Services.

•The Care Coordinator will work with the member’s service providers to complete the HRA and develop the ICP including the CMHR Services as indicated by the member’s needs and desires of the member and family as appropriate to the level of care needed. •The Care Coordinator will work with the member’s service providers to complete the HRA and develop the ICP including the CMHR Services as indicated by the member’s needs and desires of the member and family as appropriate to the level of care needed.

•The same continuity of care parameters will be followed for members already enrolled in CCC Plus. •The same continuity of care parameters will be followed for members already enrolled in CCC Plus.

•Enrolled in another MCO? The provider will need to contact the MCO the member is enrolled in for assistance as each CCC Plus MCO is now supporting their own CMHRS calls•Enrolled in another MCO? The provider will need to contact the MCO the member is enrolled in for assistance as each CCC Plus MCO is now supporting their own CMHRS calls

•Enrolled in Medicaid, but not CCC Plus? Magellan of VA will continue to assist Medicaid members that are not enrolled in CCC Plus with Behavioral Health Services•Enrolled in Medicaid, but not CCC Plus? Magellan of VA will continue to assist Medicaid members that are not enrolled in CCC Plus with Behavioral Health Services

New Members to CCC PlusNew Members to CCC Plus

SlideSpanFigureFigureFigureFigureCarved Out Behavioral Health Services Carved Out Behavioral Health Services

Behavioral Health Services that are still carved out of CCC Plus Plans and still managed by Magellan of Virginia (BHSA):Behavioral Health Services that are still carved out of CCC Plus Plans and still managed by Magellan of Virginia (BHSA):•Psychiatric Residential Treatment Facility (PRTF) [formerly called Residential Level C]:Any CCC+ member admitted to a PRTF is temporarily excluded from the CCC Plus program until they are discharged. They are covered by Fee For Service until discharged.•Psychiatric Residential Treatment Facility (PRTF) [formerly called Residential Level C]:Any CCC+ member admitted to a PRTF is temporarily excluded from the CCC Plus program until they are discharged. They are covered by Fee For Service until discharged.•Psychiatric Residential Treatment Facility (PRTF) [formerly called Residential Level C]:Any CCC+ member admitted to a PRTF is temporarily excluded from the CCC Plus program until they are discharged. They are covered by Fee For Service until discharged.

•Treatment Foster Care Case Management (TFC-CM):Members admitted to TFC-CM currently remain in CCC Plus. This service is managed by the BHSA, while the CCC+ Plans manage the other medical, ARTS, mental health, transportation and pharmacy services as needed.•Treatment Foster Care Case Management (TFC-CM):Members admitted to TFC-CM currently remain in CCC Plus. This service is managed by the BHSA, while the CCC+ Plans manage the other medical, ARTS, mental health, transportation and pharmacy services as needed.

•Therapeutic Group Home (TGH) [formerly called Residential A & B]:Members admitted to a Therapeutic Group Home will remain in CCC Plus but their TGH per diem service is managed by the BHSA. The CCC+ Plans work collaboratively with Magellan of Virginia (BHSA) to manage and coordinate the other medical, ARTS, mental health, transportation and pharmacy services as needed. •Therapeutic Group Home (TGH) [formerly called Residential A & B]:Members admitted to a Therapeutic Group Home will remain in CCC Plus but their TGH per diem service is managed by the BHSA. The CCC+ Plans work collaboratively with Magellan of Virginia (BHSA) to manage and coordinate the other medical, ARTS, mental health, transportation and pharmacy services as needed.

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SlideSpanFigureFigureFigureFigureSpan BillingSpan Billing

Span BillingSpan Billing•What is span billing?•What is span billing?•What is span billing?

−Repetitive services that span multiple dates of service on a single claim. In other words, this means that providers can submit one claim which includes multiple units for multiple days for that level of care.−Repetitive services that span multiple dates of service on a single claim. In other words, this means that providers can submit one claim which includes multiple units for multiple days for that level of care.−Repetitive services that span multiple dates of service on a single claim. In other words, this means that providers can submit one claim which includes multiple units for multiple days for that level of care.

•For example: •For example:

−Intensive Community Treatment (ICT) is a level of care for which span billing is allowed−Intensive Community Treatment (ICT) is a level of care for which span billing is allowed

−If member received 3 units of ICT on 12/4/17, 2 units of ICT on 12/6/17 and 4 units of ICT on 12/7/17----instead of submitting 3 separate claims for those 3 dates (i.e. 3 units on 12/4/17; 2 units on 12/6/17; 4 units on 12/7/17) , DMAS allows the provider to submit for 9 units from 12/4/17-12/7/17 on one claim−If member received 3 units of ICT on 12/4/17, 2 units of ICT on 12/6/17 and 4 units of ICT on 12/7/17----instead of submitting 3 separate claims for those 3 dates (i.e. 3 units on 12/4/17; 2 units on 12/6/17; 4 units on 12/7/17) , DMAS allows the provider to submit for 9 units from 12/4/17-12/7/17 on one claim

•Do you do span billing?•Do you do span billing?

−Yes, we do! −Yes, we do! −Yes, we do!

SlideSpanFigureFigureFigureFigureFigureContacting MCC of VAContacting MCC of VA

Provider/Member Services LineProvider/Member Services LineProvider/Member Services LineProvider/Member Services Line1-800-424-4524, TTY: 711Additional Training will be provided.

FigureFigure

FigureFigureVisit MCCofVA.comVisit MCCofVA.com

SlideSpanFigureFigureQuestions?Questions?

SlideSpanFigureFigureFigureFigureConfidentiality statement for educational presentationsConfidentiality statement for educational presentations

By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment.*If the presentation includes legal information (e.g., an explanation of parity or HIPAA), add this:The information contained in this presentation is intended for educational purposes only and should not be considered legal advice.Recipients are encouraged to obtain legal guidance from their own legal advisors.

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