BPA HEALTH€¦ · 17/06/2019 · Network. This Provider Orientation Packet is designed to supplement the WITS training you have already completed and the BPA Health Orientation

BPA HEALTH NEW SUD PROVIDER

ORIENTATION PACKET (UPDATE 6/17/19)

New Provider Orientation Packet Page 1 of 29

BPA Health New SUD Provider Orientation Packet

Table of Contents SUD Provider Overview ................................................................................................................ 2

Funding ........................................................................................................................................... 2

Partner Specific Information........................................................................................................ 3

Services .......................................................................................................................................... 7

Implementation of Evidence-based Programs (EBP).............................................................. 8

Supervision Requirements ........................................................................................................... 8

Policies and Procedures .............................................................................................................. 8

Critical Incidents ........................................................................................................................... 8

Complaints and Appeals ............................................................................................................ 9

Staff Updates ................................................................................................................................. 9

Documentation ............................................................................................................................. 9

Quality Assurance and Compliance Audits .......................................................................... 11

Billing and Withholds ................................................................................................................. 11

Meetings ..................................................................................................................................... 12

Resources, Technical Assistance, and Training .................................................................... 12

What happens next? ................................................................................................................. 12

Appendix .................................................................................................................................... 14

Appendix A –IDHW ROI ............................................................................................................. 15

Appendix B – IDOC Status Report ........................................................................................... 16

Appendix C – Case Management Assessment (Sample) .................................................. 17

Appendix D – Client Handbook (Sample) ............................................................................. 19

Appendix E – Release of Information (Sample) .................................................................... 24

Appendix F – Service Plan (Sample) ....................................................................................... 25

Appendix G – Provider Orientation Checklist ....................................................................... 28


Welcome to the BPA Health Substance Use Disorder (SUD) Provider

Network. This Provider Orientation Packet is designed to supplement the

WITS training you have already completed and the BPA Health Orientation

webinar you have watched, in order to assist you in successfully

implementing a quality SUD program that is compliant with State, Federal

and BPA Health standards. Documents mentioned in this orientation packet

and the webinar can be found on our website at www.bpahealth.com. We

encourage you to review this information with all employees.

SUD Provider Overview

All providers in the BPA Health Substance Use Disorders (SUD) Network are required to

comply with IDAPA codes 16.07.15 and 16.07.17, as well as BPA Health SUD Provider

and Supervision Manuals, and terms of signed contract and addendums. These

requirements cover administrative and clinical processes.

Funding - The State of Idaho’s SUD treatment dollars are funded through the following

State Partners:

Idaho Department of Health and Welfare (IDHW) receives funding from State

General Funds, and Federal grants including the Substance Abuse Treatment

and Prevention Block Grant (SABG), and the State Targeted Response Grant for

the treatment and prevention of Opiate Use Disorders -Idaho’s Response to the

Opioid Crisis (IROC).

o Substance Abuse Block Grant (SABG) –The SABG requires Providers to

adhere to specific guidelines including Specialized Services for Pregnant

Women and Women with Children (PWWC); Prioritized Services for Persons

Who Inject Drugs (PWID); education on the effects of IV drug use, HIV, and

TB and the risk of needle sharing; and screening and treatment for

tuberculosis (TB). More detailed information on SABG requirements can be

found in the BPA Health Orientation video and in the BPA Health SUD

Provider Manual.

o Idaho’s State Opioid Response Grant (Referred to as IROC/SOR) – the

grant requirements include: IROC/SOR Providers to use clinically

appropriate evidence-based practices (EBP) for Opioid Use Disorder

treatment, develop an agreement with a Data 2000 Waivered Prescriber

who may provide Medication Assisted Treatment (MAT), not require clients

to taper off or stop the use of MAT inconsistent with prescriber’s

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recommendations OR require clients to use MAT, encourage Naloxone

training and kits, and collect all outcomes data, including GPRA if

required. See Addendum for specific details.

Idaho Department of Corrections (IDOC) who receives funding from the State

General Fund and Millennium Fund

Idaho Supreme Court (ISC) who receives funding from the State General Fund

Idaho Department of Juvenile Corrections (IDJC) who received funding from the

State General Fund

Oversight- based on funding source:

SUD SERVICES

Network

Management

Eligibility

Screening

Initial

Authorization

Continued

Stay Review

Claims

IDHW BPA BPA BPA BPA BPA

IDOC BPA IDOC IDOC BPA BPA

ISC BPA Courts Courts Courts Courts

IDJC BPA IDJC IDJC IDJC IDJC

Partner Specific Information – Populations, processes and requirements vary by

funding type. See addendums for more information. Here are some important things to

remember:

IDHW

Populations Served include:

PWWC Pregnant women and women with dependent children.

PWID - Persons

Who Inject Drugs

Individuals who report an IV use as primary and

continuous method of substance use with specific IV use

within the last 30 calendar days.

IROC/SOR Individuals who have Opioid Use Disorder (OUD)

DHW Supervised

Misdemeanant

Individuals with a misdemeanant charge who are

supervised by misdemeanor probation officers and require

SUD treatment.

Adult Mental

Health (AMH)

Referred

Adult co-occurring behavioral health clients referred by

an IDHW Adult Mental health clinician for SUD treatment

only.

IDHW Adult Voluntary population who earn less than 100% Federal

Poverty Guideline (FPG) and meet clinical criteria.

IDHW Adolescent

Population under the age of 18 that are not involved in

the criminal justice system and who do not have health

insurance.


IDHW

Misdemeanor

Problem-Solving

court

Supervised Misdemeanants who are participating in a

problem-solving court.

Child Protection

Clients entering treatment services through a Child

Protection/SUD liaison referral and have an open child

protection case

State Hospital Clients entering SUD treatment services directly from state

hospitals.

IDHW Adult

Mental Health

Court (MHC)

Individuals involved with Mental Health Court

IDWH has two (2) Specialty Provider Networks which require signed addendums.

See the addendums for additional requirements:

o Pregnant Women and Women with Dependent Children (PWWC) – agree

to treat the family as a unit, admitting both women and their children into

treatment services, if appropriate. At a minimum, treatment program shall

provide or arrange for the provision of an array of services (see

addendum for specifics) to pregnant women and women with

dependent children, including women who are attempting to regain

custody of their children.

o Idaho Response to the Opioid Crisis (IROC/SOR) – agree to utilize an

evidence based practice identified for treatment of opiate use disorders

(OUD), develop a partnership with a Data Waiver 2000 Medication

Assisted Treatment (MAT) prescriber, coordinate treatment and MAT

services, facilitate payment to MAT prescriber and payment for

medications, link clients with HIV/AIDS/Infectious Disease treatment

providers, and encourage clients to receive Naloxone training and kits,

work with pregnant women with OUD, and collect outcome data.


IDOC


19-2524 Adult felons under active IDOC supervision granted

access to state funded SUD services via IC 19-2524.

Risk to Revocate

Adult felons under active IDOC supervision with

drug/alcohol use within the previous 30 calendar day

period.

Reentry (or

Parolee

Aftercare)

Adult felons reentering the community on active IDOC

supervision after a period of IDOC incarceration.

Provider service requests outside of the IDOC matrix are forwarded by BPA

Health to IDOC for review and consideration.

IDOC requires providers to sign the IDOC Addendum in order to receive IDOC

referrals (see addendum for complete requirements). Exceptions may be made

in some rural areas. Provider must agree to:

o Complete GAIN assessment within ten business (10) days if one hasn’t

already been completed

o Utilize cognitive-behavioral based programming that addresses SUD and

criminogenic thinking

o Require Drug and Alcohol Tests up to two times per week

o Utilize Case Management

o Utilize LSI-R score, found in the comment section of the initial referral, in

establishing treatment program

o Consistent and regular contact with Probation/Parole Officer (PPO),

identified in the comment section of the initial referral. A monthly Status

Update Report must be submitted via IDOC electronic procedures.

19-2524 GAIN assessments must be completed within 10 days of referral unless

otherwise specified in the comment section of the referral. If the provider is

unable to meet this deadline, they must contact the Pre-Sentence Investigator

(PSI) or District Clinician to transfer the authorization to another provider. If

unable to reach the client or client is no-showing/rescheduling and the deadline

will not be met the Provider must communicate this to either the PSI or District

Clinician as it will impact sentencing dates with the court. Documentation of this

communication must be in the client file. All PSI GAINs must be consented and

referred to the appropriate IDHW DBH Region. DHW screens all pre-sentence

assessments and makes mental health treatment recommendations for the

courts. DO NOT MAKE mental health treatment recommendations for the 19-


2524 population. Mental health treatment recommendations can be referred to

the screening recommendations of DHW.

The following services (not levels of care) are available to some IDOC clients.

o Pre-Treatment

Up to four (4) hours a week of group or individual treatment and RSS

(see matrix for which are allowed).

Maximum of sixty (60) days to assess willingness and readiness to

change, explore and address risk factors, gather collateral

information, and assess all six (6) ASAM Dimensions.

Prior to the end of 60 days, if/when provider determines client is

attending and engaged in 50% or greater of appointments being

offered (attendance and engagement guidelines don’t apply if

client meets criteria for Level 3.5 – which can be authorized prior to

attending pre-treatment), provider shall complete either an ASAM

Concurrent Review or a GAIN assessment if there is not a current

GAIN, to identify readiness and willingness to commit to SUD

treatment and assesses readiness and willing to commit to

treatment submit Authorization Change Request (ACR) to admit

into a level of care.

If client is making progress but doesn’t need a higher level of care,

or is not ready to engage in a higher level, another Pre-Treatment

episode may be requested.

Discharge from Pre-Treatment if client has completed early

intervention and does not meet criteria for higher level of care OR if

the client is unwilling to participate (less than 50%) and lack of RSS

availability is not the reason. Work with the PO in these cases to find

alternatives to treatment in the community.

o Re-entry/Parolee Aftercare – The purpose is to focus on identification and

intervention for issues related to motivation for change, relapse prevention

and social support and environment during the community reintegration

process.

Authorizes four (4) hours a week of bundled education, group,

individual and individual with family member present therapy

services and RSS services.

Provider shall engage client in treatment immediately (within 10

business days). IDOC has been granted a waiver from DHW to not

require these clients to complete a GAIN. Providers are encouraged

to do conduct a dimensional assessment with clients to determine

needs and to develop service plan based on that interview. Many

of these clients will also be engaged in aftercare groups at IDOC


District offices. Collaboration with the PPO and required aftercare

groups should be considered when developing the service plan

with the client.

Authorization Change Request (ACR) may be submitted for review

if client displays increased symptomology and meets admission

criteria for a level of care or if client is not ready to commit/engage

in services and could benefit from additional Parolee Aftercare

services.

ISC


Problem Solving

Courts

Individuals that have pled guilty and agreed to

participate in a problem-solving court. Offenders

admitted to a problem-solving court would receive SUD

services as necessary.

Problem Solving Courts – District courts may choose to contract with a specific

provider(s) to provide treatment services to individual enrolled in problem

solving courts (e.g. Drug Court). BPA Health does not manage the court

contracts.

IDJC


Justice Involved

Juveniles

Justice-involved juveniles requiring SUD services at ASAM

Level 1.0 or higher who are not engaged in a problem

solving court.

Providers must work collaboratively with referral sources, such as probation

officers and others on the client’s treatment team.

Providers must attempt to engage client’s family, with whom they have a close

emotional connection, in treatment. If this is not clinically recommended, or

client or family refuses this shall be clearly documented in WITS.

Services There are a number of authorized Treatment and Recovery Support Services (RSS).

Descriptions of these services can be found in IDAPA and the BPA Health SUD Provider

Manual. See the Partners’ Rate Matrices on the BPA Health website for the most up-to

date listing of allowable services, rates, and service limitations.


Implementation of Evidence-based Programs (EBP) All treatment providers must utilize EBPs for all group services. The EBP must be

appropriate for clients being served and staff must meet criteria to facilitate the EBP.

Prior to implementing an EBP, providers must complete and submit a written

description of the EBP (form can be found on BPA Health website), for review and

approval.

Supervision Requirements All clinicians, trainees, case managers, and recovery coaches are required to meet

criteria outlined in IDAPA and the BPA SUD Provider Manual in order to bill for services

and must receive regular supervision as outlined in the BPA Health Supervision Manual

(see manual on BPA Health website). Supervision is an integral part of any quality

assurance program. Watch the supervision webinar on the BPA Health website to learn

more about how to incorporate into your agency.

Policies and Procedures All treatment and RSS providers shall maintain written policies and procedures as

outlined in IDAPA, BPA Health SUD Provider and Supervisor Manuals, and contracts

and addendums.

Critical Incidents Providers must submit a completed Critical Incident Report form within twenty-four (24)

hours of becoming aware of a critical incident (form is located on BPA Health

website).

A critical incident is any incident that threatens the safe and efficient operations of

provider; or has caused, or could have caused physical or emotional distress to staff,

visitors, or the participants of the program. Reporting incidents such as, but not limited

to, office break-ins, staff arrest, staff engaging in inappropriate relationships with

clients, client suicide attempts or completions, injuries requiring medical treatment

more intensive than first aid, self-inflicted injuries that require more intensive medical

treatment than first aid, death by natural causes of a current client or one who has

received services within the last thirty (30) days, or death of a former client other than

natural causes more than one year after discharge. Additionally, homicide; any

incident involving suspected or alleged abuse, neglect, or exploitation of minors or

vulnerable adults; or threats must also be reported.

Providers serving adolescents in residential treatment are also required to report the

following to BPA Health as well as to Probation Officers and parents/guardians:

Drugs and/or alcohol found and/or used in the facility

Any sexual contact or inappropriate physical behavior


Any incident where a client leaves the facility premises without permission

If a provider isn’t sure if an incident meets criteria of a critical incident they are to

submit to BPA Health for review and determination. Failure to comply with reporting

requirements may result in sanctions.

Once BPA Health receives a critical incident form it is reviewed to determine if it meets

criteria as well as looks for possible quality improvement areas with systems, processes,

or provider services. BPA Health will monitor and look for patterns of similar critical

incidents with providers around the state to inform possible changes in processes,

training needs, and/or identify need for root cause analysis.

Complaints and Appeals BPA Health will investigate all complaints and review all appeals, with the exception of

those regarding referrals or compensation for IDJC or ISC funded treatment. Those are

referred directly to IDJC or ISC for investigation and follow-up. Our complaints and

appeals policies can be found in the BPA Health SUD Provider Manual. The Appeals

form can be found on the BPA Health website.

Staff Updates Providers must complete the staff update form located on the BPA Health website for

all new staff members and for any staff that leaves the organization. This form must be

completed within 24 hours of a staff member being hired or leaving. Additionally,

providers must notify the WITS Helpdesk within 24 hours of a staff member leaving to

ensure WITS access is removed (form can be found on WITS website). Failure to

comply with either of these may result in sanctions.

Documentation In order to bill for a service the encounter note must be entered into WITS. In addition

to intake documentation, all encounter notes, plans, discharge summaries must be

clear, individualized, and reference evidence-based programs. Any documentation

entered by an intern or trainee must include documentation that it was reviewed by

and counter-signed by supervisor or Qualified SUD Professional (QP). All claims are

paid on encounter notes entered into WITS (exception is ISC’s flat fee rates).

Required – There are a number of required documents that need to be completed or

reviewed at intake. All required forms, as well as sample templates, can be found in

the attachments in this packet and on the BPA Health website.

Financial determination (required for treatment providers only) - completed in

WITS (generally by person entering the authorization), updated by treatment

provider as changes occur and minimally once per year. This is not required for

IDJC or ISC funded clients.


IDHW General Release Form (required form for all)

Releases of Information (ROI) for any other appropriate individuals to coordinate

care (e.g. PO, Recovery Support Service providers, physician, etc.). This is

required for all (sample form on website).

Notification of use of any trainees (required for treatment providers only – this

may be a part of a provider’s Client Handbook - sample on website)

Client Rights (required for all – rights listed in IDAPA)

TB/HIV/Infectious Disease referrals (required for treatment providers only – this

may be a part of Client Handbook – sample on website)

HIPAA and 42 CFR Part 2 confidentiality practices notification (required for all –

this may be a part of Client Handbook – sample on website)

Assessments – identify the clients’ strengths and needs and serve as the basis of

clients’ treatment and case management plans. For IDOC clients, it is important to also

consider LSI-R score.

GAIN assessments must be consented in WITS to BPA Health and/or funding

partner (BPA Health does not review IDJC or ISC assessments). If client transfers

to another provider the GAIN needs to be consented in WITS to new provider as

soon as written consent is obtained. GAINs should be completed within 10 days

of initial authorization. If unable to complete for any reason and the client is

IDOC funded then this should be communicated with IDOC and PSI (if

applicable).

Case Management (CM) assessments must be completed for all clients

receiving case management services prior to developing case management

plans. A sample CM assessment can be found on BPA Health website.

Service Plans - must be developed with the client, be client centered and address all

client strengths and needs. A sample form that can be used for treatment and/or case

management can be found on BPA Health website. Plans must include:

Goals, objectives (SMART), and evidence based interventions

Frequency of each service/intervention being provided

Target dates for goals and objectives

Plan for family engagement and/or enhancing sober supports

Treatment plans should include all Recovery Support Services (RSS) and clearly

identify if CM is providing intervention

Discharge criteria

Encounter Notes - must be entered in WITS within five (5) business days of the date of

service and released to billing within thirty (30) days. The note should be individualized

and meet applicable requirements. See WITS e-manual for more information.


Residential, Transitional and SSH providers may bundle up to five (5) days of service in

one note. Group and individual notes for residential providers must be entered as

Miscellaneous notes.

Group notes for all treatment services must include documentation of EBP

service. Consider using DAP or SOAP notes.

Case Management notes may be bundled for CM services provided

throughout a day (exception is CM family without client present which has a

separate billing code). Within the note break down by time that each service

was provided during the day (i.e. 1:00 – 1:30 met with client and discussed …..

3:15 – 3:30 completed and submitted IDOC Status Update form). If providing

CM services there must be a minimum of one face-to-face CM appointment

each month with either the client or the client’s family.

Discharge summary and closing authorization - must be entered by treatment

provider in WITS within 15 calendar days of successful discharge or known termination.

If client stops coming to treatment provider has 45 calendar days from last billed date

of service to discharge. Treatment providers must notify RSS providers when they are

discharging a client. Upon discharge, all treatment and RSS providers must close out

authorization by sending in a Note to Authorizer (NTA) to BPA Health for IDHW and

IDOC clients. For IDJC and ISC providers work collaboratively with probation officers to

determine discharge.

Quality Assurance and Compliance Audits As a part of BPA Health’s Quality Assurance plan we will provide technical assistance,

training and quality assurance audits. If warranted, we may also conduct a For-Cause

Audit. During audits we will review client charts, supervision files, personnel files, and

proof of insurance. As a part of EBP audit we will speak with staff, survey clients and

observe groups. If a provider scores below 80% on an audit or consistent quality or

compliance concerns are noted the provider will be required to submit a corrective

action or performance improvement plan and will have more frequent monitoring.

The following audit tools can be found on BPA Health website:

Initial Quality, Effectiveness, and Compliance Audit

Quality, Effectiveness, and Compliance Audit

Supervision Audit (Treatment, Case Management, and Recovery Coach

providers)

Evidence-Based Program (EBP) Audit (treatment providers only)

Facility Renewals

Billing and Withholds All claims shall be submitted in WITS. See WITS e-manual for more information. BPA

Health will withhold 5% of all paid IDHW and IDOC claims and at the end of each


quarter will review specific metrics to determine how much of the 5% will be paid to

the provider for compliance with the contracted items. Current provider withhold

metrics can be found on the BPA Health website.

IDJC and ISC claims are paid directly by IDJC and ISC and are paid at 100%. They do

not participate in provider withholds.

Meetings Providers are encouraged to participate in the following regional meetings:

Regional BPA Health Provider Forums – quarterly

Regional Behavioral Health Boards and committees – monthly

Idaho WITS User Group (IWUG) Calls – quarterly (registration on WITS calendar)

Resources, Technical Assistance, and Training BPA Health’s website at www.bpahealth.com includes important resources including:

BPA Health SUD Provider and Supervision Manuals

Communications from Partners and BPA Health (these will also be emailed)

Current Rate Matrices

Training information and registration links as well as some archived training

webinars and materials

Required and sample forms

List of contracted BPA Health providers

Copies of all audit tools

WITS website at http://wits.idaho.gov/ includes valuable information in their e-manual,

user guides, and in their trainings. The WITS Helpdesk is available to assist you with any

WITS related questions. In addition to the required New Provider Training, some of the

additional WITS training and materials you will want to become familiar with include:

Scheduler and Group Notes (treatment only)

Consenting GAINs

Authorization and clinical dashboards

Submitting Authorization Change Requests and Notes to Authorizer

What happens next? We recognize this is a lot of information. Technical assistance is available as you begin

providing services in the BPA Health SUD Network. Please do not hesitate to contact

your local Clinical Quality Coordinator with questions or the WITS Helpdesk with WITS

specific questions. We will be setting up an initial technical assistance audit in a few

months, after you have begun to provide SUD services.

Once the SUD New Provider Orientation has been completed the Provider Network

Management (PNM) department will be notified and they will complete contracting

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http://wits.idaho.gov/


to get you activated in the network. Once contracting is complete PNM will notify WITS

who will finalize your agency set-up in WITS. This can take up to two weeks to complete

and then you will be able to begin receiving authorizations. Please make sure to

check in WITS daily for new referrals and authorizations or important WITS

announcements and read communications that come from BPA Health!

Welcome aboard!


Appendix


Appendix A –IDHW ROI


Appendix B – IDOC Status Report


Appendix C – Case Management Assessment (Sample)



Appendix D – Client Handbook (Sample)






Appendix E – Release of Information (Sample)


Appendix F – Service Plan (Sample)




Appendix G – Provider Orientation Checklist

New Employee/Agency BPA Provider Orientation Checklist

Resource / Topic Date

Covered

Provider Manual

Provider Rights and Responsibilities

Referral Sources and Funding

Billable Services

Services for Women and Children

Supervision Requirements

Clinical Guidelines

Utilization Management Program

Audits and Quality Assurance Program

Critical Incident Reporting Requirements

Appeals and Complaints

BPA Health Contacts

BPA Health Website Overview

New Provider Training Video

New Provider Orientation Packet

BPA Health and Partner Communications

Withhold Metrics

Forms

o Staff Update

o Critical Incident

o EBP Written Description

o IDOC Status Report

o Service Plan (treatment and/or case

management)

o Provider Handbook

Case Management Assessment

Resources

o Provider and Supervision Manuals

o Rate Matrices

o Audit tools

o Upcoming and past training information

o ADA Resources

Meetings

o IWUG - Quarterly

o BPA Health Regional Provider Forums –

Quarterly


o Regional Behavioral Health Board - Monthly

State Rules and Guidelines

IDAPA Rules (16.07.15 and 16.07.17)

ASAM Criteria

Evidence-based Practice and Programs

WITS Resources and Website

Employee Signature Date