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Training presented May 2007 1
Rule 132 Medicaid Community Rule 132 Medicaid Community Mental Health Service ProgramMental Health Service Program
Training presented May 2007 2
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
Training presented May 2007 3
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/
Training presented May 2007 4
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
Training presented May 2007 5
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
Training presented May 2007 6
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
Training presented May 2007 7
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
Training presented May 2007 8
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
Training presented May 2007 9
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
Training presented May 2007 10
Topics for future and separate Topics for future and separate discussionsdiscussions
DCFS specific transitionDHS/DMH contract requirements
Training presented May 2007 11
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
Training presented May 2007 12
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
Training presented May 2007 13
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 presented May 2007 14
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]
Training presented May 2007 15
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
Training presented May 2007 16
Summary of Service ChangesSummary of Service Changes
Mental health assessmentTreatment plan development, review and
modificationTherapy/counselingSkills training and development
Training presented May 2007 17
Summary of Service Changes Summary of Service Changes (cont.)(cont.)
Therapeutic behavioral servicesMental health day treatmentMental health intensive outpatientActivity therapyIntensive family-based services
Training presented May 2007 18
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
Training presented May 2007 19
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
Training presented May 2007 20
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
Training presented May 2007 21
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
Training presented May 2007 22
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
Training presented May 2007 23
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)
Training presented May 2007 24
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)
Training presented May 2007 25
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
Training presented May 2007 26
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
Training presented May 2007 27
QuestionsQuestions
Training presented May 2007 28
New or Substantially Changed New or Substantially Changed ServicesServices
Case Management – Mental HealthCommunity support – individualCommunity support – groupCommunity support – residentialCommunity support – teamAssertive community treatmentPsychosocial rehabilitation
Training presented May 2007 29
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.
Training presented May 2007 30
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
Training presented May 2007 31
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
Training presented May 2007 32
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
Training presented May 2007 33
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
Training presented May 2007 34
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
Training presented May 2007 35
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
Training presented May 2007 36
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
Training presented May 2007 37
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
Training presented May 2007 38
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
Training presented May 2007 39
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
Training presented May 2007 40
QuestionsQuestions
Training presented May 2007 41
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
Training presented May 2007 42
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
Training presented May 2007 43
Assertive Community Assertive Community Treatment (cont.)Treatment (cont.)
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
Training presented May 2007 44
Assertive Community Assertive Community Treatment (cont.)Treatment (cont.)
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
Training presented May 2007 45
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
Training presented May 2007 46
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
Training presented May 2007 47
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
Training presented May 2007 48
QuestionsQuestions
Training presented May 2007 49
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
Training presented May 2007 50
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
Training presented May 2007 51
QuestionsQuestions
Training presented May 2007 52
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
Training presented May 2007 53
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
Training presented May 2007 54
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
Training presented May 2007 55
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
Training presented May 2007 56
Job Leaving/Termination Job Leaving/Termination SupportsSupports
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 Job loss is not a reason to discontinue
participation in supported employment
Training presented May 2007 57
Outreach and Engagement
&
Stakeholder Education
Training presented May 2007 58
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
Training presented May 2007 59
Outreach and EngagementOutreach and Engagement
Definition Provided face to face, by telephone or video
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
Training presented May 2007 60
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
Training presented May 2007 61
QuestionsQuestions