New Provider Fee for Service (FFS) Initiative Technical Assistance Training Session

1. New Provider Fee for Service (FFS) Initiative Technical Assistance Training Session Department of Human Services (DHS) Division of Mental Health & Addiction Services (DMHAS) Authorization and Billing Training September 2014

2. How to Request a FFS Authorization for Treatment and Bill for Services DASIE Required for all publicly funded clientsDetermines client income and program eligibility PRIOR AUTHORIZATION Go toAUTHORIZATION LINKRequest ASSESSMENT VOUCHER (Not applicable for Drug Court referrals, skip to admission) ASSESSMENT/EVALUATION Clinician completes LOCI to determine Clinical need required to continue admission. ASI required for FFS clients ADMISSION - Level of Care is populated in admission based on LOC recommended by the agency in the LOCI. Be sure to select correct site license.Choose payer source in admission based on DASIE eligibility Click AUTHORIZATION LINK toRequest TREATMENT authorization-review info for accuracy prior to requesting a Treatment authorization If client is eligible and funds are available, an authorization is created. Enhancements, if needed, should be added

3. How to Request a FFS Prior Authorization for Treatment and Bill for Services BILLING Provider claims (bills) for services rendered in www.nj-das.net Click on “Provider Services” then choose “Enter a new claim”. You will need Clients Date of BirthLevel of Care and Enhancement Services must be recorded For a 30 day authorization, agency must provide services and submit claims in first 15 days to keep authorization active or it will cancel back to the start date. Agency must provide services and submit claims in second 15 days or the authorization will cancel mid-point Agency receives electronic reimbursement from CSC for authorized services every two weeks

4. Login to NJSAMS Real Time Data • Login to NJSAMS Real Time Data • NJSAMS system requirement is Microsoft Internet Explorer Version 8 or higher as internet browser. Please do not use any other browsers like Google Chrome or Fire Fox etc. and please do not search NJSAMS in Google, MSN or any other internet search tools. Please use URL/Link https://njsams.rutgers.edu/NJSAMS If your agency’s current browser is not Internet Explorer, please download Internet Explorer version 8 or higher • Enter your User ID and password. NEVER share your user ID & password with another staff member. Everyone needs their own user ID & password

5. Summary DMHAS Fee-for-Service Request and Approval Process • Prior-authorization for any service is requested through NJSAMS after completing the DASIE, LOCI, and ASI • Authorizations for treatment are requested after completing above and Admission screens (Drug Court does not fund Assessments) • Vouchers are requested through NJSAMS to CSC, the DMHAS Fiscal Agent • CSC approves the request based on: • Availability of funds; Client eligibility; Provider Eligibility • If the request meets the criteria for authorization: • Services are authorized through an interface of NJSAMS and CSC • Provider can view service request status on NJSAMS immediately • New authorizations must be secured every 30 days (or more often if authorization is of a shorter duration)

6. NJSAMS DASIE (DMHAS Addictions Income Eligibility) • DASIE is an income and program eligibility tool in New Jersey Substance Abuse Monitoring System (NJSAMS) • https://njsams.rutgers.edu/NJSAMS If your agency staff needs to know how to enter client in NJSAMS, please click on “Help” on the horizontal menu. Also Data Entry Forms are available under “Document”

7. NJSAMS How to start • Open Internet Explorer or click on the link https://njsams.rutgers.edu/njsams • Enter User ID and Password • Search your client by Client ID, SSN or last Name

8. NJSAMS Home Screen

9. NJSAMS Screens You Will Use • DASIE: Client Identifiers- calculation of income and program eligibility; required for all publicly funded treatment • Assessment Screens: Clinical information, ASI, LOCI • Admission Screens: LOC, Payer, Choose license # • Prior Authorization Link • Funding Source Screen (on the 5th tab/accordion/page) • Discharge (If the client is discharged, voucher is cancelled by system)

10. DASIE: Client Identifiers • Name – First, Last • Birth date and Gender • Social Security Number • Client ID is generated • Initiative specific number • SBI # - Criminal Justice Initiatives; Court Referred client • DUII- Driver’s License number • Household size and household income input used to calculate Federal Poverty Level (FPL) to determine eligibility for public funding

12. NJSAMS DASIE

13. NJSAMS DASIE

14. NJSAMS DASIE (Program Eligibility for FFS)

15. NJSAMS DASIE

16. NJSAMS DASIE Final Report

17. The Client FFS eligibility in DASIE

18. NJSAMS – Click on Treatment Authorization • When the client name displays click on “Select” • Click on “Treatment Authorization” to request voucher

19. Assessment Authorization in DASIE • For FFS funding, other than Drug Court, you will need an Assessment authorization • Once assessed, the client will need to be admitted prior to securing an authorization for Addictions Treatment, including any enhancements

20. Steps in NJSAMS Prior Admission • Intake Assessment before admission • DASIE (Income for FPL and Program Eligibility) • Addiction Severity Index (ASI) • Level of Care Index (LOCI)Must be completed to continue Admission

21. Admission in NJSAMS Note: Level of Care (LOC) is populated from the Initial Level of Care the Clinician recommends in the LOCI evaluation – after admitted, LOC in admission cannot be changed

22. Treatment Authorization in NJSAMS • Detail from Admission module populates fields in Treatment Authorization Section • Select correct funding source based on FFS Initiative eligibility in Program Eligibility in DASIE • If requirements are not met, the following message will pop-up when clicking on treatment authorization:

23. Treatment Authorization Cont’d • Authorization request date • Current date will auto fill in the system • Service Request start date • can be 7 days in advance, or due to weekends and holidays, can be backdated 5 days • If you wait to backdate, funds MAY not be available for new clients for those funding initiatives with new clients limits • Enhanced Services can be added or removed by checking and unchecking Note: Once an authorization is generated, current information should be accessed through www.nj-das.net

24. Adding and Removing Enhanced Services Services for Vivitrol no longer available are highlighted in yellow

25. Discharge Module • Full Discharge • Reasons for Discharge • If the client is continuing care • Continuing Care Type

26. NJSAMS Prior-authorization Parameters(See Chart 2 reference) • Assessment • Initial Treatment Authorization at LOC • Continuing Stay Treatment Authorization at same agency - no extension required • Continuing Stay Treatment Authorization at same agency - extension required as per LOC parameter • Change Level of Care (LOC) within agency • Transfer to new Level of Care (LOC) at new provider • Transfer to new provider same (LOC) Level of Care • Parallel Care

27. To recap – NJSAMS Data Elements Required for Treatment Prior Authorization DMHAS DASIE Completed Assessment Clinical Information LOCI completed - LOCI date reference Addiction Severity Index (ASI) completed Admission Level of Care (populated from initial LOCI) Admission Date Funding And Service Request Information Funding Source (need to select) Authorization request date Service date range depends on LOC Packages Discharge Continuing Care Discharge Full Discharge

28. Fee for Service (FFS) Network Initiatives • Driving Under the Influence (DUII) • Drug Court Initiative (DCI) • MAP – State Parole Board (SPB) • MAP – Department of Corrections (DOC) • Medication Assisted Treatment Initiative (MATI) • Screening, Brief Intervention & Referral to Treatment (SBIRT) – Mercer County only • South Jersey Initiative (SJI) • Recovery and Rebuilding Initiative (RRI) [Annex A 2]

29. Drug Court Initiative (DCI) • It is a good idea for Providers to market their program to local or statewide Drug Courts • Referrals will come directly from the Drug Court Coordinator; not from DMHAS • For all admission denials and administrative discharges, contact Steve Fishbein with specific reason for each via e-mail Steve.Fishbein@dhs.state.nj.us • Drug Court extensions have a separate process than other initiatives (will be addressed later in this presentation)

30. Drug Court Initiative (DCI) • Physical and mental health medications are billed through a paper billing process • DC reimburses providers at cost for 2 months per level of care (this is meant to be used as a bridge while providers assist clients to access other means for paying for their medications) • To request an electronic version of medication billing forms • Send an e-mail to Chad Williams at Chad.Williams@dhs.state.nj.us , (609) 292-7808 or Steve Fishbein at Steve.Fishbein@dhs.state.nj.us, 609-777-0655

31. Driving Under the Influence (DUII) DUII Agency eligibility • Providers must have a current IDRC/IDP Affiliation Agreement in place for all sites and LOCs • Residential Providers Affiliate with IDP directly; Ambulatory Providers MUST Affiliate locally (County IDRC) • Providers MUST share monthly report/information with IDRCs for all clients receiving DUII funding

32. Driving Under the Influence (DUII) DUII Client Eligibility • NJ resident with a DUII conviction after October 17, 2005 • Client income 350% FPL (Federal Poverty Level) • Client does not have to be referred by IDRC, but connection with IDRC must be established in the NJSAMS • When Drivers License is entered into the DASIE module, conviction eligibility is shown/determined • Any difficulties regarding convictions should be directed to: idp@dhs.state.nj.us  for assistance • If you do not receive a response in 24 hours, contact Andrea Connor at Andrea.Connor@dhs.state.nj.us or Tom Czeizinger at Tom.Czeizinger@dhs.state.nj.us

33. MAP – State Parole Board (SPB) • State Parole Board funds assessments and treatment for those referred from the Mutual Agreement Program (MAP) • MAP Abscond Procedure revised April 2013* • All referrals should be preceded by a SPB MAP referral form that includes the SBI number • Division of Parole Phone List April 2013* • DMHAS SPB contacts • Chad Williams; 609-292-7808; chad.williams@dhs.state.nj.us * Documents located on www.NJ-DAS.net (under References)

34. MAP–Department of Corrections (DOC) • Funds Assessments and Long Term Residential (Level lll.5) treatment only • Recently added urine reimbursement (add clinical review enhancement in order to claim urines) • DMHAS DOC contact • Chad Williams; 609-292-7808; chad.williams@dhs.state.nj.us Steve Fishbein; 609-777-0655 steve.fishbein@dhs.state.nj.us

35. Medication Assisted Treatment Initiative (MATI) • MATI funds medication-assisted and other treatment services for indigent New Jersey adult residents who have an opiate addiction and a history of injectable drug use • Individual must test positive for opiates or have a documented one year history of opioid dependence • Particular emphasis is placed on providing access to treatment for individuals referred by Syringe Access Programs (SAP) • If the client meets criteria for MATI-FFS, the client must refer to MATI-MMU (Mobile Medication Unit) • With the exception of Turning Point and Straight and Narrow, who can admit clients directly into Medically Enhanced Detox

36. Medication Assisted Treatment Initiative (MATI) • MATI FFS referrals must come directly from one of six (6) MATI-contract providers, unless a referral for Medically Enhanced Detoxification (this referral would come directly from one of two approved statewide MATI FFS Medically Enhanced Detox Providers) • When a MATI contract provider identifies a client who requires a Level of Care (LOC) not provided by the standard MATI contract, the MATI contract agency submits a MATI referral request for authorization to DMHAS • DMHAS MATI Contact, Adam Bucon, (609) 984-3316, adam.bucon@dhs.state.nj.us

37. Medication Assisted Treatment Initiative (MATI) • Approval for authorization provided to MATI contract provider via DMHAS MATI FFS staff • MATI contract provider notifies MATI FFS agency of approval and refers client for appropriate LOC • MATI FFS agency admits client and obtains authorization for appropriate LOC • MATI FFS agency has seven (7) days to secure an authorization from the date that DMHAS notifies the MATI contract agency

38. Recovery & Rebuilding Initiative (RRI) Client Eligibility: to be eligible for services available through RRI, consumers must: • Be 18 years of age or older; United States citizen or legal resident • Have been living in one of the storm affected counties between Oct. 28-30, 2012 (Atlantic, Bergen, Cape May, Cumberland, Essex, Hudson, Middlesex, Monmouth, Ocean, Union) • Meet American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC-2) for Level 111.7, 111.7D or 111.7DE treatment Federal funding for treatment services provided to RRI consumers must be accessed as the payer of last resort. Agencies are required to review all available resources before requesting the use of RRI funds

39. Recovery & Rebuilding Initiative (RRI) • Provider Eligibility: Participating providers must be licensed by the NJ Department of Human Services, Office of Licensure under the Standards of Licensure of Residential Substance Use Disorder Treatment Facilities (N.J.A.C 10: 161 A) and be able to provide co-located detoxification and short term residential services • Services available through the RRI: Assessments, Short Term Residential, Inpatient Detoxification, Medically Enhanced Inpatient Detoxification, Case Management, Co-occurring Services, Vivitrol and Transportation

40. Screening, Brief Intervention & Referral to Treatment (SBIRT) • Funds Outpatient (Level l) & Intensive Outpatient (Level ll.l) only • For Mercer County residents & Mercer County providers only (Expect to expand to Middlesex County in near future) • Referrals will come solely from Henry J. Austin Federally Qualified Health Center (HJA), with 5 project sites serving the greater Trenton area • Contact Kathleen Russo at 609-984-4053 or Kathleen.Russo@dhs.state.nj.us

41. Structure for Fee for Service Benefits Packages (see sample ASAM and Enhancements excel sheets) • Structure of FFS Benefit Package • ASAM [Annex A 1] • Assessment • Outpatient Service Packages • Intensive Outpatient • Partial Care • Long Term Residential Packages • Short Term Residential Packages • Detoxification • Medically Monitored Enhanced Detoxification • Enhancements [Annex A 3] • Clinical Review • Co-Occurring Clinical Services • Co-Occurring Medication Monitoring Services • Psychiatric Evaluation • Medication Assisted Induction/Stabilization Methadone • Medication Assisted Methadone Maintenance • Medication Assisted Induction/Stabilization Suboxone • Medication Assisted Suboxone Maintenance • Recovery Support • Medical Services • Vivitrol Enhancements

42. Co-occurring Network Enhancement • Co-occurring services are an enhancement to treatment • There is a difference between Co-occurring Licensure and being approved as a Co-occurring provider in the FFS network • Provider must contact Office of Licensure (OOL) to add co-occurring services to their existing Ambulatory or Residential Addictions License per N.J.A.C. 10:161B-10.4 • DMHAS requires that once approved for the MATI, DUII, RRI or SJI FFS networks, a provider must apply and be accepted into the Co-occurring network • Once OOL approves co-occurring status, a provider must submit a separate application seeking quantitative detail descriptions of how co-occurring services will be delivered, scoring a 70 or above to be FFS co-occurring approved

43. Co-occurring Enhancement Services • Psychiatric Evaluation • Comprehensive Intake Evaluation • Medication Monitoring/Consultation • Clinical Consultation • Family Therapy (with or w/out client present) • Individual Therapy- half hour or one hour session • Co-occurring Group Therapy • Crisis Intervention • Case Management DMHAS Co-occurring contact is Chad Williams, 609-292-7808; Chad.Williams@dhs.state.nj.us

44. Extension Request Process • Who: All fee for service network providers will need to submit an Extension Request LOCI for continued care review • What: Extensions allow the client to continue in treatment after the initial authorization expires at the same level of care • When: Providers are prompted to submit an extension request within NJSAMS 15 days prior to the end of the authorization • Where: Providers request an extension in the NJSAMS Extension Request LOCI (ERL) • Why: Providers will not get reimbursed for services if the client continues in treatment without a new authorization

45. FFS Extension Review Process for Continuing Care Authorizations • All Fee for Service Network providers must submit the ERL through NJSAMS for the DMHAS Extension Review Staff • DMHAS Extension Review will consist of: • The completion of the ERL – all appropriate ASAM Dimensions completed using ASAM Risk Rating language with supporting clinical documentation. Extension request LOCIs cannot be more than 30 days old when submitted to Drug Court and DMHAS otherwise they will not be accepted • When the ERL is completed appropriately, the provider is notified by DMHAS Extension Review staff via ERL in NJSAMS

46. ERL Approval • Approval Status can be found under ERL by clicking “MODULES” on horizontal menu.

47. FFS Extension Review Process for Continuing Care Authorizations • If corrections to the ERL are needed to be made by the provider, then the Extension Request will be denied by DMHAS Extension Review Staff via ERL in NJSAMS • The request will be denied until the Extension Request is resubmitted and appropriately completed by the provider; the request can then be approved by DMHAS Extension Review Staff

48. FFS Extension Review Process for Continuing Care Authorizations • Examples of Fee for Service Extension Request Denials: • The DMHAS Extension Review Staff determined that the ERL was insufficient in its information as it does not have supportive documentation in the appropriate dimensions to justify the need for treatment at the level of care requested • Client was already discharged from treatment; an extension request is no longer needed • Client’s level of care was changed which does not require an extension request • The provider requested an extension for ASAM Level 1.0 (Outpatient Treatment) which does not ever require an extension

49. Drug Court Extension Review Process for Continuing Care Authorizations • Extension Request Policy for Drug Court participants requires additional steps • Each Drug Court treatment provider must contact the referring Drug Court and e-mail them an ERL (Extension Request LOCI) for their review, prior to submitting to DMHAS • The LOCI MUST be able to justify the level of care • A Drug Court Extension request cannot proceed without Drug Court notification • Once the referring Drug Court team completes their final review of the ERL, the Drug Court Coordinator will then forward the Extension Request to the DMHAS Extension Mailbox indicating their approval • DMHAS staff reviews the DC Coordinators’ approved extension request per the general policy • The Drug Court Coordinators’ denied extension requests are not forwarded to the DMHAS extension Mailbox

50. Drug Court Extension Requests • Drug Court Clients extension requests must be approved by Drug Court Coordinator • You can find the Drug Court Coordinator and their back-up’s e-mail addresses on www.nj-das.net under Documents /References • All Fee for Service Network providers must submit the ERL via NJSAMS for the DMHAS Extension Review Staff