State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ®

1. State of MarylandDepartment of Health and Mental Hygiene & VALUEOPTIONS® September 2009 Clinical Training for OMS Providers

2. Presenters • Nancy Calvert, Director, Provider Relations, ValueOptions® Maryland • Jennifer Lowther, ClinicalDirector, ValueOptions® Maryland

3. Agenda • Update • Outcomes Measurement System • Overview of ProviderConnect • Requesting Authorizations • Questions

4. Updates • ValueOptions® Maryland Website • http://maryland.valueoptions.com • Provider Alerts • MHA Policy Clarification Memos and Announcements • ValueOptions® Maryland Updates and Announcements • Training Schedule • ProviderConnect “tips” • Maryland Specific ProviderConnect “demo” • Provider Forms – including a hard copy concurrent review form • Coming Soon: • Provider Manual • Diagnostic Crosswalk • Fee Schedule • Service Grid • Consumer Information

5. OMS Information on Website • http://maryland.valueoptions.com • “For Providers” • “Provider Forms” • OMS Tools • Discharge Information Sheet • Adult Questionnaire • Definitions for Adult OMS Interview • Adult Questionnaire Response Cards • Adult Discharge Form – Consumer Not Participating • Child and Adolescent Questionnaire • Child and Adolescent Response Cards • Child and Adolescent Discharge Form – Consumer not Participating • The OMS Interview Guide will be included in the Provider Manual

6. September 25th System Upgrades • Online Uninsured Eligibility Registration (request function) is now available to providers. • Axis 1-V diagnoses are now required on concurrent reviews • The “Individual Care Plan” • The Plan tab has been added to the Mobile Treatment authorization request screen. • The Service Code Field has been removed • Providers now have the option to print the Plan separately. • “MCO” is no longer a required field. • “Education Level” has been deleted from the federally required questions. • “N/A” is no longer an option to the “Race” question.

7. Outcome Measurements System(OMS) • Measures consumer outcomes regarding the management of their illness and the quality of their lives. • Supports recovery and resiliency • An important measure of the benefit provided by services in the PMHS

8. OMS • In effect since September 2006 • Collaboration between • Mental Hygiene Administration (MHA) • University of Maryland Systems Evaluation Center (SEC) • MHA Administrative Service Organization (ASO) • Only for outpatient services provided by • In-state providers • Hospital outpatient clinics • Federally Qualified Health Centers (FQHC) • Outpatient Mental Health Clinics (OMHC) • Local Health Departments • Consumers: • Ages 6-17 and 18-64 Regardless of age, Dually eligible Medicare/Medicaid consumers are excluded from OMS

9. OMS Questionnaires • Separate questionnaires for adults and youth • Adult questionnaire contains the BASIS-24 questions • Cover several life domains: • Living situation, Employment, School attendance, Substance use, Legal system involvement, Symptoms, Functioning, etc • Administered every six months • Documentation of completion should be included in the consumer’s clinical contact/progress notes.

10. OMS Service Bundle • 150 Unit Service Bundle Includes: • 2 outpatient evaluations (90801) • 2 family therapy sessions without consumer present (90846) • Medication management • Individual Therapy • Group Therapy • Excluded: • All extended therapy codes • Additional sessions of 90801 or 90846 • Services associated with crisis bed stays • Intensive Outpatient Services (IOP) • Partial Hospitalization Programs (PHP) • Initial and subsequent inpatient care • Combination of service rules apply • http://maryland.valueoptions.com/provider/announcements/2005_Announcement_Archive.pdf

11. Services Included in the OMS Authorization • 90801: Initial Evaluation* • 90804: Individual Psychotherapy (20-30 minutes) • 90805: Individual Psychotherapy with Med Eval/Mgmt • 90806: Individual Psychotherapy (40-50 minutes) • 90807: Individual Psychotherapy with Med Eval/Mgmt • 90846: Family Psychotherapy without Patient Present* • 90847: Family Psychotherapy with Patient Present • 90849: Multiple Family Group • 90853: Group Therapy • 90862: Medication Management • 90875: Individual Psychotherapy with Biofeedback • 90876: Individual Psychotherapy with Biofeedback • T1015: FQHC Clinic Visit • Rev Codes: 0510, 0513, 0910, 0914, 0915, 0916, 0917, 0918, 0919

12. OMS Services, continued • Discharge Codes (included in the authorization bundle) • 90889 • 0929 • Not included:* • Extended visit codes (90808, 90809) • More than two initial evaluations (90801) • More than two family psychotherapy without patient present services (90846) • *Separate pre-authorization required

13. OMS Registration/Authorization • Initial Registration: • 2 visits/3 months • 2 additional visits may be requested telephonically under special circumstances • Continuing Registration (150 bundle) • May be requested with the initial registration • The start date of the continuing registration will always the day after the date of the OMS interview • End of Authorization/Discharge • May be performed up to 10 days after the authorization is closed • After 100 days neither a continuing OMS nor a discharge OMS will be accepted. • With consumer present: • Discharge Information Sheet • OMS Questionnaire • Without Consumer Present: • Discharge Information Sheet • Discharge OMS Form

14. End Users License Agreement(EULA) • Required for all OMS Providers of service to adults • OMHC, FQHC, Hospital Based Clinics • Allows inclusion of the BASIS-24 questions • Return a signed copy to ValueOptions® Maryland • Maintain individually signed copies in staff personnel files • Failure to sign: • Questionnaire must still be completed (minus the BASIS 24 questions) • Providers will only receive 12 visits per authorization period. • Available on both the MHA and ValueOptions® Websites • Contact: Teana Jones • 410-691- 4015 Fax: 410 691-4001 • Scotteana.jones@valueoptions.com

15. ProviderConnect

16. ValueOptions® ProviderConnect ProviderConnect is an online tool that increases convenience & decreases administrative burden. • Free, secure, online application • Easy access 24 hours a day, 7 days a week • Complete multiple transactions in a single sitting

17. ValueOptions® ProviderConnect Features With ProviderConnect providers can: • Verify Consumer eligibility • Register Uninsured Consumers • Request Authorizations • View Authorizations • Submit Claims (Batch and Direct/On-line claim) • View Claim Status • View and Print Provider Summary Voucher • Submit inquiries to Customer Service • Access and print forms

18. Accessing ProviderConnect • Each provider has a secure login and online registration, including a provider ID number via the ProviderConnect Web site. • Additional logins for other providers in the same practice are available through ProviderConnect. Contact: • ValueOptions® EDI Helpdesk • (888) 247-9311, Option 3 • Monday through Friday • 8 a.m. – 6 p.m. EST Turn around time for additional logins is 48 hours.

19. OMS Authorization Requests • Live Demonstration

20. Questions valueoptionstransition@dhmh.state.md.us

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