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2019 CMHP Required Reports. How to use this training. The speaker icon on a lower right hand corner indicates a voice-over function. Click the speaker icon and click the play arrow to listen to an expanded explanation of page content.
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How to use this training The speaker icon on a lower right hand corner indicates a voice-over function. Click the speaker icon and click the play arrow to listen to an expanded explanation of page content. If you cannot hear the content — check volume level of your device. If you need an alternative format, please contact gobhi.reports@gobhi.net Test HERE
Welcome to 2019! In an effort to make this process meaningful and less of a hassle for providers, our departments have come together to streamline processes and ensure efficient and effective reporting. Reporting is a requirement for all GOBHI contracted providers. It allows GOBHI to have the most up to date information on our network and provides resources to our members. All items listed on the required reporting meet external quality review, NCQA, or quality improvement requirements and allow GOBHI the opportunity to provide technical assistance and support tailored to provider network needs.
What is submitted? Providers have tailored requirements, which are outlined in a format that easily tracks progress of submission for both provider and GOBHI. GOBHI is available for one-on-one additional support for those who have additional question or are not able to attend a training. Some of the reporting documents have been embedded into an excel document that’s been designed to take the hassle out of submission and provides immediate feedback on patterns and trends your organization may be experiencing.
Documents There are 2 documents that are part of the 2019 required reporting year. • 2019 CMHP Required Reporting Overview (Word) • 2019 Quarterly Submission Template (Excel)
Accounting The G.2 report is a log of all third party payments that a CMHP receives for services provided to GOBHI members. The purpose is to make certain that the state subtracts this revenue from the overall encounters to ensure that they are not overstating the cost of services and inadvertently committing Medicaid fraud. This report is reviewed (by Sumuer and Lori) and used only to determine that it matches the information provided on the G4 report.
Accounting cont. The G4 report is a report that encompasses all things G4 related. There isn’t any reason to call them out separately. All of the tabs feed into the final product, and it is simply referred to as the G.4 Report. If the title starts with “G.4” then this is the summary information. The G.4 report is required by GOBHI’s MHO contract and then passed to the CMHPs via the delegation agreements. The purpose of the report is to determine how a CMHP is using their Medicaid dollars and how much (if any) is retained by the CMHP in the form of reserves. The report is reviewed by Lori and Sumuer. Potential outcomes are the determination that rates should be changed or potentially that the CMHP is underutilizing Medicaid funds.
Accounting cont. • This is the audited financials that each CMHP presents to its board. Once completed, GOBHI needs a copy. This is a requirement from the CCO contracts. Sumuer reviews these reports to ensure that the CMHPs meet federal accounting guidelines. Potential outcomes include loss of delegation agreement if the financials include a qualified opinion from auditors that indicates misuse of federal Medicaid funds.
Accounting cont. This report is required annually by the CCO and MHO contracts. It ensures that the rates charged by CMHPs for services rendered actually reflect the cost of the services. This report is reviewed by Sumuer in conjunction with the G4 and encounter data reports to determine if rates are reasonable. Potential outcomes of review are the request to raise or lower rates charged by the CMHP.
Organizational Excellence (OE) CFR, OAR, and contract requirement — All licensed practitioners and organizational providers under contract with GOBHI need to be credentialed, screened, and then posted for public review on our website and made available in other forms as required by an individual requesting an accommodation. DSN was a quarterly submission requirement, but this year it is annual with the expectation that any changes in staff are sent to GOBHI.
OE cont. Conflict of Interest CFR, OAR, and Contract requirement. A “conflict” is a situation in which a person is in a position to derive personal benefit from actions or decisions made in their official capacity. Under law this only needs to be disclosed (whether an individual is still allowed to participate in the decision making is then determined by the rest of the governing body). GOBHI must see a policy that shows how COI is managed only for those in a position to derive personal benefit. We don't need one for employees and subcontractors from them. Fraud, Waste, and Abuse (FWA) CFR, OAR, Contract (more so contract) requirement. Each contracted entity (independent practitioners should be covered by GOBHI's) needs to have a developed FWA policy.
OE cont. GOBHI is required to pay for emergency services and post-emergency stabilization services or urgent care services required under the CCO contract This is a requirement in the CCO contract. (See Exhibit D: 33 Conditions that may result in sanctions: l) Discussion with CMHP if post-emergency stabilization services are not being provided. If unable to provide at local CMHP, GOBHI will look at ways to make surethis service is available for members
OE cont. • The Access Measures Form is used to collect data to find out how accessible behavioral healthcare services are to our members. GOBHI uses the data to assess network adequacy and to provide reports to OHA, the EQR, and to NCQA. • Providers are required to submit based on OAR 410-141-0220, 410-141-3220, NCQA and GOBHI Contracts.
OE cont. — Access Measures The OE team reviews access measures and compares against baseline data, other service providers, and required standards. GOBHI’s Board of Directors views the measures to assess how the GOBHI network is meeting member needs. Network Management team views access measures as part of the decision making process when determining network adequacy when a provider is in consideration for in-network contracting. If access is too low in a specific area, GOBHI may look for other providers in that area to meet member need.
OE cont. Each CMHP submits up to 6 charts per quarter using documentation criteria required for an agency’s Certificate of Approval (COA). Charts are reviewed using the predesigned tool provided by GOBHI after approval by the Board of Directors. Charts are for CMHP internal review to assess for areas of growth and areas where they are excelling. GOBHI will review the submission to also look for trends and areas where technical assistance can be provided. GOBHI will also be doing a “peer-review” process during annual reviews to ensure agencies are reviewing their charts the same as GOBHI.
OE cont. Adverse Events Contract requirement Agency needs to attest to their Adverse Event (if any). Seclusion & Restraint OAR and Contract requirement All contracted entities need to have a seclusion and restraint policy or attest to not practicing seclusion and restraint.
Integrated Health Outcomes (IHO) • Choice Model (AMHI) Admit and Discharge from Residential Care Report (Monthly) • SPOC Referrals report (Monthly) • ACT Report (Quarterly) • SE Report (Quarterly) Questions and Concerns on these reports can be sent to: care.management@gobhi.net
Adverse Incident Reports Adverse Incident Reports are due to GOBHI within 24 hours of the time the agency became aware of the incident. The fillable PDF and/or Word documents have been available to agencies since mid-2017.
Questions or Concerns For Choice Model, ACT and SPOC reports contact care.management@gobhi.net All other reports contact gobhi.reports@gobhi.net
2019 CMHP Quarterly Submission Template The reporting template is required for the submission of: • Access Measures • Chart Reviews • Adult MH • Youth MH • Adult SUD • Youth SUD • WRAP (x2) • Adverse Attestation • Seclusion & Restraint Attestation Submission of items outside of the template will not be counted as a complete submission.
Let’s go through the template! All of the due dates for items required in the template – notice they are all the same due dates Access Measures — data collected from your agency reflecting the availability of services for members Chart Reviews – Up to 6 charts per agency per quarter – if the agency does not have a WRAP program pick 2 more mental health charts – if the agency is SUD only, submit 4 charts and leave WRAP blank. Attestations — Adverse Incident and Seclusion & Restraint – document to be signed (typed name) attesting to Adverse Events and S&R
Due Dates All due dates are the same for each item within the template. If the template is complete, then the template is ready for submission. You can choose to track your submissions in the template or on the overview Word document.
Access Measures Instructions Tabs Information Tabs
Questions, Concerns, Additional Assistance Please call us at GOBHI’s main office Local: 541-278-2101 Toll free: 1-800-493-0040 TTY 1-800-399-7335 Or email us at gobhi.reports@gobhi.net
