Accessing Resources for IMH Services: Clarity about Sources, Eligibility and Documentation

1. Accessing Resources for IMH Services: Clarity about Sources, Eligibility and Documentation Celeste Putnam FSU Center for Prevention & Early Intervention Policy Director of Early Childhood Integration of Care Tallahassee, FL Kathryn Shea, LCSW The Florida Center for Early Childhood, Inc. President/CEO Sarasota, FL

2. Statewide Medicaid Managed Care Program • Florida Legislature created the Statewide Medicaid Managed Care Reform. • Implementation is underway now – May through October • Families will receive a series of notification letters starting 90 days before implementation by Region.

3. Managed Medical Assistance Plans • Managed Medical Assistance (MMA) Plans will provide all the state plan services to the vast majority of Medicaid recipients • The MMA health plans will be operated by Health Maintenance Organizations and Provider Service Networks

4. Managed Medical Assistance Plans • Health Plans were selected through a competitive process • The number of plans per Agency for Health Care Administration (AHCA) Region were specified in Legislation • Plans will be integrated- will provide both behavioral health and physical health services

5. Managed Medical Assistance Plans • Medipass will end as the health plans roll out and will terminate in October 2014 • Behavioral Health Prepaid Mental Health Plans will end as the health plans roll out (Value Options, Megellan)

6. Medicaid Specialty Plans • Medicaid selected several specialty plans for populations with special health care needs • Sunshine State Health Plan will be available for children in the child welfare system (voluntary) • Magellan Complete Care will be available for persons with severe mental illness (voluntary)

7. Children’s Medical Services Network • Children’s Medical Services (CMS) will provide integrated health care services to children through a managed care network. • Children must have special healthcare needs • Enrollment is voluntary

8. AHCA Regions

9. MMA Plans by Region by Roll Out Schedule

10. Medicaid Community Behavioral Health Care Services • Young children and their families are eligible for health care services. • Eligibility • Pregnant women – 191% of poverty • Infants under age 1- 206% of poverty • Children ages 1-5 – 140% of poverty • Children ages 6-19 – 133% of poverty • Child Welfare out of home and up to age 26

11. Florida Medicaid – What Sets Us Apart? • Critical Changes in 2001 Handbook: • In-Depth Assessment – Early Childhood Best Practice “2. Be exhibiting symptoms of an emotional or behavioral nature that are atypical for the child’s age and development. For children 0 through 3 years of age, Medicaid encourages use of the Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood (DC: 0–3) for assistance in determining the infant or child’s ICD-9-CM diagnosis.”

12. Florida Medicaid • Critical Changes in 2001 Handbook: • Individual AND FAMILY Therapy (family added) • Individual and family therapy services include the provision of insight oriented, cognitive behavioral, or supportive therapy to an individual or family. • Individual and family therapy may involve the recipient, the recipient’s family (without the recipient present), or a combination of therapy with the recipient and the recipient’s family. • Allows for providing and billing dyadic therapy

13. Florida Medicaid • New Revised Handbooks (3) – 2014 • Significant Changes • No specific “Services for 0-5 Section” • No mention of encouraging use of DC: 0-3R

14. Florida Medicaid • Significant Changes: • No ICD-9CM/ICD-10 codes excluded • Two new Provider titles: Bachelor’s Level Infant • Mental Health Practitioner and Infant Mental Health Aides • Does designate that assessments/services for recipients under the age of 6 years must be provided by the approved professionals “who have training and experience in infant, toddler, and early childhood development and the observation and assessment of young children.” *Seeking clarification from AHCA in some areas.

15. IMH Documentation • General Medicaid Rules ~ • Rule #1 – KNOW THE HANDBOOK!!!!!!! The ultimate “reimburse-ability” of a service by Medicaid will depend upon the quality and content of the documentation. If an activity is not documented in the record, from a legal point of view, the activity did not take place.

16. IMH Documentation • Rule #2: Remember who the “client” is! • Unless you are treating the parent for a specific mental health disorder, the infant/child is the “identified client”. The chart is opened under the child’s name. • All documentation must focus on the child’s diagnosis, course of treatment, and discharge planning. • Treatment goals are focused on the child’s improvement with the parent providing the mechanism/vehicle for child’s improvement.

17. IMH Documentation • General Medicaid Rules~ • All entries must be typed or handwritten using only black ink • Entries must be individualized to each child • All entries must be legible and kept in chronological order • All entries must be dated and legibly signed by the therapist who rendered the service using full name, credentials, and professional title

18. IMH Documentation • General Medicaid Rules~ • Person(s) referenced in the documentation should be identified at least once on each Progress Note Page (i.e. Harry [cousin of client]) • Errors in notes – If an entry is erroneous or incorrect, clearly draw one linethrough the error; write “error” to the side in parentheses; enter the correction; add signature, title, and the date; if an explanation seems appropriate, do not hesitate to clarify why the correction is needed.

19. IMH Documentation • General Medicaid Rules~ • Entries should be made in the record at the time the service is rendered • Document that the services provided correspond to the billing in the type of service, amount of service (length of time the activity took), the service date and entry date. • Assure the activities are documented with detail sufficient to support the “amount of service” billed to Medicaid.

20. IMH Documentation • General Medicaid Rules~ • Activities claimed for reimbursement must be meaningful and appropriate for the needs of each individual. A continued need for therapy services must be substantiated. (Medically necessary) • Completion/updates of Assessments, Treatment Plans, reviews, reports, correspondence, etc. should be referenced in the Progress Notes. Documentation should clearly identify where the information can be located (what section of record)

21. IMH Documentation • General Medicaid Rules~ • Therapy services should be documented in progress notes beginning with the date a new referral is received and initial assessment conducted. Include who made the referral, the reason(s) for the referral, etc. • Be certain all appropriate releases of information, authorization for assessment and services is obtained and updated as required.

22. IMH Documentation • General Medicaid Rules~ • Each progress note entry must describe: • Who the service was with (mother/infant) • The kind or type of contact (family therapy) • Where the contact took place (home/office) • Intervention or specific service rendered (CPP) • Purpose of contact (Treatment Goal #1) • Outcome of contact (Progress made as seen by…..) • Continued need for services (services continue to be medically necessary because…) • Any follow up needed (referrals, contact with treating physician, etc.)

23. IMH Documentation • Medicaid Made Easy ~ • Simplify all you can • Create check lists for each file of what/when due • Create forms that makes it easier for the workers, but gives Medicaid the information it needs • Conduct internal trainings frequently (quarterly minimum). The more the workers hear the same information, the more it sinks in. Take advantage of all Medicaid trainings, Webinars, etc. Contact Medicaid for in-house training if needed.

24. IMH Documentation • Medicaid Made Easy ~ • Simplify all you can • Conduct peer reviews of charts to ensure quality and accountability • Document all internal trainings, use sign-in sheets, document all peer reviews, charts reviewed, outcomes, etc. • Make sure all department reviews/audits are incorporated into overall agency Continuous Quality Improvement (CQI) Plan

25. Medical Necessity for IMH • Tips for minimizing audit risk • Must continually document in assessment, treatment planning, treatment plan reviews, progress notes the medical necessity for services

26. Medical Necessity for IMH • From Medicaid: • There is adequate evidence to indicate that the child is at risk for a more intensive, restrictive and costly mental health placement; and • There is adequate evidence to indicate the child’s condition cannot be improved with less intensive services or interventions

27. Medical Necessity for IMH • Adequate evidence should include: • Narrative describing the risk factors/behaviors for child/parent/relationship (not just a check list!) • History of infant/child functional impairment in sensory/ behavior/social emotional development (poor attachment, at risk for expulsion, etc.) • Tools that support impaired functioning (ASQ-SE, TABS, CBCL, PSI, Maternal Depression screening, DECA, etc.)

28. Medical Necessity for IMH • Adequate evidence should include (cont’d): • Failed interventions (parenting classes, PBS, ECMH consultation, etc.) • Risk to child without immediate treatment interventions (more intensive, costly services, etc.) • Child and parents willingness/ability to benefit from services

29. IMH Documentation It’s not about quantity of writing…. It’s about quality of writing and incorporating all aspects of service provision

30. Billing IMH Services • The ONLY code Medicaid cares about is the ICD Code; not DSM or DC:0-3R!!! • The DSM 5 DOES NOT automatically crosswalk to the same ICD-9-CM codes, nor will they to the ICD-10 codes. • IDC-10 implementation now postponed another year! • Florida crosswalk created in 2001 to “crosswalk” the DC:0-3R codes to ICD-9-CM codes. Updated in 2010. Can be found on www.thefloridacenter.org – “Resources” page. Continue to use Crosswalk to bill to ICD-9-CM Codes

31. IMH Funding Possibilities • Department of Children and Families (DCF) Substance Abuse and Mental Health • General Revenue • Block Grant • Special category 100-800 funds • DCF Child Welfare • Title IV E Waiver • Child Abuse Prevention and Treatment Act • Title V Children’s Medical Services

32. Other Funding Sources • Child Care and Development Block Grant • IDEA Part C Early Steps • Home Visiting Programs – Healthy Start and MIECHV • Federally Qualified Health Care Centers

33. THE END!

34. Contact Information • KATHRYN SHEA, LCSW • PRESIDENT & CEO • The Florida Center for Early Childhood • Email: kathryn.shea@thefloridacenter.org • www.thefloridacenter.org • (941) 371-8820 ext. 1043 • CELESTE PUTNAM • FSU Center for Prevention and Early Intervention Policy • cputnam@cpeip.fsu.edu