Billing Strategies for ACT

1. Billing Strategies for ACT Michael Oyster, LPC, CADC III Choice Model Lead ACT and Supported Employment Coordinator June 11, 2019 Health Systems Division Operations & Policy

2. Michael Oyster, LPC, CADC III Licensed Professional Counselor (LPC) Certified Alcohol & Drug Counselor (CADC III) Over 20 years in community mental health and substance abuse treatment services, crisis services and program development An explorer of billing services so that programs have the funding for sustainability

3. Learning Objectives • Review eligible referrals to ACT • Identify strategies and processes to bill for ACT services based on knowledge of the funding system • Learn guidelines when billing for ACT services for a variety of insurances and other funding sources • Contribute to the discussion about challenges you face as well as develop solutions to meet those challenges

4. ACT Eligibility • ACT Admission Criteria: OAR 309-019-0245 • SPMI • Not a primary diagnosis of • Substance use • Intellectual developmental disability • Borderline Personality Disorder • PTSD • Autism Spectrum • Long term disability • Significant functional impairments • Practical daily living tasks (personal business, medical / legal, housing, self care, nutrition, hygiene) • Employment or homemaker role • Safe living situation

5. ACT Eligibility • ACT Admission Criteria: OAR 309-019-0245 • SPMI • Not a primary diagnosis of • Substance use • Intellectual developmental disability • Borderline Personality Disorder • PTSD • Autism Spectrum • Long term disability • Significant functional impairments • Practical daily living tasks (personal business, medical / legal, housing, self care, nutrition, hygiene) • Employment or homemaker role • Safe living situation

6. Exhibit M from CCO Contract 2019 • In relation to ACT, CCOs must ensure: • Those with SPMI are assessed for ACT eligibility • ACT services are provided for those with SPMI • Additional ACT capacity is created to serve SPMI • When 10 or more members are on a waitlist for more than 30 days by • Increasing existing ACT team capacity • Adding additional ACT teams • Consult with OHA to develop a plan to develop additional qualified providers • Denials of ACT services are based on established criteria, recorded and compiled to accurately report denials • Provide a Notice of Adverse Benefit Determination (NOA) for all denials of ACT services

7. Strategies and Processes • The ACT billing code is a bundled code that is used by Medicaid • Other insurances do not reimburse for the ACT code

8. OSH and Medicaid • Historically, Medicaid has been suspended when clients are in Oregon State Hospital • A bill has been passed that allows participants to keep their Medicaid throughout the hospital stay • The details of how this will work is still being developed • Until the details are worked out, use other funding resources to support in-reach and coordination with OSH • Choice Model funding • County Funding through Service Elements

9. Guidelines When Billing ACT • When delivering ACT services for other insurances, unbundle the code

10. The Services of ACT • Psychiatry • Nursing • Mental Health Therapy • Substance Use Therapy • Case Management • Supported Employment • Supported Education • Peer Delivered Services

11. Discussionproblem Solving

12. Contact Michael Oyster LPC, CADC III Choice Model Lead, ACT and SBIRT Coordinator Office: (503) 945-9813 Michael.W.Oyster@state.or.us Health Systems Divisions Operations & Policy