EPSDT Chart Documentation Training

1. EPSDT Chart Documentation Training California Institute for Mental Health October 19, 2006 � Oakland October 30, 2006 � Burbank October 31, 2006 � Riverside November 13, 2006 - Sacramento This is the second in a series of 4 regional trainings to be held in: Burbank October 30th - today Riverside October 31th Sacramento November 13th Web Cast scheduled for November 17th from 1:00 PM to 4:00 PM and will be posted on the CIMH web site on the 18th of November. Some logistics: Bathrooms are���������.. Lunch is on your own today: Theresa has prepared a list of places to eat and if you don�t have one be sure to pick up the list at the break. We will be breaking for lunch at 12:00 and return at 1:00 PM Questions: You will find 3x5 cards on the tables. I know you will have many questions�These cards are for your questions and they will wind up being answered in the Q and A Panel at the end of the presentation today. We will need you to put your questions in the boxes by 1:00 PM. If your question is not answered by the panel today, DMH will make sure the question goes to the appropriate venue to be answered and then will be posted on the DMH website under the frequently asked questions sections under program compliance. The EPSDT regulations are complex and we want to make certain that that accurate information in circulated, so all questions will be deferred to the Q and A panel at the end of the training.This is the second in a series of 4 regional trainings to be held in: Burbank October 30th - today Riverside October 31th Sacramento November 13th Web Cast scheduled for November 17th from 1:00 PM to 4:00 PM and will be posted on the CIMH web site on the 18th of November. Some logistics: Bathrooms are���������.. Lunch is on your own today: Theresa has prepared a list of places to eat and if you don�t have one be sure to pick up the list at the break. We will be breaking for lunch at 12:00 and return at 1:00 PM Questions: You will find 3x5 cards on the tables. I know you will have many questions�These cards are for your questions and they will wind up being answered in the Q and A Panel at the end of the presentation today. We will need you to put your questions in the boxes by 1:00 PM. If your question is not answered by the panel today, DMH will make sure the question goes to the appropriate venue to be answered and then will be posted on the DMH website under the frequently asked questions sections under program compliance. The EPSDT regulations are complex and we want to make certain that that accurate information in circulated, so all questions will be deferred to the Q and A panel at the end of the training.

2. ACKNOWLEDGEMENTS CIMH wants to acknowledge the invaluable assistance of the following stakeholders and their organizations: Rusty Selix and staff, California Council of Community Mental Health Agencies Nicette Short and staff, California Alliance of Child and Family Services Don Kingdon and staff, California Mental Health Directors Association Carol Sakai and staff, State Department of Mental Health (Leave slide up for awhile longer) The following stakeholders were a great help and support in the development of this first initial set of trainings that focus on the most common areas for recoupment. These stakeholders additionally will be offering on-going and significant contribution to the EPSDT manual that will be completed later this year. I would like to thank Rusty Selix' and Adrienne Shilton who did much of the work related to this project. Nicette Short who has offered so much expertise and especially support towards ensuring the work would offer the right information to people Don Kingdon who offered support to the project and coordinated smooth access to the mental health directors Carol Sakai and her staff for their invaluable assistance in this project(Leave slide up for awhile longer) The following stakeholders were a great help and support in the development of this first initial set of trainings that focus on the most common areas for recoupment. These stakeholders additionally will be offering on-going and significant contribution to the EPSDT manual that will be completed later this year. I would like to thank Rusty Selix' and Adrienne Shilton who did much of the work related to this project. Nicette Short who has offered so much expertise and especially support towards ensuring the work would offer the right information to people Don Kingdon who offered support to the project and coordinated smooth access to the mental health directors Carol Sakai and her staff for their invaluable assistance in this project

3. Review of Training Objectives Strengthen insight and knowledge of effective practices of chart documentation. Identify and reduce common errors in chart documentation. Identify promising practices of chart documenation. One of the main purposes of this training is to help both counties and providers strengthen the knowledge about the work they do related to documentation and overall treatment plan implementation and how it relates to documentation. Additionally the focus of the training will be on identifying common errors in chart documentation and with some information on how to reduce common errors. And finally in-bedded in the training you will find we will offer some best practices on chart documentationOne of the main purposes of this training is to help both counties and providers strengthen the knowledge about the work they do related to documentation and overall treatment plan implementation and how it relates to documentation. Additionally the focus of the training will be on identifying common errors in chart documentation and with some information on how to reduce common errors. And finally in-bedded in the training you will find we will offer some best practices on chart documentation

4. Overview of the ESPDT Program History and Description of the Federal Medicaid EPSDT Program California�s EPSDT Program EPSDT and California�s Mental Health System I know the knowledge level is high in the audience and we will be giving a very brief history and description of the federal Medicaid program, California's medi-cal program including the California mental health system as it all related to EPSDTI know the knowledge level is high in the audience and we will be giving a very brief history and description of the federal Medicaid program, California's medi-cal program including the California mental health system as it all related to EPSDT

5. History and Description of the Federal Medicaid EPSDT Program EPSDT is Medicaid's comprehensive and preventive child health program for individuals under 21 years of age. EPSDT was defined by law under OBRA '89, and includes four screening services. OBRA also required coverage of all federally-covered services for children under 21 years of age, even if not covered for adults. The EPSDT program consists of two mutually supportive, operational components:  (1) assuring availability and accessibility of required health care resources; and (2) helping eligible children and their parents or guardians to effectively use these resources. EPSDT was enacted in amendments of the Social Security Act of 1967 in response to the high rejection rates for new draftees into the military due to untreated childhood illness. This mandated prevention orientation screening and early identification of conditions that could interfere with a child�s natural growth and development and also included comprehensive health and developmental assessments and treatment necessary to ameliorate acute and chronic physical and mental health conditions for children and youth up to age 21. The Omnibus Budget Reconciliation Act of 1989 codified existing regulations and made a number of changes to the 1967 statute and required the state to provide screening services to identify defects, conditions and illnesses, to provide the diagnostic and treatment services needed to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, and to effectively inform individuals of the screening and treatment services available under EPSDT. Some of the changes were the modifications of alcohol and other drug screening, counseling and treatment for themselves and their families, including health education. Children who are on Medicaid are entitled to receive all EPSDT services that are medically necessary even if these services are beyond those provided under the state plan for the general Medicaid population. Supporting language in the OBRA 89 is to �provide and to promote family-centered, community based, culturally competent, coordinated care for children with special health care needs� EPSDT was enacted in amendments of the Social Security Act of 1967 in response to the high rejection rates for new draftees into the military due to untreated childhood illness. This mandated prevention orientation screening and early identification of conditions that could interfere with a child�s natural growth and development and also included comprehensive health and developmental assessments and treatment necessary to ameliorate acute and chronic physical and mental health conditions for children and youth up to age 21. The Omnibus Budget Reconciliation Act of 1989 codified existing regulations and made a number of changes to the 1967 statute and required the state to provide screening services to identify defects, conditions and illnesses, to provide the diagnostic and treatment services needed to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, and to effectively inform individuals of the screening and treatment services available under EPSDT. Some of the changes were the modifications of alcohol and other drug screening, counseling and treatment for themselves and their families, including health education. Children who are on Medicaid are entitled to receive all EPSDT services that are medically necessary even if these services are beyond those provided under the state plan for the general Medicaid population. Supporting language in the OBRA 89 is to �provide and to promote family-centered, community based, culturally competent, coordinated care for children with special health care needs�

6. California�s EPSDT Program California�s Medi-Cal Program is required to cover EPSDT services per OBRA �89. EPSDT screening services are provided in California through CHDP, which also offers these services to low income children not eligible for Medi-Cal. DHS administers the CHDP program. DHS is Medicaid �Single� State agency, responsible for Medi-Cal program administration. DHS contracts with other State agencies to administer portions of Medi-Cal. EPSDT services provided in California under OBRA 89 have been provided through the Child Health and Disability Prevention Program (CHDP) This program offers a full range of health assessment, diagnosis and treatment in addition to assisting families in finding a local CHDP provider. The administration of Medicaid benefits under the CHDP program and EPSDT program for children is shared between the state and federally mandated program. The state agency charged with administering the Medicaid program. In California, the single state agency is the Department of Health Services (DHS) and the Medicaid program is called Medi-Cal. EPSDT services provided in California under OBRA 89 have been provided through the Child Health and Disability Prevention Program (CHDP) This program offers a full range of health assessment, diagnosis and treatment in addition to assisting families in finding a local CHDP provider. The administration of Medicaid benefits under the CHDP program and EPSDT program for children is shared between the state and federally mandated program. The state agency charged with administering the Medicaid program. In California, the single state agency is the Department of Health Services (DHS) and the Medicaid program is called Medi-Cal.

7. EPSDT and California�s Mental Health System In the 1970s, DHS first allowed billing of local mental health services under Medi-Cal, including services for children under 21 years of age covered under the State Plan. OBRA �89�states were required to provide children under 21 with all medically necessary health care services, even if not included in their Medicaid State Plan. California lost a suit alleging failure to comply with OBRA �89 by not providing enough funding to cover all of mental health services needed by children. DHS expanded EPSDT mental health services in 1995, allowing MHPs to bill Medi-Cal for expanded services to children under 21 years of age. The Lawyers who sued California in 1994, charged that California was violating the EPSDT policy by failing to provide enough care�especially mental health care. In 1990, a national study found that California ranked 50th among states in identifying and treating severely mentally ill children. Consequently, as a result of a 1994 lawsuit (T.L. v. Belshe'), the Department of Health Services (DHS) was required to expand certain EPSDT services, including outpatient mental health services. DHS and DMH crafted an agreement in 1995 to implement expanded services as required by the court. And the rest is history!! The Lawyers who sued California in 1994, charged that California was violating the EPSDT policy by failing to provide enough care�especially mental health care. In 1990, a national study found that California ranked 50th among states in identifying and treating severely mentally ill children. Consequently, as a result of a 1994 lawsuit (T.L. v. Belshe'), the Department of Health Services (DHS) was required to expand certain EPSDT services, including outpatient mental health services. DHS and DMH crafted an agreement in 1995 to implement expanded services as required by the court. And the rest is history!!

8. EPSDT and California�s Mental Health System In 1997, Freedom of Choice 1915(b) Waiver was implemented In 1998 specialty mental health managed care program was implemented, making MHPs responsible for most mental health services within California, including EPSDT expanded scope services. Local mental health departments implemented plans to meet additional service demands and providing access to care. In 1999, MHPs became responsible for TBS services. The freedom of choice Medicaid waiver is known as the Specialty Mental Health Services Consolidation Waiver. The state consolidated programs into one �carved out� specialty mental health program now responsible for all medi-cal specialty mental health care including the EPSDT program. Under the waiver, mental health services are delivered through county mental health managed care which called Mental Health Plans (MHP) Each MHP contracts with DMH to provide specialty mental health services. The waiver provision, which provides exemption from some Medicaid regulations, seeks to promote cost effectiveness and efficiency in state Medicaid plans. Provider choice is restricted to within the county MHP provider network which has caused problems for foster and adopted youth when they move from one county to another. Therapeutic Behavioral Services are the result of a legal judgment and permanent injunction in the Emily Q. vs. Bonta case. TBS services have become part of EPSDT and therefore the responsibility of the county MHP The freedom of choice Medicaid waiver is known as the Specialty Mental Health Services Consolidation Waiver. The state consolidated programs into one �carved out� specialty mental health program now responsible for all medi-cal specialty mental health care including the EPSDT program. Under the waiver, mental health services are delivered through county mental health managed care which called Mental Health Plans (MHP) Each MHP contracts with DMH to provide specialty mental health services. The waiver provision, which provides exemption from some Medicaid regulations, seeks to promote cost effectiveness and efficiency in state Medicaid plans. Provider choice is restricted to within the county MHP provider network which has caused problems for foster and adopted youth when they move from one county to another. Therapeutic Behavioral Services are the result of a legal judgment and permanent injunction in the Emily Q. vs. Bonta case. TBS services have become part of EPSDT and therefore the responsibility of the county MHP

9. Purpose of EPSDT Chart Documentation Training The evolution of EPSDT is integrally related to Budget trailer bill language (5% extrapolation, stratification and independent statistician expert) and Stakeholder involvement. CiMH in partnership with CMHDA, CACFS, CCCMHA, DMH and DRG, is presenting the chart documentation trainings. The stakeholder partnership will develop a chart documentation manual/handbook which will be disseminated in late 2006-2007. AB 1807 FY 2006-07 Trailer Bill Language on EPSDT Audits: The state will revise its method for auditing legal entities that provide specialty mental health services under EPSDT and it�s method for extrapolating data obtained from those audits. AB 1801 Budget Items; develop and provide training for counties and provider organizations, develop a manual on billing procedures and related processes associated with operating an effective and qualitative EPSDT Program. The first training shall focus on the most common concerns regarding documentation within the program.AB 1807 FY 2006-07 Trailer Bill Language on EPSDT Audits: The state will revise its method for auditing legal entities that provide specialty mental health services under EPSDT and it�s method for extrapolating data obtained from those audits. AB 1801 Budget Items; develop and provide training for counties and provider organizations, develop a manual on billing procedures and related processes associated with operating an effective and qualitative EPSDT Program. The first training shall focus on the most common concerns regarding documentation within the program.

10. Purpose of EPSDT Chart Documentation Training The goal of the EPSDT training is to strengthen knowledge and practices of chart documentation, identify and reduce common errors. The focus and the content of the training will be on identifying the four most common reasons for recoupment and reducing chart errors. The concept for this program is �Train-the-Trainer�. Participants were selected by the county or legal entity to participate in the training and bring back information to train their staff. This training is designed to promote a train the trainer concept so that you can take the material from the training and use it to train others in your county or provider organization. CIMH will be implementing a web cast on Friday, November 17th from 1:00 PM to 4:00 PM. This is a good time to have staff involved in the training.This training is designed to promote a train the trainer concept so that you can take the material from the training and use it to train others in your county or provider organization. CIMH will be implementing a web cast on Friday, November 17th from 1:00 PM to 4:00 PM. This is a good time to have staff involved in the training.