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CABHA Rules Highlights

CABHA Rules Highlights. CABHA Rules Highlights. CABHA Kickoff February, 2011. Kelly Crosbie, Behavioral Health Manager NC Division of Medical Assistance. Jim Jarrard, Deputy Director NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

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CABHA Rules Highlights

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  1. CABHA Rules Highlights CABHA Rules Highlights CABHA Kickoff February, 2011 Kelly Crosbie, Behavioral Health Manager NC Division of Medical Assistance Jim Jarrard, Deputy Director NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services LME and CABHA Regional Kick-Off Meeting

  2. Where are the CABHA Rules Found? http://reports.oah.state.nc.us/ncac/title 10A - health and human services/chapter 22 – medical assistance eligibility/subchapter p.rules.html P The CABHA Rules are DMA Rules (i.e., found in Administrative Code among other DMA rules). P The CABHA Rules were not vetted through the DMH/DD/SAS Commission. The CABHA Rules were approved by the State Rules Review Commission, as are all pending rules. P LME and CABHA Regional Kick-Off Meeting

  3. Overview of Rules by Section 10A NCAC 22P .0101: Purpose and Scope 10A NCAC 22P .0201: Definitions 10A NCAC 22P .0301: Service Delivery ä Identifies approved services for continuum ä Identifies required agency practices to assure coordination of care. Identifies required documentation to assure choice, appropriate referrals, and collaboration with primary care (CCNC), FQHCs, Health Departments, primary care case management, and other community agencies. ä LME and CABHA Regional Kick-Off Meeting

  4. Overview of Rules by Section 10A NCAC 22P .0302: Access To Care • Critical Access Behavioral Health Agency (CABHA) certification … for the one service site identified by the applicant in the attestation letter... • CABHAs shall be monitored for performance concerning timely and effective consumer access to care … • (c) CABHAs shall provide service(s) for persons in need of emergent, urgent, and routine MH/SA services … face-to-face emergency care, assessment, treatment or referral services … • (d) CABHAs shall ensure availability of emergent, urgent and routine care and appointments for all consumers. • (e) CABHAs shall perform "first responder" crisis response 24 hours a day, 7 days a week, 365 days a year to all consumers accessing CABHA services. • (f) [Consumers being] discharged from a state-operated facility shall [receive] community-based service(s) within seven days of … discharge. LME and CABHA Regional Kick-Off Meeting

  5. Overview of Rules by Section 10A NCAC 22P .0303: Coordination of Benefits ä Requires that Federal funds be accessed as payer of last resort 10A NCAC 22P .0401: Certification Requirements ä Requires 3-Year Accreditation Requires Medical Director, Clinical Director, QM Director and Training Director ä ä Requires Good Standing ä Requires performance bond or letter of credit within twelve (12) months of certification LME and CABHA Regional Kick-Off Meeting

  6. Overview of Rules by Section 10A NCAC 22P .0402: Good Standing ä Identifies criteria for maintenance of Good Standing with DMA, DMH/DD/SAS and DHSR 10A NCAC 22P .0403: Medical Director Requirements ä Identifies appropriate credentials and experience for CABHA Medical Director ä Identifies appropriate involvement of Medical Director with CABHA Organization and Staff ä Identifies requirements for notification when the agency is without a Medical Director, and timeframes for replacing Medical Director. LME and CABHA Regional Kick-Off Meeting

  7. Overview of Rules by Section 10A NCAC 22P .0403: Medical Director Requirements (continued) ä CABHA Medical Director may serve as 50% or less Medical Director for no more that two (2) CABHAs at a time. ä 750 consumers or more: 100% Medical Director required. No more than two (2) physicians. May bill up to 24 hours per week for CABHA. ä 376-749 consumers or more: 50% Medical Director required. No more than one (1) physician. May not bill up to 12 hours per week for CABHA. ä 375-fewer consumers: 20% Medical Director required. No more than one (1) physician. May not bill for CABHA. LME and CABHA Regional Kick-Off Meeting

  8. Overview of Rules by Section 10A NCAC 22P .0404: Clinical Director Identifies appropriate credentials and experience for CABHA Clinical Director ä ä Identifies appropriate involvement of Clinical Director with CABHA Organization and Staff Identifies requirements for notification when the agency is without a Clinical Director, and timeframes for replacing Clinical Director. ä ä Must be directly employed by the CABHA. ä May be shared by no more than two (2) persons, each working 20 hours per week. May not serve as 50% Clinical Director for more than one (1) CABHA. ä LME and CABHA Regional Kick-Off Meeting

  9. Overview of Rules by Section 10A NCAC 22P .0404: Clinical Director (continued) ä A Medical Director may also be the Clinical Director ä A CABHA that requires a 100% FTE Medical Director and who hires a psychiatrist or ASAM/ABAM certified physician may have one (1) individual fill both the Medical Director and Clinical Director positions. That individual may not bill services for the CABHA. A CABHA must notify the Director of DMH/DD/SAS within ten (10) days when either the Medical Director, Clinical Director, QM Director or Training Director positions are vacant. ä LME and CABHA Regional Kick-Off Meeting

  10. Overview of Rules by Section Note on Rule Implementation of 10A NCAC 22P .0400: Staffing Requirements: ä Notification of Staff Changes to DMA/DMH ä Review of Staff Changes by DMH ä Results of Staff Change Reviews LME and CABHA Regional Kick-Off Meeting

  11. Overview of Rules by Section 10A NCAC 22P .0405: Quality Management Director ä Identifies appropriate credentials and experience for CABHA QM Director ä Identifies appropriate involvement of QM Director with CABHA Organization and Staff Identifies requirements for notification when the agency is without a QM Director, and timeframes for replacing Quality Management Director. ä The Quality Management Director and the Training Director positions may be filled by the same person or by no more than two (2) individuals. ä An individual who serves as both the Quality Management Director and Training Director may not provide direct services to CABHA consumers. ä LME and CABHA Regional Kick-Off Meeting

  12. Overview of Rules by Section 10A NCAC 22P .0406: Training Director ä Identifies appropriate credentials and experience for CABHA Training Director ä Identifies appropriate involvement of Training Director with CABHA Organization and Staff ä Identifies requirements for notification when the agency is without a Training Director, and timeframes for replacing Training Director. 10A NCAC 22P .0407: Exception Process ä Identifies protocol by which a physician who does not meet the requirements in .0403. (a) (1) and (2), may be approved to be a CABHA Medical Director LME and CABHA Regional Kick-Off Meeting

  13. Overview of Rules by Section 10A NCAC 22P .0500: Certification Procedures ä Identifies the process for becoming a CABHA. 10A NCAC 22P .0501: Letter of Attestation and Desk Review 10A NCAC 22P .0502: Interview 10A NCAC 22P .0503: Verification Review 10A NCAC 22P .0504: Existing Critical Access Behavioral Health Agencies CABHAs certified prior to adoption of these rules have 180 calendar days to be compliant with all rules, except the performance bond requirement, for which 365 days are allowed to come into compliance. ä LME and CABHA Regional Kick-Off Meeting

  14. Overview of Rules by Section Note on Rule Implementation of 10A NCAC 22P .0500: Certification Procedures: ä Certified agencies that change continuums will need to submit the entire attestation packet to the LME team. ä The packet will be reviewed for information related to the continuum change and staff experience with the age and disability of the new continuum. ä A verification review focusing on the continuum change and staff experience will be conducted on site LME and CABHA Regional Kick-Off Meeting

  15. Overview of Rules by Section 10A NCAC 22P .0600: Monitoring, Decertification and Appeal Procedures 10A NCAC 22P .0601: Monitoring ä By Department or LME Site visits, data or documentation reviews, post-payment reviews, investigations, etc. ä ä Targeted in response to complaints or other monitoring results ä Customary Plan of Correction (POC) process in place. 10A NCAC 22P .0602: Decertification and Suspension Identifies circumstances under which CABHAs may be decertified or suspended. ä LME and CABHA Regional Kick-Off Meeting

  16. Overview of Rules by Section 10A NCAC 22P .0603: Appeal Procedures ä First Review: Reconsideration review by DHHS ä Second Review Office of Administrative Hearings (only after DHHS Reconsideration Review completed) ä Section identifies timeframes for notification of intent to appeal. ä Section identifies timeframes for DHHS response to Reconsideration request or OAH Appeal. LME and CABHA Regional Kick-Off Meeting

  17. Heads-Up! … FYI Duplication/Streamlining Workgroup To Be Constituted… ä The Secretary of DHHS has charged DMA/DMH/DHSR with forming a workgroup to focus on addressing any overlapping of process in the areas of endorsement, CABHA certification, monitoring, accreditation, licensure, etc. More coming soon LME and CABHA Regional Kick-Off Meeting

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