Georgia Association of Homes and Services for Children |
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Georgia Association of Homes and Services for Children |
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Notes from the Mental Health - 2/28/2008 - Provider Network Meeting Agenda , in Forsyth, Georgia
Georgia Child and Adolescent Consumer Supports Program administered through a Third Party Administrator – this is a program that provides non Medicaid reimbusible services to those who need these “wrap around” services but Medicaid will not pay for.
The Third Party Administrator receives all referrals through the web. Only Core and IFY providers can access these services through a IRP on the website for the clients that they are providing services to. These services are granted on a “as needed” basis. There is a limited amount of money available for these services, so priority of need is critical determination. These programs can be found at: https://fms.publicpartnerships.com/gata . More than 20,000 consumers has been entered into the system. The TPA does not do utilization review but administration of the services. They are guaranting “real time” approval. Money will limit the amount of services delivered in a Region. These services does not apply to a RBWO clients on Medicaid.
The documentation standards for this are that · Requests must be documented in the consumers Individual Request Plan (IRP) · Tutoring must be provided in a 1:1 OR 2:1 setting and consumers who are referred to learning centers will be expected to attend consistently. NOT homework assistance. · Only one payment per family per year for all housing related goods and vehicle repair or lease. · Reciepts must be kept for all goods and services
Warnings: Excessive referral requests may be denied or suspended pending a meeting with the Division. Do not hit the submit button on the web more than once. Wait for the web to process. This program does not handle crisis. Appeals for denials will be determined within five days.
Contact pplga@pcgus.com for more information. Network Development Office – 866 835 3371 Financial Operations Center – 866 315 3741
Behavioral Aides have been pulled out of the TPA program and moved into the “Fee for Service” System effective April 1, 2008. Parenting Instruction will go live next week.
State Plan Amendment is being revised. This is an agreement between the State and the federal government. The State is amending our state plan because of CMS concerns with our State Plan for Medicaid Services. Medicaid does no want to pay for something that they believe they should not be paying for. Examples of this is targeted case management and bundled Level of Care services. Medicaid pays for services not programs. CMS require practitioner specific rates. New codes are being planned because of the different modifiers defining the services. Please note the handouts.
Rate setting will be based on cost reports. Cost reports will look at the all the costs related to providing services. Billable hours are also taken into account. See handouts on how these are determined. There are a number of activities that consumers need that Medicaid does not pay for. Documentation, transportation, phone calls and no shows are amoung these activities. They still need to be taken into account.
The new rates for services should be approved by July 2008.
CMS was concerned about the residential providers who now want to do also treatment services. They wanted to know what kind of firewalls were going to be in place. They are wanting to know if they were going to serve the general community as well. The were concerned about shared staff in a group home and the MRO providers. Freedom of Choice for all consumers need to be in place. MOU (memorandum of understandings) between the MRO and the Residential provider is not acceptable. Room and board can not be paid for by Medicaid. They want to know DHR’s involvement with these services. Other questions were posed as reflected on the handouts.
CMS does not trust Georgia. Everyone needs to be prepared.
Providers need to make sure that consumers have a freedom of choice. Referral to self is not acceptable. A form informing freedom of choice of providers is a smart move. Medical necessity will determine eligibility of services. Authorization is not the same as medical necessity. Rehabilitative services covered by Medicaid must be recommended by a physician or other licensed practitioner within the wscope of their practice under State law.
Authorization for services take a certain procedure. See notes. Mental Health - 2/28/2008 - Order for Service
Please note the handouts. Any questions concerning technology should be address to this office through John Quesenberry. The Technology Authority has no information about this website.
New Services being Offered
Community Transitional Planning
Residential Services Independent Residential Service Semi-Independent Residential Service Intensive Residential - Mental Health - 2/28/2008 - Adolescent Intensive Residential Treatment. Family Treatment Homes
New Residency documentation requirements for consumers over the age of 18. New caregiver data requirements.
These new data elements will be effective July 1, 2008
Any questions concern the MICP or technology mhmris@dhr.state.ga.us
Structured Activity Supports – These new services provide children and adolescents who are core customers with homework assistance, leisure, and recreational activities.
· Target Population is children and adolescents · Provided for up to two hours a day during non-school hours · Offered in conjuctin with treatment services, like counseling, group and family counseling. · Providees support to youth who have significant behavioral health problems. · To provide the child or adolescents with experiences and supports that wil enable them to develop skills to become fully integrated into their communities and to develop positive outcomes. · Provided to children in RBWO if they are in a clinic based services. · May include games, hobbies, play activities and pro social behaviors. · Diversionary activities like TV is not included. · Homework assistane must be actively involved · Typical youth will attend to after school services from 3-5 days a week. · Can only be billed when offered in conjunction with other therapeutic activities like counseling. · Must be a part of a treatment plan. · Licensed professional must recommend this services · Intervention must be documented · Tied to Core providers and the services they offered. · These services will be paid for by state dollars
Behavioral Assistance · This service helps the consumer have access to normal routines and rhythms of community living by accompanying consumers to activities and events and assists them with making good decisions and maintaining safe and appropriate behavior while out in public. · Ordered by linsed clinician and document on the IRP · May be provided in school classrooms for short periods of times to help with transitions · Tield to specific treatment goals and be developed in coordination with family. · Provides shoupport in variety of environments. · Not baby sitting. · Available in the evenings on weekends and on holidays. · Typically provided on to one but can be small groups up to 4 consumers. · My include time transporting. · Staffing requirements is a bachelor’s degree or associates with 4 years direct experience working with children in a behavioral setting. · Can be high school with 6 years direct experience working with children. · Does not have to be dedicated staff
Community Transition Planning · This is a service for Core, IFI, and ACT providers to ensure a coordinated plan of transition from the state hospital or qualifying facility where Medicaid billing is not allowed to the community. · In partnership with other community services providers and the hospital and facility staff, the community service agency maintains responsibility for carrying out transitional activities. · Applicable to PRTF transitions. · Available to those currently in state hospitals and other qualifying facilities who meet Core Customer Eligibility Definition. · Each episode of CTP must include contact with the consumer, family, or caregiver with one face to face contract. · Transitional activities include educating the consumer, family and caregiver on service options offered by the chosen primary service agency and participation in the state hospital or treatment tema meetings to develop a transition plan. · This may also be used for other staff who work with the consumer in the community or will work with the consumer in the future to maintain or establish contact with the consumer.
DHR LEP/SI Policy 1701
DHR is mandated by law to provide English language assistance to any client that it serves. Provider shall ensure free language access to clients. These requirements of the contract with providers will be checked.
Guiding Principles regarding co-occurring disorders Mental Health - 2/28/2008 - Co occurring disorders memo Research has shown that mental health and drug abuses services are most effective when provided together. DMHDDAD aspire to be responsive to the needs of these consumers. Co occurring disorders are both considered primary. All clients will be served no matter which program sees them first. Integrated services will be provided and seamless to the individual. One therapist is preferred but 2 or more occur. Outreach will be assertive. Long term community based care will be provided to be most effective. Provided in culturally competent manner. Training on best practice and techniques. Workforce development will be stressed to improve.
Seminar on co occurring disorders will be held in May and June. Motivational Interviewing will be held in April 2008 Clinical supervision will be help in June Group treatment seminar will be in May 2008 These trainings are posted on http://mhddad.dhr.georgia.gov/ttraining
Behavioral Health Link.
They had over 9800 calls to the center in January, half were scheduled for an appointment, and 55 providers used. It took 5.8 days for the person to get an appointment.
APS FY08 Quality Improvement Projects by Julie Currie - Mental Health - 2/28/2008 - Order for Service .
Two major trends over the past two years. Audit scores have significantly decreased. New providers are unclear of audit expectations, service guidelines, and payer regulations Billing support deficiencies were the most common error. Documentation does not support what is billed Progress notes does not support billing Is documentation present?
Develop billing best practices resource Learn from those who are doing it well. Find out what is going wrong with those with bad scores. APS will provide one on one technical assistance. Documentation of audit deficiencies will be cited to the regulation
New providers will receive Mock Audits APS will have Ambassador to new providers to assist in training. Audits are appeal-able. These policies can be found on their website.
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