welcome n.
Download
Skip this Video
Download Presentation
Welcome

Loading in 2 Seconds...

play fullscreen
1 / 25

Welcome - PowerPoint PPT Presentation


  • 100 Views
  • Uploaded on

Department of Public Health and Human Services. Welcome. Comprehensive School and Community Treatment Program Training Fall 2007. Department of Public Health and Human Services. What We Will Learn Today. History About the CSCT Program Requirements How to Bill How to Document

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Welcome' - dorit


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
welcome

Department of Public Health and Human Services

Welcome

Comprehensive School and Community Treatment Program Training

Fall 2007

what we will learn today

Department of Public Health and Human Services

What We Will Learn Today

History

About the CSCT Program

Requirements

How to Bill

How to Document

More Information

history of medicaid in schools

Department of Public Health and Human Services

History of Medicaid in Schools

Schools have been billing Medicaid for over 10 years

2001 MT Legislature issued a directive to allow for increased Federal Spending

The CSCT program was reinstated into the school based services and enacted in the fall of 2003

why schools can bill medicaid

Department of Public Health and Human Services

Why Schools Can Bill Medicaid

Title XIX (19) of the Social Security Act

Oversight is done by Centers for Medicare/Medicaid (CMS)

Includes Early Periodic Screening, Diagnostic & Treatment Program (EPSDT)

Medicare Catastrophic Coverage Act makes the connection to Individual Education Plans (IEP)

Individuals with Disabilities in Education Act (IDEA)

CSCT Services can be provided for students without an IEP..

this is different from all other School-Based services in Montana

why is the csct program a school based service

Department of Public Health and Human Services

Why is the CSCT Program a School-Based Service

Helps to eliminate the risk of removing students from home and school

Program is operated by the school through a contract with a mental health center

Source of funding makes this available only thru school programs

reimbursable services

Department of Public Health and Human Services

Reimbursable Services

Code H0036- Community psychiatric supportive treatment, face-to-face, per 15 minutes (Medicaid specific)

Includes individual, family and group counseling

Behavioral interventions with student (minimum of 8 minutes for one 15 minute unit)

Direct Crisis intervention when student is present in a school-owned or operated facility

Services need to correspond with a students' Individual Treatment Plan (ITP)

non reimbursable activities

Department of Public Health and Human Services

Non-Reimbursable Activities

Observation & monitoring/supervision

Non face to face service

Time in meetings

More than 720 units of service per month per team

Educational/Academic assistance with schoolwork

Watching movies—attending assemblies---fieldtrips

Less than 8 minutes of service in the 15 minute unit that is billable

provider requirements

Department of Public Health and Human Services

Provider Requirements

Services must be provided by at least two program staff

Caseload for program cannot exceed 720 units (15 minutes each) per month per team

At least one of the two staff must be:

Licensed Psychologist

Licensed Clinical Social Worker

Licensed Professional Counselor

An In-training licensed professional can be employed with the approval of the Children’s Mental Health Bureau at the state department

service requirements

Department of Public Health and Human Services

Service Requirements

Does not require Passport approval and can only be provided to children with Severe Emotional Disturbances (SED) found in ARM 37.86.3702

Does not have to be included on IEP

Services not specified on the IEP must be provided and billed to ALL children who require services

Free Care rule applies with non-IEP services

free care rule

Department of Public Health and Human Services

Free Care Rule

Services must be made available to all children, not just Medicaid eligible recipients

All recipients must be billed, not just Medicaid

To meet this rule CSCT programs must:

Establish sliding fee schedule

Determine third party liability (other insurance if any)

Bill recipients for cost of service

Students with IEP’s are exempt from the “Free Care Rule” in regard to CSCT services

slide11

Department of Public Health and Human Services

Part time Staff

37.106.1960 MENTAL HEALTH CENTER: COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM, STAFFING AND TRAINING

(5) This rule is not intended to prevent the use of part-time staff to provide

CSCT services throughout the year, including school vacation periods. If a child or adolescent receives CSCT services during time periods when school is not regularly in session, then part-time staff may be used and billed as set forth in ARM 37.86.2225.

administrative rule for prior authorization of outpatient therapy with csct

Department of Public Health and Human Services

Administrative Rule for Prior Authorization of Outpatient Therapy with CSCT

37.88.101MEDICAID MENTAL HEALTH SERVICES, AUTHORIZATION REQUIREMENTS (1) Mental health services for a medicaid recipient under the Montana medicaid program will be reimbursed only if the following requirements are met: . . .(c) prior authorization has been obtained for outpatient therapy services that are provided concurrently with comprehensive school and community treatment (CSCT) program services described at ARM 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, 37.106.1965 and 37.86.2225;

program requirements approval

Department of Public Health and Human Services

Program Requirements/Approval

Provided by a licensed mental health center

Program is approved with a CSCT area of endorsement by Quality Assurance Division (QAD) at the state department

Information can be found in Appendix C of School Based Provider Manual

Students with SED’s are served

Certification of match is completed by schools at the end of the year

For federal match requirements to obtain these dollars for reimbursement.

provider approval

Department of Public Health and Human Services

Provider Approval

Individual provider/staff approval is generally not required

Expectation is that CSCT staff are available throughout each day to work with children as needed

CSCT programs can use Pre-Licensed Professionals on an infrequent basis

Contact Diane White, Clinical Program Officer for Children’s Mental Health @ 406-444-1535 for approval of in-training staff personnel (this could be changing)

students with sed s served

Department of Public Health and Human Services

Students with SED’s Served

Services can only be provided to students with serious emotional disturbances (ARM 37.86.3702, rule at end) regardless of whether the child is eligible for Special Education services

Program not intended for children with functional limitations that require activities of daily living (ADL)

These services are covered by other Medicaid services like paraprofessional staff

certification of match

Department of Public Health and Human Services

Certification Of Match

The Federal government requires an annual certification of non-federal expenditures to cover the costs associated with CSCT services

Individual schools are responsible for this match worksheet that is kept on file at the department.

provider enrollment with mt medicaid

Department of Public Health and Human Services

Provider Enrollment with MT Medicaid

Provider Notice for School Based Service dated March 7, 2007

Schools re-enrollment and National Provider Identification Number (NPI)

Mental Health Centers need to work with schools to get the CSCT program staff (teams) enrolled and identified as TEAM 01 and so on

Important and needs to be done before billing for service’s (October 1, 2007)

how to bill for services

Department of Public Health and Human Services

How to Bill for Services

Details can be found in the School Based Services Manual

Only use H0036 code

Field 19 on CMS-1500 is location for “TEAM 01” etc.

WINASAP 2003 is available from ACS and is HIPPA compliant for use in electronic billing

Contact Tom Keith @ 406-451-9532

documentation requirements

Department of Public Health and Human Services

Documentation Requirements

37.85.414MAINTENANCE OF RECORDS AND AUDITING

(1) All providers of service must maintain records which fully demonstrate the extent, nature and medical necessity of services and items provided to Montana Medicaid recipients. The records must support the fee charged or payment sought for the services and items and demonstrate compliance with all applicable requirements. . . .

(b) When reimbursement is based on the length of time spent in providing the service, the records must specify the time spent or the time treatment began and ended for each procedure billed to the nearest minute. Total time billed using one or multiple procedure codes may not exceed the total actual time spent with the Medicaid client.

slide20

Department of Public Health and Human Services

37.86.3702 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, ELIGIBILITY

(2) "Serious emotional disturbance (SED)" means with respect to a youth from the age of six through 17 years of age that the youth meets requirements of (2)(a) and (2)(b).

(a) The youth has been determined by a licensed mental health professional as having a mental disorder with a primary diagnosis falling within one of the following DSM-IV (or successor) classifications when applied to the youth's current presentation (current means within the past 12 calendar months unless otherwise specified in the DSM-IV) and the diagnosis has a severity specifier of moderate or severe:

(i) childhood schizophrenia (295.10, 295.20, 295.30, 295.60, 295.90);

(ii) oppositional defiant disorder (313.81);

(iii) autistic disorder (299.00);

(iv) pervasive developmental disorder not otherwise specified (299.80);

(v) asperger's disorder (299.80);

(vi) separation anxiety disorder (309.21);

(vii) reactive attachment disorder of infancy or early childhood (313.89);

slide21

(viii) schizo affective disorder (295.70);(ix) mood disorders (296.0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89); (x) obsessive-compulsive disorder (300.3); (xi) dysthymic disorder (300.4); (xii) cyclothymic disorder (301.13); (xiii) generalized anxiety disorder (overanxious disorder) (300.02); (xiv) posttraumatic stress disorder (chronic) (309.81);(xv) dissociative identity disorder (300.14); (xvi) sexual and gender identity disorder (302.2, 302.3, 302.4, 302.6, 302.82, 302.83, 302.84, 302.85, 302.89); (xvii) anorexia nervosa (severe) (307.1); (xviii) bulimia nervosa (severe) (307.51); (xix) intermittent explosive disorder (312.34); and (xx) attention deficit/hyperactivity disorder (314.00, 314.01, 314.9) when accompanied by at least one of the diagnoses listed above

slide22

b) As a result of the youth's diagnosis determined in (2)(a) and for a period of at least six months, or for a predictable period over six months the youth consistently and persistently demonstrates behavioral abnormality in two or more spheres, to a significant degree, well outside normative developmental expectations, that cannot be attributed to intellectual, sensory, or health factors: (i) has failed to establish or maintain developmentally and culturally appropriate relationships with adult care givers or authority figures;

(ii) has failed to demonstrate or maintain developmentally and culturally appropriate peer relationships; (iii) has failed to demonstrate a developmentally appropriate range and expression of emotion or mood; (iv) has displayed disruptive behavior sufficient to lead to isolation in or from school, home, therapeutic or recreation settings; (v) has displayed behavior that is seriously detrimental to the youth's growth, development, safety or welfare, or to the safety or welfare of others; or (vi) has displayed behavior resulting in substantial documented disruption to the family including, but not limited to, adverse impact on the ability of family members to secure or maintain gainful employment.

slide23

Serious emotional disturbance (SED) with respect to a youth under six years of age means the youth exhibits a severe behavioral abnormality that cannot be attributed to intellectual, sensory, or health factors and that results in substantial impairment in functioning for a period of at least six months and obviously predictable to continue for a period of at least six months, as manifested by one or more of the following: (i) atypical, disruptive, or dangerous behavior which is aggressive or self-injurious;(ii) atypical emotional responses which interfere with thechild's functioning, such as an inability to communicate emotional needs and to tolerate normal frustrations; (iii) atypical thinking patterns which, considering age and developmental expectations, are bizarre, violent, or hypersexual; (iv) lack of positive interests in adults and peers or afailure to initiate or respond to most social interaction; (v) indiscriminate sociability (e.g., excessive familiarity with strangers) that results in a risk of personal safety of the child; or (vi) inappropriate and extreme fearfulness or other distress which does not respond to comfort by care givers.

slide24

(3) A youth must be reassessed annually by a licensed mental health professional, as to whether or not they continue to meet the criteria for having a serious emotional disturbance. For the initial or for an annual reassessment, the clinical assessment must document how the youth meets the criteria for having a serious emotional disturbance.

more information contacts

Department of Public Health and Human Services

More Information & Contacts

School–Based Services Program Provider Manual

Download a copy from www.mtmedicaid.org

Also found at Web site is Provider Notices, Fee

Schedules, Forms and HIPAA information

DPHHS Contact:

Rena Steyaert Diane White

Program Officer Clinical Program School Based Officer Children’s Services Mental Health

(406)-444-4066 (406)-444-1535

rsteyaert@mt.govdwhite@mt.gov

ad