Transcript BHRS Training

Behavioral Health
Rehabilitation
Quest MHSA, LLC - Tutorial
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The following information is not
sanctioned by any state or federal
agency, you as a licensed or certified and
credentialed clinician are ethically and
legally responsible for following
state/federal regulations in the services
you provide.
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Medicaid Policy OAC 317:30-5-240 - 249
Outpatient BH Services: are covered when provided under a full
BioPsychoSocial Assessment and Individualized Treatment Plan
conducted by a licensed BH professional. The Tx Plan is developed
to treat the identified mental health and/or substance abuse
disorder(s), with the goal of improvement of functioning,
independence, and well-being of the member. The member must
be able to actively participate, have sufficient cognitive abilities,
communication skills, and short term memory to benefit from
treatment.
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Behavioral Health
Rehabilitation Specialist
BA or MA degree from an accredited college/univ; AND
Completion of the ODMHSAS BHRS training; OR
Cert. Psychiatric Rehab Practitioner credential; OR
Certification as an Alcohol and Drug Counselor; OR
Licensed as a RN w/DMHSAS BHRS credential; OR
BHRS prior to 7/1/10 w/DMHSAS credential on file.
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Psycho-Social Rehab Services (PSR)
PSR is the process of restoring community functioning
and well-being of an individual who has a psychiatric
and/or substance abuse disorder. Rehabilitation work
seeks to effect changes in a person’s environment and
in a person’s ability to deal with his/her environment,
so as to facilitate improvement in symptoms or
personal distress.
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Individual
Performed Face 2 Face
with only the client and the
BHRS
sessions may include a
client’s family/support
system in order to focus on
the individuals
goals/objectives.
Ages 6 and up, younger will
need prior approval
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Group
Performed F2F with only
the BHRS and a group of
clients
Staffing Ratios:
1 BHRS to 14 adults (18-up)
1 BHRS to 8 children (6-17)
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PSR Policy
Community or Office Based
Travel time to and from PSR is NOT compensable.
SoonerRide (SR):
Ind PSR, SR is covered
Group PSR, SR is NOT-covered, unless the client has special transportation
needs for wheelchair, etc.
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PSR Policy
Breaks, meals and times when the client is
unable/unwilling to participate are NOT compensable, &
must be deducted from billed time.
CMS federal 8-min rule: when you do 8 minutes
minimum, then you round up to a 15 min unit.
If you do less than 8 min, then you do not bill that unit.
The BHRS must be present interacting, teaching, and/or
supporting the learning objectives of the member for the
entire claimed time.
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Daily Limits
Individual PSR -
6 units/1.5 hours per day maximum allowed
Clinical standard is 1 hr
Time must be age/developmentally appropriate.
Group PSR -
24 units/6 hrs adults, 16 units/4 hrs children
Group clinical standard is 1 - 1.5 hrs per subject/topic
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PSR - 8 main Areas
Psychiatric
Social
Vocational/Educational
Daily Living Skills
Financial
Community/Legal
Health/Medical
Housing
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Psychiatric
Symptom Management
depression
anxiety & panic attacks
ADHD
Anger
trauma
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Vocational/Educational
NOT-Tutoring
Coping Skills
Job Application/Resume’
Interviewing
Motivation
Customer Service
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Social
Relationships
Family
Boundaries
Communications
Community Integration
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Daily Living Skills
Hygiene
Food Planning/Preparation
Cleaning
Safety
Scheduling/Time Mgmt
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Community/Legal
Accessing Resources
Being an Active Part of
one’s community
Presentation skills
Setting up Supports
Taking Charge of Records
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Financial
Budgeting
Bill Paying/Utilities
Setting up a Bank Account
Tax Preparation
Saving
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Health/Medical
Nutrition
Exercise
Meditation/Relaxation
Medical/Psych Appt Mgmt
Symptom Mgmt
Schedules/Logs
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Housing
Housing
Furniture
Safety
Appliances
Maintenance
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Do’s & DON’TS
Don’t do the daily
maximum allowed hours
just because the policy says
you can.
Don’t do the daily
maximum in order to
fatten your wallet.
Do what is clinically right
for the client.
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Do’s & DON’TS -
contd.
Don’t take a kid to an activity and bill for the whole time.
Don’t take a group of kids to an activity, go off w/ one
kid to do Ind Rehab and leave the rest unattended.
Do take a kid to an activity, and bill only the F2F time
that you spend teaching a skill or observing the client
practicing that skill.
Don’t treat a kid age 0-5 unless you have approval thru
Quest’s Clinical Director and proper oversight by LBHP
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Do’s & Don’ts-
contd.
Don’t go sit in a child’s
class and bill the whole
time.
Do sit in a child’s class to
observe, then do some
instruction w/ the child
when allowable, focused on
what will help them to
maintain better in school
and with their peers.
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Do’s and Don’ts - Contd.
Do - “teaching”
Do - “practicing”
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Don’t - “processing feelings”
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Don’t - “tutoring”
Don’t - work without the
Do - “role playing”
supervision/consultation of the
Do - monitoring how the therapist or Quest’s Clinical Director
on
cases
client is doing on their Tx
Plan goals
•Don’t – “mentoring”or“coaching”
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Do - coordinate with the
therapist on client care
Don’t - “parent skills training”
(unless the parent is covered)
•
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Case Management
Do Case Management to
assist a client in accessing
needed resources in their
community to live
independently.
Don’t do CM and bill it as
PSR! Go get your CM
certification so you can bill
for this!!
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Progress Notes (PNs)
Focus - What objective(s) were worked
on in session? What skills were
taught/learned/practiced?
Intervention - what specific
behaviors/suggestions did you do to
promote change?
Response - what did the client report?
how did the client respond to the
intervention(s)? what did they practice?
Plan - what is the client going to work on
between now and next session?
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Group PNs
Write 1 note for each child in group, majority will be
similar, but the client response (and possibly homework)
will be individual to the client.
If you do more than 1 group in a day:
You will do PNs for each separate group topic
Example:
1st group, 1 hour on Anger Mgmt,
2nd group, 1 hour on Personal Hygiene
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PSR 75% Rate Schedule
Individual PSR
$8.84 per 15 min
Group PSR
Adult (18 and over)
$2.04 per 15 min
Children (0-17)
$2.92 per 15 min
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BHRS Safety Rules
Quest takes the safety of our
contractors very seriously.
Please do not ever feel that you have
to enter or stay in a situation that
you do not feel safe, leave
immediately, call the main office and
we’ll reschedule your appointment
at a safe location.
Read “The Quest Contractor Safety
Manual” at www.questmhsa.com
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BHRS Resources
Clinical Director - Alisa Longnecker, [email protected]
Quest Website - www.questmhsa.com, Click on Resources
Center for Psychosocial Rehab - http://cpr.bu.edu/
Technical/Websites/Computer/Logins Paul Marcum, [email protected]
Billing/Payroll
Marla Maple, [email protected]
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THE END
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