Transcript Service Documentation Workshop

Service
Documentation
Workshop
Presented as part of the Test Site Project for the
2004 Real Choice Grant
Integrating Long-Term Supports
with Affordable Housing
DHS AMH Division October 15,
2007
Presented by:
Terry N. Mastin, M.A.
Housing Supports Reform Specialist
Addictions and Mental Health Division
Oregon Department of Human Services
[email protected]
503-945-6722
DHS AMH Division October 15,
2007
An Overview
• How are the services you provide to the
people in the community paid for?
• What are the overall requirements for
providing services?
• How can you document the services you
provide correctly?
DHS AMH Division October 15, 2007
Section I
How are the services you
provide to the people in the
community paid for?
DHS AMH Division October 15, 2007
Medicaid
•Title XIX of the Social Security Act is a Federal/State
entitlement program that pays for medical assistance for
certain individuals and families with low incomes and
resources.
•Medicaid, became law in 1965 as a cooperative venture
jointly funded by the Federal and State governments to
assist States in furnishing medical assistance to eligible
needy persons.
•Medicaid is the largest source of funding for medical
and health-related services for America's poorest people.
DHS AMH Division October 15,
2007
Medicaid
Within broad national guidelines established by
Federal statutes, regulations, and policies, each
State:
(1) establishes its own eligibility standards
(2) determines the type, amount, duration, and
scope of services
(3) sets the rate of payment for services
(4) administers its own program
DHS AMH Division October 15,
2007
Medicaid
•Medicaid policies for eligibility, services, and
payment are complex and vary considerably,
even among States of similar size or geographic
proximity.
•A person who is eligible for Medicaid in one
State may not be eligible in another State.
•The services provided by one State may differ
considerably in amount, duration, or scope from
services provided in a similar or neighboring
State.
(12/14/05). Medicaid Program General Summary. Retrieved August 22, 2007, from Centers for Medicare and
Medicaid Services Web site: http://www.cms.hhs.gov/MedicaidGenInfo/03_TechnicalSummary.
DHS AMH Division October 15,
2007
Title XIX Social Security Act
Medicaid
Oregon Medicaid State Plan
Oregon Health Plan
•Oregon Health Plan Standard
•Oregon Health Plan Plus
•Family Health Insurance
Assistance Program (FHIAP)
Psychiatric Long Term Care
•Extended Care Management Unit
•Psychiatric Security Review Board
Mental Health
Organizations
Community Mental
Health Provider DHS AMH Division October 15,
2007
Community Mental
Health Programs
A Different View……………………..
Title XIX Medicaid
Oregon State
Medicaid Plan
Oregon Health Plan and
Psychiatric Long Term Care
MHOs, CMHPs, &
Mental Health
Providers
Consumers,
Peers, Staff
DHS AMH Division October 15,
2007
Another
angle….
Consumers, Peers, Staff
MHOs, CMHPs, & Mental
Health Provider Agencies,
Oregon Medicaid State
Plan, OHP, PLTC
Medicaid, Title XIX
DHS AMH Division October 15,
2007
Section II
What are the overall
requirements for providing
services?
DHS AMH Division October 15, 2007
Medicaid Documentation
• Department of Human Services audits community
providers through the Provider Audit Unit.
• Audits serve three functions: compliance,
education, and technical assistance.
• Audits are required by Federal Statutes to assure
and preserve the integrity of the Medicaid program.
DHS AMH Division October 15,
2007
Top 10 Mental Health Audit Findings
1. Lack of documentation, including annual updates:
• Mental Health Assessment
• Treatment Plan
• Progress Notes for every service delivered
• Signed Consent to Treat in file
2. Treatment Plan does not list frequency and duration of
modalities to be delivered.
3. Progress note does not justify the therapeutic value of
the treatment (named activity rather than therapy).
4. Progress note does not list the actual time spent.
5. QMHA provided services outside the scope of practice.
DHS AMH Division October 15,
2007
Top 10 Mental Health Audit Findings
6.
Excessive billing for H0034
(medication training and support).
7. Billing for services not provided and for units that
exceed the time spent with the client.
8. Duplication of billing within the mental health staff
9. Billing for services over the phone that are not
covered
• Prescription refills
• Confirming appointments
10. Lack of dates and signature on Treatment Plans,
Assessments, and Progress Notes.
Fraud and Abuse
DHS AMH Division October 15,
2007
Training, April 13, 2007, Eugene,
OR.
Medicaid Documentation
Where to look for
documentation
requirements?
DEPARTMENT OF HUMAN SERVICES,
ADDICTIONS AND MENTAL HEALTH
DIVISION: MENTAL HEALTH SERVICES
OREGON ADMINISTRATIVE RULES
DIVISION 16
MEDICAID PAYMENT FOR
REHABILITATIVE MENTAL HEALTH
DHS AMH Division October 15,
SERVICES
2007
Supervision Requirements
• Medical supervision is documented through
written agreement or job description
between a Licensed Medical Practitioner
(LMP) and the Provider and must occur
annually including review of the Assessment
and Treatment Plan
• Clinical supervision is documented through
written agreement or job description and
must occur monthly including oversight
responsibility, monitoring and training
DHS AMH Division October 15,
2007
Medicaid Coverage: Documentation
ASSESSMENT
TREATMENT PLAN
PROGRESS NOTE
DHS AMH Division October 15,
2007
Another view………….…
ASSESSMENT
TREATMENT PLAN
PROGRESS NOTE
DHS AMH Division October 15,
2007
Assessment
What are the minimum requirements
for an assessment?
DHS AMH Division October 15,
2007
Assessment
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Done by QMHP during enrollment, and
Updated annually
Reviewed and approved by LMP at
least annually
DSM five axes diagnosis
Clinical formulation
DHS AMH Division October 15,
2007
Assessment (cont.)

Includes treatment domains:
Cognitive
Family
Substance Abuse
Emotional
Behavioral
Developmental
Social
Physical health/medical care
Nutritional
School or Vocational
Cultural
DHS AMH Division October 15,
Legal
2007
Treatment Plan
What are the minimum
requirements for a
Treatment Plan?
DHS AMH Division October 15,
2007
Treatment Plan
Specifies the DSM Axis I diagnosis that is
the medically appropriate reason for
clinical care and the main focus of
treatment.
 Individualized treatment goals and
measurable objectives to be achieved.
 The regimen of rehabilitative mental
health services that will be used to meet
the treatment goals and achieve the
measurable objectives.

DHS AMH Division October 15,
2007
Treatment Plan (cont.)
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The projected schedule for service delivery,
describing the expected amount, duration and
scope of each type of planned therapeutic session
or service.
The printed name, signature and date of signature
of the primary QMHP.
The projected schedule for revising the Treatment
Plan at least annually thereafter in conjunction with
the annual Comprehensive Mental health
Assessment.
Signature of consumer/client on plan.
Criteria for discharge.
DHSplan
AMH Division
LMP will approve the
at October
least15,annually.
2007
Progress Notes
What are the minimum
requirements of a
Progress Note?
DHS AMH Division October 15,
2007
Progress Note
The specific Medicaid service rendered.
 The date the service was rendered.
 The printed or stamped name of the
QMHP or QMHA who rendered the
service.
 The setting in which the service was
rendered.
 The amount of time it took to deliver
the service.

DHS AMH Division October 15,
2007
Progress Note (cont.)

The signature, computerized signature or
written initials and date of this authentication
and educational credentials of the QMHP or
QMHA providing the service. If written initials
are utilized to authenticate a progress note,
the Provider must maintain a printed list of
staff with their corresponding initials. A
stamped signature may be utilized if the QMHP
or QMHA also authenticates this signature by
initialing and dating the stamped signature.
DHS AMH Division October 15,
2007
Progress Note (cont.)

For services that are not specifically
included in the client’s Treatment Plan,
or exceed the scope of the plan,
maintain an explanation of how the
services being billed relate to the
Treatment Plan.
DHS AMH Division October 15,
2007
Section III
How can you document the
services you provide correctly?
DHS AMH Division October 15, 2007
Putting it all together………
The assessment determines the
“clinically appropriate” need for mental
health services.
The treatment plan spells out the
“medically appropriate” services to be
delivered.
The progress note documents the
delivery of the “prescribed services”
and the “client’s clinical response to
the specific treatment.”
DHS AMH Division October 15, 2007
Remember?....................
ASSESSMENT
TREATMENT PLAN
PROGRESS NOTE
DHS AMH Division October 15,
2007
Shifting the focus…………..
YES—document the clinical
intervention you provided.
YES—document the
client’s/consumer’s response to the
intervention.
YES—document the progress toward
the goal the clinical intervention
addressed.
NO—Narrate and/or describe what
took place, blow by blow.
DHS AMH Division October 15, 2007
Variances
A variance from those requirements not
established by federal regulations
may be granted for up to one year by
submitting a written request including:
Section of the rule
Reason
Alternative practice
A timetable for compliance
to the AMH Medicaid Policy Unit
DHS AMH Division October 15, 2007
Document Packet
YCAMH Adult Behavioral Health
Assessment
 Sample Letter from a Collateral Source
 YCAMH Continued Service
Request/Continuum of Care Plan
 YCAMH Residential Services Treatment
Plan Addendum

DHS AMH Division October 15, 2007
What is a clinical formulation?
Break into small groups.
 Example of clinical formulation in packet.
 Read “Sample Letter from a Collateral
Source.”
 Come up with a clinical formulation, as a
group, using that scenario.

DHS AMH Division October 15, 2007
Treatment Plans
Rejoin your small group.
 Compare the minimum requirements for a
treatment plan to the YCAMH Continued
Service Request/Continuum of Care Plan and
the Residential Services Treatment Plan
Addendum.
 What requirements are met?
 Any required elements missing?

DHS AMH Division October 15, 2007
Progress Notes
As a large group, generate some scenarios
on the services/supports you provide in a
typical day.
 Provide a progress note for each scenario
that contains the minimum requirements
for a progress note, per the Oregon
Administrative Rules, Division 16.

DHS AMH Division October 15, 2007
Evaluation and Wrap Up
What was helpful, useful, and/or positive
about the training today?
 What was not helpful, not useful, and/or
not positive about the training today?
 What suggestions for improvement can
you give me for future trainings.
 Any other comments?

for attending today!
DHS AMH Division October 15,
2007