Transcript OMHSAS & Permissible Arraignments for Licensed

OMHSAS & Permissible Arrangements
for Psychologists
Providing Behavioral Health
Rehabilitation Services
TRAINING ON MEDICAL ASSISTANCE
BULLETIN
OMHSAS-11-05
ISSUED MARCH 8, 2011
OVERVIEW
Background on Pennsylvania DPW-OMHSAS
Medical Assistance Bulletin (MAB)
II. Introduce Verification of Responsibilities form
III. Examples of appropriate/inappropriate service
delivery arrangements
I.
MAB OMHSAS-11-05
March 8, 2011
Over time, OMHSAS found….
some psychologists lacked a full understanding of the
BHRS requirements they were a provider of or how these
requirements intersected with Pennsylvania State Board
of Psychology regulations. Key findings include:
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Exceeding supervision limit of unlicensed professionals (MT’s
& BSC’s)
Allowing other psychologist or “providers” to bill for services
under their provider number or billing for services supervised
by other psychologist
No participation in treatment planning or service delivery
No oversight of program development
Deviating from approved Service Description
Providing BHRS
Background…
1989 Congress amends the Early and Periodic Screening,
Diagnosis and Treatment (EPSDT) provisions of the Medicaid
statue, requiring states to provide necessary treatment and
services
1994 Therapeutic Support Staff (TSS), Mobile Therapy (MT)
and Behavioral Specialist Consultant (BSC) added to
Medicaid fee schedule (MAB 01-94-01).
2001 MAB 01-01-05 revises policies related to BHRS including
qualifications, training and supervision requirements for TSS
2003 MAMIS-to-PROMISe transition psychologists
previously enrolled as “provider type 50” re-enrolled as
“provider type 19” to align with federal taxonomy codes.
2005 DPW begins utilizing National Provider Identifier (NPI)
and associating with PROMISe ID.
2007 DPW begins offering MA Bulletins via email
General Enrollment
 To do business with the Department of Public Welfare,
provider entities must first enroll in the Pennsylvania Medical
Assistance Program.
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Enrollment requires a complete a base provider enrollment form and
applicable addenda documents.
For psychologists ….
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Must be licensed without restriction and meet established provider type
criteria:
http://www.dpw.state.pa.us/provider/promise/enrollmentinformation/index.htm
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Approved applicants are issued unique PROMISe number and entered
into statewide network
Providing BHRS
Current regulations allow for a psychologist to offer
BHRS as an independently recognized provider
(provider type 19)
To provide BHRS,
a psychologists must….
Providing BHRS
 Submit Service Description (SD) the OMHSAS-
Children’s Bureau for review and approval (new
provider)
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A completed SD includes information as outlined in MAB 0194-01 and formatted in accordance with Attachment 7 of MAB
1153-95-01
Supporting documentation includes: signed Verification of
Responsibility form, copy of valid license, letters of county
support and collaboration with BH-MCO’s (technical assistance
materials provided by the Children’s Bureau available upon request).
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Approval, denial or request for revisions provided within 45
days of submission
Providing BHRS
MAB 01-96-11 requires providers to submit a revised
Service Description if….
“there are substantial changes in a service that the
Department previously approved.”
According to MAB 01-96-11 examples of “substantial changes”
include some of the following:
1. Changes to the actual services provided
2. Change in staff qualifications or staffing ratios
3. Change in service site (e.g. main service location or counties
served, addition of a new service location)
Providing BHRS
 MAB OMHSAS-11-05 initiates requirement for
Verification of Responsibility form
 Acknowledges
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awareness of regulations governing
standard billing practices and limits on supervised
employees.
This is required for all new submissions effective March 8,
2011
 Service
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Descriptions will not be approved without submission
Previously approved providers must sign and submit to
OMHSAS-Children’s Bureau
Verification of Responsibilities
I understand that when I provide Behavioral Health Rehabilitation Services (BHRS) I
must comply with both the Pennsylvania Board of Psychology’s licensing requirements
and the requirements that govern participation in the Pennsylvania Medical Assistance
Program and provision of BHRS. I also understand that I am fully responsible for any
services billed under my Medical Assistance provider number. By signing the attached
service description, I accept responsibility for the following services to be billed using
my Medical Assistance provider number:
Evaluations
MT
BSC
TSS
_______________________
Psychologist Signature
_______________________
Psychologist Printed Name
________________________
Date
________________________
Psychologist License Number
Providing BHRS
 Why is the Department of Public Welfare-OMHSAS
requiring the psychologists’ signature?
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The signed “Verification of Responsibilities” acknowledges
that the psychologist will be using their individual MA
provider number and thus financially, legally and ethically
responsible for all services outlined on the approved Service
Description.
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Providers lacking direct involvement in the development of their
Service Description risk program noncompliance, unethical
practice arrangements or unacceptable billing practices resulting
in financial penalties or practice sanctions
Permissible Service Arrangements
 The Professional Psychologist Practice Act (1986,
P.L. 89, No. 33) empowers the Pennsylvania State
Board of Psychology to define and regulate standards
for professional practice.
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Title 49, Chapter 41 State Board of Psychology, defines
standards for the employment and supervision of unlicensed
persons with graduate training in psychology.
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Subsections 41.58(b) and 41.58(c)(2) directly apply to the
provisions of BHRS for psychologist providers and supervision of
BSC’s, MT’s and TSS.
Permissible Service Arrangements
 § 41.58 “Standards for the employment and
supervision of unlicensed persons with graduate
training in psychology”
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Paragraph (b) requires that the employing psychologist must:
Ensure proper educational requirement of any employee
 Bear full professional responsibility for services provided by
employee
 Provide appropriate supervision arrangements, including proper
delegation of supervisory responsibilities to other psychologists
and/or qualified professionals
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Permissible Service Arrangements
§ 41.58 “Standards for the employment and
supervision of unlicensed persons with graduate
training in psychology” continued…..
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Paragraph (c)(9)
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Prohibits the employing psychologist from supervising more than
three full-time (FTE) or their equivalent in part-time employees.
 “FTE” based on established personnel policy and in accordance
with applicable labor laws and regulations
Permissible Service Arrangements
Psychologist
FTE
(MT or BSC)
FTE
FTE
Permissible Service Arrangements
Then how are TSS employed?
Permissible Service Arrangements
 PA State Board of Psychology: the work of a TSS as it
is currently defined and being provided is not the
practice of psychology
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However, regulations by the Board and by virtue of billing
under their MA provider number, the psychologist remains
responsible for all aspects of BHRS.
 MAB 01-01-05 (June 2001) revised minimum staff
qualifications and established minimum training and
supervision requirements for TSS workers
Permissible Service Arrangements
 Additionally, MAB 01-01-05 establishes minimum
qualifications for professionals supervising TSS
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These criteria allow BSC’s and MT’s who meet the educational
requirement to provide supervision up to 9 full-time
equivalent TSS workers
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For TSS employed 20hrs per week or more, ongoing supervision
includes:
• At least 1hr individual or group supervision per week
• On-site assessment and assistance prior to working alone with
children or adolescents (varies depending on experience)
• Periodic on-site supervision (determined by supervisor)
Permissible Service Arrangements
 The purpose of the guidance document from the
bulletin is:
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To provide examples of arrangements a psychologist enrolled
in the MA Program to provide BHRS. The examples address
both permissible and impermissible arrangements.
 To identify specified regulations and policies that
apply to psychologists enrolled in the MA program to
provide BHRS.
Permissible Service Arrangements
Licensed
Psychologist
TSS
Entity
MT/BSC
TSS
TSS
TSS
TSS
TSS
Service Arrangements
Program
Pre-Doc
Intern
Licensed
Psychologist
Entity
TSS
Unlicensed
Professional
MT/BSC
TSS
TSS
TSS
TSS
TSS
Service Arrangements
Psychologist
(Type 19)
Psychologist
(Type 19)
Psychologist
(Type 19)
BHRS
BHRS
BHRS
(3 FTE & TSS)
(3 FTE & TSS)
(3 FTE & TSS)
Entity
Penalties
 Providers billing for services without proper
approval or for unnecessary services face civil and
criminal penalties in accordance with state and
federal laws. Penalties may include:
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Nonpayment of questionable claims
Civil monetary penalties
Exclusion from the Medicaid Program
Imprisonment and criminal fines
Penalties (cont.)
 Additionally, the Pennsylvania State Board of
Psychology may impose penalties and sanctions
including:
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Civil monetary penalties
License suspension/revocation
Additional training and corrective actions deemed appropriate
by the Board.
Information
Service Bulletins and policies related to
the provision of BHRS can be found:
www.parecovery.org
Pennsylvania Recovery and Resiliency- Provides access to behavioral health resources both at
the state and community level
www. services.dpw.state.pa.us/olddpw/bulletinsearch.aspx
DWP link to bulletin search (A list of BHRS-related bulletins referenced in OMHSAS-05-11)
www.paproviders.org
Pennsylvania Community Providers Association (PCPA) serves as a forum for the exchange of
information and experience, archived information related to BHRS and updates on trainings for
providers
www.pacode.com
Provides access to regulatory language governing DPW and the provision of BHRS
Information
Provider Enrollment
Provides assistance regarding MA enrollment processes, file maintenance and
general MA enrollment questions:
1-800-537-8862
Hours of operation: Monday – Friday, 8 AM-4:30 PM
http://www.dpw.state.pa.us/provider/promise/enrollmentinformation/index.htm
OMHSAS Toll-Free Inquiry Line
Technical assistance for behavioral health counties, plans and providers to assist
with enrollment, billing, eligibility discrepancy, etc.
1-800-433-4459
Hours of operation: Mon-Fri 8 AM-4 PM,
Voicemail available after 4 PM
Information
Contact:
Garrett Rosas, PsyD
Consulting Psychologist
OMHSAS- Bureau of Children's Behavioral Health Services
P.O. Box 2675
Harrisburg, PA 17105-2675
Voice: 717-425-7674
Fax: 717-705-8268
[email protected]
Courtney Coover, Chief
Planning, Policy & Development Division
OMHSAS- Bureau of Children's Behavioral Health Services
P.O. Box 2675
Harrisburg, PA 17105-2675
Voice: 717-772-7855
Fax: 717-705-8268
[email protected]
www.dpw.state.pa.us