Family Support October 28 th & November 6 th 2015 The Managed Care Technical Assistance Center of New York
• Welcome • MCTAC Overview • Business/Billing Rules • Services Definition • Service Components • Example
MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State. MCTAC’s Goal Provide training and intensive support on quality improvement strategies, including business, organizational and clinical practices to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care .
Who is MCTAC?
MCTAC Partners
• Individual Employment Support Services • Rehabilitation • Prevocational • Psychosocial Rehabilitation • Transitional Employment Support • Intensive Employment Support • Community Psychiatric Support and Treatment • On-going Supported Employment (CPST) • Peer Supports • Habilitation • Family Support and Training • Crisis Respite • Non Medical Transportation • Self Directed Services Pilot (anticipated • Short-Term Crisis Respite start date July of 2016) • Intensive Crisis Respite • Educational Support Services
NYS Allowable Billing Combinations of OMH/OASAS State Plan Services and BH HCBS ¡ OASAS HCBS/State OASAS OMH Clinic/ OASAS Opioid OMH OMH OMH IPRT/ OMH Partial Plan Outpatient OLP**** ¡ Clinic*** ¡ Treatment ACT ¡ PROS ¡ CDT ¡ Hospital* ¡ Services ¡ Rehab ¡ Program ¡ PSR ¡ Yes ¡ Yes ¡ Yes ¡ ¡ ¡ ¡ Yes ¡ ¡ CPST ¡ ¡ ¡ ¡ ¡ ¡ Yes/No ¡ Yes ¡ ¡ Habilitation ¡ Yes ¡ Yes ¡ Yes ¡ ¡ Yes ¡ Yes ¡ Yes ¡ ¡ Family Support and Yes ¡ Yes ¡ Yes ¡ ¡ ¡ Yes ¡ Yes ¡ Yes ¡ Training ¡ Education Yes ¡ Yes ¡ Yes ¡ ¡ Yes ¡ Yes ¡ Yes ¡ Yes ¡ Support Services ¡ Peer Support Yes ¡ Yes ¡ Yes ¡ ¡ Yes ¡ Yes ¡ Yes ¡ Yes ¡ Services ¡ Employment Yes ¡ Yes ¡ Yes ¡ ¡ ¡ Yes ¡ Yes ¡ Yes ¡ Services ¡ *If a participant is admitted into a Partial Hospital program, their HCBS payments will be suspended so that their services will not be terminated. ** All HARP Members are eligible for Crisis Respite Services except for individuals residing in excluded settings. However, MCOs can choose to provide crisis respite as an in lieu of service for those individuals. ***If ¡an ¡individual ¡receives ¡OASAS ¡ state ¡plan ¡peer ¡services ¡ through ¡an ¡OASAS ¡clinic, ¡then ¡they ¡are ¡ not ¡eligible ¡for ¡HCBS ¡peer ¡services ¡ and ¡vice ¡versa ****OLP= ¡Other ¡Licensed ¡Professionals ¡
Allowable Billing Combinations of Adult BH HCBS and Adult BH HCBS ¡ Adult BH HCBS PSR ¡ CPST ¡ Residential Family Education Peer Support Employment Combinations ¡ Support Support and Support Services ¡ Services ¡ Service ¡ Training ¡ Services ¡ PSR* ¡ ¡ YES ¡ YES ¡ YES ¡ YES ¡ YES ¡ YES ¡ CPST ¡ YES ¡ ¡ YES ¡ YES ¡ YES ¡ YES ¡ YES ¡ Habilitation* ¡ YES ¡ YES ¡ ¡ YES ¡ YES ¡ YES ¡ YES ¡ Family Support YES ¡ YES ¡ YES ¡ ¡ YES ¡ YES ¡ YES ¡ and Training ¡ Education YES ¡ YES ¡ YES ¡ YES ¡ ¡ YES ¡ YES ¡ Support Services ¡ YES ¡ YES ¡ YES ¡ YES ¡ YES ¡ ¡ YES ¡ Peer Support Services ¡ YES ¡ YES ¡ YES ¡ YES ¡ YES ¡ YES ¡ ¡ Employment Services ¡ * PSR and Habilitation may only be provided at the same time by the same agency. ** All HARP Members are eligible for Crisis Respite Services except for individuals residing in excluded settings. However, MCOs can choose to provide crisis respite as an in lieu of service for those individuals.
FST session provided to one family Ø Billed daily in 15 minute increments with a limit of 12 units per day. Ø FST is detailed by using modifiers that indicate whether the service was provided to the family with the recipient present or to the family without the recipient present. Ø May be provided on or off-site. Ø Staff transportation is billed separately as appropriate. Transportation claiming is done at the recipient level and then is only for a single staff member, regardless of the number of persons involved in providing the service.
Group FST (consists of 2-3 families) Ø Billed daily in 15 minute increments with a limit of 6 units (1.5 hours) per day. Ø Group sessions may be billed on the same day as an FST one family session. Ø May be provided on or off-site. Ø Payment for FST group sessions is differentiated through the use of Px modifier codes to distinguish the number of families present in the session (i.e., 2 or 3). Ø Billing is at the recipient (family level (e.g., if the group consists of the families of three recipients and, for purposes of this example, eight people are in the group, there would be only three claims submitted).
HCBS services will be subject to utilization caps at the recipient level that apply on a rolling basis (any 12 month period). These limits will fall into three categories: 1. Tier 1 HCBS services will be limited to $8,000 as a group. There will also be a 25% corridor on this threshold that will allow plans to go up to $10,000 without a disallowance. 2. There will also be an overall cap of $16,000 on HCBS services (Tier 1 and Tier 2 combined). There will also be a 25% corridor on this threshold that will allow plans to go up to $20,000 without a disallowance. 3. Both cap 1 and cap 2 are exclusive of crisis respite. The two crisis respite services are limited within their own individual caps (7 days per episode, 21 days per year). If a Plan anticipates they will exceed any limit for clinical reasons they should contact the HARP medical director from either OMH or OASAS and get approval for a specific dollar increase above the $10,000 effective limit.
• Setting – Home, Community, office. • Admission/Eligibility Criteria – Participant assessed to need, and has a preference for family support and consultation services. – A release of information from the individual is always required to allow staff to contact significant people, except in cases of threat of injury or death ¡ ¡
• Limitations/Exclusions • The total combined hours for Family Support and Training are limited to no more than a total of 40 hours in a calendar year. • Certification/Provider Qualification – Para-professional staff may provide this service. • Staffing ratios/case limits – 1:15 for staff to individual ratio – 1:16 for groups with family members.
Ø Training and support necessary to facilitate engagement and active participation of the family Ø Provided only at the request of the individual Ø Recovery oriented, trauma-informed approach to partnering with families and other supporters Ø Family is defined as the persons who live with or provide care to a person served and may include § Parent § Spouse or significant other § Children § Relatives § Foster family § In-laws § Does not include individuals who are employed to care for the participant. Ø Training includes instruction about treatment regimens, elements, recovery support options, recovery concepts, and medication education specified in the Individual Recovery Plan
Ø Training on treatment regimens including elements such as: recovery support options, recovery concepts and medication education and use of equipment Ø Assist the family to provide a safe and supportive environment Ø Provide one-on-one and group counseling Ø Facilitate family and friends support groups under the direction of a certified peer
Ø Provide family mediation and conflict resolution services Ø Development and enhancement of the family’s specific problem-solving skills, coping mechanisms, and strategies Ø Collaborate with the family and caregivers Ø Assist the family in the acquisition of knowledge and skills necessary to understand and address the specific needs of the individual Ø Provide family with training/workshops
Ø Assisting the family in understanding various requirements, such as the individual recovery plan, crisis/safety plan and plan of care process Ø Training on: Ø community integration and self-advocacy Ø behavioral intervention strategies Ø mental health and substance use conditions Ø services and supports including providing benefits and entitlements counseling Ø skills and knowledge to family members of recipients with mental health and substance use disorders
HCBS Manual: https://www.omh.ny.gov/omhweb/News/2014/hcbs- manual.pdf HARP Billing Manual: https://www.omh.ny.gov/omhweb/bho/harp-mainstream- billing-manual.pdf Fee Schedule and Rate Codes: http://www.omh.ny.gov/omhweb/bho/phase2.html
10/26 -- Crisis Respite 10/27 – Employment Education 10/28 -- Family Support 11/2 – Peer Supports 11/6 – Family Support 11/9 – Peer Supports 11/13 – Hab/Rehab/CPST 11/16 – Hab/Rehab/CPST TBD (in-person or web-based) -- Non-Medical Transport
Visit ¡www.mctac.org ¡to ¡view ¡past ¡trainings, ¡sign-‑up ¡for ¡ updates ¡and ¡event ¡announcements, ¡and ¡access ¡resources. ¡ ¡ ¡ mctac.info@nyu.edu @CTACNY 21 ¡
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