01 – sud qm annual dmc-ods training (pptx) · 2020. 10. 7. · 1 client name and sanwits id...

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ANNUAL DMC-ODS TRAININGSEPT 24, 2020

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County of San Diego Behavioral Health ServicesDrug Medi‐Cal Organized Delivery System

Today,

Please submit your questions

via Chat.

We may answer some

questions today and send

FAQ following training.

BHS QI LEADERSHIP TEAMDMC-ODS

Tabatha Lang, Quality Improvement Team Administrator

Steve Jones, Behavioral Health Program Coordinator, SUD QM Team

Terri Kang & Michael Blanchard, SUD QM Supervisors

Erin Shapira, SUD Supervisor, AAIII

Liz Miles, Principal Administrative Analyst, Performance Improvement

Team (PIT)

Krystle Umanzor, AAIII

AnnLouise Conlow, MIS Program Coordinator

Cynthia Emerson, SUD MIS Manager, AAIII

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“Big Picture” updates – State and

County level

Review DMC-ODS Systemwide Data

Successes

Areas for improvement

Resources

DMC-ODS Requirements

STATE OF THE STATE OVERVIEW

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Tabatha Lang, LMFTChief, Quality Improvement

• All the flexibilities can be found on the DHCS or BHS websites.

• DHCS will review these Public Health Emergency (PHE) flexibilities to

determine which ones should be

permanent provisions, and whether

federal approvals are necessary.

https://www.dhcs.ca.gov/

https://www.sandiegocount

y.gov/hhsa/programs/bhs/

COVID-19 FLEXIBILITIES

STATE OF THE STATE

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DHCS MEDI-NURSE LINE

Medi-Nurse Line:

Accessed by calling 1 (877) 409-9052

Available in multiple languages, through Language Line (Spanish

+17 additional languages).

Offers 24/7 advice for people without health insurance or who

have fee for service Medi-Cal but don’t have a regular doctor to

oversee their care.

General questions about COVID-19 symptoms answered.

DHCS MEDI-NURSE LINE

Information referrals to helpful COVID-19 resources.

All callers who present with COVID-19 symptoms will also have

access to trained and knowledgeable nurses for clinical

consultation and triaging.

Directions to get tested and/or seek treatment, inclusive of

referrals to COVID-19 resources.

Uninsured callers will also be referred to a qualified provider in

the county of the caller who can perform presumptive eligibility

(PE) determinations to provide temporary coverage to minimally

obtain COVID-19 testing, testing related, and treatment

services.

(cont.)

MEDI-CAL 2020 SECTION 1115 WAIVER UPDATE

The current 1115 waiver (Medi-Cal 2020) is set to expire on December 31, 2020.

Prior to the COVID-19 public health emergency, DHCS planned to implement CalAIM in conjunction with the end of the waiver period.

COVID-19 has greatly impacted all aspects of California’s health care delivery system due to focus on surge planning, infection control, transition to telehealth/telework, and reprioritization of resources.

Health care systems, plans, providers, and counties requested a delay in CalAIM, due to the need to address the pandemic.

While the state is still committed to CalAIM, an extension of the Medi-Cal 2020 waiver is crucial to maintaining the current delivery system and services for beneficiaries.

The final FY 2020-2021 state budget reflected a delay in funding for CalAIM.

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DHCS must request a waiver extension from CMS in order to keep Medi-Cal 2020 from expiring on December 31.

12-month extension will provide the necessary federal authority and Medicaid matching funds. –Support the financial viability of the delivery system in the context of COVID-19.

Goal to submit 1115 Extension request to CMS by September 15.

(cont.)


Medi-Cal Managed Care

Whole Person Care

Global Payment Program

Drug Medi-Cal Organized Delivery System

Low-Income Pregnant Women

Former Foster Care Youth

Community-Based Adult Services

Coordinated Care Initiative

Dental Transformation Initiative & Designated State Health Programs (DSHP)

Tribal Uncompensated Care

Rady’s CCS Pilot

(cont.)


Extension requests and local impact - Whole Person Care (WPC)

Continue WPC Pilot Program as currently structured:

Additional year of funding at FY 2019-2020 (PY 4) expenditure levels.

New target population for individuals impacted by COVID-19.

Allow WPC pilots to modify their budgets in response to COVID-19.

(cont.)

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Extension requests and local impact: DMC-ODS 12-month extension of authority for county-based pilots including expenditure authority

for residential SUD services in IMDs; Medi-Cal funding.

Technical Changes:

Remove limitation on the number of residential treatment episodes that can be reimbursed in a one-year period.

Clarify that reimbursement is available for SUD assessment and appropriate treatment even before a definitive diagnosis is determined .

Clarify the recovery services benefit.

Expand access to MAT.

Increase access to SUD treatment for American Indians and Alaska Natives.

(cont.)

1915(B) SPECIALTY MENTAL HEALTH SERVICES WAIVER EXTENSION

On May 8, 2020, DHCS formally requested an extension of the

state’s current Medi-Cal SMHS Waiver, authorized under Section 1915(b) of the Social Security Act.

As originally approved by CMS, this 1915(b) waiver was set to expire

on June 30, 2020.

DHCS requested CMS’ approval to extend the term of the waiver

through December 31, 2021.

On June 2, 2020, DHCS received a response from CMS approving

a six-month extension to December 31, 2020, acknowledging the need for an additional extension request due to the delay of

CalAIM.

DHCS is now seeking a second extension to the 1915(b) waiver to

December 31, 2021, to coincide with DHCS’ extension request for the

1115 waiver.

1915(B) SPECIALTY MENTAL HEALTH SERVICES WAIVER EXTENSION (cont.)

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METRICS FOR ACCESS (NETWORK ADEQUACY)

Time & Distance

Timeliness of Appointments and

Services

Provider Ratios

Penetration Rates

Grievance & Appeals

CMS Core Set and other Quality

Measures

Holding counties and managed care plans accountable to the following standards for access and quality through multiple metrics:

• Current development of a public dashboards for Mental Health and SUD.

SPECIFIC ACTIVITIES RELATED TO MEETING THE NEEDS OF YOUTH IN FOSTER CARE SYSTEM

AB 2083: Better coordinate between county and state

agencies, focused on trauma-informed practices.

Therapeutic Foster Care:

Implement and scale model

Pathways to Well-Being (Katie A.):

Ensure children/youth have access to coordinated and

intensive home-based treatment services.

Family Urgent Response System:

Implement statewide hotline and county mobile response to

allow prompt intervention and issue resolution for children/youth

in foster care and their families.

CalAIM Foster Care Model of Care Workgroup:

Evaluate options for better and more reliable health care for

children/youth in child welfare.

SPECIFIC ACTIVITIES RELATED TO MEETING THE NEEDS OF YOUTH IN FOSTER CARE SYSTEM

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DMC-ODS SYSTEM MONITORING:R E S U LT S & I M P R O V E M E N T S

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Steve Jones, LCSW, BHPC

SYSTEM MONITORINGAND PERFORMANCE

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Technical Assistance Reviews (TA)

Quality Assurance Reviews (QAR)

Medical Record Review (MRR)

Serious Incidents

Grievance and Appeals

Fraud, Waste, and Abuse

Misc. Items

DMC-ODS BY THE NUMBERS

Total ACL calls decreased by 3.03%

Total Admissions decreased by 4%*

Outpatient decreased by 3.3%

Residential decreased by 1.4%

Total unique clients served decreased by 6.3%

NOTE:

FY1920 data may be impacted due to the public health emergency

Admissions were based on SanWITS data pulled on 8/8/20.

*OTP admission data corrected to exclude grandfathered admissions and reflect true admissions; this correction resulted in an update to total admissions number/%.

FY19/20 FY18/19ACL calls for SUD services 5620 5796Admissions 17,744 18,430*

Outpatient 8373 8660Residential 4804 4870OTP 2620 2571*

Unique clients served 15,903 16,965

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TECHNICAL ASSISTANCE (TA) REVIEWS FY19/20

Top Reasons for Disallowance: Documentation does not establish medical necessity criteria/MD or LPHA did not substantiate the

basis of the SUD diagnosis. Treatment plan does not contain all required elements No progress note for service claimed Documentation does not substantiate that physical exam requirement was met LPHA/counselor did not print, sign, date progress note within timelines

FY1920 Outpatient(QM / Self)

Residential(QM / Self)

WM(QM / Self)

Number of TA 35 10 166 26 37 4

Number of Charts Reviewed 157 30 603 111 122 8

Number of Charts in Compliance 66 7 251 93 44 8

Number of Services Reviewed 1698 670 16,727 2931 1052 77

Number of Services Disallowed 427 125 3982 252 402 0

Overall Result 86% 84% 84% 93% 83% 93%

Disallowance Rate 24% 22% 24% 12% 31% 0%

QUALITY ASSURANCE REVIEW (QAR) FY19/20

Top Reasons for Disallowance: Treatment plan does not contain all required elements Group sign in sheet requirements not met Progress note does not contain all required elements Initial treatment plan not completed within timelines LPHA/counselor did not print, sign, date progress note within timelines

FY1920 QM Reviews Self ReviewsNumber of QAR 73 220Number of Charts Reviewed 903 1089Number of Charts in Compliance 500 763Number of Services Reviewed 10,563 14,060Number of Services Disallowed 1712 1597Overall Result 89% 92%Disallowance Rate 17% 11%

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MEDICAL RECORD RESULTS –OUTPATIENT FY19/20

Number of MRR 25

# of Charts Reviewed 163

# of Charts in Compliance 94

# of Services Reviewed 2042

# of Services Disallowed 665

Overall Review Result 91%

Disallowance Rate 30%

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Overall P&P Result 95%

F. Medication monitoring (storage, self-administration) 87%

G. Medical Director's P&Ps 87%

H. Relapse Plan 93%

Grievance/Appeal information available to clients in all threshold languages and posted

93%

Data Entry Standards met 54%

NOTE: 10 outpatient reviews were cancelled due to the public health emergency.

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INTAKE/ADMISSION – Items under 95% 95%

1 Client name and SanWITS ID number on each chart form as required. 72%

4 The Initial Level of Care Assessment completed with all signatures upon intake (within 7 calendar days).

92%

5Initial Level of Care Assessment form documentation supports the Recommended and the Actual Level of Care designated. 94%

8 If the Initial LOC Assessment is completed by a SUD counselor, documentation of a Face to Face visit with a LPHA/MD in the chart. 92%

9 ASAM LOC information for the Initial LOC Assessment is entered into SanWITS 83%

10Diagnosis Determination Note meets standards (LPHA documents the basisfor DSM-5 diagnosis, and legibly printed name, adjacent signatures and datewithin 30 days of admission. (Day of admit + 29 days)

85%

11 Risk Assessment and Safety Management Plan (or HRA for admits prior to 8/1/19) completed upon admit.

88%

12 ASI or YAI is completed within 30 days of admission for outpatient. 87%

MEDICAL RECORD RESULTS –OUTPATIENT FY 19/20

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CONSENTS/CONFIDENTIALITY – Items below 90% 88%

25 Written summary of Federal Confidentiality Requirements per 42 CFR, present in chart, with all required signatures and dated.

62%

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ROIs (Release of Information) that are 42 CFR compliant are present in the chart for communication with the client’s PCP, other treatment providers and collateral contacts. If a client refuses to sign a ROI, this must be documented in the chart. There must be documentation of attempts to coordinate care with the other treatment providers and collateral contacts within 30 days of admission and as needed throughout treatment.

72%

HEALTH/MEDICAL – Items below 90% 86%

32For pregnant and parenting clients, documentation substantiates primary medical care, including referral for prenatal care, has been provided for/arranged. 88%

33 Documentation substantiates physician orders have been communicated to the client.

79%

34There is documentation to support that the physician has reviewed the physical examination results, with typed or legibly printed name, signature and date (signature adjacent to typed or legibly printed name).

57%


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TREATMENT PLANNING – Items below 90% 86%

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Initial Treatment Plan shall include typed or legibly printed name adjacent to signature, date of signature of counselor, client (or reason why client's signature not obtained) and medical director/LPHA and was completed within 30 calendar days of admission. (Day of admit + 29 days)

77%

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Updated treatment plans shall include typed or legibly printed name adjacent to signature, date of signature of counselor, client (or reason why client's signature not obtained) and medical director/LPHA and was completed within 90 calendar days of counselor's signature on last treatment plan. (Counselor signature date + 89 days)

75%

40ASAM Level of Care Recommendation forms are complete as part of the initial and updated treatment planning process. 81%

42 ASAM Level of Care Recommendation form information was entered into SanWITS 50%

43 Updated treatment plans accurately reflect the client's progress or lack of progress in treatment.

82%


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TREATMENT PLANNING – Items below 90% 86%

49 Problem statements are correctly matched with the appropriate ASAM dimension.

85%

50 Each treatment plan includes goals to address each problem statement (unless deferred). Goals and action steps are specific, achievable, and measurable.

87%

54Treatment plan covering the review period includes a goal for all health needs (physical/dental) identified at intake/assessments/reassessments/physical exam results, if applicable.

86%

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Treatment plan includes the goal of obtaining a physical exam until that goal is obtained (if physical exam requirement is not met by physician reviewing most recent physical exam-must be within 12 months of admit; or, physician, NP, or PA performed a physical within 30 days).

73%


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PROGRESS NOTES – Items below 92% 92%

58For each service claimed, the LPHA or counselor who conducted the service completed a progress note with adjacent typed/legibly printed name, signature and date within 7 calendar days of service. (Day of service + 6 days)

85%

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Progress note summaries include topic and description of service (provider support and interventions, description of client’s progress on treatment plan problems, goals, action steps, objectives, and/or referrals. client’s ongoing plan including any new issues)

85%

60Progress notes include the correct service code, date of service, including start and end times and duration of travel or documentation time, if applicable. 70%

61 Time billed is equal to time documented and substantiated in documentation. 86%

64Progress note narrative for clinical services reflects utilization of Evidence Based Practices of Relapse Prevention (RP) within the treatment session or group with client.

86%

67If services were provided in the community, progress notes document the location and how the provider ensured confidentiality. 90%

72 The topic of the session 83%


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CONTINUING SERVICES JUSTIFICATION – EXCELLENT RESULTS! 99%

74Continuing Services Justification (aka Stay Review Justification) completed no sooner than five months and no later than six months after client's admission to treatment (or date of completion of the most recent justification).

97%

75 The LPHA has documented medical necessity for continued services at the same level of care, or recommended step-down or step-up in level of care.

97%

76 Client's personal, medical, and substance use history 100%

77 Documentation of the client's most recent physical exam 100%

78 The client's progress notes and treatment plan goals 100%

79 The LPHA's or counselor's recommendations 100%

80 The client's prognosis 100%

81If the LPHA determines continuing treatment services are not medically necessary, the documentation reflects following required discharge and warm handoff processes.

100%

82 CalOMS Annual Update is completed as required (no sooner than 10 months and no later than 12 months after client's admission into treatment)

100%


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DISCHARGE – Items under 90% 82%

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LPHA or counselor completed a discharge plan for each planned discharge within 30 calendar days prior to scheduled last treatment service with client. (Discharge Plan includes typed or legibly printed name, signature, and signature date of client and counselor or LPHA)

62%

84 There is documentation of care coordination/warm hand off at discharge to another level of care or recovery services.

58%

85 Description of client's triggers 88%

86 A plan to avoid relapse when confronted with these triggers 88%

87 A support plan 88%

88 Documentation indicates the client was given a copy of the discharge plan. 54%

89LPHA or counselor completed a discharge summary for each client within 30 calendar days of the date of the last face-to-face or telephone contact with the client. 81%

94 CalOMS Discharge completed as required. 89%


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FINANCIAL/BILLING 94%

95 Financial Responsibility and Information form is completed. 95%

96 Initial and monthly DMC eligibility is documented in the chart. 93%

97 Perinatal services claimed only by a perinatal certified/contracted program and only for when a client is eligible (pregnant and 60 days post-partum)

100%

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MEDICAL RECORD RESULTS –RESIDENTIAL FY 19/20

Residential Number of MRR 25







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P&P's – Items below 90% 91%

1 D. Monitoring/Supervision of EBP 89%

1 E. Monitoring/Supervision of ASAM 87%

1 G. Medical Director's P&Ps 89%

1J. Providing translation services to client's whose preferred language is other than English; Limited English Proficiency posters in all 6 threshold languages are posted.

82%

2 Program is following written P&Ps 83%

6 Data Entry Standards met 28%


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INTAKE/ADMISSION – Items under 90% 97%

1 Client name and SanWITS ID number on each chart form as required. 83%

11 Risk Assessment and Safety Management Plan (or HRA for admits prior to 8/1/19) completed upon admit.

83%

CONSENTS/CONFIDENTIALITY 90%

25 Written summary of Federal Confidentiality Requirements per 42 CFR, present in chart, with all required signatures and dated.

80%

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ROIs (Release of Information) that are 42 CFR compliant are present in the chart for communication with the client’s PCP, other treatment providers and collateral contacts. If a client refuses to sign a ROI, this must be documented in the chart. There must be documentation of attempts to coordinate care with the other treatment providers and collateral contacts within 30 days of admission and as neededthroughout treatment.

73%

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HEALTH/MEDICAL – Items under 90% 85%

33 Documentation substantiates physician orders have been communicated to the client.

68%


68%

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TREATMENT PLANNING – Items under 90% 89%

42 ASAM Level of Care Recommendation form information was entered into SanWITS

54%

44 Treatment Plans document client's preferred language. 84%

52 Each treatment plan includes frequency for all interventions/services. 89%

53Each treatment plan includes the client's SUD DSM-5 diagnosis(es) as documented on the Diagnosis Determination Note. (If more than one SUD diagnosis, Tx plan must include all as documented on the DDN).

80%

54Treatment plan covering the review period includes a goal for all health needs (physical/dental) identified at intake/assessments/reassessments/physical exam results, if applicable.

82%

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Treatment plan includes the goal of obtaining a physical exam until that goal is obtained (if physical exam requirement is not met by physician reviewing most recent physical exam-must be within 12 months of admit; or, physician, NP, or PA performed a physical within 30 days).

75%

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PROGRESS NOTES – Items under 90% 86%

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For residential program services, the LPHA or counselor shall document at a minimum one weekly progress note per calendar week (Sunday to Saturday) that is completed within the following calendar week with the LPHA or counselors typed or legibly printed name adjacent to their signature and signature date.

79%

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For residential services, the LPHA or counselor shall document at minimum one weekly progress note per calendar week (Sunday to Saturday) that includes a progress note narrative with the description of the services, specifically the provider support and interventions, a description of the client’s progress on the treatment plan, problems, goals, action steps, objectives, and/or referrals, and clients’ ongoing plan, including any new issues.

76%

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For each case management progress note summaries include topic and description of service (provider support and interventions, description of client’s progress on treatment plan problems, goals, action steps, objectives, and/or referrals. client’s ongoing plan including any new issues)

87%

62Progress notes include the correct service code, date of service, including start and end times and duration of travel or documentation time, if applicable. 73%


85%

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Progress notes reflect treatment hours as appropriate for determined ASAM level of care (20 hours of structured activity per week for Residential levels 3.1 and 3.5; 5 hours of clinical activity for Residential level 3.1; 10 hours a week of clinical activity for Residential 3.5).

73%

69If services were provided in the community, progress notes document the location and how the provider ensured confidentiality. 84%

71 There is a group sign-in sheet for each group service provided to the client.

84%

72Adjacent typed/legibly printed name and signature of the LPHA or counselor conducting the session and date. The date of signature must be the same day as the group service.

86%

73 The date of the session and start and end time of the session 77%

74 The topic of the session 85%

75 A typed/legibly printed list of the client's first and last names and signatures of each client that attended the session

88%

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DISCHARGE – Items below 90% 97%

77 There is documentation of care coordination/warm hand off at discharge to another level of care or recovery services.

85%

81 Documentation indicates the client was given a copy of the discharge plan.

74%

FINANCIAL/BILLING – Items below 90% 84%

89 Initial and monthly DMC eligibility is documented in the chart. 85%

91 Residential authorizations are present in the chart and completed within required timelines.

89%

92All residential bed day claims meet required level of service activity. (Minimum: one hour of billing service per day per DHCS Information Notice 18-001)

63%


Note: 4 reviews were cancelled due to the public health emergency.

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Number of MRR 3







MEDICAL RECORD RESULTS –WITHDRAW MGMT FY 19/20

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P&P's – Items under 90% 85%1 A. Program Integrity/Paid Claims Verification 75%

1 B. Assessment 75%

1 D. Monitoring/Supervision of EBP 75%

1 E. Monitoring/Supervision of ASAM 75%

1 H. Relapse Plan 75%

1 L. Diversion control policy 75%

1 M. Naloxone use policy 75%

2 Program is following written P&Ps 50%

4Forms/self-addressed and postage paid envelopes for Grievance/Appeal are easily accessible to clients without need for asking.

50%

6 Data Entry Standards met 25%

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INTAKE/ADMISSION – Excellent Results! No items under 90% 95%


CONSENTS/CONFIDENTIALITY – Items under 90% 96%

27 Acknowledgement of DMC-ODS Beneficiary Handbook and Provider Directory signed and dated.

83%

28 SUD Program Checklist form is completed and signed upon admission. 83%

HEALTH/MEDICAL 93%


33%

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TREATMENT PLANNING – Item under 90% 93%

42 ASAM Level of Care Recommendation form information was entered into SanWITS

50%

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If no physical exam results within the 12-month period preceding admission have been obtained and reviewed by the MD (or program with IMS has not provided a physical exam within 72 hours of admit), treatment plan includes the goal of obtaining a physical exam, even if the program is unable to assist in completing the goal during the treatment episode.

67%

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63Progress note narrative for clinical services reflects utilization of Evidence Based Practices of Motivational Interviewing (MI) within the treatment session or group with client.

50%


50%

72A typed/legibly printed list of the client's first and last names and signatures of each client that attended the session 88%

DISCHARGE – Excellent Results! 99%

FINANCIAL/BILLING – Excellent Results! 100%

THE TREATMENT – COMPLIANCE CYCLE

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INITIAL ASSESSMENT

AND RE-ASSESSMENT

TREATMENT PLAN

PROGRESS NOTES

ADJUST TREATMENT

OR DISCHARGE

CLIENT

TREATMENT RAPPORT EMPATHY ENGAGEMENT GOALS EBPs SCOPE PROGRESS ASSESS RISK TRIGGERS SAFETY PLAN UPDATES

COMPLIANCE KNOW YOU

TIMELINES SIGNATURES SCOPE WHO

MONITORS? QUALITY DOC. DISALLOWANCE TRAINING CONTINUOUS

IMPROVEMENT

MEDICAL RECORD REVIEWS FY20/21 PUBLIC HEALTH EMERGENCY (PHE)

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All providers will have a medical record review for FY20-21

• Prioritizing reviews – OTPs, Programs not reviewed last FY, Programs not billing, High Risk Programs

• A different way of reviewing records

• Review billing for all rendering staff

• Modified tool for PHE – fewer items on tool

• Scan or fax documents to QM

• Guest access to electronic health record

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• Required if compliance is less than 90% or disallowance rate greater than 5% (QM has discretion to ask for a QIP for specific issues)

• QIP due within 14 days of receipt of final report

• Respond specifically to deficiencies• Trending issues• Specific staff issues• Billing and documentation issues• Timeline issues

• Create a specific monitoring plan – the who, what, where, when and how of the plan

• Submit evidence (Monitoring plan, training, sign-in sheets, etc.)

QUALITY IMPROVEMENT PLAN(QIP)

• Billing corrections completed (See Billing Summary of MRR report)

• Follow up process with QM on QIP activities

QUALITY IMPROVEMENT PLAN(QIP)

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DHCS Requirement for FY20-21: Self-Reporting Disallowanceso QM is piloting the new process with one legal entityo Process:

QM analyst will send out a billing summary tool to all providers each month.

Providers will document all services disallowed (not identified as a result of a QM review) during the previous calendar month in the tool with the corrective action taken.

Documented services shall be returned within a designated time period.

If no services were disallowed, a response is needed for tracking purposes.

QM analyst will be confirming corrective action took place. o Expecting to roll out process to all providers in mid-October 2020. o Tip sheets and the tool will be shared and posted on the Optum

website.

NEW REQUIREMENT FOR FY20-21SELF REPORTING DISALLOWANCES

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MEDICATION MONITORING FY 19/20 THE ISSUE IS CONSENT

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SERIOUS INCIDENT REPORTS

Serious Incident by DMC-ODS System of Care64 Total Cases

Serious Incidents by Level of CareJUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Total

Outpatient 1 0 3 3 5 2 2 0 1 1 1 1 20Residential Adult 6 5 1 4 4 4 4 1 1 0 3 1 34Residential Child/Adolescent 0 0 0 0 0 0 0 0 0 0 0 0 0DUI 0 0 1 0 0 1 1 2 0 0 2 0 7Drug Court 0 0 0 0 0 0 0 0 0 0 0 0 0Recovery Center Adult 0 0 0 0 0 0 0 0 0 0 0 0 0Recovery Center Child/Adol. 0 0 0 0 0 0 0 0 0 0 0 0 0Opioid Treatment Program 1 0 0 0 0 0 0 1 0 0 0 0 2Other 0 0 1 0 0 0 0 0 0 0 0 0 1

Serious Incidents by RegionJUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Total

Central 3 2 1 2 1 2 3 2 0 1 2 0 19North Central 1 1 0 0 0 1 0 0 0 0 0 0 3East 0 1 1 2 2 0 2 0 0 0 1 1 10South 4 0 0 2 0 1 1 0 0 0 0 0 8North Inland 0 0 2 1 6 3 1 2 0 0 3 0 18North Coastal 0 1 1 0 0 0 0 0 2 0 0 1 5Out of County 0 0 0 0 0 0 0 0 0 0 0 0 0Countywide 0 0 1 0 0 0 0 0 0 0 0 0 1

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Serious Incidents by SUD Diagnosis

JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Total

None 1 1 2 2 2 1 0 0 0 0 2 0 11

Alcohol 0 0 3 1 0 1 2 2 1 0 0 1 11

Amphetamine 0 0 0 1 0 0 2 0 0 0 0 1 4

Sedatives 0 0 0 0 0 0 0 0 0 0 0 0 0

Opiates 4 3 0 2 5 2 2 2 1 1 2 1 25

Cocaine 1 1 0 0 0 0 0 0 0 0 0 0 2

Substance Disorder NOS 2 0 0 0 0 0 0 0 0 0 0 0 2

Marijuana 0 0 0 0 0 1 0 0 0 0 0 0 1

Other Stimulant 1 1 1 2 1 0 0 0 2 0 8

SERIOUS INCIDENTS FY19-20

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SUBSTANCE USE DISORDER SERVICES - ADULT

Jul-19 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 2 0 0 1 8

Aug-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5

Sep-19 0 0 1 0 0 2 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 6

Oct-19 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 3 7

Nov-19 0 0 3 0 0 0 0 0 0 0 0 0 0 1 0 0 0 4 0 0 1 9

Dec-19 0 0 1 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 3 7

Jan-20 1 0 1 0 0 0 0 0 0 0 0 2 0 0 0 0 0 2 0 0 1 7

Feb-20 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 2 4

Mar-20 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2

Apr-20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1

May-20 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 2 0 0 2 6

Jun-20 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2

Totals 3 1 10 0 0 4 0 0 0 0 0 3 0 7 1 0 0 13 0 0 22 64

SERIOUS INCIDENT REPORTS:REMINDERS

When reporting Serious Incidents, report the program name, client name, date of incident, specific details about incident.

NEW SIR Reporting - Must report all client deaths; SIR form is being updated. Will include SanWITS ID # and the following:

Residential programs – in addition to SIR, report death, injury that requires medical treatment, communicable diseases, poisonings, natural disaster and/or fires or explosions on premises by phone and DHCS 5079 written report to DHCS

All SUD Counselor Code of Conduct violations within 24 hours –online form, or by phone, fax, email to DHCS SUD Complaints.

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SB 425 makes hospitals, clinics and a variety of health facilities responsible for reporting a patient’s written complaint of sexual abuse and other sexual misconduct by doctors and a range of other medical professionals to the appropriate state licensing board.

The reporting provisions of SB 425 apply to allegations of sexual abuse or sexual misconduct involving physicians and surgeons, who are licensed by the Medical Board of California, and to individuals licensed by the state’s Podiatric Medical Board, Board of Psychology, Dental Board, Dental Hygiene Board, Osteopathic Medical Board, Board of Chiropractic Examiners, Board of Registered Nursing, Board of Vocational Nursing and Psychiatric Technicians, Board of Optometry, Veterinary Medical Board, Board of Behavioral Sciences, Physical Therapy Board, Board of Pharmacy, Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board, Board of Occupational Therapy, Acupuncture Board and the Physician Assistant Board.

Each incident of failing to report as SB 425 requires is subject to a civil fine of as much as $50,000. The fine would increase to as much as $100,000 for each willful failure to report.

SERIOUS INCIDENT REPORTS:SENATE BILL 425

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SERIOUS INCIDENT TRENDS

Overdose and death under questionable

circumstances

Serious allegations of or confirmed inappropriate staff

behavior

Suicide attempt

Level One incidents

PREVENTING BOUNDARY VIOLATIONS

Education

“Whose needs are being met in this interaction – the

client’s or my own?”

Self-awareness and monitoring

Peer debriefing/consultation

Clinical Supervision

PREVENTING BOUNDARY VIOLATIONS

Free Resource

https://store.samhsa.gov/product/

TIP-52-Clinical-Supervision-and-

Professional-Development-of-the-

Substance-Abuse-

Counselor/SMA14-4435.html

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CME SUICIDE DATA

FY 2019-20, 390 suicides in SD County (14% decrease)

124 (or 32%) were BHS clients or former BHS clients

29 (or 7%) had received BHS SUD services

Data trends for the 124 BHS clients (or former clients)

Primary Method: Hanging (36%) vs Firearm (25%)

Primary MH Dx: Depression (18%) vs Psychosis (16%)

Primary SUD Dx: Alcohol (15%) vs Cannabis (10%)

CLINICAL CASE REVIEW TRENDS

FY 2019-20, reviewed 28 suicide cases

18% received SUD services

Identified clinical trends and system issues:

39% Coordination of care concerns

32% No safety plan documented

32% Limited or cloned documentation

25% CLT missed appointment and no follow-up

18% Risk assessment not completed or updated

GRIEVANCE/APPEAL DEFINITIONS

Grievance Appeal

Expression of dissatisfaction about any matter (formerly known as “complaint”)

Broadly speaking, an action that determines a client does not meet medical necessity for services, or ends or changes a DMC beneficiary’s receipt of DMC-ODS services.

Written acknowledgement – letter postmarked within 5 calendar days of receipt of grievance. Includes date of receipt of grievance, name, telephone number and address of who to contact about grievance (JFS or CCHEA)

Most likely Provider NOABD –• Termination Notice (10 days prior)• Denial Notice (within 2 business

days of the decision) • Timely access (within 2 business

days)

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EXEMPT GRIEVANCES

Is a written acknowledgement always required when a grievance is

received?

No – grievances received over the phone or in person that are resolved

to the beneficiary's satisfaction by the close of the next business day

following receipt are exempt from the requirement to send a written

acknowledgement

These are called “Exempt Grievances”

THE GRIEVANCE PROCESS

Providers are encouraged to resolve grievances at the program level within 24 hours. This would be an EXEMPT grievance.

All grievances, whether the client is a DMC beneficiary or does not have insurance, will be handled by the Patient Advocacy Contractors, CCHEA and JFS.

Programs must have all grievance and appeal forms and envelopes available to clients to access at any time. Client should not have to ask for the materials to file a grievance or appeal.

This is a beneficiary right.

GRIEVANCE & APPEAL CONTRACTORS

JFS Patient Advocacy Program – provided by Jewish Family Services

For all inpatient or residential SUD services

1-800-479-2233 or 619-282-1134

Email: [email protected]

CCHEA Patient Advocacy Program provided by the Consumer Center for

Health, Education, and Advocacy, a unit of Legal Aid

For all Outpatient SUD services

1-877-734-3258

TTY-1-800-735-2929

Please provide copies of medical records to JFS or CCHEA within 7 calendar days

from the date of the request. They will provide the program with a signed ROI.

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EXEMPT GRIEVANCES FY19-20

Confidentiality Concern

2%

Client's Rights14%

Peer Behaviors1%

Physical Environment

3%

Other3%

Quality of Care77%

DMC-ODS EXEMPT GRIEVANCES, BY CATEGORYFY 2019-20

Total number of exempt grievances for FY 2019-20 = 117

GRIEVANCES FY19-20

5

5

129

1

2

5

26

2

8

2

0 20 40 60 80 100 120 140

Other

Access

Quality of Care

Service Denials

Program Requirements

Confidentiality Concern

Client's Rights

Peer Behaviors

Physical Environment

Lost Property

DMC-ODS Grievances, by CategoryFY 19-20

Total number of grievances for FY 2019-20 = 185

GRIEVANCES - QUALITY OF CARE

52

22

12

2

44

Staff Behavior Treatment Issues orConcerns

Medication Culturalappropriateness

Other Quality of CareIssue

DMC-ODS Grievances & Appeals Related to Quality of Care, by Subcategory

FY 2019-20

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GRIEVANCE TRENDSQUALITY OF CARE - OTHER

Discharge planning issues, discharge plan

“Wrongfully discharged” or “without reason” - NOABDs

Meeting with counselors

Sharing around Treatment Plan Goals

Food (quality, type of food - vegan/vegetarian diets not accommodated well) Phone calls (clients not being allowed to contact

friends/family/probation officers)

GRIEVANCES FY19-20

Residential94%

OS/IOS3%

OTP3%

DMC-ODS Grievances, by ModalityFY 2019-20

APPEALS FY19-20

Other7%

Quality of Care20%

Service Denials13%

Program Requirements

60%

DMC-ODS APPEALS BY CATEGORYFY 2019-20

Total number of appeals for FY 2019-20 = 15

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REQUIRED BENEFICIARY MATERIALS (INCLUDING GRIEVANCE/APPEAL MATERIALS)

1. Offer copy in preferred format of the DMC-ODS Beneficiary Handbook (print copy in preferred language or large print format; link to online versions)

2. Offer link to Provider Directory 3. Have Readily Available in all threshold languages* (without

beneficiary having to ask):1. Grievance and Appeal Form (CCHEA for outpatient programs/JFS

for Residential) 2. Self address stamped envelopes (for appropriate agency)3. Grievance and Appeal Brochures

4. Post in all threshold languages*1. Limited English Proficiency (LEP) Posters2. Grievance and Appeal Poster3. Access and Crisis Line Poster

*County of San Diego Current Threshold Languages: Arabic, English, Farsi, Spanish, Tagalog, Vietnamese

ADDITIONAL BENEFICIARY MATERIALS (INCLUDING GRIEVANCE/APPEAL MATERIALS)

Optional (but helpful) beneficiary materials:

• “Quick Guide” To DMC-ODS Services brochures (salient points from DMC-ODS Beneficiary Handbook) – available in all threshold languages*

• Audio versions of these “Quick Guides” –recorded in all threshold languages

• Tip Sheet – How to Apply for Medi-Cal

*County of San Diego Current Threshold Languages: Arabic, English, Farsi, Spanish, Tagalog, Vietnamese

“Mega Regs” address need for procedures to detect and

report FWA (FWA = Fraud, Waste and Abuse)

Duty - to prevent FWA

Obligation – to report suspected instances of FWA

PROGRAM INTEGRITY – “FWA”

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Making false statements or misrepresentation of material

facts

In order to obtain some benefit or payment for which no entitlement

would otherwise exist

The acts may be committed for the person’s own benefit or for the

benefit of another party

In order to be considered fraud, the act must be performed knowingly,

willfully and intentionally

EXAMPLE: Purposely billing for services never provided

FRAUD INVOLVES

Billing Drug Medi-Cal for appointments the client failed to keep

(i.e. billing for “no shows”)

Falsifying a diagnosis so, on paper, client will meet “medical

necessity.”

Knowingly billing for services at a level of complexity higher than

services actually provided or documented in the file

Knowingly falsifying records in order to claim for a service higher

than what was actually provided

MORE EXAMPLES OF FRAUD

WASTE & ABUSE

Waste: Not Defined in Statute. Generally understood as spending that

can be eliminated without reducing quality of care.

Example: inefficient billing methods (i.e. data entry errors)

Abuse:

Practices that result in unnecessary cost to DMC

Reimbursement for non-medically necessary services

Reimbursement for services that don’t meet recognized standards

for care.

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The County takes all allegations of fraud, waste and abuse

very seriously and will review all allegations thoroughly.

To the extent of the law, reports can remain anonymous.

THE COUNTY CARES

WHAT STEPS CAN YOU TAKE?

1. Talk to your supervisor

2. Talk to your COR

3. Call the HHSA Compliance Office – 619-338-2807

4. Call the Office of Ethics and Compliance – 619-531-6263

5. Utilize the County Anonymous Hotline – 866-549-0004

The best prevention against FWA is YOUR awareness and diligence

TRANSITIONAL CARE SERVICES - TCS

TCS may be delivered as following:

May be provided up to 30 days prior to admission and 30 days post discharge

DMC billing for case management to coordinate care between levels of care at separate programs

Individual services as assessment and collateral

Crisis Intervention

Focus is on transitioning client and care coordination

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Bulletin #30 October 17, 2011 CLONED DOCUMENTATION The Medicare intermediary who processes our claims, has begun sending out the following information to providers.

Palmetto’s message:

“When documentation is worded exactly like or similar to previous entries, the documentation is referred to as cloned documentation. “Whether the cloned documentation is handwritten, the result of pre-printed template, or use or Electronic Health Records, cloning of documentation will be considered misrepresentation of the medical necessity requirement for coverage of services. Identification of this type of documentation will lead to denial of services for lack of medical necessity and recoupment of all overpayments made. “It would not be expected that every patient had the same exact problem, symptoms, and required the exact same treatment. Cloned documentation does not meet medical necessity requirements for coverage of services rendered due to the lack of specific, individual information for each unique patient.

“Documentation exactly the same from patient to patient is considered cloned and often occurs when services have a specific set of limited or select criteria. Cloned documentation lacks the patient specific information necessary to support services rendered to each individual patient.”

NOTICE ON NONDISCRIMINATION

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Notice Regarding State Nondiscrimination Requirements - June 13, 2020

The Department of Health Care Services (DHCS) and its plans, providers, counties and other partners serve Medi-Cal beneficiaries of all ages, religions, abilities, sexual orientations, gender identities, races, ethnicities and national origins. We strive to improve the health and well-being of all Californians. This commitment is enshrined in state law, which provides protections beyond the minimum standards in federal law.

This commitment is undiminished by recent changes to federal regulations. On June 12, 2020, the U.S. Department of Health and Human Services (HHS) finalized a rule, citing Section 1557 of the Affordable Care Act (ACA), that eliminates preexisting federal rules protecting individuals from discrimination based on categories like gender identity and sexual orientation. In addition, the final rule eliminates federal requirements that Medicaid programs include taglines in significant communications that inform individuals with Limited English Proficiency about the availability of language assistance services.

We remind our plans, providers, counties and other partners that, regardless of the change in federal regulations, under California law,1 no person may—on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, or sexual orientation—be unlawfully denied full and equal access to the benefits of, or be unlawfully subjected to discrimination under, any program or activity that is conducted, operated, administered or funded by the State. This includes, but is not limited to, the Medi-Cal program.

In addition, California law requires DHCS, as well as managed care plans providing covered benefits to DHCS beneficiaries, to provide notice of the availability of free language assistance services in English and in the top 15 languages spoken by limited-English-proficient individuals in California.

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9 CCR § 10572§ 10572. Health‐Related Services.(e) No person, who, within the previous 24 hours, has consumed, used, or is still otherwise under the influence of alcohol or drugs as specified in section 10501(a), shall be permitted on the premises except for individuals admitted for detoxification or withdrawal. The licensee shall have specific written rules and policies and procedures to enforce this provision.

RESIDENTIAL ADMISSIONS CLARIFICATION

DHCS GUIDANCE – Certifications Unit

If a client has been assessed, meets the diagnosis of a substance use disorder (SUD), and is determined to not be under the influence or in need of detoxification or withdrawal management services at the time of admission, the client may be admitted into the residential program for SUD treatment and recovery services. Record of the assessment(s), diagnosis, and determination of the client’s level of care must be documented and contained in the client record for review.

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CERTIFICATION RENEWALS

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Informational Bulletin Regarding Medi-Cal Revalidation RequirementIn accordance with the directives of the Patient Protection and Affordable CareAct (ACA), the Department of Health Care Services (DHCS) has established arevalidation requirement to implement Code of Federal Regulations (CFR), Title42, Section 455.414. Pursuant to CFR 455.414, “the state Medicaid agencymust revalidate the enrollment of all providers regardless of provider type atleast every 5 years.”

DHCS will send out notices to each provider to begin the revalidation process.Providers must wait to submit the revalidation until asked by DHCS to do so.After receiving a revalidation request from DHCS, providers should follow allapplicable instructions to revalidate enrollment.

YOUR GO TO RESOURCE

86https://www.dhcs.ca.gov/

87https://www.dhcs.ca.gov/

PUBLICATIONS – LETTERS, NOTICES AND BULLETINS

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Bulletins, Information Notices, and Letters

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SUBJECT: Addition of Oxycodone and Fentanyl to the List Of Substances to be Tested or Analyzed for in Samples Collected from Patient Body Specimens

REFERENCE: This addition to the testing panel clarifies Title 9, California Code of Regulations (CCR), Division 4, Chapter 4, Subchapter 5, Section 10315.

PURPOSE: The purpose of this Information Notice is to inform all Narcotic Treatment Programs (NTP) licensed by the Department of Health Care Services (DHCS) that oxycodone and fentanyl have been added to the list of substances that must be tested or analyzed for in each patient body specimen sample collected.

BACKGROUND: Title 9, CCR, Division 4, Chapter 4, Subchapter 5, Section 10315 specifies which substances NTPs must test or analyze for in body specimen samples collected from patients. These are substances that are commonly used and/or are contraindicated with methadone. Title 9, CCR, Division 4, Chapter 4, Subchapter 1 commencing with Section 10000 was amended as part of regulations package 14-026 and became effective July 1, 2020. The amendment to Title 9, CCR, Division 4, Chapter 4,

POLICY: DHCS now requires oxycodone and fentanyl to be on the list of substances that all NTPs must test or analyze for in patient body specimen samples according to Title 9, CCR, Division 4, Subchapter 5, Section 10315(a).

BEHAVIORAL HEALTH INFORMATION NOTICE NO.: 20-050

BEHAVIORAL HEALTH INFORMATION NOTICE NO.: 20-006

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SUBJECT: Updates to Alcohol and/or Other Drug (AOD) Program Certification Standards

PURPOSE: This Information Notice (IN) notifies licensed or certified substance use disorder (SUD) programs of changes to the AOD Program Certification Standards.

REFERENCE: Health and Safety Code Section 11830.1 and MHSUDS IN No. 17-017

POLICY: The AOD Program Certification Standards (revised February 2020) replace the previous AOD Program Certification Standards (revised May 1, 2017). Changes were made to: Address the recent implementation of Senate Bill 1228, which prohibits remuneration for referrals; Provide clarification that licensed residential treatment facilities do not need DHCS approval for Incidental Medical Services in order to allow client access to Food and Drug Administration-approved medications for medication-assisted treatment (MAT);

• Remove the maximum number of counseling hours for intensive outpatient services;

• Specify that client rights must include the right to take medications prescribed by a licensed clinician for physical, mental health or SUD conditions; and to

• Require training for staff on the fundamentals of MAT, including how medications work to treat addiction, information about addiction as a chronic disease, and the importance of removing stigma from the use of medications in an SUD treatment plan.

These Standards become effective on July 1, 2020. Currently certified SUD programs or programs seeking initial DHCS certification shall have until July 1, 2020, to comply with these Standards.

Free MAT staff training resources are available at www.CaliforniaMAT.org/resources.

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SUMMARY: DMC-ODS QI FOCUS AREAS FY20-21

Increased timeline compliance (DDN, Tx Plans, PNs)

Increased Group Sign-In Requirement compliance

Increased compliance with Discharge Plan completion and

provision of copy to client

Decreased disallowances (meet Federal guideline of 5%!)

0% Serious Staff Allegations on SIRs

SUD QM – increased monitoring of LOC Transitions and

Residential Authorization timelines

PERFORMANCE IMPROVEMENT TEAM

PIT Hot Topics

0 QI Workplan Evaluation

0 Cultural Competency

0 TPS Results

0 Performance Improvement Projects

0 External Quality Review Recommendations and Reports

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QI Workplan

0 QIWP Target Area: Services Are Client Centered0 Decrease the proportion of Grievances/Appeals related to Quality of Care by 5%,

compared to the previous fiscal year.0 Increase by 5% the number of Youth clients who indicate they received services that

were right for them on the SUD Treatment Perception Survey (TPS).0 QIWP Target Area: Services Are Safe

0 Establish a baseline for SUD serious incidents, identifying trends specifically in suicide attempts, serious allegations of or confirmed inappropriate staff behavior; and apparent overdose of alcohol/drugs.

0 QIWP Target Area: Services Are Effective0 90% of clients who were discharged with a status of Left Before Completion with

Satisfactory Progress or Left Before Completion with Unsatisfactory Progress from residential withdrawal management programs shall not be readmitted into the same or another withdrawal management program within 30 days.

0 100% of SUD Teen Recovery Center contracts will have a minimum of two school-based sites that are operational.

0 BHS will have two active PIPs (Performance Improvement Projects) that contribute to meaningful improvement in clinical care as monitored by the EQRO.

QI WORKPLAN

0 QIWP Target Area: Services Are Efficient and Accessible0 Ensure average speed to answer calls is within 60 seconds. 0 A minimum of 30% of Substance Use Disorder clients with a referred discharge will

connect with services within 10 days.0 Ensure Medication Assisted Treatment (MAT) services are available in San Diego's North

County region. 0 QIWP Target Area: Services are Equitable

0 A minimum of 85% of Adult TPS satisfaction survey respondents will agree that staff were sensitive to his/her cultural background (race/ethnicity, religion, language, etc.).

0 QIWP Target Area: Services Are Timely0 100% of Opioid Treatment programs (OTPs) shall meet the access timeliness standard

of 3 business days for an initial dosing of medication. 0 Establish a baseline for the number of timely access NOABDs required.

CULTURAL COMPETENCE

BHS administers two assessment tools:

Organizational Assessment: Cultural and Linguistic Competence Policy

Assessment (CLCPA)

Last issued: February 2020

Individual/Staff Assessment: Promoting Cultural Diversity Self-

Assessment Checklist (PCDSA)

Next issued: October 2020

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CULTURAL COMPETENCE CLCPA Results:

228 programs responded: 161 (70.6%) MH Services and 67 (29.4%) SUD Services programs.

Respondents indicated that they were fairly or very familiar with the diverse communities and the demographic makeup of their service areas (Section 1).

Majority of respondents indicated support for cultural competence in the overall organizational philosophy most of the time or all the time (Section 2).

Most respondents indicated some form of personal and program staff involvement in the communities’ culturally diverse activities (Section 3).

About 4 out of 5 respondents reported collaborating with CBOs to address the health and mental health needs of culturally diverse groups in their service area (Section 4).

Responses indicated that the organizations’ staff were relatively diverse culturally and linguistically, with Peer Support Specialists and Support staff as the most diverse and the board members/executive management as the least diverse (Section 5).

Most respondents indicated that their programs regularly engaged in activities focused on adapting behavioral health care delivery to cultural and linguistic diversity (Section 6).

Programs use trained medical interpreters more regularly than certified medical interpreters or sign language interpreters (Section 7).

TREATMENT PERCEPTIONS SURVEY (TPS) - ADULTOctober 7-11, 2019

Individual items on the Adult TPS (2,412) are grouped into five domains for analysis:

Perception of Access

Convenience of the location of treatment services had the highest dissatisfaction compared to any other item in the TPS (5%), but feedback in this area was overall positive.

Perception of Quality and Appropriateness

93% of adult clients agreed or strongly agreed the staff spoke to them in a way they could understand.

Perception of Care Coordination

The Perception of Care Coordination domain had the overall lowest satisfaction rating among adult clients compared to the other four domains (82%).

Perception of Outcome Services

85% of adult clients agreed or strongly agreed as a direct result of the services they are receiving, they are able to do things that they want to do.

General Satisfaction

92% of adult clients agreed or strongly agreed they felt welcomed at the place where they received services.

Individual items on the Youth TPS (137 responses) are grouped into five domains for analysis:

Perception of Access

Youth clients reported having a good experience enrolling in treatment with the highest dissatisfaction compared to any other item in the TPS (8%).

Perception of Quality and Appropriateness

84% of youth clients agreed or strongly agreed the staff treated them with respect.

Perception of the Therapeutic Alliance

85% of the youth clients agreed or strongly agreed the staff members who provided them services took the time to listen to what they had to say.

Perception of Care Coordination

Overall, 78% of youth clients reported satisfaction within the Perception of Care Coordination domain.

Perception of Outcome Services

Three quarters (75%) of the youth clients agreed or strongly agreed to that they are better able to do things they want to do as a result of the services they received.

General Satisfaction

Compared to other items on the TPS, a smaller proportion of youth clients reported overall dissatisfaction with services (1%).

Treatment Perceptions Survey (TPS) -Youth

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PERFORMANCE IMPROVEMENT PROJECTS

The proportion of co-served adults in the mental health and SUD systems of care who received a PERT service has almost doubled over the past five fiscal years.

Despite almost half of clients (40%) who received a PERT service during FY 18-19 being diagnosed with a SUD, only 19% were admitted to a SUD treatment provider within the DMC-ODS during the fiscal year. Furthermore, 75% of these admissions occurred more than 30 days after the PERT service.

Non‐Clinical PIP: Improving client linkages following a PERT contact

Clinical PIP: Improving connections to services after discharge with referral In San Diego County, the rate of connection to a program after discharge with referral, including

from residential and withdrawal management (acute care) services is low and is decreasing.

Continuity of care is linked to length of abstinence, number of arrests, days in jail, housing, and employment, and increased rates of completed treatment and length of stay in treatment.

EQRO RECOMMENDATIONS

San Diego should review trends and data from its call center to identify unsuccessful call interactions where callers decline service, screening has stopped or there was no hand off referral made. These are critical lost opportunities for client engagement in critical lifesaving care.

San Diego should identify the root cause of very low urgent service appointment requests as reported by its SUD provider network and enhance training and monitoring to assure that urgent issues of clients are being fully identified and addressed in a timely fashion.

San Diego should address the low usage rate of Spanish language TPS surveys and take steps to identify issues that cause downward variances within the individual program sites impacting client’s perception of care.

San Diego should track and report timely follow-up from residential discharge and WM readmission data in a manner that is consistent with CalEQRO.

San Diego should establish a framework to guide, develop and establish productivity standards to measure performance, system capacity and gauge efficiency in treatment programs.

San Diego should take active steps to ensure its process of enhancing SanWITS to be a fully functional EHR is resourced at a level to assure completion timelines.

San Diego should continue to seek opportunities to expand access in the eastern and northern rural and remote areas of the county for residents with SUD in partnership with surrounding counties, FQHC clinics, mental health and using telehealth and mobile services such as the ROAM service.

EQR REPORTS

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EQR REPORTS

EQR REPORTS

EQR REPORTS

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For more information or reports, contact [email protected].

Krystle Murguia, QI SUD Performance Improvement Team (PIT) [email protected]

PIT CONTACT INFO

MANAGEMENT INFORMATION SYSTEMS (MIS)

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AnnLouise Conlow, MIS Program CoordinatorCynthia Emerson, SUD MIS Manager

Cheryl Lansang, SUD MIS Agency/Facility Administrator

SANWITS MOVING FORWARD

ELECTRONIC HEALTH RECORD UPDATES

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PROJECT PLAN PHASE 2, 2ND QUARTER FY 20‐21 Clinical Documentation Training

Diagnostic Determination Note (DDN)

Adult Initial LOC Assessment

Adolescent Initial LOC Assessment

Recommended LOC Assessment

Parent/Guardian Initial LOC Assessment

Risk Assessment and Safety Plan

Discharge Summary


PROJECT PLAN PHASE 2, 2ND QUARTER FY 20‐21

Dashboards –

LPHA – workload

Clinical – used for counselors, supervisors, QA

Pilots –

Consent and Referrals

Document Storage

Scheduler


PROJECT PLAN PHASE 3, APR – MAY 2021

New Interface Refresh

New Home Page

Modified Client Profile

New CalOMS Outcome Measure

New Diagnosis Screen

New Treatment Plan

New Recovery Plan

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PROJECT PLAN PHASE 4, DEC 2021 FY 21‐22

New Encounter Screen with Progress Notes

Transition from SanWITS Billing to CIMS Billing Module

Interoperability for OTP Providers

E-Prescribing Integration

SDIR Linkage


PROJECT PLAN FUTURE ENHANCEMENTS

New Client Record Dashboard

User Customizable Home Dashboard

ASI & YAI Assessment replacement

Interoperability for non-OTP providers

RESOURCES

See Optum Webpage at https://www.optumsandiego.com/ for the following:

CalOMS Tx Data Collection Guide

CalOMS Tx Data Dictionary

DATAR Web Manual

SanWITS Tip Sheets

SanWITS Users Guide

User Access Forms

See RegPacks for SanWITS Virtual Training at www.regpacks.com/dmc-ods

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For more information on the EHR please contact

SUD MIS Support at:

[email protected]

MIS CONTACT INFO

Email the SUD QM team at -

[email protected]

QUESTIONS?

THANK YOU FOR ATTENDING!

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01 – sud qm annual dmc-ods training (pptx) · 2020. 10. 7. · 1 client name and sanwits id...

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