OBH Contractors Webinar

April 12, 2012

PRESENTERSPRESENTERSPeter J. CalamariPeter J. Calamari

Ken SaucierKen SaucierDanita LeBlancDanita LeBlanc

Dr. Rochelle DunhamDr. Rochelle DunhamDr. Michael GomilaDr. Michael Gomila

David McCantsDavid McCantsRandy LemoineRandy Lemoine

Welcome & Introduction

Goal of Webinar

Goal of today’s Webinar is to:

a) Introduce contractors to OBH’s Medicaid Enrollment Policy

b) Present Residential AD Options available in LBHP

c) Clarify Billing Process for current Fiscal Year – FY12

d) Establish a Technical Assistance Process so that contractors can get ongoing assistance needed in implementing Clinical Advisor.

Medicaid Application Policy

Medicaid Application Policy All individuals seeking OBH network

services must complete the Medicaid application process if they are not a current recipient or have not been denied Medicaid in the last 12 months.

Providers are responsible for informing, encouraging, assisting clients with this process & maintaining required documentation of the application process

Medicaid Application Policy (con.)

If individuals refuse to complete the Medicaid application, they will not be eligible to receive discounted Behavioral Health services from providers in the LA Behavioral Health Partnership.

If the individual is incapacitated and unable to complete the application, OBH will pay for services until the individual is able to complete the application. (see definitions)

Medicaid Application Procedures

Medicaid Application Procedures

Providers are to post signs in the facility informing individuals of the requirement to complete a Medicaid application.

Providers are to notify individuals of what information they will need to have with them to complete a Medicaid application

Medicaid Application Submission

Medicaid Application Submission

Online Medicaid application process –− https://bhsfweb.dhh.louisiana.gov/

OnlineServices/− confirmation number & date

Scan a paper application & email to celeste.gauthier@la.gov or jessica.brown3@la.gov− Keep copy of paper application & transmission

documentation in the chart.

Fax a paper application to 318-253-4060.− Keep copy of paper application & transmission

documentation in the chart

Behavioral Health Residential Treatment

Options

Behavioral Health Residential Treatment Options

- GridBH RESIDENTIAL TX OPTIONS

Quick Reference Guide 4.9.12

Psychiatric Residential Treatment Facility (PRTF) <21

Therapeutic Group Home (TGH) <21

RESIDENTIAL REHAB <21

RESIDENTIAL REHAB 21+ year old

Basic Non-Medical Group Homes to 18 unless in school or will finish in 6mos

Licensure DHH DHH DHH DHH DCFS

ASAM 3.7: Medically Monitored Intensive Residential Tx-Adoles. 3.7d:Medically Monitored Residential Detox-Adolescent

3.1: Clinically Managed Low Intensity Residential Tx-Adolescent 3.2d: -Clinically Managed Residential - Adolescent

3.1: Clinically Managed Low Intensity Residential-Adolescent.; 3.5: Clinically Managed High Intensity Residential Tx-Adolescent; 3.2d: Clinically Managed Residential Social Detox-Adolescent

3.1: Clinically Managed Low Intensity Residential Tx-Adults 3.2: Clinically Managed Residential Social Detox-Adults 3.3: Clinically Managed Medium Intensity Residential Tx-Adult 3.5: Clinically Managed High Intensity Residential Tx-Adult 3.7: Medically Monitored Intensive Residential Tx- Adult 3.7d: Medically Monitored Residential Detox-Adults

Doesn’t apply

# Beds Can be 17 or more beds

8 or less beds Up to 16 beds No restrictions on bed # “in Lieu of” service provision

no bed restrictions

Accreditation CARF COA TJC

Required by CMS: Accreditation is required before payment rec’d

Required by RS: 40:2009 Allowed 18 mos. (of actively working toward) obtaining it.

Required by RS: 40:2009 Allowed 12 mos. to obtain beginning 5/1/12; 3 month extension possible

Required by RS 40:2009 Allowed 12 mos. to obtain beginning 5/1/12; 3 month extension possible

None required by licensure

Medical/Non-medical Psychiatrist directed Psychiatrist (or psychologist) directed

Physician supported Physician supported Non-Medical

$ for therapy – activities must be on active treatment plan

Per diem rate for Tx, and room/board paid by Medicaid. Licensed and unlicensed staff covered in per diem treatment.*

Per diem rate for treatment by unlicensed staff. Fee for service for licensed staff. ($127.81)

Per diem rate for treatment by licensed unlicensed staff 3.1: $60.15 3.5: $212.47 3.2d: $44.06

Per diem rate for treatment by licensed & unlicensed staff. 3.1: $15.30 3.2d: $15.15 3.3: $28.50 3.5: $70.38 3.7: $137.74 3.7d: $106.50

None. No per diem rate for treatment.

$ for room & board Room & board paid for through Room & board paid for through Room & board paid for through SGF Room & Board paid using non-

Behavioral Health Residential Treatment Options

– Grid (cont.)

$ for practitioners – activities must be on active treatment plan

Licensed practitioners enrolled with the SMO are not in the per diem rate and services are billed separately to Medicaid

LMHP services included in the per diem treatment rate as indicated in the Service Manual

LMHP services included in the per diem treatment rate as indicated in the Service Manual

SMO will reimburse for services of licensed independent practitioners who are not employees of the home & who are enrolled with the SMO for BH treatment

Tx Provided on site by staff Practitioners provide Tx in the group home or in community

Treatment provided onsite Treatment provided onsite Treatment is not provided by the home

School not covered by Medicaid

Provided On Site by Local Education Authority (LEA)

In local public system Provided On Site by Local Education Authority (LEA)

Not applicable In local public system

Staffing/type Professional staff usually not internal employees

Therapeutic staff are not internal employees of the group home

Staffing levels Provider must meet the staffing levels described in the Service Manual

Provider must meet the staffing levels described in the Service Manual

Provider must meet the staffing levels described in the Service Manual for the level of care they are providing

Provider must meet the staffing levels described in the Service Manual for the level of care they are providing

Total Rates 3.7=$335.49 TGH rate $202.80 3.1=$133.08 3.5=$298.38 3.2d=$88.12

3.1: $30.00 3.2d: $35.00 3.3: $50.00 3.5: $102.00 3.7: $194.00 3.7d: $150

$125.63 per diem R&B

Misc. SMI, severe EBD, Co-occurring Must be a home-like setting Substance Use Disorders Only Substance Use Disorders & Co-occurring

Behavioral Health Residential Treatment Options

Quick Reference Grid

See LBHP Service Manual and Codes for more detail

http://new.dhh.louisiana.gov/index.cfm/page/538

Behavioral Health Residential Treatment Options

(cont.)

Psychiatric Residential Treatment Facility (PRTF) <21

Therapeutic Group Homes (TGH) <21

Addictive Disorders’ Residential Rehabilitation – Adolescents <21

Addictive Disorders’ Residential Rehabilitation – Adults 21+

Bed Limits

Bed Limits PRTF

− Can be 17 or more beds

TGH− 8 beds or less

Residential Rehab-Adolescents− 16 beds or less

Residential Rehabilitation-Adults− No bed restriction b/c of ‘in lieu of’

service provision

Accreditation

Accreditation Accreditation is required for all of the

Behavioral Health Residential Treatment Options by CMS &/or the State:− Bodies: CARF, COA, JCO

PRTF – Accreditation is required before payment is received; CMS requirement

TGH- Allowed 18 months to achieve accreditation

Residential Rehabilitation- Adult & Adolescents: Allowed 12 months from 5/1/12 to achieve, with 3 months extension

AD Residential Staffing

AD Residential Staffing

AD Residential staffing rates for the various ASAM levels in the LBHP Service Manual are higher than previously required

OBH is currently reviewing the staffing requirements for the various ASAM levels

Residential Per Diem

Residential Per Diem PRTF:

− Per diem rate for Treatment & Room/Board paid by Medicaid

− *Licensed & unlicensed staff covered in per diem

− Physicians & pharmacists can bill separately–active treatment plan

TGH:− Per diem rate for Treatment by

unlicensed staff paid by Medicaid.− Fee for service for Licensed staff can bill

separately− Room/Board paid through State General

Funds (SGF)

Residential Per Diem (cont.)

Residential Rehabilitation-Adolescents & Adults

− Per diem rate for treatment covers the services of both licensed & unlicensed staff.

− Room and Board is paid through State General Funds

− Rates vary based on ASAM levels

FY12 Contracts Requiring LBHP Billing

FY12 Contracts Requiring LBHP Billing

Assertive Community Treatment (ACT)

Substance Abuse Residential (All ASAM levels)

Substance Abuse Outpatient

Multi-systemic Therapy (MST)

Contract Billing Procedures and Forms

All Clients - Form

Department of Health and Hospitals - Office of Behavioral Health

CFMS: DHH:Provider Name:Address:

Billing Period:Invoice Date:

First Last DOB SS #Medicaid

(date applied)

Medicaid Status

(confirmation number)

Type of Service (use separate line for each

service)

Total Units (days / visits /

quantity) Cost/UnitMedicaid

Billed OBH BilledThird Party

Billed Total Billed

Jane Doe 22/22/22 333-33-3333 22/22/22 02.a (66678)Addiction Services -

Outpatient (IOP) 144 units $2.34/unit $336.96 $336.96

John Smith 55/55/55 555-55-5555 55/55/55 01Addiction Services -

Outpatient (IOP) 132 units $2.34/unit $308.88 $308.88

Supplement to PaymentServices:Addiction Services – Outpatient (ASAM Levels I, II.1, II.D)Assertive Community Treatment (ACT)Multi-Systemic Therapy (MST)Residential Treatment:Residential Rehab < 21 y.o. (ASAM Levels III.1, III.2D, III.5)Residential Rehab 21+ y.o. (ASAM Levels III.1, III.2D, III.3, III.5, III.7D)Room and Board for Residential AD Services

Medicaid Status:01 Person Medicaid Eligible02 Assisted with Medicaid Application

a. Confirmation number (included)b. Faxed application to Medicaid;

maintained copy of application with fax transmission

c. Scanned and e-mail application to Medicaid; maintained copy on file

d. Applications remains incomplete; person has not provided appropriate documentation to finalize

03 Medicaid Denied in last 12 months04 Person Refuses to Apply for Medicaid

Monthly Billing FormFee For Service

Revised OBH/04.09.2012

Invoice Date:

Invoice Number:

Contract Period:

Service Type:

$

OBH - Approved by

Provider Name:

PROVIDER'S SIGNATURE:

(MEDICAID REIMBURSEMENT):TOTAL AMOUNT DUE:

2. If you received a Medicaid reimbursement (through Magellan) for these services, you must reduce your total amount due by the amount received for Medicaid.

Approval Date:

source, and that the goods have been delivered or the services rendered in accordance with the contract, and per the

I hereby certify that the above bill is correct and just, that payments for the same has not been received from any

attached documentation. The value of your approved Contract/Agreement cannot be exceeded regardless of the Payor Source.

APPROVAL DATE:

NUMBER OF PARTICIPANTS SERVED:

COMMENTS

VENDOR CERTIFICATION:

Department of Health and Hosptials

Monthly Billing Form - Fee for Service

REQUEST FOR PAYMENT

TOTAL ADJUSTED AMOUNT DUE:

Billing Period:

Address:

Office of Behavioral Health

1. At minimum # of units x cost of units = $x should be included

COST TO BE REIMBURSED

OBH Invoice – Cost Reimbursement Form

ReCap Sheet Revised 4.2.2012

State of Louisiana          

Department of Health and Hospitals   Date of Invoice:  

Office of Behavioral Health    

    CFMS #:  

Name and Address of Vendor:    

    DHH #:  

     

    INVOICE #:  

     

    Period Ending:  

                   

Instructions for completing columns below:

1. Enter the amount approved in column 1.

2. Insert current period cost in column 2.3. Enter Medicaid Received in RED BOX AS A NEGATIVE AMOUNT. Preset formulas will spread the Medicaid collected amount. (Formula uses your

current cost percentage.)

4. Column 4 nets column 2 and column 3 for total in column 4.

5. Enter the cumulative Year to Date Costs through LAST period in Column 5. This amount should be your Column 6 from previous period invoice.

6. Add column 2 and 5 to obtain Column 6.

7. Subtract Column 6 from Column 1 to obtain Column 7 Remaining Balance OF Funds.

ACCTING DIST. # (FROM KADS)

CATEGORIES

OBJECT DETAIL

1 2 3 4 5 6 7

AMOUNT APPROVEDFOR THIS FY

COST FORREPORTED

PERIOD

LESS MEDICAID RECEIVED (See

Instructions)ADJUSTED COST FOR

PERIOD

CUMULATIVECOST THRU

LAST PERIOD

CUMULATIVECOST THRU

REPORTED PERIODBALANCE OF

FUNDS

  Personal Services (11)     0.00 0.00   0.00 0.00

  Related Benefits (41)     0.00 0.00   0.00 0.00

  Travel (12)     0.00 0.00   0.00 0.00

  Operating Services (13)     0.00 0.00   0.00 0.00

  Supplies (14)     0.00 0.00   0.00 0.00

  Professional Services (15)     0.00 0.00   0.00 0.00

  Capital Assets (16)     0.00 0.00   0.00 0.00

  Administrative (17)     0.00 0.00   0.00 0.00

                 

                 

                 

                 

TOTAL   0.00 0.00 0.00 0.00 0.00 0.00 0.00

VENDOR'S CERTIFICATE I HEREBY CERTIFY THAT THE ABOVE BILL IS CORRECT AND JUST, THAT PAYMENT THEREFORE HAS NOT BEEN RECEIVED, AND THAT THE GOODS HAVE BEEN DELIVERED OR THE SERVICES RENDERED IN ACCORDANCE WITH THE LAWS OF THE STATE OF LOUISIANA. THE VALUE OF YOUR APPROVED CONTRACT/AGREEMENT CANNOT BE EXCEEDED REGARDLESS OF THE PAYOR SOURCE.

VENDOR NAME       APPROVED BY    

Clinical Advisor Technical Assistance

Clinical Advisor (CA) Technical Assistance

Magellan Weekly CA Webinar− Priority Focus: CA

access, configuration & billing− Critical Implementation Tasks & Timelines− Identify needs/issues for resolution− Tracking progress/ Update on corrections and

enhancements− On-the-spot training by MGLN IT

Magellan Clinical Advisor Resources− www.magellanoflouisiana.com

Basic Training Guide Billing Training Recorded Webinar Computer-based Training (modules)

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Clinical Advisor (CA) Technical Assistance

Magellan Clinical Advisor Resources− Tim Hebert, MGLN-LA IT Director

TBhebert@magellanhealth.com− Joseph Chustz, MGLN-LA Sr. Program Analyst

JAchustz@magellanhealth.com− Paula Turner, MGLN-LA Claims Administrator

JPturner@magellanhealth.com

Magellan CA Helpdesk− Email: MEHelpDesk@Magellanhealth.com− Phone: 888-411-6343

OBH CA support− Joseph Fontenot – joseph.fontenot@la.gov − Randall Lemoine - randall.lemoine@la.gov

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Presentation and Attachments Can Be Found

at:

http://new.dhh.louisiana.gov/index.cfm/faq/category/87

Questions

This Webinar will be available today for 30 minutes after the presentation for you to send questions. The answer to the questions will be posted on the OBH site by COB Tuesday, April 17, 2012

Other Contact PersonsOBH Medicaid Policy

Residential OptionsBilling Process

Danita.Leblanc@la.govKenneth.Saucier@la.gov