Arkansas Department of Human Services

BH webinarNovember 1, 2018

Agenda

• BH Update

• ILP Certification, Enrollment, and Policy

BH Update

ILP Certification Process

Division of Provider Services and Quality AssuranceDept. of Licensure and Certification

Sherri Proffer, RN

Independently Licensed Practitioners (ILPs)• Independently Licensed Practitioner” is an individual that is licensed to

engage in private/independent practice by the appropriate State Board. The following licensure can qualify as Independently Licensed Practitioners:

– Licensed Certified Social Worker (LCSW)

– Licensed Marital and Family Therapist (LMFT)

– Licensed Psychologist (LP)

– Licensed Psychological Examiner – Independent (LPEI)

– Licensed Professional Counselor (LPC)

Independently Licensed Practitioners (ILPs)Application Process

• DHS will review Independently Licensed Practitioner application forms and materials (DHS will return incomplete applications to senders without review.

• For approved applications, a site survey will be scheduled within forty-five (45) -ninety (90) - calendar days of the application, or sooner. Once a site approval is completed the ILP will receive the site certification. An ILP may have many sites, but each site shall be certified independently.

• Please notify our office when you have your first client. The DPSQA will conduct a survey to ensure compliance with the regulations.

• DHS will mail a Statement of Deficiencies (SOD) report to the applicant within ten (10) calendar days of the site visit. Providers having deficiencies on survey reports must submit an approvable Plan of Correction (POC) to DHS within fifteen (15) calendar days after the date you receive the SOD. All SODs will be sent certified for proof of receipt.

• DHS will accept or reject each corrective action plan in writing within after receipt.

Approved Site Locations

• ILPs may have DPSQA sites certified at the following locations:

• Within an office or clinic of a physician or psychologist is allowed for an Independently Licensed Practitioner. You may have your own office or have a building with many offices for several ILPs.

• However, an Independently Licensed Practitioner site cannot be an adjunct to a school, a day care facility, or a long-term care facility. However, they can provide mobile care in the home, school or office where clinically indicated and appropriate.

Approved Site Locations

• ILPs may have multiple sites, but each shall fill out an application form and each site shall be certified. A site visit shall occur before each site is certified to ensure compliance with the certification manual. Each site shall have it’s own name in order to bill Medicaid for services it performs.

• Sites may have more than one ILP working in the office, but each ILP shall have their own office and space to provide private individual counselling. Each ILP shall have their own provider number. Each ILP shall have their own policies and procedures as outlined in the ILP Certification Manual. Multiple ILPs occupying one site may utilize the same policies and procedures, but shall list the individual ILP’s name on each P &P.

Noteworthy Certification Requirements

• Independently Licensed Practitioner must maintain copies of disclosure forms signed by the client, or by the client’s parent or guardian before Outpatient Behavioral Health Services are delivered except in emergencies. Such forms must at a minimum:

• Disclose that the services to be provided are Outpatient Behavioral Health Services;

• Explain Outpatient Behavioral Health Services eligibility, SED and SMI criteria;

• Contain a brief description of the Independently Licensed Practitioner services;

• Explain that all Outpatient Behavioral Health Services care must be medically necessary;

• Disclose that third party (e.g., Medicaid or insurance) Outpatient Behavioral Health Service payments may be denied based on the third party payer’s policies or rules;

• Identify and define any services to be offered or provided in addition to those offered by the Independently Licensed Practitioner, state whether there will be a charge for such services, and if so, document payment arrangements;

Noteworthy Certification Requirements

• Notify that services may be discontinued by the client at any time;

• Offer to provide copies of Independently Licensed Practitioner and

Outpatient Behavioral Health Services rules;

• Provide and explain contact information for making complaints to

the provider regarding care delivery, discrimination, or any other

dissatisfaction with care provided by the Independently Licensed

Practitioner;

• Provide and explain contact information for making complaints to

state and federal agencies that enforce compliance under § III(G)(1).

Noteworthy Certification Requirements

• Emergency Response Services: Applicants/providers must establish, implement, and maintain a site-specific emergency response plan, which must include:

• A 24-hour emergency telephone number;

• The applicant/provider must:– Provide the 24-hour emergency telephone number to all clients;

– Post the 24-hour emergency number on all public entries to each site;

– Include the 24-hour emergency phone number on answering machine greetings;

– Informing the client to call 911 or go to the ED is NOT acceptable;

– Identify local law enforcement and medical facilities within a 50-mile radius that may be emergency responders to client emergencies.

Noteworthy Certification Requirements

• DHS Access to Applicants/Providers– DHS may contact applicants and providers at any time;

– DHS may make unannounced visits to applicants/providers.

– Applicants/providers shall provide DHS prompt direct access to applicant/provider documents and to applicant/provider staff and contractors.

– DHS reserves the right to ask any questions or request any additional information related to certification.

Noteworthy Certification Requirements

• Each applicant/provider must establish and maintain procedures, competence, and capacity:– For assessment and individualized care planning and delivery;

– For discharge planning integral to treatment;

– For mobile care face-to-face intervention with the client at a place other than a certified site operated by the provider. Mobile care must be:

– Either clinically indicated in an emergent situation or necessary for the client to have access to care in accordance with the care plan; Delivered in a clinically appropriate setting; and delivered where Medicaid billing is permitted if delivered to a Medicaid eligible client;

– To assure that each mental health professional makes timely clinical disposition decisions;

– To make timely referrals to other services;

Noteworthy Certification Requirements

• Independently Licensed Practitioner must include:– Outpatient Services, including individual and family therapy at a minimum.

– Ability to provide Pharmacologic Management at the certified site or the agreement of collaboration with a physician to provide Pharmacologic Management for clients of the Independently Licensed Practitioner. You may identify the client’s PCP, however there shall be documentation in the client’s file indicating that the PCP knows that you will contact him/her re: this requirement. Having the PCP sign the documentation will suffice. DPSQA does not need the physician's resume or their license.

– Ability to refer clients to other practitioners or agencies for Outpatient Behavioral Health Services.

Becoming an ILP

• Meet the qualifications.

• Pick your site and ILPs may share a site, but each has to have their own office or setting for counselling, meetings, etc.

• Fill out an application and mail or email to our office.

• DPSQA will come and complete an site visit and review your disclosure statement.

• If approved, mail your ILP certification to you.

• Apply for a Medicaid Provider number.

• After you accept clients please contact us or we might show up in 3-6 months for your survey.

• ILP certifications sites are renewed annually.

Surveying ILPs for compliance with the ILP certification requirements

• Areas of non-compliance:– Crisis/Emergency Policy and Procedure

• calling 911 or going to the ED – not identifying an individual and their telephone number

– Documentation re: the ILP’s current license, required in-services (when they were held, the topic of in-service and who attended, Dyadic training)

– Criminal Record Checks in the file, as appropriate

– Client’s record did not have: A mental health diagnosis, medical necessity and why mobile care is necessary

– Proper documentation• Remember once you receive your letter from Beacon requesting a Plan of

Correction/Corrective Action Plan, you must submit your plan of correction to: Linda Kizer, RN, DPSQA, linda.kizer@dhs.arkansas.gov

Contact Information

Sherri Proffer, RNAssistant DirectorDivision of Provider Services and Quality AssurancePO Box 8059, Slot S408Little Rock, AR 72203Sherri.proffer@dhs.Arkansas.gov501.320.6182

Linda Kizer, RNLicensure and Certification UnitDivision of Provider Services and Quality AssurancePO Box 8059, Slot S408Little Rock, AR 72203Linda.Kizer@dhs.arkansas.gov501.320.6283

ILPPROVIDER ENROLLMENT AND APPLICATION

PROCESS

• Each ILP must enroll and receive a Medicaid Provider ID Number.

• ILPs may have multiple sites. However, if you choose to have multiple sites, it is in your best interest to enroll each site as part of a group for tax purposes. There will be more information provided during the Group Enrollment portion of the presentation.

• Effective Date on the Enrollment application is the Date on the Certificate received from the Division of Provider Services and Quality Assurance.

Who must enroll?

Fill out a Medicaid Provider Application if you:–Have never been a Medicaid Provider and have just

received your license and certification –Are a current Medicaid Provider with a ID ending

with 95 and have recently received a license and certification –Have had a Medicaid Provider ID ending with 19

which has been inactive for more than 6 months

You do not need to fill out a Medicaid Provider Application if you:

• Are a current and active Medicaid Provider with a ID ending with 19. You will need to upload your current license and certification in the provider portal. Log into the portal –click on characteristics-find upload.

• Have had a Medicaid Provider ID ending with 19 which has been inactive for 6 months or less. You will need to send Sharon Donovan your current license and certification to update your Profile.

• All applications must be submitted onlinehttps://portal.mmis.arkansas.gov/armedicaid/provider/Home/ProviderEnrollment/tabid/477/Default.aspx

• You can also view a video for step by step instructions on how to complete an enrollment application

• Please gather all required documents prior to beginning the application process; if documents are missing, processing time will take much longer

• Please allow at least 30 business days for processing. Contact Sharon Donovan only when you have not received a decision after 35 business days

Required Documents

Contract – Agreement to participate in Medicaid. Must include:• DMS 653• DMS 675• DMS 689• Electronic Funds Transfer (EFT) Form- You must provide either a

voided check or bank letter to verify the account you listed in EFT Enrollment. The name on the check/bank letter must match the name of the applicant

DMS Forms 653,675, and 689 are part of the electronic application and can be electronically signed and dated via the online application. The completed, signed and dated EFT form must be scanned and uploaded to the online application

Required Documents

Current license • From the professional licensing board • Name on license must perfectly match all other

documentation• Must be scanned and uploaded to the online application

Required Documents

Request for Taxpayer Identification Number and Certification (W9). Must include:• Provider Name (middle name must be initial only) which must

match the name on the application • Address• SSN• Signature with Date Must be scanned and uploaded to the online application

Required Documents

• Current Certification from Division of Provider Services and Quality Assurance.–Applications without a certification will be enrolled as a Non-

Credentialed Provider and will not be able to bill as an ILP–Must be scanned and uploaded to the online application.

• Section IV Form (Only if you are enrolling as an individual within a group)

Enrollment/Provider/Specialty Types

Enrollment Type:– Individual (ILP)– Individual within a Group ( ILP in a Billing Group 44)

Enrollment/Provider/Specialty Types

Provider Type/Specialty Type:

Licensed Professional Counselor (LPC)

19/W2

Licensed Clinical Social Worker (LCSW)

19/WI

Licensed Marital and Family Therapist (LMFT)

19/R5

Licensed Psychological Examiner-Independent (LPE-I)

19/62

Licensed Psychologist 19/62

GROUPPROVIDER ENROLLMENT AND APPLICATION

PROCESS

• An ILP Group is made up of one or more ILP with the sole purpose to bill for the ILP.

• Must enroll and receive a Medicaid Provider ID Number.

• Groups may have multiple sites. You must have a Medicaid ID # for each site.

• Before enrolling as an ILP Group, please wait until one of your ILPs has completed and received a Medicaid ID number; fill out a Section IV form for that ILP and submit it together with the Group Enrollment Application.

• Effective Date on Enrollment application is the Date on the Certificate received from the first enrolled ILP.

Required Documents

Contract – Agreement to participate in Medicaid. Must include:• DMS 653• DMS 675• DMS 689• Electronic Funds Transfer (EFT) Form- You must provide either a

voided check or bank letter to verify the account you listed in EFT Enrollment. The name on the check/bank letter must match the name of the applicant

DMS Forms 653,675, and 689 are part of the electronic application and can be electronically signed and dated via the online application. The completed, signed and dated EFT form must be scanned and uploaded to the online application.

Required Documents

• Request for Taxpayer Identification Number and Certification (W9). Must include:– Provider Name (middle name must be initial only) which must match

the name on the application – Address– SSN– Signature with Date – Must be scanned and uploaded to the online application – Section IV Form ( Only if you are enrolling as an individual within a

group)

Enrollment/Provider/Specialty Types

Enrollment Type• Group

Enrollment/Provider/Specialty Types

Provider Type/Specialty Type:

Licensed Professional Counselor (LPC)

44/W2

Licensed Clinical Social Worker (LCSW)

44/WI

Licensed Marital and Family Therapist (LMFT)

44/R5

Licensed Psychological Examiner-Independent (LPE-I)

44/62

Licensed Psychologist 44/62

CLAIMS/BILLING

ILP– When billing, enter the ILP Medicaid ID # in the billing and

rendering/performing provider field

ILP within a Group– When billing, enter the Group Medicaid ID # in the billing provider

field and the ILP Medicaid ID # in the rendering/performing provider field

Questions?