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    11

    Professional Development & Training Series:

    Behavioral Health Quality Assurance (BHQA) Staff

    Workshop #2: California’s Medicaid State Plan:

    Specialty Mental Health Services & Expanded Definitions

    June 2017

    San Francisco Department of Public Health

    Behavioral Health Services

    Quality Management

    Clinical Documentation Improvement Program (CDIP)

    Staff contact: Joseph A Turner, PhD (joe.turner@sfdph.org) version 1 (6/8/17)

  • Handouts

     Build a binder for workshop materials:

     Powerpoint: steal these slides for your training!

     CDIP Medicaid State Plan: a must-have reference for

    a true QA professional

     CDIP Comparison of Service Definitions: better

    understanding of the intention of services

     Bonus Materials: Issue Brief from Families USA—

    excellent review of State Plans and mechanisms for

    updates (Waivers & State Plan Amendments) Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 6/8/2017 2

  • Recap on the Series

     Problem: People Do Not Understand…

     Quality assurance…

     Managed care…

     BHQA staff deserve education, training & support:

     Workshop 1: don’t have to memorize CCR Title 9, do have

    to understand purpose, structure and medical necessity

     Workshop 2 (today): don’t have to memorize State Plan,

    but need to understand…

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 6/8/2017 3

  • 4

    Recap on the Series

    6/8/2017

    Federal

    State

    County

    Provider

    Workshop #1 Workshop #2 Workshop #3 Workshop #4 Workshop #5

    State Plan

    CCR Title 9 Boilerplate

    Contract

    1994

    SDMC

    Manual

    Medi-Cal

    Certification

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org)

  • Jargon Check: Quality Assurance

    5

    …retrospective

    comparison against

    a standard

    …real-time

    investigation of

    processes

    …organized

    system to monitor

    & improve quality

    6/8/2017Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org)

  • 6

    Switching Gears…

    Specialty Mental Health Services

    are defined in regulation…

    …what do those words mean?

    …what resources can help me understand?

    6/8/2017Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org)

  •  “Outpatient”

     Outpatient is jargon: “Hospital” and “Non-Hospital”

    are the technical words of DHCS

     “Outpatient Bundle” is BHS short hand for:

     Non-Hospital

     Mode 15 (billing by minutes)

     “Mental Health Services” (assessment, plan development,

    therapy, rehabilitation, collateral)

     Targeted Case Management

     Medication Support Services

     Crisis Intervention Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 7

    SMHS “Outpatient Bundle”

    Service Definitions

  •  “GO TO” resource for service definitions…

     CCR Title 9, Division 1, Chapter 11: remember

    Workshop #1…

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 8

    SMHS “Outpatient Bundle”

    Service Definitions

    Domain Detail CCR Title 9

    Reference

    Medical

    Necessity (Non-

    Hospital)

    • Medi-Cal criteria (diagnosis, impairments, interventions)

    • EPSDT criteria

    §1830.205 &

    §1830.210

    Definitions of

    Services

    • Definition of assessment, plan development, etc. §1810.204

  •  CDIP Tools-Outpatient Service Definitions

     Slides

     Checklist

     Table

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 9

    SMHS “Outpatient Bundle”

    Service Definitions

  •  Barriers to Understanding

     Regulation: the definitions and words from regulation

    can be hard to read and digest

     Prior Learning: the definitions from past learnings (e.g.,

    in school) make it hard to understand definitions and

    words from regulation

     Insufficient Knowledge: lack of general knowledge of

    managed care compounds difficulty

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 10

    SMHS “Outpatient Bundle”

    Service Definitions

  •  Facilitators to Understanding

     Context and background: it’s easier to learn about

    something if you know the history, background, culture

    and context

     Opportunities to compare and contrast: as we

    explore the similarities/differences among things, our

    understanding deepens

     Thorough and in-depth analysis: taking the time and

    effort to conduct a complete analysis leads to

    knowledge Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 11

    SMHS “Outpatient Bundle”

    Service Definitions

  • 12

    Switching Gears…

    Specialty Mental Health Services

    are explicated in other areas…

    …say what?!

    …isn’t Title 9 the center of the SMHS

    Universe?

    6/8/2017Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org)

  • California’s Medicaid State Plan

     California’s Medicaid State Plan

     Medicaid is a federal program that is jointly

    implemented by the Federal and State governments

     “Jointly Implemented” = every state creates a Medicaid

    State Plan that outlines the terms and agreements of

    the contract—Federal government approves plan

     Since DHCS is the California “single state agency”

    responsible for Medicaid, our State Plan is posted at

    the DHCS website

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 6/8/2017 13

  • California’s Medicaid State Plan

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 6/8/2017 14

    www.dhcs.ca.gov/formsandpubs/laws/Pages/CaliforniStatePlan.aspx

  • California’s Medicaid State Plan

     Document Structure:

     Four sections

     Section 1: Single State Agency Organization

     Section 2: Coverage and Eligibility

     Section 3: Services

     Section 4: General Program Administration

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 6/8/2017 15

    completely

    framed

    around

    health

    services…

    we are a tiny

    portion!

  • California’s Medicaid State Plan

     Where do SMHS get defined/addressed?

     Section 3: Services

     Attachment 3.1-A: Amount, Duration & Scope of Medical &

    Remedial Care & Services Provided to the Categorically

    Needy

     Supplement 1 to Attachment 3.1-A: Targeted Case Management

     Supplement 3 to Attachment 3.1-A: Rehabilitative Mental Health

    Services

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 6/8/2017 16

  • Outpatient Bundle Service

    Definitions in State Plan

     Assessment

     "Assessment" means a service activity designed to

    evaluate the current status of a beneficiary's mental,

    emotional, or behavioral health. Assessment includes

    one or more of the following: mental status

    determination, analysis of the beneficiary's clinical

    history, analysis of relevant biopsychosocial and

    cultural issues and history, diagnosis, and the use of

    testing procedures.

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 6/8/2017 17 bold/italics = unique language

  • Outpatient Bundle Service

    Definitions in State Plan

     Plan Development

     "Plan Development" means a service activity that

    consists of one or more of the following:

    development of client plans, approval of client plans

    and/or monitoring of a beneficiary's progress

    Staff Contact: Joseph A Turner, PhD (joe.turner@sfdph.org) 6/8/2017 18 bold/italics = unique language

  • Outpatient Bundle Service

    Definitions in State Plan

     Therapy

     "Therapy" means a service activity that is a therapeutic intervention that focuses primarily on symptom reduction and restoration of functioning as a means to improve coping and adaptation and reduce functional impairments. Therapeutic intervention includes the application of cognitive, affective, verbal or nonverbal, strategies based on the principles of development, wellness, adjustment to impairment, recovery and resiliency to assist a beneficiary in acquiring greater personal, interpersonal and community functioning or to modify feelings, thought processes, conditions, attitudes or behaviors which are emotionally, intellectually, or socially ineffective. These interventions and techniques are specifically implemented in the context of a professional clinical relationship. Therapy may be delivered to a beneficiary or group of beneficiaries and may include family therapy directed at improving the beneficiary's functioning and at which the be