Toolkit 03-11-09

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Integrati nToolk it

First steps to integrating mental health, physicalhealth and addiction services for OregonMedicaid clients

March 11, 2009

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Contents What is integration? ........................................................................................1

About this guide ....................................................................................... 1Who will bene t from integration? ............................................................ 1

Sharing client information ...............................................................................2Who can share client information? ........................................................... 2

Accepted information sharing under SB 163 (2007) ........................... 3

Screening client needs ...................................................................................4Scree ning and assessment tools ............................................................. 4

Screening, Brief Intervention, and Referral to Treatment (SBIRT) ...... 4Mental health and substance abuse screening instruments ............... 5

Proce dure codes ..........................................................................................11Healt h and Behavior Assessment and Intervention Codes .....................11

Assessment codes ............................................................................ 12Intervention codes ............................................................................. 12Claim submission .............................................................................. 1 3Documentation requirements ........................................................... 1 3

Scree ning, Brief Intervention, Referral and Treatment (SBIRT) codes .. 14Screening and brief intervention codes ............................................. 14

Claim submission .............................................................................. 14Documentation requirements ............................................................ 14

Appe ndix ......................................................................................................15Shari ng client information ....................................................................... 1 6

Sample SB 163 (2007) acknowledgement form ................................ 1 6Summary of state and federal privacy laws ....................................... 1 6

Syste ms of Care ..................................................................................... 18Four Quadrant Clinical Integration Model .......................................... 18

Pathway of Care Model ..................................................................... 22Asses sment and Intervention Codes .................................................... 2 3

HSC line placement effective January 1, 2009 ................................. 2 3Limitations of coverage ..................................................................... 24

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3/11/09 Integration Toolkit 1

What is integration?At a minimum, integration means physical, mental health and addictions providers share informationabout their common clients. For purposes of this guide, addictions and mental health includes

behavioral health care. Integration efforts will move up the spectrum to involve client screening practices, care coordination, and co-location of physical and mental health providers. Ultimately,administrative and nancial functions will be aligned to support clinical integration.

For rst steps, DHS will focus on reducing administrative, regulatory and communication barriers tomake integration more feasible and less complicated for Oregon Health Plan (OHP) providers and

participating managed care organizations (MCOs). Managed care organizations include:

Fully Capitated Health Plansz

Mental Health Organizations - County-based as well as other fully capitated Mental HealthzPlans.Physician Care Organizationz

Chemical Dependency Organizationz

Dental Care Organizationsz

For the purposes of this guide, all of the above organizations will be represented by the term ManagedCare Organizations (MCOs). In administrative rules, the term Prepaid Health Plan is used to denoteall of these managed care organizations.

About this guide

This toolkit represents the work of a team of stakeholders and DHS staff to address at least a few barriers to the many integration projects already underway. It provides information that clari es onlya limited number of issues related to how providers and MCOs can move toward integration in thefollowing areas:

Sharing client informationz

Screening client needsz

Using Health and Behavior Assessment and Intervention Codesz

Establishing billing guidelinesz

This Toolkit only provides guidelines and is not intended as the nal authority or regulation. DHSwill continue to research and provide more information as integration efforts continue. For more moreinformation, go to the DHS Behavioral Health and Primary Care Integration Web site atwww.oregon.gov/DHS/ph/hsp/integration.shtm l.

Who will benefit from integration?

DHS recommends implementing integration efforts for all persons who need some combination of behavioral health and primary care assessment and treatment, regardless of the care setting in whichthey enter the system. Populations come from all ages and cultural groups, and include:

Persons with depression, anxiety disorders or other mood disorders, substance use disorders,zor psychosis.Persons with special residential and support needs.z
http://www.oregon.gov/DHS/ph/hsp/integration.shtmlhttp://www.oregon.gov/DHS/ph/hsp/integration.shtmlhttp://www.oregon.gov/DHS/ph/hsp/integration.shtml

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2 Oregon Department of Human Services 3/11/09

Persons in urban, rural, frontier, and mixed service areas.z

Persons with chronic disease, such as heart disease, diabetes, hypertension, or obesity.z

Children with conditions such as childhood onset schizophrenia.z

Sharing client informationExisting state and federal privacy laws describe when health care providers must obtain client authorization to release health care information, and when it is not required.

Authorization is permission by an individual or his/her personal representative(s) for thezrelease or use of information.It gives the provider permission to obtain and use information from third parties for speci edz

purposes, or to disclose information to a third party speci ed by the individual.

With proper and signed Release of Information consent forms, providers can share information as speci ed in those consent forms.

Senate Bill 163 (2007), now codi ed as Oregon Revised Statutes (ORS) 192.527 and 192.528, permits some health information about OHP clients to be shared wtihout client authorization, as longas there is client acknowledgement of the provisions of ORS 192.527 and 192.528.

Acknowledgement means thatzinformation has been provided andreceived. It only has to be signed once(no time limit).DHS obtains client acknowledgementzusing the OHP 7210 (OHPApplication); however, DHS iscurrently unable to track theseacknowledgements centrally.Once this acknowledgement iszobtained, a minimal data set of information can be shared when

providing behavioral or physical healthcare services to OHP clients.

Who can share client information?

All providers, whether FFS or managed care, must continue to make sure to obtain clientauthorization for the speci c disclosure of substance abuse records. Each disclosure requires speci c

client authorization; and follow existing privacy laws. See Appendix for a summary of these laws.How information can be shared under Senate Bill 163 (2007) as combined with other applicablecon dentiality laws is illustrated on the following page. See the Appendix for a sampleacknowledgement form.

Minimal data set allowed by SB 163 (2007)Client name;Medicaid ID number;Performing provider number;Hospital provider name;Attending physician;Diagnosis;Date(s) of service;Procedure code;Revenue code;Quantity of units of service provided; or Medication prescription and monitoring.

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FCHPPCO MHOMedical information for behavioral health assessment

Minimal data set with client acknowledgement

Minimal data set with client acknowledgement

Behavioral Health Providers

MHO

Medical ProvidersFCHPPCO

Behavioral health information for medical treatmentClinical information with client authorization

Behavioral Health Providers

MHO

Medical ProvidersFCHPPCO

Substance abuse treatment recordsOnly with cilent authorization

Clinical information with client authorization

Only with client authorization

Accepted information sharing under SB 163 (2007)

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Screening client needsUse of screening tools to assess client health care needs in the physical health, mental health, andaddiction services settings can help to ensure care is delivered in the right place and at the right time.

Screening tools are most useful when providers use them within az system of integrated care ,where providers have de ned pathways to meeting identi ed client needs in a timely manner.See the Appendix for some examples of integrated care models.

The speci c assessment tools used may differ according to the speci c health care setting, aszwell as by age group. Assessment tools include interviews, observations, psychophysiologicalmonitoring, and health-oriented questionnaires.

Screening and assessment tools

The tools listed in this section are not intended to be a complete list. Instead, they are a compilation of commonly-used tools to build on.

Each managed care entity should work with its provider network to ensure that they have azworkable list of screening tools for all ages and possible behavioral health issues.

The department will make as wide a range of tools possible available on the Integration Webz page at www.oregon.gov/DHS/ph/hsp/integration.shtm l.SBIRT is a structured process for delivering screening and brief interventions in primary carezsettings with individuals who may be experiencing substance use issues. For this reason, and

because SBIRT is intended to intervene early before any substance use diagnosis has beenmade, this practice is identi ed separately from the individual screening tools listed.

Screening, Brief Intervention, and Referral to Treatment (SBIRT)The SBIRT Initiative targets those with nondependent substance use and provides effective strategiesfor intervention prior to the need for more extensive or specialized treatment.

SBIRT is a comprehensive, integrated, public health approach to the delivery of earlyzintervention and treatment services for persons with substance use disorders, as well as thosewho are at risk of developing these disorders. Primary care centers, hospital emergency rooms,trauma centers, and other community settings provide opportunities for early intervention withat-risk substance users before more severe consequences occur.The Initiative involves implementation of a system within community and/or medical settingszthat screens for and identi es individuals with or at-risk for substance use-related problems.Screening determines the severity of substance use and identi es the appropriate level of intervention.The system provides for brief intervention or brief treatment within the community setting or z

motivates and refers those identi ed as needing more extensive services than provided in thecommunity setting to a specialist setting for assessment, diagnosis, and appropriate treatment.

Research on SBIRT has demonstrated signi cant reductions in alcohol use and illicit drug use among patients who received brief interventions in healthcare settings. Screening tools applied in the SBIRTresearch include the AUDIT and the ASSIST described below. For more information about SBIRT,go to http://sbirt.samhsa.go v. For information about SBIRT procedure codes and billing, see theProcedure Codes section of this document.
http://www.oregon.gov/DHS/ph/hsp/integration.shtmlhttp://www.oregon.gov/DHS/ph/hsp/integration.shtmlhttp://sbirt.samhsa.gov/http://sbirt.samhsa.gov/http://sbirt.samhsa.gov/http://www.oregon.gov/DHS/ph/hsp/integration.shtml

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Mental health and substance abuse screening instrumentsThe Oregon ABCD Screening Initiative and the Technical Assistance Partnership for Child andFamily Mental Health (TA Partnership) compiled the following list of assessments. For moreinformation, go to www.tapartnership.org .

Also see http://lib.adai.washington.edu/instruments / for detailed descriptions of alcohol and drugabuse screening tools.

Children

Instrument Screens for Target

population Web site

Ages and StagesQuestionnaires(Social Emotional)(ASQ: SE)

Personal-social(self-regulation,compliance,communication,adaptive functioning,autonomy, affect,and interaction withpeople)

Ages 660months

www.brookespublishing.com/store/books/squires-asqse/index.ht m

Brief Infant- Toddler Social EmotionalAssessment(BITSEA)

Socio-EmotionalIssues

Ages 1236months

http://tinyurl.com/8yhkf

Child andAdolescent Needsand Strengths(CANS)

Comprehensivemental health needsand strengths

0-18 years,multipleversions

www.nctsnet.org/nctsn_assets/pdfs/measure/CANS-MH.pdf

Drug Use Screening

Inventory - Revised(DUSIR)

Current status,

identifying areas inneed of prevention,and evaluating changeafter a treatmentintervention.

Adults and

adolescents>16 yrs.; youth1016 yrs.

www.dusi.com/

Eyberg ChildBehavior Inventory(ECBI)

Behavioral Disorders(e.g., attention,conduct, oppositional-de ant)

Ages 216years

http://tinyurl.com/cxrj3

Pediatric SymptomChecklist (PSC)

PsychosocialDysfunction

Ages 416years

http://psc.partners.org/psc_ detailed.htm

ReynoldsDepression Scale(RDS)

Depression Ages 812years

www.hogg.utexas.edu/pages/IHCscreen.htm l
http://www.tapartnership.org/http://%20http//lib.adai.washington.edu/instruments/http://%20http//lib.adai.washington.edu/instruments/http://www.brookespublishing.com/store/books/squires-asqse/index.htmhttp://www.brookespublishing.com/store/books/squires-asqse/index.htmhttp://www.brookespublishing.com/store/books/squires-asqse/index.htmhttp://www.brookespublishing.com/store/books/squires-asqse/index.htmhttp://tinyurl.com/8yhkfhttp://www.nctsnet.org/nctsn_assets/pdfs/measure/CANSMH.pdfhttp://www.nctsnet.org/nctsn_assets/pdfs/measure/CANSMH.pdfhttp://www.dusi.com/http://tinyurl.com/cxrj3http://psc.partners.org/psc_detailed.htmhttp://psc.partners.org/psc_detailed.htmhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://psc.partners.org/psc_detailed.htmhttp://psc.partners.org/psc_detailed.htmhttp://tinyurl.com/cxrj3http://www.dusi.com/http://www.nctsnet.org/nctsn_assets/pdfs/measure/CANSMH.pdfhttp://www.nctsnet.org/nctsn_assets/pdfs/measure/CANSMH.pdfhttp://tinyurl.com/8yhkfhttp://www.brookespublishing.com/store/books/squires-asqse/index.htmhttp://www.brookespublishing.com/store/books/squires-asqse/index.htmhttp://www.brookespublishing.com/store/books/squires-asqse/index.htmhttp://%20http//lib.adai.washington.edu/instruments/http://www.tapartnership.org/

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Children


population Web site

Temperament andAtypical Behavior Rating Scale (TABS)

Behavioral Disorders Ages 1171months

www.brookespublishing.com/store/books/bagnato-tabs/index.htm

Adolescents


population Web site

Beck DepressionInventoryFastscreen for Medical Clients

Biological, Medical,Substance AbuseIssues

Adolescentsand Adults

www.hogg.utexas.edu/pages/IHCscreen.html For information on studies of effectiveness, view: http://asm.

sagepub.com/cgi/reprint/9/2/16 4Child andAdolescent Needsand Strengths(CANS)

Comprehensivemental health needsand strengths

0-18 years,multipleversions

www.nctsnet.org/nctsn_assets/pdfs/measure/CANS-MH.pdf

ColumbiaDepression Scale(CDS)


www.teenscreen.org/cms/content/views/49/7 8

Columbia HealthScreen (CHS)

Suicide Ages 1118years


ComputerizedLifestyleAssessment (CLA)

Lifestyle strengths,concerns, and risks

Adults andadolescents

www.mhs.com/

CRAFFT Substance Abuse Ages 1418years

http://ebn.bmjjournals.com/cgi/content/full/6/1/23 For more information, [email protected]

DiagnosticPredictive Scales

(DPS)

General Mental HealthDisorders

Ages 918years


Drug Use ScreeningInventory - Revised(DUSIR)

Current status,identifying areas inneed of prevention,and evaluating changeafter a treatmentintervention.

Adults andadolescents>16 yrs.;youth 1016yrs.

www.dusi.com/
http://www.brookespublishing.com/store/books/bagnato-tabs/index.htmhttp://www.brookespublishing.com/store/books/bagnato-tabs/index.htmhttp://www.brookespublishing.com/store/books/bagnato-tabs/index.htmhttp://www.brookespublishing.com/store/books/bagnato-tabs/index.htmhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://asm.sagepub.com/cgi/reprint/9/2/164http://asm.sagepub.com/cgi/reprint/9/2/164http://asm.sagepub.com/cgi/reprint/9/2/164http://www.nctsnet.org/nctsn_assets/pdfs/measure/CANSMH.pdfhttp://www.nctsnet.org/nctsn_assets/pdfs/measure/CANSMH.pdfhttp://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.mhs.com/http://ebn.bmjjournals.com/cgi/content/full/6/1/23http://ebn.bmjjournals.com/cgi/content/full/6/1/23mailto:[email protected]:[email protected]://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.dusi.com/http://www.dusi.com/http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78mailto:[email protected]://ebn.bmjjournals.com/cgi/content/full/6/1/23http://ebn.bmjjournals.com/cgi/content/full/6/1/23http://www.mhs.com/http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.teenscreen.org/cms/content/views/49/78http://www.nctsnet.org/nctsn_assets/pdfs/measure/CANSMH.pdfhttp://www.nctsnet.org/nctsn_assets/pdfs/measure/CANSMH.pdfhttp://asm.sagepub.com/cgi/reprint/9/2/164http://asm.sagepub.com/cgi/reprint/9/2/164http://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.brookespublishing.com/store/books/bagnato-tabs/index.htmhttp://www.brookespublishing.com/store/books/bagnato-tabs/index.htmhttp://www.brookespublishing.com/store/books/bagnato-tabs/index.htm

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Adolescents


population Web site

Eyberg ChildBehavior Inventory(ECBI)

Behavioral Disorders(e.g., attention,conduct, oppositional-de ant)

Ages 216years

http://tinyurl.com/cxrj3

Global Appraisal of Individual Needs-Short Screen (GAIN-SS)

Substance abusedisorders


www.chestnut.org/LI/gain/GAIN_ SS/index.htm l

Michigan AlcoholismScreening Test(MAST)

Lifetime alcohol-related problems andalcoholism


http://adai.washington.edu/instruments/pdf/Michigan_ Alcoholism_Screening_ Test_156.pdf

Mood Disorder Questionnaire(MDQ)

Bipolar disorder Adults andadolescents

http://ajp.psychiatryonline.org/cgi/reprint/157/11/1873

Personal ExperienceScreeningQuestionnaire(PESQ)

Substance Abuse Ages 1218years

http://tinyurl.com/d8qom

ReynoldsDepression Scale(RDS)


www.hogg.utexas.edu/pages/IHCscreen.htm l

Substance Abuse

Subtle ScreeningInventory (SASSI)

Individuals who have

a high probability of having a substanceuse disorder

Adults and

adolescents

http://pubs.niaaa.nih.gov/

publications/sassi.pdf

Adults


population Web site

Addiction SeverityIndex (ASI)

Recent and lifetimeproblem areas in

substance abusingpatients

Adults www.tresearch.org/resources/instruments/ASI_5th_Ed.pdf

Addiction AdmissionScale (AAS)

Alcohol/drug abuseproblems

Adults http://pearsonassessments.com/clinical/substance.htm
http://tinyurl.com/cxrj3http://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://ajp.psychiatryonline.org/cgi/reprint/157/11/1873http://ajp.psychiatryonline.org/cgi/reprint/157/11/1873http://tinyurl.com/d8qomhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://pubs.niaaa.nih.gov/publications/sassi.pdfhttp://pubs.niaaa.nih.gov/publications/sassi.pdfhttp://www.tresearch.org/resources/instruments/ASI_5th_Ed.pdfhttp://www.tresearch.org/resources/instruments/ASI_5th_Ed.pdfhttp://pearsonassessments.com/clinical/substance.htmhttp://pearsonassessments.com/clinical/substance.htmhttp://pearsonassessments.com/clinical/substance.htmhttp://pearsonassessments.com/clinical/substance.htmhttp://www.tresearch.org/resources/instruments/ASI_5th_Ed.pdfhttp://www.tresearch.org/resources/instruments/ASI_5th_Ed.pdfhttp://pubs.niaaa.nih.gov/publications/sassi.pdfhttp://pubs.niaaa.nih.gov/publications/sassi.pdfhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://tinyurl.com/d8qomhttp://ajp.psychiatryonline.org/cgi/reprint/157/11/1873http://ajp.psychiatryonline.org/cgi/reprint/157/11/1873http://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://tinyurl.com/cxrj3

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Adults


population Web site

Addiction PotentialScale (APS)

Personality factorsunderlying thedevelopment of addictive disorders.

Adults http://pearsonassessments.com/clinical/substance.htm

Alcohol, Smokingand SubstanceInvolvementScreening Test(ASSIST)

Psychoactivesubstance use andrelated problemsamong primary carepatients.

Adults www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_ TEST.pdf

Alcohol UseDisordersIdenti cation Test(AUDIT)

Hazardous or harmfulalcohol consumption

Adults http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf

Beck DepressionInventoryFastscreen for Medical Clients

Biological, Medical,Substance AbuseIssues

Adolescentsand Adults

www.hogg.utexas.edu/pages/IHCscreen.html For information on studies of effectiveness, view: http://asm.sagepub.com/cgi/reprint/9/2/16 4

ComputerizedLifestyleAssessment (CLA)

Lifestyle strengths,concerns, and risks


www.mhs.com/

Drug Use ScreeningInventory - Revised(DUSIR)

Current status,identifying areas inneed of prevention,and evaluatingchange after atreatment intervention.

Adults andadolescents>16 yrs.;youth 1016yrs.

www.dusi.com/

Five ShotQuestionnaire

Heavy alcoholdrinking in its earlyphase

Adults http://adai.washington.edu/instruments/pdf/Five_Shot_ Questionnaire_121.pdf

Global Appraisal of Individual Needs-Short Screen

(GAIN-SS)

Substance abusedisorders


www.chestnut.org/LI/gain/GAIN_ SS/index.htm l

GAD-7 Generalized anxietydisorder

Adults

MacAndrewAlcoholism Scale(MAC)

Traits andcharacteristicsfrequently associatedwith substance abuse

Adults www.pearsonassessments.com/index.ht m
http://pearsonassessments.com/clinical/substance.htmhttp://pearsonassessments.com/clinical/substance.htmhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdfhttp://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdfhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://asm.sagepub.com/cgi/reprint/9/2/164http://asm.sagepub.com/cgi/reprint/9/2/164http://asm.sagepub.com/cgi/reprint/9/2/164http://www.mhs.com/http://www.dusi.com/http://adai.washington.edu/instruments/pdf/Five_Shot_Questionnaire_121.pdfhttp://adai.washington.edu/instruments/pdf/Five_Shot_Questionnaire_121.pdfhttp://adai.washington.edu/instruments/pdf/Five_Shot_Questionnaire_121.pdfhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://www.pearsonassessments.com/index.htmhttp://www.pearsonassessments.com/index.htmhttp://www.pearsonassessments.com/index.htmhttp://www.pearsonassessments.com/index.htmhttp://www.pearsonassessments.com/index.htmhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://www.chestnut.org/LI/gain/GAIN_SS/index.htmlhttp://adai.washington.edu/instruments/pdf/Five_Shot_Questionnaire_121.pdfhttp://adai.washington.edu/instruments/pdf/Five_Shot_Questionnaire_121.pdfhttp://adai.washington.edu/instruments/pdf/Five_Shot_Questionnaire_121.pdfhttp://www.dusi.com/http://www.mhs.com/http://asm.sagepub.com/cgi/reprint/9/2/164http://asm.sagepub.com/cgi/reprint/9/2/164http://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://www.hogg.utexas.edu/pages/IHCscreen.htmlhttp://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdfhttp://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://www.who.int/substance_abuse/activities/en/ASSIST%20V.3-%20Guidelines%20for%20use%20in%20primary%20care_TEST.pdfhttp://pearsonassessments.com/clinical/substance.htmhttp://pearsonassessments.com/clinical/substance.htm

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Adults


population Web site

Michigan AlcoholismScreening Test(MAST)

Lifetime alcohol-related problems andalcoholism


http://adai.washington.edu/instruments/pdf/Michigan_ Alcoholism_Screening_Test_156.pd f

Mood Disorder Questionnaire(MDQ)

Bipolar disorder Adults andadolescents

http://ajp.psychiatryonline.org/cgi/reprint/157/11/1873

Rapid AlcoholProblems Screen(RAPS-4)

Alcohol dependenceduring the last year

Adults www.arg.org/RAPS4-1.htm l

Self-AdministeredAlcoholismScreening Test(SAAST)

Alcoholism in generalmedical inpatient andoutpatient settings.

Adults

Substance AbuseSubtle ScreeningInventory (SASSI)

Individuals who havea high probability of having a substanceuse disorder


http://pubs.niaaa.nih.gov/publications/sassi.pdf

TACE Patients at risk for drinking amountswhich may bedangerous to thefetus.

Pregnantwomen

http://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htm

TWEAK Patients in needof more thoroughassessments of their drinking patternsand alcohol-relatedproblems

Adults http://adai.washington.edu/instruments/pdf/TWEAK_252.pdf

Older adults


population Web site

PHQ-9 Depression, alsobeing used for other diagnoses, includingADHD


http://impact-uw.org/tools/phq9.htm l
http://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://ajp.psychiatryonline.org/cgi/reprint/157/11/1873http://ajp.psychiatryonline.org/cgi/reprint/157/11/1873http://www.arg.org/RAPS4-1.htmlhttp://www.arg.org/RAPS4-1.htmlhttp://pubs.niaaa.nih.gov/publications/sassi.pdfhttp://pubs.niaaa.nih.gov/publications/sassi.pdfhttp://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htmhttp://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htmhttp://adai.washington.edu/instruments/pdf/TWEAK_252.pdfhttp://adai.washington.edu/instruments/pdf/TWEAK_252.pdfhttp://impact-uw.org/tools/phq9.htmlhttp://impact-uw.org/tools/phq9.htmlhttp://impact-uw.org/tools/phq9.htmlhttp://impact-uw.org/tools/phq9.htmlhttp://impact-uw.org/tools/phq9.htmlhttp://adai.washington.edu/instruments/pdf/TWEAK_252.pdfhttp://adai.washington.edu/instruments/pdf/TWEAK_252.pdfhttp://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htmhttp://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htmhttp://pubs.niaaa.nih.gov/publications/sassi.pdfhttp://pubs.niaaa.nih.gov/publications/sassi.pdfhttp://www.arg.org/RAPS4-1.htmlhttp://ajp.psychiatryonline.org/cgi/reprint/157/11/1873http://ajp.psychiatryonline.org/cgi/reprint/157/11/1873http://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdfhttp://adai.washington.edu/instruments/pdf/Michigan_Alcoholism_Screening_Test_156.pdf

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In addition, the following tools are useful for screening for mental health and substance use disordersin young adult and adult populations.


population Web site

CAGE Alcohol/drugscreening tool

Adults http://pubs.niaaa.nih.gov/publications/inscage.htm

Duke Health Pro le Health issues inadults in behavioralsettings

Adults http://healthmeasures.mc.duke.edu /

Short-TermAssessment of Riskand Treatability(START)

Risk of violence Adults all ages www.bcmhas.ca/Research/Research_START.htm

PHQ-9 Depression, alsobeing used for other diagnoses, includingADHD


http://impact-uw.org/tools/phq9.htm l

The Primary CareEvaluation of Mental Disorders(PRIME-MD)

Early psychosisdetection

Lateadolescence/early adulthood
http://pubs.niaaa.nih.gov/publications/inscage.htmhttp://pubs.niaaa.nih.gov/publications/inscage.htmhttp://healthmeasures.mc.duke.edu/http://healthmeasures.mc.duke.edu/http://healthmeasures.mc.duke.edu/http://www.bcmhas.ca/Research/Research_START.htmhttp://www.bcmhas.ca/Research/Research_START.htmhttp://impact-uw.org/tools/phq9.htmlhttp://impact-uw.org/tools/phq9.htmlhttp://impact-uw.org/tools/phq9.htmlhttp://impact-uw.org/tools/phq9.htmlhttp://impact-uw.org/tools/phq9.htmlhttp://www.bcmhas.ca/Research/Research_START.htmhttp://www.bcmhas.ca/Research/Research_START.htmhttp://healthmeasures.mc.duke.edu/http://healthmeasures.mc.duke.edu/http://pubs.niaaa.nih.gov/publications/inscage.htmhttp://pubs.niaaa.nih.gov/publications/inscage.htm

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Procedure codesThe following codes, used for assessment, intervention, and screening, are billed to the physicalhealth plans (FCHPs or PCO) or Division of Medical Assistance Programs (DMAP).

Mental health providers do not contract with physical health plans. The following codes are capitatedto the physical health plans. It is up to the physical health plan to determine whether it will reimbursea mental health provider who does not have a contract with the plan.

Where possible, the department encourages physical health plans to contract with mental health providers to provide integrated services to clients.

Payment for services provided to plan members is a matter between the provider and the planzauthorizing the services, except as otherwise provided in OAR 410-141-0410 (OHP PrimaryCare Managers).If a physical health plan denies payment to a provider because arrangements were not madezwith the physical health plan prior to providing the service, DMAP will not reimburse the

provider, except as outlined in OAR 410-141-0120 (OHP PHP Provision of Health CareServices).

DHS will work with the managed care plans to ensure that the billing process for these codes is well-understood. Each plan must still decide whom they cover and how to add behavioral health specialiststo their provider panels as needed.

Health and Behavior Assessment and Intervention Codes

The Health and Behavior Assessment and Intervention codes (96150 through 96154) allow certain behavioral health specialists to work with a client upon referral from a medical professional who hasmade the primary physical health diagnosis.

For the purposes of the Oregon Health Plan, a behavioral health specialist is a mental health

professional licensed for individual practice who by training and experience demonstratescompetencies matching the needs of the medical setting and the population to be served.

A new HSC guideline references the CMS guidelines that provide limitations of coverage, medicalnecessity, indications of coverage, documentation requirements, and utilization guidelines for thesecodes.

For CMS guidelines, go toz www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_ version=49 .For the current HSC guidelines, go toz www.oregon.gov/OHPPR/HSC/current_prior.shtm l.Also refer to your Current Procedural Terminology (CPT) codebook for information onz

appropriate use of these codes.
http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.oregon.gov/OHPPR/HSC/current_prior.shtmlhttp://www.oregon.gov/OHPPR/HSC/current_prior.shtmlhttp://www.oregon.gov/OHPPR/HSC/current_prior.shtmlhttp://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49

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Assessment codesAssessment codes 96150 and 96151 are used to identify the biopsychosocial factors important to the

prevention, treatment, or management of physical health problems (not mental health problems).

Upon referral by a physical health provider, the behavioral health specialist should use these codeswhen:

The client has an underlying physical illness or zinjury,The purpose of the assessment or reassessmentzis to diagnose or treat physical (not mental)illness, andThe assessment or reassessment does notzduplicate other provider assessments.

In addition, the following criteria also apply.

Additional criteria for Initial Assessment (CPT Code 96150)A biopsychosocial factor that may be signi cantly affecting the treatment, or medicalzmanagement of an illness or an injury.The client is expected to have the capacity to understand or respond meaningfully to thezintervention.The clients attending physician documents that the client needs assessment to successfullyzmanage his/her physical illness to resolve barriers to the management of his/her physicaldisease and activities of daily living.

Additional criteria for Reassessment (CPT Code 96151)Question of a suf cient change in the clients status warranting re-evaluation of his or her zcapacity to understand or to respond meaningfully to the intervention.The clients attending physician documents the need for reassessment.z

Intervention codesIntervention codes 96152 through 96154 are used to bill for cognitive, behavioral, social, and/or

psychophysiological procedures designed to improve the biopsychosocial factors directly affecting theclients health, well-being, treatment, or management of speci c physical health problems.

Upon referral by a physical health provider, the behavioral health specialist should use these codeswhen the following criteria apply:

Individual Intervention (CPT Code 96152) or Group Intervention (CPT Code 96153)Client has an underlying physical illness or injury.z

The purpose of the intervention is not the treatment of mental illness.z

The client is expected to have the capacity to understand or respond meaningfully to thezintervention.The client requires intervention to address:z

What are biopsychosocial factors?These are non-physiological

factors that contribute to the clientsphysiological functioning, such as:

Psychological factorsPsycho-physiological factorsBehavioral factorsEmotional factorsCognitive factorsSocial factors

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Non-compliance with the medical treatment plan, or z

The biopsychosocial factors associated with physical illness, andz

The speci c intervention(s) and client outcome goal(s) have been clearly identi ed.z

Family Intervention (CPT Code 96154)The family representative directly participates in the care of the client.z

Immediate family members (including siblings, children, grandchildren, grandparents,z

parents, spouse)Primary caregiver who provides care on a voluntary, uncompensated, regular, sustainedz

basisGuardian, or health care proxyz

The intervention is necessary to address biopsychosocial factors that affect compliancezwith the plan of care, symptom management, health-promoting behaviors, behaviors which

place the client or others at risk for safety, health-related risk-taking behaviors, and overalladjustment to medical illness.

Claim submissionWhen billing DMAP or the physical health plan for Health and Behavior Assessment InterventionCodes, bill one unit for each 15 minutes of service (one hour equals four units of service).

ICD-9-CM diagnosis code(s) re ecting thez physical condition(s) being treated must be present on the claim.HSC limits use of assessment codes for initial assessment to 4 units (1 hour) per quarter, andzuse of assessment codes for reassessment to 4 units (1 hour) per quarter.HSC limits use of intervention codes to 48 units (12 hours) per quarter.z

Do not submit documentation with your claim; instead, make sure you have the appropriatezdocumentation on le and available upon request.

Documentation requirementsAccording to CMS guidelines, the clients medical record must support that the indications of coverage have been met, and that services were reasonable and necessary. Medical records includecomplete nursing home records, doctors orders, progress notes, of ce records, and nursing notes.

For the complete CMS guidelines, go to www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_ version=49 .
http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49

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Screening, Brief Intervention, Referral and Treatment (SBIRT) codes

SBIRT is a preventative service under the Oregon Health Plan. The SBIRT codes (99408 and 99409)allow health care professionals to screen, provide brief interventions, and refer to specialty servicesfor Substance Use Disorders.

Screening and brief intervention codes

Screening and brief intervention codes for SBIRT include:CPT Code 99408: Used to implement structured screening and brief intervention services for zalcohol and/or substance abuse lasting 15-30 minutes.CPT Code 99409: Used to implement a structure screening and brief intervention services for zalcohol and/or substance abuse lasting more than 30 minutes.

Claim submissionWhen billing DMAP or the physical health plan, bill one unit per encounter.

Payment for services provided to plan members is a matter between the provider and the planz

authorizing the services. Contact the members health plan for limitations and guidelines.Payment for services provided to fee-for-service (open card) clients, is billed directly tozDMAP. For questions regarding reimbursement, limitations or guidelines, contact Provider Services at 800-366-6016.

Documentation requirementsThe clients medical record must support that the services were reasonable and necessary. Medicalrecords should include the screening tool results, notes regarding brief intervention and/or referral asapplicable.

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Appendix

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Sharing client information

Sample SB 163 (2007) acknowledgement form

The sample at right shows the information that must be provided to clients for their acknowlegement before the listed information can be shared for treatment purposes as permitted by ORS 192.527 and192.528. The acknowledgement form must be signed and dated by the client. Keep a copy of the

completed form on le.

Summary of state and federal privacy laws

This summary is a brief outline. It should not be treated as a complete description of all applicable privacy and con dentiality laws potentially applicable in individual cases. If more than one law couldapply to the health information, the law that is the most protective of the clients privacy applies.

HIPAA and stateprivacy law

The HIPAA Privacy Rules allow covered entities to exchange protectedhealth information (PHI) for treatment purposes without the individualsauthorization under the following circumstances, among others:

A covered entity may disclose protected health information for its owntreatment, payment, or health care operations.A covered entity may disclose protected health information for treatment activities of a health care provider.

45 CFR 164.506(c) (1) & (2). See also ORS 192.520(2) & (3).Uses and disclosuresfor purposes of medical assistance

Federal and state law permits the use and disclosure of information aboutrecipients of medical assistance for purposes related to the administrationof the medical assistance program.

See 42 CFR 431 Subpart F; 42 CFR 457.1110; ORS 410.150, 411.320,and 412.074.

ORS 179.505 -Disclosure of writtenaccounts by healthcare services provider

ORS 179.505 limits use and disclosure of records about clients of publiclyfunded treatment for mental health conditions, developmental disabilities,public health, and substance abuse.

Because ORS 179.505(6) does not expressly permit disclosure for treatment purposes to MCOs, it is more protective of client privacy thanHIPAA or other state laws. Consequently, MCOs are required to obtainclient authorization for these treatment records that HIPAA might not haverequired.

Other federal law Substance abuse treatment records are also con dential under federal lawat 42 CFR Part 2. Disclosure of these records for treatment purposes to

coordinate care requires the client to sign an authorization form.

This federal regulation remains unchanged by ORS 192.527 and 192.528.

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Systems of Care

Four Quadrant Clinical Integration Model

The Four Quadrant Clinical Integration Model, used with permission of the National Councilfor Community Behavioral Healthcare (NCCBH), is a client-centered care delivery model for determining what part of the delivery system can provide the most appropriate care.

This model is a framework that provides guidance to determine which setting can provide the mostappropriate care, and who provides the medical home (main point of care) for the client The

behavioral health (BH) provider or the primary care provider (PCP).

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Quadrant II(continued)

The Providers:The primary care physician assures the full-scope healthcare home either throughpracticing on site or supervision of the nurse practitioner, consultation withbehavioral health provider and stepped care.

Psychiatric consultation with the primary care provider may be an element inthese complex behavioral health situations, but it is more likely that psychotropic

medication management will be handled by the specialty behavioral healthprescriber, in collaboration with the primary care physician.

Standard health screening (e.g., glucose, lipids, blood pressure, weight/BMI) andpreventive services will be provided. Wellness programs (e.g., nutrition, smokingcessation, physical activities) are available as primary as well as secondarypreventive interventions, incorporating recovery principles and peer leadership andsupport.

Quadrant III The Population:Low to moderate behavioral health and moderate to high physical healthcomplexity/risk.

The Model:Person Centered Healthcare Home: a primary care team that includes abehavioral health consultant/care manager, psychiatric consultant, screening for behavioral health concerns, stepped care, and access to specialty medical/surgicalconsultation and care management.

The Providers:In addition to the services described in Quadrant I, the primary care provider collaborates with medical/surgical specialty providers and care managers (e.g.,diabetes, asthma) to manage the physical health concerns of the individual.

Specialty healthcare and care management programs could also integratebehavioral health screening and the behavioral health consultant/care manager into a wide array of self management and rehabilitation programs, buildingon research ndings regarding the frequency and impact of depression incardiovascular or diabetes populations.Depending on the setting, the behavioral health consultant may also (inaddition to the services described in Quadrant I) provide health education andbehavioral supports regarding lifestyle and chronic health conditions found inthe general public (diabetes, asthma) or conditions found in at-risk populations(Hepatitis C, HIV).These population-based services, as articulated by Dyer, would include:patient education, activity planning, prompting, skill assessment, skill building,

and mutual support.41 In addition to these services, the behavioral healthconsultant might serve as a physician extender, supporting ef cient use of physician time by problem solving with individuals trying to manage either acuteor chronic health concerns or related medication adherence issues.

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Quadrant IV The Population:Moderate to high behavioral health and moderate to high physical healthcomplexity/risk.

The Model:Person Centered Healthcare Home: primary care capacity in a behavioral healthsetting, including medical nurse practitioner/primary care physician, nurse care

manager, wellness programming, screening/tracking for health status concerns,and stepped care to a full-scope healthcare home. Access to the array of specialtybehavioral health services designed to support recovery and access to specialtymedical/surgical consultation and care management.

The Providers:In addition to the services described in Quadrant II, the primary care physiciancollaborates with medical/surgical specialty providers and external care managersto manage the physical health concerns of the individual.

In some settings, behavioral health consultant/care manager services may alsobe integrated with specialty provider teams (for example, Kaiser has behavioralhealth consultants in OB/GYN programs, working with substance abusingpregnant women). Nurse care management is added, along with focusedgoal setting and self management planning, to the standard health screening/registry tracking (e.g., glucose, lipids, blood pressure, weight/BMI). Wellnessprograms (e.g., diabetes groups) are available as secondary and tertiarypreventive interventions, incorporating recovery principles and peer leadershipand support.The organization of collaborative care for this population will frequently beperson-speci c, developed by the team of care providers in collaboration withthe individual. With the expansion of Medicaid disease management programs,there may be coordination with external care managers in addition to multiplehealthcare providersthis may be the role of the nurse care manager or the

specialty behavioral health clinician/case manager as the team de nes speci croles and responsibilities.The nurse care manager, behavioral health clinician/case manager, andexternal care manager should assure they are not duplicating tasks, butworking together to support the needs of the individual. A speci c protocolshould be adopted that de nes the methods and frequency of communicationamong all providers/team members.

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Pathway of Care Model

There are multiple pathways of care (also known asintegrated care pathways or clinical pathways ) that can

be used to address the needs of individuals.

Health care organizations should consider what their current pathways of care look like and how resources

might be redistributed and incentives created to enablemore clients to be accommodated by the service deliverydesign.

The model on this page, used with permission of Peter Davidson, shows the important similarities and linkages

between the behavioral and primary care systems.

It also demonstrates the basic steps in treating illness,whether it is behavioral or medical.

Pre-treatment or treatment readinessAn effective pre-treatment phase is critical to a clientsreadiness for treatment. This includes:

Access:z Community supports that, throughinformation gathering and triaging, allow clientsentry into the medical or behavioral health caresetting; andFace-to-face consult z in the clinical setting.

Treatment

Active treatment in the clinical setting (medical or behavioral).

Post-treatment or aftercareThis includes continutation treatment in the clinical setting, and recovery/maintenance assistancethrough community supports.

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Assessment and Intervention Codes

HSC line placement effective January 1, 2009

Addition of CPT codes 96150-96154

Lines Condition type

10-12, 26, 33, 35-36, 42, 46, 52, 61, 66, 76, 82, 87,100, 109-110, 129, 135, 141, 150-152, 169, 174,180, 183-184, 192, 194, 196, 200, 206, 211, 225,233-234, 237-238, 250, 265-268, 274, 284, 301,303, 305, 312, 325, 330, 336, 355, 359, 369-370,373, 407, 416-417, 419-420, 427, 430, 433, 436,438, 440, 442, 460, 463-465, 470, 481, 483, 497

Chronic disease

65, 139, 236, 350, 365 Renal dialysis

15, 55-56, 120, 136, 148, 165, 191, 228, 246, 271,289, 352, 384

Chronic infections (TB, HIV, etc.)

102, 124-125, 145, 160, 167-168, 182, 197-198,208-209, 219, 221-222, 229-230, 243, 249, 252,272, 275-278, 286, 291, 309-311, 319, 337-339,354, 453

Cancer

63, 80, 203 Burns

1 Maternity care

79, 92, 103, 106, 111, 170, 253-256, 279, 313, 332 Organ transplant

84, 159, 397, 429 Spinal cord injury/abscess

101, 138, 186, 202, 273, 340 Injuries to the nervous system (concussion,

stroke, etc.)8 Medical obesity

404 Reduction in self-directed care

147, 166, 287 Amputation of limb

6 Tobacco dependence

41, 68, 391 TAB/SAB related

Addition of CPT code 96154 only (Family assessment/intervention)

Lines Condition type

13-14, 16-18, 20-22, 25, 28-29, 34, 37, 39-40, 47,50, 53, 70, 74, 85, 94, 96, 98, 112, 114, 116, 123,142, 292, 374

Newborn issues requiring parental training/assessment

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Limitations of coverage

This list is from the CMS guidelines for behavioral services on the CMS Web site at www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49 .

When the indications of coverage have not been met.z

Health and behavioral intervention services are not considered reasonable and necessary to:z

Update or educate the family about the clients conditionz

Educate non-immediate family members, non-primary care-givers, non-guardians, theznon-health care proxy, and other members of the treatment team, e.g. health aides, nurses,

physical or occupational therapists, home health aides, personal care attendants and co-workers about the clients care plan.Treatment-planning with staff z

Mediate between family members or provide family psychotherapyz

Educate diabetic clients and diabetic clients family members 2z

Deliver Medical Nutrition Therapy 3z

Maintain the clients or familys existing health and overall well-beingz

Provide personal, social, recreational, and general support services. These services mayz be valuable adjuncts to care; however, they are not psychological interventions. Examplesof these services are:

Stress management for support staff z

Replacement for expected nursing home staff functionsz

Recreational services, including dance, play, or artz

Music appreciation and relaxationz

Craft skill trainingz

Cooking classesz

Comfort care serviceszIndividual social activitiesz

Teaching social interaction skillsz

Socialization in a group settingz

Retraining cognition due to dementiaz

General conversationz

Services directed toward making a more dynamic personalityz

Consciousness raisingz

Vocational or religious advicez

General educational activitiesz

Tobacco withdrawal supportz

Caffeine withdrawal supportz

Visits for loneliness relief z

Sensory stimulationz

Games, including bingo gamesz
http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=13492&lcd_version=49

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Projects, including letter writingz

Entertainmentz

Excursions, including shopping outings, even when used to reduce azdysphoric stateTeaching grooming skillsz

Grooming servicesz

Monitoring activities of daily livingzTeaching the client simple self-carez

Teaching the client to follow simple directivesz

Wheeling the client around the facilityz

Orienting the client to name, date, and placez

Exercise programs, even when designed to reduce a dysphoric statez

Memory enhancement trainingz

Weight loss managementz

Case management services including but not limited to planning activities of z

daily living, arranging care or excursions, or resolving insurance problemsActivities principally for diversionz

Planning for milieu modi cationsz

Contributions to client care plansz

Maintenance of behavioral logsz

Provision of support services, not requiring the skills of a Clinical Psychologist (CP)z(Specialty Code 68).When a health and behavior assessment/intervention service is not rendered,z e.g .:

Reviewing activity therapy reportsz

Supervising nursing and ancillary personnelz

Leading or directing treatment teamsz

Only monitoring the behavioral effects of medicationsz

Only providing medication recommendationz

Documents

Toolkit 03-11-09