Welcome to “Billing for Consumer Centered Family Consultation in PROS” Webinar Hosted by: The Family Institute for Education, Practice & Research & The

Welcome to “Billing for Consumer Centered Family Consultation in PROS”

Webinar

Hosted by: The Family Institute for Education, Practice & Research

&

The Office of Mental Health

For audio please call 1-800-244-9194 and enter the code: 990024#

Any technical difficulties please call 585-279-7902

This webinar will begin shortly. Thank you for your patience.

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Agenda for Today

• Hello & Introductions

• PROS Clarification Guidance 13– Staff Competencies in Evidence Based Practices

• Key questions from PROS programs regarding billing issues

• Wrap-up

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• Click on the blue line that’s says: “View Unofficial NYCRR online here”• Click on Title 14 – Department of Mental Hygiene• Click on the + before Chapter XIII Office of Mental Health for a

dropdown list• Click on the + before Part 512 Personalized Recovery Oriented

Services• You will have a list of all the sections of part 512, with a link to each one

PROS Guidance Documents: http://www.omh.ny.gov/omhweb/PROS/handbook.html

Provides additional links to:• PROS Clarification Documents• Person Centered Recovery Planning Workbook• Finance Chapter• Additional resources

Part 512: PROS Regulations on the web -- http://www.dos.ny.gov/info/nycrr

Useful Links

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PROS Clarification Guidance 13

Staff Competencies in Evidenced Based Practices

http://www.omh.ny.gov/omhweb/PROS/Clarification/Clarification13.pdf

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Staff Competencies in Evidence Based Practices Guidelines

•Evidence Based Practices have been proven to be effective in overcoming specific mental health barriers•Family Psychoeducation provides families the information and clinical guidance to prepare them in assisting the family member diagnosed with mental illness•Staff providing Family Psychoeducation must have completed required training (refer to Clarification #13 Staff Competencies in PROS)•Programs are expected to maintain documentation for staff members who have been trained to provide Family Psychoeducation

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Pros Regulations: 512.5(i) definition for Family Psychoeducation:

(i) Family Psychoeducation is a service designed to provide information, clinical guidance and support to collaterals and individuals admitted to the PROS program when desired and appropriate, for the purpose of assisting and enhancing the capacity of collateral to facilitate an individual's recovery. Such service includes, but is not limited to:

Education about mental illness and its treatment

Information on community resources Guidance on how to manage or cope with

difficult behaviors Emotional support and counseling Crisis planning Problem-solving skills training

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Specific examples of family psychoeducation are:

• Consumer Centered Family Consultation (CCFC)

• Psychoeducational Multiple Family Groups (MFGs)

• Behavioral Family Therapy (BFT)

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Additional Information from the Family Institute

Family Education/Support is a service designed to provide information and support to collaterals and individuals enrolled in the PROS program when desired and appropriate, for the purpose of enhancing collateral’s knowledge and coping skills. Such service includes, but is not limited to:

Education about mental illness and its treatment Information on community resources Information about common ways to manage or cope

with difficult behaviors Emotional support Information about problem-solving techniques

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CCFC, Family Psychoeducation &PROS

• Family Psychoeducation is an Intensive Rehabilitation Service that can be provided in PROS

• As an IR Service, it is reflected on the IRP, in Monthly Progress Notes, and in billing using the same rules and guidelines used with any other PROS IR Service

• CCFC is a curriculum that can be used to deliver the IR Service, Family Psychoeducation, in PROS

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Role of CollateralsPROS Regulations 512.4(g)(1-3)

• Collaterals are significant others, family members, or people with whom the person interacts with regularly through work, school, or other setting

• Collaterals must be identified in the Individualized Recovery Plan or pre-admission notes, and approved by the individual, as having a role in evaluation, assessment, and/or services

• Collaterals may not be a staff member of the PROS program or any other mental health service provider unless the person is participating specifically in the role of the person’s collateral

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• Medicaid can be billed for services provided to collaterals as long as there is appropriate documentation

•Document services to and with collaterals in Assessments, IRP, and progress notes

Documentation of Collaterals in PROSPROS regulations 512.11(a)(iii)

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Key questions from PROS programs regarding PROS Services, activities, and billing:•How long can the service be provided?

•When is an intervention a CRS service, an IR Service or an activity?

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Question # 1

How do we structure the IRP for consumers around the CCFC model?

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Answer to question #1•The PROS IR Service Family Psychoeducation may be delivered using the CCFC curriculum and modalities

•Family Psychoeducation should be included on the individual’s IRP as a service designed to help the person overcome mental health barriers and attain goals

•Participating family members, friends, etc must be identified on the IRP as collaterals; document that the individual agrees to include these people in his or her services/IRP

•As with any IR Service, justification for continuation of the service must be documented every 3 months

•The IR Service Family Psychoeducation may be delivered using the CCFC model as long as there continues to be a demonstrated and documented need

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Question # 2

What categories do we bill the different CCFC services under?

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Answer to question #2Community Rehabilitation Services:

Prior to identifying Family Psychoeducation as a service that the person would like to use as part of his/her IRP, CRS services can be delivered to individuals and/or collateralsProvide curriculum-based, recovery-focused PROS Services that are documented in Progress Notes and, as necessary, on the person’s IRP such as:

•IRP Planning: Discussion with the individual about whether involving collaterals as resources would be helpful in recovery•Engagement: Helping the person to identify collateral and family who may be resources for the person; encouraging the individual to include these people as part of his/her recovery•Assessment: Including collaterals/family members in Assessment Service as a resource for additional insight/assistance for the individual

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Answers to Question #2, continued

Intensive Rehabilitation/ Family Psychoeducation:

Delivery of services/interventions as defined in the CCFC curriculum provided during normal hours of PROS operation

• CCFC Pre-planning sessions with the individual

• Engagement with the family/collaterals via phone – consumer must be present

• Face to face meetings with individual and/or collaterals as part of CCFC curriculum

Phone contact with collaterals may not be billed as a service unless the person is present

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Question # 3

Can PROS programs bill for a CCFC if it is after hours?

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Answer to question #3

•Providers may bill for the CCFC as an IR service, as long as it is during the program’s hours of operation as stated on the operating certificate

•If there is a need to provide services after the program’s hours of operation, it requires a modification to the operating certificate

• The PROS Program Administrator should contact the local OMH Field Office for assistance if hours need to be modified

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Question # 4

Can we bill for a CCFC during a lunch hour?

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Yes, providers can bill for service if it is during the lunch hour as long as:• It is a scheduled appointment• It is reflected on the IRP• It takes place during the program’s hours of operation

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Question # 5

Is there a limit to the number of CCFC’s PROS can bill for?

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•As long as there is a demonstrated need for Family Psychoeducation, there is no limit to the number of CCFCs a person can receive

• Family Psychoeducation must be reflected on the IRP as a PROS Service that the individual is using in order to overcome a mental health barrier and achieve a life role

•As with any IR Service, justification for continued need for the service must be documented every 3 months

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Question # 6

If you have different people in the CCFC but the same consumer, how many CCFCs can you bill for?

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•There is no limit to the number of CCFCs that can be provided and billed•Family Psychoeducation/CCFC must be documented on the IRP as an IR Service that addresses a mental health barrier that prevents a person from achieving a life role goal•As with all IR Services, you must review the continued need for the service every 3 months and document the justification for continuing to provide the service

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Question # 7

How long can we keep family services open as an IR service?

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•You may provide Family Psychoeducation as an IR Services as long as there is a need• You can continue to bill as long as you justify and document the continued need for the service every 3 months•In order for the service to be considered Family Psychoeducation, it must meet the criteria as described in PROS Clarification #13 http://www.omh.ny.gov/omhweb/PROS/Clarification/Clarification13.pdf

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Question # 8

Can we bill for a phone CCFC and does the consumer need to be in the room?

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•CCFC can be provided via a phone call, but can not be billed as a PROS Service unless the individual is present and participating in the phone call (i.e. a conference call)

•If the consumer requests that you have a phone CCFC with a collateral without the consumer being present, you should naturally honor the request. Document the intervention in the monthly Progress Notes but, do not bill it as a PROS Service

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Question # 9

Can CCFC be billed as a PROS Service Family Psychoeducation if it is delivered to a collateral without the individual being present?

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Answer to question #9• Face to face services may be delivered to a collateral without the individual being present and billed to Medicaid; see 512.11(a)(iii) and 512.4(g)(1-3)

•As a quality practice, encourage participants to recognize the advantage of participating in at least one, if not all, of the CCFCs

•Provide follow-up to the individual around the discussion in any CCFC delivered to consider how the CCFC discussion impacts the person’s life role goals, mental health barriers, and recovery process

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Question # 10

How do we bill for other family programs, interventions, and activities (e.g., Family Information Night, Family Education Workshop)?

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Answer to question #10•Activities such as Family Information Night or Family Education Workshop may be counted as Program Participation if they occur during normal hours of operation at the PROS

•Only specific PROS Services can be billed to Medicaid

• Services to collaterals that are not delivered as part of CCFC curriculum may be billed as PROS Services if they are delivered as a specific, curriculum-based PROS Service in compliance with the PROS Regulations 512.5 Service Categories and Requirements

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Thank you for your participation

If you have any additional questions, please contact:

Sherri Ladd at 585-279-7902 [email protected]