CHILDREN’S MENTAL HEALTH WAIVER by ntx18253

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									CHILDREN’S MENTAL HEALTH
         WAIVER


Virginia Department of Medical
 Assistance Services (DMAS)
    Website: www.dmas.virginia.gov




                  2007               1
 What is the Children’s
 Mental Health Waiver?
• A demonstration waiver intended to show
  that home and community based services
  are beneficial (and budget neutral) to
  individuals who would otherwise be in a
  Psychiatric Residential Treatment Facility
  (PRTF)
• Demonstration is for 5 years
• Anticipated that VA will be able to convert
  the demonstration into a HCBW after 5
           years
      • Implementation Date of 12/1/07
                                                2
           Background
• PRTFs are the primary provider for youth
  with serious mental health issues requiring
  an institutional level of care
• Until the release of this demonstration,
  states were not allowed to have waivers
  that used PRTF’s as an alternate
  institution




                                                3
             Eligibility
• Medically needy persons: incomes up to
  133% of the AFDC payment standard as of
  July 16, 1996
  – Monthly income of $251.14, $289.78 or
    $376.71 depending on place of residence
    ($319.80, $356.88 or $454.22 for family of 2)

• Certain aged, blind or disabled adults:
  incomes up to 80 percent of the federal
  poverty level ($654/mo.)


                                                    4
            Eligibility
Children & adolescents under the age of 21:

  •Who have been in a PRTF at least 90 days
  •Who have a psychiatric diagnosis
  •Who remain eligible for Medicaid after
    they leave the PRTF
  •Who have a family (foster or biological)
    willing to take the child home



                                              5
       Eligibility
•Who have community services available
immediately upon discharge from a
PRTF
•Who will continue to meet the PRTF
level of care
•Who have a case manager




                                         6
       Initial Enrollment
            Process
•   Children who are in a PRTF and have been
    there at least 90 days will be identified
    by DMAS

•   Either CSA or CSB meets with
    child/family to offer choice and
    determine eligibility




                                                7
      Initial Enrollment
           Process
• If CMH services are chosen, Transition
  Coordinator is chosen to assist with
  enrollment process

• Transition Coordinator will initiate contact
  with DSS to determine eligibility




                                                 8
      Initial Enrollment
           Process
• Must have CAFAS
• Complete Medicaid eligibility documents
• Sign choice form choosing waiver
• Notify PRTF of desire to obtain waiver
  services
• Develop Comprehensive Services Plan
           (CSP) or IFSP
• Medical and Psychological Evaluations

                                            9
      Initial Enrollment
           Process
• CSP and Individual Service Plans (ISPs)
  for specific services will be submitted to
  DMAS for review
• All services must be preauthorized
• Anticipate KePRO will assume ISP review
  in May 2008
• Individual will be admitted to the waiver
  based on their date of application for the
  waiver


                                               10
CMH Waiver Services
    Overview




                      11
      Waiver Services
• Transition Coordination
• Environmental Modifications
• Companion Services (agency and consumer
  directed)
• Respite Services (agency and consumer
  directed)
   – Service Facilitation for consumer-
     directed only
          • Therapeutic Consultation
         • Family Care Giver Training
       • In Home Residential Supports
                                            12
Transition Coordination
       Services

Services that are provided to individuals
who are in the PRTF and who choose to
receive services in the community




                                            13
 Transition Coordination
        Services
• The assessment of the individual/family
  situation;
• Assistance with meeting the requirements
  of the waiver enrollment;
• Referral for Medicaid re-determination;
• Developing a community plan of care in
  coordination with the family, and others;
• Identifying community service providers;
      ● Monitoring the initial transition
           to the community
                                              14
 Transition Coordination
     Service Limits

• Limited to 3 months prior to discharge
  from the PRTF and one month post
  discharge
• May only be billed after the individual
  leaves the PRTF




                                            15
 Transition Coordination
        Services
Documentation:
• Individual Service Authorization Request
  (ISAR)
• Individual Service Plan (ISP)
• Comprehensive Services Plan (CSP)




                                             16
 Transition Coordination
 Provider Requirements
Must be either:
• Treatment foster care case manager
• Mental health case manager
• Coordinator with the CSA program
• FAPT members




                                       17
    Billing Codes for
 Transition Coordination

• H2015 –Transition Coordination -
• Unit is 15 minutes with up to a maximum of
  80 Units – for 4 months
• $16.50 per unit




                                               18
Consumer Direction (CD)
• Allow recipients or family caregivers
  direct control over who, how, and when
  services are provided.

• Waiver recipient is the employer of record
  with the IRS.
• In Virginia personal assistants are
  classified as domestic servants and are
  not subject to worker’s compensation
            claims.
                                               19
    Consumer Direction
• Attendants cannot be a legally responsible
  relative, a spouse or a parent of a minor
  child.
• Payment is not made to other family
  members unless there is objective, written
  documentation as to why there are no
  other providers available to provide the
  service.
  • Children under 18 must have an adult to
    direct their services; individuals 18 and
      over may direct their own care if they
             are competent to do so.
                                                20
 Consumer Direction and
   Fiscal Management
• The assistant is paid on behalf of the
  waiver recipient by a fiscal management
  entity, Public Partnerships Limited (PPL)

• PPL is recognized by the IRS and allows
  recipients to receive consumer-directed
  services while being assured that all
  employment tax responsibilities are
  properly handled.


                                              21
  Service Facilitation

Supports for assisting the individual (if
over 18) or the person who is managing the
individual’s consumer-directed services.
The service facilitator helps train the
individual on how to become the employer.




                                             22
    Service Facilitation
  Provider Qualifications
• Enrolled as a Medicaid CD Services
  Facilitator

• Possess a minimum of an undergraduate
  degree in a human services field

• or be a QMHP and have 2 years of
  satisfactory experience working with
  seriously emotionally disturbed individuals


                                                23
    Service Facilitation
Responsibilities include:
  • Conducting assessments regarding the
  individuals particular needs
  •Assisting in the development of the ISP
  •Providing training to family/caregiver on
  their responsibilities as an employer
  •Provide ongoing support
  •Be available by telephone



                                               24
    Service Facilitation
Responsibilities (cont.):
  •Provide employee management training
  •Submit criminal record to PPL and Child
  Protective Services Central Registry to
  DSS
  •Verify bi-weekly timesheets are signed
  •Face to face every 6 months to reassess
     services and appropriateness for
     companion care and respite


                                             25
    Service Facilitation
Documentation:
 •ISPs, reassessments
 •All correspondence and contacts
 •Trainings provided
 •Individual/family/caregiver satisfaction
 •Acknowledgement that individual/family/
     caregiver know their responsibilities of
     the services

                                                26
    Service Facilitation
• Initial visit is done only once upon entry
  into the CD model of services
• If a change in service facilitators is made,
  the new service facilitator must complete
  and bill for a reassessment




                                                 27
  Service Facilitation
The service facilitator must work with the
individual and family to make arrangements
to transfer to agency directed services if
there is consistent difficulty hiring and
retaining employees.




                                             28
    Service Facilitation
Individual/Family/Caregiver Responsibilities:
  •Interview
  •Hire/ check references
  •Train/ supervise
  •Manage/ approve timesheets – submit to
  CD service facilitator and PPL
  •Fire attendants
      •Have an emergency back-up plan

                                                29
Billing Codes for Service
        Facilitation
• H2000 CD –Initial Comprehensive Visit -
  $174.12 Rest of State, $226.03 NOVA
• S5109 CD – Employee Management
  Training/Consumer Training -
  $173.04 Rest of State, $224.95 NOVA
• 99509 CD - Routine Home Visit -
  $54.08 Rest of State, $70.30 NOVA


                                            30
Billing Codes for Service
        Facilitation
• T1028 CD – Reassessment visit –
  $86.52 Rest of State, $113.56 NOVA
• S5116 CD – Management Training –
  $21.63 Rest of State, $28.12 NOVA
• 99199 Criminal Check - $15.00
• 99199 CPS Registry Check - $5.00



                                       31
Respite Services (agency
        and CD)
Services provided to individuals and their
families/caregivers to offer temporary,
periodic and routine relief to unpaid
caregivers
Respite services may be provided in the
individual’s home or place of residence, in
the community, or in a licensed respite
facility



                                              32
Respite Services (agency
        and CD)
Respite services include the following:
  •Assistance with/or monitoring of personal
  hygiene
  •Nutritional support/ meal preparation
  •Safety
  •Does not include nursing care




                                               33
Respite Services (agency
        and CD)
Service units and limitations of respite:
• In-Home Residential Support and
  Companion Services can not be provided at
  the same time as Respite
• Can receive consumer-directed respite and
  agency respite, but combination of
  services cannot exceed 720 combined
  hours in a calendar year
• Must have a service facilitator if choosing
           CD respite
                                                34
      Respite Services
    (Consumer Directed)
Qualifications for attendant:
• Must be 18 years of age
• Have the required skills to perform CD
  services as specified in the individuals ISP
• Capable of following a care plan with
  minimal supervision
• Submit to criminal history background
  check and Child Protective Services
  Central Registry (if working with a minor)

                                                 35
      Respite Services
     (Agency Directed)
   Attendant must have satisfactorily
   completed a training curriculum:

1) Registered as a certified nurse
   or
2) Graduation from approved educational
   curriculum that offers certificates for:
   nursing assistant, home health aide, or
   meeting paraprofessional criteria

                                              36
      Respite Services
      (agency and CD)
Qualifications of Supervisor:
• QMHP or LMHP to supervise all attendants
• QMHP or LMHP supervisor must make
  initial home visit and assessment prior to
  start of services
• Conducts reassessments or changes to ISP




                                               37
Respite Services (agency
        and CD)
Documentation needed for PA:

• Individual Service Authorization Request
  (ISAR)
• Individual Service Plan (ISP)
• Respite authorization must be requested
  for each calendar year (1/1 – 12/31)



                                             38
Billing Codes for Respite
      (agency and CD)
• S5150 – CD Respite (paid to attendant by
  fiscal agent) –
• Unit = hour
  $8.60 per unit for rest of state, $11.14
  for NOVA
• T1005 – Agency Respite –
• Unit = hour
  $12.53 per unit for rest of state, $14.76
  for NOVA

                                              39
    Companion Services
     (Agency and CD)
Provides
• Assistance with skill development
• Understanding family interaction
• Behavioral interventions for support and
  safety
• Community integration




                                             40
    Companion Services
     (Agency and CD)
Criteria:
• There must be clear and present danger to
  the child if left unsupervised
• The child can never be left alone any time
  due to severe emotional disturbance




                                               41
    Companion Services
     (Agency and CD)
Criteria (cont.):
• Must be necessary to ensure the child’s
  health and safety
• Can be authorized when no one else is in
  the home who is competent to monitor the
  child for safety




                                             42
    Companion Services
     (Agency and CD)
Units and limitations:
• May not exceed 8 hours a day, either
  separately or in a combination of CD and
  agency directed companion services
• Hours are based on the child’s needs
• Can be authorized for family/caregivers to
  sleep (day or night time) when the
  individual can not be left alone at any time


                                                 43
    Companion Services
     (Agency and CD)
Companion services may include:
• Assistance or help with meal preparation
• Community access and activities
• Laundry
• Shopping
• Light housekeeping
      Reminder for medication (self-
                  administered)
     Support to assure safety
                                             44
      Companion Services
        Qualifications
      (Agency Directed)
• Must be a licensed by DMHMRSAS as a
  residential services provider, supportive
  in-home residential services, day support
  service provider, or respite service
  provider
• Or meet the DMAS criteria to be a
  personal care/respite service providers

                                              45
      Companion Services
        Qualifications
     (Consumer Directed)
Qualifications for attendant:
• Must be 18 years of age
• Have the required skills to perform CD
  services as specified in the individuals ISP
• Capable of following a care plan with
  minimal supervision
• Submit to criminal history background
  check and Child Protective Services
  Central Registry (if working with a minor)

                                                 46
   Companion Services
Qualifications (Agency and
            CD)

• QMHP or LMHP to supervise all assistants
• QMHP or LMHP supervisor must make
  initial home visit and assessment prior to
  start of services
• Conducts reassessments or changes to ISP




                                               47
    Companion Services
      (Agency and CD
Responsibilities of supervisor:
• Developing of the ISP with assistance
  from the individual/family/caregiver
• Must provide follow up home visits to
  monitor the provision of services (every
  three months)
• Annual Reassessment



                                             48
     Companion Services
    (Agency and Consumer
         Directed)
Documentation needed for PA:
• Individual Service Authorization Request
  (ISAR)
• Individual Service Plan (ISP)
• Initial and subsequent assessments and
  change to ISP
• Reviews on quarterly/annual/ or as often
  as needed


                                             49
     Billing Codes for
    Companion Services
• S5135 Agency-directed Companion Care –
• Unit = hour
• $12.53 per unit rest of state, $14.76 per
  unit for NOVA

• S5136 CD Companion Care –
• Unit = hour
• $8.60 per unit rest of state, $11.14 per
  unit for NOVA


                                              50
Therapeutic Consultation

Provides expertise, training, and technical
assistance by a licensed professional to
assist family members, caregivers, and
other service providers in supporting the
individual.




                                              51
Therapeutic Consultation
Specialty Areas:
• Psychology
• Behavioral Consultation
• Therapeutic Recreation
• Speech and Language Pathology
• Occupational Therapy
• Rehabilitation Engineering


                                  52
Therapeutic Consultation
Criteria:
• Have a demonstrated need for
  consultation in any of these services.
• ISP cannot be implemented effectively
  without such consultation from this
  service.




                                           53
Therapeutic Consultation
 Provider Qualifications
Virginia-licensed or certified practitioners
• Psychology                 ● Social Work
• Occupational Therapy       ● Medicine
• Therapeutic Recreation
• Rehabilitation
• Speech/Language Therapy
• Counseling
• Marriage and Family Therapy
• Psychiatric Clinical Nurse Specialists /
            Psychiatric Nurse Practitioners
                                               54
Therapeutic Consultation
Units and limitations:
• Unit of service is one hour,
• May not include direct therapy to waiver
  clients or monitoring activities, and may
  not duplicate the activities of other
  services offered through State Plan for
  Medical Assistance



                                              55
Therapeutic Consultation
Units and limitations:
• The need for these services is based on
  the individual’s ISP, and is clinically
  necessary
• May be provided in the individual’s home,
  and in appropriate community settings
• Intended to meet desired outcomes as
  identified in the ISP


                                              56
Therapeutic Consultation
Documentation:
• Individual Service Authorization Request
  (ISAR)
• ISP detailing the recommended
  interventions or support strategies for
  providers and family/caregivers to use to
  better support the individual in the service
• Ongoing documentation of consultative
      services rendered, contacts, monthly
      notes                                    57
Therapeutic Consultation
Documentation:
• Monthly, quarterly, semi-annual and annual
  notes
• 3 months or less, the provider must
  forward the monthly notes or a summary
  to the case manager
• 3 months or longer, written quarterly &
  semi-annual reviews must be completed by
  the provider and forwarded to the case
           manager

                                               58
Therapeutic Consultation
Documentation:
• If consultation service extends beyond
  one year, the ISP must be reviewed by the
  provider with the individual and
  family/caregiver and case manager
• A final disposition summary must be
  forwarded to the case manager within 30
  days following the end of service


                                              59
   Billing Codes for
Therapeutic Consultation

• 97139 Therapeutic Consultation –
• Unit = hour
• $55.13 per unit for rest of state, $63.40
  per unit for NOVA




                                              60
    Family/Caregiver
        Training
Training and education related to seriously
emotionally disturbed individuals in the
areas of:
 – community integration;
 – family dynamics;
 – stress management;
 – behavioral interventions; and mental
   health

                                              61
    Family/Caregiver
        Training
 Services provided to the family/caregiver
   to assist with maintaining the individual
   at home.
“Family” is defined as the persons who live
with or provide care or support to a waiver
individual.
– for example: parent/step-parent, children,
  other relatives, legal guardian, foster family,
  spouse, and in-laws


                                                    62
      Family/Caregiver
          Training
Criteria:
• The need for training and the content of
  the training in order to assist the family/
  caregivers with maintaining the individual
  at home must be documented in the ISP
• The training must be necessary in order to
  improve the family or caregiver’s ability to
  provide care and support



                                                 63
Family/Caregiver Training
   Provider Qualifications
 Individual Family/Caregiver Trainers must
  be licensed or certified to practice in
  Virginia:
• Licensed Professional Counselors
• Licensed Clinical Social Worker
• Licensed Psychologist
• Licensed Marriage and Family Therapists
• Psychiatric Clinical Nurse


                                             64
      Family/Caregiver
      Training Service
Units and limitations:
• Individual’s family/caregiver can receive
  up to 80 hours of Family/Caregiver
  Training services per ISP treatment year
• Training cannot be a service already being
  provided under Medicaid State Plan
• Individuals employed to care for the
  consumer cannot receive training


                                               65
Family/Caregiver Training
Requirements:
• Training shall be provided on an individual
  basis, in small groups, through seminars or
  in conferences provided by Medicaid-
  allowed Family/Caregiver Training
  Providers
• The training must be prior authorized by
  DMAS before it can be provided


                                                66
      Family/Caregiver
          Training
Documentation:
• ISAR/ISP
• Assessments/ reassessments
• Documentation of dates of services and
  type of service
• Documentation to support that services
  provided are appropriate and necessary


                                           67
      Billing Code for
 Family/Caregiver Training

• S5111Family/Caregiver Training –
• Unit = hour
• $46.86 per unit for rest of state, $53.89
  per unit for NOVA




                                              68
  In-Home Residential
       Support

Assistance or specialized supervision
provided primarily in an individual’s home
or foster home to allow the individual to
acquire, retain, or improve the self-help,
socialization, behaviors and adaptive skills
necessary to reside successfully in home
and community-based settings.


                                               69
    In-Home Residential
         Support
Training and assistance in or reinforcement
  of:
• Functional skills and appropriate behavior
• Health and safety
• Personal care
• ADLs
• Use of community resources
• Assistance with medication management
• Monitoring health, nutrition, and physical
           condition
           • Life skills training and cognitive
             rehabilitation                       70
   In-Home Residential
        Support
Criteria:
• Have a demonstrated need for in-home
  residential support services
• Individual must be present during
  treatment




                                         71
   In-Home Residential
        Support
Units and limitations:
• May not be provided simultaneously with
  respite or companion care
• Majority of service rendered is in the
  home that the individual resides in
• Reimbursed on an hourly basis for time the
  in-home residential support staff is
  working directly with the individual
• Not to use as a 24 hour service


                                               72
     In-Home Residential
      Support Provider
        Qualifications
• Must be licensed by DMHMRSAS as a
  provider of supportive residential services
• Must have training in mental health and
  appropriate interventions, strategies, and
  support methods for persons with severe
  emotional disturbance


                                                73
   In-Home Residential
        Support
Responsibilities of supervisor:
• Routine supervision/oversight of direct
  care staff
• Have and document at least one
  supervisory contact per month per staff
  person regarding delivery and performance
• Observe staff at least semi-annually



                                              74
    In-Home Residential
         Support
Responsibilities of supervisor:
• Monthly contact with individual and
  family/caregiver regarding satisfaction
  with services delivered by each staff
  person




                                            75
    In-Home Residential
         Support
Documentation:
• Individual Service Authorization Request
  (ISAR)
• ISP (semi-annually and annually)
• Assessments
• Ongoing documentation (confirm
  attendance, time, specific information
  regarding the individual’s response to ISP
  objectives)


                                               76
    In-Home Residential
         Support
Documentation cont’d:
• Assessments available in at least a daily
  note or a weekly summary
• Semi-annual observation documentation,
  including satisfaction




                                              77
Billing Code for In-Home
   Residential Support

• H2014 In-Home Residential Support
  Service -
• Unit = hour
• $19.85 per unit for rest of state, $22.82
  per unit for NOVA




                                              78
      Environmental
      Modifications

Physical adaptations to the home or to a
vehicle that are necessary to ensure the
health, welfare, and safety of the
individual.




                                           79
         Environmental
         Modifications
Such adaptations include:
• Items to ensure the safety of the
  individual, family or caregiver and the
  community
• Modifications can be made to an
  automotive vehicle only if it is the primary
  vehicle used by the individual



                                                 80
         Environmental
         Modifications
Units and limitations:
• Available if individual is receiving at least
  one other waiver service
• A maximum limit of $5,000.00 may be
  reimbursed per ISP year
• Costs for environmental modifications can
  not be carried over from ISP year to ISP
  year


                                                  81
        Environmental
        Modifications
Exclusions:
• General utility: carpeting, roof repairs,
  central air conditioning, etc.
• Adaptations to add square footage to the
  home
• Modifications to bring substandard
  dwelling up to a minimum habitation
  standards


                                              82
        Environmental
        Modifications
Criteria:
• The individual must have a demonstrated
  need for equipment or modifications in the
  individual’s primary home and/or primary
  vehicle.
• Must be in accordance with all applicable
  federal, state or local building
      codes and laws



                                               83
    Environmental
 Modifications Provider
    Qualifications
Services provided by provider with a
durable medical equipment participation
agreement with DMAS




                                          84
        Environmental
        Modifications
Documentation:
• ISAR that documents the need for service
• Documentation of the time frame involved
  to complete the modification and the
  amount of services and supplies
• Documentation of satisfaction of client,
  family/caregiver
• Instructions regarding warranty, repairs,
  complaints, and servicing needs


                                              85
        Billing Codes for
 Environmental Modifications
• S5165 Environmental Modification, Mod’s
  Only.

• 99199 Environmental Modification,
  Maintenance Cost Only.

• Not to exceed $5,000.00 in the CSP year



                                            86
      QUESTIONS
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                                         87
       DMAS Contacts
• Mendy Meeks, Children’s Mental Health
  Waiver Project Manager, 804-225-4285
  *email: mendy.meeks@dmas.virginia.gov

• Tammy Whitlock, 804-225-4714

*website: www.dmas.virginia.gov



                                          88
Thank You


            89

								
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