New Provider Orientation PowerPoint - Department of Services to ...

Division of Prevention and BehavioralHealth Services (DPBHS)• Partner with Delaware Division of Medicaid & MedicalAssistance (DMMA)• DPBHS provides mental health and substance abuse servicesbeyond the basic 30 visits per calendar year, and the moreintensive services as designated by clinical appropriateness andnecessity• CARF Accredited• Network of Providers• Direct Services of Residential Treatment Services, Day TreatmentServices, and Intensive Outpatient Services through TerryChildren’s Center and Silver Lake Consortium

DPBHS Administrative Unit- Training Administration- Treatment Provider Services- DPBHS Billing Unit- DPBHS Quality Improvement- DPBHS Budget Management

DPBHS Treatment Provider Services- Program Administration Unit – writes, oversees and managescontracts for delivery of treatment services by externalagencies, while serving as liaison between the Division andcontracted agencies through ongoing communication and sitevisits.- Billing Unit – processes bills received from contractedagencies via paper submission and review of direct data entryof claims through the FACTS Provider Invoice module, whileinterfacing with Program Administrators and DMSS FiscalUnit to ensure appropriate billing practices are occurring

DPBHS Program AdministratorsFACTS currently houses basic contractual information:• Contract start and end dates• Proposed Expenditure Amount/Contract Amount• Level of care as covered by contract• Different program criteria (i.e., gender specific), rate ofreimbursement (if entered)FACTS is also used by PA Unit to record site visitinformation; QI Unit uses FACTS to record monitoringvisits/CAP reports for each in-network service provider

DPBHS Contract Deliverables# of DaysPost-AdmissionRcvd byDPBHSClinicalDocumentation to be Sentto DPBHS5 ProviderCertificate ofNeedReferencetoTreatmentProviderManualAcute CareProgramsCrisis Hosp5.1.4.3 •Non-Acute CareProgramsRTC**Day IOP BI5 Safety Plan 6.4 • • • • • •5AdmissionSummary -with physiciansignature6.5 •8.1.3 • • • • •10 days postadmission to anew LOCwithin sameagencyUpdated/RevisedTreatment Plan

DPBHS Contract Deliverables(Continued)# of DaysPost-AdmissionRcvd byDPBHSClinicalDocumentation to be Sentto DPBHS15 AdmissionSummary –with signatureof licensedindependentpractitioner(RTC’s musthavephysiciansignatureReferencetoTreatmentProviderManualAcute CareProgramsCrisis HospNon-Acute CareProgramsRTC**Day IOP BI6.5 • • •

DPBHS Contract Deliverables(Continued)# of DaysPost-AdmissionRcvd byDPBHSClinicalDocumentation to be Sentto DPBHS30 Comprehensive TreatmentPlan24 hoursafterdischarge7 days afterdischargeTransferInstructionSheetDischargeSummaryReferencetoTreatmentProviderManualAcute CareProgramsCrisis HospNon-Acute CareProgramsRTC**Day IOP BI6.6 • • • • • •6.9.4 • • • • • •6.9 • • • • • •

DPBHS Human Resources Data Form• DPBHS Credentialing Process is currently under review• Currently DPBHS uses the Human Resources Data Formfor information pertaining to contracted agencies’ staffthat would be directly working with any youth to ensureclient safety• Upon receipt, administrative support data enters thisinformation into the Staff Maintenance portion of FACTS

Basic Contract Demographics• There are 16 Levels of Care within the DPBHS treatment services continuum:1. Crisis Intervention2. Crisis Beds3. Inpatient Hospital for Mental Health4. Day Hospital Services for Mental Health5. Routine Outpatient Services Mental Health6. Routine Outpatient Services Substance Abuse7. Intensive Outpatient Services for Mental Health8. Intensive Outpatient Services for Substance Abuse9. Day Treatment Services for Mental Health10. Day Treatment Services for Substance Abuse11. Part Day Treatment Services for Substance Abuse12. Residential Treatment Services for Mental Health13. Residential Treatment Services for Substance Abuse14. Individual Residential Treatment15. Therapeutic Respite16. Behavioral Intervention

Basic Contract DemographicsContinuedDPBHS also has ancillary services:1. Transportation2. TranslationProgram Administrators also oversee state-run facility contracts:1. Hospitals2. Bus3. Labs/X-Ray/Pharmacy4. Nursing Services5. Psychiatric Services

Contracts Demographics Continued• 43 Different Contracted Agencies for the TreatmentServices Continuum• 10 Different Transportation Providers• 5 Different Translation Providers• 9 Contracts through State Run Facilities• 8 Other Contracts for Assessment, Training, PsychiatricServices, and InternsTOTAL # of Contracts = 75

DPBHS Billing Overview• Bills come into DPBHS through paper submission ordirect data entry into FACTS Provider Invoice• If via paper submission, DPBHS billing representativesenter the claims data into Provider Invoice portion ofFACTS• If electronically data entered, agencies can only submit theentries; a DPBHS billing representative must review thesubmissions for accuracy before finalizing it for payment• All bills after entry into FACTS are sent to DMSS FiscalUnit for provider payment

DPBHS Quality Improvement Unit• Oversees monitoring of treatment providers in DPBHSprovider continuum reviewing service delivery in accordanceto:• DSCYF Operating Guidelines• DPBHS Treatment Provider Manual• Executed Contracts• Completion of Required Forms• Billing Compliance/Appropriateness/Documentation of Service Delivery• Manages Division Complaints and Appeals Received• Manages Incident Reporting Specific to DPBHS and trackscumulative information regarding each type of ReportableEvent• Oversees and Manages Medical Records

Overview of QI MonitoringThe Monitoring Process:1. Clinical Charts Review2. Supervision3. Incident/Safety Reports4. Clinical Deliverables5. Environment of Care6. Billing Audits

Post-Monitoring• QI Unit writes Monitoring Report outlining compliancerates and shares with the Provider• For any area not in compliance, the Provider then has tosubmit either a Performance Improvement Plan or aCorrective Action Plan• Provider Submitted Responses are reviewed internally bythe Quality Management Committee• Subsequent follow-up visits occur after to review areas ofnon-compliance

DPBHS Appeals Policy• Level of care decisions, denial of continued stay andeligibility may be appealed by parent/legal guardian, legalrepresentative for the client, by a substance abuse clientage 14 years or older, or by a provider with consent andapproval of the child’s parent or legal guardian

DPBHS Appeals ProcedureProvider appeals for reconsideration of continued stayauthorization and level of care decisions are made as follows:Psychiatric hospitals and all other facilities certified by DPBHSas Medicaid ‘Psych Under 21’ facilities (42 CFR, Subpart456.236)There are 3 steps involved in this process.For all other non-Psych Under 21 facilities there is an informalappeal directed to the Director of CSMT and a more formalwritten processEligibility Appeals – can be made with DPBHS or DHSSMedicaid

DSCYF Incident Reporting Policy• Both the Department (DSCYF) and the Division (DPBHS)require the complete and timely report of events involving; clientinjury to themselves, events in which a client has injured anotherindividual, or situations/events that have the potential tonegatively impact our clients.• The DPBHS Incident Reporting Policy (PI002) states that thepurpose of the policy is to, “establish reporting requirements,identification of accountability for timely and accuratereporting and investigation of incidents, clear reportingaccountability and lines of communication.”

Events that must be reportedwithin 4 hours to the ClinicalServices Team1. Alleged abuse by staff members2. Alleged sexual contact, assault or rape of or by aDelaware child3. Child/youth death or death of a program staff memberwhile on duty4. Escape, AWOL or runaway5. Hospital admissions including psychiatric6. Disturbance that has the potential for harming a child orcausing major program disruption7. Abduction of youth

Incidents that must be reported tothe DE abuse hotline• Allegations of abuse/neglect by anyparty• Anything sexually inappropriatebetween clients• Medication errors involving lifethreatening medications or with thepotential to cause harm• Restraints with injury that raiseconcern• Supervision issues• Abuse Hotline : 1-800-292-9582

Written Notification Procedures:•ALL Incident Reports aredue within 72 hours•Be sure that the form isclear, complete andincludes all notificationsprior to submission.•Fax to DPBHS (302) 661-7270.

How DPBHS Reportable EventsAre Captured in FACTS• Contractor submits DSCYF Reportable Event directly toe-fax number• Contractor must submit separate form for each client thathas a Reportable Event• DPBHS representative reviews information and entersinformation into FACTS• DPBHS QI Manager and Management Analyst compilesIncident Reporting information cumulatively for internalreview by various committees and DPBHS Leadership

DPBHS Contacts for TreatmentProviders: Provider Relations• Manager of Provider Services:Jennifer Tse – 302-633-2572Jennifer.Tse@state.de.us• Program Administrators:Vanessa Bennifield – 302-633-2597Vanessa.Bennifield@state.de.usStacy Shamburger – 302-633-2559Stacy.Shamburger@state.de.us

DPBHS Contacts for TreatmentProviders: Quality Improvement• Manager of Quality ImprovementKelly Soliman – 302-633-2738Kelly.Soliman@state.de.us• Quality Improvement AnalystBonnie Crofts – 302-633-2555Bonnie.Crofts@state.de.us

DPBHS Contacts for TreatmentProviders: Billing Unit• Billing Unit Manager:Kimberly Scully – 302-892-6433Kimberly.Scully@state.de.us• Billing Unit Representatives:Adriane Crisden – 302-892-6464Adriane.Crisden@state.de.usEartha Hopkins – 302-633-2570Eartha.Hopkins@state.de.usSheila Hunton – 302-892-6418Sheila.Hunton@state.de.us