PROS Billing Power Point presentation

Report
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.
1
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
2
Useful Links
Part 512: PROS Regulations on the web --
http://www.dos.ny.gov/info/nycrr
• 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
3
PROS
Clarification Guidance 13
Staff Competencies in Evidenced Based Practices
http://www.omh.ny.gov/omhweb/PROS/Clarification/Clarification13.pdf
4
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)
7
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
8
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 Collaterals
PROS 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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Documentation of Collaterals in PROS
PROS regulations 512.11(a)(iii)
• 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
11
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?
12
Question # 1
How do we structure the IRP for consumers
around the CCFC model?
13
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
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demonstrated and documented need
Question # 2
What categories do we bill the different CCFC
services under?
15
Answer to question #2
Community 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 collaterals
Provide 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
19
Question # 4
Can we bill for a CCFC during a lunch hour?
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Answer to question #4
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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Answer to question #5
•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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Answer to question #6
•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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Answer to question #7
•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/Clarif
ication13.pdf
27
Question # 8
Can we bill for a phone CCFC and does the
consumer need to be in the room?
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Answer to question #8
•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 or
[email protected]
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