Outcome Measures on Service Request Authorizations...Outcome Measures on Service Request Authorizations Clinical Department March 2017. Objectives of this training • Discuss the

Outcome Measures on Service Request Authorizations

Clinical Department

March 2017

Objectives of this training

• Discuss the addition of outcome questions to Service Request Authorization submissions

• Discuss why the outcome questions have been added

• Discuss how the questions will be answered during the submission process

• Review the specific services that are affected

• Review the specific questions for each level of care

March 2017Outcome Questions Provider Training

2

Purpose of Outcome Questions

• Magellan of Virginia is committed to ensuring that members are receiving effective behavioral healthcare.

• With that goal in mind, there will be an addition of up to 11 outcome questions that will be REQUIRED to be answered PRIOR to answering Service Request Authorization (SRA) questions and/or uploading forms.

• The inclusion of these outcome questions will allow Magellan to begin collecting meaningful data regarding the effectiveness of services.


3

Which Services are Affected?

The addition of these questions will begin 5/1/17 for the following levels of care:

1. Therapeutic Day Treatment (TDT)*

2. Intensive In Home (IIH)

3. Mental Health Skill Building (MHSS)

4. Psychosocial Rehabilitation (PSR)

5. Intensive Community Treatment (ICT)

6. Partial Hospitalization (PHP)

7. EPSDT Behavior Therapy

*Please note, the TDT questions ARE different than what is currently required on the SRA.


4

Therapeutic Day Treatment (TDT)

TDT Outcome Questions

1. In the last 30 days, how often did the individual use substances (including alcohol and tobacco)?

a) Never

b) Rarely (1-2 times a month)

c) Occasionally (1-2 times a week)

d) Often (3-4 times each week)

e) Most Days (daily or almost daily)

2. Number of days absent in the school year.

a) There will be a dropdown 0-99.

3. Number of excused absences in the past 30 days.




4. Number of unexcused absences in the past 30 days.


5. Number of days of out of school suspension in the last 30 days.


6. Number of days of in-school suspension or in school separated from classroom participation in the last 30 days.




7. Total # of disciplinary referrals (including bus referrals) child received in the past 30 days.


8. Number of graded subjects the child is satisfactorily passing in current school year.




9. Number of graded subjects the child is taking in the current school year.


10. Is the child involved in organized social activities (e.g. clubs, sports, community service)?

a) Yes

b) No


Intensive In Home (IIH)

IIH Outcome Questions

1. In the last 30 days, how often did the individual use substances (including alcohol and tobacco)?a) Neverb) Rarely (1-2 times a month)c) Occasionally (1-2 times a week)d) Often (3-4 times each week)e) Most days (daily or almost every day)

2. How many days in the last 30 days has the individual expressed suicidal ideation?a) There will be a dropdown 0 to 30.



3. How many days in the past 30 days has the individual expressed homicidal ideation?

a) There will be a dropdown 0 to 30.

4. In the last 30 days, how often did the individual experience difficulty with tolerating and managing intense emotions?a) Neverb) Rarely (1-2 times a month)c) Occasionally (1-2 times a week)d) Often (3-4 times each week)e) Most days (daily or almost every day)



5. In the past 30 days, how many times has the individual had interactions with law enforcement as a result of the individual's behavior?


6. How many days in the past 30 days has the individual engaged in delinquent behaviors (e.g. truancy, curfew violations, vandalism, and shoplifting)?




7. In the past 30 days, how frequently has the individual engaged in verbally or physically aggressive behaviors towards others?

a) Neverb) Rarely (1-2 times a month)c) Occasionally (1-2 times a week)d) Often (3-4 times each week)e) Most days (daily or almost every day)



8. Describe the type of aggressive behaviors.

a) No evidence of aggressive verbal or physical behaviors towards others

b) Aggressive verbal behaviors

c) Aggressive physical behaviors

d) Aggressive verbal and physical behaviors

e) Dangerous level of aggression and/or acute homicidal ideation with a plan

9. Was the member able to maintain placement in the home within the last 30 days?

a) Yes

b) No



10. Describe the relationships within family system within the last 30 days.

a) No improvement

b) Minimal improvement

c) Moderate improvement

d) Significant improvement


Mental Health Skill Building (MHSS)

MHSS Outcome Questions

1. How frequently in the past 30 days has the individual experienced difficulty with social functioning (e.g., ability to form and maintain positive social relationships)?




2. In the past 30 days, how frequently have natural supports been involved in the individual's life? Natural supports are unpaid individuals or family members who support the individual's health and well-being.




3. How frequently in the past 30 days has the individual had difficulty completing activities of daily living (e.g., personal hygiene, housework, preparing meals, money management)?




4. Describe the individual's significant functional impairment in completing activities of daily living in the following four areas: personal hygiene, housework, preparing meals, and money management in the last 30 days.

a) No impairment in completing activities of daily living.

b) Impairment in one of the above listed areas

c) Impairment in two of the above listed areas

d) Impairment in three of the above listed areas

e) Impairment in four of the above listed areas



5. How many days in the past 30 days has the individual had difficulty with self-care (meeting nutritional needs, exercise, medication management, and monitoring health conditions)?a) Neverb) Rarely (1-2 times a month)c) Occasionally (1-2 times a week)d) Often (3-4 times each week)e) Most days (daily or almost every day)

6. Describe the individual's significant functional impairment with respect to self-care in the following four areas: meeting nutritional needs, exercise, medication management, and monitoring health conditions).

a) No impairment in meeting self-care needs.b) Impairment in one of the above listed areas c) Impairment in two of the above listed areasd) Impairment in three of the above listed arease) Impairment in four of the above listed areas



7. Did the individual maintain residential stability (i.e., no unplanned loss/change in housing or psychiatric hospitalizations) in the last 30 days?a) Yesb) No

8. How many times in the past 30 days did the individual admit to an ER or hospital due to physical health reasons?

a) There will be a dropdown 0-30



9. In the last 30 days, how often did the individual use alcohol, illegal substances, or abuse other legal substances?

a) Never




e) Most Days (daily or almost every day)




a) There will be a dropdown 0 through 30.

11. How many days in the past 30 days has the individual expressed suicidal ideation?



Psychosocial Rehabilitation (PSR)

PSR Outcome Questions









3. How frequently in the past 30 days has the individual had difficulty completing activities of daily living (e.g., personal hygiene, housework, preparing meals, money management)?




4. Describe the individual's significant functional impairment in completing activities of daily living in the following four areas: personal hygiene, housework, preparing meals, money management in the last 30 days.








5. How many days in the past 30 days did the individual engage in behaviors that placed his/her safety at risk?a) There will be a dropdown 0-30

6. Describe the type of behaviors that placed his/her safety at risk.a) No evidence of behaviors that placed safety at risk b) Behavior posed mild risk to personal safety (little to no risk of physical injury)c) Behavior posed a moderate risk to personal safety (e.g., some risk of physical injury) d) Behavior posed a significant risk to personal safety (risk of severe physical injury/death)



7. Did the individual maintain residential stability (i.e., no unplanned loss/change in housing or psychiatric hospitalizations) in the last 30 days?a) Yesb) No

8. In the last 30 days, how often did the individual use alcohol, illegal substances, or abuse other legal substances?a) Neverb) Rarely (1-2 times a month)c) Occasionally (1-2 times a week)d) Often (3-4 times each week)e) Most days (daily or almost every day)








Intensive Community Treatment (ICT)

ICT Outcome Questions


a) Never








a) Never







3. How many days in the past 30 days has the individual had difficulty completing activities of daily living (e.g., personal hygiene, housework, preparing meals, money management)?

a) Never







4. Describe the individual's significant functional impairment in completing activities of daily living in the following four areas: personal hygiene, housework, preparing meals, money management in the last 30 days.






5. In the past 30 days, how many PCP, psychiatric, or outpatient medical appointments did the individual miss without rescheduling?




6. How many times in the past 30 days did the individual admit to an ER or hospital due to physical health reasons?


7. Did the individual maintain residential stability (i.e., no unplanned loss/change in housing or psychiatric hospitalizations) in the last 30 days?

a) Yes

b) No




a) Never












Partial Hospitalization (PHP)

PHP Outcome Questions


a) Never








a) Never







3. How many days in the past 30 days has the individual had difficulty completing activities of daily living (e.g., personal hygiene, housework, preparing meals, money management)?

a) Never







4. Describe the individual's significant functional impairment in completing activities of daily living in the following four areas: personal hygiene, housework, preparing meals, money management in the past 30 days.








5. In the last 30 days, how often did the individual experience difficulty with tolerating and managing intense emotions?

a) Never





6. How many days in the past 30 days did the individual engage in behaviors that placed his/her safety at risk?




7. Describe the type of behaviors that placed his/her safety at risk

a) No evidence of behaviors that placed safety at risk

b) Behavior posed mild risk to personal safety (little to no risk of physical injury)

c) Behavior posed a moderate risk to personal safety (e.g., some risk of physical injury)

d) Behavior posed a significant risk to personal safety (risk of severe physical injury/death)

8. Did the individual maintain residential stability (i.e., no unplanned loss/change in housing or psychiatric hospitalizations) in the last 30 days?

a) Yes

b) No




a) Never







10. How many days in the past 30 days has the individual expressed homicidal ideation??





EPSDT Behavior Therapy

EPSDT Behavior Therapy Outcome Questions

1. How often did the individual initiate or engage in age-appropriate social interactions with others within the past 30 days?

a) Neverb) Rarely (1-2 times a month)c) Occasionally (1-2 times a week)d) Often (3-4 times each week)e) Most Days (daily or almost every day)

2. How often did the individual make requests or express needs/wants either verbally or nonverbally within the past 30 days?

a) Neverb) Rarely (1-2 times a month)c) Occasionally (1-6 times a week)d) Often (at least 1 time daily)e) Frequently (10 or more times daily)



3. Describe the individual's display of age-appropriate adaptive behaviors (i.e. personal care, functional play, motor skills) within the past 30 days.

a) Unable to display age-appropriate adaptive behaviors even when prompted. a) Displayed age-appropriate adaptive behaviors only when prompted. b) Occasionally displayed (2+ times/week) age-appropriate adaptive behaviors

with no prompting required.c) Frequently displayed (daily) age-appropriate adaptive behaviors with no

prompting required.4. How often did the individual experience difficulty tolerating and modulating intense emotions in the past 30 days?




5. How often did the individual engage in self-injurious behavior within the past 30 days?


6. How often did the individual display obsessive, repetitive, or ritualized behavior within the past 30 days?




7. Describe the frequency and severity of the individual’s aggressive behaviors within the past 30 days?

a) No instances of aggressive behaviors or significant verbal threats toward others

b) Rare instances (1-2 times a month) or mild level of aggression toward others, including verbal threats

c) Occasional instances (1-4 times/week) or moderate level of aggression, including verbal threats

d) Frequent instances (daily or nearly daily) or dangerous level of aggression toward others



8. How frequently was the individual able to comply with directives in the past 30 days?

a) Never





9. How frequently was the caregiver able to implement behavioral strategies in the home within the past 30 days?

a) Never






Frequency Rating Guidelines

Frequency Rating Guidelines- Example of Never


58

S M T W T F S

No instances

Frequency Rating Guidelines- Example of Rarely


59

S M T W T F S

x

x

1-2 instances per month

Frequency Rating Guidelines- Example of Occasionally


60

S M T W T F S

x

x x

x x

x

1-2 instances per week

Frequency Rating Guidelines- Example of Often


61

S M T W T F S

x x x x

x x x

x x x x

x x x x

3-4 instances per week

Frequency Rating Guidelines- Example of Most Days


62

S M T W T F S

x x x x x x

x x x x x x x

x x x x x x

x x x x x x

Daily or Nearly Every Day

Points to Remember

• If a member is experiencing suicidal or homicidal ideation or other high risk behaviors, please evaluate whether they need to be referred or assessed for a higher level of care.

• If a member is abusing alcohol or other substances, evaluate whether they are receiving the most appropriate service or whether additional services may be needed.

• Effective 4/1/17, substance abuse services are expanding for Medicaid members.


63

Magellan Support

If you have questions about Outcome Questions:

•Call our customer service line at 1-800-424-4046 and ask to speak with a Care Manager.

•Join our weekly provider call on Fridays from 1-2 pm.

‒Dial-In: 888-850-4523

‒Passcode: 743713

•Select Contact Us on the Magellan of Virginia website to submit an e-mail to the clinical team.


64

http://www.magellanofvirginia.com/utility-va/contact-us.aspx

Legal disclaimers

Confidentiality Statement for Educational Presentations


66

By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment.

Confidentiality Statement for Providers


67

The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

Thanks

Outcome Measures on Service Request Authorizations...Outcome Measures on Service Request Authorizations Clinical Department March 2017. Objectives of this training • Discuss the

Documents