Residential Provider Training: Service Request Authorizations · • Resources and Trainings 2 Residential SRA Provider Training June 2017. Revised Assessment Process prior to Admission

Residential Provider Training: Service Request Authorizations

Magellan of Virginia

June 2017

Training Objectives

• Discuss Best Practices When Completing Service Request Authorizations (SRA)

• Overview of Regulations Reflected in SRAs

• Family engagement

• Therapeutic Intervention

• Therapeutic Leave Passes

• Review Changes to Service Request Authorizations (SRA)

• Brief Overview of EPSDT Services

• Resources and Trainings

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Revised Assessment Process prior to Admission and Authorization

Referral to the Residential Provider

• As of July 1, 2017, any youth being considered for residential services, must be referred to Magellan and be assessed by the Independent Assessment, Certification and Coordination Team (IACCT) in the youth's locality. The IACCT will fully assess the needs of the youth and family to determine if community based or residential services are the most appropriate interventions.

• If residential services are determined by the IACCT team, then the guardian chooses a facility to provide the intervention to the youth.

• Once the IACCT is aware of the provider identified, the IACCT Licensed Mental Health Professional (LMHP) will forward the psychosocial assessment, the Certificate of Need (CON), the Child and Adolescents Needs Assessment (CANS), and the Adverse Childhood Effects (ACES) screening to the facility within 1 calendar day.

• The SRA is submitted to Magellan by the residential provider after:

• The IACCT team has determined the residential treatment is the most suitable intervention

• The guardian has identified the facility

• The facility has received the required documents from the IACCT provider

• For more information on the IACCT process, refer to the IACCT Guide found on the Residential Process Page- http://magellanofvirginia.com/for-providers-va/residential-program-process.aspx

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For the Member Already Placed in the Facility

An Emergency Placement Occurs and Member has Medicaid

• Provider should notify Magellan within 5 business days of member being placed at the facility

• The guardian or facility may complete the inquiry form to initiate the IACCT process

• If the IACCT Team determines that residential treatment is the most viable intervention and the family identifies the facility, the provider can then submit the SRA to Magellan for review

Member becomes Medicaid Eligible while at the facility

• Provider should notify Magellan within 5 business days of member’s eligibility becoming active

• The guardian or facility may complete the inquiry form to initiate the IACCT process

• If the IACCT Team determines that residential treatment is the most viable intervention and the family identifies the facility, the provider can then submit the SRA to Magellan for review

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If a SRA is submitted to the Magellan prior to the member going through the

IACCT process, the SRA will not be reviewed.

Revised Program Requirements Impacting SRA Submissions

Changes to Program Requirements in the Regulations• Weekly Family Engagement

• Implementation of Evidenced-based and Trauma Informed Therapeutic Interventions

• For Therapeutic Group Homes (TGH)- A minimum of one intervention per 24 hour period

• For Psychiatric Residential Treatment Facility (PRTF)- A minimum of 3 interventions per 24 hour period

• Twenty-four Therapeutic passes are available per youth, per admissions

• Passes are not privileges, but an integral part of the therapeutic and family engagement process

• Focus on Discharge Planning

• Discharge planning is intentional, specific, focused, collaborative, and begins on the first day of admission

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Regulation Changes Continued

• Increased Care Coordination with:

• Residential Care Manager (RCM)- Assists in coordinating the residential placement and reviews authorizations at least every 30 days (at least every 90 days for Early and Periodic Screening, Diagnostic and Treatment or EPSDT Residential Treatment)

• Family Support Coordinator (FSC)- Provides education, support, and promotes family engagement with the family throughout the course of treatment

• For additional information on changes to residential treatment services, review the Residential Treatment Guide (Changes to Residential Treatment Services Guide and the recent training, titled (Update on Residential Program Changes and Regulations) found on the Magellan of Virginia website

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Changes to Submission Times and Required Documentation

When is the SRA Submitted?

• Providers for both Psychiatric Treatment Residential Facilities (PTRF) and Therapeutic Group Homes (TGH) should submit SRAs within 1 business day of admission

• This is a change for TGH – 3 business days is no longer allowed.

• For concurrent reviews, the SRA should be submitted no more than 7 days prior to the end of the current authorization and no later than the start date requested

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Changes to Documentation Requirements

When submitting initial requests, both PTRF and TGH should include:

• SRA

• Initial Plan of Care (IPOC)

• Rate sheet, if applicable

• The CON and CANS no longer have to be included in the submission, but should be in the member’s medical record. The ACEs should also be in the member’s medical record.

‒ The CON, CANS, and ACES is provided to the facility by the IACCT provider.

When submitting concurrent requests, both PTRF and TGH should include:

• Comprehensive Plan of Care (CIPOC)

• Rate sheet, if applicable

• The CANS does not have to be submitted, but a CANS completed every 90 days should be in every member’s file.

‒ The IACCT provider shares the CANS with the facility every 90 days

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Best Practices when Completing SRAs

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When completing SRAs remember to:

• Ensure the clinical responses fully address the specific questions on the SRA. It is suggested not to merely copy and paste from the treatment plan, but ensure each question is answered in its entirety and relevant to the question being asked.

• Provide clear details of significant and current clinical information on the member since the previous review, avoiding vague language and avoiding historical information.

• If mentioning SI, HI, or gestures please specify frequency (including dates), intentionality, specific statements or gestures made by member, and how this was addressed

• Please fully describe aggression- the type of aggression, the intensity, the frequency, the outcome of the aggression, and the frequency, including dates.

• Include dates and frequency of significant behaviors and symptoms that speak to the continued need for placement and that meets medical necessity criteria

• Complete all sections on the SRA.

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Looking at the New SRA

Changes to the SRA

• There is now only 1 initial and 1 concurrent residential SRA for both levels of care.

• When requesting EPSDT 1:1 services, there is now a separate SRA for this

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The New Initial SRAResidential Initial Request

The New Concurrent SRAResidential Continued Stay

Residential A Group Homes and the SRA

What about Level A Group Home and SRAs?

• Current Level A group home providers have until June 30, 2017 to apply for a license through the Department of Behavioral Health and Developmental Services (DBHDS) to provide Medicaid reimbursed therapeutic group home services.

• If Level A group home providers do not apply for this new license by June 30, 2017, they will continue to use the current SRA

• For the Level A group home providers that have applied for the new license by June 30, 2017, they will use the new SRA starting July 1, 2017

• For more details about the Level A transition plan, please refer to Memo for Level A providers.docx and Providers Intent to Apply for Licensure-DBHDS.docx

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Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services

EPSDT SERVICES INCLUDE:

• EPSDT Residential Treatment Services for both PRTF and TGH

• EPSDT 1:1 Services

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A Brief Overview for EPSDT Residential Treatment Facilities

• EPSDT Residential Treatment Services may be provided to persons with developmental delays, such as autism and intellectual disabilities.

• EPSDT Residential Treatment services include, but is not limited to clinically directed programming including applied behavior analysis and other evidence based/evidence informed behavior modification models.

• EPSDT Residential Treatment services are intended to be a temporary, rehabilitative, structured environment that fosters increased adaptive functioning and appropriate social-communicative interactions.

• Providers must be licensed and credentialed to provide EPSDT residential treatment services. They are unable to use the current residential license for this service.

• For medical necessity criteria and additional information about EPSDT residential treatment facilities, please refer to http://www.dmas.virginia.gov/Content_pgs/obh-home.aspx, where providers can find a draft of the Residential Treatment Services

Manual.

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Initial SRA for EPSDT Residential Treatment ServicesEPSDT Residential Intial Request

Concurrent SRA for EPSDT Residential Treatment Services

EPSDT Residential Continued Stay

Brief Overview of EPSDT 1:1 Support Services

• 1:1 Support is an intervention involving a specific level of monitoring for an individual who requires one dedicated staff person to personally monitor one member in order to help ensure health and safety.

• The need for 1:1 supports must be reviewed at least weekly by the treatment team and the physician to determine continued need for this intervention.

• 1:1 supports will be authorized in increments up to 7 days and authorizations are based on the individual needs of the member at the time of the authorization request.

• For additional information about EPSDT 1:1 support services, please refer to http://www.dmas.virginia.gov/Content_pgs/obh-home.aspx where providers can find a draft of the Residential Treatment Services Manual

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Initial SRA for EPSDT 1:1 Support ServicesEPSDT Residential 1 to 1 Intial Request

Concurrent SRA for EPSDT 1:1 Support ServicesEPSDT Residential 1 to 1 Continued Stay

For more detailed information related to residential changes:

Quick Reminder and Important Information

• If you have not already, please complete the Residential Program Description Form (Residential Program Description Form)

• A draft of the Residential Treatment Services Manual can be found:

• http://www.dmas.virginia.gov/Content_pgs/obh-home.aspx

• https://www.virginiamedicaid.dmas.virginia.gov/ECMPdfWeb/ECMServlet?memospdf=Medicaid-memo-06-01-2017.pdf

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Useful Guides• All guides and other links can be found on the

Residential Program Process page

• http://magellanofvirginia.com/for-providers-va/residential-program-process.aspx

• Your Guide to IACCT Your Guide to IACCT

• Changes to Residential Treatment Services Guide Changes to Residential Treatment Services Guide

• Residential Services for Substance Use and Behavioral Health Guide Residential Services for Substance Use and Behavioral Health Guide

• LDSS Guide to Family Engagement during Residential Placement LDSS Guide to Family Engagement during Residential Placement

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Trainings

Below are trainings that may be beneficial, but more can be found on the Residential Process tab.

• Recorded training - Update on Residential Program Changes and Regulations Update Residential Program Changes and Regulations (pdf)

• Recorded training - IACCT Residential Provider Training PART 1IACCT Residential Provider Training presentation (pdf) PART 1

• Recorded training - IACCT Residential Provider Training PART 2IACCT Residential Provider Training presentation (pdf) PART 2

• Changes to Level A B C Psychiatric Residential Treatment Independent Certification Team and Care Coordination Process

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Additional Information and Resources

Best Practices for Residential Interventions for Youth and their Families -- used with permission of BBI Resource Guide for Judges and Legal Partners with Involvement in the Children’s Dependency Court System

Executive Summary Best Practices for Residential Interventions for You -- used with permission of BBI Resource Guide for Judges and Legal Partners with Involvement in the Children’s Dependency Court System Executive Summary

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Legal disclaimers

Confidentiality Statement for Educational Presentations

Residential SRA Provider Training June 2017

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.

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Confidentiality Statement for Providers

Residential SRA Provider Training June 2017

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.

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Thanks