County ofSan Bernardino Department of Behavioral Health ...

1 CountyofSanBernardinoDepartmentofBehavio ralHealthProvidingServicestoAdoptionAssi stanceProgram(AAP)andKinshipGuardianship AssistancePayment( kingap )ChildrenPlacedO ut-of-CountyProcedureEffectiveDateApprov alDate05/04/0910101/09 PurposeStandardizedFormstorAuthorizingOu t-ot-CountyServicesAdministrativeService sOrganizationProcedureToprovidetheDepart mentofBehavioralHealth(DBH)witha processforfacilitatingtheprovisionofmedi callynecessaryspecialtymentalhealthservi cestoMedi-CalbeneficiarieswithanAAPorKin GAPaidcodewhoareresidingoutsideoftheirco untyoforiginbyauthorizing,documenting,re imbursing,andbeingreimbursedforservicesi naccordancewithTitle9,CCR (b)(4)(A).CaliforniaDepartmentofMentalHe alth(DMH)hasadoptedstandardizedformstobe utilizedbyCountyMentalHealth Plans(MHP).Theseformsaretobeusedwhenauth orizing,documenting, : MH5120:SB785 ClientAssessment MH5121:SB785 ClientAssessmentUpdate MH5122:SB785 ClientPlan MH5123:SB785 ProgressNoteslDayRehabilitativeServices MH5124:SB785 ProgressNoteslDayTreatmentIntensiveServi ces MH5125:SB785 ServiceAuthorizationRequest(SAR) MH5126:SB785 OrganizationProviderAgreementforFosterCh ildrenPlacedOutOfCountyDBH,inaccordancew iththeCountyMentalHealthPlan(MHP),provid esSpecialtyMentalHealthServicesforMedi-C albeneficiarieswhoareminorsandwhoresideo ut-of-homeandoutoftheirCountyofjurisdict ionbytheutilizationofanAdministrativeSer viceOrganization(ASO).

2 Medi-Calbeneficiarieswhomeettheabovecrit eriamayinitiateaccesstomentalhealthservi cesbycontactingValueOptions, 'sPage1 of7 CountyofSanBernardinoDepartmentofBehavio ralHealthProvidingServicestoAdoptionAssi stanceProgram(AAP)andKinshipGuardianship AssistancePayment( kingap )ChildrenPlacedO ut-of-CountyProcedure,ContinuedAdministr ativeServicesOrganizationProcedure(conti nued)SanBernardinoasHostCountytoAAP/KinG APC hildrenVaiueOptionsmaybecontactedat (1-800-236-0756).WhenDBHisnotifiedthata child/youthinanAAP/KinGAPaidcategoryisin needofmedicallynecessaryspecializedmenta lhealthservices, ,servicesmaynotbeavailablethroughValueOp tions,Thesecircumstancesinclude,butareno tlimitedto,thefollowing: ValueOptionsisnotcontractedtoprovideDayT reatmentRehabilitation,DayTreatmentInten sive,andTherapeuticBehavioralServices(TB S).

3 ValueOptionsisunabletoprovidetherequeste dservices,DBHwillfollowtheprocedureoutli nedbelowin"SanBernardinoasCountyofOrigin forAAP/KinGAPC hildren;roleofAccessUnitwhenSARisrequest edbyMHPforservicestobeprovidedbyanIndivi dualorPrivateProvider."Childrenandyouthw ithAAP/KinGAPMedi-Cal,regardlessofCounty ofOrigin,shallbeprovidedservicesinthesam emannerasservicesareprovidedtoanyotherch ildoryouthforwhomSanBernardinoislistedas thecountyofresponsibility,orcountyoforig in,ontheMedi-CalEligibilityDataSystems(M EDS).WhenDBHisnotifiedthatanAAP/KinGAPch ildfromanothercountyoforiginisrequesting specialtymentalhealthservices, "StandardizedformsforauthorizingOut-of-s ervicestotheCountyServices"sectionofthis procedure( ,AAP/KinGAPC linicalAssessment,ClientPlan,andSAR). 'sPage2 of7 CountyofSanBernardinoDepartmentofBehavio ralHealthProvidingServicestoAdoptionAssi stanceProgram(AAP)andKinshipGuardianship AssistancePayment( kingap )ChildrenPlacedO ut-of-CountyProcedure,ContinuedSanBernar dinoasHostCountytoAAP/KinGAPC hildren(continued) (7) (continued) 'scountyoforigin(forcountyclinicsandnon- DBHM entalHealthProviders)withinthree(3) 'scountyoforiginandprovideclinical/provi derstaffwithpertinentinformationonauthor ization( ,dateofexpiration).

4 (fiscalunit),clinicalstaff, (a&b)reportsandsendalertstoDBH/providerc linic( ,expiredauthorizations,providingservices notauthorized). ; ( ,countyoforiginwillbeenteredasinsurancec omoanv), (fiscal) 'sPage3 of7 CountyofSanBernardinoDepartmentofBehavio ralHealthProvidingServicestoAdoptionAssi stanceProgram(AAP)andKinshipGuardianship AssistancePayment( kingap )ChildrenPlacedO ut-of-CountyProcedure,ContinuedSanBernar dinoasHostCountytoAAP/KinGAPC hildren(continued) ( ) paymentnotreceived, ,shallbeevaluatedforthoseservicesonlywhe ntheSAR,whichispreparedbya privateorpublicprovider,isreceivedfromth eMHPoftheHostCountyinaccordancewithWelfa reandInstitutionsCodeSections11376(a)(b) &16125(a)(b).WhenDBHreceivesa SAR(MH5125 SAR)froma hostcountyMHP(forpublicorprivateprovider ),DBHshall,byutilizingthestandardformspr ovidedbyDMH, (3) ,requestadditionalinformationandmakedete rminationwithin3 workingdaysofreceiptofadditionalinformat ionorfourteen(14)calendardaysofreceiptof originalSAR, 'sPage4 of7 CountyofSanBernardinoDepartmentofBehavio ralHealthProvidingServicestoAdoptionAssi stanceProgram(AAP)andKinshipGuardianship AssistancePayment( kingap )ChildrenPlacedO ut-of-CountyProcedure,ContinuedSanBernar dinoasCountyofOriginforAAP/KinGAPC hildren(continued) (fiscalservices)forservicestobeKinGAPaid codesonly(notnecessarytoprovideprovideda taauthorizationforAAPaidcodes).

5 Countyclinic(continued) (90) necessary, 'sPage5 of7 CountyofSanBernardinoDepartmentofBehavio ralHealthProvidingServicestoAdoptionAssi stanceProgram(AAP)andKinshipGuardianship AssistancePayment( kingap )ChildrenPlacedO ut-of-CountyProcedure,ContinuedSanBernar dinoasCountyofOriginforAAP/KinGAPC hildren(continued)RolesResponsibilitiesA dministrativeFiscalservicesoftheAdminist rativeServicesUnitwillbeServices(fiscalr esponsibleforprocessingpaymentrequeststh atareservices)forreceivedfromtheCountyof OriginMHPandwillnotKinGAPaidprocesspayme ntsfromindividualprovidersorgroupcodeson lyhomeorganizations,Withinthirty(30)days fromdateofauthorization,arrangementforre imbursementtohostcountyMHPshallbemadebyt heutilizationofoneofthefollowingmethods: Implementa PurchaseRequestwiththeContractProviderfo rreimbursementoftheinitialtreatmentautho rization ImplementaPurchaseOrderifinitialanalysis determinesthatthedurationofservicesmaybe ongoingorthepotentialofa long-termrelationshipwiththeContractProv iderisdeterminedAAPS pecialBillingProceduresResolutionofDisag reementWhenDBHistheHostCountyforanAAPaid codechild/youth,andtheservicesarebeingpr ovidedinaDBHclinic, , , resultoftheauthorizationand/orpaymentpro cesswillberesolvedinaccordancewithTitle9 CCR (c).

6 DBHwilldesignateanon-affiliatedProgramMa nagertoprovidearbitrationasrequested. Arbitratorswillservethroughouttheyearona 'sPage6 of7 CountyofSanBernardinoDepartmentofBehavio ralHealthProvidingServicestoAdoptionAssi stanceProgram(AAP)andKinshipGuardianship AssistancePayment( kingap )ChildrenPlacedO ut-of-CountyProcedure,ContinuedReference sRelatedPoliciesCaliforniaDepartmentofMe ntalHealth, ,CCR (b)(4)(A) , of7