OBH-PASRR Level II Specialized Services …

1 OBH-PASRR Level II Specialized Services verification process FAQ. The following questions were answered during the recent phone calls held by OBH regarding a new Specialized Services verification process : QUESTIONS. Q1. What do we do if an individual is recommended Specialized Services and they only have Medicaid? A. Nursing facility (NF) residents with Medicaid are, in fact, eligible for Services under the Louisiana Behavioral Health Partnership (LBHP) managed by Magellan. They are thereby entitled to receive basic behavioral health Services while in the NF. The Services include the following: o Mental Health Inpatient psychiatric hospitalization Physician Services (medication management visits with a psychiatrist).

2 Outpatient therapy or counseling appointments o Substance Use Intensive outpatient treatment programs Individual counseling and group therapy Detoxification Services Residential treatment Services o To access Services call Magellan of Louisiana at 1-800-424-4399 or go to the website at o Local Governing Entities (LGEs) are also providers under LBHP that can be contacted directly for Services o Additional Tips: First, become familiar with the service provisions, rights and responsibilities, and grievance procedures for Magellan. These can be found on Magellan's website at or by calling Magellan directly at 1-800-424-4399. Particularly useful information is in the Member Handbook: Second, review the eligibility and service information and be prepared to discuss and ask informed questions when you contact Magellan and speak with a member Services specialist or care manager.

3 The guidance regarding Services to residents in NFs may be located at the following website: Remember that while most residents are entitled to a basic package of behavioral health Services which can be delivered while they are residing in the nursing home, they may or may not qualify for enhanced Services . Some residents will not qualify at all for Services under the LBHP. For these individuals, you may want to contact the Local Governing Entity (LGE). providing behavioral health Services in your facilities location. Contact 1. OBH-PASRR Level II Specialized Services verification process FAQ. information for the LGE's is available at: Third, ask to speak with the Care Manager Supervisor if the Magellan representative answering your call is unable to assist you.

4 Fourth, you may file a grievance with Magellan via mail, phone or online at: Finally, if you feel you have not received adequate assistance through Magellan, please contact the Office of Behavioral Health at 225-342-2540 to discuss the situation with someone in the Consumer Recovery & Membership Services Section. Q2. Local mental health agencies agency won't serve nursing home patients. A. Local mental health agencies are providers and should serve NF residents with most insurances including indigent residents. However, it is the NF responsibility to transport residents to appointments. OBH Headquarters has forwarded the LGEs information regarding Services available to NF residents. Should nursing homes continue to have problems accessing Services please contact our office at 225-342-2540 to discuss the situation with someone in the Consumer Recovery &.

5 Membership Services Section. Q3. What is the difference between lesser Services and Specialized Services and what is the responsibility of the NF? A. The differences between lesser Services and Specialized Services (SS) are as follows: o Lesser Services : These Services are within the scope of Services which are provided or arranged by the NF. They are intended to help NF residents with a diagnosis of mental illness to achieve the highest possible Level of mental and psychosocial well-being. The following are examples of Services of a lesser intensity: Medical Management, including medication management (provided by the NF), as specified in the resident's plan of care: Services designed for the individual, taking into account the resident's total needs and problems, including prescribing, administering, and monitoring all medications.

6 Counseling regarding adjustment to the NF, interpersonal relations, and family involvement (provided by the NF): Short term counseling designed to assist the resident in his adjustment to the facility. Training and support to maintain functional Level (provided by the NF) as specified in the resident's plan of care: Activities tailored to the individual's physical, emotional, and social needs, including ADL's, independent living skills, and communication skills, which may include coordination with primary therapist(s), follow through, and support of a behavior program. 2. OBH-PASRR Level II Specialized Services verification process FAQ. Social Services support (provided by the NF): Activities and/or Services tailored to the individual's social needs, in consideration of the total medical needs such as transportation, referrals to other agencies or community programs, or assistance in obtaining medical appliances and devices.

7 Age and functional Level activity program (provided by the NF) as specified in the resident's plan of care: Activities designed individually to address the needs of the resident, such as structured work and leisure activities. o Specialized Services (SS): These Services are beyond the scope of Services provided by the NF, and require high degree of intensity. These Services , combined with the Services provided by the nursing facility, result in the continuous and aggressive implementation of a plan of care. o Level II recommendations should be found on the Level II determination form. o State Responsibility OBH and OCDD act as resource experts through the PASRR Level II. determination recommending any type of service and support an individual will need while residing in the NF.

8 The state identifies practical, available types of Services that will meet the Level II individual's needs including Specialized Services , those recognized as Specialized rehabilitative Services , and those that are a part of NF Services noted in the standards for payment. o Nursing Facility Responsibility The NF provides for NF Services , NF Specialized rehabilitative Services , specifies in the POC, prescribes, and arranges for all other needed Services (NF Services and NF SRS), including SS, which are variously funded and reimbursed. If the NF. cannot arrange for a needed service, it must either provide the service at its own expense, or transfer the resident. Notify the Level II PASRR authority when there is a significant change in status.

9 Respond to request by the Level II PASRR authority for verification that an individual is receiving Specialized Services . Q4. To whom will letters requesting verification of Specialized Services be addressed? A. All correspondence will be sent to the administrator of the nursing facility. Q5. How soon will it be before the nursing homes receive the letter? A. OBH will start sending out letters to NF on September 15th. The letters will include a list of individuals that have been recommended Specialized Services with instructions to provide OBH. provider information, frequency of visits, etc. 3. OBH-PASRR Level II Specialized Services verification process FAQ. Q6. What is the timeframe for the NF to respond to a request for information and what is the expectation for NF upon admission when an individual is recommended for Specialized Services ?

10 A. The expectation for NF to provide OBH with verification of Specialized Services through the Tracking Form upon admission or resident review is 30 days. With regard to the Specialized service verification letters being sent to NF, the NF will be asked to respond to OBH within one week of receipt of the information as it is expected these individuals should already have Services in place. If not, then OBH. will be working with the NF to establish Services when indicated. Q7. What are the Services available for clients who are Medicaid pending and when Medicaid eligibility can take 3-4 months? A. NF should determine the benefits available to residents who are pending Medicaid. If clients have a different insurance provider, Specialized Services recommended should be arranged.