SHORT-DOYLE/MEDI-CAL ORGANIZATIONAL PROVIDER’S …

1 short - doyle / medi -CALORGANIZATIONAL provider S MANUALforSPECIALTY MENTAL HEALTH SERVICES underTHE REHABILITATION OPTIONandTARGETED CASE MANAGEMENT SERVICESC hildren/Adolescents,Transitional Age Youth (TAY),Adults and Older AdultsEffective: July 1, 1993 Updated: January 1, 2018**LOS ANGELES COUNTYLOCAL MENTAL HEALTH PLANJ onathan E. Sherin, , , DirectorLos Angeles County Department of Mental HealthDennis Murata, MSW, Deputy DirectorOffice of Performance DataCompiled by: Quality Assurance DivisionPage | 2T A B L E O F C O N T E N T SCHAPTERSPAGE(S)LASTUPDATEC hapter 1: Service, Documentation, and Reimbursement BasicsGeneral Service and Reimbursement RulesOverview56/30/17 Service Philosophy65/6/16 medi -Cal Reimbursement Rules71/1/18 General Documentation Rules101/1/18 medi -Cal Medical NecessityDescription126/17/15 Medical Necessity Criteria135/6/16 Documentation for Medical Necessity.

2 The Clinical Loop146/12/14 The Clinical Loop156/12/14 AssessmentDescription156/12/14 New Client Assessment1610/6/17 Returning Client Assessment196/30/17 Continuous Client Assessment206/30/17 Assessment Addendum215/6/16 ClientTreatment PlanDescription2110/6/17 Annual Client Treatment Plan226/30/17 Update Client Treatment Plan236/30/17 Additional Information2410/6/17 Progress NotesDescription255/6/16 Progress Notes266/30/17 Service ComponentsDefinition2711/21/14 Service Components286/30/17 Chapter 2: Services Based on Minutes of Staff Time (Mode 15)Service Overview and Reimbursement RulesGeneral Rules346/12/14 Documentation Rules345/6/16 Types of ServicesMental Health Services (MHS)366/30/17 Medication Support Services (MSS)3710/6/17 Crisis Intervention (CI)396/12/14 Targeted Case Management (TCM)416/30/17 Page | 3 CHAPTERSPAGE(S)LASTUPDATES ervices to Special Populations426/30/17 Therapeutic Behavioral Services (TBS)426/30/17 Intensive Care Coordination & Intensive HomeBased Services476/30/17 Intensive Care Coordination (ICC)5110/31/17 Intensive Home Based Services (IHBS)5310/31/17 Chapter 3.

3 Services Based on Blocks of Time (Mode 10)Service Overview & Reimbursement RulesGeneral Rules5711/21/14 Crisis Stabilization Services (CS)5711/21/14 Day Treatment Intensive (DTI)5910/6/17 Day Rehabilitation (DR)6510/6/17 Socialization Day Services6911/21/14 Vocational Services7111/21/14 Chapter 4: Services Based on Calendar DaysGeneral Rules745/6/16 Adult Residential Services (Transitional and Long-Term)745/6/16 Crisis Residential Treatment Services775/6/16 Psychiatric Health Facility806/30/17 Psychiatric Inpatient Hospital Services856/30/17 Chapter 5: SHORT-DOYLE/MEDI-CAL provider CertificationOverview926/30/17 General Requirements926/30/17 Certification Process936/30/17On-Site Review946/30/17 Certification Checklist and Protocol976/30/17 AppendixOutpatient medi -Cal Included Diagnoses1012/17/17 Inpatient medi -Cal Included Diagnoses1052/17/17 Page | 4 CHAPTER 1 Service, Documentation, andReimbursement BasicsGENERAL SERVICE AND REIMBURSEMENT RULESMEDI-CAL MEDICAL NECESSITY THE CLINICAL LOOPASSESSMENTCLIENT TREATMENT PLANPROGRESS NOTESSERVICE COMPONENTSPage | 5 GENERAL SERVICE AND REIMBURSEMENT RULESO V E R V I E WMedicaid is a joint federal and state program that helps with medical costs for somepeople with limited income and resources.

4 In California, the Medicaid program is calledMedi-Cal and there is a carve out for specialty mental health services . SpecialtyMental Health Services are Rehabilitative Services (which include mental healthservices, medication support services, day treatment intensive, day rehabilitation, crisisintervention, crisis stabilization, adult residential treatment services, crisis residentialtreatment services, and psychiatric health facility services), Psychiatric InpatientHospital Services, Targeted Case Management, Psychiatric Services, PsychologistServices, EPSDT Supplemental Specialty Mental Health Services and PsychiatricNursing Facility Services (CCR ).The State Department of Health CareServices (State DHCS) (formerly State Department of Mental Health) administers theprogram in California by agreement with the federal Center for Medicare and MedicaidServices (CMS).

5 This agreement is set forth in the State Plan and subsequentamendments. The Los Angeles County Department of Mental Health (LACDMH) actsas the Local Mental Health Plan (hereafter referred to as the MHP), the entity whichenters into an agreement (under the State Contract) with the State DHCS to arrange forand/or provide specialty mental health services within the manual reflects the current requirements for Rehabilitative Services, TargetedCase Management and EPSDT Supplemental Specialty Mental Health Servicesreimbursed by medi -Cal as Specialty Mental Health Services and serves as the basisfor all documentation and claiming in LACDMH regardless of payer Policy , all providers, whether Directly-Operated or Contracted, mustabide by the information found in this manual .

6 Information referenced in this manualincorporates requirements from the following key sources: Code of Federal Regulations (CFR); California Code of Regulations (CCR); State Plan Amendments (SPA); State Contract; State DHCS Mental Health Services Division medi -Cal Billing manual ( medi -CalBilling manual ); State DHCS Letters and Information Notices; DHCS medi -Cal manual for Intensive Care Coordination (ICC), Intensive Home-Based Services (IHBS) and Therapeutic Foster Care (TFC) for medi -CalBeneficiaries ( medi -Cal manual ); LACDMH Policy and Procedure; LACDMH sources may be cited throughout the manual . The symbol " " placed in thereference denotes Section and is followed by the associated regulation s numericalcode. All references to a regulatory section from California Code of Regulations arefrom Title 9, Chapter 11 unless otherwise | 6 While the above cited sources may refer to beneficiary , patient , or recipient , thisManual will universally use the term client for Quality Assurance Division issuesQuality Assurance (QA) Bulletinsas a way ofcommunicating updates or clarifications to information found in this are considered to be official LACDMH requirements and will be incorporatedinto this manual as funded programs that are not funded by medi -Cal may allow for reimbursement ofservices that do not meet the requirements as set forth in this document.

7 Refer to the Guidelines for Claiming by Funded Program for additional information on claiming andreimbursement by funded E R V I C E P H I L O S O P H Y A N D R E Q U I R E M E N T SMedi-Cal services provided under the federal Rehabilitation Option focus on clientneeds, strengths, choices and involvement in treatment planning and goal is to help clients take charge of their lives through informed are based on the client's long-term goals/desired result(s) from mental healthservices concerning his/her own life and his/her diagnosis, functional impairment(s),symptoms, disabilities, life conditions and rehabilitation arefocused on achieving specific, measurable objectives to support the client inaccomplishing his/her desired results.

8 Program staffing ismulti-disciplinary and reflectsthe cultural, linguistic, ethnic, age, gender, sexual orientation and other socialcharacteristics of the community that the program serves. Families, caregivers, humanservice agency personnel and other significant support persons who, in the opinion ofthe client or the person providing the service, has or could have a significant role in thesuccessful outcome of treatment (CCR ) areencouraged to participate inthe planning and implementation process in meeting the client's needs, choices,responsibilities and aredesigned to use both licensed andnon-licensed personnel who are experienced in providing services in the mental programs providing specialty mental health services must inform clients and theirlegal guardians (if applicable)

9 That acceptance and participation in the mental healthsystem is voluntary and shall not be considered a prerequisite for access to othercommunity services. In addition, clients and their legal guardians retain the right toaccess other medi -Cal or SHORT-DOYLE/MEDI-CAL reimbursable services and have theright to request a change of provider and/or staff person/therapist/case manager at | 7M E D I C A L R E I M B U R S E M E N T R U L E SKey Points Applicable to One or More Mode of Services A provider must either be certified as a Mental Health Rehabilitation provider (CCR )or licensedby State Department of Health Services (DHS) as aPsychiatric Hospital Service, Inpatient Hospital Service, or Outpatient HospitalService to be eligible for reimbursement for providing medi -Cal services.

10 See theCertification Guidelines Hospital outpatient departmentsas defined in Title 22, CCR 51112, operatingunder the license of a hospitalmay only provide services in compliance withlicensing requirements. Every claim must be supported by a progress note that must be present in theclinical record prior to the submission of the claim(State Contract). All covered servicesmust be provided under the direction(CCR )ofan Authorized Mental Health Discipline (AMHD) and as designated by theProgram Manager:Examples of service direction include, but are not limited to: Being the person providing the service; Acting as a clinical team leader; Direct or functional supervision of service delivery; or Approval of Client Care person providing direction is not required to be physically present at the servicesite to exercise direction (State DMH Letter No.)