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Authors Posts by Sarah Eyster

Sarah Eyster

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Ms. Eyster represents the association at state-level meetings and serves as staff liaison to the Mental Health Committee. She is responsible for member communication of, and the analysis of, Department of Human Services and other key policy decisions.

The conversion from ICD 9/DSM 4-TR to ICD 10/DSM 5 has come and gone. Many RCPA members are reporting claims denials for billing codes related to the Schizophrenia NOS and PTSD NOS. The reason is that the DSM 5 only offers the Schizophrenia NOS code but the ICD 10 offers seven other choices for Schizophrenia and similarly for PTSD. Clinicians are using the DSM 5 for documentation and choosing the available option; however, when converted to ICD 10 for billing and payment, the person does not meet the criteria for Schizophrenia NOS – therefore, CMS is denying payment. And if you think you are out of the woods in the substance abuse arena, think again; those problems are forthcoming.

RCPA is pleased to offer this webinar: DSM 5/ICD 10 Troubles: Understanding and Rectifying Revenue Problems, by Lisette Wright of Behavioral Health Solutions, P.A. Wright is author of the published curriculum ICD-10 and DSM-5: Coding, Documentation and Clinical Diagnostic Criteria Training, and has trained close to 13,000 clinicians across the country. Her soon-to-be-published graduate level test is titled Coding and Documentation Compliance for the ICD and DSM: A Comprehensive Guide for Clinicians, Routledge, late fall 2016.

Wednesday, June 1, 2:00 – 3:30 pm
Member Registration: $25
Non-Member Registration: $40
Register here no later than Monday, May 30, 2016

RCPA will host its annual conference at the Hershey Lodge on September 27–30, 2016. At this large-scale, statewide event, the RCPA board of directors wants to continue the important tradition of recognizing individuals and organizations/facilities for their dedication and commitment to service. The following award categories have been created for this event and recognition:

  1. RCPA Innovation Award. Presented to an individual or organization in recognition of significant innovation. Examples include cross-systems integration, physical/behavioral health integration, and implementation of new technologies. Up to three awards may be given in any year.
  2. Exemplary Service to RCPA Award. Presented to an individual or organization/facility that has shown a strong commitment and dedication in service to the association, its members, and related issues.
  3. Legislative Leadership Award. Presented to an individual who has shown significant leadership and commitment to government affairs and legislative issues, on behalf of RCPA and its members.
  4. Community Leadership Award. Presented to an individual in recognition of extending service and knowledge to the community at large, and efforts in helping the community understand the needs of individuals served by RCPA members. This can be for specific or short-term significant acts, or to recognize a career-long body of work.
  5. Lifetime Achievement Award. Presented to an individual in honor of his/her significant, consistent, and enduring contribution throughout his/her career in support and furthering of the field.

At this time, RCPA is accepting nominations through an open solicitation of members (e.g., designated contact person, CEOs/executive directors, staff) and RCPA committees. Members may nominate one or more individuals/organizations in one or more categories. Nominations will be reviewed by a sub-group of the board of directors to make recommendations for final selection and approval by the full board.

Include the name/organization (if applicable) of the nominee, the award category, and a statement about why you believe the individual/organization should be honored. Nominations should be made by Monday, May 16. Please send nominations to Cindy Lloyd.

Award recipients are not limited to RCPA members and every award may not be presented annually. Please join the association in continuing this tradition and in offering nominations for those who deserve recognition for their significant contributions.

SAMHSA and the Centers for Medicare & Medicaid Services (CMS) invite you to join a presentation of the final rule on mental health and substance use disorder parity for Medicaid and CHIP, to be held on Thursday, April 14, 1:00 – 2:00 pm.

This rule implements the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) for 23 million beneficiaries enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and the Children’s Health Insurance Program (CHIP), ensuring that benefits for mental health and substance use disorder treatments and services are offered on equal footing with medical and surgical benefits. This presentation will include a discussion of the application of parity to Medicaid and CHIP programs, key changes from the Notice of Proposed Rulemaking, and answers to frequently asked questions.

The Department of Human Services (DHS) has announced the selection of 16 locations to participate in the Certified Community Behavioral Health Clinic (CCBHC) planning grant. The federal grant encourages states to adopt innovative approaches to community-based behavioral health services.

This initiative will further the Wolf Administration’s goal of improving the delivery of care for behavioral health and substance use treatment in the community where people live, providing Pennsylvanians with easier and more consistent access to the services they need. In an effort to provide CCBHC access to all affected Pennsylvanians, the 16 locations are comprised of both rural and urban locations throughout the state.

The federal Excellence in Mental Health Act established the CCBHCs as a way to improve quality and use evidenced-based practices in behavioral health.

The CCBHCs will provide nine core services:

  • Crisis services;
  • Targeted case management;
  • Outpatient mental health and substance abuse services;
  • Patient-centered treatment planning;
  • Screening, assessment, and diagnosis;
  • Psychiatric rehabilitation services;
  • Peer and family support;
  • Care for veterans and members of the military; and
  • Outpatient primary care screening and monitoring.

The following clinics were selected:

  • Berks Counseling Center, Berks
  • Cen Clear Child Services, Clearfield
  • Cen Clear Child Services, Jefferson
  • Cen Clear Child Services, Blair
  • Community Council Mental Health and Mental Retardation, Philadelphia
  • Community Counseling Center of Mercer County, Mercer
  • Community Guidance Center, Clearfield
  • Creative Health Services, Montgomery
  • Kidspeace, Monroe
  • NHS Delaware County, Delaware
  • Northeast Treatment Centers, Philadelphia
  • Pittsburgh Mercy, Allegheny
  • Public Health Management Corporation, Philadelphia
  • Resources for Human Development, Philadelphia
  • Safe Harbor, Erie
  • The Guidance Center, McKean

As part of being selected as a CCBHC, the CCBHC Assessment and Readiness Review webinar is taking place on Friday, April 8 at 9:00 am. You are welcome to join DHS in person in the Clothestree Conference Room. To join via webinar, please register using this link. Once registered, you will receive a confirmation email with your connection link. Please note, this link will be unique to you and should not be shared with others.

RCPA, through the National Council, will be offering support to all selected CCBHCs. In addition, all selected CCBHCs are welcome to attend a monthly nationwide call with National Council and state leaders. More information will be available later this week.

RCPA congratulates all selected CCBHC providers. Please contact Sarah Eyster for more information.

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Audits Every Two Years for Best Facilities/Notice of Changes
The Department of Drug and Alcohol Programs (DDAP) proposes to amend §709.11 and §709.14 (relating to the General Standards for Freestanding Treatment Facilities). The proposed amended language to §709.11 (application for license) seeks to enlarge the amount of time between inspections from one year to up to two years for the free standing drug and alcohol facilities that, for the prior two years, have not had any citations in four critical areas. Specifically, facilities that have been cited in the last two years for conduct or omissions that: 1) jeopardized the safety of any persons, 2) compromised the quality of treatment provided, 3) violated a client’s confidentiality rights or resulted in treatment being provided without informed consent, are not eligible to have the annual inspection time extended. In addition, facilities that have failed to take reasonable and timely remedial measures as requested by the department are not eligible for this extension.

Increasing the time between inspections serves as an incentive and rewards the best of the facilities by reducing the administrative burden associated with an annual inspection. In addition, the proposed amended language to §709.14 (restriction on license) requires drug and alcohol facilities to inform DDAP of major changes in ownership, location, or operations, 30 days before such an occurrence, rather than 90 days after the occurrence.

DDAP is requesting comments on the preliminary proposed regulations before moving forward with the formal IRRC process. Written comments are due by Wednesday, April 27, 2016. A stakeholder meeting will be held on Monday, May 2, at 11:30 am, at the University of Pittsburgh Child Welfare Research Center, 403 East Winding Hill Road, Mechanicsburg, PA 17055.

CCBHCs will transform how behavioral health care is financed and reimbursed. As states and providers embark on this transformation, they face many questions, including:

  • How do we decide which prospective payment methodology to use – and what will its impact on behavioral health providers be?
  • How will we finance the state’s contribution?
  • How do state licensure and CCBHC certification requirements intersect?

 

Clearly understanding the unique financial opportunities and challenges associated with CCBHCs is a key ingredient to a successful implementation. This webinar will provide attendees with straightforward explanations of hot topics related to CCBHC financing and reimbursement. Our expert presenters will translate the current SAMHSA and CMS guidance to ensure all attendees are familiar with the relevant federal instructions and guidance.

 

The webinar will focus on the following topics:

  1. Prospective Payment Systems: explanation of the principles of PPS1 and PPS2 and overview of challenges identified in each approach, including a deep dive into the costs that go into your payment rate;
  2. Certification vs Licensure: clarification of the difference between certification and licensure and explanation of federal guidance on this point; and
  3. State Financing Strategies: description of state level financing mechanisms for their share of the Medicaid match, including the use of Certified Public Expenditures.

 

COST REPORTING, CLINIC LICENSURE, STATE FINANCING, AND MORE

Date: Monday, March 28, 3:00 pm EDT

Presenters: Steve Kohler, senior manager, McBee Associates, Inc.; Steve Rosenberg, president, Community Oriented Correctional Health Services; Dan Mistak, general counsel, Community Oriented Correctional Health ServicesSusannah Vance Gopalan, partner, Feldesman Tucker Leifer Fidell LLP.  Register here.

The Department of Human Services (DHS) has announced that they are extending the request for application deadline to Thursday, March 3, 2016, at 5:00 pm. Late last week, a glitch in the Certified Community Behavioral Health Clinics (CCBHC) application was discovered. The Department of Human Services (DHS) fixed the issues and application information can now be entered in the correct fields. Due to this potentially causing a delay in completion of the application, DHS is extending the deadline. The application is available here.

Additional changes include that the required letters of support from the County Mental Health/Intellectual Disability Programs, and Single County Authorities, should be submitted directly to the CCBHC resource account. They should not be sent to the agency submitting the application.

DHS also invites you to attend the second CCBHC Steering Committee meeting. This meeting is taking place on Monday, February 29, 2016, 9:00 am – 12:30 pm at the Child Welfare Resource Center (403 East Winding Hill Road, Mechanicsburg). The first portion of the meeting will be devoted to providing an update and the remainder of the time will focus on the following CCBHC workgroups: Stakeholder Engagement, Data Collection and Reporting, Prospective Payment System, and CCBHC Certification.