Behavioral Health Learning Group August 10, 2016 Record of Learning Behavioral Health Participants • Kenton Beachy, Mental Health America of Franklin County • Duane Casares, Directions for Youth and Families • Nancy Cunningham, Nationwide Children’s Hospital • Megan Daugherty, Mental Health America of Franklin County • Jamie McKenna, Directions for Youth and Families • Dustin Mets, CompDrug • Alex Meyer, CompDrug • Jeri O’Donnell, OhioHealth
Coordinated by: • • • • •
Jim Schmidt, OhioHealth Jennifer Sheets, Concord Counseling King Stumpp, Netcare Access Staci Swenson, PrimaryOne Health Amy Walton, PrimaryOne Health
Healthcare Collaborative of Greater Columbus • Michelle Missler • Krista Stock
Shared Learning Discussion Purpose: Share and discuss regional, state, and national emerging activities and the implications for behavioral health organizations. Key takeaways: Quality Payment Program (QPP) is the new Medicare payment model for providers established under Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) beginning in 2017. CMS will publish final rules later in 2016. Under QPP, providers will start to be paid based on quality, cost, practice improvement, and use of care information. Behavioral health providers may be included depending on the types of clinicians that provide services in their organizations. QPP resources Ohio was selected by CMS as one of 14 regions to implement the patient-centered medical home (PCMH) model, Comprehensive Primary Care Plus (CPC+). CPC+ aims to strengthen primary care and reward value by incentivizing providers to improve quality and lower costs. What could this mean for behavioral health organizations? Primary care providers will focus on improving practice functions such as care coordination with others including behavioral health providers. Proposed quality metrics include those similar to the ones behavioral health providers are already focused on. CPC+ resources Ohio Medicaid and The Governor’s Office of Health Transformation has also launched Ohio’s PCMH model for providers. It is highly aligned with CPC+ using similar quality metrics, payment incentives, and practice transformation indicators. Both CPC+ and Ohio CPC use a multipayer approach to also engage commercial plans to reward providers in similar ways. This could give providers the scale needed to invest in transformation resources. Behavioral health providers can contribute to the success of these models by working with primary care practices to drive improvement in areas such as care coordination and patient engagement. Ohio CPC resources Dustin Mets shared an update on Ohio’s Behavioral Health Redesign and important changes to the timeline. See attached handouts or go to the Behavioral Health Redesign resources. Important dates for providers to keep in mind: o The implementation date for requiring that rendering practitioners are included on service claims is January 1, 2017 for all organizations. Practices will need to enroll rendering practitioners in MITS and affiliate them with the employing agency. o All providers will be required to transition to the new code sets beginning with dates of service July 1, 2017. Behavioral health providers are encouraged to use the links provided to sign up for updates and monitor progress of these initiatives. BHLG members can discuss implications for providers in upcoming sessions.
Shared Learning Discussion (continued) Briefing: Get Connected, MHAFC, Megan Daugherty, What is the Get Connected program and what resources are available for behavioral health providers? Megan shared an overview of the Get Connected (GC) program. GC is a 6-week program to help patients learn how to take charge of their health and wellness leading that can ultimately lead to better self-management of chronic health conditions. The group discussed ways organizations can utilize the program within their own organizations. Several BHLG participating organizations are already using the GC program. PrimaryOne Health shared a success story about one of their patients that participated. Go to the Get Connected website for more information about the program and how to contact Megan. Strategic Guidance Purpose: HCGC will use learning from the discussion to shape regional project work Briefing: What learning is taking place while gathering an inventory of depression screening and education work across our region? Discussion: If success was guaranteed in having all patients in our region screened for depression, what are the opportunities and challenges for improving depression management? Learning from the discussion: Opportunities: De-stigmatization of mental illness • increased awareness and opportunity for intervention • better understanding that depression is treatable • normalizing screening and diagnosis will lead to a better understanding of how widespread this condition is Innovation and Resources • Identification of challenges can lead to innovation • Tele-Psych is an opportunity • Increased data could result in increased resources Integrated Care • Forces organizations to rethink how you organize care • Integration can lead to a higher level of compliance Positive Patient Outcomes • Consistency in med management & adherence • Creates an opportunity to identify self-medicating behaviors • Validates patient experience • Positive outcomes for patients • Increased opportunity for diagnosis and treatment
Challenges: • Managing the side effects of medications • Changing the belief that depression = “crazy” • Demand is greater than supply-perpetuating an existing issue in the BH community • Roles and responsibilities -Defining “who” administers the screening • Cultural challenges of diagnosis and management • Who monitors the individual? Who receives the funding to manage, monitor, track • Patient engagement and follow through • Touching patients for short periods of time • Data tracking, potential medication side effect
Download the slides shared in today’s session. Future learning sessions: Behavioral Health Learning Group session: November 16, 2016, 9:00-10:30AM Regional Learning Session: August 19 and December 9, 8:30 – 11:30 am, Register at www.hcgc.org/registration/ Learning session value survey: Very High Value High Value Medium Value Low Value No Value
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Additional comments or reflections or suggestions for future learning topics: • Good discussion on depression. It is a great learning experience to hear about what is going on with other providers • Information in shared learning discussion is all very helpful! • Future topic: working with managed care organizations - what are providers learning/accomplishing? • I've missed a couple of meetings but I really like today's format and structure. A mix of updates, shared learning, small group work, and large group discussion. Great mix and energizing • Robust discussion - good networking • Thank you! • Very informative session - updates were really helpful, and the strategic guidance session was interesting. • Great info • Learned of resources that will be very useful in practice
Rendering Practitioner Enrollment Update July 7, 2016
Behavioral Health Redesign Brief Update on Rendering Practitioner Enrollment & Agency Affiliation The Ohio Department of Medicaid has received a number of inquiries regarding the deadline for providers of community mental health and/or community substance use disorder services to enroll and affiliate rendering practitioners with their agency(ies). As a reminder, the implementation date for requiring rendering practitioners on Medicaid community behavioral health service claims is January 1, 2017 (not July 1, 2016). Practitioners who must enroll with Ohio Medicaid: Physicians (MD/DO), Psychiatrists Physician Assistants Certified Nurse Practitioners Clinical Nurse Specialists Licensed Psychologists Licensed Independent Social Workers
Licensed Independent Chemical Dependency Counselors Licensed Professional Clinical Counselors Registered Nurses Licensed Practical Nurses Licensed Independent Marriage and Family Therapists
Community behavioral health agencies must take two actions prior to January 1, 2017: 1.
Continue enrolling rendering practitioners in MITS and
2.
Affiliate those rendering practitioners with the employing agency.
MITS Technical Limitation: Agencies that have submitted their MITS revalidation request (Application Tracking Number [ATN] issued) cannot affiliate with their rendering practitioners until their revalidation is complete. However, a rendering practitioner can affiliate themselves with their employing agency regardless of its MITS revalidation status. Agencies providing community mental health and/or community substance use disorder services that are in the MITS revalidation process should work with their rendering practitioners to affiliate in MITS with their rendering practitioners.
Resources: Instructions - Enroll rendering practitioners (April 19 MITS BITS). Instructions - How to affiliate individual practitioners.
MITS BITS Provider Information Release
Rendering Practitioner Update
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Behavioral Health Redesign Updates – August 4, 2016 In our July 15, 2016 communication to the Behavioral Health Redesign Stakeholder group, we indicated that we would share any policy changes and/or substantive updates that occur in advance of our next meeting. As you know, we received several “on fire” issues and recommendations that we have taken under serious consideration. At this point, we want to provide you with a few clarifications and updates as well as reminders of activities that will be occurring over the next few months. This is not an exhaustive list. Rather, we will share with you any additional clarifications or updates that we have before the August 23, 2016 meeting in another communication so they can help inform our discussion. Clarifications Physician assistants are able to provide and therefore bill using the evaluation & management (E&M) codes as well as the psychotherapy, prolonged service, and interactive complexity add-on codes. The coding chart has been updated to reflect the correct rate for ASAM Level 3.3. Psychology assistants are included in the coverage and limitations work book. Board-licensed school psychologists are included in the coverage and limitations work book. The venipuncture code was omitted in error and will be reinserted in the coverage and limitations work book. The weekly rates for methadone and buprenorphine administration coding has been corrected to $114.66 in the coverage and limitations work book. Policy Updates The requirement that Masters-level practitioners have 1 year of experience in order to provide Therapeutic Behavioral Services (TBS) has been eliminated. The requirement that Bachelors-level practitioners have 2 years of experience in order to provide TBS has been eliminated. Qualified mental health specialists who have a minimum of three years of experience on or before July 1, 2017 will be able to provide TBS. The following will be available on January 1, 2017 for opioid treatment programs (OTPs): o The daily and weekly buprenorphine administration coding and buprenorphinebased medication J-codes will be available for federally-recognized OTPs. o Weekly methadone rate will be available for state-licensed OTPs. o Oral naltrexone J-code. o Naloxone J-code. o The established patient office visit (99211) will be available to be used when administering the naloxone on site. Reminders All Medicaid claims will require a rendering provider by submission of their National Provider Identifier (NPI) beginning with dates of service of January 1, 2017.
All providers must transition to the new code set, including CPT/HCPCS and the E&M codes, for dates of service beginning July 1, 2017.
ODM and OhioMHAS are continuing to conduct the regional trainings. Eight of the ten trainings have been completed, and across all ten trainings, there have been over 1,500 registrants. The slide deck, as well as the draft manual, and the draft coverage and limitations workbook containing the new CPT/HCPCS codes, rates and coverage information are currently available at bh.medicaid.ohio.gov. Please refer to the website for dates and information on additional training opportunities. In addition, OhioMHAS has partnered with the Ohio Council to provide trainings on clinical practice change, coding, and documentation for the CPT code changes. These trainings will be held on August 25, August 29, and September 12, 2016. Additional information and registration instructions are available here: Ohio Council Practice Change Flyer. You do not need to be a member of the Ohio Council in order to participate in these trainings. OhioMHAS and ODM are also partnering with the Ohio Association of County Behavioral Health Authorities to conduct another series of regional trainings later this fall. Please see the list below for dates and locations for these Behavioral Health “201” trainings. Additional information on how to register will be forthcoming. We look forward to meeting with you at the August 23, 2016 stakeholder meeting to discuss these and any additional clarifications or updates we may share before then. A meeting confirmation, agenda and any additional materials will be sent to the group in advance.
BEHAVIORAL HEALTH REDESIGN 201 TRAININGS
Behavioral Health Redesign – Cleveland Thornton Center Cuyahoga Community College 2500 East 22nd Street Cleveland, Ohio 44115
October 14, 2016
Behavioral Health Redesign - Central Ohio Xenos Christian Fellowship 1340 Community Park Drive Columbus, OH 43229
October 18, 2016
Behavioral Health Redesign – NE Ohio Cuyahoga Falls Natatorium 2345 4th Street Cuyahoga Falls, OH 44221
October 20, 2016
Behavioral Health Redesign – SW Ohio Mt. Washington Presbyterian Church 6474 Beechmont Avenue Cincinnati, Ohio 45230
October 27, 2016
Behavioral Health Redesign – NE Ohio Promedica Hospital Auditorium 2142 North Cove Boulevard Toledo, OH 43606
November 4, 2016
Behavioral Health Redesign - SE Ohio Zane Trace Campus Center 1555 Newark Road Zanesville, Ohio 43701
November 14, 2016
Behavioral Health Redesign – Heartland First Christian Church 6900 Market Ave N, Canton, OH 44721
November 15, 2016
Behavioral Health Redesign - Central Ohio Ohio Department of Agriculture 8995 East Main Street Reynoldsburg, OH 43068
November 21, 2016