Mental Health Data Alliance, LLC (MHData) May 10, 2018 DHCS CSI and DCR Data Quality Improvement Project Welligent County Issues Mental Health Data Alliance, LLC (MHData) May 10, 2018

Project Goals Support the ability to submit good data to the current state CSI and DCR mental health data systems Close the feedback loop for counties to validate that they have good data in the CSI and DCR state mental health data systems Improve the value of state CSI and DCR mental health data systems for counties, the state and stakeholders

Approach Over 1.5 years: Provided counties with 2 reports which provide an overview of current data and errors for CSI and DCR Met with counties to review reports and identify potential causes of data patterns and inconsistencies Work with counties and DHCS to improve processes to submit data to DCR and CSI Provide counties with 2 reports which provide an overview of improved data for CSI and DCR

Welligent Counties Tri-City

General Findings All CSI type services should be reported, regardless of funder. Mode 05 programs may not be set up in EHR to report to CSI. Programs and providers may not be calibrated to report to CSI. After initial calibration of the EHR, when a new provider or program is added, the submitting entity may not have a process in place to identify and flag appropriate programs and providers for reporting to CSI, resulting in a steady decline over time as old programs and providers are retired and new programs and providers become established. There are unresolved causes of “Relational” errors Periodic records reported as of “date collected” are more frequent than expected.

Specific Issues by County: Tri-City County would like to have a process to make batch corrections of records rather than one by one. The report is useful and county would like to have it more frequently. There were over 14,000 errors due to "Relational Error" without further description. It is difficult to correct errors one by one in the BHIS system. It is inefficient to correct errors after they have been submitted to the CSI rather than before submission in the source EHR. It is difficult to address errors for all clients because the CSI limits the report to one client per time. There are no Mode 05 Services showing for Tri-City which are all out-of-county. Mode 15 (30-38) Mental Health Services have not been reported since FY 2008/09. Mode 15 Crisis Intervention minutes have dropped to 1/8 of or less since FY 2007/08. Mode 15 Linkage/Brokerage clients are down to about 20-30 per month on FY 2016/17, down from over 100 per month in FY 2013/14. Mode 15 Medication Support has not been reported since FY 2013/14. Periodic Records appear to be reported more frequently than assessments are given/collected. There was a dip in total clients from August of 2014 through April of 2015.

Review of What is Required to be Reported

CSI Reporting Requirements Who needs to be reported? What needs to be reported? Reporting Periodic Records Health Information Systems

Who needs to be reported? CSI system reflects Medi-Cal clients, non-Medi-Cal clients, and services provided in County, City/Mental Health Plan programs County-staffed providers: all clients & services must be reported Contract Providers: Clients & services provided in contract with County Mental Health Program must be reported. “All persons served in treatment programs must be reported to the CSI System. This includes both Medi-Cal and non-Medi-Cal clients, and persons served by the private practitioners that were formerly in the Fee-For-Service System” (MH-Ltr98-03). Exceptions: State Hospital and Conditional Release CONREP clients Phase I (Inpatient) Consolidation providers and services References: 10-Reporting Tips - Tip One - April 2016 (Technical Supplement F); MH-Ltr98-03 Reporting Tips, Tip 1 (top 3 bullets). 97-17 notice (4th bullet)

What needs to be reported? Client record information at first contact 24 Hour Services (Mode 05) Day Services (Mode 10) Outpatient Services (Mode 15) Periodic Records References: 10-Reporting Tips - Tip One - April 2016 (Technical Supplement F); MH-Ltr98-03 Reporting Tips, Tip 1 (top 3 bullets). 97-17 notice (4th bullet)

Review of Diagnoses Fields and ICD-10

CSI and ICD-10 Fields Reference: CSI Data Dictionary on and after October 2015

Reporting DX Reference: 10-Reporting Tips – Tip Three – April 2016 International Classification of Diseases 10th Edition (ICD-10) code is required. The Principal and Secondary Mental Health Diagnoses must be diagnoses for which mental health services are provided. The S-09.0 Principal Mental Health Diagnosis should reflect the diagnosis that is the primary focus of attention or treatment for mental health services. The S-10.0 Secondary Mental Health Diagnosis should reflect the diagnosis that is the secondary focus of attention or treatment for mental health services. Up to three diagnoses are allowed in the data field S-11.0 Additional Mental or Physical Health Diagnosis. They may include mental, substance use, developmental disorders, or physical health disorders. If there are more than three diagnoses available to be reported, list the three most important. Up to three General Medical Condition (GMC) Summary Codes from the list of general medical conditions provided are allowed in the S-34.0 General Medical Condition Summary Code field. Identify whether or not the client has a substance abuse/dependence issue in the S-37.0 Substance Abuse/Dependence field. If the client does have a substance abuse/dependence issue, then report the substance abuse/dependence diagnosis in the S-38.0 Substance Abuse/Dependence Diagnosis field. Reference: 10-Reporting Tips – Tip Three – April 2016

Reporting Rules DHCS originally did not allow “R69” (Illness, unspecified) and “Z0389” (Encounter for observation for other suspected diseases and conditions ruled out) but believe they are now valid codes.  They had previously accepted “9999999” (DIAGNOSIS DEFERRED) and “0000000” (NO DIAGNOSIS), respectively. Reference: 10-Reporting Tips – Tip Three – April 2016; communications with DHCS

SECONDARY MENTAL DIAGS by County In FY2017/18 Stanislaus and San Luis Obispo still had large numbers of these errors

SECONDARY MENTAL DIAGS

ADDTL MENTAL/PHYS DIAGS by County In FY2017/18 Imperial, Marin, Mono, Monterey, San Bernardino, San Luis Obispo, Santa Clara, Sonoma, and Ventura still had large numbers of these errors

ADDTL MENTAL/PHYS DIAGS

Review of Reporting Periodic Records

Reporting Periodic Records Periodic Records, which contain data elements that change such as living arrangement, are collected and submitted at three intervals: First Contact with County Mental Health Plan Annually thereafter for active or continuing clients Formal Discharge from County Mental Health Plan After initial collection at admission, it is expected that the periodic data would be collected concurrently with outcome measures. References: Reporting Periodic Data, MH-Ltr98-03. 97-17 and 98-03 (same info in both). Also Reporting Tips, Tip 5 (pretty much same thing).

Periodic Records Periodic Fields: P-01.0 DATE COMPLETED P-02.0 EDUCATION P-03.0 EMPLOYMENT STATUS P-08.0 CONSERVATORSHIP / COURT STATUS P-09.0 LIVING ARRANGEMENT P-10.0 CAREGIVER

Reporting Periodic Records 1. AT “FIRST CONTACT” WITH THE COUNTY MENTAL HEALTH PLAN “First contact” Periodic data collection and reporting: Collection and reporting of Periodic record data for all County Mental Health Plan clients at “first contact,” or prior to the initial provision of mental health services, ensures baseline functioning level data are collected at the beginning of each client’s contact with the County Mental Health Plan. 2. “ANNUALLY THEREAFTER” FOR ALL ACTIVE OR CONTINUING COUNTY MENTAL HEALTH PLAN CLIENTS “Annual” Periodic data collection and reporting: Collection and reporting of Periodic record data on an annual basis for all active or continuing County Mental Health Plan clients ensures that current functioning level data are collected for analysis with baseline functioning level data to relate changes in a client’s functioning levels over time. County Mental Health Plans are encouraged to utilize a client’s annual Universal Method to Determine Ability to Pay (UMDAP) appointment to collect Periodic record data for annual reporting. Ideally, CMHPs should report Periodic record data annually (e.g., within a twelve month period) for all active or continuing clients. 3. AT “FORMAL DISCHARGE” FROM THE COUNTY MENTAL HEALTH PLAN “Formal discharge” Periodic data collection and reporting: Collection and reporting of Periodic record data at formal discharge (i.e., no further mental health services needed, client has reached treatment goals) from the County Mental Health Plan ensures that functioning level data as of “formal discharge” are collected for analysis with baseline and annual functioning level data to assess treatment efficacy of services delivered by the County Mental Health Plan. References: Reporting Periodic Data 97-17 and 98-03 (same info in both). Also Reporting Tips, Tip 5 (pretty much same thing).

Date Completed

Periodic Record Example

Periodic Record Analysis Looked at Children 6-16 in grades 1-11 who had periodic records two fiscal years in a row and found:

Periodic Record Analysis Looked at Children 6-16 in grades 1-11 who had periodic records two fiscal years in a row and found:

Next Steps Request for vendors to attend Webinar for Correction and Batch correction of CSI errors on May 31. Register: https://attendee.gotowebinar.com/register/1668479594631998723) Ask EHRs to work with counties to set up all CSI type services to report to CSI (regardless of if they are funded by Medi-Cal or other funders). Ask EHRs to adjust process to update information for clients, such as Special Population, which are not prompted for update such that outdated information is often sent with service records. Ask EHRs to establish a process for identifying new programs/services which should be flagged for reporting to CSI as they come online.

Next Steps Ask EHRs to comply with DHCS guidelines for Periodic Records: Periodic information should be collected at initial contact, discharge and annually Periodic records should only be sent when information is collected The “Date_Completed” field in the periodic record should reflect the date the information was gathered from the client If information is not collected, then information should not be sent

Discussion Other issues? Comments? Next Steps? Email Support DHCS: mhsdata@dhcs.ca.gov MHData: support@mhdata.org

DHCS CSI and DCR Data Quality Improvement Project Mental Health Data Alliance, LLC (MHData)