Mental Health Data Alliance, LLC (MHData) May 3, 2018 DHCS CSI and DCR Data Quality Improvement Project Epic Healthlink County Issues Mental Health Data Alliance, LLC (MHData) May 3, 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

Epic Healthlink Counties Contra Costa Santa Clara

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.

Specific Issues by County: Contra Costa It is very difficult to test data submission when switching EHR with de-identified data. It makes it very hard to do testing. If a county can't send up real data, then the county can't predict what the real errors would be once there is a switch to production submission of real data. Testing should be permitted on real data. Mode 05 Adult Residential clients dipped in January of 2016 Mode 05 IMD clients are low. Mode 05 SNF Intensive clients dropped significantly in July of 2011. Mode 10 Crisis Stabilization - ER monthly clients dipped significantly in February of 2016. There was a dip in clients in November 2015 through February 2016.

Specific Issues by County: Santa Clara The county is moving to NetSmart avatar in early 2018. County gets error report but unable to target the errors because they are only receiving the summary. Mode 05 IMDs clients appear to be declining, but unfortunately should be increasing Mode 05 Jail Inpatient stopped reporting, but not being reported now. County not sure who was reporting it. Mode 05 PHF is not being reported regularly. Mode 15 (30-38) Mental Health Services has been declining unrealistically each year. Mode 15 (40-48) Mental Health Services has been declining unrealistically each year. Mode 15 Collateral has been declining unrealistically each year. Mode 15 Linkage/Brokerage has been declining unrealistically each year. Mode 15 Medication Support dropped with the switch to Avatar. The total number of clients has been declining unrealistically.

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)

Health Information Systems MHP HIS Requirements:  (a) The MHP shall maintain a health information system that collects, analyzes, integrates, and reports data and provides information on areas including, but not limited to, utilization, grievances and appeals as required by title 42 CFR section 438.242(a). (b) The basic elements of the health information system as required by title 42 CFR section 438.242(b) shall, at a minimum: (1) collect data on a beneficiary and provider and on services furnished to beneficiaries; (2) ensure that data received from providers is accurate and complete by verifying the accuracy and timeliness of reported data; screening the data for completeness, logic, and consistency; and collecting service information in standardized formats to the extent feasible and appropriate. Contracted Provider HIS Requirements: Contracted providers shall maintain a health information system that collects, analyzes, integrates, and reports data. The system shall ensure that data received from providers is accurate and complete. The system shall make all collected data available to the Department and, upon request, to CMS. Reference: 2013-2018_MHP_Contract_pg54; 9 CCR § 1810.376

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

GENERAL MEDICAL CONDITION SUMMARY CODE by County In FY2017/18 Kern and San Luis Obispo still had large numbers of these errors GENERAL MEDICAL CONDITION SUMMARY CODE by County

GENERAL MEDICAL CONDITION SUMMARY CODE

GENERAL MEDICAL CONDITION SUMMARY CODE

GENERAL MEDICAL CONDITION SUMMARY CODE

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

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 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)