Billing Strategies for ACT

Slides:



Advertisements
Similar presentations
Welcome to AreaColumbia MentalHealthCenter. Hours of Operation Monday – Friday 8:30 AM to 5:00 PM.
Advertisements

Accessing Substance Abuse and Mental Health Services in Washtenaw County Barrier Busters Presentation July 24, 2013.
SCHOOL PSYCHOLOGISTS Helping children achieve their best. In school. At home. In life. National Association of School Psychologists.
The Alcohol and Drug Abuse Administration State Care Coordination 1.
DHSS DSAMH Department of Health and Social Services Division of Substance Abuse and Mental Health.
Medicaid and Vivitrol Strategies in Colorado
OVERVIEW OF DDS ACS HCBS MEDICAID WAIVER. Medicaid Regular state plan Medicaid pays for doctor appointments, hospital expenses, medicine, therapy and.
Iowa Health and Wellness Plan
Documenting the Recovery Journey in Progress Notes Essential Skills for Providers.
Planning for the Future: Understand DMH-DD Systems and Service Options Presented By: Kadesh Burnett; St. Louis County Regional Office Family Support Coordinator.
DMAS Office of Behavioral Health
IMPLEMENTATION OF HOUSE BILL 2782 REFORMING THE GENERAL ASSISTANCE PROGRAM This presentation was prepared at member request by staff from the House of.
Iowa Health and Wellness Plan Healthy Behaviors Program.
2/16/12 Marilyn Bertolucci Coordinator of Special Education Services.
Accommodation Plans.  Civil Rights legislation for persons with disabilities indicates that schools must afford students with disabilities equal opportunities.
Psychiatric Mental Health Nursing in Acute Care Settings.
A View From the Ground Better Care at Lower Cost for High Risk Patients.
A Pennsylvania and New Jersey Collaboration 2012.
REAL-START : Risk Evaluation of Autism in Latinos (Screening Tools and Referral Training) Assuring No Child Enters Kindergarten With an Undetected Developmental.
Kristie R. Schmiege, MPH, CCS, CADC, CPC-M Director of Substance Abuse Services Genesee County Community Mental Health May 18,
MaineCare Behavioral Health Homes January,
Page 1 DBHDS Virginia Department of Behavioral Health and Developmental Services Systemic Therapeutic Assessment Respite and Treatment (START) Bob Villa.
11/8/2006 Benefits and Work Incentives Planning: System Development NCHSD Fall Conference November 8, 2006 Damon Terzaghi: Oregon Competitive Employment.
Health Care Science Technology
Magellan Training: Medicaid Rehabilitation Option MRO.
Special Education Process: Role of the School Nurse Marge Resan, Education Consultant Special Education Team Wisconsin Department of Public Instruction.
Module V – Coordinated Care BUPRENORPHINE TREATMENT: A TRAINING FOR MULTIDISCIPLINARY ADDICTION PROFESSIONALS.
Developmental Disabilities Eligibility Information Shared by Molly Holsapple ODDS February 17, 2011 specific questions contact your County DD Program.
Services Overview: Mental Health/Substance Use Disorders Programs and Managed Care Plans 1 Medi-Cal Managed Care Plans (MCP) County Mental Health Plan.
Lakeview Rehab at Home What we’ve learned so far Third Thursday Presentation January 20, 2011.
Assertive Community Treatment An Evidence-based Practice.
EPSDT Specialty Mental Health Services John Burton Foundation Lynn Thull, PhD California Alliance of Child and Family Services December 17 th, 2015 California.
MCCMH and ARC of Macomb What does your local PIHP provide? How can you make your voice heard? SECTION 298 UPDATE.
Medicated Assisted Treatment (MAT) Terry R. Jones Director of Behavioral Health.
Current Mental Health Care Systems
Current Mental Health Care Systems
ACT: A Vital Strategy in Fulfilling the Promise of Olmstead
NH Statewide Addiction Crisis Line HELP (4357)
NYS Health Home 101.
Inclusive Community Choices
FADAA Health Care Reform
MENTAL HEALTH MEDI-CAL ADMINISTRATIVE ACTIVITIES
Chapter 2 Ethical and Legal Issues
Current Mental Health Care Systems
Specialized Recovery Services Program: Ohio’s 1915(i) program
Assertive Community Treatment (ACT) Referral Process
Association of Indiana Counties Annual Conference September 27th, 2017
Community Services Proposed 2017 Budget August 23, 2016
Transition Essentials
  Medicaid Waivers July 2018.
Developing an Effective Assisted Outpatient Treatment Program
Developmental Disabilities Program
Service Development Initiatives, Adult Mental Health & Learning Disabilities Division This briefing is produced to support managers within adult mental.
State of Alaska Department of Labor and Workforce Development Division of Vocational Rehabilitation or DVR for short Angela Gray, Rehabilitation Counselor.
Behavioral Health Crisis Center “A back of the napkin view”
FY18 Contract Training June 26, 2017.
Primary Care Integration
Roles of the Mental Health Team:
Increasing Collaboration Around Social Determinants of Health
Forsyth County Daymark Recovery Services
General Education Homebound (GEH)
Assertive community treatment webinar
FY18 Contract Training June 26, 2017.
Beaver County Single Point of Accountability
Component 1: Introduction to Health Care and Public Health in the U.S.
Unlocked Potential: Breaking the Code of Job Development
Vision Transformative collaboration that fosters resilient self-sustaining Recovery Communities. Mission To develop and sustain measurable solutions that.
A Training For Multidisciplinary Addiction Professionals
Who is eligible? A child or adult who is: 1) Eligible for Medicaid
Transforming the Delivery of Substance Use Disorder Treatment in States Update August 2019.
Presentation transcript:

Billing Strategies for ACT Michael Oyster, LPC, CADC III Choice Model Lead ACT and Supported Employment Coordinator June 11, 2019 Health Systems Division Operations & Policy

Michael Oyster, LPC, CADC III Licensed Professional Counselor (LPC) Certified Alcohol & Drug Counselor (CADC III) Over 20 years in community mental health and substance abuse treatment services, crisis services and program development An explorer of billing services so that programs have the funding for sustainability

Learning Objectives Review eligible referrals to ACT Identify strategies and processes to bill for ACT services based on knowledge of the funding system Learn guidelines when billing for ACT services for a variety of insurances and other funding sources Contribute to the discussion about challenges you face as well as develop solutions to meet those challenges

ACT Eligibility ACT Admission Criteria: OAR 309-019-0245 SPMI Not a primary diagnosis of Substance use Intellectual developmental disability Borderline Personality Disorder PTSD Autism Spectrum Long term disability Significant functional impairments Practical daily living tasks (personal business, medical / legal, housing, self care, nutrition, hygiene) Employment or homemaker role Safe living situation

Exhibit M from CCO Contract 2019 In relation to ACT, CCOs must ensure: Those with SPMI are assessed for ACT eligibility ACT services are provided for those with SPMI Additional ACT capacity is created to serve SPMI When 10 or more members are on a waitlist for more than 30 days by Increasing existing ACT team capacity Adding additional ACT teams Consult with OHA to develop a plan to develop additional qualified providers Denials of ACT services are based on established criteria, recorded and compiled to accurately report denials Provide a Notice of Adverse Benefit Determination (NOA) for all denials of ACT services

Strategies and Processes ACT Physical Health Behavioral Health Informal Services The ACT billing code is a bundled code that is used by Medicaid Other insurances do not reimburse for the ACT code

OSH and Medicaid Historically, Medicaid has been suspended when clients are in Oregon State Hospital A bill has been passed that allows participants to keep their Medicaid throughout the hospital stay The details of how this will work is still being developed Until the details are worked out, use other funding resources to support in-reach and coordination with OSH Choice Model funding County Funding through Service Elements

Guidelines When Billing ACT When delivering ACT services for other insurances, unbundle the code Informal Services Behavioral Health Physical Health

The Services of ACT Psychiatry Nursing Mental Health Therapy Substance Use Therapy Case Management Supported Employment Supported Education Peer Delivered Services

Discussion problem Solving

Contact Michael Oyster LPC, CADC III Choice Model Lead ACT and Supported Employment Coordinator Office: (503) 945-9813 Michael.W.Oyster@state.or.us Health Systems Divisions Operations & Policy