Network Adequacy Standards Mental Health Slide 1 Network Adequacy Standards Mental Health Timely Access, Timely Access Reporting, Timely Access Monitoring & Support DATA DRIVEN Power Point Presentation September 5, 2019 Respectfully submitted by QI-IT

Agenda Slide 9 DHCS Network Adequacy Standards Timeliness Requirements, Effective July 1, 2018 Timely Access Reporting (2): Timely Access Tracking & Completion Timely Access Monitoring & Support Quarterly (Short-Term) Name: Timely Access Reporting Monthly (Long-Term) Name: Client Services Information Assessment Record 6 Data fields 1st Submission March 2019 (Dec 2019-Feb 2019 requests) 2nd Submission July 2019 (Mar 2019-May 2019 requests) 3rd Submission October 2019 (June 2019-Aug 2019 requests) 16+ Data fields 1st Submission August 2019 (June 24-30, 2019 requests) 2nd Submission September 2019 (July 2019 requests) Monthly thereafter

DHCS - Timely Access Requirements, Effective July 1, 2018 Provider Type Timely Access for Non-Urgent Appointments MH Outpatient Mental Health Services Within 10 business days from request to appointment MH Psychiatry Within 15 business days from request to appointment Authorization Timely Access for Urgent Appointments Do not require prior authorization Within 48 hours of a request Required prior authorization Within 96 hours of a request Network Adequacy = the ability of a health plan to provide its participants/patients a sufficient number of in-network providers DHCS References: https://www.dhcs.ca.gov/formsandpubs/Documents/FinalRuleNAFinalProposal.pdf https://www.cibhs.org/sites/main/files/file-attachments/wed_1030__medicaid_managed_care_final_rule_boylan_a__horner_d.pdf

Non-urgent Timely Access Quarterly Reporting “Short-Term” New clients: 1. Never had a service/Avatar ID 2. Absence for 12 months &+ 3. Had an incomplete assessment Requested Data Fields: Name of the beneficiary Date of the request for services Referral source (e.g., beneficiary, authorized representative, social services agency, managed care plan) Date of the assessment or first “kept” Medi-Cal service Explanation if no service was provided Optional: Information about offered appointments and/or “no-shows” Next submission: October 2019 (Data: June 2019-August 2019)

Timely Access Quarterly Reporting “Short-Term” Last NACT submission: July 1, 2019 Service Request Period: March 2019 – May 2019 data Data Source: DBH Avatar: Avatar Access Form & Entered Services N=820 N=783 N=744

Monthly Client Services Information Assessment Record “Long-term” Data collection and monthly reporting/submission began over 20 years ago (1998) on all persons served regardless of funding Client Services Information had mainly 3 reporting records until March 2019: Demographic Service Periodic Beneficiary Assessment Record (Timely Access) - IN# 19-020 Non-urgent, non-psychiatry mental health service appointments only Data collection required to start June 23, 2019 1st submission due in August 2019 for June 2019 service requests References: 9 CCR § 3530.10 § 3530.10. Client and Service Information System Data. https://govt.westlaw.com/calregs/Document/I78065AB0D45311DEB97CF67CD0B99467?contextData=%28sc.Default%29&transitionType=Default DMH LETTER NO.: 98-0 https://www.dhcs.ca.gov/formsandpubs/MHArchiveLtrs/MH-Ltr98-03.pdf

Monthly Client Services Information Assessment Record “Long-Term” Reference: https://www.sccgov.org/sites/bhd-p/QI/Documents/MHSUDS_Info_Notice_19-020-CSI_Assessment_Record.pdf

Monthly Client Services Information Assessment Record “Long-Term” Reference: https://www.sccgov.org/sites/bhd-p/QI/Documents/MHSUDS_Info_Notice_19-020-CSI_Assessment_Record.pdf

Monthly Reporting: Client Services Information Assessment Record “Long-Term” Requested Data Fields: Date of 1st contact to request service Referral source Assessment appointment 1st offer date Assessment appointment 2nd offer date Assessment appointment 3rd offer date Assessment appointment accepted date Assessment start date * Assessment end date * Treatment appointment 1st offer date Treatment appointment 2nd offer date Treatment appointment 3rd offer date Treatment appointment accepted date Treatment start date * Closure reason Closed out date Referred to * Data will be extracted via a query from entered services via (1) Clinical notes, (2) Batch upload or (3) Direct service entry

Timely Access Tracking & Completion County DBH MyAvatar “Access” Form Legend: Renamed New Tab w/same info Tab: Request Information - Service request, urgent or not, & disposition Tab: Contact Attempts - Track efforts in making the offer of assessment appointment Tab: Assessment Scheduling - Assessment appointment(s) offered & accepted Tab: Treatment Scheduling - Treatment appointment(s) offered & accepted Tab: Access Closure - Closure reason & closed out date Tab: Administrative Only - Test call & not meeting timeliness notification letter issued Actual/kept assessment and treatment dates will be extracted/pulled for reporting via a query

Timely Access Tracking & Completion MyAvatar “Access” Form Request Information New service request, urgent or not, & disposition Assessment Scheduling Assessment appointments offered & accepted Treatment Scheduling Treatment appointments offered & accepted Contact attempts (3) to offer the assessment appt. New: 1. Never had a service/Avatar ID 2. Absence for 12 months &+ 3. Had an incomplete assessment Access Closure Assessment: Did not accept any offered assessment appt. Accepts offered assessment date but did not show Attended the assessment appt. but did not complete Does not meet medical necessity criteria Treatment: Completes assessment process but declines offered treatment dates Accepts offered treatment date but did not show  Submission Close Out Date – for those in red QA Review & Feedback Week 1 ------------->-------------------------------------->--------------------------------------->-----------------------> Week 5 <- Week 6 – 8 -> Pre-submission Review

Current Tracking & Completion 1st submission is August 2019 for June 2019: June 24-30, 2019 Service Requests Disposition # of Request First Ass. Offer Filled First Ass. Accept Filled Had Assessment Treatment First Offer Filled Not a Mental Health Request 3   1 Other 4 Referred to Community Resources Referred to Crisis Services 6 2 Referred to MHP Provider 106 65 60 68 35 Referred to PCPs/Health Care Plan 12  Blank 5 Total 140 66 61 75 36 # of Requests Medi-Cal 140 80% Not Medi-Cal 34 20% Total 174 Referred to MHP Provider & Had First Assessment Referred to MHP Provider 68 0-14 Days 42 62% 15 & + Days BUT Offered in 0-14 Days 5 7% 15 & + Days 21 31%

Current Tracking & Completion Submission A minimal complete Timely Access (Assessment Record) will consist of: DATE OF FIRST CONTACT TO REQUEST SERVICE ASSESSMENT APPOINTMENT FIRST OFFER DATE May decline CLOSURE REASON With reason “Beneficiary did not accept any offered assessment dates” CLOSED OUT DATE The date that Beneficiary declined

Current Tracking & Completion 1st Report for submission – June 2019, Period: June 24-30, 2019 Observations: Had the assessment service & did not fill out First Assessment Offered Had the assessment service & did not fill out First Assessment accepted First & Second Assessment Offered have the same date Others: Some programs do not have access to enter the service request Some programs do not have access and do not enter

Monitoring & Support Reports in Avatar: Fresno MH Access NACT Submission report More QA reports coming Support: DBH QA Review - weekly Webinar training series coming

1st Contact of Service Request Situations Client Services Information Assessment Record Frequently asked 1st Contact of Service Request Situations Situation: If a person other than a future client contacts the MHP seeking services for the future client What to do: Depends on the legal status of that person making the initial contact: Legally authorized to consent to services for the future client – YES Does not have legal authorization to consent to service – NO. Contact the client/legally authorized person to confirm the interest in service, then offer an assessment appointment & that date is the 1st contact to request services Situation: If a beneficiary/client enters the system via a crisis intervention What to do: This date is considered the be 1st contact to request services Situation: If a beneficiary/client enters the system via a crisis stabilization or in-patient service What to do: 1st contact is when a beneficiary/client is discharged and the first stepdown service is requested by provider, client, or other referral source

Questions ? Slide 11 We have a few handouts for you: Simplified flowchart Q&A Questions ?

Thank you for your time & Feedback Slide 11 Thank you for your time & Feedback