State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® September 2009 Clinical Training for OMS Providers

Presenters Nancy Calvert, Director, Provider Relations, ValueOptions® Maryland Jennifer Lowther, Clinical Director, ValueOptions® Maryland

Agenda Update Outcomes Measurement System Overview of ProviderConnect Requesting Authorizations Questions

Updates ValueOptions® Maryland Website – Provider Alerts MHA Policy Clarification Memos and Announcements ValueOptions® Maryland Updates and Announcements – Training Schedule – ProviderConnect “tips” – Maryland Specific ProviderConnect “demo” – Provider Forms – including a hard copy concurrent review form – Coming Soon: Provider Manual Diagnostic Crosswalk Fee Schedule Service Grid – Consumer Information

OMS Information on Website “For Providers” “Provider Forms” OMS Tools Discharge Information Sheet Adult Questionnaire Definitions for Adult OMS Interview Adult Questionnaire Response Cards Adult Discharge Form – Consumer Not Participating Child and Adolescent Questionnaire Child and Adolescent Response Cards Child and Adolescent Discharge Form – Consumer not Participating The OMS Interview Guide will be included in the Provider Manual

September 25 th System Upgrades Online Uninsured Eligibility Registration (request function) is now available to providers. Axis 1-V diagnoses are now required on concurrent reviews The “Individual Care Plan” – The Plan tab has been added to the Mobile Treatment authorization request screen. – The Service Code Field has been removed – Providers now have the option to print the Plan separately. “MCO” is no longer a required field. “Education Level” has been deleted from the federally required questions. “N/A” is no longer an option to the “Race” question.

Outcome Measurements System (OMS) Measures consumer outcomes regarding the management of their illness and the quality of their lives. Supports recovery and resiliency An important measure of the benefit provided by services in the PMHS

OMS In effect since September 2006 Collaboration between – Mental Hygiene Administration (MHA) – University of Maryland Systems Evaluation Center (SEC) – MHA Administrative Service Organization (ASO) Only for outpatient services provided by – In-state providers Hospital outpatient clinics Federally Qualified Health Centers (FQHC) Outpatient Mental Health Clinics (OMHC) Local Health Departments Consumers: – Ages 6-17 and Regardless of age, Dually eligible Medicare/Medicaid consumers are excluded from OMS

OMS Questionnaires Separate questionnaires for adults and youth – Adult questionnaire contains the BASIS-24 questions Cover several life domains: – Living situation, Employment, School attendance, Substance use, Legal system involvement, Symptoms, Functioning, etc Administered every six months Documentation of completion should be included in the consumer’s clinical contact/progress notes.

OMS Service Bundle 150 Unit Service Bundle Includes: – 2 outpatient evaluations (90801) – 2 family therapy sessions without consumer present (90846) – Medication management – Individual Therapy – Group Therapy Excluded: – All extended therapy codes – Additional sessions of or – Services associated with crisis bed stays – Intensive Outpatient Services (IOP) – Partial Hospitalization Programs (PHP) – Initial and subsequent inpatient care Combination of service rules apply pdf

Services Included in the OMS Authorization 90801: Initial Evaluation* 90804: Individual Psychotherapy (20-30 minutes) 90805: Individual Psychotherapy with Med Eval/Mgmt 90806: Individual Psychotherapy (40-50 minutes) 90807: Individual Psychotherapy with Med Eval/Mgmt 90846: Family Psychotherapy without Patient Present* 90847: Family Psychotherapy with Patient Present 90849: Multiple Family Group 90853: Group Therapy 90862: Medication Management 90875: Individual Psychotherapy with Biofeedback 90876: Individual Psychotherapy with Biofeedback T1015: FQHC Clinic Visit Rev Codes: 0510, 0513, 0910, 0914, 0915, 0916, 0917, 0918, 0919

OMS Services, continued Discharge Codes (included in the authorization bundle) Not included:* Extended visit codes (90808, 90809) More than two initial evaluations (90801) More than two family psychotherapy without patient present services (90846) *Separate pre-authorization required

OMS Registration/Authorization Initial Registration: – 2 visits/3 months – 2 additional visits may be requested telephonically under special circumstances Continuing Registration (150 bundle) – May be requested with the initial registration – The start date of the continuing registration will always the day after the date of the OMS interview End of Authorization/Discharge – May be performed up to 10 days after the authorization is closed – After 100 days neither a continuing OMS nor a discharge OMS will be accepted. – With consumer present: Discharge Information Sheet OMS Questionnaire – Without Consumer Present: Discharge Information Sheet Discharge OMS Form

End Users License Agreement (EULA) Required for all OMS Providers of service to adults – OMHC, FQHC, Hospital Based Clinics Allows inclusion of the BASIS-24 questions Return a signed copy to ValueOptions® Maryland Maintain individually signed copies in staff personnel files Failure to sign: – Questionnaire must still be completed (minus the BASIS 24 questions) – Providers will only receive 12 visits per authorization period. Available on both the MHA and ValueOptions® Websites Contact: Teana Jones – Fax: –

ProviderConnect 15

ValueOptions ® ProviderConnect Free, secure, online application Easy access 24 hours a day, 7 days a week Complete multiple transactions in a single sitting ProviderConnect is an online tool that increases convenience & decreases administrative burden.

ValueOptions ® ProviderConnect Features Verify Consumer eligibility Register Uninsured Consumers Request Authorizations View Authorizations Submit Claims (Batch and Direct/On-line claim) View Claim Status View and Print Provider Summary Voucher Submit inquiries to Customer Service Access and print forms With ProviderConnect providers can:

Accessing ProviderConnect Each provider has a secure login and online registration, including a provider ID number via the ProviderConnect Web site. Additional logins for other providers in the same practice are available through ProviderConnect. Contact: ValueOptions ® EDI Helpdesk (888) , Option 3 Monday through Friday 8 a.m. – 6 p.m. EST Turn around time for additional logins is 48 hours.

OMS Authorization Requests Live Demonstration

20 Questions

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