1. Mental Health Data Alliance, LLC (MHData) April 26, 2018
DHCS CSI and DCR Data Quality Improvement Project Echo InSIST County Issues
Mental Health Data Alliance, LLC
(MHData)
April 26, 2018

2. 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

3. 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

4. Echo Insyst Counties
Alameda
San Bernardino
Contra Costa
San Joaquin

5. 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.
Client settings such as Special Population are not prompted for update and outdated information is often sent with service records.
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.
Many Echo InSYST counties experienced large numbers of errors after the switch to ICD-10.
Periodic records reported as of “date collected” are more frequent than expected.

6. Specific Issues by County: Alameda
Mode 05 Hospital Administrative Day sometimes has 0 values and large variability to low numbers some months.
Mode 05 IMDs reported in CSI are likely lower than actually served. There was a drop in clients in July 2009
Mode 05 Mental Health Rehab Center clients fell from about 175 to about 120 starting in October 2015.
Mode 05 Psychiatric Health Facility dropped in January of 2015.
Mode 10 Crisis Stabilization - ER monthly clients fell in early 2016 and forward.
Mode 10 Vocational Services are no longer being reported (since FY 2006/07) but are still being provided by the county. They may now be coded as something else or may be missing.
Mode 15 (40-48) Mental Health Services drop from 8,000 clients to 7,000 in June of 2016 and then to 5,000 in July of 2016.
Mode 15 Collateral services drop from over 3,000 to just over 2,000 beginning in July of 2016.
Mode 15 Crisis Intervention services dropped in suddenly from over 1,000 in December of 2012 to just over 5000 in January of 2013 forward.
Mode 15 Linkage/Brokerage services drop from 2,500+to just 2,000 beginning in November of 2015.
Mode 15 Medication Support services decline slowly from 5,500+ clients in October of 2014 to about 3,500 clients in October of 2016.

7. Specific Issues by County: San Bernardino
The county is getting errors that don't make sense. For example, when trying to sent Mode 05 discharge record, the system gives an error that the system cannot find the associated admission record, even though the county knows that it is there. Also, the county receives files with errors to clean which contain clients who do not belong to their county.
The data in the CSI is not accurate. Corrections are difficult. In order to report on time, the county has to submit data with high error rates.
There were over 200,000 (28%) service records with outstanding fatal errors in FY 2015/16 and over 25,000 (12%) in FY 2016/17.
Mode 05 Hospital Inpatient clients dropped from ~350 down to single digits in November 2015 through March of 2016.
There was a sudden drop in total clients served beginning in October from ~15,000 down to ~10,000 moving forward. This pattern was seen consistently across most service types.

8. Review of What is Required to be Reported

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

10. 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) notice (4th bullet)

11. 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) notice (4th bullet)

12. Review of Diagnoses Fields and ICD-10

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

14. 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 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

15. 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 “ ” (DIAGNOSIS DEFERRED) and “ ” (NO DIAGNOSIS), respectively.
Reference: 10-Reporting Tips – Tip Three – April 2016; communications with DHCS

16. 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

17. GENERAL MEDICAL CONDITION SUMMARY CODE

18. GENERAL MEDICAL CONDITION SUMMARY CODE

19. GENERAL MEDICAL CONDITION SUMMARY CODE

20. 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

21. ADDTL MENTAL/PHYS DIAGS

22. SUBSTANCE ABUSE / DEPENDENCE DIAGNOSIS
In FY2017/18
No County had large numbers of these errors

23. SUBSTANCE ABUSE / DEPENDENCE DIAGNOSIS

24. Review of Reporting Periodic Records

25. 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 (same info in both). Also Reporting Tips, Tip 5 (pretty much same thing).

26. Periodic Records Periodic Fields: P-01.0 DATE COMPLETED
P EDUCATION
P EMPLOYMENT STATUS
P CONSERVATORSHIP / COURT STATUS
P LIVING ARRANGEMENT
P-10.0 CAREGIVER

27. 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 (same info in both). Also Reporting Tips, Tip 5 (pretty much same thing).

28. Date Completed

29. Periodic Record Example

30. Next Steps
Request for vendors to attend Webinar for Correction and Batch correction of CSI errors on May 31.
Register:
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.

31. 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

32. Discussion Other issues? Comments? Next Steps? Email Support
DHCS:
MHData:

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