1. Mental Health Waiver Provider Meeting
October 25, 2016

2. Agenda Introductions Waiver Update Mental Health Waiver Renewal
DMHAS Housing and Support Program
Role of CSP vs MHW Clinician
Mandated Reporting
Providing services as authorized
Critical Incidents
Medicaid Coverage Issues
Billing
Timely Filing
Notes
MHW Advisory Council

3. Waiver Update (as of 10/19/16)
553 Active clients on the waiver
876 Enrolled in program to date
52 Actively planning for admission to waiver
105 Referrals pending disposition

4. Enrolled by Month
Year 8 Average = 21.8/mth

5. Available Census Slots, Waiver Year 8
April 2016 – March 2017
811 (previously 553; +46%)
Currently Enrolled
552 (68% capacity)

6. Mental Health Waiver Renewal
The renewal has been submitted.
CMS approval is anticipated in late 2016/early 2017.
New Census slots for the next 5 years:
Year 9:
Year 10:
Year 11:
Year 12:
Year 13:
Language has been added to the waiver to allow for a waitlist
60 Slots must be held each year for MFP clients

7. DMHAS Housing and Support Program
There is a budget for this program so clients should never be told they are guaranteed any services
Referral must be made through waiver clinician and approval will be based on need and availability of funds
Clients should always be looking at other available community resources
Clients who are applying for or receiving a DMHAS housing subsidy should be applying for other long term housing subsidies.

8. Role of CSP vs MHW Clinician

9. Mandated Reporting
Recovery Assistants are considered mandated reporters in the State of Connecticut
Protective classes: Children and Elderly
Discussion of mandated reporting is provided during Recovery Assistant Training
Please make sure that staff are aware of your agency’s protocol regarding reporting of incidents.

10. Providing services according to authorization
Services must be provided as authorized by the clinician
If a client is requesting, or a provider feels that more hours are needed, it must be pre-approved and the recovery plan and authorization must be revised.
Clinicians are not required to approve services provided without prior authorization.
If an agency has agreed to provide services for the 6 month period, and they run out of units do to overutilization before the end of the authorization, units may be recouped to allow for clients to continue receiving services.

11. Critical Incidents (CI)
A Critical Incident (CI) is defined as an incident that may have a real or potential serious impact on Waiver participants, staff, facilities, funded agencies, or the public or may bring about adverse publicity.
Examples of CI include but is not limited to: death; suicide attempt; threat; abuse/neglect/exploitation of client; missing persons; involvement of emergency services; criminal activity.
When in doubt? Submit one anyway!
Please submit written report to ABH within one business day of becoming aware of incident occurring
Fax to attn: Dan Gerwien
Critical Incident Report Form is available on ABH website in PDF or fillable Word format. (

12. Medicaid Coverage issues
CSP must play active role in assisting client to maintain Husky C coverage
Per DSS, redetermination paperwork is mailed two months in advance of expiration and is due one month from receipt.
DSS will only grant retroactive coverage up to 90 days from when the person loses coverage but only if he/she is still determined eligible

13. Billing Reminders Next three week cycle is December 16th
There are no longer submission deadline dates on the claim submission schedule
CLEAN claims will be paid within a 30 day period from the date of submission
Eligibility issues, insurance issues or the initial activation of a client onto the waiver may delay payment beyond the 30 day period

14. Timely Filing Please pay attention to the 60 day timely filing rule.
Given the numerous eligibility issues that come up with our clients, billing within the timely filing period allows us to hopefully rectify any issues before receiving payment is no longer possible.
LTSS eligibility needs to be back in place within 90 days or services cannot be paid retroactively.
Please notify ABH staff immediately if you become aware of any eligibility issues with your clients.
Heidi late plan example

15. Encounter Notes
Encounter notes must either be located in a client’s home or securely stored at the agency.
You must be able to supply notes for auditing purposes to ABH, DMHAS, DSS or CMS
Please make sure the supervisor is reviewing encounter notes for quality (both RA and CSP). Notes should contain all required elements and be using skill building language.

16. Monthly Progress Notes
Due by the 10th day of the following month
e.g., April notes due by May 10th
CSP notes include two sections, both required
Individual interventions
General summary

17. Quarterly Report Cards
Distributed during the first week of November
Will include:
Feedback from clients and clinicians
Quarterly monthly note percentage
If under 70% provider will receive monthly note audit
If monthly note audit is not completed in timely manner corrective action will be issued

18. MHW Advisory Council Meets twice a year in April and October
Open to any WISE provider to send a representative
We encourage staff to identify WISE clients who might be interested in participating. Staff can bill for time spent with client at meeting

19. ABH Contact Information
Ann Marie Luongo, Program Manager
(860)
Dan Gerwien, Quality Assurance Supervisor
(860)
Monica Vaughn, Program Specialist
(860)
Erin Henriksen, Utilization Review Support
(860)
Krystal Powell, Claims Coordinator
(860)