1. 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

2. 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 (Dec 2019-Feb 2019 requests)
2nd Submission July (Mar 2019-May 2019 requests)
3rd Submission October (June 2019-Aug requests)
16+ Data fields
1st Submission August (June 24-30, 2019 requests)
2nd Submission September (July 2019 requests)
Monthly thereafter

3. 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:

4. 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 (Data: June 2019-August 2019)

5. 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

6. 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#
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 § § Client and Service Information System Data.
DMH LETTER NO.:

7. Monthly Client Services Information Assessment Record “Long-Term”
Reference:

8. Monthly Client Services Information Assessment Record “Long-Term”
Reference:

9. 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

10. 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

11. 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 > > > > Week 5
<- Week 6 – 8 ->
Pre-submission Review

12. 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%

13. 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

14. 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

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

16. 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

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

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