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Home My WebLink AboutMH-209 MHIDDEI Funded Family Based Mental Health Services1 FRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: MH/IDD/EI Funded Family Based Mental Health Services PROCEDURE NUMBER: MH-209 Effective Date: May 16, 2008 Date Revised: January 28, 2021 INTRODUCTION: This procedure is written to provide case management staff, providers of Family Based and PerformCare with specific authorization procedures for Family Based Mental Health Services. It applies to Health Insurance Premium Payment (HIPP) and MH/IDD/EI funded children/families. Due to the intensive nature of Family Based service provision, it is the request of MH/IDD/EI that other less intensive interventions/services be fully utilized prior to initiating a Family Based referral. PROCEDURE: 1. It is recommended that if a child without Medical Assistance (MA) or Behavioral Health Managed Care Organization (BHMCO) is identified by a psychiatrist or psychologist on an evaluation as needing Family Based services, a discussion needs to occur between the Case Manager, their immediate supervisor and the Child and Adolescent Service System Program (CASSP) Coordinator about a possible referral. [NOTE: While it is the expectation of MH/IDD/EI that a Case Manager be involved, it is acknowledged that extenuating circumstances may not permit this. In the absence of a Case Manager, the selected Family Based provider would assume the responsibilities associated with a Case Manager as described below during the referral process.] During this meeting, it will be determined whether or not Family Based therapy is the most appropriate service for the child and family or if other, less intensive interventions should be considered, and whether other funding sources are available. If it is mutually agreed to pursue other services prior to Family Based, the Family Based referral process will be ended. 2. If the mutually agreed upon decision is to move forward with the Family Based referral, the assigned Case Manager will inform the family of the provider(s) who is/are contracted through MH/IDD/EI and licensed to provide Family Based services. 3. The Case Manager will complete the “Family Based Mental Health Services (FBMHS) Referral/Authorization Request Form” (see attached) and attach applicable documentation. The Case Manager (or the selected Family Based provider) will also submit a CASSP Referral Form (if applicable) to the CASSP Coordinator for review. 2 4. The Mental Health (MH) Program Specialist and CASSP Coordinator will review the submitted documentation within five (5) business days. If approved, the Case Manager will complete and submit a referral packet to the chosen provider, which includes the referral form, a psychological/psychiatric evaluation recommending Family Based or a letter from a physician recommending the service and documentation verifying the utilization of less intensive services. [NOTE: MH/IDD/EI is also agreeable to accepting the PerformCare documents as a satisfactory substitute.] This packet will clearly describe risk factors for out-of-home placement or hospitalization or will indicate that the child is returning from an out-of-home placement or treatment. 5. Upon receipt of the referral packet, the provider will schedule an intake with the family. The date of the intake is dependent upon the availability of Family Based services. 6. After the intake, if the family is still interested in receiving Family Based services, the selected provider will notify the MH Program Specialist of the service start date. The provider will submit initial units of service projection based on the respective procedure codes to the Mental Health Program Specialist for the purposes of entering the service authorization into the billing system and for actual service provision tracking purposes. The provider does have the opportunity to request revisions to the unit amounts per procedure code during the authorization period. These changes can be requested as often as necessary. 7. All Family Based billing will be held by the provider for MH/IDD/EI funded clients until a determination of private health insurance, MA or BHMCO eligibility is made. Since MH/IDD/EI is to be the payer of last option, written documentation from other potential payer sources as to lack of coverage and/or ineligibility for benefits must be secured prior to MH/IDD/EI funding being made available for service provision reimbursement. 8. If the child is ineligible for MA and BHMCO and the ineligibility letter is received by the Case Manager, the provider will then bill MH/IDD/EI the full pay rate for this service. [NOTE: There is the option to appeal the denial/ineligibility. The appeal can be either parent or agency initiated. The Case Manager would continue to monitor the appeal process. If the denial/ineligibility is overturned, MH/IDD/EI and the agency would discuss the possible need for reimbursement of funds.] 9. If the child becomes eligible for MA and BHMCO, the provider (and/or Case Manager) will notify the MH Program Specialist. The MH Program Specialist will end date the authorization as of the eligibility date. The provider will work with PerformCare (the BHMCO) to complete the transition process. The Case Manager will submit a packet to PerformCare for authorization. [However, if the child remains eligible for Medicaid only, the transition packet will not be sent to PerformCare. The Case Manager would complete a 32-week MA fee-for-service authorization for the child.] 10. If the child becomes eligible for MA or BHMCO, the provider will retroactively bill the BHMCO immediately preceding the eligibility date. Under fee-for-service billing, MH/IDD/EI will provide the State required program match to MA billing and the provider will bill MH/IDD/EI for this amount (referred to as split billing). 11. The actual service utilization will be monitored on a quarterly basis by MH Program Specialist. Children who have MA and are requesting Family Based will follow PerformCare Policy and Procedure CM-CAS-033 “Prior Authorization and Re-Authorization Procedure for Requesting Family Based Mental Health (FBMH) Services”. ATTACHMENT: Family Based Mental Services (FBMHS) Referral/Authorization Request Form 3 Family Based Mental Health Services (FBMHS) Referral/Authorization Request Form (For use with non-PerformCare members) Individual’s Name: ______________________________ BSU #: _______________________ Case Manager’s Name: ___________________________ Date: ________________________ Provide clear justification/rationale behind the request for Family Based Mental Health Services. (If needed, please attach additional documentation): ____________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Services received prior to FBMHS request (Please check all that apply): ____ Outpatient Services ____ Individual Therapy ____ Psychiatry ____ Family Therapy ____ School Based Outpatient ____ Med Management ____ Case Management ____ IBHS ____ Youth Peer Support Services _____ Therapeutic Support Staff (TSS) ____ Parent-Child Interactive Therapy (PCIT) _____ Mobile Therapy ____ Residential Treatment Facility (RTF) _____ CRR Host-Home ____ Family Based Mental Health Services _____ Other: ___________________________ Please provide the name of the provider and dates of service for all the above checked services as well as indicate if it was a successful or unsuccessful discharge: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 4 Please attach supporting documentation (check all that apply): _____ Individualized Education Plan (IEP) _____ Psychiatric/Psychological Evaluation (completed within one year) _____ Other: ________________________________________________________________________ Health Insurance: ____ Private Insurance ____ MA (not PerformCare) ____ None ____ Other (Please explain): ________________________ PROMISe Eligibility Verification attached: ______ Yes _____ No Denials (please check as appropriate and attach): ____ MA _____ BHMCO Date FBMHS Initiated: _____________ Total number of units authorized at service initiation: ______________ End date of current authorization: ____________________ Date BHMCO Membership Terminated (if applicable) : ______________________ Reason for Termination: ________________________________________________________________ Agency Identified to provide FBMH services (check one): ____ Laurel Life Services ____ PA Counseling Services ____ Momentum Services ____ Family Care Services TO BE COMPLETED BY THE MH/IDD/EI Authorization Request has been APPROVED _____ or DENIED _____ [NOTE: Authorizations can only be entered if above ineligibility has been received.] If denied, reason for denial and recommendations for additional services: ________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Name of staff member making above determination: _____________________________________ Signature: _______________________________________________________________________ Date of Determination: _________________