ia and documentation training 20201103 - merced county, ca

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Drug Medi-Cal (DMC) Organized Delivery

System (ODS) Documentation

Requirement Training

Merced County

• Treatment Modalities

• Provider Staff – Counselors, LPHAs, & Medical Director

• Substance Use Disorder Diagnosis & Medical Necessity

• Documentation Requirements

• Corrective Action Plans

• Resources

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Agenda

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Outpatient Drug Free Treatment Outpatient Services

Intensive Outpatient Treatment Intensive Outpatient Services

Naltrexone Treatment Naltrexone Treatment

Narcotic Treatment Program (methadone) Opioid (Narcotic) Treatment Program OTP/NTP (methadone + additional medications)

Perinatal Residential SUD Services (limited by bed capacity)

Residential Services (not restricted by bed capacity or limited to perinatal)

Detoxification in a Hospital (with a TAR) Withdrawal Management (at least one level)

Recovery Services

Case Management

Physician Consultation

Partial Hospitalization (Optional)

Additional Medication Assisted Treatment (Optional)

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Treatment Modalities

State Plan vs DMC-ODS

Outpatient Services

State Plan

• Referred to as ODF

• Individual counseling limited

• DMC certified sites only

DMC-ODS

• ASAM Level 1.0

• Adults = up to 9 hours per week

• Adolescents = less than 6 hours per week

• Not limited to DMC certified sites

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Intensive Outpatient Services

State Plan

• IOT

• 3 days, 3 hours per

week

• DMC certified sites only

DMC-ODS

• IOS

• ASAM Level 2.1

• Adults = min. of 9 hours, max. of 19 hours per week

• Adolescents = min. of 6 hours, max. of 19 hours per week

• Not limited to DMC certified sites

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Withdrawal Management

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Additional Medication Assisted Treatment

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Residential Services

State Plan

• Limited to pregnant and postpartum

• Treatment capacity of 16 or less

DMC-ODS

• Open to all populations

• No maximum capacity

• Limitations on length of stay

• ASAM designation

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• Prior authorization required

• 24-hour structure

• 7 days a week

• Minimum of 5 hours of clinical service

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Residential Treatment Services

(Non-Perinatal, Perinatal & Adolescents)

• Must provide at least one service per day

– Intake

– Individual – Group Counseling

– Patient Education

– Family Therapy

– Collateral Services

– Crisis Intervention Services

– Treatment Planning – Transportation Services

• To and from medically necessary treatment.

– Discharge Services

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Residential Treatment Requirements(Non-Perinatal, Perinatal & Adolescents)

IN 18-001

http://www.dhcs.ca.gov/formsandpubs/Documents/MHSUDS%20Information%20Notices/MHSUDS_Info_Notice_18-001-Residential_Reimbursement.pdf

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http://www.dhcs.ca.gov/provgovpart/Documents/DMC-ODS_Waiver/DMC_ODS_Residential_Updated_October_2017.pdf

• Length of stay – 1 to 90 days, 90 day maximum

– 30 day, one-time extension, per 365-day period

– Maximum of 2 non-continuous 90-day regimens, in a one-year period

– Exception – if beneficiary moves to a new County or comes to you from another County

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Residential Treatment –Adults, Non-Perinatal

•Length of stay

– Duration of their pregnancy

– Plus 60 days postpartum

•Beneficiary record must contain proof of

pregnancy and last day of pregnancy

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Residential Treatment –Perinatal

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• Address treatment and recovery issues specific to pregnant and postpartum women

– Such as relationships, sexual and physical abuse, and development of parenting skills

• Covered services as well as

– Mother/child habiltative & rehabilitative services

– Service access

– Education to reduce harmful effects of alcohol and drugs on mom & fetus or infant

– Coordination of ancillary services

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Perinatal Services

• Length of stay

– Maximum of 30 days

– 30 day, one-time extension, per year

– Maximum of 2 non-continuous 30-day regimens, per 365-day period

• Individuals up to 18 years old

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Residential Treatment -Adolescents

• Youth Treatment Guidelines– http://www.dhcs.ca.gov/individuals/Documents/Youth_Treatment_Guidelines.pdf

• Youth Advisory Group (YAG) on Substance Use Disorder Services– Collaborate with DHCS to develop and implement a SUD system of care for

youth.

– YAG members represent counties, state departments, and subcommittee chairs of the County Behavioral Health Directors Association of California.

– Other stakeholders and field experts are welcome to attend YAG meetings and participate on workgroups.

• Please direct your comments, suggestions, or questions regarding the YAG to the following email address: [email protected]

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Adolescents

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• Assist beneficiary in accessing support services surrounding:– medical

– educational

– social – prevocational

– vocational

– rehabilitative – Other community services

• Focus on coordination of SUD care, primary care and criminal

justice

• Provided by counselor or LPHA

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Case Management

• Access based on beneficiary

– Completed treatment services previously

– Beneficiary concerns

• Triggered

• Relapse

• Preventative measure to prevent relapse

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Recovery Services

• Services Include:

– Outpatient counseling

– Recovery Monitoring (coaching via phone and internet)

– Peer-to-Peer

– Education/Job skills

– Family Support (childcare/family/marriage education

linkages)

– Support Groups (linkages)

– Ancillary Services (linkages to housing, transportation)

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Recovery Services

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• “Aftercare” is a general term used to describe any ongoing or follow-up treatment for substance abuse that occurs after an initial rehab program. No matter the setting, treatment provider, or methods used, the goals of addiction aftercare programs are the same and include:

– To maintain recovery from substance abuse.– To find ways to prevent relapse.

– To achieve a life filled with rewarding relationships and a sense of purpose.

– One reason that continuing treatment is essential in all situations is because longstanding substance abuse can, in some cases, alter the normal functioning of the brain. Some of these changes do not instantly reverse once use ends. In fact, they can last long after substance use has terminated.

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Recovery Services

• DMC physicians’ consult with:

– Addiction medicine physicians

– Addiction psychiatrists

– Clinical pharmacists

• DMC physicians can bill when seeking expert advice on tx plans. Consultation services may also address medication selection, dosing, side

effect management, adherence, drug-drug interactions, or level of care considerations.

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Physician Consultation

Unit of Service

State Plan

• Face-to-face contact on a

calendar day

• State Reimbursement Rate

• ODF = 50-minute individual,

90-minute group

• IOS = 3 hours = bundled

rate

ODS

• Contact with a beneficiary

• Fiscal Plan

• Most services billed in 15-minute increments

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Provider Staff – Counselors, LPHAs,

Medical Director

• Responsibilities include:• Intake - including Assessment

• Initial & Updated Treatment Plans

• Individual & Group Sessions

• Sign-In Sheets

• Crisis Intervention

• Collateral Services

• Progress Notes

• Case Management Services

• Continuing Services Justification

• Discharge Plan / Discharge Summary

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Counselor/LPHA

(IA, III.PP.10.ii.)

LPHAs include: • Physician • Nurse Practitioners • Physician Assistants• Registered Nurses• Registered Pharmacists • Licensed Clinical Psychologists• Licensed Clinical Social Worker • Licensed Professional Clinical Counselor • Licensed Marriage and Family Therapists • License Eligible Practitioners working under the supervision of licensed clinicians

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Licensed Practitioner of the Healing Arts (LPHA)*

(IA, III.A.1.i.a.)

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The Role of the Medical Director/Physician

• Develop & Implement Medical Policies & Standards

• Ensure Physicians & LPHAs

– trained to perform diagnosis & determine

medical necessity, within scope

– receive five hours of continuing education

related to addiction medicine annually

• Physicians do not delegate their duties to

non-physician personnel

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(IA, III.PP.6.i.a-g)

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Substance Use Disorder (SUD)

Diagnosis & Medical Necessity

42 CFR 438.210(a)(4)

• Place appropriate limits on a service

- On the basis of criteria applied under the State plan, such as medical necessity; or

• For the purpose of utilization control, provided that

- The services furnished can reasonably achieve their purpose

- Must ensure that the services are sufficient in amount, duration or scope to reasonably achieve the purpose for which the services are furnished.

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Medical Necessity

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IV. Definitions, 55

• Adult beneficiaries must have one SUD

diagnosis from the DSM Fifth Edition

• Must meet the ASAM Criteria definition of medical necessity for services

based on the ASAM Criteria.

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Medical Necessity Criteria

Determination that Services

are Medically Necessary

• Intake Assessments

• DSM Criteria

• 22 CCR § 51303

By - Physician

DMC-ODS Waiver

• Intake Assessments

• ASAM – 6 Dimensions

• DSM Criteria

• 42 CFR 438.210(a)(4)

• 22 CCR § 51303

By - Physician or LPHA

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State Plan

Required professional reviews the initial treatment plan to determine

whether the services are medically necessary. Shall type or legibly print name, sign & date treatment plan within 15 days of the therapist or

counselor.

• IV. Definitions, 58• Youth under 21 may be assessed to be at risk for developing a

substance use disorder, and if applicable, must meet the ASAM adolescent diagnostic admission criteria.

• Beneficiaries under age 21 are eligible to receive Medicaid• services pursuant to the Early Periodic Screening, Diagnostic

and• Treatment (EPSDT) mandate. Under the EPSDT mandate,

beneficiaries under age 21 are eligible to receive all appropriate and medically necessary services needed to correct and ameliorate health.

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Medical Necessity Criteria

Youth/Adolescents

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Medical Necessity –EPSDT Beneficiaries

• The physician shall determine whether substance use disorder services are medically necessary, within thirty (30) calendar days of each beneficiary’s admission to treatment date.

• iii. Adolescents are eligible to receive Medicaid services pursuant to the Early Periodic Screening, Diagnostic and Treatment (EPSDT) mandate. Under the EPSDT mandate, beneficiaries under the age 21 are eligible to receive all appropriate and medically necessary services needed to correct and ameliorate health conditions that are coverable under section 1905(a) Medicaid authority. Nothing in the DMC-ODS overrides any EPSDT requirements.

ASAM Level 0.5

– Early Intervention for Adolescents, this level of care constitutes a service for

individuals who, for a known reason, are at risk of developing substance-related problems, or a service for those for whom

there is not yet sufficient information to document a diagnosable substance use disorder.

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Adolescents

RJ(74

Diagnosis

State Plan

• Physician

• Therapist, physician assistant, nurse practitioner

ODS

• Medical director

• LPHA

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Working within the scope of their practice

RJ(74 Tracie, this slide may need to be updated based on response from KitahoRudnick, Janet (SUDPPFD-PIB)@DHCS, 8/7/2018

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• DSM 5

• DSM criteria

• Face-to-face review

• Medical Director or LPHA must document the basis for

the diagnosis separate from the treatment plan

– Narrative summary includes personal, medical and

SUD history11/19/2020 37

Substance Use

Disorder

Intake, Assessment, Physical Examination & Admission

SUD Treatment is NOT

“one-size-fits-all”

What does this mean????

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Individual Treatment Needs

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Collect information to complete documentation and CalOMSAdmission.

IA Definition

• Process of determining a beneficiary meets the medical necessity criteria

• Beneficiary is admitted into a substance use disorder treatment program.

• Intake must occur to bill DMC

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Intake

• Drug/Alcohol History

• Medical History

• Family History

• Psychiatric/Psychological

History

• Social/Recreational History

• Financial Status/History

• Educational History

• Employment History

• Criminal History, Legal Status

• Previous SUD Treatment

History

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Intake Assessments -

Required Components

• One suggestion is to use the following formula to ensure it is

in your documentation:

• “Due to client’s _________________(symptoms of SUD), client ________(behaviors) resulting in _____________ (impairment).”

• This structure clearly demonstrates the connection between the

substance use and the problem or impairment. It is important to

remember that substance use alone cannot lead to the impairment or problem.

• For example:

Susie may be drinking alcohol all throughout the day,

but this fact alone does not lead to her job loss. Something

occurred as a result of Susie drinking all day. Perhaps she was caught drinking at work. Another way to think is how the actions

lead to consequences.

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DMC-ODS Waiver

Required Components Continued

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• For SUD services, the initial intake that is completed upon the

clients’ admission to treatment is where the documentation of Medical Necessity begins. As with any standard intake, it is a

compilation of information gathered from interviewing the client

and, if applicable, with information from significant others that may be involved with the client’s treatment or referral for

treatment.

• Who can document? An LPHA or Counselor

• Timeframe? Treatment Plan is due within 30 calendar days from

the client’s admission to treatment.

• You MUST document all the symptoms to support a diagnosis.

• Example:

Alcohol use disorder-we will need 6 or more DSM symptoms to support

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DMC-ODS Waiver

Required Components Continued

• Dimension 1: Substance Use, Acute Intoxication, Withdrawal

Potential (Drug/Alcohol Use History)

• Dimension 2: Biomedical Condition and Complications (Medical

History)

• Dimension 3: Emotional, Behavioral, or Cognitive Condition and

Complications (Psychiatric/Psychological History)

• Dimension 4: Readiness to Change

• Dimension 5: Relapse, Continued Use, or Continued Problem

Potential (Drug/Alcohol Use History)

• Dimension 6: Recovery/Living Environment (Family,

Social/Recreational, Employment, Criminal History & Legal Status)

• Ensure intake assessment includes – Financial Status/History, Education History, Previous SUD Treatment History 44

DMC-ODS Waiver

ASAM – Six Dimensions Compared to Required Assessment Information

May include:

� Physical examination

� Laboratory testing (UA)

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Additional Intake Services

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• Shall include:

– Identifier (i.e., name, number)

– Birthday

– Gender

– Race and/or Ethnic Background

– Address

– Telephone number

– Next of Kin or Emergency Contact

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Beneficiary Record

• Treatment Episode

• Consent to Treatment Form

• Referrals

• Retention– 438.3 (h) 10 years

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Beneficiary Record

State Plan• 22 CCR § 51341.1(7) “…providers shall accept proof of

eligibility for Drug Medi-Cal as payment in full for treatment services rendered. Providers shall not charge fees to a beneficiary for access to Drug Medi-Cal substance use disorder services or for admission to a Drug Medi-Cal treatment slot.”

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Beneficiary Fees

DMC-ODS WaiverPP. Requirements for Services

Copies of the following documents shall be provided to the beneficiary upon admission:

a. Beneficiary rights, share of cost if applicable,

notification of DMC funding accepted as payment infull, and consent to treatment.

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Obtain copy & review physical exam

completed within last 12 months

Required within 30 calendar days of admission

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Physical Exam Requirements OPTION 1

Physician or physician extender performs

a physical examination

Can be billed as intakeRequired within 30 calendar days of admission

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Include goal to obtain a physical

examination on the treatment plan

Required within 30 calendar days of admission

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• Remember, all ASAM assessments must have at least a mild to transfer to the treatment plan.

• Physical Health will be a problem, goal and objective for the client on the treatment plan.

• Client must obtain a physical exam within the first 30 days and bring in proof of this exam• Problem: Client preventative action for health has been neglected and physical

health issues have been exacerbated by client’s ongoing substance use.• Goal: Client will obtain a physical health exam within the next 30 days.• Objective: Client will identify and make a primary care appointment to obtain

physical exam as evidenced by client bringing back proof of the exam from the physician.

• If client does not within the first 30 days, continue to document your efforts to assist client with this.

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Physical Examinations

• Ensure that all fields on the physical examination form have been completed.

• Medical director/physician should review physical examination results. – The physician shall type or legibly print their name, sign and date

documentation to support they have reviewed the physical exam results. The signature shall be adjacent to the typed or legibly printed name.

IA, III.PP.12.iii

• Ensure the treatment plan includes identified significant medical illness, if applicable.

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• Physical Examinations—NO WAIVERS PERMITTED DMC requires that all clients have a documented physical examination.

• All clients must have had a physical examination within the twelve‐month period prior to admission to treatment.

• If documentation of a physical examination cannot be obtained, providers must describe in the client record efforts taken to obtain documentation.

• If a client had a physical exam within twelve months prior to treatment admission, a physician must review the exam within 30 calendar days of the admission date to determine if the client has any significant medical illnesses.

• A copy of the physical exam must be included in the client record. Treatment Plans must incorporate any relevant findings from the physical examination that need to be addressed or followed up. Thus all ASAM documentation must have at least MILD in Dimension 2-Bio Medical Conditions to capture this and it must be on the treatment plan as an objective to address.

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Treatment Plans

State Plan AND DMC-ODS Waiver

• Individualized

• Based on ALL issues identified during intake assessment(s)

• Beneficiary’s prescription for treatment services

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Treatment PlanningOverview

• Beneficiary

• Counselor

• LPHA

• Medical Director

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Who’s Responsible?

(IA, III.PP.13.i.a.)(IA, III.PP.13.i.b.i.ii.1.iii.1.)

(IA, III.PP.13.ii.a.b.i.c.i.)

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Treatment Plan Required Components

DMC- ODS

• Problem Statements

• Goals

• Objectives

• Target Dates (date objective to be completed)

• Description of Service; type and frequency (Interventions)

• Assignment of Primary Counselor (Problem area)

• Beneficiary’s Diagnosis (do not need DSM 5 coding)

• Physical Examination Goals

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Treatment Planning

State Plan

• Required components:

– Assignment of

primary therapist or counselor

– Physician must sign

DMC-ODS

• Required components:

– Assignment of

primary LPHA or counselor

– Medical director or LPHA must sign

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Problem Statements

(IA, III.PP.13.i.a.i.1.)

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• Goals to address each problem statement

• If a client has a problem in EVERY dimension, this does not necessarily mean that every problem must be treated.

• **WE MUST take into account what is feasible for the client as well as the priorities for the client. In order to develop a meaningful treatment plan, the client must be involved. It is in the PROGRESS NOTE where you DOCUMENT as to why a particular area will or will not be addressed. That way nobody is guessing at what and why you are doing it. SPELL IT OUT. ☺☺☺☺

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Treatment Plan Goals


• Goals to address each problem

statement

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Treatment Plan Goals


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Objectives


• By the provider and/or beneficiary

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Objectives


MUST be measureable ******

Sally May will attend at least 2 self-help meetings a

week and submit verification of attendance to

Primary Counselor during her individual sessions as evidenced by providing signed self-help sheet.

Over the next 90 days, Susie will attend assigned

treatment groups and individual counseling

sessions. She will focus on the development and use of a Relapse Prevention Plan. Client will

increase her ability to remain sober as evidenced

by: Client will verbalize at least 3 new coping skills

that will assist her to prevent relapse and will have no positive tests.

• By the provider and/or beneficiary

• Date for the accomplishment of

objective

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Target Dates


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Description of Service


• Type and frequency

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Description of Service


�MUST indicate type of counseling and frequency

of the service�MUST indicate the type of staff that will be

completing the service

�MUST contain Evidenced Based Practice interventions (CBT, Motivational Interviewing,

Trauma-Informed, MRT, etc.)

Example: Program Planning: Bert will meet with primary

AOD Counselor once per month to review

progress toward completion of treatment plan goals and objectives.

Individual Counseling (Substance Abuse):

Counselor will utilize Trauma informed treatment as well as Motivational Interviewing in working

with this client.

• The assignment of a primary therapist

or counselor must be documented

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Assignment of Primary Therapist or Counselor


• The beneficiary’s diagnosis as

documented by the LPHA

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Diagnosis


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Physical Exam and/or Significant Medical Issues

• 30 calendar days from admission– Counselor/LPHA

– Beneficiary

• IA Requirement

• 15 calendar days from Counselor signature

date

-LPHA

• Residential Withdrawal Management

• Recovery Services – Client plan

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Timelines and RequirementsInitial Treatment Plan

(IA, III.PP.13.i.b.i.ii.1.iii.1.)

• 90 calendar days

– From initial or prior treatment plan

• Unless there is…

– A change in treatment modality

– Or a significant event

• Whichever occurs first

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Timelines and RequirementsUpdated Treatment Plan

(IA, III.PP.12.ii.a.b.i.c.i.)

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Progress Notes

• Topic of session OR purpose of the

service

• Date, start and end times

• Description of progress OR lack of

progress on treatment plan

• Identify how & where services were

provided – in person, by telephone or

telehealth

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Progress Note Documentation Requirements

• Progress notes are individual narrative summaries and shall include all of the following:

• Description of progress OR lack of progress on treatment plan

• Date, start and end times start and end times and topic of the counseling session.

• Identify how & where services were provided – in person, by telephone or telehealth

• If services were provided in the community, identify the location and how the provider ensured confidentiality.

• Minimum One Progress Note,Per Calendar Week

• For Residential, must address the service provided each day

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Progress Note Intensive Outpatient Services, Residential –

Perinatal and Non-Perinatal

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• Beneficiary’s name

• The purpose of the service

• Narrative summary

• Date, start & end times

• Identify if the service was provided in-person, by phone or telehealth

• If services were provided in the community, identify the location and how the provider ensured confidentiality.

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Progress Note Case Management

• Physician Consultation

• Medication Assisted Treatment

• Withdrawal Management

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Other DMC ODS Services

• We are using the BIRP format

• B-Behavior: counselor observation, client statements1. Subjective data about the client-what are the client’s observations,

thoughts, direct quotes?

2. Objective data about the client-what does the counselor observe during the session (mood, appearance, affect)?

• I-Intervention: Counselors methods used to address goals and objectives, observation, client statements. Evidenced based methods must be noted.1. What goals and objectives were addressed this session?2. Was homework reviewed?

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Other DMC ODS Services

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R-Response: Client’s response to the intervention and progress made toward treatment plan goals and objectives.

1.What is the client’s current response to the clinician’s intervention in the session?

2.Client’s progress attending to goals and objectives outside of the session?

P-Plan: Document what is going to happen next.

1. What in the Treatment Plan needs revision?2. What is the clinician going to do next? What will client do

next?3. What is the next session date?

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IA Contract Progress Notes Timelines:• Outpatient, NTP, Case Management and Physician progress notes- within seven calendar

days of the session/service. • Intensive Outpatient and Residential notes - within the following calendar week.

According to BHRS Completed and signed within 3 calendar days of the session. Date of the session counts as Day 1.

Face to face time is time with the client, in person. If session or service was provided by phone, there would be no face to face time.Non Face to Face time is billable time spent on a service activity that does not include

interaction with the client. Example: Analyzing information to determine risk rating level for the dimensions of the ASAM Criteria outside of the session with the client. Service Time is total time (face to face and/or non face to face, travel and documentation)

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Sign-In Sheet

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• Establish and maintain a sign in sheet for every group counseling session to include:

• Typed or legibly printed name of LPHA and or counselor• Date of session

• Topic of session• Start and end time of session

• Typed or legibly printed name of beneficiary• BHRS-The end time does not print on our log, therefore you MUST

manually write this on the page where the time is captured. • The AOD Counselor/Clinician MUST type of legibly print name

and sign. NEW: ON the bottom of the group log, where you typically sign and enter your server number, ADJACENT to your signature, you now MUST PRINT your name. Even though your name populates at the top of the form, you must PRINT and SIGN your name on the bottom of the page, adjacent to one another. This is a new State requirement, so please make sure you include both of these components.

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Sign-In Sheets

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Continuing Services Justification (CSJ)

• Outpatient Services

• Intensive Outpatient Services

• Case Management

• Naltrexone Treatment

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Which modalities require

completion of a CSJ (Stay

Review)?

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State Plan & DMC-ODS Waiver• At 5-6 months from

– admission date– last Stay Review

• *Therapist/counselor or **LPHA/counselor shall review – progress and eligibility

– recommend continuation of services or not

– There will need to be an updated ASAM assessment, treatment plan review and update. This will provide guidance on what changes, if any, need to be made on the clients’ treatment plan. The primary counselor and the client will work together to review progress and discuss whether the goals are still relevant or if modifications are needed

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Continuing Services

*State plan requirement**DMC-ODS requirement

State Plan

• Medical necessity by physician

DMC-ODS Waiver

• Medical necessity by medical director or LPHA

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Continuing Services

State Plan & DMC-ODS Waiver• Review of the following shall be documented:

− Beneficiary’s personal, medical,

substance use history− Most recent physical exam

− Progress notes & treatment plan goals

− LPHA’s/counselor’s recommendation

− Beneficiary’s prognosis

Discharge from treatment

OR

Move to a different level of care

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MD/LPHA Determines NO Medical Necessity

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Discharge Documentation

• Importance of Completion

• Counties and Providers are Monitored for Compliance

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CalOMS Discharge

State Plan and DMC-ODS Waiver

• Discharge Plan is required for planned discharge

– Within 30 days of last face-to-face service

• Required elements:

– List of relapse triggers

– Plan for avoiding relapse when faced with triggers

– Support plan

• People

• Organizations

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Discharge Planning

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*State plan requirement

**DMC-ODS requirement

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Discharge Planning

State Plan & DMC-ODS Waiver

• During last face-to-face, *therapist/counselor or

• **LPHA/counselor and beneficiary sign and date plan

• A copy must be provided to beneficiary

– Must be documented

State Plan & DMC-ODS Waiver• Discharge summary is required for an unexpected

lapse in treatment services for 30+ days

• Completed by *therapist/counselor or **LPHA/counselor within 30 days of last face-to-face

– Duration of the treatment

– Reason for discharge

– Narrative summary of the treatment episode

– Prognosis

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Discharge Summary


State Plan & DMC-ODS Waiver• Aftercare” is a general term used to describe any ongoing or follow-up treatment for

substance abuse that occurs after an initial rehab program. No matter the setting, treatment provider, or methods used, the goals of addiction aftercare programs are the same and include:

– To maintain recovery from substance abuse.

– To find ways to prevent relapse.

– To achieve a life filled with rewarding relationships and a sense of purpose.

– One reason that continuing treatment is essential in all situations is because longstanding substance abuse can, in some cases, alter the normal functioning of the brain. Some of these changes do not instantly reverse once use ends. In fact, they can last long after substance use has terminated.

• Discharge summary is required for an unexpected lapse in treatment services for 30+ days • Completed by *therapist/counselor or **LPHA/counselor within 30 days of last face-to-face

– Duration of the treatment– Reason for discharge– Narrative summary of the treatment episode– Prognosis

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After Care/Recovery


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Corrective Action Plan (CAP)

• Corrective Action Plan

- The written plan of action document which the Contractor or its subcontracted service

provider develops and submits to DHCS to address or correct a deficiency or process that is non-compliant with laws,

regulations or standards.

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What is a CAP?

(IA, III.PP.IV.A.17.)

• Provider submits to the County

• County reviews and approves

• Due to DHCS within 60 calendar days

– Required revisions due within 30 days of

notification

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Submission Requirements

(IA, III.OO.5.6.)

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• County ensures plan is fully implemented

• County Certification of Compliance

– DHCS Form 8049

– [email protected]

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CAP Completion

CAP (IA, III.DD.1.)

• Treatment Modalities

• Staffing - Roles and Responsibilities

• SUD Diagnosis & Medical Necessity

• Documentation Requirements

• Corrective Action Plans

• Resources

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AREAS THAT WE COVERED

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Resources

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• FAQs, Fact Sheets & Information Notices

• Special Terms and Conditions

• Technical Assistance

• Webinars

• Beneficiary Access

• Resources for Counties

• [email protected]

• [email protected]

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DMC-ODS Resources

• 42 CFR Part 2– Confidentiality of Alcohol and Drug Abuse Patient

Records• https://www.gpo.gov

• 42 CFR Part 438– Managed Care Subparts A-J

• https://www.gpo.gov/fdsys/granule/CFR-2011-title42-vol4/CFR-2011-title42-vol4-part438/content-detail.html

• 45 CFR– HIPAA Privacy Rule

• https://www.hhs.gov/hipaa/for-professionals/privacy/index.html

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Federal Requirements

• MHSUDS Information Notices

– http://www.dhcs.ca.gov/formsandpubs/Pages/MHSUDS-Information-Notices.aspx

• State Health Information Guidance (SHIG)

– http://www.chhs.ca.gov/ohii/pages/shig.as

px

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Additional Resources

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• SUD County Reports– [email protected]

• Program/Counselor Complaints– http://www.dhcs.ca.gov/individuals/Pages/

Sud-Complaints.aspx

– Public Number: (916) 322-2911

– Toll Free number: (877) 685-8333

• Certifying Organization Complaints– [email protected]

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Complaints

• Certifying Organizations– http://www.dhcs.ca.gov/provgovpart/Pages/Co

unselorCertificationOrganizations.aspx

• Counselor Certification– DHCS Revoked and/or Suspended Counselor

List

– http://www.dhcs.ca.gov/provgovpart/Pages/CounselorCertification.aspx

• Licensed Professionals– http://www.mbc.ca.gov/Breeze/License_Verif

ication.aspx

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Certification & License

• DHCS Medi-Cal Fraud Website– http://www.dhcs.ca.gov/individuals/Pages/

StopMedi-CalFraud.aspx

• 1-800-822-6222

• [email protected]• Medi-Cal Fraud Complaint – Intake Unit

Audits and InvestigationsPO Box 997413, MS 2500

Sacramento, CA 95899-7413

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Medi-Cal Fraud

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SUD Medical Directors are required to take 5 hours of continuing medical education in addiction medicine annually.

There are many courses online and in person where Medical Directors can get their required Continued Medical Education (CMEs) credits. The key provisions in Title 22 are addiction medicine and CME not Continued Education Units (CEUs). The American Society of Addiction Medicine has a great website to give you an idea of the types of trainings that could fulfill this requirement: http://www.asam.org/education

Additional websites that provide information on physician Continuing Medical Education (CME):

• http://cmelist.com/addiction-substance-abuse-cme.htm

• http://www.audio-digest.org/CME-Series-Specials/substance-abuse

• http://www.abam.net/become-certified/earning-cme-for-the-2014-examination-application/

• http://www.csam-asam.org/online-cme

• http://psychiatry.ufl.edu/education/addiction-medicine-cme-program/

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Medical Director Required Training Resources

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DMC-ODS Waiver

Residential Facility Information• Information Notice – 15-035, ASAM Designation for

Residential Facilities• http://www.dhcs.ca.gov/formsandpubs/Documents/MHSUDS_Information_N

otice_15-035_ASAM_Designation_8.27.pdf

• Counselor/Registrant– Certifying Organization Website – Registry

– DHCS Revoked and/or Suspended Counselor List

– DHCS Counselor Certification Page http://www.dhcs.ca.gov/provgovpart/Pages/CounselorCertification.aspx

• Licensed Professionals– Department of Consumer Affairs (BreEZe)

http://www.mbc.ca.gov/Breeze/License_Verification.aspx

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Status Verification