Note/Concern

Suggested Remedy

Comprehensive Need Assessment (CNA) Definition

Need to include in definition that for Case Management services, a QMHP may completed the CNA with a diagnosis provided by a LMHP type.  Suggest adding this clarification to the definition for clarity purposes for the rest of the manual.

Comprehensive Need Assessment Process

With requiring that the LMHP type complete the CNA for services (other than CM services), it means that CM as a QMHP cannot complete the CNA for the provider.  The Case Manager’s role is to complete a comprehensive assessment to understand the individual’s needs and link with appropriate services.  Therefore, I recommend that the Case Manager be able to conduct the annual CNA for providers with the LMHP type render the diagnosis, reviewing the assessment and signing agreement with CNA.  If this is not put in place, it is going to require individuals to receive multiple CNAs and continue to system stress of LMHP availability to conduct services. 

Comprehensive Needs Assessment Required Components

Clarify that QMHPs can complete sections; however, cannot render a diagnosis, the diagnosis would be from a LMHP type or MD with diagnosis authority.  Again suggest that the Case Manager QMHP be able to complete the CNA with a review and signature of a LMHP type.

Chapter II, Page 8  Indicates keeping records in compliance with state retention requirements (mostly 6 years after service discharge or after 18th birthday for minors) In conflict the MCO CCC Plus contracts that require 10 year retention

Add clarifying language to this section to indicate either following state laws for retention of records or contracts with MCOs if more stringent.

Chapter II, Page 9, Indicates that providers are required to submit serious incident reports to MCOs/DMAS for 180 days after service discharge; concern that this is not in compliance with federal HIPAA regulations.

HIPAA allows for disclosures without consent for TPO; providing information to insurance company for incidents that occur while individual is receiving services paid for by MCO would be allowed.  However, once the insurance company is no longer paying for the services, it would seem this would not be covered under that allowance.  Concern that this requirement is in violation of HIPAA regulations.  Suggest requiring that providers submit serious incident reports while an individual is receiving services that are billed or will be billed to the applicable MCO.

Medication Management definition and Responsibilities; The definition excludes medical staff (RNs/LPNS/MDs, etc.) from providing medication management services in line with their professional licenses.

Include a RN/LPN, medical licensed staff may provide medication management in accordance with their medical license and may provide the supervision to QMHPs and Peers to provide medication monitoring support

Clarify that medication administration may be provided in accordance with medication administration regulations (i.e. done by those who have completed the training and under RN/medical supervision).

Provide allowance that Peers may provide medication monitoring and medication administration, if they have completed the required training

Counseling definition excludes psychiatrists, etc. from providing this service. 

Indicate that therapy may only be provided by LMHP type and supportive counseling activities as outlined in the ISP signed by a QMHP. 

ICT/PACT teams and service requirement:

(1)Chapter IV, page 59 provide "Counseling" (by a LMHP-type) as a condition of service

(2) Chapter IV, page 59 requires medication management, but based on definition excludes the nurse and doctor who are part of ICT/PACT teams from providing the management

(1)VAC35-105-1370 identifies the roles and responsibilities of the PACT/ICT team.  There should not be additions of requirements for counseling by a LMHP to these requirements.  This will impede ability for individuals to receive ICT/PACT services.  Additionally, Pact/ICT services are set up to meet individuals “where they are”.  Requiring that all individuals receiving counseling may prevent some from engaging with services.  There needs to be allowance for assessing the clinical appropriateness of the service with allowing the individual receiving services choice of service activities.

(2) Change Medication Management Definition and Requirements as outlined above

Questions:
(1) Chapter II, Page 28 indicates that adverse benefit determinations may be appealed.  What is definition of adverse benefit determination?

(2) Chapter IV, Page 17 indicates requirement for monthly updates to be sent to CM for all services on individual's treatment status.  What does this mean? 

(1) Provide Clarification with a definition of what is meant by Adverse Benefit Determination.

(2) Do not add another documentation requirement to the system.  However, use an already existing document to allow for the needed communication.  Include the following:  Providers must send Quarterly ISP reviews to the CM and alert the CM if there are serious incidents and/or service disruptions on the monthly basis

Concern as all MCOs can establish own authorization forms and process (Chapter IV, Page 1, Page 29).  Concern for providers tracking different registration/enrollment criteria and forms.

Require the agreement of one form to avoid service disruption to individuals and confusion by service providers. 

Chapter IV, Page 22 indicates that parent/guardian must sign ISP and Quarterly for minor seeing services. In violation of Virginia code if they are seeking outpatient services; cannot require to have guardian signature on ISP or Quarterly Review

Realign requirement to be in compliance with VA Code 16.1-338 A

Chapter IV, Page 25 Indicates all Clinical Services including assessment, crisis treatment, counseling and assistance with Medication management be provided by LMHP. 

Indicate a Case Management CNA by a QMHP; make changes to the medication management definition as defined above; include that QMHP and peers may provide supportive counseling activities as defined in the ISP and under the supervision of a LMHP.  Further, make changes as mentioned above regarding completion of CNA.

Required component of PSR is to provide education to teach individual about. Appropriate medications to avoid complication and relapse; However, Page 54 only LMHP type can do medication Management

Change the Medication Management Definition as indicated above.

MHSS service issues with Medication Management definition and criteria of service

(1)  Chapter IV, Page 65 Goal of service is assistance with medication management, but providers excluded from providing unless LMHP type

(2) Chapter IV, Page 68 contradiction as indicates QMHP can do medication management under LMHP type supervision

(1) & (2) Change the Medication Management Definition as indicated above.

MHSS provider exclusion as indicated in Chapter IV, Page 71 and Page 72:  MHSS services cannot be provided by same service provider as MH supervised living or therapeutic group home and concern on definition of partnership.

This excludes individual choice of Medicaid Provider.  Additionally can be an issue in areas where there are limited provider options and may cause individuals not to receive the services they need to live in the community. 

Indicate MHSS services may not be provided by the same staff member as who is providing the supervised living service, there must be distinct treatment goals for each service that do not overlap and there must be documentation of choice of providers being offered to the individual.