Welcome

1. Department of Public Health and Human Services Welcome Comprehensive School and Community Treatment Program Training Fall 2007

2. Department of Public Health and Human Services What We Will Learn Today History About the CSCT Program Requirements How to Bill How to Document More Information

3. Department of Public Health and Human Services History of Medicaid in Schools Schools have been billing Medicaid for over 10 years 2001 MT Legislature issued a directive to allow for increased Federal Spending The CSCT program was reinstated into the school based services and enacted in the fall of 2003

4. Department of Public Health and Human Services Why Schools Can Bill Medicaid Title XIX (19) of the Social Security Act Oversight is done by Centers for Medicare/Medicaid (CMS) Includes Early Periodic Screening, Diagnostic & Treatment Program (EPSDT) Medicare Catastrophic Coverage Act makes the connection to Individual Education Plans (IEP) Individuals with Disabilities in Education Act (IDEA) CSCT Services can be provided for students without an IEP.. this is different from all other School-Based services in Montana

5. Department of Public Health and Human Services Why is the CSCT Program a School-Based Service Helps to eliminate the risk of removing students from home and school Program is operated by the school through a contract with a mental health center Source of funding makes this available only thru school programs

6. Department of Public Health and Human Services Reimbursable Services Code H0036- Community psychiatric supportive treatment, face-to-face, per 15 minutes (Medicaid specific) Includes individual, family and group counseling Behavioral interventions with student (minimum of 8 minutes for one 15 minute unit) Direct Crisis intervention when student is present in a school-owned or operated facility Services need to correspond with a students' Individual Treatment Plan (ITP)

7. Department of Public Health and Human Services Non-Reimbursable Activities Observation & monitoring/supervision Non face to face service Time in meetings More than 720 units of service per month per team Educational/Academic assistance with schoolwork Watching movies—attending assemblies---fieldtrips Less than 8 minutes of service in the 15 minute unit that is billable

8. Department of Public Health and Human Services Provider Requirements Services must be provided by at least two program staff Caseload for program cannot exceed 720 units (15 minutes each) per month per team At least one of the two staff must be: Licensed Psychologist Licensed Clinical Social Worker Licensed Professional Counselor An In-training licensed professional can be employed with the approval of the Children’s Mental Health Bureau at the state department

9. Department of Public Health and Human Services Service Requirements Does not require Passport approval and can only be provided to children with Severe Emotional Disturbances (SED) found in ARM 37.86.3702 Does not have to be included on IEP Services not specified on the IEP must be provided and billed to ALL children who require services Free Care rule applies with non-IEP services

10. Department of Public Health and Human Services Free Care Rule Services must be made available to all children, not just Medicaid eligible recipients All recipients must be billed, not just Medicaid To meet this rule CSCT programs must: Establish sliding fee schedule Determine third party liability (other insurance if any) Bill recipients for cost of service Students with IEP’s are exempt from the “Free Care Rule” in regard to CSCT services

11. Department of Public Health and Human Services Part time Staff 37.106.1960 MENTAL HEALTH CENTER: COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM, STAFFING AND TRAINING (5) This rule is not intended to prevent the use of part-time staff to provide CSCT services throughout the year, including school vacation periods. If a child or adolescent receives CSCT services during time periods when school is not regularly in session, then part-time staff may be used and billed as set forth in ARM 37.86.2225.

12. Department of Public Health and Human Services Administrative Rule for Prior Authorization of Outpatient Therapy with CSCT 37.88.101MEDICAID MENTAL HEALTH SERVICES, AUTHORIZATION REQUIREMENTS (1) Mental health services for a medicaid recipient under the Montana medicaid program will be reimbursed only if the following requirements are met: . . .(c) prior authorization has been obtained for outpatient therapy services that are provided concurrently with comprehensive school and community treatment (CSCT) program services described at ARM 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, 37.106.1965 and 37.86.2225;

13. Department of Public Health and Human Services Program Requirements/Approval Provided by a licensed mental health center Program is approved with a CSCT area of endorsement by Quality Assurance Division (QAD) at the state department Information can be found in Appendix C of School Based Provider Manual Students with SED’s are served Certification of match is completed by schools at the end of the year For federal match requirements to obtain these dollars for reimbursement.

14. Department of Public Health and Human Services Provider Approval Individual provider/staff approval is generally not required Expectation is that CSCT staff are available throughout each day to work with children as needed CSCT programs can use Pre-Licensed Professionals on an infrequent basis Contact Diane White, Clinical Program Officer for Children’s Mental Health @ 406-444-1535 for approval of in-training staff personnel (this could be changing)

15. Department of Public Health and Human Services Students with SED’s Served Services can only be provided to students with serious emotional disturbances (ARM 37.86.3702, rule at end) regardless of whether the child is eligible for Special Education services Program not intended for children with functional limitations that require activities of daily living (ADL) These services are covered by other Medicaid services like paraprofessional staff

16. Department of Public Health and Human Services Certification Of Match The Federal government requires an annual certification of non-federal expenditures to cover the costs associated with CSCT services Individual schools are responsible for this match worksheet that is kept on file at the department.

17. Department of Public Health and Human Services Provider Enrollment with MT Medicaid Provider Notice for School Based Service dated March 7, 2007 Schools re-enrollment and National Provider Identification Number (NPI) Mental Health Centers need to work with schools to get the CSCT program staff (teams) enrolled and identified as TEAM 01 and so on Important and needs to be done before billing for service’s (October 1, 2007)

18. Department of Public Health and Human Services How to Bill for Services Details can be found in the School Based Services Manual Only use H0036 code Field 19 on CMS-1500 is location for “TEAM 01” etc. WINASAP 2003 is available from ACS and is HIPPA compliant for use in electronic billing Contact Tom Keith @ 406-451-9532

19. Department of Public Health and Human Services Documentation Requirements 37.85.414MAINTENANCE OF RECORDS AND AUDITING (1) All providers of service must maintain records which fully demonstrate the extent, nature and medical necessity of services and items provided to Montana Medicaid recipients. The records must support the fee charged or payment sought for the services and items and demonstrate compliance with all applicable requirements. . . . (b) When reimbursement is based on the length of time spent in providing the service, the records must specify the time spent or the time treatment began and ended for each procedure billed to the nearest minute. Total time billed using one or multiple procedure codes may not exceed the total actual time spent with the Medicaid client.

20. Department of Public Health and Human Services 37.86.3702 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, ELIGIBILITY (2) "Serious emotional disturbance (SED)" means with respect to a youth from the age of six through 17 years of age that the youth meets requirements of (2)(a) and (2)(b). (a) The youth has been determined by a licensed mental health professional as having a mental disorder with a primary diagnosis falling within one of the following DSM-IV (or successor) classifications when applied to the youth's current presentation (current means within the past 12 calendar months unless otherwise specified in the DSM-IV) and the diagnosis has a severity specifier of moderate or severe: (i) childhood schizophrenia (295.10, 295.20, 295.30, 295.60, 295.90); (ii) oppositional defiant disorder (313.81); (iii) autistic disorder (299.00); (iv) pervasive developmental disorder not otherwise specified (299.80); (v) asperger's disorder (299.80); (vi) separation anxiety disorder (309.21); (vii) reactive attachment disorder of infancy or early childhood (313.89);

21. (viii) schizo affective disorder (295.70);(ix) mood disorders (296.0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89); (x) obsessive-compulsive disorder (300.3); (xi) dysthymic disorder (300.4); (xii) cyclothymic disorder (301.13); (xiii) generalized anxiety disorder (overanxious disorder) (300.02); (xiv) posttraumatic stress disorder (chronic) (309.81);(xv) dissociative identity disorder (300.14); (xvi) sexual and gender identity disorder (302.2, 302.3, 302.4, 302.6, 302.82, 302.83, 302.84, 302.85, 302.89); (xvii) anorexia nervosa (severe) (307.1); (xviii) bulimia nervosa (severe) (307.51); (xix) intermittent explosive disorder (312.34); and (xx) attention deficit/hyperactivity disorder (314.00, 314.01, 314.9) when accompanied by at least one of the diagnoses listed above

22. b) As a result of the youth's diagnosis determined in (2)(a) and for a period of at least six months, or for a predictable period over six months the youth consistently and persistently demonstrates behavioral abnormality in two or more spheres, to a significant degree, well outside normative developmental expectations, that cannot be attributed to intellectual, sensory, or health factors: (i) has failed to establish or maintain developmentally and culturally appropriate relationships with adult care givers or authority figures; (ii) has failed to demonstrate or maintain developmentally and culturally appropriate peer relationships; (iii) has failed to demonstrate a developmentally appropriate range and expression of emotion or mood; (iv) has displayed disruptive behavior sufficient to lead to isolation in or from school, home, therapeutic or recreation settings; (v) has displayed behavior that is seriously detrimental to the youth's growth, development, safety or welfare, or to the safety or welfare of others; or (vi) has displayed behavior resulting in substantial documented disruption to the family including, but not limited to, adverse impact on the ability of family members to secure or maintain gainful employment.

23. Serious emotional disturbance (SED) with respect to a youth under six years of age means the youth exhibits a severe behavioral abnormality that cannot be attributed to intellectual, sensory, or health factors and that results in substantial impairment in functioning for a period of at least six months and obviously predictable to continue for a period of at least six months, as manifested by one or more of the following: (i) atypical, disruptive, or dangerous behavior which is aggressive or self-injurious;(ii) atypical emotional responses which interfere with thechild's functioning, such as an inability to communicate emotional needs and to tolerate normal frustrations; (iii) atypical thinking patterns which, considering age and developmental expectations, are bizarre, violent, or hypersexual; (iv) lack of positive interests in adults and peers or afailure to initiate or respond to most social interaction; (v) indiscriminate sociability (e.g., excessive familiarity with strangers) that results in a risk of personal safety of the child; or (vi) inappropriate and extreme fearfulness or other distress which does not respond to comfort by care givers.

24. (3) A youth must be reassessed annually by a licensed mental health professional, as to whether or not they continue to meet the criteria for having a serious emotional disturbance. For the initial or for an annual reassessment, the clinical assessment must document how the youth meets the criteria for having a serious emotional disturbance.

25. Department of Public Health and Human Services More Information & Contacts School–Based Services Program Provider Manual Download a copy from www.mtmedicaid.org Also found at Web site is Provider Notices, Fee Schedules, Forms and HIPAA information DPHHS Contact: Rena Steyaert Diane White Program Officer Clinical Program School Based Officer Children’s Services Mental Health (406)-444-4066 (406)-444-1535 rsteyaert@mt.govdwhite@mt.gov