INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT

1. INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT QIO Request Submission Requirements New 6/14/2012

2. Topics • Service Type(s) • KePRO SCDHHS Website • Service Type Requirements • Contact Information

3. Prior Authorization Service Types • PRTF-Psychiatric Residential Treatment Facility • Freestanding Inpatient Psychiatric (under 21 y.o.)

4. Forms Navigate to Forms TAB to obtain Documents

5. PRTF Fax Form

6. PRTF Fax Form

7. PRTF Fax Form

8. Freestanding Psychiatric Inpatient (under 21) Fax Form

9. PRTF

10. PRTF Psychiatric Residential Treatment Facilities (PRTFs) are facilities, other than a hospital, that provides psychiatric services to children under age 21 in an inpatient setting. PRTFs provide Inpatient Psychiatric Services to children under 21 who do not need acute inpatient psychiatric care, but need a structured environment with intensive treatment services. PRTF admissions must be prior authorized by KEPRO

11. PRTF • Required Documentation for Provider’s Records: • CALOCUS • Must be completed and current within 90 days prior to requested start date • Certificate of Need (CON) • Valid for 45 days from the date it is completed • 30 day treatment plan • Plan must be created within first 14 days • Required documentation to submit to KePRO: • PRTF Fax form • Provider will attest to information from CALOCUS and CON • 30 day treatment plan • Plan must be created within first 14 days • Additional clinical

12. LENGTH OF APPROVAL • Requests initially approved for a 90-day stay. • Continued stay requests approved for a 90-day stay. • If indication given that the recipient is a “SUB CLASS” (DJJ juveniles with a serious mental illness) – approvals will be issued in 180-day increments.

13. OVERLAPPING REQUESTS • Requests for services will not be approved with overlapping dates. • If for same facility, new approval period will not be approved until the old approval has ended. • If for a different facility, the first-approved facility must send in notice of discharge prior to new approval being issued.

14. PRTF Criteria • Initial Admission • McKesson Interqual Psychiatric Residential Treatment Level of Care Functioning criteria • SCDHHS Psychiatric Hospital Services Provider Manual

15. CRITERIA FOR PRTF ADMISSION • Current diagnosis • Symptoms/behaviors (length experienced and intensity) • Prior treatment history • Support system • Functioning – How illness affects performance of ADLs and relationships with others.

16. PRTF - CONTINUED STAY REQUESTS Require treatment plan which has been updated within previous 30 days. After one year, requires submission of new CALOCUS, updated treatment plan, and clinical information to meet McKesson requirements. • Criteria requires information on current symptoms, how illness is affecting functioning, and current services being received.

17. FREESTANDING PSYCHIATRIC INPATIENT (UNDER 21)

18. CRITERIA • Inpatient Freestanding Psychiatry • Must meet criteria for either: • Immediate Safety Risk • Potential Safety Risk

19. IMMEDIATE SAFETY RISK • Symptoms within previous 48 hours. • Recipient is exhibiting symptoms that lead to immediate concern of decreased safety for recipient or other people. Example: Suicidal with definite plan

20. POTENTIAL SAFETY RISK • Symptoms present within last week that lead to concern over recipient’s safety. • As this is less urgent, requires more detailed documentation of medical necessity.

21. POTENTIAL SAFETY RISK • Clinical to be submitted includes: • Symptoms/circumstances that cause concern • Social risk; changes within previous month in relationships with others, role performance (school) or residence • Is recipient expected to adhere to treatment plan? • Why is current support system inadequate to provide care as an outpatient?

22. ADOLESCENT SUBSTANCE USE • Freestanding Inpatient Psychiatry admissions for substance use issues have a separate set of criteria that must be met. • Requirements include submission of the recipient’s history of substance use as well as behaviors exhibited as a result of substance use.

23. CRITERIA – ADOLESCENT SUBSTANCE USE • Require evidence of impairments in: • Relationships – such as a negative peer group or gang involvement, or increased conflicts with others. • Role performance – How has substance use affected education?

24. CRITERIA – ADOLESCENT SUBSTANCE USE • Admission to a residential treatment center for substance use issues also requires information on: • Prior treatment history • Issues in current social/home setting that places the recipient at increased risk • Support system

25. INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT Registration for Atrezzo Connect Provider Portal

26. How To Register For Atrezzo Connect • Website Address: https://scdhhs.kepro.com • Select “ Registration For Atrezzo Connect” (Slide 3) • Enter your 10 digit National Provider Identifier (NPI) number and Legacy South Carolina Medicaid provider ID • Select a unique user name and password & complete required user information

28. Atrezzo Connect Atrezzo Connect allows for: • Secure access to Atrezzo Connect (Provider Portal) • Provider will be able to access letters by Case/Request, Respond/Send messages To/From KePRO

29. Required Information for Security Verification • The provider must enter information to verify authenticity for security reasons • Registration Code: • SCDHHS Legacy ID

30. Simple -5 Step Registration Process • Start by clicking the Atrezzo Login button on the SCDHHS-KePRO website

31. Login Page • You will be brought to this login page

32. Step 2 – Enter NPI and Legacy ID • Enter your organization’s NPI number and Legacy Provider ID = Provider Registration Code • Click NEXT

33. Step 3 – Terms of Agreement • Review Terms of Agreement. Upon acceptance, you will be taken to setup for User information.

34. Step 4 – Verify Address • Click on the correct address(s) for the new account (this associates your user information with these locations) • If all apply, check all of them • Click SELECT

35. Step 5 – Enter Account Information • Enter user account information • User Name, Password, First/Last Name, E-mail and Fax Number are required fields! • Click NEXT-This will take you to the Password setup and security question Slide) • Passwords do not expire. Minimum 8 characters required.

36. Successful Completion • Successful Completion of setup, takes you to the Home Page

37. View all request and Create new request • Click Member to search using Member id or Last • name/DOB • Click Request/Case to search using Case id, • Member info or Request info

38. Create Preferences, Manage User accounts and New Provider Registration Use this tab to change your password or update your contact information View Atrezzo User Guide and View FAQs

39. Account Administrator • All information submitted for registration under Provider/Facility Information will represent as the Provider Portal Administrator (Group Admin). • The Group Admin is responsible for managing and creating all Submitting User accounts for your NPI # • Create other Group Admins’ & Admin Users • Set Preferences, i.e. Diagnosis and Procedure codes, etc

40. KePRO Contacts

41. Thank You! 42