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HomeMy WebLinkAboutResolutions - 1996.05.23 - 24838MAY 9, 1996 MISCELLANEOUS RESOLUTION #96110 BY: PUBLIC SERVICES COMMITTEE - SHELLEY TAUB, CHAIRPERSON IN RE: COMMUNITY MENTAL HEALTH - EARNED REVENUE CONTRACTS WITH THE MICHIGAN DEPARTMENT OF MENTAL HEALTH To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: WHEREAS the Michigan Department of Mental Health has requested approval of "Earned Revenue" contracts with the Oakland County CMH Board for the periods 8/1/95 - 9/30/95, 10/1/95 - 12/31/95 and 1/1/96 - 9/30/96, to provide for reimbursement of CMH costs for pre-admissions and continued stay reviews of inpatient and day hospital services under the State's Medicaid Managed Care program; and WHEREAS approval of these contracts is necessary in order for the revenue earned by the Board since August 1, 1996 to be received from the Department of Mental Health; and WHEREAS the terms of the proposed Earned Revenue Contracts have been reviewed by Oakland County Corporation Counsel and are acceptable to the Administration with modification of the 8/1/95 - 9/30/95 and 10/1/95 -12/31/95 agreements to make the language on page 4, 111.B, fourth sentence consistent with the newer 1/1//96 - 9/30/96 agreement, i.e., "In the event that the BOARD realizes costs incurred after the billing has been submitted for a month, or corrections need to be made to a submitted billing, the Board may submit a revised billing that replaces the billing previously submitted". WHEREAS these contracts have been approved by the Oakland County Community Mental Health Board. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners approves the three attached agreements with the Michigan Department of Mental Health as modified. Chairperson, on behalf of the Public Services Committee I move the adoption of the foregoing resolution. PUBLIC SERVICES COMMITTEE 'AGREEMENT between THE MICHIGAN DEPARTMENT OF MENTAL HEALTH AND THE COMMUNITY MENTAL HEALTH BOARD This AGREEMENT is made by and between the MICHIGAN DEPARTMENT OF MENTAL HEALTH, hereafter referred to as the "DEPARTMENT and the COMMUNITY MENTAL HEALTH BOARD, hereafter referred to as the 'BOARD', to tie effective from August 1, 1995, through September 30, 1995. I. PURPOSE This agreement is intended to specify the requirements for Medicaid reimbursement for the completion of PRE-ADMISSION SCREENINGS FOR NON-STATE HOSPITAL PSYCHIATRIC INPATIENT SERVICES, and PRE-ADMISSION SCREENINGS AND CONTINUING STAY REVIEWS FOR HOSPITAL-BASED PARTIAL HOSPITALIZATION PROGRAMS, AND RELATED MEDICAID MANAGED CARE ACTIVITIES, including the method of costing, billing and payment for these services. REQUIREMENTS A. Screenings and reviews as described herein shall be conducted and reported in accordance with the following documents: • 1. Medicaid Services Administration (MSA) Bulletin 95-02, for Mental Health Clinics, issued July 1, 1995. 2. Federal OMB Circular A-87, "Cost Principles for State, Local and Indian Tribal Governments," dated Wednesday, May, 17, 1995. 3. Requirements for the Medicaid Managed Mental Health Services Program, Inpatient Pre-Admission Screening Procedures, Partial Hospitalization Review Procedures, and Utilization Management Criteria - Level of Care Determination, distributed by the DEPARTMENT. 1 4. Quality Improvement and Performance Monitoring Plan for Managed Mental Health Services Program, distributed by the DEPARTMENT. The DEPARTMENT will notify the BOARD of any changes in these documents due to federal or state requirements. Such changes will be incorporated into this Agreement within sixty (60) days of the DEPARTMENT's notification to the BOARD, unless otherwise provided by federal regulations. INPATIENT PRE-ADMISSION SCREENING B. The BOARD will provide pre-admission screening for Medicaid recipients not enrolled in a capitated health plan, requesting or presented for admission to a psychiatric hospital or psychiatric unit. Pre-admission screening activities are defined as: Staff activities to conduct a brief assessment to determine whether or not psychiatric inpatient is the appropriate level of care. This may include staff travel time for face-to-face screenings. This does not include: comprehensive assessments or evaluations; referral activities; involuntary petitions/applications; court work; or certifications. Inpatient services must be coordinated with the Michigan Peer Review Organization (MPRO) which is responsible to authorize Medicaid payment for the inpatient stay. PARTIAL HOSPITAUZATION SCREENING AND AUTHORIZATION C. The BOARD will provide pre-admission screening, episode management, and retrospective reviews for Medicaid recipients not enrolled in 'a capitated health plan, who request or are referred for Partial Hospitalization Programs (PHP). Pre-admission screenino a arnersons wno are CM( etnea 1T1 PHF into an alternative service are defined as: Staff activities to conduct a brief assessment to determine whether or not a PHP is the appropriate level of care. This does not include: comprehensive assessments or evaluations; or referral activities. IJ Dr DE Disoae manauerner admitted to a i includes the pre-admission screening, continuing stay reviews and payment authorization activities associated with an episode of service in a PHP. These are defined as: Pre-admission screening: Staff activities to conduct a brief assessment to determine whether or not a PHP is the appropriate level of care. Continuing stay reviews: Staff activities conducted at intervals following admission, to determine whether further PHP service is needed. Payment authorization: Staff activities to notify the PHP and/or the Medical Services Administration (MSA) regarding the number of days of PHP service which are approved for Medicaid payment. Retrospective reviews for persons admitted to PHP are defined as: Staff activities to review the entire PHP medical record to determine whether or not the admission was appropriate, whether some or all of the days of care were appropriate for Medicaid payment, and to authorize the Medicaid payment. RECONSIDERATIONS AND APPEALS D. The BOARD will provide for a reconsideration of a decision which it renders regarding (1) request for psychiatric inpatient admission, (2) request for admission to, or payment authorization for, a PHP. Reconsideration activities are defined as: Time spent by the clinical supervisor or CMH psychiatrist in reviewing the documentation of the CMH clinician's decision; time spent in obtaining additional information from the person requesting reconsideration; time spent rendering and documenting the reconsideration decision. E. The BOARD will participate in Department of Social Services (DSS) hearings for appeals of decisions which it renders regarding (1) request for psychiatric inpatient admissions, (2) request for admission to, or payment authorization for, a PHR Appeal activities are defined as: Time spent by clinical staff/supervisor or Community Mental Health (CMH) psychiatrist in a DSS hearing. 3 S- OUT OF STATE F. The BOARD will provide pre-admission screening and prior admission authorization for children referred for out-of-state psychiatric inpatient placements. Pre-admission reviews are conducted in accordance with Under 21 Elective Admission Certificate of Need requirements: Time spent by CMH clinicaVmedical staff in conducting pre-admission review and in submitting Medicaid payment authorization documentation to DSS/MSA and the treating facility. G. The BOARD will provide continued stay reviews and Medicaid payment authorization for children's out-of-state psychiatric inpatient placements. Continued stay review activities are defined as: Time spent by CMH clinical staff in conducting continued stay reviews • and in submitting Medicaid payment authorization documentation to DSSIMSA and the treating faaility. III. RECORDS, BILLINGS AND REIMBURSEMENTS A. The BOARD will maintain all documentation and records concerning activities performed, and verification of compliance with standards for subsequent audit, and actual cost documentation for a period of seven (7) years and assure that all such documents will be accessible for audit by appropriate DEPARTMENT staff and other authorized agencies. B. The BOARD will submit monthly billings to the DEPARTMENT for activities performed in accordance with the terms of this Agreement. Billings will be on an actual cost basis, as defined in the DMH billing procedures for Medicaid Managed Mental Health Care. Only one (1) bill for all the various activities performed under this contract will be considered for payment per month, and should be submitted to the DEPARTMENT within forty-five (45) days after the end of the month in which the activities were performed, except for the September bill which should be submitted within fifteen (15) days after the end of the month. In the event that the BOARD realizes costs incurred after the billing has been submitted for a month, the Board may submit a revised billing. In any event, all bills for services provided under this Agreement must be received by the DEPARTMENT no later than October 15, 1995. Submitted bills will also include separate statements for each of the types of activities performed, as well as a total bill for the month. The forms attached to this contract are to be used for billings submitted under this contract. 4 Payments made to the BOARD for these activities will be included as earned revenue from the DEPARTMENT on the bi-monthly and final expenditure reports of the BOARD. Projected revenues will be identified as 'Other Earned Revenue' on the Summary of Projected Funding, Line 11(E), 0MH/DMH Grants and Earned Contract Totals. No local funds will be required for the state share of these payments. Payments made under this Agreement are subject to the requirements under the Single Audit Act of 1984. The CFDA number for the federally-funded portion, which will be required for the state share of payments made to the Board under the Agreement, is 93.778. IV. DEPARTMENT RESPONSIBILITIES A. The DEPARTMENT agrees that for bills received which are correctly and completely submitted on a timely basis as specified in Paragraph III. B. above, payments will be made within forth-five (45) days of receipt of billing by the BOARD. The DEPARTMENT will reimburse the BOARD for its actual direct and Indirect costs for the activities associated with this agreement, up to an average maximum of: Inpatient pre-admission screening: face-to-face: up to $125 per screening telephone: up to $30 per screening Partial hospital pre-admission screening where admission is diverted: face-to-face: up to $95 per screening telephone: up to $30 per screening Management of Partial Hospitalization episode where person is admitted: up to $220 per episode Retrospective review: up to $95 per episode Reconsiderations: up to $50 per reconsideration Appeals: actual cost per appeal Out-of-state placement: actual cost per review 5 C. The spending target for the two-month term of this agreement is attached. PLEASE NOTE that the state has imposed a 5-month expenditure CAP for the key review activities covered by this Agreement. The first two months activities/expenditures will be monitored against the overall limit, but the total CAP will only apply to the total 5-month period. The key review activities included in the expenditure CAP are the Inpatient pre-admission screenings and the partial hospitalization reviews. The activities excluded from the CAP Include the reconsiderations, appeals, and out-of-state placements. D. The DEPARTMENT will prepare claims for federal financial participation and submit these claims to the Department of Social Services. The BOARD will provide the DEPARTMENT with such documentation as may be required to support claims for federal financial participation. The DEPARTMENT will hold the BOARD financially harmless where the BOARD has followed procedures as outlined in Federal Office of Management and Budget Circular A--87, and has documentation as to the activities performed and the costs associated with those activities. The BOARD will be held responsible for lack of documentation or failure to follow A-87. V. TERMINATION The Agreement may be terminated by either party with sixty (60) days notice. Such notice shall be made in writing, and sent by certified mail. Termination will take effect sixty (60) days from receipt of said notice. Chairperson, Community Mental Health Board Date James K. Haveman, Jr., Director Date Michigan Department of Mental Health Attachments: A. Medicaid Administrative Activities Earned Contract Maximum Billable Amount. B. Medicaid Managed Mental Health Care Activity Billing Forms 6 MEDICAID MANAGED MENTAL HEALTH PROGRAM ADMINISTRATIVE ACTIVITIES Earned Contract Board: - Oakland Direct Service Target: (Annualized 12 month Amount) $5,118,715 Administartive Activities (Maximum Billable Amount) 12 Month Maximum Amount $196,731 2 Month Maximum Amount for 8/95-9/95 $32,788 5 Month Maximum A.mouint for 8/95-12/95 $81,971 PEdirlf_A 414 1.11 $125. $ 95 $ 30 $220 $ 95 FOR MONTHS, , THROUGH FINAL MONTHLY BILLING FOR MANAGED CARE CONTRACT I IT -DEEM • MONTHLY ACTUAL COSTS - SEE fOOTNOTE 1 Altlisi LIAX/A11.41 • r V 1. _ • , • 11 ' ' • • . . .1, iNPATiENT PHE ADMISSION/ FACE•TO-FACE 2) INPATIENT PREADMISSION/ PHONE - 13) PHP PREADMISSION/ FACE-TO-FACE PHP PREADMISSION/ PHONE • 5) PHP EPISODE MANAGEMENT 6) PNP RETROSPECTIVE 7)TOrAL BILLABLE COSTS-SECT1ON ODD LINES I THROUGH 0, COLUMNS) 41) ACCUMULATED TOTAL REIMBURSED COSTS $ _ AND TOTAL UNREIMBURSOKSILLED)COSTS $ proTAL COSTS BILLED TO DATE(ADD UNES 7 AND 5, COLUMNS)) 10) CONTRACT CAP • 1 -• • • - •re., •ff.; 48•••••,8:, ..:f •::lled ,41 ,1 tr.4 1.1' rio 8. 88...4,-4/;.n .'ope, • I 2)RECONSIDERADONS 131APPEALS I d)Ou T OF STATE PLACEMENT-AWN 5)OuT OF STATE PLACEMENT-CONr ig STAY ^.•.16.. I• • I. • z.•••••11,4 r I t'a.a , •• . • IC $ 95 GTMEMilJ 11MEMIMMXIMBEMMI MO MO /7 ('4 ATOM nftu A tE c F Ano ?CRECY coo Ts. no score PEMEIENTS 3144r TNEINI MAUL COO TS Ang wpm= IN COWLAINCIr MOW COO COMMA A.4):, VOTri maticarcis F011 SLUE MO LOCAL 00tflO&OHIE CaaJC, ilk Will PONCIal A40 IwOCED09111 #0,1 urr.a..apfte COOT ALLOCAIX3P0 P41419 AND POP KT COST A4111, natamitnyAN2 001070ACTItwin DE4L 00VITOOSENT: notrAtL PROOZOIAWS #60111 BEM MUMMA AMMO. illourgo APPORTNO IDOCIWIMAnOM nAJP NB8PAIWAVEO 4,0 • AVALAJLI ADA rer•-••Lupn LPG" AtOLISY. 7/4 POMO WWII FLU FINONCM1ANOOOMPUIVIO1 IWSPONSIOLIFY PORK; copra •C•AD GEN1VCAT4 Ca•n 1041C) Of MP OS ff 110•01ltiO AU. COST AT ACIIIAti. AN TOXSOLONCE VADIPIIDWW. ONO ONCULAMMI AND000.10, THIPONIDA0010 OW ALL COM AM SALA= romarAmo•sames A41 AITCP01011./T1 PROVINVY Are MOIR 0001AiliffA SICK CAI! CO•MAIITY •IPRAL •014PIDAPAVTOI AsIMAVINOWArlOrt 11n11/DOZIPUE DO 101A1. COTIO AO MUM, On DAS SWIM TO II MD TO 11 MOO 047. PIP4SMION'T 01. NOWA MATO MPUDst IltaiCaCrIt001.0100•111,11 A/' as AGREEMENT . • between THE MICHIGAN DEPARTMENT OF MENTAL HEALTH AND THE COMMUNITY MENTAL HEALTH BOARD This AGREEMENT is made by and between the MICHIGAN DEPARTMENT OF MENTAL HEALTH, hereafter referred to as the 'DEPARTMENT" and the COMMUNITY MENTAL HEALTH BOARD, hereafter referred to as the 'BOARD', to be effective from October 1, 1995, through December 31, 1995. I. PURPOSE This agreement is intended to specify the requirements for Medicaid reimbursement for the completion of PRE-ADMISSION SCREENINGS FOR NON. STATE HOSPITAL PSYCHIATRIC INPATIENT SERVICES, and PRE- ADMISSION SCREENINGS AND CONTINUING STAY REVIEWS FOR HOSPITAL-BASED PARTIAL HOSPITALIZATION PROGRAMS, AND RELATED MEDICAID MANAGED CARE ACTIVMES, iricluding the method of costing, billing and payment for these services. II. REQUIREMENTS A. Screenings and reviews as described herein shall be conducted and reported in accordance with the following documents; • 1. Medicaid Services Administration (MSA) Bulletin 95-.02, for Mental Health Clinics, issued July 1, 1995. Federal OMB Circular A-87, 'Cost Principles for State, Local and Indian Tribal Governments,' dated Wednesday May, 17, 1995 and OASC-10 'Cost Principles and Procedures for Establishing Cost Allocation Plans and Indirect Cost Rates for Grants and Contracts with the Federal Government". 3. Requirements for the Medicaid Managed Mental Health Care Program, Inpatient Pre-Admission Screening Procedures, Partial Hospitalization Review Procedures, and Utilization Management Criteria - Level of Care Determination, distributed by the DEPARTMENT. 4. Reimbursement Instructions for the Metlicald•Martiged Mental Health Care Program dated August 1, 1995 distributed by the DEPARTMENT. 5. Quality improvement and Performance Monitoring Plan for Managed Mental Health Services Program, distributed by the DEPARTMENT. The DEPARTMENT will notify the BOARD of any changes in these documents due to federal or state requirements. Such changes will be incorporated into this Agreement within sixty (60) days of the DEPARTMENTs notification to the BOARD, unless otherwise provided by federal regulations. INPATIENT PRE-ADMISSION SCREENING B. The BOARD will provide pre-admission screening for Medicaid recipients not enrolled in a capitated health plan, requesting or presented for admission to a psychiatric hospital or psychiatric unit Pre-admission screening activities are defined as: Staff activities to conduct a brief assessment to determine whether or not psychiatric inpatient is the appropriate level of care. This may include staff travel time for face-to-face screenings. This does not include: comprehensive assessments or evaluations; referral activities; involuntary petitions/applications; court work; or certifications. Inpatient services must be coordinated with Michigan Peer Review Organization (MPRO) which is responsible to authorize Medicaid payment for the inpatient stay. PARTIAL HOSPITALIZATION SCREENING AND AUTHORIZATION , C. The BOARD will provide pre-admission screening, episode management, and retrospective reviews for Medicaid recipients not enrolled in a capitated health plan, who request or are referred for Partial Hospitalization Programs • (PHP). Pre-admission screening activities for persons who are diverted from PHP into an alternative service are defined as: Staff activities to conduct a brief assessment to determine whether or not a PHP is the appropriate level of care. This does not include: comprehensive assessments or evaluations; or referral activities. 2 Eisode management. .rjarzi. s a admitted u 2 h H includes the pre-admission screening, continuing stay reviews and payment authorization activities associated with an episode of service in a PHP. These am defined as: Pre-admission screening: Staff activities to conduct a brief assessment to determine whether or not a PHP is the appropriate level of care. Continuing stay reviews: Staff activities conducted at intervals following admission, to determine whether further PHP service is needed. Payment authorization: Staff activities to notify the PHP and/or the Medical Services Administration regarding the number of days of P HP service which are approved for Medicaid payment /Retrospective reviews for persons admitted to PHP are defined as: Staff activities to review the entire PHP medical record to determine whether or not the admission was appropriate, whether some or all of the days of care were appropriate for Medicaid payment, and to authorize the Medicaid payment. RECONS1DEF1ATIONS AND APPEALS D. The BOARD will provide for a reconsideration of a decision which it renders regarding (1) request for psychiatric inpatient admission, (2) request for admission to, or payment authorization for, a PHP. Reconsideration activities are defined as: Time spent by the clinical supervisor or CMH psychiatrist in reviewing the documentation of the CMH clinician's decision; time spent in obtaining additional information from the person requesting reconsideration; time spent rendering and documenting the reconsideration decision. E . The BOARD will participate in DSS hearings for appeals of decisions which it renders regarding (1) request for psychiatric inpatient admissions, (2) request for admission to, or payment authorization for, a PHP. Appeal activities are defined as: Time spent by clinical staff/supervisor or CMH psychiatrist in a DSS hearing. 3 E, OUT OF STATE F. The BOARD will provide pre-admission screening and prior admission authorization for children referred for out-of-state psychiatric inpatient placements. Pre-admission reviews are conducted in accordance with Under 21 Elective Admission Certificate of Need requirements: Time spent by CMH clinicaVmedical staff in conducting pre-admission review and in submitting Medicaid payment authorization documentation to DSS/MSA and the treating facility. G. The BOARD will provide continued stay reviews and Medicaid payment authorization for children's out of state psychiatric inpatient placements. Continued stay review activities are defined as: lime spent by CMH clinical staff in conducting continued stay reviews and in submitting Medicaid payment authorization documentation to DSS/MSA and the treating facility. III. RECORDS, BILLINGS AND REIMBURSEMENTS A. The BOARD will maintain all documentation and records concerning activities performed, and verification of compliance with standards for subsequent audit, and actual cost documentation for a period of seven (7) years and assure that all such documents will be accessible for audit by appropriate DEPARTMENT staff and other authorized agencies. B. The BOARD will submit monthly billings to the DEPARTMENT for activities performed in accordance with the terms of this Agreement. Billings will be on an actual cost basis, as defined in the DMH billing procedures for Medicaid Managed Mental Health Care. Only one (1) bill for all the various activities performed under this contract will be considered for payment per month, and should be submitted to the DEPARTMENT within forty-five (45) days after the end of the month in which the activities were performed. In the event that the BOARD realizes costs incurred after the billing has been submitted for a month, the Board may submit a revised billing that replaces the billing previously submitted. The monthly average maximum will then apply to the revised billing. In any event, all bills for services provided under this Agreement must be received by the DEPARTMENT no later than February 15, 1996. Submitted bills will also include separate statements for each of the types of activities performed, as well as a total bill for the month. Th& form attached to this contract is to be used for billings submitted under this contract. 4 C. Payments Made to the BOARD for these activities will be included as . earned revenue from the DEPARTMENT on the bi -monthly and final expenditure reports of the BOARD. Projected revenues will be identified as *Other Earned Revenue* on the Summary of Projected Funding, Line 11(E), CMH/DMH Grants and Earned Contract Totals. No local funds will be required for the state share of these payments. Payments made under this Agreement are subject to the requirements under the Single Audit Act or 1984. The CFDA number for federally funded portion will be required for the state share of payments made to the Board under the Agreement Is 93.778. IV. DEPARTMENT RESPONSIBILITIES A. The DEPARTMENT agrees that for bills received which are correctly and completely submitted on a timely basis as specified in Paragraph III. B. above, payments will be made within forty-five (45) days of receipt of billing by the BOARD. B. The DEPARTMENT will reimburse the BOARD for its actual direct and indirect costs for the activities associated with this agreement, up to an average monthly maximum of: (Activities within the Board's target) Inpatient pre-admission screening: face-to-face: $125 per screening telephone: $30 per screening - Partial hospital pre-admission screening where admission is diverted: face-to-face: $95 per screening telephone: $30 per screening Management of Partial Hospitalization episode where person is admitted: $220 per episode Partial Hospitalization Retrospective review: $95 per episode (Activities not within Board's target) Reconsiderations: $95 per reconsideration Appeals: actual cost per appeal Out-of-state placement: actual cost per review 5 4 ••• • C. The DEPARTMENT ur iilthbZirITi the BOARD up to a 5-month expenditure CAP . for • the key review activities covered by this Agreement. The key review activities included In the expenditure CAP are the inpatient pre-admission screenings and the partial hospitalization reviews. The activities excluded from the CAP include the reconsiderations, appeals, and out-of•state placements. D. The DEPARTMENT will prepare claims for federal financial participation and submit these claims to the Department of Social Services. The BOARD will • provide the DEPARTMENT with such documentation as may be required to support claims for federal financial participation. E. The DEPARTMENT will hold the BOARD financially harmless where the BOARD has followed procedures as outlined in Federal Office of Management and Budget Circular A-87 and OASC-10, and has documentation as to the activities performed and the costs associated with those activities. The BOARD will be held responsible for lack of documentation or failure to follow A-87 and OASC-10. V. TERMINATION The Agreement may be terminated by either party with sixty (60) days notice. Such notice shall be made in writing, and sent by certified mail. Termination will take effect sixty (60) days from receipt of said notice. Community Mental Health Board Date James K Haveman, Jr. Director Date Michigan Department of Mental Health Attachments: A. Medicaid Administrative Activities Earned Contract Maximum Billable Amount. B. Medicaid Managed Mental Health Care Activity Billing Form ‘,TAIOrE I MONTHLY' AmxiMulA 0 r or 1b • • (sow . -Idac eris,r1444 , - (c 4 • _ 4 t 4", • • , .)1W4ITTV Ei ' 1171(C,•?v •• ri :t 41".4 ';'..r4"i i( ( nENT PREADMISSION/PHONE C' rREADMISSIONIFACETO-FACE 0 ME-ADMISSION/PHONE E " RETROSPECTWE 1 INSOOF MANAGEMENT 41. extABLE COSTS-..SECTION I(400 LINES I THROUGH I, COLUMNS) -usTUIATEO TOTAL REIMBURSED COSTS $ ANO TOTAL UNREVATTURSED(BILLED) COSTS $ • FOR MONTHS, • THROUGH • L COSTS STUEO TO DATE(A00 UNES T ANO S. COLUMNS)) NTRACTCAP CIIMEZZAIBIO FWIZZJUL *•,_ • • - •• • ''VSIPERAT IONS EATS V STA TE PLACEMENT -ADATIN SrATE rLAGEATENT COM' fl STAY $ 95 s. . . V;•1.4•41,1,., ••••;:fme:If • ••••"t $12'i $ 30 $' 95 $ 30 $220 $ 95 CAM 3q APRIOTIMP INPYCT MDMitr Oarra REPenev771,NsT NAC1UI 00117.NVIMA•coupumar Mow eiRcuLARA mg. =ors ARINIcpur$ Pon WAIT APO (Om IKAINNIalwrr. AND OW- to. 001IT MINCItig APO r? rvfneureir corraucloo Toy now Aye wOMILLT Miff nun pesv ~rime airmen, omiPNSD ouverommn INSTALL MilaefiXtla HOE we • nuogotro, O TAT1WNSS TN P? uts ppm Arnpwisgar wag ArOLIFVF. IOW* ALMA/ft MU INIVICIAL ANOCOMPIMMIREIrcomurreaRAU corm •11.11--1173nrtS Caw Poole CIFW7VII P45111' p443min•corpo cum AT weftima AACI ire powwow. WM mew our Cinat.Are A47,043 OASC-Ip, iNE glove ACKNOWLEDOES 1740 AU coons APIESUILNer TOALOT ANnAlgtaarg nAL my. one ARCIP•1111TV VOOLIWIffis Mpg Dar 0011111/PINT NORM /WAD, MCMAP OPIUM, mom Asomme now* COM As meille mosums YORAM 70 IPS MONO orwmagewrer man mom Avniaisso 'TAW nee IrafterrAll DEPARTMENT OF MENTAL HEALTH LANSING. MICHIGAN 48913 10/1/95 MEDICAID ADMINISTRATIVE ACTIVITIES EARNED CONTRACT , MAXIMUM BILLABLE AMOUNT Board: Oakland Administrative Activities: 5 Month Maximum Amount, 8/95-12195 $81,971 AGREEMENT • between THE MICHIGAN DEPARTMENT OF MENTAL HEALTH AND THE COMMUNITY MENTAL HEALTH BOARD This AGREEMENT is made by and between the MICHIGAN DEPARTMENT OF MENTAL HEALTH, hereafter referred to as the *DEPARTMENT" and the COMMUNITY MENTAL HEALTH BOARD, hereafter referred to as the 'BOARD", to be effective from January 1, 1996, through September 30, 1996. I. PURPOSE This agreement is intended to specify the requirements for Medicaid reimbursement for the completion of PRE-ADMISSION SCREENINGS, CONTINUING STAY REVIEWS, AND RETROSPECTIVE REVIEWS FOR NON- STATE HOSPITAL PSYCHIATRIC INPATIENT SERVICES, and PRE-ADMISSION SCREENINGS, CONTINUING STAY AND RETROSPECTIVE REVIEWS FOR HOSPITAL-BASED PARTIAL HOSPITALIZATION PROGRAMS, AND RELATED MEDICAID MANAGED CARE ACTIVMES, including the method of costing, billing and payment for these services. II. REQUIREMENTS A. Screenings and reviews as described herein shall be conducted and reported in accordance with the following documents; 1. Medicaid Services Administration (MSA) Bulletin 95-02 for Mental . Health Clinics, issued July 1, 1995 and Bulletin 95-06 for Mental Health Clinics, issued December 1, 1995. 2. Federal OMB Circular A-87, "Cost Principles for State, Local and Indian Tribal Governments,* dated Wednesday May, 17, 1995 and OASC-10 "Cost Principles and Procedures for Establishing Cost Allocation Plans and Indirect Cost Rates for Grants and Contracts with the Federal Government". 3. Requirements for the Medicaid Managed Mental Health Care Program, Psychiatric Inpatient Pre-Admission and Episode Management Review Procedures, Partial Hospitalization Review ‘l Procedures, and Utilization Management Criteria Level of Care' Determination, .distributed by the DEPARTMENT. 4. Reimbursement Instructions for the Medicaid Managed Mental Health Care Program dated January 1, 1996 distributed by the DEPARTMENT. 5. Quality Improvement and Performance Monitoring Plan for Managed Mental Health Services Program, distributed by the DEPARTMENT. The DEPARTMENT will notify the BOARD of any changes in these documents due to federal or state requirements. Such changes will be incorporated into this Agreement within sixty (60) days of the DEPARTMENTs notification to the BOARD, unless otherwise provided by federal regulations. INPATIENT PRE-ADMISSION SCREENING, CONTINUED STAY REVIEWS AND AUTHORIZATION B. The BOARD will provide pre-admission screening, episode management, and retrospective reviews for Medicaid recipients not enrolled in a capitated health plan, requesting or presented for admission to a psychiatric hospital or psychiatric unit. Pre-admission screening activities for persons who are diverted from psychiatric inpatient into an alternative service are defined as: Staff activities to conduct a brief assessment of Medicaid recipients who are referred by a source external to CMH for admission to private psychiatric inpatient services to determine whether or not psychiatric inpatient is the appropriate level of care. The disposition of this assessment is to divert the recipient to an alternative service. Activities may include staff travel time for face-to-face .screenings. Activities do not include: comprehensive assessments or evaluations; referral activities; involuntary petitions/applications; court work; or certifications. Pre-admission screening activities for persons from another CMH service area who are assessed as needing psychiatric inpatient services are defined as: Staff activities to conduct a brief assessment of a Medicaid recipient who is from another CMH service area. The scope of such activities is defined above. 2 i1ul$euj L)IiCt•Crle male k.,mri curing the pre. admission screening regarding the disposition of the crisis and regarding which . CMH .will assume responsibility for managing the inpatient episode.' Pre-admission screening by the local CMH is to be billed only when the home CMH has indicated that they will manage the inpatient episode. If the local CMH conducts the pre-admission and manages the episode, that activity is to be billed as Inpatient Total Episode Management. Inpatient Total Episode Management for persons who are admitted to private psychiatric inpatient services includes the pre-admission screening, continuing stay reviews and payment authorization activities associated with an episode of service in a psychiatric inpatient program. These are defined as: Pre-admission screening: Staff activities to conduct a brief• assessment to determine whether or not psychiatric- inpatient is the appropriate level of care. Continuing stay reviews: Staff activities conducted at intervals following admission, to determine whether further inpatient service is needed. • Payment authorization: Staff activities to provide the admission authorization number and the payment authorization number to the hospital and/or treating psychiatrist. Inpatient Total Episode Management cannot be billed until after discharge. Inpatient Continued Stay Care Management is defined as: Continuing stay reviews and payment authorization for a Medicaid recipient from the CMH service area who was assessed as needing admission through a pre-admission screening conducted by another CMH. The other CMH will have billed for the pre-admission screening review. Inpatient Continued Stay Care Management cannot be billed until after discharge. Retrospective reviews for aersons admitted to psychiatric inpatient are defined as: Staff activities to review the entire inpatient medical record to determine whether or not the admission was appropriate, whether some or all of the days of care were appropriate for Medicaid -- payment, and to authorize Medicaid payment through the issuance of authorization numbers. Retrospective reviews are conducted for a person who was either retroactively enrolled in Medicaid after the end of the episode of inpatient care, or for whom Medicaid payment for inpatient days of care is being sought because the recipient's other "primary insurance failed to cover the entire episode of care. Inpatient Retrospective Reviews cannot be billed until after discharge. PARTIAL HOSPITALIZATION SCREENING AND AUTHORIZATION C. The BOARD will provide pre-admission screening, episode management, and retrospective reviews for Medicaid recipients not enrolled in a capitated health plan, who request or are referred for Partial Hospitalization Programs (PHP). pre-admission screening activities for persons who are diverted from PHP inuLsito_alternative sfindg& are defined as: Staff activities to conduct a brief assessment to determine whether or not a PHP is the appropriate level of care. This does not include: comprehensive assessments or evaluations; or referral activities. Episode Management for persons who are admitted to PHP includes the pre-admission screening, continuing stay reviews and payment authorization activities associated with an episode of service in a PHP. These are defined as: Pre-admission screening: Staff activities to conduct a brief assessment to determine whether or not a PHP is the appropriate level of care. Continuing stay reviews: Staff activities conducted at intervals following admission, to determine whether further PHP service is needed. Payment authorization: Staff activities to notify the PHP and/or the Medical Services Administration regarding the number of days of PHP service which are approved for Medicaid payment. PHP Episode Management cannot be billed until after discharge. 4 E.; - _Retrospective Reviews for persons admitted to PHP 'are defined as: Staff activities to review the entire PHP medical record to determine whether or not the admission was appropriate, whether some or all of the days of care were appropriate for Medicaid payment, and to authorize Medicaid payment through the issuance of authorization numbers. Partial Hospitalization Retrospective Reviews cannot be billed until after discharge. RECONSIDERATIONS AND APPEALS D. The BOARD will provide for a reconsideration of a decision which it renders regarding (1) request for psychiatric inpatient admission or inpatient payment authorization, (2) request for admission to, or payment authorization for, a PHP. Reconsideration activities are defined as: Time spent by the clinical supervisor or CMH psychiatrist in reviewing the documentation of the CMH clinician's decision; time spent in obtaining additional information from the person requesting reconsideration; time spent rendering and documenting the reconsideration decision. E. The BOARD will participate in Department of Social Services (DSS) hearings for appeals of decisions which it renders regarding (1) request for psychiatric inpatient admission or inpatient payment authorization, (2) request for admission to, or payment authorization for, a PHP. Appeal activities are defined as: Time spent by clinical staff/supervisor or CMH psychiatrist in a DSS hearing. OUT OF STATE F. The BOARD will provide pre-admission screening and prior admission authorization for children referred for out-of-state psychiatric inpatient placements. Pre-admission reviews are conducted in accordance with Under 21 Elective Admission Certificate of Need requirements: Time spent by CMH clinical/medical staff in conducting pre-admission review and in submitting Medicaid payment authorization documentation to DSS/MSA and the treating facility. 5 G. The BOARD will provide continued stay "reviews and Medicaid payment -- authorization for children's out of state psychiatric inpatient placements. Continued stay review activities are defined as: Time spent by CMH clinical staff in conducting continued stay reviews and in submitting Medicaid payment authorization documentation to DSS/MSA and the treating facility. RECORDS, BILLINGS AND REIMBURSEMENTS A. The BOARD will maintain all documentation and records concerning activities performed, and verification of compliance with standards for subsequent audit, and actual cost documentation for a period of seven (7) years and assure that all such documents will be accessible for audit by appropriate DEPARTMENT staff and other authorized agencies. The BOARD will submit monthly billings to the DEPARTMENT for activities performed in accordance with the terms of this Agreement: Billings will be on an actual cost basis, as defined in the DMH billing procedures for Medicaid Managed Mental Health Care. Only one (1) bill for all the various activities performed under this contract will be considered for payment per month, and should be submitted to the DEPARTMENT within forty-five (45) days after the end of the month in which the activities were performed, except for the September bill which should be submitted within fifteen (15) days after the end of the month. In the event that the BOARD realizes - costs incurred after the billing has been submitted for a month or corrections need to be made to a submitted billing, the Board may submit a revised billing that replaces the billing previously submitted. The monthly average maximum will then apply to the revised billing. In any event, all bills for services provided under this Agreement must be received by the DEPARTMENT no later than October 15, 1996. Submitted bills will include separate statements for each of the types of activities performed, as well as a total bill for the month. The form attached to this contract is to be used for billings submitted under this contract. Payments made to the BOARD for these activities will be included as earned revenue from the DEPARTMENT on the bi-monthly and final expenditure reports of the BOARD. Projected revenues will be identified as "Other Earned Revenue"' on the Summary of Projected Funding, Line 11(E), CMH/DMH Grants and Earned Contract Totals. No local funds will be required for the state share of these payments. Payments made under this Agreement are subject to the requirements under the Single Audit Act or 1984. The CFDA number for federally funded portion will be required for the state share of payments made to the Board under the Agreement is 93.778. 6 . I'. s avoi.../ naJr 1./1101b4Ll I ICJ A. The DEPARTMENT agrees that for bills received which are correctly and completely submitted on *a timely basis as specified in Paragraph Ill. B. above, payments will be made within forty-five (45) days of receipt of billing by the BOARD. B. The DEPARTMENT will reimburse the BOARD for its actual direct and indirect costs for the activities associated with this agreement, up to an average monthly maximum of Activities within the Board's Expenditure Cap Inpatient pre-admission screening where admission Is diverted, or a pre-admission screening for a recipient from another CMH service area: face-to-face: $125 per screening telephone: $30 per screening Inpatient Total Episode Management: $220 per episode Inpatient Continued Stay Care Management Only: $100 per episode Inpatient Retrospective Review: $95 per review Partial hospital pre-admission screening where admission is diverted: face-to-face: $95 per screening telephone: $30 per screening Management of Partial Hospitalization episode where person is admitted: $220 per episode . Partial Hospitalization Retrospective review: $95 per episode Activities not within Board's Expenditure Cat) Reconsiderations: $95 per reconsideration Appeals: actual cost per appeal Out-of-state placement: actual cost per review 7 - • The DEPARTMENT wilrreimburse the BOARD up to. a 9-month expenditure CAP for the key review activities covered by this Agreement The key review activities included in the expenditure CAP are the inpatient reviews and the partial hospitalization reviews. The ,activities excluded from the CAP include the reconsiderations, appeals, and out-of-state placements. The DEPARTMENT will prepare claims for federal financial participation and submit these claims to the Department of Social Services. The BOARD will provide the DEPARTMENT with such documentation as may be required to support claims for federal financial participation. E. The DEPARTMENT will hold the BOARD financially harmless where the BOARD has followed procedures as outlined in Federal Office of Management and Budget Circular A-87 and OASC-10 1 and has documentation as to the activities performed and the costs associated with those activities. The BOARD will be held responsible for lack of documentation or failure to follow A-87 and OASC-10. V. TERMINATION The Agreement may be terminated by either party with sixty (60) days notice. Such notice shall be made in writing, and sent by certified mail. Termination will take effect sixty (60) days from receipt of said notice. Community Mental Health Board Date James K. Haveman, Jr. Director Date Michigan Department of Mental Health Attachments: A. Medicaid Administrative Activities Earned Contract Maximum Billable Amount. B. Medicaid Managed Mental Health Care Activity Billing Form 8 DEPARTMENT OF MENTAL HEALTH - LANSING. MICHIGAN 48913 January 31, 1996 MEDICA4MANAGED MENTAL HEALTH SERVICES Expenditure Targets and Administrative Billing Caps Board: Oakland Direct Service Expenditure Target 10/95 - 9196 $5,162,296 Administrative Maximum Billable Cap 1/96 - 9/96 $155,312 e r 4174.0.MIITVIVAI.1.1172: .:` Liana aft hail Idoh-rdiMailio 1 ISECTADWF1509 sfITIFED:Atlitirs r cot,/ TRA CT CA 17 4W lic .tt i., t op' lic 11 I d II i-ufil ltACI 0 t t ANNITY C.; /4 .96 _ _ _ . _ l-INAL MON I tiLY BILLING Full MANAGED CARE CONTRACT" 804A0 kAiot:a - liftiittAL100.initi i',*; _ 0 . Itiiiii6D : ii n v ) . 1 ...;,... 4 , fi iiiiiiiiiLYAr-----"-------- — --- -- - ''-' ---*---------- h",/i.a *.r4 1 10.4144#,LR I) INPA TiENT PRE-ADABSSION / FACE-TO-FACE . $12 5 ?INPATIENT PRE.ADmISSIOtir PHONE I 3) INPATIENT CONTINUED STAY CARE MGMT J1 00 --- . - , 4) INPATIENT TOTAL EPISODE MONIT(PAS d CS) . $220 1 5) rNPA TIENT RETROSPECTIVE REVIEW _.4 ...$ q c 6) PUP PREADMISSION / FACE-TO-FACE ,$ 95 7) PUP PRE -ADMISSION/ PHONE r $ 30 8) PUP EPISODE MANAGEMENT . $ 2 2 0 9) PUP RE TROSPECTIVE $ 95 10) TOTAL BILLABLE COSTS-SECTION l(ADD LINES 1 THROUGH 0, COLUMN S) I I) ACCUMULATED TOTAL REIMBURSED COSTS $ AND TOTAL UNREMIBURSED(RILLED) COSTS $ ,FOR MONTHS, THROUGH 12) TOTAL COSTS BILLED TO DATE(ADD LINES WAND 11, COLUMNS)) 13) CONTRACT CAP ' rmArA vet ME AdA INS r cbtftFiAcr 'C.A .Pt-t•IMS:AitiotiNtilMilAWAtralgrfAX1NVE VittatilMINMILDIMITIMNI111101MbrikatAtftelk COLUMN 511 IN RECONSIDERATIONS 16) APPEALS Ii) OUT OF STAIE PLACEMENT ADAM 18) Our OF STATE PLACEMENI-CONr 0 SlAY lardtAMETNIEMOt$P$EMWAVNIMMISMENEVEMEMI mtrableatirs OILLtD missIONtillAbONOMANtiffISMEREMMINII I QIiIt pi Ot si I •1.0 tADOIECI C.051 144 604140 14EPAESE11114 ACII.W. COSS'S NW REPORIED SacoIveImct MTH FEDERAL CACIAAAA A4 'COS I .1 PAMICIPtES FOR SIAN SAW OC41 00 04004110.4 440 L14102 Jo (.41 014.A.:40g s oreti s s 144 at.) C051 4til0W10A PciuVS AM, *40414EGI COSI lt4TES10110.01AtallANO C061044Cr3 WM DA 'WAAL itawevadtra: ltrAr ALt PA0C1101"1111414 OU55IO4LOI45014140 AIL MOGIA10 sutrombva 4ks-ua45N14.1i#00 A.44 444 Pail I4A50 4410 45 4'44141kt SCAM At WA nuA1461 WON MEOWS!' ME SOAAO AS51.44E419141. PIMANCiAL AMOCOMPESANCE AUPONSIIIILITY FINIALS COM sowlv) CIA: ACALOA 114 [see 64:S4A0 CSMIOIES iiw at ASS ASPOAreoweL COS IS A r AC1Utt AND IN COArti4NCe NITTINIONTA 445 JAMAAV Q0C-MilMIIKAWACAMONLIFOOti 1)50 451 COSI. Mt SUSita SO AtOol Aft0 ativadsf tAt4 snrnSASSAY IOA PACIlift APIO MOMS 00OVIAINIAlIOtt tuft COIAksoal V A1555144 WALSH IMAMS MAE CIOA Olir 4 1 4 ±44.. all:',.:i, l:Jit/i- G. 11,.. 00 , 7.1..rwerip ,. A.Ato.yxri:..) i . .,:l3 •:-•,' I ;4, :,',.)iel.:.,: F-7t-- iria_ ,.. 01 . i L ,,.. ..-,. . ' n I ', 1.1 I. ', I • ...fl h... P :I i '''. ' •- a .1 , . ., , i !t • ... 1. ti.0 "'031 „ i - - 5171MAIRDIRTOrisli 044” 4160114AJAIrt 5.4u1H0t1A11 101All CISUS AS &OWN Ott 11411S IMAM WU PAC 10 ISIE 11104)10. FISCAL NOTE (M.R. #96110) BY: FINANCE AND PERSONNEL COMMITTEE, SUE ANN DOUGLAS, CHAIRPERSON RE: COMMUNITY MENTAL HEALTH - EARNED REVENUE CONTRACTS WITH THE MICHIGAN DEPARTMENT OF MENTAL HEALTH TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS Chairperson, Ladies and Gentlemen: Pursuant to Rule XII-F of this Board, the Finance and Personnel Committee has reviewed the above referenced resolution and finds: 1. The resolution approves an agreement that allows for full reimbursement from the State of Michigan for Medicaid Managed Care activities as defined with the agreement. 2. Some of the services as defined are currently being provided through the contract for crisis services and the associated revenue for those services have already been included in the budget. 3. Upon CMH Board approval of the contract with the Michigan Peer Review Organization (MPRO) for some of the services defined in this earned contract, a budget amendment will be recommended to recognize both the revenues and expenditures associated with the MPRO contract. 4. Amendments to the Biennial Budget are not recommended at this time. FINANCE AND PERSONNEL COMMITTEE Resolution #96110 May 23, 1996 Moved by Huntoon supported by Devine the resolution be adopted. AYES: Huntoon, Jacobs, Jensen, Johnson, Kaczmar, Kingzett, McCulloch, McPherson, Moffitt, Obrecht, Palmer, Pernick, Powers, Schmid, Amos, Crake, Devine, Dingeldey, Douglas, Garfield, Holbert. (21) NAYS: None. (0) A sufficient majority having voted therefor, the resolution was adopted. STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Lynn D. Allen, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on May 23, 1996 with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac, Michigan this 23rd day of May 1 aTir Lynn D. Allen, County Clerk