HomeMy WebLinkAboutResolutions - 1997.04.24 - 24945REPORT (Misc. #97069)
BY: FINANCE AND PERSONNEL COMMITTEE, SUE ANN DOUGLAS, CHAIRPERSON
IN RE: EARNED REVENUE CONTRACT WITH THE MICHIGAN DEPARTMENT OF COMMUNITY
HEALTH/ OCTOBER 1, 1996 - SEPTEMBER 30, 1997
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen:
The Finance and Personnel Committee, having reviewed the above
referenced resolution, recommend its adoption with the following amendments:
1. Change the first WHEREAS paragraph to read "WHEREAS the Michigan
Department of Community Health...".
2. Change the NOW THEREFORE BE IT RESOLVED paragraph to read "NOW
THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners approves the attached agreement with the Michigan
Department of Community Health".
Chairperson, I move acceptance of the foregoing report.
FINANCE AND PERSONNEL COMMITTEE
Miscellaneous Resolution 197069
BY: Public Services Committee, Shelley Taub, Chairperson
RE: EARNED REVENUE CONTRACT WITH THE MICHIGAN DEPARTMENT OF COMMUNITY
HEALTH/OCTOBER 1, 1996-SEPTEMBER 30, 1997
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
Community Mental Health Services Board for the periods 10/1/96 to
9/30/97, 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 October 1, 1996 to be received from
the Department of Community 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.
WHEREAS this contract has been approved by the Oakland County
Community Mental Health Services Board.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners approves the attached agreement with the Michigan
Department of Mental Health.
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 COMMUNITY HEALTH
AND
THE OAKLAND COUNTY
PROGRAM
COMMUNITY MENTAL HEALTH SERVICES
This AGREEMENT is made by and between the MICHIGAN DEPARTMENT OF COMMUNITY
HEALTH, hereafter referred to as the "DEPARTMENT" and the
OAKLAND COUNTY COMMUNITY MENTAL HEALTH BOARD, hereafter
referred to as the "CMHSP", to be effective from October 1, 1996, through September 30, 1997.
L 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
ACTIVITIES, 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".
1
Medicaid Managed Mental Health Care
Reimbursement Agreement for Review Activities
3. Requirements for the Medicaid Managed Mental Health Care Program,
Psychiatric Inpatient Pre-Admission and Episode Management Review
Procedures, Partial Hospitalization Review 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 October 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
CMHSP, unless otherwise provided by federal regulations.
INPATIENT PRE-ADMISSION SCREENING, CONTINUED STAY REVIEWS AND
AUTHORIZATION
B. The CMHSP 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 scr - 11` OS a as .-s "I's ins a. I
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.
2
ns from another CMHSP
Total Episo rrient for per ons who aea to _Emma ati CIE Man lUt
Medicaid Managed Mental Health Care
Reimbursement Agreement for Review Activities
Staff activities to conduct a brief assessment of a Medicaid recipient who
is from another CMHSP service area. The scope of such activities is
defined above.
The local CMHSP is required to contact the home CMHSP during the pre-
admission screening regarding the disposition of the crisis and regarding
which CMHSP will assume responsibility for managing the inpatient
episode.
Pre-admission screening by the local CMHSP is to be billed only when the
home CMHSP has indicated that they will manage the inpatient episode.
If the local CMHSP conducts the pre-admission and manages the episode,
that activity is to be billed as Inpatient Total Episode Management.
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 CMHSP service area who was assessed as needing admission
through a pre-admission screening conducted by another CMHSP. The
other CMHSP will have billed for the pre-admission screening review.
Inpatient Continued Stay Care Management cannot be billed until after discharge.
3
af4rS011 Nno anzi Prtari from PHP into A
Medicaid Managed Mental Health Care
Reimbursement Agreement for Review Activities
FietrOSDE ye reviews f Dr persons aornirtea to osvrnia 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 CMHSP 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
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.
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
Medicaid Managed Mental Health Care
Reimbursement Agreement for Review Activities
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 CMHSP 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 CMHSP will participate in Department of Community Health - Medical
Services Administration (DCH-MSA) 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 DCH-MSA
hearing.
OUT OF STATE
F. The CMHSP 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 DCH/MSA and the treating facility.
5
Medicaid Managed Mental Health Care
Reimbursement Agreement for Review Activities
G. The CMHSP 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 DCH/MSA
and the treating facility.
III. RECORDS, BILLINGS AND REIMBURSEMENTS
A. The CMHSP 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 CMHSP 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 DCH 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 CMHSP realizes costs incurred after the billing has been submitted for a
month or corrections need to be made to a submitted billing, the CMHSP 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, 1997. 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.
C. Payments made to the CMHSP for these activities will be included as earned
revenue from the DEPARTMENT on the bi-monthly and final expenditure reports
of the CMHSP. Projected revenues will be identified as "Other Earned Revenue"
on the Summary of Projected Funding, Line II(E), CMH/DCH 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 CMHSP under
the Agreement is 93.778.
6
Medicaid Managed Mental Health Care
Reimbursement Agreement for Review Activities
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
CMHSP.
B. The DEPARTMENT will reimburse the CMHSP for its actual direct and indirect
costs for the activities associated with this agreement, up to an average monthly
maximum of:
Activities within the CMHSP'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 CMHSP's Expenditure Cap
Reconsiderations: $95 per reconsideration
Appeals: actual cost per appeal
Out-of-state placement: actual cost per review
7
Medicaid Managed Mental Health Care
Reimbursement Agreement for Review Activities
C. The DEPARTMENT will reimburse the CMHSP up to a 12-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.
D. The DEPARTMENT will prepare claims for federal financial participation and
submit these claims to the Medical Services Administration. The CMHSP will
provide the DEPARTMENT with such documentation as may be required to
support claims for federal financial participation.
E. The DEPARTMENT will hold the CMHSP financially harmless where the CMHSP
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 CMHSP 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.
Oakland County Board of C mmissioners Chairperson Date
3 7
Unity Mental Health Service Program Date
James K. Haveman, Jr. Director Date
Michigan Department of Community Health
Attachments:
A. Medicaid Managed Mental Health Care Activity Billing Form
B. Medicaid Administrative Activities Earned Contract Maximum Billable Amount.
8
REVISED FOR USE WITH CONTRACT BEGINNING 10-1-96 MONTHLY BILLING FOR MANAGED CARE CONTRACT
I--.. , ^
1
MONTHLY ACTUAL COSTS-SEE FOOTNOTE 1 MONTHLY MAXIMUM
= .12.0...:7 11=7211il : '' „... . 1.. ... .17., -.4, . t , 4„,.. • • t, ' '1=',1•1 r1:7' i• 4 t 4 ..• ''' ?I" 4:-.W. • 1 ' .11 !'-ft41.4,!;,.2.,:. . -;illilltAW , • : 4f,t1-,, . g.., . • t•--kf ' ' , ,
', (4=7111111e . n I Lt. ..' '
1) INPATIENT PRE-A011.1ISSION / FACE-TO-FACE $12503
2) INPATIENT PRE-ADMISSION l PHONE &woo
3) INPATIENT CONTINUED STAY CARE MGMT sloo.co
4) INPATIENT TOTAL EPISODE MGMT(PAS & CS) _.
5) INPATIENT RETROSPECTIVE REVIEW $14.00
6) PHP PRE-ADMISSION/ FACE-TO-FACE 505.03
7) PUP PRE-ADMISSION/ PHONE moor
8) PHP EPISODE MANAGEMENT
9) PHP RETROSPECTIVE MOO
10) TOTAL BILLABLE COSTS-SECTION ((ADD LINES 1 THROUGH 9, COLUMN S)
11) ACCUMULATED TOTAL REIMBURSED COSTS $ AND TOTAL UNREIMBURSED(BILLED) COSTS $ ,FOR MONTHS, THROUGH
12) TOTAL COSTS BILLED TO DATE(ADD LINES WAND 11, COLUMNS))
...
13) CONTRACT CAP
.... P VI in '7 o .7' ... 1 -, ,i--,r-r.) --;,/ :i,T ,--. fr: ill >,41:1 r '.10'. i '.4 '1'4 '. ',7":* 17 . r7:7: :1'. • :','i i° 4:1=111NMANLUDAYSZONIREINMENCONTA
. 1
FS) RECONSIDERATIONS
16) APPEALS
17) OUT OF STATE PLACEMENT .A0MIN
18) OUT OF STATE PL ACEMENT-CONT 0 STAY -
1-1IctaKal,4BLECOSTB-46OWN ltlibbi.WelaB,MRINIaiatraiLlA9413
..
I • , '. /7 / • ' .- iffigalORIVIPOWEINEEGFAlaTCRLIEM1111=11
r00$1001. (I) INREPORFINO OfIECT APE) INORECT COSTit MIF WARD REPRESENTS THAT THESE AC17JA4 CMS ARE REpORTE0 IN Co nAPLIANCE NONFEDERAL WS CIRCULARS, A-TIT, vows PRINCIPLES FOR STATE' ANO LOCAL OCNERNIAENTV, ATV CIASC40. COST PRINCIPLES ATEI
PROCEDURES FOR ESTAIRegesivo COST AttoCA TOON PLANS ANO riorrrecr cosr RATES FOR GRANTS AND CONTRACTS WITH NE FEDERAL 00VERNATENT; TWIT ALL PROCEDURES HAVE SEEN FOLLOWED. ANDALL morrow suPeoRnwo DOCUMENTATION HAS SEEN PREPARED
ATV I S APAILAIRE FOR REVENIODO 1."-W PrOuEST THE BOARD ASSUMES FULL FINANCIAL AND CONPLONCE RESPONSIBILITY F001 ALL COSTS
SIN me ermnrcanov r145 c...4 go,400 CERTIFES THAT IT HAS REPORTED ALL COSTS AT ACTUAL ATV PI COMPLIANCE WITH FEDERAL OMB CIRCULARS A407 AND OASC-I0 THE BOARD ACKNONA EWES THAT ALL COSTS ARE SLASJECT TO AUDIT AND ASSUMES FULL
RESPOVSIIIRITY FOR PROPRIETY AND PROPER 00CUAIENTATICW
DATE.
C • MENTAL HEALTH ROLM DTRECTOR
TICH AUTNORZATIDV I AtITHORITE ME TOTAL COSTS AS SHOWN ON Wet IMMO TO SE PAID TO THE OMO.
DATE. - — - - OEPARMENT Of COTAKINNY HEALTH ArmrOAIZED STAFF
Tt
DEPARTMENT OF COMMUNITY HEALTH
LANSING, MICHIGAN 48913
MEDICAID MANAGED MENTAL HEALTH SERVICES
Expenditure Targets and Administrative Billing Caps
Board: Oakland
Direct Service Expenditure Target 10/96 - 9/97 $3,966,276
Administrative Maximum Billable Cap 10/96 - 9/97 $149,661
FISCAL NOTE (M.R. #97069)
BY: FINANCE AND PERSONNEL COMMITTEE - SUE ANN DOUGLAS, CHAIRPERSON
IN RE: EARNED REVENUE CONTRACT WITH THE MICHIGAN DEPARTMENT OF COMMUNITY
HEALTH/OCTOBER 1, 1996 - SEPTEMBER 30, 1997
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 of Medicaid Managed Care activities as defined with
the agreement.
2) The FY 1997 and the FY 1998 Budgets contemplated approval of the
subject agreement, therefore budget amendments are not required.
FINANCE AND PERSONNEL COMMITTEE
1
Resolution #97069 April 24, 1997
Moved by Taub supported by Obrecht the Finance and Personnel Committee
Report be accepted.
A sufficient majority having voted therefor, the report was accepted.
Moved by Taub supported by Obrecht the resolution be adopted.
Moved by Taub supported by Obrecht the resolution be amended to coincide
with the recommendation in the Finance and Personnel Committee Report.
A sufficient majority having voted therefor, the amendment carried.
Vote on resolution, as amended:
AYES: Obrecht, Palmer, Pernick, Powers, Schmid, Taub, Wolf, Amos, Coleman,
Devine, Dingeldey, Douglas, Garfield, Holbert, Huntoon, Jensen, Johnson, Kaczmar,
Kingzett, McCulloch, Millard, Moffitt. (22)
NAYS: None. (0)
A sufficient majority having voted therefor, the resolution, as amended,
was adopted.
I HEREBY .4R• THE FOREGOING RESOLUTir asdP
L. Brooks Patterson. County ExeGutive
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 April 24, 1997 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 24th day of April 1997.
• Ly4n7b. Allen, County Clerk
4
/g0A
Date