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HomeMy WebLinkAboutResolutions - 1998.03.05 - 25416February 12, 1998 Miscellaneous Resolution 98016 BY: Public Services, David Moffitt, Chairperson IN RE: Community Mental Health - Earned Revenue Contract with Michigan Department of Community Health To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: WHEREAS the Michigan Department of Community Health has requested approval of Earned Revenue contracts with the Board for the first quarter of 1997/98 fiscal year; and WHEREAS the Earned Revenue contracts provide for reimbursement of Community Mental Health costs for pre-admissions and continued stay reviews of inpatient and day hospital services under the State's Medicaid Managed Care program; and WHEREAS the maximum billable cap amounts have been adjusted based upon the 7/97 expansion; and WHEREAS the terms of the proposed Earned Revenue contracts have been reviewed by the Oakland County Corporation Counsel and are acceptable to the Administration; and WHEREAS on December 16, 1997, the Oakland County Community Mental Health Services Board approved a resolution regarding Earned Revenue Contract. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners approves the attached agreement with the Michigan Department of Community Health to be effective from October 01, 1997 through December 31, 1997. Chairperson, on behalf of the Public Services , I move the adoption of the foregoing resolution. Public Services AGREEMENT between THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH AND THE Oakland County COMMUNITY MENTAL HEALTH SERVICES PROGRAM agent of Oakland County Board of Commissioners This AGREEMENT is made by and between the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, hereafter referred to as the 'DEPARTMENT' and the Oakland County (agent of 0.C.B.0.C.) COMMUNITY MENTAL HEALTH BOARD, hereafter referred to as the "CMHSP", to be effective from October 1, 1997, through December 31, 1997. 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 HOSPITAUZATION 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 all Medicaid recipients 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. The CMHSP is required to notify the Health Plan during the screening activity and to involve the Health Plan, as necessary, with the disposition. 2 Medicaid Managed Mental Health Care Reimbursement Agreement for Review Activities Activfties 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 CMHSP selyjcearea who are assessed as needing psychiatric inpatient service l are defined_as; 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. 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. Notification of the Health Plan is required at the time of the screening and disposition. 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. 3 Medicaid Managed Mental Health Care Reimbursement Agreement for Review Activities 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. Retrospective reviews for persons 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 recipients 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 all Medicaid recipients who request or are referred for Partial Hospitalization Programs (PHP). Pre-admission screening activities for persons who are diverted froin etip 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. 4 DEM manauerneri Ders on who are admitted to PH; Medicaid Managed Mental Health Care Reimbursement Agreement for Review Activities 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. 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. 5 Medicaid Managed Mental Health Care Reimbursement Agreement for Review Activities 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 clinical/medical staff in conducting pre-admission review and in submitting Medicaid payment authorization documentation to DCI-I/MSA and the treating facility. 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, BILUNGS 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 6 Medicaid Managed Mental Health Care Reimbursement Agreement for Review Activities 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 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 February 15, 1998. 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. 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 Ill. 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 Medicaid Managed Mental Health Care Reimbursement Agreement for Review Activities 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 C. The DEPARTMENT will reimburse the CMHSP up to a 3-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. 8 Medicaid Managed Mental Health Care Reimbursement Agreement for Review Activities 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. nty Board of Commissioners Chairperson Date Community Mental Health Service Program Date James K. Havernan, Jr. Director Date Michigan Department of Community Health Attachments: A. Medicaid Administrative Activities Earned Contract Maximum Billable Amount. B. Medicaid Managed Mental Health Care Activity Billing Form 9-97 OakVan 9 REVISED FOR USE WITH CONTRACT BEGINNING 10-147 MONTHLY BILLING FOR MANAGED CARE CONTRACT f . r., ,S , . 'Y'r • Torii'747Tolii/TilrgiTil:EUT4-41-1•-nii tsii 40 MONTHLY MAXIMUM , .(.7.1W7 , . •ir • • ...;, It'i. ••Y ,., .— 1 I •:•%•)1,1•. , *". I . , ,...$ ' ,• ' •.• • • •• : ,' , n•...i', ;,../ ,..'•;• . , It'r-,•• JrI • ' •12.17117.7.,71P'I'.:iil '47" i 75.4 ! r...i• 1 i '' ' ' • i• {...i'''.'.•' . n J.?: * . • " -., .., .„ . , f•-•n:•6•.,,i,, ' . l n •'. r .....11 ' 1 , , i '.. : s , • , I) INPATIENT PRE-ADMISSION/ FACE-TO-FACE 2) INPATIENT PRE -ADANSSION/ PHONE 3) INPATIENT CONTINUED STAY CARE MGMT 4) INPATIENT TOTAL EPISODE WARMS & CS) 5) INPATIENT RETROSPECTIVE REVIEW 8) PIP PRE-ADMISSION/ FACE-TO-FACE 7) PHP PREADMISSION/ PHONE 8) PHP EPISODE MANAliEMENT 9) PHP RETROSPECTIVE 1 I . i 10) TOTAL BILLABLE COSTS-SECTION I(ADD LINES 1 THROUGH 9, COLUMN II) 11) ACCUMULATED TOTAL REIMBURSED COSTS 8 AND TOTAL UNREMIIIIMISED(BILLED) COSTS 8 ,FOR MONTHS, THROUGH It) TOTAL COSTS BILLED TO DATE(ADO LINES 10 AND 11, COLUMNS)) 13) CONTRACT CAP i )6, ". ' .7 4 0.1 ,/ NI ( '. Ia.,. 1,/(,(.it . i : •VI' v't :Ik •f•I I‘I l l 1 ,4•1 , l' 0 r+ t: 1 `.: :1 k J; : i , . .-.11 '• I c... ii"r:.%I., 1‘,,/.:,,..r.' ii....,(i,,y1,...i. IS) RECONSIDERATIONS 16) APPEALS . 17) OUT OF STATE PLACEMENT•ADMIN II) OUT OF STATE PLACEMENT-CONT 0 STAY I slir '• - t , . . . pp •..Iff j • ' • I I? # .- • '/. C • ff:/,••1 , ( , I • t I manor' (I) SOIEPOPINva anger AHD WO/WC/ COON, 1741POO P RIIPM11401 OMIT PON WM&WOMAN WOWED I 14 00AVIANCE WON MOIR& COO OPICOLUM A4/. 12011111 PRINC*11,41 POI STA/ I MO LOCAL GOVERNMENTS; NO 0nSC•ill COST MOvCILES 4n0 0 rOOF Oa A III FM IIIITAIMIONO GOO AuocAnao rum mo romiscr color min MA OMPOLVI, 00NONCTIO NMI nit Mew OOVEAVUENT*, /WAILPOOCIOXPES MIT le IEN POLLOOVO WV AU. REQUIRED strromnIvo 000LOONI4TION MS Of EN MIAOW 4,A0 a A mufti MI wilvelmi07 uramarounr. OSIOMO Ail UAW 1,414 011144104 OM oompuvicesturomaturrpormu ears. WISP CIWOVIC4rom nti GIMP CORTVO• /IGOR Mil AMOR MO ALL COM AT ACTIML NO emeciavowcff onto MOM/ OW GlICVL41111A4I AND 04.0.10. ME WNW ACKNOWL1100011 THAT AU. COMM& SUWECT TO AU01 I ANO AMMO' FOAL • mg aropargav pal MOWRY MO MOM DOCUMINTAVION Oat COIWO.OVY ANOTIA MAL Of HOW= POOONIM PIFIWTOR ocw Amara:Anon 1114ITIORia 1141 MAL =Ors AO MOON ON INN SUMO TO ai PAID TO De atom out IMIMIPM.Malf AA otetuu.s.MY a.s. • vs. •••••n•n•n••n••n 0n•••n• 1 DEPARTMENT OF COMMUNITY HEALTH LANSING, MICHIGAN 48913 MEDICAID MANAGED MENTAL HEALTH SERVICES Medicaid Administrative Actvities Earned Contract Maximum Billable Amount Board: Oakland Community Mental Health Services Program Total Administrative Maximum Billable Cap 10/97-12/97 $54,341 Resolution #98016 February 12, 1998 The Chairperson referred the resolution to the Finance Committee. There were no objections.