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Authors Posts by Jim Sharp

Jim Sharp

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The Integration Edge is a new resource from the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) that outlines practical tips and examples from organizations that have been working to integrate primary and behavioral health care. CIHS has been exploring partnerships, confidentiality issues, and sharing information and data-driven care. CIHS will regularly update The Integration Edge with new topics and practical examples. Whole person, health care focused practitioners and provider organizations looking for additional advice or with a topic they would like to see highlighted can visit this new website or contact CIHS by phone 202-684-7457 or email.

Know about the latest topics as they are added to The Integration Edge when you sign up for the email as the center adds new topics and other news related to integration.

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Patrick Kennedy, former United States Representative and founder of the Kennedy Forum, has issued an open letter to the heads of the leading insurance companies in response to the findings of last week’s Surgeon General’s report. The report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, addresses a broad array of issues, ranging from illicit drug abuse to prescription drug addiction, alcohol use, binge drinking, and teen alcoholism. Mr. Kennedy’s letter urges the commercial nation’s health industry to take action in five key areas:

  1. Eliminate the onerous medical management practices responsible for inadequate, ineffective treatment of addiction;
  2. Immediately ensure that all plans cover and reimburse for well-supported medication-assisted treatment (MAT), including buprenorphine, buprenorphine-naloxone, buprenorphine-hydrochloride, methadone, naltrexone, acamprosate, and disulfiram, at rates equal to coverage for medications used to treat other forms of chronic illness;
  3. Incentivize greater coordination of care;
  4. Adequately disclose processes for ensuring parity compliance;
  5. Promote screening and work with communities to implement prevention interventions.

Each of these requests is clarified in further detail in the letter. Patrick Kennedy was the prime sponsor of the Mental Health Parity and Addiction Equity Act of 2008 and author of the book, A Common Struggle (Blue Rider Press/Penguin Random House, 2015).

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The Department of Human Services (DHS) Secretary Ted Dallas announced several improvements to ChildLine, the department’s child abuse hotline, as well as to the child abuse history clearance process.

“Keeping children safe is a critical part of our mission at DHS and has been a priority of the Wolf Administration from day one,” said DHS Secretary Ted Dallas, “The improvements we are announcing today represent the highest performance levels since 24 new bills that amended the child protection law went into effect in January 2015.” The department experienced significant challenges in January 2015, when the changes went into effect, and by the Wolf Administration’s first day in office, DHS was inundated with calls and clearance applications that the department was not adequately staffed or funded to handle. From 2014 – 2015, the department experienced:

  • 14 percent increase in calls to ChildLine from 164,911 to 188,357;
  • 39 percent increase in reports of suspected child abuse; and
  • 162 percent increase in clearance requests from 587,545 to 1,536,921.

As a result of these increases, performance and ChildLine suffered in early 2015. Specifically:

  • Processing time for child abuse clearances averaged 26 days – well above the 14 days required by law;
  • 48 percent of clearances were processed on time; and
  • 43 percent of calls to ChildLine were abandoned or deflected.

DHS acted immediately to address these issues by adding staff and improving training. In addition, DHS has implemented technology changes that properly record all calls, regardless of the nature of the call, and make it easier for staff to receive and process calls. As a result, DHS data today reads much differently:

  • Clearances are processed on average in 1.6 days, well below the statutorily required 14 days;
  • 100 percent of clearances are processed on time; and
  • The abandoned or deflected rate is down to 2 percent.

“None of the improvements I am announcing today could have happened without the hard work of staff at DHS and, on behalf of the administration, I thank them for all their efforts,” said Dallas. DHS has also encouraged individuals to use its website to get more information on the changes to the law, mandated reporting information and training, and clearances. This has resulted in approximately 80 percent of clearance requests and 42 percent of child abuse referrals currently coming in electronically, reducing paperwork for staff and the public.

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On August 25, RCPA, in collaboration with key state agencies, hosted a webinar on changes impacting providers of child and adolescent autism services as well as HealthChoices managed care organizations. The webinar also reviewed the use of behavioral health, physical health, and rehabilitation procedure codes that reflect services for the diagnostic assessment and treatment of ASD covered under Act 62. The procedure codes that are on the MA Program fee schedule will be subject to the cost avoidance process for MA FFS claims beginning September 30.

The webinar also included a review of updated information and guidance for families that providers can duplicate and make available to families of children with an autism spectrum disorder. Visit the DHS Act 62 web page for resources to use when communicating with families, including:

  • Fact Sheet
  • Frequently Asked Questions
  • How to Appeal
  • Sample Appeal Letters
  • Act 62 Infographics

Representatives from the Department of Human Services (DHS) and the Insurance Department reviewed the recently issued Medical Assistance (MA) Bulletin for providers relating to Act 62 titled, Payment of Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder (ASD). The purpose of this bulletin is to remind providers enrolled in the MA Program, both fee-for-service and HealthChoices, of the requirement to bill a child’s or adolescent’s private health insurance company before submitting a claim for the diagnostic assessment or treatment of ASD. New codes will be implemented by September 30. The recording of the webinar is available for review. The Power Point presentations for both the managed care and the service provider presentations are also now available.

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The Department of Human Services (DHS) has just issued a Medical Assistance (MA) Bulletin for providers relating to Act 62 titled, Payment of Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder (ASD). The purpose of this bulletin is to remind providers enrolled in the MA Program, both fee-for-service (FFS) and HealthChoices, of the requirement to bill a child’s or adolescent’s private health insurance company before submitting a claim for the diagnostic assessment or treatment of ASD. It is also to inform providers of the diagnosis codes and procedure codes which will be included in the MA FFS cost avoidance process, effective Friday, September 30. HealthChoices managed care organizations will provide guidance and information to contracted practitioners and providers in the Medicaid managed care system with regard to implementation by September 30.

The DHS clinical staff has identified behavioral health, physical health, and rehabilitation procedure codes that reflect services for the diagnostic assessment and treatment of ASD covered under Act 62. The procedure codes that are on the MA Program fee schedule will be subject to the cost avoidance process for MA FFS claims beginning September 30.

Registration is open now for two webinar sessions on Thursday, August 25 that are being held by DHS in collaboration with RCPA:

  • Session 1, 12:00–1:00 pm: The target audience for this webinar session is BH-MCOs, counties, and county oversight organizations.
  • Session 2, 1:00–2:00 pm: The target audience for this webinar session is behavioral health and pediatric rehabilitation provider organizations.

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RCPA is encouraging leaders and training staff from residential treatment facilities (RTFs) to attend this important event and staff development opportunity on Tuesday, August 30, 10:00 am – 3:00 pm at the Child Welfare Resource Center, 403 Winding Hill Road, Mechanicsburg.

The day’s agenda will include a presentation on youth suicide prevention by Dr. Matt Wintersteen, covering such topics as risk assessment and safety planning. Following the networking lunch will be a presentation on an evidence-based screening tool and a review and discussion of enhancing family engagement and the attachment-based family therapy model. The day will also include an introduction to a specific suicide prevention and intervention approach and strategies for implementing a train-the-trainer resource for interested RTFs. Register here for this event.

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RCPA is collaborating with key state agencies to host a very important webinar on changes impacting providers of child and adolescent autism services as well as HealthChoices managed care organizations. Representatives from the Department of Human Services (DHS) will review Act 62 of 2008, billing guidance for providers, and the revised ICD-10 diagnostic codes and intervention procedure codes related to children and adolescents with autism spectrum disorders. These codes may apply to both commercial health plans and Medical Assistance plans. The webinar will also include updated information and guidance for families. Registration is now open for both sections of the webinar.

The webinar will be held in two sessions on Thursday, August 25, 2016:

  • Session 1, 12:00–1:00 pm: The target audience for this webinar session is BH-MCOs, counties, and county oversight organizations.
  • Session 2, 1:00–2:00 pm: The target audience for this webinar session is behavioral health and pediatric rehabilitation provider organizations.

All participants are welcome to sit in for either or both sessions. Both webinars will be recorded and made available on RCPA and state websites. The DHS Bulletin related to the changes in diagnostic and intervention procedure will be sent to members once it is issued.

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