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Authors Posts by Jim Sharp

Jim Sharp

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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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The Department of Human Services (DHS), in collaboration with the Insurance Department, will be implementing updated physical health and behavioral health autism spectrum disorder (ASD) related procedure and diagnosis codes as a key element of the state’s Medicaid (MA) cost avoidance initiative, effective September 30. These changes will reflect a more complete and updated array of ASD related procedure and diagnostic codes that will be recognized by commercial insurance plans as well as MA. The goal of these changes is to identify the service array that is covered by commercial health insurance plans, reduce the financial burden on the MA system, and to improve the uniformity of coding and billing for services. The September 30 implementation date will allow additional time for the state, in collaboration with RCPA, to provide outreach and training to providers of services for children with an ASD. As a member of the state’s Act 62 External Work Group, RCPA will be meeting with DHS to develop materials and plan for informational webinars to prepare providers for these changes. RCPA will provide information and updates as they become available.

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A recent news release from the American Psychiatric Association reports that diagnosis of autism spectrum disorder before the age of 4 means that a child is more likely to get effective, evidence-based treatment, such as behavioral therapy. When children are diagnosed after that threshold, they are less likely to receive such treatment, but they are more likely to be treated with medication, according to research published online in the August 1 release of Psychiatric Services in Advance. The strongest evidence for effective treatment for autism is for behavioral intervention therapy directed at core autism symptoms, such as social skills and inflexible behaviors. Early intensive treatments may have long-term benefits for children’s functioning. Other therapies, including complementary and alternative medicine and medication treatments for autism, are more controversial and are not as strongly supported by scientific studies. Psychiatric Services in Advance articles have been peer reviewed but have not yet appeared in the print journal. Publication ahead of print allows articles to become available in a rapid and timely manner.

The American Academy of Pediatrics recommends that all children be screened for autism at 18 months and again at 24 months. Current information suggests that only about half of primary care practitioners screen for autism. The average age at diagnosis in the United States is more than 4 years old.

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In June, the Behavioral Health Rehabilitation Service (BHRS) Regulations Work Group completed a series of conference calls with RCPA members and other providers, managed care representatives, and advocacy groups. Meeting notes provided by the Office of Mental Health and Substance Abuse Services and the Bureau of Autism Services from the several work group conference calls are available below. While these notes don’t fully reflect the active and thoughtful discussions that were evident in each of the work group’s conference calls, they may provide some insight into those conversations. The Department of Human Services will be working throughout the month of July to put together a document based on the BHRS Regulation Work Group’s feedback, and ideas for review and comments by work group members, in early August.

Meeting documents are below:

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The Department of Human Services (DHS) is implementing a number of measures related to services for children and adolescents with behavioral health needs. The full text of their announcement is available for review and a summary of key elements of the DHS action plans are highlighted below:

 

Behavioral Health Rehabilitation Services (BHRS)

  • Concentrating efforts on the development of appropriate regulatory guidance for BHRS.
  • Established a work group that will review existing policies, bulletins, and data that will be used to draft the regulations by November 2016.

 

Applied Behavioral Analysis (ABA)

  • Developed a two-year action plan to enhance access and quality of ABA services.
  • Will develop new requirements for the training, qualifications, skills, and experience of practitioners.
  • Issued bulletins clarifying the training requirements for TSS workers and newly licensed behavior specialists who use BSC-ASD services to provide ABA.
  • Issued a bulletin that provides guidelines to assess the medical necessity of ABA.

 

Behavior Specialist Licensure

  • Will send out guidance to accredited colleges and universities that are interested in developing graduate-level coursework or programs.
  • Will provide guidance for students on how they can satisfy the coursework and experience requirements while working towards their degree.

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A recent edition of the Pittsburgh Post-Gazette focused on the planning efforts by Highmark Insurance to assure health care parity and the economic and health care value of integrated health care.

The Post-Gazette article notes that “behavioral health care is still provided under a “separate and unequal” system, eight years after enactment of a federal law that meant to curb such disparity,” noted Patrick Kennedy in a meeting with a group of Pittsburgh-area health insurance caseworkers. “But that may start to change by fall when employer compliance monitoring is expected to begin for the Mental Health Parity and Addiction Equity Act,” the 49-year-old former Rhode Island congressman told about 20 case managers at Highmark Health. Mr. Kennedy was upbeat, saying a renaissance was at hand as employers and insurers learn about the cost-saving value of behavioral health coverage. “The business model isn’t there yet. This is going to take time,” he said. “Let’s find the value so it makes sense for insurance companies.”

In a related effort, the Pennsylvania Parity Coalition will be meeting this week with the Pennsylvania Insurance Department, to discuss the implementation and monitoring of commercial insurance plans as part of the federal parity requirements in the move toward integrated health care. RCPA, along with leading provider and consumer advocacy groups and representatives of ParityTrack, supported by the Kennedy Forum, make up the core leadership of the Pennsylvania Parity Coalition.

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Research position or fellowship in suicide prevention research in schools

Leaders in mental health and suicide prevention research are working to implement a grant to study an evidence-based approach to youth suicide prevention. They are now looking for a project coordinator (masters or doctoral level preferred) and a research assistant (BA level) to run a large, school-based suicide prevention study with teachers in urban and suburban middle and high schools in Pennsylvania. This project will study a promising prevention model by recruiting 30 schools and training over 1,000 teachers.

The work of the research team will involve identifying schools, working with school personnel to plan the training, implementation of the assessment system, coordinating the training, and collecting pre-, post-, and follow-up quantitative and qualitative data. Both the project coordinator and research assistant are 18-month positions starting September 1. Interested individuals should send their resumes with cover letters to Guy Diamond, PhD and Matthew Wintersteen, PhD.

RCPA has played a long-standing role in the Pennsylvania Youth Suicide Prevention Initiative and works in collaboration with state and local organizations to reduce the risk and rate of youth suicide in communities across the Commonwealth.

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