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Mental Health

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Mental Health Weekly (MHW) editor’s note: “As in past Special Preview Issues, we asked our readers to send us their thoughts on the challenges and opportunities awaiting the field in 2018. Here are their comments.”

RCPA President & CEO Richard Edley’s comments on value-based purchasing as related to behavioral health have been featured in the above referenced article in Mental Health Weekly, January 1, 2018 Issue (page 3).

“As we enter 2018, one of the most pressing issues for behavioral health providers is the movement, or rush, toward “value-based purchasing” (VBP). Indeed, this is the catchphrase of the year. But what is value-based purchasing when it comes to behavioral health?…” See full article here.

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ABFT training is being offered on the following dates:

We have been consulting with the model developers at Drexel University and our partners at OMHSAS Children’s Bureau to update the plan for making this a successful training. We have negotiated reduced fees for the total training package in hopes of attracting more trainees.

The clinical strategies of ABFT can be utilized in various child serving programs to include schools, outpatient clinics, and residential treatment programs. It is designed to treat depression and prevent suicide among adolescents and young adults, ages 14–24.

Download the registration brochure here. If you have any questions or concerns, please contact Robena Spangler.

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The Department of Human Services has been working in collaboration with Managed Care Organizations (MCOs), county oversight organizations, and RCPA regarding the concerns and challenges with implementing federal Ordering, Referring and Prescribing (ORP) requirements by the January 1, 2018 deadline. The Department of Human Services has informed RCPA of the following:

  • The ORP requirements for Fee-for-Service continue to apply; i.e., allORP practitioners must be enrolled in the Pennsylvania Medical Assistance (MA) Program or the rendering provider will not be paid.
  • In the HealthChoices managed care delivery system, if a rendering network provider submits a claim to an MCO with the National Provider Identifier (NPI) information that results in edits identifying that the non-networkORP is not enrolled in MA, the claim can be paid. However, if the non-MA enrolled ORP has a high volume of claims, the MCO will work with the network provider and non-MA enrolled ORP to have them enroll in MA or work to transition the member to an enrolled MA provider.

Contact your contracting BH-MCO for additional information.

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The Wolf Administration has launched the Pennsylvania Link to Community Care website, which connects older Pennsylvanians and individuals with a disability or behavioral health need to services and supports available in their community.

The website provides users with a wide variety of resources, including a home care directory and an information referral tool. It is a collaboration of the departments of Aging (PDA) and Human Services (DHS), and is an extension of PDA’s Aging and Disability Resource call center. By providing assistance online, the initiative further enhances the Commonwealth’s efforts to help Pennsylvanians locate and best utilize services at the local level.

The site features 12 service and support categories: Advocacy, Behavioral Health, Employment, Finance, Health Care, Housing, In-Home Services, Legal, Meals, Protection from Abuse, Support Groups, and Transportation.

Users can find information about organizations, services, and programs within these categories. A major component to the site is the home care directory, which connects individuals to in-home services available in their counties. In-home service providers appearing on the searchable directory may offer personal care, assistance with activities of daily living, companionship services, respite care, and/or habilitation services.

If you are an in-home service provider licensed by the Pennsylvania Department of Health, and would like to appear on the home care directory, you may submit your information by navigating to the footer of the site and selecting “Apply.”

In addition to the home care directory, another major feature of the website is the information referral tool. This tool guides users through a series of questions and then provides a list of resources based on their specific needs.

Moving forward, the departments of Aging and Human Services will continue to enhance the website using data and feedback from users, and expand the resources and information provided through the site. This includes working with your organization and other stakeholders to increase the number of options appearing within each category. Read the press release here.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) offers 14 self-paced online business courses to behavioral health organizations and providers through BHbusiness. The courses are available at no cost and participants can earn continuing education credits at their own pace.

New courses include Value-Based Purchasing and Bundled Payments. Other course offerings include:

  • Data-Driven Decision Making;
  • New Business Planning;
  • Assessing Your Readiness in Integrating Primary Care;
  • Costing Out Your Services;
  • Effectively Marketing Your Services;
  • Exploring Affiliations and Mergers;
  • Improving Your Third Party Billing System;
  • Planning For the Next Generation of HIT (Health Information Technology);
  • State Assessment on Sustaining SUD Service for Safety Net Populations;
  • Strategic Business Decision Making;
  • Third Party Contract Negotiations; and
  • Eligibility and Enrollment: The ACA, Insurance Eligibility, and Your Business.

The link to the registration page can be found here.

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On November 3, 2017, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2018 Medicare Physician Fee Schedule final rule. The proposed rule updates payment policies, payment rates, and quality provisions for services with an overall payment update of .41 percent.

Some of the key provisions finalized in the rule include:

  • Addition of several codes to the list of telehealth services, eliminating the required reporting of the telehealth modifier GT for professional claims in an effort to reduce administrative burden for practitioners, and separating payment for CPT code 99091, which describes certain remote patient monitoring, for 2018;
  • Adoption of CPT codes for CY 2018 for reporting several care management services currently reported using Medicare G-codes and clarifying a few policies regarding chronic care management;
  • Increase in payment rates for office-based behavioral health services that better recognizes overhead expenses for office-based face-to-face services with a patient;
  • Revision of Part B drug payments for infusion drugs furnished through an item of durable medical equipment (DME) to conform with requirements of the 21st Century Cures Act;
  • Revision of payment for chronic care management in Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs), and establishing requirements and payment for RHCs and FQHCs furnishing general behavioral health integration (BHI) services and psychiatric collaborative care model (CoCM) services;
  • Implementation of the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018;
  • Change to the current Physician Quality Reporting System (PQRS) program policy that requires reporting of 9 measures across 3 National Quality Strategy domains to only require reporting of 6 measures for the PQRS with no domain requirement; and
  • Revision to the rules for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program to reduce burden and streamline program operations.

In addition, CMS indicated they will continue to consider the following based on comments from stakeholders:

  • Stakeholder input in response to the proposed rule’s comment solicitation on how CMS could expand access to telehealth services, within the current statutory authority;
  • Reviewing and updating “outdated” Evaluation and Management (E/M) visit codes; and
  • Reviewing stakeholders’ comments for potential future rulemaking or publication of sub-regulatory guidance pertaining to the Clinical Laboratory Fee Schedule (CLFS) data collection and reporting periods.

The final rule will be published in the November 15, 2017 Federal Register.

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Three associations representing community intellectual disability/autism (ID/A) and behavioral health (BH) services providers released a study today that provided a comprehensive review of the ID/A and BH Direct Support Professional (DSP) workforce, the crisis within the workforce, and means to address the crisis. The study identified the need for investment in this workforce as the most important step state policymakers can take to address the workforce crisis.

See the full press release here, which also includes a link to the study being referenced. Contact Jack Phillips, RCPA Director of Government Affairs, with any questions.

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The Office of Child Development and Early Learning (OCDEL) is offering two opportunities to attend a free conference in Harrisburg and in Scranton this November. The conference is open to stakeholders who focus on services for prenatal through third grade.

The conference will be held in:

*Act 48, PQAS, and Infant/Toddler credits are offered.

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