Crosswalk Management System - Dasis Home Page Management System. CWMS_PROXY ... State Mental Health Hospital ... Comprehendsive Screening Unit for Youth General Hospital SRS Area Office

REPORT CROSSWALK TO STATE

23-DEC-16 02:25Report Date :

Run by :

Report :

CWMS_PROXY

Filename :

Crosswalk Management System

CWMS_PROXY

Crosswalk Report

Page 2 of 26

Status : IN

Start Date : 01-JAN-96End Date :

Follow-up :

Media ID : KCPC (Kansas Client Placement Criteria)

KansasSystem

K

1

2

3

System Transaction Type

State Code

Reporting Date

A

C

D

-

Add

Change

Delete

KS

Add

Change

Delete

State Postal Abbreviation


Two Character Alpha State Code

Month and year data file submitted

-

-

-

K = Key Field

Treatment Episode Data SetItem No Item Value State System Data

Substance Abuse and Mental Health Services AdministrationCenter for Behavioral Health Statistics and Quality

KCPC (Kansas Client Placement Criteria)Version : 1

A

C

D

-

CWMS_PROXY

Crosswalk Report

Page 3 of 26

KansasMinimum

K

K

K

K

K

1

2

3

4

5

6

State Provider Identifer

Client Identifer (Admission)

Co-Dependent/Collateral

Client Transaction Type

Date of Admission

Prior Treatment Episodes

1

2

0

1

2

3

4

5

99

Primary Client

Collateral Client

0

1

2

3

4

5

Unknown

No

Yes

0 Previous Episodes

1 Previous Episodes

2 Previous Episodes

3 Previous Episodes

4 Previous Episodes

5 Or More Previous Episodes

Unknown

Provider ID

Client ID - unique

Co-dependent/collateral

Client tranaction type

Date of Admission

No Prior treatment episodes

~

~

~

~

~

~

K = Key Field



2

1

0

1

2

3

4

5

7

8 characters

Algorithim including parts of name, birth, date, gender - mhuniqueid

Admission Date (MMDDYYY)

CWMS_PROXY

Crosswalk Report

Page 4 of 26

KansasMinimum

7 Principal Source of Referral

01

01

01

04

05

05

06

07

08

10

11

12

13

14

16

17

18

22

Friends

Family/Relative(s)

Self

Clergy

Priate Health Car Professional

Priate Health Car Professional

Attorney

Court

Peace Officer

State Mental Health Hospital

Private Psychiatric Hospital

Alcohol and Drug Program

Comprehendsive Screening Unit for Youth

General Hospital

SRS Area Office

Social Service/Community Agency/Group Home

State Mental Retardation Hospital

Community Mental Retardation Facility

Individual (includes self-referral))



Other Community Referral

Other Health Care Provider

Employer/Employer Assistance ProgramEAP


Court/Criminal Justice/DUI/DWI




Alcohol/Drug Abuse Provider







Principal Source of Referral/Detailed Criminal Justice Referral

~

K = Key Field



01

01

01

06

03

05

06

07

07

03

03

02

03

03

06

06

03

03

CWMS_PROXY

Crosswalk Report

Page 5 of 26

KansasMinimum

7 Principal Source of Referral

23

24

26

27

29

30

31

32

33

34

36

37

38

39

40

41

43

44

45

SRS Vocational Rehabilitation Disability Determination

Veterans Administration (VA) Hospital

College/school

In-House Staffer/Transfer

Penal System

Self- Help Group(s)

DUI/DWI

Adult Residential Facility

Other Employee Assistance Program (EAP)

Military

Probation

Parole/Community Corrections or Service Programs

Community Mental Health Center

Diversionary Program

Youth Center (YCAT,YCAL,TCAA,YCAB)

State or Local Health Department

Managed Care Organization

Parole

Community Corrections



School (Educational)

Alcohol/Drug Abuse Provider

















~

K = Key Field



06

03

04

02

07

06

07

06

05

06

07

07

03

07

07

03

03

07

07

CWMS_PROXY

Crosswalk Report

Page 6 of 26

KansasMinimum

7

8

9

Principal Source of Referral

Date of Birth

Gender

46

47

48

49

50

51

52

53

54

55

56

57

58

1

2

Community Services Programs

State Work Assistance Program

SRS-other

SRS-EES/Kanwork

SRS-Income Maintenance

SRS-Privatized Foster Care

SRS-Privatized Family Preservation

Juvenile Justice Authority

SRS-Children and Family Services

JJA-Larned Juvenile Correction Facility

JJA-Topeka Juvenile Correction Facility

JJA-Beloit Juvenile Correction Facility

JJA-Atchison Juvenile Correction Facility

Male

Female














Male

Female


Date of Birth

Sex

~

~

~

K = Key Field



06

05

06

06

06

06

06

07

06

07

07

07

07

1

2

Birth Date (MMDDYYYY)

CWMS_PROXY

Crosswalk Report

Page 7 of 26

KansasMinimum

10

11

Race (Hispanic collected as race to be reported as 97 in Race and 06 in Ethnicit

Hispanic or Latino Origin ( Ethnicity)

1

2

3

6

7

8

9

0

1

2

3

4

White

African American

American Indian

Asian

Other

Alaskan Native

Pacific Islander

Not of Hispanic Origin

Mexican

Puerto Rican

Cuban

Other Hispanic

White

Black or African American

American Indian/Alaskan Native ( States using Alaskan Native in 01 use for other

Asian

Other Single Race

Alaska Native (Aleut, Eskimo, Indian)

Native Hawaiians or Other Pacific Islanders

Not of Hispanic or Latino Origin

Mexican

Puerto Rican

Cuban

Other Specific Hispanic

Race

Ethnicity

~

~

K = Key Field



05

04

02

13

20

01

23

05

02

01

03

04

CWMS_PROXY

Crosswalk Report

Page 8 of 26

KansasMinimum

12 Education

00

01-12

14

15

16

17

18

19

20

21

25

28

29

Years completed -0

Years completed 01-12

One Year of College

Two Years of College: Includes Associate Degree

Three Years of College

Four Years of Coleege or More (no degree)

Batchelor Degree

Graduate Work (no degree)

Master Degree

Doctorate Degree

Kindergarten

General Education Degree (G.E.D.)

Vocational Training Beyond High School

Less Than One Grade Completed

Years of School(Highest Grade) ( General Equivalency Degree, use 12)









Less Than One Grade Completed



Education~

K = Key Field



00

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

00

01-25

01-25

CWMS_PROXY

Crosswalk Report

Page 9 of 26

KansasMinimum

13 Employment Status

2

3

4

5

7

Part-time

Fulltime

Retired

Unemployed

Not in Labor Force

Part Time - works less tahn 35 hours per week

Full Time - works 35 or more hours a week- includes military

Full Time - works 35 or more hours a week- includes military

Unemployed - looking for work in past 30 days or on layoff from job

Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.

Employment Status~

K = Key Field



02

01

01

03

04

CWMS_PROXY

Crosswalk Report

Page 10 of 26

KansasMinimum

14 Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)

-

-

0001

0002

0003

0004

0005

0006

0007

0008

0009

0010

0011

0012

0013

0014

0015

Can never be marked "None"

If Collateral Client

Alcohol

Cocaine/Crack

Marijuana, Hashish,THC, Any Other Cannabis Preps

Heroin

Non-presciption Methadone

Other Opiates and Synthetics

PCP -phencyclidine

Other Hallucinogens

Methamphetamine

Other Amphetamine

Other Stimulants

Benzodiazepines

Other Tranquilizer

Barbituates

Other Sedatives or Hypnotics

None

Not Collected

Alcohol

Cocaine, Crack

Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)

Heroin

Non-Prescription Methadone


PCP

Hallucinogens

Methamphetamine

Other Amphetamines

Other Stimulants

Benzodiazepines

Other Non-Benzodiazapine Tranquilizers

Barbiturates

Other Non-Barbituate Sedatives or Hypnotics

Substance Problem (Primary, Secondary, and Tertiary)

~

K = Key Field



01

98

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

CWMS_PROXY

Crosswalk Report

Page 11 of 26

KansasMinimum

14 Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)

0016

0017

0018

0021

0022

0023

0024

0025

0026

Inhalants

Over-the-counter

Other drug combinations

MDMA, Ecstasy

Flunitrazepam (rohypnol)

GHB/GBL

Ketamine (special K)

Clonazepam (klonopin, Rivotril)

LSD

Inhalants

Over-the-Counter

Other

Other Amphetamines

Benzodiazepines

Other

Other

Benzodiazepines

Hallucinogens


~

K = Key Field



17

18

20

11

13

20

20

13

09

CWMS_PROXY

Crosswalk Report

Page 12 of 26

KansasMinimum

15

16

Usual Route of Administration ( Primary-15A, Secondary-15B, Tertiar-15C)

Frequency of Use ( Primary-16A, Secondary-16B, Tertiary-16C)

-

-

1

2

3

4

5

-

-

1

2

3

4

5

If no secondary or tertiary problem

If collateral client

Oral

Smoking

Inhalation

Injection (IV or intramuscular)

Other

If no secondary or tertiary


No Past Month Use

1-3 Times in Past Month

1-2 Times Per Week

3-4 Times Per Week

Daily

Not Applicable

Not Collected

Oral

Smoking

Inhalation

Injection (IV or intramuscular, intradermal or subcutaneous)

Other

Not Applicable

Not Collected

No use in the past month

1-3 times in past month

1-2 times per week

3-6 times per week

Daily

Usual Route of Administration (Primary, Secondryand Tertiary)

Frequency of Use (Primary, Secondary and Tertiary)

~

~

K = Key Field



96

98

01

02

03

04

20

96

98

01

02

03

04

05

CWMS_PROXY

Crosswalk Report

Page 13 of 26

KansasMinimum

17 Age of First Use (Primary-17A, Secondary-17B, Tertiary-17C)

-

-

00

01-95


If no secondary or tertiary problem

Zeros indicate a newborn with a substance dependency problem

Age of First Use

Not Collected

Not Applicable

Newborn with a substance dependecy problem

Age at First Use, in years

Age of First Use (Primary, Secondary and Tertiary)

~

K = Key Field



98

96

00

01-95

CWMS_PROXY

Crosswalk Report

Page 14 of 26

KansasMinimum

K 18

19

Type of Services

Medication-Assisted Opioid Therapy

05

06

07

08

10

21

22

34

35

36

37

38

39

1

2

Acute Care Detox

Social Detox

Intermediate

Reintegration

Intensive Outpatient

Inpatient

Outpatient

Person Centered Case management - Level l

Person Centered Case management - Level ll

Person Centered Case management - Level lll

Medicaid Case Management - Level l

Medicaid Case Management - Level ll

Medicaid Case Management - Level lll

Yes

No

Detoxification - Hospital Inpatient ( Detox, 24 hour Service)

Detoxification Free-standing Residential ( Detox, 24 hour Service)

Rehabilitation/Residential - Short-term, ( 30 days or fewer)

Rehabiliation/Residential - Long-term, ( more than 30 days)

Ambulatory - Intensive Outpatient

Rehabilitation/Residential - Hospital (other thandetox)

Ambulatory - Non-Intensive Outpatient







Yes

No

Type of Service (Admission Modality)

Opioid Replacement Therapy

~

~

K = Key Field



01

02

04

05

06

03

07

07

07

07

07

07

07

1

2

CWMS_PROXY

Crosswalk Report

Page 15 of 26

KansasSupplementalK = Key Field



CWMS_PROXY

Crosswalk Report

Page 16 of 26

KansasSupplemental

1 Detail Drug Code, Primary

0001

0002

0003

0004

0005

0006

0007

0008

0009

0010

0011

0012

0013

0014

0015

0016

0017

0018

Alcohol

Cocaine/Crack

Marijuana, Hashish,THC, Any Other Cannabis Preps

Heroin

Non-presciption Methadone


PCP -phencyclidine

Other Hallucinogens

Methamphetamine

Other Amphetamine

Other Stimulants

Benzodiazepines

Other Tranquilizer

Barbituates

Other Sedatives or Hypnotics

Inhalants

Over-the-counter

Other drug combinations

Alcohol

Crack

Marijuana/Hashish,THC and any other cannabis sativa preparation

Heroine/Morphine

Non - Prescription Methadone

Other Opiates or Synthetics

PCP or PCP Combinations

DMT, mescaline, peyote,STD and Other Hallucinogens

Methamphetamine/Speed

Other Amphetamines

Other Stimulants

Halazepam,oxazepam(Serax),Prazepam,Temazepam(Restoril) and other

Other non-benzodiazepineTranquilizer

Other Barbiturate Sedatives

Other Non-Barbiturate Sedatives

Gasoline,glue, and other inapproriately inhaled products

Other Over-The-Counter

Synthetic Cannabinoid (Spice), Carisoprodol (Soma) and other drugs


~

K = Key Field



0201

0301

0401

0501

0601

0706

0801

0902

1001

1109

1201

1308

1403

1509

1604

1703

1809

2002

CWMS_PROXY

Crosswalk Report

Page 17 of 26

KansasSupplemental

1

2

3

4

Detail Drug Code, Primary

Detail Drug Code, Secondary

Detail Drug Code, Tertiary

Diagnostic Code (DSM or ICD) field should be coded 999.98 - field 19 replaces i

0021

0022

0023

0024

0025

0026

999.98

MDMA, Ecstasy

Flunitrazepam (rohypnol)

GHB/GBL

Ketamine (special K)

Clonazepam (klonopin, Rivotril)

LSD

Not Collected

Methyleneioxymethampetamine (MDMA, Ecstacy

Flutirazepram (Rohypnol)

GHB/GBL - ( gamma-hyroxybutyrate, gamma-butyrolactone)

Ketamine - ( Special K)

Clonazepam - (Klonopin, Rivotril)

LSD

Same as Detail Drug Code, Primary

Same as Detail Drug Code, Primary

Not Collected




Not Collected

~

~

~

-

K = Key Field



1103

1309

2003

2004

1310

0901

_

_

999.98

CWMS_PROXY

Crosswalk Report

Page 18 of 26

KansasSupplemental

5

6

7

8

Psychiatric Problem in Addition to Alcohol or Drug Problem

Pregnant at Admission

Veteran Status

Living Arrangements

-

1

2

-

1

2

1

2

3


Yes

No


yes

No

Homeless

Dependent Living

Independent Living

Uncollected

Yes

No

Not Collected

Yes - female client was pregnant at admission

No - female client was not pregnant at admission

Homeless - clients with no fixed address; includes homeless shelter

Dependent Living - clients living in a supervised setting

Independent Living - clients living alone or with others but no supervision

Psych Problem in aadition to alcohol and drug

Pregnant at Admission

Veteran Status

Living Arrangement

^

^

^

^

K = Key Field



8

1

2

8

1

2

01

02

03

CWMS_PROXY

Crosswalk Report

Page 19 of 26

KansasSupplemental

9 Source of Income/Support

0

1

2

3

4

5

6

7

No Income

Wages /Salary/Self Employed

Public Assistance

Retirement/Pension

Disability

Child Support/Alimony

Unemployment Insurance

Other

None

Wages/Salary

Public Assistance

Retirement/Pension

Disability

Other

Other

Other

Source of Income^

K = Key Field



21

01

02

03

04

20

20

20

CWMS_PROXY

Crosswalk Report

Page 20 of 26

KansasSupplemental

10 Health Insurance

01

02

04

05

06

07

08

09

11

12

13

14

15

16

17

18

Blue Cross/Blue Shield

Other Private Insurance

Other Public/Govment Funds (Not Champus or ADAS)

Private Pay

ADAS Funds

No Charge

Volunteer Services

Health Maintenance Organization (HMO)

Employment Assistance Program (EAP)

Student Assistance Program (SAP)

Medicaid

Medicare

Champus

Veterans Administration (VA)

Dept of Corrections (SB67 - 4th Time Dui)

Community Corrections SB123


Private Insurance (other than BCBS or HMO)

Other (e.g. TriCare)

None

None

None

None


None

None

Medicaid

Medicare



None

None

Pay Source - also Health Insurance^

K = Key Field



02

01

20

21

21

21

21

06

21

21

04

03

20

20

21

21

CWMS_PROXY

Crosswalk Report

Page 21 of 26

KansasSupplemental

11 Expected/Actual Primary Source of Payment

01

02

04

05

06

07

08

09

11

12

13

14

15

16

17

18


Other Private Insurance

Other Public/Govment Funds (Not Champus or ADAS)

Private Pay

ADAS Funds

No Charge

Volunteer Services


Employment Assistance Program (EAP)

Student Assistance Program (SAP)

Medicaid

Medicare

Champus

Veterans Administration (VA)

Dept of Corrections (SB67 - 4th Time Dui)

Community Corrections SB123


Other Health Insurance Companies

Other Government Payments

Self-Pay


No Charge ( Free, Charity, Special Research or Teaching)

Other

Other Health Insurance Companies


Other

Medicaid

Medicare





Pay Source - also Health Insurance^

K = Key Field



02

07

05

01

05

08

09

07

05

09

04

03

05

05

05

05

CWMS_PROXY

Crosswalk Report

Page 22 of 26

KansasSupplemental

12 Detailed Not in Labor Force

-

12

13

14

4

4

If not in labor force and none of the above

Homemaker (Occupation)

Student (Occupation)

Inmate of Institution (Occupation)

Retired (Employment)

Disability (Income Source)

Other

Homemaker

Student

Inmate of Institution ( Prison or Institution - keeps people out of work force)

Retired

Disabled

Detailed not in labor force^

K = Key Field



06

01

02

05

03

04

From #17 Occupation, #16 Employment, #20 Income Source - if Employment = 7 and Occupation not = to 12,13 or 14 and Income Source not = 4

CWMS_PROXY

Crosswalk Report

Page 23 of 26

KansasSupplemental

13 Detailed Criminal Justice Referral Categories

07

08

29

31

36

39

44

45

53

55

56

57

58

Court

Peace Officer

Penal System

DUI/DWI

Probation

Diversionary Program

Parole

Community Corrections

Juvenile Justice Authority

JJA-Larned Juvenile Correction Facility

JJA-Topeka Juvenile Correction Facility

JJA-Beloit Juvenile Correction Facility

JJA-Atchison Juvenile Correction Facility

State/Federal Court

Other Recognized Legal Entity ( Local Law, Corr. Agncy, Youth Ser., Review Board

Prison

DUI/DWI

Probation/Parole

Diversionary Program (E.G. TASC)

Probation/Parole








~

K = Key Field



01

04

06

07

03

05

03

04

04

04

04

04

04

CWMS_PROXY

Crosswalk Report

Page 24 of 26

KansasSupplemental

14

15

Marital Status

Days Waiting to Enter Treatment

1

2

4

5

6

7

0-996

998

Never Married

Married

Divorced

Separated

Widowed

Common-Law

Days Waiting


Never Married - includes clients who are single or whose

Now Married ( includes those living together as married)

Divorced

Separated (legally seperated or otherwise absentbecasue of marital discord))

Widowed

Now Married ( includes those living together as married)

Number of Days waiting

Not Collected

Marital Status

Days waiting to enter treatment

^

^

K = Key Field



01

02

04

03

05

02

000-996

998

CWMS_PROXY

Crosswalk Report

Page 25 of 26

KansasDischarge/NOMS

1

2

System Transaction at Discharge

State Code at Discharge

- KSState abreviation according postal codes


Two Character Alpha State Code

-

-

K = Key Field



-

REPORT CROSSWALK TO STATE

Crosswalk Management System

End of Report

Documents

Crosswalk Management System - Dasis Home Page Management System. CWMS_PROXY ... State Mental Health Hospital ... Comprehendsive Screening Unit for Youth General Hospital SRS Area Office