Documentation Best Practices for Family Peer Support Providers: Part 1YVETTE KELLY, CTACANNE KUPPINGER, CTAC

October 16, 2019

Please Note‣Refer to state guidance documents for official guidance.‣Providers should follow internal agency policy and

procedures in alignment with state issued guidance and manuals.‣ Information is current as of the date of the presentation.‣Slides and recording will be posted to the CTAC website.

Part 1: AgendaQuality Documentation

Pathways to Care

Working with the Family for the Benefit of the Child

Service Authorizations

Q&A and Resources

State Guidance Documents

CFTSS Health Record Documentationhttps://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/cftss_prov_guide_hlth_rec_doc.pdf

Child and Family Treatment and Support Services Provider Manualhttps://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/updated_spa_manual.pdf

Qua

lity

Docu

men

tatio

n

Quality Documentation

Multi-System

Community Based

Culturally Competent

Least Restrictive

Family Focused

Child Centered

CFTSS Core Principles

Documentation Reflects PrinciplesPrinciples guide your work

+ Evident in your documentation

Example: David NoteReviewed LPHA recommendation regarding David’s school issues with his father. School does not understand impact of David’s social issues. FPA will attend the next CSE meeting with father to address a) child’s lack of friends which is impacting his attendance and b) need for reading assistance. Referral made to parent support group so father can meet other parents whose children have similar needs.

Example: David Better NoteFPA and David’s father discussed the LPHA recommendation. Father understands the CSE process but has been frustrated that the “school isn’t doing all they can do because David is quiet and not a problem.” FPA helped the father chose two priority issues a) David’s lack of friends which his father feels is impacting his attendance and b) need for reading assistance. FPA offered to attend CSE with father who stated he will consider that. FPA explained about a support group in town and, at the father’s request, and will check to see if any other fathers attend.

Example: Nina Note Recommendation indicated that Nina is not getting enough sleep which is having a negative impact on her behavior. Nina’s mother shared that she is not following the pediatrician’s recommendation. FPA and mother discussed possible changes to routine to increase Nina’s sleep. Referral made to County Mental Health for clinic services due to Nina’s nightmares.

Example: Nina Better NoteRecommendation indicated that Nina is not getting enough sleep which is having a negative impact on her behavior. Nina’s mother shared she arrives home late and wants time with her daughter. FPA helped the mother brainstorm possible changes to their routine that could give them time, but also get Nina more sleep. Nina’s mother also shared that Nina has been having nightmares since moving to this country. FPA explained some options for getting Nina some support to cope with her fears which included some in-home services as the family is concerned about what others might think.

Path

way

s to

Car

e

Who can make a CFTSS referral?Anyone can make a referral to CFTSS!

Parents, youth, pediatricians, care managers, schools, clinicians, childcare providers, and others.

Once a referral is made, a Licensed Practitioner of the Healing Arts (LPHA) will need to assess the child, document medical necessity and write a recommendation.

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Important to Note about CFTSSFamily Peer Support Services (FPSS) is one of six CFTSS services. ‣A child does not need to be enrolled in a Health Home to

receive CFTSS ‣A child does not need to meet HCBS eligibility in order to

receive CFTSS‣There are Medical Necessity Criteria for Family Peer

Support Services. A recommendation is needed to establish Medical Necessity.

Sample Recommendation FormRecommendations must: • Be in writing • Be signed and dated• Include an explanation of the medical

need for the service• Have the NPI# of the LPHA, if an

enrollable practitioner type; if not, the NPI# of the employing agency of the LPHA

The sample LPHA Recommendation Form can be found here.

Sample Recommendation FormBasic Information • Including Medicaid #

Diagnoses and Symptoms

Areas of Functioning• Self-Direction/Control • Self-Care • Family Life • Social Relationships • Symptom Management

Recommended CFTSS Services and Needed Interventions

Reason for Recommendation

LPHA Signature and Date

When is a New Recommendation Needed?‣ The recommending LPHA must have current knowledge of the

child, their functioning and needs, and diagnosis‣ If a child’s needs change significantly and they need additional

CFTSS, they will need a new recommendation‣ This does NOT mean a new recommendation is needed in

order to update the FPSS treatment plan as this will be done on an ongoing basis

Before Seeking Medicaid ReimbursementCheck to be sure that:

Child has a recommendation for FPSS

Child is currently enrolled in Medicaid

Your agency is in the child’s MMCPs Network

Check with the family, HH and MMCP to determine what services the child is receiving to improve coordination and prevent duplication.

Wor

king

with

the

Pare

nt

for t

he B

enef

it of

the

Child

Impact on Documentation• In Medicaid, the child or youth is the beneficiary.

• The parent/caregiver(s) are a critical resource for the child and the family well-being matters to child outcomes.

• The work you do with parents needs to be defined and described by clearly connecting your work to the child’s goals and objectives.

Additional Assessment by FPSS Provider‣Explain FPSS to the family and discuss parent’s interest in FPSS‣Discuss the parent’s areas of strength and where they need

support in relationship to their child’s goals. ‣Some providers use the Family Assessment of Needs and

Strengths (FANS) as the basis for a conversation to identify how to work together, but this is not required

RECOMMENTATION + FPSS ASSESSMENT = BASIS FOR TREATMENT PLAN

Components of FPSSEngagement, Bridging and

Transition Support

Self-Advocacy, Self-Efficacy

and Empowerment

Parent Skill Development

Community Connections and Natural

Supports

How can I support you

...to learn how the system works

...to build up your support system

...to figure out what works

...to feel strong

...to navigate big transitions

...to advocate for what they need

...to understand their diagnoses

...to learn new parenting strategies

....to support your child!

Serv

ice

Auth

oriz

atio

n

Medical Necessity and Utilization Management

Medical Necessity answers the question: Is this service appropriate and necessary?

Utilization Management (UM) is: Set of procedures MMCPs use to monitor or evaluate clinical necessity, appropriateness, efficacy, or efficiency of behavioral health care services.

Service Authorization Basics

The first 3 service visits with FPSS do

not require authorization,

however providers should notify MMCPs

before providing services to ensure proper and timely

payment.

If more services are needed MMCPs

perform concurrent review and if service is deemed medically necessary, authorize

further services. MMCPs must provide

a minimum of 30 service visits as part of this authorization.

Plans are not required to perform concurrent review. However, if they choose to, they

cannot do before the 4th visit.

Initial Treatment PlanBy the 4th session or no more than 30 days after the first face-to-face with the parent/caregiver:

• An assessment of the parent/caregiver’s needs and strengths should be completed

• A FPSS Treatment Plan is developed to assist the parent/caregiver in meeting the needs of the child (based on the LHPA recommendation)

• FPSS Treatment Plan must be signed by the parent/caregiver, FPA and FPA’s supervisor

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Medical Necessity Criteria

1. Admission

2. Continued Stay

3. Discharge

1. FPSS Admission Criteria‣ Behavioral Health diagnosis or evidence of skills lost or underdeveloped

due to a physical health diagnosis ‣ Likely to benefit from services to prevent symptoms from developing or

getting worse‣ Family is available, receptive and demonstrates need for services to help

in areas such as: building skills in the family to benefit the child, promoting empowerment, strengthening supports in the child’s environment.

‣ Treatment planning includes family/caregiver(s) and/or other support systems, unless not clinically indicated or relevant.

‣ Recommended by LPHAThis is a summary. For full admission, continued stay and discharge

criteria see official medical necessity guidance document.

1. Admission Documentation TipsYour documentation should show:• That a parent/caregiver is available and receptive to receiving the service.

• There is a need for services to help in areas within the scope of FPSS such as building skills in the family to benefit the child, promoting empowerment, strengthening supports in the child’s environment.

• How the parent/caregiver was involved in treatment planning.

Obviously, if the family is not interested in the service, you would note that and communicate with the recommending LPHA.

2. FPSS Continued Stay Criteria

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‣ The child/youth continues to meet admission criteria.‣ The child/youth is making progress but has not fully reached their goals

and additional services will be helpful.‣ Participation is contributing to the youth’s progress.‣ Additional services will contribute to the child/youth’s progress.‣ The child/youth does not require an alternative and/or higher, more

intensive level of care or treatment.‣ The child/youth is at risk of losing skills gained if the service is not

continued.‣ Treatment planning includes family/youth and other supports.

All must be met

2. Continued Stay Documentation Tips• Documentation must support ongoing need (medical necessity) to ensure services are reimbursable

• Track and note both progress AND remaining needs in progress notes

• Reference parent/child changes • Describe new interventions if progress is stalled• Be sure to describe FPA interventions• Update treatment plan as needed. If objectives are all met, but there is still work to do, update treatment plan.

3. FPSS Discharge Criteria

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‣ Child/youth no longer meets admission criteria‣ Child/youth has met goals‣ Family withdraws consent‣ Child/youth and/or family is not making/expected to make progress with

continued services‣ Child/youth and/or family is no longer engaged despite multiple,

reasonable efforts by providers‣ Child/youth and/or family no longer needs this services as they are

receiving similar benefit from other services

3. Discharge Documentation Tips‣Evidence goal/objectives have been met‣Explanation that progress is not be made and why‣ Include the plan for ongoing services and/or supports‣ For an unplanned discharge, document efforts to reconnect

with the family‣ If relevant, document why this service is no longer best to meet

the needs.

FPSS Documentation: Part 2

October 23, 2019 1:30-2:30 pmRegister here:

https://registration.nytac.org/event/?pid=1&id=874

Topics Include:Treatment Planning for FPSS

Progress Notes

Reso

urce

s

CTAC Online Learning ModuleQuality Documentation Series

PEP Online Training Modules

Documenting YourWork

Creating a Plan to Support Families

Measuring the Impact of Your Work with Families

Children’s Behavioral Health Transition to Managed Care

https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/index.htm

Family Assessment of Needs and Strengths (FANS)

https://www.ftnys.org/training-credentialing/family-needs-strengths-fans/

State MailboxesDivision of integrated Children and Family Services:dcfs@omh.ny.gov

NYS OMH Managed Care Mailbox:OMH-MC-Children@omh.ny.gov

NYS OASAS Mailbox:PICM@oasas.ny.gov

NYSDOH Health Homes for Children:HHSC@health.ny.gov

NYS OCFS Mailbox: OCFS-Managed-Care@ocfs.ny.gov

Listservs

‣ Subscribe to the Children’s Managed Care Listservhttp://www.omh.ny.gov/omhweb/childservice/

‣ Subscribe to DOH Health Home Listservhttp://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/listserv.htm

‣ Health Home Bureau Mail Log (BML) https://apps.health.ny.gov/pubdoh/health_care/medicaid/program/medicaid_health_homes/emailHealthHome.action

Contact CTAC Please send questions to:

ctac.info@nyu.edu

Logistical questions usually receive a response in 1 business day or less.

Longer & more complicated questions

can take longer.

We appreciate your interest and patience! Visit www.ctacny.org to view past

trainings, sign-up for updates and event announcements, and access resources

Please Note: ‣ It is important to note that this presentation provides

general guidance on documentation best practices. Please consult state guidance documents.‣The organization you work for will provide you with

agency-specific training on their documentation requirements and process.‣Documentation requirements may vary based on the

specific service, modality, and payor.

Thank You!Yvette Kelly Director of Children's Services and Healthcare Innovation CTAC/MCTAC

Anne KuppingerSenior Research Coordinator CTAC/MCTAC