Primary Care Provider Referral Training

October 2016

For PCPs at FQHCs, RHCs, IHCs, Groups, and Solo Practices

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1. About Beacon Health Options

2. Medi-Cal Managed Care Mental Health Benefits for Mild to Moderate Impairments

• California Medi-Cal Behavioral Health Delivery System Overview

• Level of Care Screening Process

3. Connecting Members to Mental Health Services: PCP Referral Form

• Requesting PCP Decision Support

• Referring Members to Beacon Network for Needs Outside PCP Scope

• Referring Members Under 21 with Autism Spectrum Disorder for Behavioral Health Treatment/ABA Services

4. ASD Comprehensive Diagnostic Evaluation and Psychological / Neuropsychological Testing

5. Beacon’s Online PCP Toolkit

6. Recap

Training Topics

About Beacon Health Options

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U.K.

Hawaii Alaska

Beacon Health Options Footprint

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5,000 employees nationally and in the U.K., serving more than 48 million people

NCQA- and URAC- Accredited Companies

LEADER IN QUALITY

• UM/CM • QM • IT • Customer

Service

KEY OPERATIONAL AREAS

• Data Analytics • Reporting • Processing • Sales Support

• Commercial • EAP • Exchange

LINES OF BUSINESS

• Federal • Medicaid • Medicare

MEMBERSHIP CENTERS

Over 2.5 Million

1,000,000 – 2,500,000

500,000 – 1,000,000

100,000 – 50,000

Under 100,000

Corporate Headquarters

Regional Service Centers

Corporate Operation Centers

Engagement Centers

Experience in California

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Beacon’s Integrated Partner Model

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Health care is local. Beacon has staff in local offices in the CA communities where we work.

Our teams include: • Program directors who oversee

local partnerships, spearhead initiatives, work with counties & stakeholders

• Network liaisons who work with contracted providers

• Clinical staff to support care coordination and referrals

Medi-Cal Managed Care Mental Health Benefits

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California benefits began on 1/1/2014

Target Population: Members with DSM diagnosis and “mild to moderate” impairment in mental, emotional, or behavioral functioning

State intent for mild-moderate level of care:

• Time-limited, solution-focused therapeutic services

• Goal: return patients to primary care when clinically appropriate

Medi-Cal Managed Care Mental Health Benefits

Beacon

• Individual and group mental health treatment (psychotherapy)

• Outpatient services to monitor drug therapy (med mgmt)

• Psychiatric consultation • Psychological testing to evaluate

a mental health condition (prior authorization required)

Managed Care Plan

• Outpatient labs, supplies and supplements

• PCP Screening, Brief Intervention, and Referral to Treatment (SBIRT) for those over 18 related to alcohol misuse

• Prescription drugs included in Medi-Cal Managed Care Plan

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California Medi-Cal Service Responsibilities

Defining the “Bright Line” Between Mild to Moderate vs Significant Impairments To be eligible for County-Funded Mental Health Services ALL of the following must be true: 1. Diagnosis: Must fall within one or more of the 18 specified diagnostic ranges 2. Impairment. The mental disorder must result in one of the following:

a) Significant impairment or probability of significant deterioration in an important area of life functioning

b) For those under 21, a probability that the patient will not progress developmentally as appropriate, or when specialty mental health services are necessary to ameliorate the patient’s mental illness or condition

3. Intervention: Services must address the impairment, be expected to significantly improve the condition, and the condition would not be responsive to physical health care–based treatment.

Title 9, California Code of Regulations (CCR), Sections 1820.205, 1830.205, and 1830.210

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Clinician screens member using CCAH/County/Beacon screening tool • Beacon Service Center Clinician (phone)

• Local Beacon Clinician (FQHC, RHC, IHC, Group, Solo)

Based on information provided by member an initial level of care is determined • If mild-moderate: Service Center Screenings: member provided 3 local referrals

Local Beacon Clinician Screenings: member continues services with Beacon clinician

• If serious: screening tool faxed to county mental health program and member advised to either call county Access line or that county will contact them, depending on the county

Level of Care Screening Process

Primary Care: Backbone of the Delivery System

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Screening and referral often begins in primary care settings.

Beacon wants to support primary care in linking clients to care in the appropriate setting.

Our referral pathways allow you to:

1. Get care coordination support for patients

2. Get a consultation with a psychiatrist to keep a patient in primary care

3. Make a referral for behavioral health treatment within Beacon’s network

4. Beacon can help decide if a member has mild to moderate needs to be served by our network; or more significant needs to be best served by the county

PCP Referrals

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Option 1: Call Beacon’s Customer Service Line

855-765-9700

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Option 2: PCP Referral Form: An Easy Way to Link Members to Mental Health Services

Getting the Form: 1. Download a copy from the Beacon website at

www.beaconhealthoptions.com 2. Email MC_CCAH@beaconhealthoptions.com to

request an electronic version.

1. Complete information on member and PCP making the referral, including member eligibility verification and email address to confirm outcome

2. Select ONE referral reason per form (use multiple forms if needed):

• PCP Decision Support • Referral for OP BH services • Referral for BHT/ABA

3. Check the boxes indicating the member’s symptoms and impairments. Provide a list of medications, if applicable.

***Medications and symptoms/impairments are important to help connect members to services and to streamline decision support with a Beacon psychiatrist.

***Include signed member consent to allow Beacon to confirm completion of referral process.

Form Completion:

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Check box on PCP Referral Form indicating preferred return communication method

Enter email address or Fax # for receipt of referral outcome

Primary Care Provider Referral Disposition will be emailed or faxed to the referring provider (sample shown at right)

Confirming Referral Outcome

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Bringing BH Expertise into the Primary Care Setting: PCP Decision Support Line

Telephone call (curbside consult) between Beacon Psychiatrist and member’s PCP to assist PCPs with diagnostic clarification or prescribing psychiatric medication

Beacon psychiatrists available weekdays for curbside consults within the following hours:

• 4 to 5 pm Monday thru Thursday

• 2 to 5 pm Friday Two Options for Requesting PCP Decision Support

Option 1: Fax completed PCP Referral Form with medication list + 2 progress notes to 866-422-3413 or send via secure email to medi-cal.referral@beaconhealthoptions.com

Specify your preferred date/time for the consult and the best number to directly call the PCP

Option 2: Call Member Services at 855-765-9700 and request consult with Beacon psychiatrist

Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting PCP Decision Support.”

Caller will be transferred to a Beacon clinician (LCSW or LMFT) to complete an internal MD referral form (basic history + medical list). Provide your preferred call back time and number

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Referring to Beacon Provider Network for Needs Outside the PCP’s Scope of Practice

PCP Referral Options:

1. Fax completed PCP Referral Form to 866-422-3413 or send via secure email to medi-cal.referral@beaconhealthoptions.com

• To receive referral outcome confirmation please check FAX or email on the referral form and provide contact details

OR

2. Call, or have the member call, Beacon at 855-765-9700 during routine business hours (M-F 8:30 am - 5 pm).

• Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting a referral for mental health services for my patient.”

Beacon’s Next Steps:

• Beacon will contact the member to connect them to services at the appropriate level of care

• Beacon will contact the source of the referral to confirm completion of referral process if provided with FAX or email contact details

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Referring Members with Autism Spectrum Disorder for Behavioral Health Treatment/Applied Behavioral Analysis

PCP’s Referral Options:

1. For members under age 21: Fax completed PCP Referral Form, Progress Note with ASD diagnosis, and MD order for BHT/ABA services to 800-596-2712 or send via secure email to care.managers@beaconhealthoptions.com. Check the box to:

• Confirm inclusion of Diagnostic Evaluation Form indicating ASD identified criteria (red flags)

• Indicate whether a comprehensive diagnostic evaluation is recommended

2. Call Beacon Service Center at 855-834-5654 during normal business hours (M-F 8:30 am- 5 pm)

• Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting a referral for autism services for my patient.

Beacon’s Next Steps

• Autism Services Care Coordinator contacts member to assist securing resources for services

• Beacon will contact the source of the referral to confirm completion of referral process if provided with FAX or email contact details

ASD Comprehensive Diagnostic Evaluation and

Psychological / Neuropsychological Testing

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Prior Authorization is not Required – 2 referral options

1. PCP requests Comprehensive Diagnostic Evaluation (CDE):

CDE is a State required evaluation for Medi-Cal members to access BHT services.

Includes a series of preliminary observations and screening tests to determine if a particular child meets criteria for Autism Spectrum Disorder (ASD).

PCPs can initiate a CDE by: 1) completing a Diagnostic Evaluation Form, a tool with information about a youth with common ASD related behavioral issues, and 2) submitting it to Beacon with a PCP Referral for BHT services.

PCPs can downloaded the Diagnostic Evaluation and PCP Referral Forms at: http://www.ccah-alliance.org/mediCal_MH_benefits.html

OR

2. PCPs can have family call Beacon at 855-765-9700 between 8:30 am - 5 pm, M- F Press 2 to bypass the phone tree. Say, “I am calling on the recommendation of my PCP to request a

referral for a comprehensive evaluation for Autism.”

The member will get help with access to a qualified psychologist trained to complete the CDE

Once the CDE is completed the member will be linked for evaluation and treatment planning including ABA and other recommended BHT services.

NOTE: Unless the member specifically requests it, PCPs will not be informed of the referral outcome when members contact the Service Center directly.

ASD Comprehensive Diagnostic Evaluation by Psychologist

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Prior Authorization is Required Psychological Testing:

• PCPs should refer members directly to Beacon if they think the member requires comprehensive psychological testing by a qualified psychologist

• PhD or PsyD who completes the initial clinical evaluation submits the request to Beacon for authorization of psychological testing

Neuropsychological Testing: • PCPs may directly refer members to Beacon for neuropsychological testing to better

define, localize, and quantify deficits, aid in diagnostic clarity, and inform appropriate treatment planning for members who are experiencing cognitive impairments that interfere with day–to-day functioning

For both types of testing, PCP’s should have the member call Beacon at 855-765-9700 during routine business hours (M-F 8:30 am - 5 pm). • Press 2 to bypass the phone tree. Say, “I am calling on the recommendation of my

PCP to request a referral for psychological (or neuropsychological) testing.”

Beacon behavioral health providers will determine what testing is clinically indicated to further assess a member’s psychological functioning, establish diagnostic indicators, and/or to modify/revise an ongoing treatment plan

Psychological & Neuropsychological Testing

Online PCP Toolkit

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www.beaconhealthoptions.com

Beacon Developed an online PCP toolkit with input from PCPs and Behavioral Health physicians

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Beacon’s Online Toolkit to Support Primary Care Practices

Toll free number or web-based access to Beacon

psychiatrists for diagnostic, prescription, or crisis support

Reference: Prescription dosing range

and side effects

Reference: Treatment algorithms

Reference: DSM

diagnostic criteria

Reference: APA guidelines

Beacon access

Prescribing references

Diagnostic references

Screening tools

Reference: PHQ-2/9

Reference: GAD-7

PCP toolkit components

Reference: Fact sheets

Reference: Self-

management strategies

Member resources

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Toolkit Includes Resources on BH Conditions Commonly Managed by PCPs

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Each BH Condition Includes Resources for PCPs and Members

Quick Recap

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1. Members with a DSM diagnosis and mild to moderate levels of impairment are managed by Beacon. Members with significant impairment and/or substance use disorder are managed by the county mental health program.

2. Beacon offers PCP’s psychiatric decision support to help with diagnostic clarification and management of psychiatric medications.

3. Medi-Cal plan enrollees under age 21 with a diagnosis of Autism Spectrum Disorder can be referred to Beacon for linkage to BHT/ABA services.

4. PCPs have two options to refer members to Beacon for any of these services.

5. Beacon will confirm completion of referral process via FAX or email if contact details are provided on the referral form.

Recap: Key Takeaway Points for Primary Care Providers

Option 1: Fax a PCP Referral Form

1. Complete form 2. Include clinically relevant background 3. Fax to 866-422-3413 4. BHT/ABA Fax to 800-596-2712

Option 2: Call 855-765-9700

1. Press 2 to bypass phone tree 2. Tell customer service representative

you are with a PCP office and specify request

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Thank you