Psychiatric Residential Treatment ... - Magellan Of Virginia...(2) In the case of a minor, the facility must notify the resident's parent(s) or legal guardian(s) as soon as possible,

Psychiatric Residential Treatment Facility (PRTF)

Attestations and Reporting Changes

May 4, 2017

Today’s Training Highlights

• Psychiatric Residential Treatment Facility (PRTF) Annual Attestation Reminder

• Federal and State Reporting Requirements

• New Changes to State Reporting Requirements

• When, What, Where and How to Report

May 4, 2017Magellan of Virginia2

Attestation Requirement for PRTF Providers

It is your responsibility to: • Complete and submit a letter attesting your facility is in compliance with the

Centers for Medicare and Medicaid Services (CMS) standards governing the use of restraint and seclusion (42 CFR § 483.350 – 483.376)

‒ Submit attestation letter to Magellan Healthcare of Virginia (Magellan) on or before July 1st annually

‒ Attestation letter must be signed by the Facility Director/Chief Executive Officer (CEO) of your facility

It is important to know:• Signed Restraint and Seclusion attestation letters are also a part of the Provider

Participation Agreement with Magellan

• If there is a change in CEO, a new letter of attestation must be submitted

• If signed attestations are not received by Magellan annually by the due date, approval for new authorizations will not occur

• A sample attestation letter is located in the Department of Medical Assistance Services (DMAS) Program Manual

May 4, 20173 Magellan of Virginia

Attestation Requirement for PRTF Providers continued

All annual attestation letters must be received by Magellan on or before July 1, 2017 by 5 p.m.

Annual attestation letters should be submitted to Magellan via fax (888-656-5396).

For additional information and to view past provider communications about attestation requirements, please visit www.MagellanofVirginia.com.

• For Providers, 2017 Communications, Annual Attestation for Residential Treatment Centers, February 24, 2017

• For Providers, 2016 Communications, Attestation Reminder RTC-Level C, July 5, 2016


http://www.magellanofvirginia.com/

http://magellanofvirginia.com/media/1568301/02-24-17_annual_attestation_for_residential_treatment_centers_email_blast_for_website.pdf

http://magellanofvirginia.com/media/1458980/07-05-16_attestation_reminder___rtc_level_cprovider_email_blast_for_website.pdf

Facility Reporting Requirements

Providers should reference the following regulations* for reporting:

• DMAS Program Manual

• Virginia State Regulation 12VAC30-60-50

• Note new changes in Section N, effective July 1, 2017

• Federal Regulations 42 CFR § 483.350 – 483.376

*Please note this training does not cover in entirety the above mentioned regulations


Regulations for Facility Reporting: DMAS Program Manual

The DMAS Program Manual reviews the following process for reporting:

Serious incidents involving any individual must be reported to BHSA* (Magellan).

Serious incidents include:

• an individual’s death,

• suicide attempt, or

• a serious injury that requires medical attention.

The incident does not need to be related to a restraint or seclusion. If an individual must go to

the emergency room to address an injury while a resident of the facility, the report must be

sent in to DMAS/BHSA* (Magellan).

*Magellan serves as the BHSA for DMAS and all attestations and incident reports should be sent directly to Magellan


Regulations for Facility Reporting: Virginia State Regulations

Virginia State Regulation 12VAC30-60-50 Utilization control: Intermediate Care Facilities for Persons with Intellectual and Developmental Disabilities (ICF/ID) and Institutions for Mental Disease (IMD).

Definitions:

• "Residential treatment facility," means the same as defined in 42 CFR 483.352, and is a 24-hour, supervised, clinically and medically-necessary, out-of-home active treatment program designed to provide necessary support and address mental health, behavioral, substance abuse, cognitive, and training needs of an individual under 21 years of age in order to prevent or minimize the need for more intensive inpatient treatment.

• Institution for Mental Disease, or "IMD" means the same as that term is defined in the Social Security Act, §1905(i).

Social Security Act:

The term “institution for mental diseases” means a hospital, nursing facility, or other institution with more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.


Regulations for Facility Reporting: Virginia State Regulations continued

Virginia State Regulation 12VAC30-60-50 Utilization control: Intermediate Care Facilities for Persons with Intellectual and Developmental Disabilities (ICF/ID) and Institutions for Mental Disease (IMD).

*Note new changes in Section N, effective July 1, 2017

• The use of Seclusion and Restraint in an IMD shall be in accordance with 42 CFR § 483.350 through 42 CFR § 483.376

• Each use of a seclusion or restraint, as defined in 42 CFR § 483.350 through 42 CFR § 483.376, shall be reported by the service provider to DMAS or the BHSA* within one calendar day of the incident



Regulations for Facility Reporting: Federal Regulations

Federal Regulation § 483.352 Definitions

Drug used as a restraint means any drug that—

(1) Is administered to manage a resident’s behavior in a way that reduces the safety risk to the resident or others;

(2) Has the temporary effect of restricting the resident’s freedom of movement; and

(3) Is not a standard treatment for the resident’s medical or psychiatric

condition.

Emergency safety intervention means the use of restraint or seclusion as an immediate response to an emergency safety situation.

Mechanical restraint means any device attached or adjacent to the resident’s body that he or she cannot easily remove that restricts freedom of movement or normal access to his or her body.


Regulations for Facility Reporting: Federal Regulations continued


Personal restraint means the application of physical force without the use of any device, for the purposes of restraining the free movement of a resident’s body. The term personal restraint does not include briefly holding without undue force a resident in order to calm or comfort him or her, or holding a resident’s hand to safely escort a resident from one area to another.

Psychiatric Residential Treatment Facility means a facility other than a hospital, that provides psychiatric services, as described in subpart D of part 441 of this chapter, to individuals under age 21, in an inpatient setting

Restraint means a “personal restraint,” “mechanical restraint,” or “drug used as a restraint” as defined in this section.




Seclusion means the involuntary confinement of a resident alone in a room or an area from which the resident is physically prevented from leaving.

Serious Injury means any significant impairment of the physical condition of the resident as determined by qualified medical personnel. This includes, but is not limited to, burns, lacerations, bone fractures, substantial hematoma, and injuries to internal organs, whether self-inflicted or inflicted by someone else.

May 4, 2017Magellan of Virginia 11


Federal Regulation § 483.356 Protection of Residents

(a) Restraint and seclusion policy for the protection of residents.

(1) Each resident has the right to be free from restraint or seclusion, of any form, used as a means of coercion, discipline, convenience, or retaliation.

(2) An order for restraint or seclusion must not be written as a standing order or on an as-needed basis.

(3) Restraint or seclusion must not result in harm or injury to the resident and must be used only -

(i) To ensure the safety of the resident or others during an emergency safety situation; and

(ii) Until the emergency safety situation has ceased and the resident's safety and the safety of others can be ensured, even if the restraint or seclusion order has not expired.

(4) Restraint and seclusion must not be used simultaneously.



Federal Regulation § 483.356 Protection of Residents

(b) Emergency safety intervention. An emergency safety intervention must be performed in a manner that is safe, proportionate, and appropriate to the severity of the behavior, and the resident's chronological and developmental age; size; gender; physical, medical, and psychiatric condition; and personal history (including any history of physical or sexual abuse).



Federal Regulation § 483.374 Facility Reporting

(a) Attestation of facility compliance. Each psychiatric residential treatment facility that provides inpatient psychiatric services to individuals under age 21 must attest, in writing, that the facility is in compliance with CMS's standards governing the use of restraint and seclusion. This attestation must be signed by the facility director.

(1) A facility with a current provider agreement with the Medicaid agency must provide its attestation to the State Medicaid agency* by July 21, 2001.

(2) A facility enrolling as a Medicaid provider must meet this requirement at the time it executes a provider agreement with the Medicaid agency*.





(b) Reporting of serious occurrences. The facility must report each serious occurrence to both the State Medicaid agency* and, unless prohibited by State law, the State-designated Protection and Advocacy system. Serious occurrences that must be reported include a resident's death, a serious injury to a resident as defined in §483.352 of this part, and a resident's suicide attempt.

(1) Staff must report any serious occurrence involving a resident to both the State Medicaid agency* and the State-designated Protection and Advocacy system by no later than close of business the next business day after a serious occurrence. The report must include the name of the resident involved in the serious occurrence, a description of the occurrence, and the name, street address, and telephone number of the facility.

(2) In the case of a minor, the facility must notify the resident's parent(s) or legal guardian(s) as soon as possible, and in no case later than 24 hours after the serious occurrence.





(b) Reporting of serious occurrences (continued).

(3) Staff must document in the resident's record that the serious occurrence was reported to both the State Medicaid agency* and the State-designated Protection and Advocacy system, including the name of the person to whom the incident was reported. A copy of the report must be maintained in the resident's record, as well as in the incident and accident report logs kept by the facility.





(c) Reporting of deaths. In addition to the reporting requirements contained in paragraph (b) of this section, facilities must report the death of any resident to the Centers for Medicare & Medicaid Services (CMS) regional office.

(1) Staff must report the death of any resident to the CMS regional office by no later than close of business the next business day after the resident's death.

(2) Staff must document in the resident's record that the death was reported to the CMS regional office.


Facility Reporting Timelines

Facilities must report any serious incident involving a resident to Magellan within 1 business day of the occurrence.

Facilities must report each instance of restraint or seclusion involving a resident to Magellan within 1 calendar day of the occurrence.


Submitting Incident Reports

Please submit the following information to Magellan via fax (888-656-5396):

• Member's name and Medicaid number;

• Facility name, address, and NPI number;

• Name(s) of staff involved;

• Detailed description of the incident, including the dates and location of theincident;

• Outcome, including the persons notified; and

• Current location of the member


If your facility requires additional clinical support to ensure member safety, please contact Magellan at 800-424-4046.

References and Resources

DMAS Program Manual:https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManual

Social Security Act:

https://www.ssa.gov/OP_Home/ssact/title19/1905.htm

Virginia State Regulations:

http://www.townhall.virginia.gov/

Code of Federal Regulations:

http://www.ecfr.gov/

Magellan of Virginia:

http://www.MagellanofVirginia.com


https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManual

https://www.ssa.gov/OP_Home/ssact/title19/1905.htm

http://www.townhall.virginia.gov/

http://www.ecfr.gov/

http://www.magellanofvirginia.com/

Confidentiality Statement for Educational Presentations


By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment.

Thank you

Documents

Psychiatric Residential Treatment ... - Magellan Of Virginia...(2) In the case of a minor, the facility must notify the resident's parent(s) or legal guardian(s) as soon as possible,