TRAINING ON MEDICAL ASSISTANCE BULLETIN OMHSAS-11-05 ISSUED MARCH 8, 2011 OMHSAS & Permissible Arrangements for Psychologists Providing Behavioral Health

TRAINING ON MEDICAL ASSISTANCE BULLETINOMHSAS-11-05

ISSUED MARCH 8, 2011

OMHSAS & Permissible Arrangements for Psychologists

Providing Behavioral Health Rehabilitation Services

OVERVIEW

I. Background on Pennsylvania DPW-OMHSAS Medical Assistance Bulletin (MAB)

II. Introduce Verification of Responsibilities form

III. Examples of appropriate/inappropriate service delivery arrangements

MAB OMHSAS-11-05 March 8, 2011

Over time, OMHSAS found….some psychologists lacked a full understanding of the BHRS requirements they were a provider of or how these requirements intersected with Pennsylvania State Board of Psychology regulations. Key findings include:

Exceeding supervision limit of unlicensed professionals (MT’s & BSC’s)

Allowing other psychologist or “providers” to bill for services under their provider number or billing for services supervised by other psychologist

No participation in treatment planning or service delivery

No oversight of program development Deviating from approved Service Description

Providing BHRS

Background…1989 Congress amends the Early and Periodic Screening,

Diagnosis and Treatment (EPSDT) provisions of the Medicaid statue, requiring states to provide necessary treatment and services

1994 Therapeutic Support Staff (TSS), Mobile Therapy (MT) and Behavioral Specialist Consultant (BSC) added to Medicaid fee schedule (MAB 01-94-01).

2001 MAB 01-01-05 revises policies related to BHRS including qualifications, training and supervision requirements for TSS

2003 MAMIS-to-PROMISe transition psychologists previously enrolled as “provider type 50” re-

enrolled as “provider type 19” to align with federal taxonomy codes.

2005 DPW begins utilizing National Provider Identifier (NPI) and associating with PROMISe ID.

2007 DPW begins offering MA Bulletins via email

General Enrollment

To do business with the Department of Public Welfare, provider entities must first enroll in the Pennsylvania Medical Assistance Program.

Enrollment requires a complete a base provider enrollment form and applicable addenda documents.

For psychologists ….

Must be licensed without restriction and meet established provider type criteria:

http://www.dpw.state.pa.us/provider/promise/enrollmentinformation/index.htm

Approved applicants are issued unique PROMISe number and entered into statewide network


Providing BHRS

Current regulations allow for a psychologist to offer BHRS as an independently recognized provider (provider type 19)

To provide BHRS,

a psychologists must….

Providing BHRS

Submit Service Description (SD) the OMHSAS-Children’s Bureau for review and approval (new provider) A completed SD includes information as outlined in

MAB 01-94-01 and formatted in accordance with Attachment 7 of MAB 1153-95-01

Supporting documentation includes: signed Verification of Responsibility form, copy of valid license, letters of county support and collaboration with BH-MCO’s (technical assistance materials provided by the Children’s Bureau available upon request).

Approval, denial or request for revisions provided within 45 days of submission

Providing BHRS

MAB 01-96-11 requires providers to submit a revised Service Description if….

“there are substantial changes in a service that the Department previously approved.”

According to MAB 01-96-11 examples of “substantial changes”

include some of the following:1.Changes to the actual services provided2.Change in staff qualifications or staffing ratios3.Change in service site (e.g. main service location or

counties served, addition of a new service location)

Providing BHRS

MAB OMHSAS-11-05 initiates requirement for Verification of Responsibility form

Acknowledges awareness of regulations governing standard billing practices and limits on supervised employees.

This is required for all new submissions effective March 8, 2011 Service Descriptions will not be approved without

submission Previously approved providers must sign and submit

to OMHSAS-Children’s Bureau

COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE

OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BUREAU OF CHILDREN’S BEHAVIORAL HEALTH SERVICES

Verification of Responsibilities

I understand that when I provide Behavioral Health Rehabilitation Services (BHRS) I must comply with both the Pennsylvania Board of Psychology’s licensing requirements and the requirements that govern participation in the Pennsylvania Medical Assistance Program and provision of BHRS. I also understand that I am fully responsible for any services billed under my Medical Assistance provider number. By signing the attached service description, I accept responsibility for the following services to be billed using my Medical Assistance provider number:

Evaluations MT BSC TSS

_______________________

Psychologist Signature _______________________ Psychologist Printed Name ________________________ Date ________________________ Psychologist License Number

Providing BHRS

Why is the Department of Public Welfare-OMHSAS requiring the psychologists’ signature? The signed “Verification of Responsibilities”

acknowledges that the psychologist will be using their individual MA provider number and thus financially, legally and ethically responsible for all services outlined on the approved Service Description. Providers lacking direct involvement in the development

of their Service Description risk program noncompliance, unethical practice arrangements or unacceptable billing practices resulting in financial penalties or practice sanctions

Permissible Service Arrangements

The Professional Psychologist Practice Act (1986, P.L. 89, No. 33) empowers the Pennsylvania State Board of Psychology to define and regulate standards for professional practice. Title 49, Chapter 41 State Board of Psychology,

defines standards for the employment and supervision of unlicensed persons with graduate training in psychology. Subsections 41.58(b) and 41.58(c)(2) directly apply to the

provisions of BHRS for psychologist providers and supervision of BSC’s, MT’s and TSS.


§ 41.58 “Standards for the employment and supervision of unlicensed persons with graduate training in psychology”

Paragraph (b) requires that the employing psychologist must: Ensure proper educational requirement of any employee Bear full professional responsibility for services provided

by employee Provide appropriate supervision arrangements, including

proper delegation of supervisory responsibilities to other psychologists and/or qualified professionals


§ 41.58 “Standards for the employment and supervision of unlicensed persons with graduate training in psychology” continued…..

Paragraph (c)(9) Prohibits the employing psychologist from supervising

more than three full-time (FTE) or their equivalent in part-time employees. “FTE” based on established personnel policy and in

accordance with applicable labor laws and regulations



Then how are TSS employed?


PA State Board of Psychology: the work of a TSS as it is currently defined and being provided is not the practice of psychology However, regulations by the Board and by virtue of

billing under their MA provider number, the psychologist remains responsible for all aspects of BHRS.

MAB 01-01-05 (June 2001) revised minimum staff qualifications and established minimum training and supervision requirements for TSS workers


Additionally, MAB 01-01-05 establishes minimum qualifications for professionals supervising TSS These criteria allow BSC’s and MT’s who meet the

educational requirement to provide supervision up to 9 full-time equivalent TSS workers For TSS employed 20hrs per week or more, ongoing

supervision includes:• At least 1hr individual or group supervision per week• On-site assessment and assistance prior to working alone

with children or adolescents (varies depending on experience)

• Periodic on-site supervision (determined by supervisor)


The purpose of the guidance document from the bulletin is: To provide examples of arrangements a psychologist

enrolled in the MA Program to provide BHRS. The examples address both permissible and impermissible arrangements.

To identify specified regulations and policies that apply to psychologists enrolled in the MA program to provide BHRS.


Service Arrangements

Service Arrangements

Psychologist (Type 19)


BHRS (3 FTE & TSS)

BHRS (3 FTE & TSS)



BHRS (3 FTE & TSS)

BHRS (3 FTE & TSS)



BHRS (3 FTE & TSS)

BHRS (3 FTE & TSS)

Entity

Penalties

Providers billing for services without proper approval or for unnecessary services face civil and criminal penalties in accordance with state and federal laws. Penalties may include:

Nonpayment of questionable claims Civil monetary penalties Exclusion from the Medicaid Program Imprisonment and criminal fines

Penalties (cont.)

Additionally, the Pennsylvania State Board of Psychology may impose penalties and sanctions including:

Civil monetary penalties License suspension/revocation Additional training and corrective actions deemed

appropriate by the Board.

Information

Service Bulletins and policies related to the provision of BHRS can be found:

www.parecovery.orgPennsylvania Recovery and Resiliency- Provides access to behavioral health resources both at the state and community level

www. services.dpw.state.pa.us/olddpw/bulletinsearch.aspxDWP link to bulletin search (A list of BHRS-related bulletins referenced in OMHSAS-05-11)

www.paproviders.orgPennsylvania Community Providers Association (PCPA) serves as a forum for the exchange of information and experience, archived information related to BHRS and updates on trainings for providers

www.pacode.comProvides access to regulatory language governing DPW and the provision of BHRS

Information

Provider EnrollmentProvides assistance regarding MA enrollment processes, file maintenance and general MA enrollment questions:

1-800-537-8862 Hours of operation: Monday – Friday, 8 AM-4:30 PM


OMHSAS Toll-Free Inquiry LineTechnical assistance for behavioral health counties, plans and providers to assist with enrollment, billing, eligibility discrepancy, etc.

1-800-433-4459 Hours of operation: Mon-Fri 8 AM-4 PM,

Voicemail available after 4 PM

Information

Contact:Garrett Rosas, PsyDConsulting PsychologistOMHSAS- Bureau of Children's Behavioral Health ServicesP.O. Box 2675Harrisburg, PA 17105-2675Voice: 717-425-7674 Fax: [email protected]

Courtney Coover, ChiefPlanning, Policy & Development DivisionOMHSAS- Bureau of Children's Behavioral Health ServicesP.O. Box 2675Harrisburg, PA 17105-2675Voice: 717-772-7855 Fax: [email protected]

www.dpw.state.pa.us

Documents

TRAINING ON MEDICAL ASSISTANCE BULLETIN OMHSAS-11-05 ISSUED MARCH 8, 2011 OMHSAS & Permissible Arrangements for Psychologists Providing Behavioral Health