Network Adequacy Standards Mental Health Timely Access Timely

Network Adequacy Standards Mental Health Timely Access, Timely Access Reporting, Timely DATA DRIVEN Access Monitoring & Support Power Point Presentation September 5, 2019 Respectfully submitted by QI-IT

Agenda § DHCS Network Adequacy Standards Timeliness Requirements, Effective July 1, 2018 § Timely Access Reporting (2): Quarterly (Short-Term) Name: Timely Access Reporting • • 6 Data fields • 1 st Submission March 2019 (Dec 2019 -Feb 2019 requests) • 2 nd Submission July 2019 (Mar 2019 -May 2019 requests) • 3 rd Submission October 2019 (June 2019 -Aug 2019 • requests) Monthly (Long-Term) Name: Client Services Information Assessment Record 16+ Data fields 1 st Submission August 2019 (June 24 -30, 2019 requests) 2 nd Submission September 2019 (July 2019 requests) Monthly thereafter § Timely Access Tracking & Completion § Timely Access Monitoring & Support

DHCS - Timely Access Requirements, Effective July 1, 2018 Provider Type Timely Access for Non-Urgent Appointments MH Outpatient Mental Health Services Within 10 business days from request to appointment MH Psychiatry Within 15 business days from request to appointment Authorization Timely Access for Urgent Appointments Do not require prior authorization Within 48 hours of a request Required prior authorization Within 96 hours of a request Network Adequacy = the ability of a health plan to provide its participants/patients a sufficient number of in-network providers DHCS References: https: //www. dhcs. ca. gov/formsandpubs/Documents/Final. Rule. NAFinal. Proposal. pdf https: //www. cibhs. org/sites/main/files/file-attachments/wed_1030__medicaid_managed_care_final_rule_boylan_a__horner_d. pdf

Non-urgent Timely Access Quarterly Reporting “Short. Term” Requested Data Fields: New clients: 1. Never had a service/Avatar ID 2. Absence for 12 months &+ 3. Had an incomplete assessment 1. Name of the beneficiary 2. Date of the request for services 3. Referral source (e. g. , beneficiary, authorized representative, social services agency, managed care plan) 4. Date of the assessment or first “kept” Medi-Cal service 5. Explanation if no service was provided 6. Optional: Information about offered appointments and/or “no-shows” Next submission: October 2019 (Data: June 2019 -August 2019)

Timely Access Quarterly Reporting “Short-Term” Last NACT submission: July 1, 2019 Service Request Period: March 2019 – May 2019 data Data Source: DBH Avatar: Avatar Access Form & Entered Services 100% N=820 90% 162 80% 2 70% 60% 50% N=744 167 91 12 26 223 40% 30% 20% 10% 238 3 123 259 N=783 13 155 24 123 17 18 20 245 216 210 Mar-19 Apr-19 May-19 0% Had 1 st kept service w/in 0 -14 Days Had 1 st kept service 15 & + Days No service W/ explanation No Service & No explanation Had 1 st kept service 15 & + Days BUT did offer w/in 0 -14 days No service W/ explanation BUT did offer w/in 0 -14 days No Service & No explanation But did offer w/in 0 -14 days

Monthly Client Services Information Assessment Record “Long-term” • Data collection and monthly reporting/submission began over 20 years ago (1998) on all persons served regardless of funding • Client Services Information had mainly 3 reporting records until March 2019: • Demographic • Service • Periodic • Beneficiary Assessment Record (Timely Access) - IN# 19 -020 • Non-urgent, non-psychiatry mental health service appointments only • Data collection required to start June 23, 2019 • 1 st submission due in August 2019 for June 2019 service requests References: • • • 9 CCR § 3530. 10. Client and Service Information System Data. https: //govt. westlaw. com/calregs/Document/I 78065 AB 0 D 45311 DEB 97 CF 67 CD 0 B 99467? context. Data=%28 sc. Default%29&transition. Type=Default DMH LETTER NO. : 98 -0 https: //www. dhcs. ca. gov/formsandpubs/MHArchive. Ltrs/MH-Ltr 98 -03. pdf

Monthly Client Services Information Assessment Record “Long-Term” Reference: https: //www. sccgov. org/sites/bhd-p/QI/Documents/MHSUDS_Info_Notice_19 -020 -CSI_Assessment_Record. pdf

Monthly Client Services Information Assessment Record “Long-Term” Reference: https: //www. sccgov. org/sites/bhd-p/QI/Documents/MHSUDS_Info_Notice_19 -020 -CSI_Assessment_Record. pdf

Monthly Reporting: Client Services Information Assessment Record “Long. Term” Requested Data Fields: 1. Date of 1 st contact to request service 9. Treatment appointment 1 st offer date 2. Referral source 10. Treatment appointment 2 nd offer date 3. Assessment appointment 1 st offer date 11. Treatment appointment 3 rd offer date 4. Assessment appointment 2 nd offer date 12. Treatment appointment accepted date 5. Assessment appointment 3 rd offer date 13. Treatment start date * 6. Assessment appointment accepted date 14. Closure reason 7. Assessment start date * 15. Closed out date 8. Assessment end date * 16. Referred to * Data will be extracted via a query from entered services via (1) Clinical notes, (2) Batch upload or (3) Direct service entry

Timely Access Tracking & Completion County DBH My. Avatar “Access” Form Legend: Renamed New Tab w/same info o Tab: Request Information - Service request, urgent or not, & disposition o Tab: Contact Attempts - Track efforts in making the offer of assessment appointment o Tab: Assessment Scheduling - Assessment appointment(s) offered & accepted o Tab: Treatment Scheduling - Treatment appointment(s) offered & accepted o Tab: Access Closure - Closure reason & closed out date o Tab: Administrative Only - Test call & not meeting timeliness notification letter issued Actual/kept assessment and treatment dates will be extracted/pulled for reporting via a query

Timely Access Tracking & Completion My. Avatar “Access” Form Request Information Assessment Scheduling New service request, urgent or not, & disposition Assessment appointments offered & accepted Contact attempts (3) to offer the assessment appt. Treatment appointments offered & accepted Access Closure ü ü Assessment: Did not accept any offered assessment appt. Accepts offered assessment date but did not show Attended the assessment appt. but did not complete Does not meet medical necessity criteria Treatment: ü Completes assessment process but declines offered treatment dates ü Accepts offered treatment date but did not show Close Out Date – for those in red QA Review & Feedback Week 1 ------------->-------------------------------->------------> Week 5 Submission New: 1. Never had a service/Avatar ID 2. Absence for 12 months &+ 3. Had an incomplete assessment Treatment Scheduling <- Week 6 – 8 -> Pre-submission Review

Current Tracking & Completion 1 st submission is August 2019 for June 2019: June 24 -30, 2019 Service Requests Medi-Cal Not Medi-Cal Total # of Requests 140 34 174 Disposition 80% 20% # of First Ass. Had Treatment Request Offer Filled Accept Assessmen First Offer Filled t Filled 3 1 4 1 4 1 Not a Mental Health Request Other Referred to Community Resources Referred to Crisis Services 6 Referred to MHP Provider 106 65 Referred to PCPs/Health Care 12 Plan Blank 5 1 Total 140 66 Referred to MHP Provider & Had First Assessment Referred to MHP Provider 0 -14 Days 15 & + Days BUT Offered in 0 -14 Days 15 & + Days 68 42 5 62% 21 31% 7% 60 2 68 1 35 1 61 2 75 36

Current Tracking & Completion Submission A minimal complete Timely Access (Assessment Record) will consist of: (1) DATE OF FIRST CONTACT TO REQUEST SERVICE (2) ASSESSMENT APPOINTMENT FIRST OFFER DATE May decline (3) CLOSURE REASON With reason “Beneficiary did not accept any offered assessment dates” (4) CLOSED OUT DATE The date that Beneficiary declined

Current Tracking & Completion 1 st Report for submission – June 2019, Period: June 24 -30, 2019 Observations: • Had the assessment service & did not fill out First Assessment Offered • Had the assessment service & did not fill out First Assessment accepted • First & Second Assessment Offered have the same date Others: • Some programs do not have access to enter the service request • Some programs do not have access and do not enter

Monitoring & Support • Reports in Avatar: • Fresno MH Access NACT Submission report • More QA reports coming • Support: • DBH QA Review - weekly • Webinar training series coming

ly Frequent asked Client Services Information Assessment Record 1 st Contact of Service Request Situations Situation: If a person other than a future client contacts the MHP seeking services for the future client What to do: Depends on the legal status of that person making the initial contact: • Legally authorized to consent to services for the future client – YES • Does not have legal authorization to consent to service – NO. Contact the client/legally authorized person to confirm the interest in service, then offer an assessment appointment & that date is the 1 st contact to request services Situation: If a beneficiary/client enters the system via a crisis intervention What to do: This date is considered the be 1 st contact to request services Situation: If a beneficiary/client enters the system via a crisis stabilization or in-patient service What to do: 1 st contact is when a beneficiary/client is discharged and the first stepdown service is requested by provider, client, or other referral source

We have a few handouts for you: • Simplified flowchart • Q&A Questions ?

Thank you for your time & Feedback