Comprehensive School and Community Treatment Program Training

1
Welcome
Department of Public Health and Human Services

• Comprehensive School and Community Treatment
  Program Training
• Fall 2007

2
What We Will Learn Today
Department of Public Health and Human Services

• History
• About the CSCT Program
• Requirements
• How to Bill
• How to Document
• More Information

3
History of Medicaid in Schools
Department of Public Health and Human Services

• Schools have been billing Medicaid for over 10
  years
• 2001 MT Legislature issued a directive to allow
  for increased Federal Spending

The CSCT program was reinstated into the school
based services and enacted in the fall of 2003
4
Why Schools Can Bill Medicaid
Department of Public Health and Human Services

• Title XIX (19) of the Social Security Act
• Oversight is done by Centers for
  Medicare/Medicaid (CMS)
• Includes Early Periodic Screening, Diagnostic
  Treatment Program (EPSDT)
• Medicare Catastrophic Coverage Act makes the
  connection to Individual Education Plans (IEP)
• Individuals with Disabilities in Education Act
  (IDEA)
• CSCT Services can be provided for students
  without an IEP..
• this is different from all other School-Based
  services in Montana

5
Why is the CSCT Program a School-Based Service
Department of Public Health and Human Services

• Helps to eliminate the risk of removing students
  from home and school
• Program is operated by the school through a
  contract with a mental health center
• Source of funding makes this available only thru
  school programs

6
Reimbursable Services
Department of Public Health and Human Services

• Code H0036- Community psychiatric supportive
  treatment, face-to-face, per 15 minutes (Medicaid
  specific)
• Includes individual, family and group counseling
• Behavioral interventions with student (minimum of
  8 minutes for one 15 minute unit)
• Direct Crisis intervention when student is
  present in a school-owned or operated facility
• Services need to correspond with a students'
  Individual Treatment Plan (ITP)

7
Non-Reimbursable Activities
Department of Public Health and Human Services

• Observation monitoring/supervision
• Non face to face service
• Time in meetings
• More than 720 units of service per month per team
• Educational/Academic assistance with schoolwork
• Watching moviesattending assemblies---fieldtrips
• Less than 8 minutes of service in the 15 minute
  unit that is billable

8
Provider Requirements
Department of Public Health and Human Services

• Services must be provided by at least two program
  staff
• Caseload for program cannot exceed 720 units (15
  minutes each) per month per team
• At least one of the two staff must be
• Licensed Psychologist
• Licensed Clinical Social Worker
• Licensed Professional Counselor
• An In-training licensed professional can be
  employed with the approval of the Childrens
  Mental Health Bureau at the state department

9
Service Requirements
Department of Public Health and Human Services

• Does not require Passport approval and can only
  be provided to children with Severe Emotional
  Disturbances (SED) found in ARM 37.86.3702
• Does not have to be included on IEP
• Services not specified on the IEP must be
  provided and billed to ALL children who require
  services
• Free Care rule applies with non-IEP services

10
Free Care Rule
Department of Public Health and Human Services

• Services must be made available to all children,
  not just Medicaid eligible recipients
• All recipients must be billed, not just Medicaid
• To meet this rule CSCT programs must
• Establish sliding fee schedule
• Determine third party liability (other insurance
  if any)
• Bill recipients for cost of service
• Students with IEPs are exempt from the Free
  Care Rule in regard to CSCT services

11
Department of Public Health and Human Services
Part time Staff 37.106.1960 MENTAL
HEALTH CENTER COMPREHENSIVE SCHOOL AND
COMMUNITY TREATMENT PROGRAM, STAFFING AND
TRAINING
(5) This rule is not intended to prevent the use
of part-time staff to provide CSCT services
throughout the year, including school vacation
periods. If a child or adolescent receives CSCT
services during time periods when school is not
regularly in session, then part-time staff may be
used and billed as set forth in ARM 37.86.2225.
12
Administrative Rule for Prior Authorization of
Outpatient Therapy with CSCT
Department of Public Health and Human Services

• 37.88.101MEDICAID MENTAL HEALTH SERVICES,
  AUTHORIZATION REQUIREMENTS (1) Mental health
  services for a medicaid recipient under the
  Montana medicaid program will be reimbursed only
  if the following requirements are met . . .(c)
  prior authorization has been obtained for
  outpatient therapy services that are provided
  concurrently with comprehensive school and
  community treatment (CSCT) program services
  described at ARM 37.106.1955, 37.106.1956,
  37.106.1960, 37.106.1961, 37.106.1965 and
  37.86.2225

13
Program Requirements/Approval
Department of Public Health and Human Services

• Provided by a licensed mental health center
• Program is approved with a CSCT area of
  endorsement by Quality Assurance Division (QAD)
  at the state department
• Information can be found in Appendix C of School
  Based Provider Manual
• Students with SEDs are served
• Certification of match is completed by schools at
  the end of the year
• For federal match requirements to obtain these
  dollars for reimbursement.

14
Provider Approval
Department of Public Health and Human Services

• Individual provider/staff approval is generally
  not required
• Expectation is that CSCT staff are available
  throughout each day to work with children as
  needed
• CSCT programs can use Pre-Licensed Professionals
  on an infrequent basis
• Contact Diane White, Clinical Program Officer for
  Childrens Mental Health _at_ 406-444-1535 for
  approval of in-training staff personnel (this
  could be changing)

15
Students with SEDs Served
Department of Public Health and Human Services

• Services can only be provided to students with
  serious emotional disturbances (ARM 37.86.3702,
  rule at end) regardless of whether the child is
  eligible for Special Education services
• Program not intended for children with functional
  limitations that require activities of daily
  living (ADL)
• These services are covered by other Medicaid
  services like paraprofessional staff

16
Certification Of Match
Department of Public Health and Human Services

• The Federal government requires an annual
  certification of non-federal expenditures to
  cover the costs associated with CSCT services
• Individual schools are responsible for this
  match worksheet that is kept on file at the
  department.

17
Provider Enrollment with MT Medicaid
Department of Public Health and Human Services

• Provider Notice for School Based Service dated
  March 7, 2007
• Schools re-enrollment and National Provider
  Identification Number (NPI)
• Mental Health Centers need to work with schools
  to get the CSCT program staff (teams) enrolled
  and identified as TEAM 01 and so on
• Important and needs to be done before billing for
  services (October 1, 2007)

18
How to Bill for Services
Department of Public Health and Human Services

• Details can be found in the School Based Services
  Manual
• Only use H0036 code
• Field 19 on CMS-1500 is location for TEAM 01
  etc.
• WINASAP 2003 is available from ACS and is HIPPA
  compliant for use in electronic billing
• Contact Tom Keith _at_ 406-451-9532

19
Documentation Requirements
Department of Public Health and Human Services

• 37.85.414 MAINTENANCE OF RECORDS AND AUDITING
• (1) All providers of service must maintain
  records which fully demonstrate the extent,
  nature and medical necessity of services and
  items provided to Montana Medicaid recipients.
  The records must support the fee charged or
  payment sought for the services and items and
  demonstrate compliance with all applicable
  requirements. . . .
• (b) When reimbursement is based on the length of
  time spent in providing the service, the records
  must specify the time spent or the time treatment
  began and ended for each procedure billed to the
  nearest minute. Total time billed using one or
  multiple procedure codes may not exceed the total
  actual time spent with the Medicaid client.

20
Department of Public Health and Human Services
37.86.3702 CASE MANAGEMENT SERVICES FOR YOUTH
WITH SERIOUS EMOTIONAL DISTURBANCE, ELIGIBILITY
(2) "Serious emotional disturbance (SED)" means
with respect to a youth from the age of six
through 17 years of age that the youth meets
requirements of (2)(a) and (2)(b). (a) The
youth has been determined by a licensed mental
health professional as having a mental disorder
with a primary diagnosis falling within one of
the following DSM-IV (or successor)
classifications when applied to the youth's
current presentation (current means within the
past 12 calendar months unless otherwise
specified in the DSM-IV) and the diagnosis has a
severity specifier of moderate or severe (i)
childhood schizophrenia (295.10, 295.20, 295.30,
295.60, 295.90) (ii) oppositional defiant
disorder (313.81) (iii) autistic disorder
(299.00) (iv) pervasive developmental disorder
not otherwise specified (299.80) (v)
asperger's disorder (299.80) (vi) separation
anxiety disorder (309.21) (vii) reactive
attachment disorder of infancy or early childhood
(313.89)
21
(viii) schizo affective disorder (295.70)(ix)
mood disorders (296.0x, 296.2x, 296.3x, 296.4x,
296.5x, 296.6x, 296.7, 296.80, 296.89) (x)
obsessive-compulsive disorder (300.3) (xi)
dysthymic disorder (300.4) (xii) cyclothymic
disorder (301.13) (xiii) generalized anxiety
disorder (overanxious disorder) (300.02) (xiv)
posttraumatic stress disorder (chronic)
(309.81)(xv) dissociative identity disorder
(300.14) (xvi) sexual and gender identity
disorder (302.2, 302.3, 302.4, 302.6, 302.82,
302.83, 302.84, 302.85, 302.89) (xvii)
anorexia nervosa (severe) (307.1) (xviii)
bulimia nervosa (severe) (307.51) (xix)
intermittent explosive disorder (312.34)
and (xx) attention deficit/hyperactivity
disorder (314.00, 314.01, 314.9) when accompanied
by at least one of the diagnoses listed above
22

b) As a result of the youth's diagnosis
determined in (2)(a) and for a period of at least
six months, or for a predictable period over six
months the youth consistently and persistently
demonstrates behavioral abnormality in two or
more spheres, to a significant degree, well
outside normative developmental expectations,
that cannot be attributed to intellectual,
sensory, or health factors (i) has failed to
establish or maintain developmentally and
culturally appropriate relationships with adult
care givers or authority figures
(ii) has failed to demonstrate or
maintain developmentally and culturally
appropriate peer relationships (iii) has
failed to demonstrate a developmentally
appropriate range and expression of emotion or
mood (iv) has displayed disruptive behavior
sufficient to lead to isolation in or from
school, home, therapeutic or recreation
settings (v) has displayed behavior that is
seriously detrimental to the youth's growth,
development, safety or welfare, or to the safety
or welfare of others or (vi) has displayed
behavior resulting in substantial documented
disruption to the family including, but not
limited to, adverse impact on the ability of
family members to secure or maintain gainful
employment.
23
Serious emotional disturbance (SED) with respect
to a youth under six years of age means the youth
exhibits a severe behavioral abnormality that
cannot be attributed to intellectual, sensory, or
health factors and that results in substantial
impairment in functioning for a period of at
least six months and obviously predictable to
continue for a period of at least six months, as
manifested by one or more of the following (i)
atypical, disruptive, or dangerous behavior which
is aggressive or self-injurious(ii) atypical
emotional responses which interfere with
thechild's functioning, such as an inability to
communicate emotional needs and to tolerate
normal frustrations (iii) atypical thinking
patterns which, considering age and developmental
expectations, are bizarre, violent, or
hypersexual (iv) lack of positive interests in
adults and peers or afailure to initiate or
respond to most social interaction (v)
indiscriminate sociability (e.g., excessive
familiarity with strangers) that results in a
risk of personal safety of the child or (vi)
inappropriate and extreme fearfulness or other
distress which does not respond to comfort by
care givers.
24

(3) A youth must be reassessed annually by a
licensed mental health professional, as to
whether or not they continue to meet the criteria
for having a serious emotional disturbance. For
the initial or for an annual reassessment, the
clinical assessment must document how the youth
meets the criteria for having a serious emotional
disturbance.
25
More Information Contacts
Department of Public Health and Human Services

• SchoolBased Services Program Provider Manual
• Download a copy from www.mtmedicaid.org
• Also found at Web site is Provider Notices, Fee
• Schedules, Forms and HIPAA information
• DPHHS Contact
• Rena Steyaert Diane White
• Program Officer Clinical Program
  School Based Officer
  Childrens Services
  Mental Health
• (406)-444-4066 (406)-444-1535
• rsteyaert_at_mt.gov dwhite_at_mt.gov