Mental Health
Mental Retardation
of Tarrant County
Mental Health
Resiliency and
disease management
clinic
Provider
Manual
SEPTEMBER,2010
Table of Contents
INTRODUCTION…………………………………………………………………………….….1
MISSION STATEMENT& VALUES…………………………………………………………..2
ORGANIZATIONAL STRUCTURE………………………….……………………………….3
IMPORTANT POINTS TO REMEMBER………………………………………………….....3
REFERRAL AND AUTHORIZATION PROCESSES…………………………………….….4
SERVICES………………………………………………………..………………….…………...5
DOCUMENTATION .................................................................................................................... 8
CLAIMS & BILLING ................................................................................................................ 15
REPORTING REQUIREMENTS ............................................................................................ 32
MONTHLY REPORT ................................................................................................................ 33
STAFF TRAINING .................................................................................................................... 37
CREDENTIALING AND CLINICAL SUPERVISION ......................................................... 40
MEDICATIONS ......................................................................................................................... 43
LA QUALITY MANAGEMENT/CONTRACT MONITORING ......................................... 44
PROVIDER PROFILE .............................................................................................................. 46
COMPLAINTS ........................................................................................................................... 47
SANCTIONS, APPEALS AND CONTRACT TERMINATION ........................................... 48
REFERENCES ............................................................................................................................ 49
Introduction
W
elcome to Mental Health Mental Retardation of Tarrant County (MHMRTC). We are
pleased to recognize you as a member of our Provider Network and look forward to
enjoying a long and mutually satisfying contractual relationship with you.
The purpose of this Provider Manual is to educate you about the policies and procedures of
MHMRTC. We ask that you read this material carefully and discuss any questions you may
have with our Director of Contracts Management/Provider Relations, Kevin McClean, at (817)
569-4456.
MHMRTC is staffed by a team of highly dedicated professionals experienced in managed care
and the provision of services for persons who are diagnosed with mental illness. MHMRTC is
dedicated to providing high quality, innovative, and cost-effective management of mental health
services.
Our philosophy is propelled by a strong commitment to service excellence supported by
management flexibility and accountability. Our on-going objective is to continually refine our
system so that we can excel in the delivery of quality services as we balance the best interests of
our consumers, providers, and employees.
MHMRTC clearly understands that open communication must exist between our service
providers and our organization in order for us to be able to provide individuals in our community
with the best possible care. We, therefore, invite you to share your perceptions, needs, and
suggestions with our Director of Contracts Management/Provider Relations, who will also, from
time to time, ask you to respond to surveys to help us identify other opportunities to improve our
services and to assess your satisfaction as a member of our provider network.
We will do all that we can to support your entry into our system and assure that your continued
participation in our network will be beneficial for all concerned.
In this Provider Manual, references may be made to consumers, clients, and covered individuals.
All of these terms are to be considered interchangeable. Other references that are used
interchangeably are MHMRTC and Local Authority (LA), and DSHS and State Authority (SA).
1
Mission Statement & Values
Mission Statement of
MHMR of Tarrant County:
To enhance the mental health and intellectual development of people in our
community.
Values
Each person is respected and valued.
Services are developed around the individual needs, values, and opinions of each person
served.
Families are valued and respected for their critical importance in a person’s support system
and are given the opportunity to have an active role in treatment planning and the delivery
of services.
Success is demonstrated in terms of outcome for each person served.
Services enhance dignity through participation and choice.
Services encourage and support growth, independence, and integration into the community.
Quality services are provided in a safe, ethical, and cost effective manner, and provide the
best value to the person served.
Programmatic and administrative best practices are recognized and valued.
A seamless system of services is realized through the coordination and collaboration of
providers in the community.
2
Organizational Structure
The organizational structure of MHMRTC includes the Mental
Health and Mental Retardation Community Advisory
Committees. These two committees are composed of individuals
from the community, including consumers, who have a vested
interest in assuring that quality services are readily available to
our consumers. The committees are empowered to provide input
into the planning process that will lead our organization into the
future. Both of the committees report to our Board of Trustees.
Our Chief Executive Officer is accountable to our Board of Trustees. The Deputy Chief
Executive Officer directs the Authority component of our organization and is accountable to our
Chief Executive Officer. Chiefs who report directly to the Deputy Chief Executive Officer direct
both Mental Health and Mental Retardation Services.
There are three Chiefs who oversee the administrative duties of our organization, which includes
Information Systems, Finance, and Human Resources and are accountable to our Chief
Executive Officer. These areas provide support services to the Authority and to MHMRTC
providers.
Currently, MHMRTC has providers in the areas of Mental Health Services, Mental Retardation
Services, Addiction Services, and Early Childhood Intervention Services. We anticipate
continued growth in expanding our service providers from the community.
Important Points to Remember
Provider’s Responsibilities
It is the provider’s responsibility to render services to MHMRTC consumers in
accordance with the terms of the contract. The provider is required to render
these services to MHMRTC consumers in the same manner, adhering to the same
standards, and within the same time availability as offered to all other consumers.
MHMRTC does not guarantee that a MHMRTC consumer or any number of MHMRTC
consumers will utilize any particular provider. Each consumer is given information regarding all
providers in the provider network and then makes the choice of provider(s).
Providers are required to immediately call MHMRTC’s Risk Management Department at
(817) 335-3022 and to contact each consumer’s MHMRTC Designated Staff Liaison to report
occurrences of the following:






Client deaths
Suicide attempts
Serious injuries – injuries which require medical care
Serious medication errors
Adverse Drug Reactions
Allegations of homicide, attempted homicide, threat of homicide with a plan
3



Incidents of restraint or seclusion
Confirmed abuse, neglect, or exploitation
Discovered pharmacy errors
Providers are required to inform consumers that they have the right to report any complaints
about the services they are receiving to the Consumer Complaint Reporting Line at:
(817) 569-4367
or
1-888-636-6344 (toll free)
All provider complaints and/or suggestions are to be communicated to the Director of
Contracts Management/Provider Relations at (817) 569-4456.
All suspicions of client abuse are to be reported to the Texas Department of Family and
Protective Services at 1-800-252-5400 or www.txabusehotline.org.
Referral and Authorization Processes
Referral Process
All referrals to Provider will come from the MHMRTC Licensed Practioner of the Healing Arts (LPHA)
after the LPHA determines that a Covered Individual meets medical necessity criteria for the delivery of
Resiliency and Disease Management services and authorizes the delivery of those services. Authorization
for services may only be made by an LPHA from MHMRTC.
412.322
(c )(2)
419.455 (2)
419.453 (30)
Determination that there is a medical necessity for Medicaid MH
rehabilitative services for the individual has been made by an LPHA.
Medical necessity--evidenced by LPHA signature on the DMN form
E-019 or the LOC-A printed from WebCARE.
There is no guarantee that Provider will be used by a Covered Individual or any number of Covered
Individuals. The LPHA will offer the Covered Individual a choice of providers from the list of
contracted Providers. Covered Individuals will document their choice and are allowed to change
Providers.
Provider will not engage in case finding or otherwise locating individuals to receive rehabilitative services
and is prohibited from offering any gift with a value in excess of $10 to potential clients and from
soliciting potential clients through direct-mail or by telephone.
4
Authorization of Services
When a client is identified as needing Resiliency and Disease Management services and agrees to
participate, the MHMRTC LPHA, will authorize the type and amount of service to be provided during the
first 90 days. Once a Provider has been selected by the client, an Authorization letter will be generated
and sent (typically faxed) to the selected Provider along with the client’s diagnosis and a copy of the
Rehabilitative Service Plan. The Authorization Letter will include the Covered Individual’s name, the
date services are authorized to begin, the type and quantity of services authorized, the lapse date for the
Authorization (by when the services must be provided or will no longer be authorized), and the
Authorization Number. Provider will not be reimbursed for services not pre-authorized with an
Authorization Number.
The LPHA is responsible for following up with the Provider within 5 to 15 working days from the referral
to confirm the Provider was able to contact the client. The Provider must develop a Treatment Plan for
the Rehab services and begin services.
The treatment plan needs to be completed within 10 days of the auth. The plan needs to meet the
following requirements:
419.456
Treatment plan (Present) developed within 10 day after authorization is
412.322( e )
a (2)
obtained (TP signed within 10 days of LOC-A)
At a minimum a staff member credentialed as a QMHP-CS must complete
412.322( e )(1)
and sign the plan
412.322 (e) (1)
Description of A presenting problem, B needs related to MI, C strengths, D
(A)-(G)
preferences, E assessment , Physical health, G COPSD complete
412.322 (e) (1)
A description of the presenting problem section A
(A)
412.322 (e) (1)
A description of the individuals strengths C
(B)
412.322 (e) (1)
A description of the individuals needs arising from the mental illness section
(C)
B/ E related needs
412.322 (e) (1)
A description of the /physical health issue/COPSD section G and F
(D)
412.322 (e) (1)
A description of the expected outcomes
(E
412.322 (e) (1)
An expected date for recovery goals to be achieved
(F)
412.322 (e) (1)
List of resources for recovery ( last section of plan after signatures or
(G)
brochure)
419.465
List of types of services (services to be delivered must be checked or written
412.322 (e) (1) (a)
(3)
out code or name of service)
(H)
(A)
412.322 (e) (1)
List of strategies to be implemented by staff to achieve goals (Strategy
(H)(i)
statement listed)
412.322 (e) (1)
The frequency, number of units, and duration of each service to be provided
(H)(ii)
is present.
412.322 (e) (1)
The credentials of staff providing the service are present.
(H)(iii)
412.322 (e) (2)
Goals address individual s needs, preferences, experiences, and cultural
(A)
background.
412.322 (e) (2)
Goals must address the individuals COPSD issue and or physical health
(B)
disorder.
412.322 (e) (2)
Goals are expressed in overt, observable actions of the individual.
(C )
412.322
(e)
Goals must be objective and measurable - using quantifiable criteria.
5
(2)(D)
412.322
(e)
(2)(E)
412.322 (e) (2)
(A)
412.322 (e) (2)
(B)
412.322 (e) (2)
(C )
412.322
(e)
(2)(D)
412.322
(e)
(2)(E)
412.322 (e) (3)
412.322 (f) (1)
(A)
412.322 (f) (1)
(B)
412.322 (f) (1)
(C)
Goals reflect individual autonomy, self direction, and desired outcomes.
Objectives address individual’s needs, preferences, experiences, and cultural
background.
Objectives address the individuals COPSD issue or physical health
disorder.
Objectives are expressed in overt, observable actions of the individual.
Objectives are objective and measurable using quantifiable criteria.
Objectives reflect individual autonomy, self direction, and desired
outcomes.
Copy of plan provided to the individual or explanation of reason why copy
is not given.
REVIEW
Review plan prior to requesting authorization for the continuation of
services. 3403 documented before 475/473
Review plan in its entirety, at least every 90 days.
Determine if the plan is addressing needs of individual. Narrative comments
by staff and client.
419.456
Document progress on all goals and objectives and any recommendation for
412.322 (f) (1) (d)
(1) continuing services, change for services, discharge from services. Check
(D)
(A)
box's marked.
Record documentation must be legible to others (other than author)
Record must have Medicaid # and client's name on each page of significant
documents, effective 11/1/99
6
Reauthorization of Services
Local Authority LPHA is responsible for reauthorization and determination of medical necessity.
As part of the Determination of Medical Necessity (DMN) oversight required by the Medicaid Rehab
guidelines, the Local Authority LPHA will determine medical necessity of services outlined in the
Provider’s Treatment Plan which is then reviewed at least every ninety (90) days. To ensure rehab
services maintain a valid authorization status, at least two (2) weeks prior to the lapse of the Treatment
Plan, Provider should review the client’s Treatment Plan, reassess the client, and request reauthorization
of the current Service Package or authorization of a Service Package that will meet the client’s needs.
The Provider will receive an Authorization Letter for continued services which will include an
Authorization Number specific to the Covered Individual, the type and amount of service authorized, and
the dates during which the services are authorized. Services must be authorized in this manner prior to
delivery of services for the Provider to be paid. Providers can confirm authorized status in WebCARE
Report Screen #251 for adults.
Occasionally, a Covered Individual will drop out of services or cannot be located by the LPHA to
reauthorize services. If such an individual presents with the Provider for services, Provider must reassess
the client and request authorization the same day via entry in WebCARE.
When the Level of Care Recommended (LOCR) equals the Level of Care Authorized (LOCA), the
assessment date is used as the effective date of authorization. When the LOCR does not equal the LOCA,
the WebCARE data entry or ‘add’ date is used as the effective date of authorization. Thus, when the
LOCA is different from the LOCR, the date the assessment is entered into WebCARE is the earliest that
billable services will be covered unless being reasssed during the already authorized period prior to
assessment and authorization expiration. If a change in level of service is subject to Fair Hearing
procedures, (reductions and terminations of level of care), the authorization date is delayed 10-14 days
from the assessment date. (See Automatic Authorization Agreement and TAC 357, Subchapter A
Uniform Fair Hearing Rules.)
NOTE: Review of Plans and reauth- we currently as the provider complete a new plan when a
client is new, autoclosed, or changes packages. Reviews are to be done at least every 90 days.
Additionally the review occurs prior to request of authorization. The rule explicitly requires this.
REVIEW
412.322
Review plan prior to requesting authorization for the continuation of services.
(f) (1) (A)
3403 documented before 475/473
412.322
Review plan in its entirety, at least every 90 days.
(f) (1) (B)
412.322
Determine if the plan is addressing needs of individual. Narrative comments by
(f) (1) (C)
staff and client.
419.456
Document progress on all goals and objectives and any recommendation for
412.322
(d)
(1) continuing services, change for services, discharge from services. Check box's
(f) (1) (D) (A)
marked.
Discharge from ServicesProvider must consult with the LPHA and obtain approval prior to
discharging a Covered Individual from rehabilitative services. Discharge requests will comply with MH014, Mental Health Services Discharge Process.
7
Services
Covered Services
Covered Services are those services which are determined by Local Authority to be Medically Necessary
Services when authorized as part of the current UA-RDM assessment and treatment plan of the Covered
Individual approved by a Licensed Practitioner of the Healing Arts. Provider is prohibited from providing
more than one rehabilitative service to an individual at the same time and on the same day.
The services proposed to serve any individual in the authorized level of care of Service Package are:

reasonable and necessary for the diagnosis or treatment of a mental health disorder or a cooccurring psychiatric and substance use disorder (COPSD) in order to improve or maintain the
individual’s level of functioning;

in accordance with professionally accepted clinical guidelines and standards of practice in
behavioral health care;

furnished in the most clinically appropriate available setting in which the service can be safely
provided;

provided at a level that is safe and appropriate for the individual’s needs and facilitates the
individual’s recovery; and

could not be omitted without adversely affecting the individual’s mental or physical health or the
quality of care rendered (Reference: Texas Administrative Code §412.303 Definitions, (39) Medical
necessity).
Diagnosis-
412.322(b)
419.455 1 ( c)
Client is an adult with severe and persistent mental illness
or a child or adolescent with a serious emotional
disturbance. MI documented covering the time services
were rendered.
Diagnosis should be completed at least one time annually by licensed staff acting within the scope of
their license- all 5 axis should be addressed and should meet DSHS contract requirement. Primary
axis must be indicated.
The diagnosis is batched to CARE along with the registration information as it is entered into
CMHC.
If new generation medication is prescribed the data must be recorded and provided so that it can
be reported to the DSHS in the weekly batch. Data must be entered in a timely manner according
to the attached procedure.
Documentation
8
Provider must maintain records necessary to verify services delivered and billed to MHMR of Tarrant
County.
Provider must additionally maintain records including the following:
1.
2.
3.
4.
5.
6.
7.
Names of all Covered Individuals enrolled with Provider
Evidence of licensure, certification or accreditation, as required
Evidence of Life Safety Code or ADA inspection and compliance, if applicable
Evidence of insurance coverage
Evidence of criminal history checks of staff
Evidence of required staff training
If Covered Individuals are paid by Provider, evidence of compliance with Department of
Labor (DOL) regulations regarding salaries and pay
8. Doctor’s orders and medication records if medications are administered by Provider staff
9. Fire Marshall inspection and results of fire drills
10. Evidence of annual health department inspection for day programs which serve or prepare
food for 10 or more Covered Individuals.
Provider will retain records for a minimum of seven (7) years.
Provider will receive, store, process, or otherwise deal with client information, if any, accessed or
generated during services in compliance with Chapter 414, Subchapter A, Client Identifying Information,
of Title 25 of the Texas Administrative Code.
Service Documentation
The Provider is responsible for documenting all services. All service documentation must meet all
Mental Health Community Services Standards, and Medicaid Rehabilitation documentation
requirements.
Registration: client must be registered in CARE.
Diagnosis: All 5 axes completed, signed and dated by LPHA at least annually and primary axis indicator
identified.
Assessments
The Provider is responsible for ongoing assessments of the Covered Individual’s need for and response to
specific rehabilitative services. These assessments occur in collaboration with the Covered Individual
and, minimally, identify the following:
 the Covered Individual’s recovery goals;
 the Covered Individual’s changing clinical needs
 the Covered Individual’s natural supports and current use and benefit from those
supports; and
 the demands and adaptability of the Covered Individual’s chosen environments.
412.322 (a) (2)
412.322 (d) (1)(A)
Obtain authorization from the department (DSHS) (doc in
CMHC or WebCARE)
419.456 a 1 (A)
9
419.456, 419.465
(b) (2) (B)
Services delivered must be within service package authorized.
Assessments must meet DSHS contract reqs for frequency and content by properly credentialed
staff. QMHP every 90 days – must be entered in a timely manner.
Treatment Plan Requirements
The Provider is responsible for developing a Treatment Plan with goals and objectives for the client
which must conform to the standards of the Mental Health Community Services Standards, Texas
Administrative Code 412 G, section 412.322 and must be developed within ten (10) working days from
the initial authorization. Treatment Plans must be signed by the assigned Provider staff and the client and
a copy provided to the LPHA upon request.
Treatment Plans must, at a minimum, be reviewed and updated every ninety (90) days, or more often if
clinically indicated.
Treatment plan (Present) developed within 10 day after authorization is obtained (TP signed within
10 days of LOC-A)
At a minimum a staff member credentialed as a QMHP-CS must complete and sign the plan
Description of A, B, C, D, E, F, G complete
A description of the presenting problem section A
A description of the individuals strengths C
A description of the individuals needs arising from the mental illness section B/ E related needs
A description of the /physical health issue/COPSD section G and F
A description of the expected outcomes
An expected date for recovery goals to be achieved
List of resources for recovery ( last section of plan after signatures or brochure)
List of types of services (services to be delivered must be checked or written out code or name of
service)
List of strategies to be implemented by staff to achieve goals (Strategy statement listed)
The frequency, number of units, and duration of each service to be provided is present.
The credentials of staff providing the service are present.
Goals address individual s needs, preferences, experiences, and cultural background.
Goals must address the individuals COPSD issue and or physical health disorder.
10
Goals are expressed in overt, observable actions of the individual.
Goals must be objective and measurable - using quantifiable criteria.
Goals reflect individual autonomy, self direction, and desired outcomes.
Objectives address individual’s needs, preferences, experiences, and cultural background.
Objectives address the individuals COPSD issue or physical health disorder.
Objectives are expressed in overt, observable actions of the individual.
Objectives are objective and measurable using quantifiable criteria.
Objectives reflect individual autonomy, self direction, and desired outcomes.
Copy of plan provided to the individual or explanation of reason why copy is not given.
Treatment Plans must, at a minimum, be reviewed and updated every ninety (90) days, or more often
if clinically indicated.
Review plan prior to requesting authorization for the continuation of services. 3403 documented
before 475/473
Review plan in its entirety, at least every 90 days.
Determine if the plan is addressing needs of individual. Narrative comments by staff and client.
Document progress on all goals and objectives and any recommendation for continuing services,
change for services, discharge from services. Check box's marked.
Record documentation must be legible to others (other than author)
Record must have Medicaid # and client's name on each page of significant documents, effective
11/1/99
Progress Notes
Progress Notes must be completed for all services delivered, and must reflect the service that took place,
client behaviors, situational stressors, needs, issues that arise, and the individual’s progress or lack of
progress towards the anticipated service outcome. Progress notes should convey clinically relevant
detail about the client by documenting:
1.
2.
3.
4.
5.
6.
the affect, attitude, and behaviors of the individual’s participation
positive or negative symptoms of their mental illness observed, (or when asked)
positive or negative side effects of their medication taken as observed, (or when asked)
any clinically relevant issues that arise during the course of service delivery
progress (or lack of progress) toward the desired objectives or goal; and
in terms that documents evidence of medical necessity by
a. maintaining or improving client functioning;
b. in the clinically most appropriate setting services can be safely provided;
11
c. provided at a safe and appropriate level for the individual’s needs and facilitates the
individual’s recovery; and
d. cannot be omitted without adversely affecting the individual’s mental or physical health
or the quality of care rendered (TAC §412.303 (39) Medical Necessity).
Progress notes must conform to the Medicaid billing requirements and the standard of the MH
Community Services Standards, in §412.326:
It is against the rules to reimburse for travel.
REQUIRED IN EVERY REHAB NOTE:
Progress note present
412.326 (2)
419.463 a (1)
419.463 (a) (4)
419.463 (a) (5)
419.463 (a) (6)
419.465 (I)
419.463 a (2)
412.326 (9)
419.463 (a) (3)
412.326 (8)
412.326(13)
412.326(13)
419.465 (a) (1)
419.463 (a) (7)
419.463 (a) (7)
Client's name/ recipient
Service date
Duration (Stop/Start Time)
Location/Setting
Client present and awake
Type of service provided is supported by sac used
The specific skill trained on and method used to provide
the training is documented
Service is face to face to individual or primary care
giver of child adolescent
Provider signature and date
Credentials of provider
412.326 (6)
419.463 (b) (4) (A)
A summary of the activities that occurred;
412.326 (7)
419.463 (b) (4) (B)
412.326 (1)
412.326 (3)
412.326 (4)
412.326 (5)
419.463 (b) (4) ©
412.326 (11)
412.326 (14)
412.326 (120
419.463 (b) (4) (D)
419.315 (d)
419.456 (a) (1)
412.326 (10)
The modality of service provision (i.e. one-to-one or
group);
The treatment plan goal's that was the focus of the
service; and
The treatment plan objective's that was the focus of the
service listed on note or written out.
Any pertinent event or behavior relating to the
individuals treatment which occurs during the provision
of service is documented within the note.
Status/progress toward treatment Goals
Service Provided was provided in excess of LOC-A
The title of curriculum being used associated with rehab
services only.
Additionally per service type
419.463 (b) (1) (A) The outcome of the individual's crisis;
12
419.456 b (1) (A)
If the service is a crisis - Medical necessity must be determined within 2 business
days after the provision of crisis services
419.463 (b) (2)
Medication Training & Support Services Applies to Children
For medication training and support services and skills training and development
services, the name of the primary caregiver or LAR to whom the service was
provided, if applicable;
419.459 (b) (3)
Medication Related/Psychosocial services must be provided by licensed medical
personnel ( Dr, PA, RN, LVN, pharmacist)
Psychosocial rehabilitative coordination services
419.463 (b) (3) (A)
A description of the coordination service provided;
419.463 (b) (3) (B)
If the service involves face-to-face or telephone contact, the person with whom the
contact was made; and
419.463 (b) (3) (C)
The outcome of the service.
NON REIMBURSABLE ACTIVITIES
419.453 (16)
419.465 (2) (B)
416.456 (1)
419.465 (2) (A-D)
A
B
C
D
If group service code, Adult group size must be more than 1 and less than 9
clients Children's groups 2 staff up to 6 kids
A Medicaid MH rehab service that is not auto's in accordance with 419.456
Service code used is upcoding
Service is a duplicate service
Service is provided in excess of amount auth'd
Department will not reimburse for more then:
2 hrs per day med training (2515,2516)
4 hrs per day psychosocial rehab (2919)
4 hrs per day rehab counseling/therapy (2921)
4 hrs per day skills train/dev (2923, 2924)
The cost of the following activities are included in the Medicaid MH
rehabilitative services reimbursement rate(s) and may not be directly billed by the
Medicaid provider:
419.465 (a) (2) (A)
Developing and revising the treatment plan and interventions that are appropriate
to an individual's needs (3403)
419.465 (a) (2) (B)
Staffing and team meetings to discuss the provision of Medicaid MH
rehabilitative services to a specific individual;
419.465 (a) (2) (C)
Monitoring and evaluating outcomes of interventions, including contacts with a
person other than the individual
419.465 (a) (2) (D)
Documenting the provision of Medicaid MH rehabilitative services (44)
419.465 (a) (2) (E)
A staff member traveling to and from a location to provide Medicaid MH
rehabilitative services (7)
419.465 (a) (2) (G)
Administering the uniform assessment (405,406)
13
419.465 (2) (B)
Services incidental to another service
If group service code, group size must be more than 1 and less than 9 clients
A Medicaid MH rehab service that is not auth'd in accordance with 419.4556
14
Claims & Billing
Gateway Portal User’s Manual
Using the Web Interface
1. Access to the website can only be granted by going through the MHMRTC IT
department. To obtain a user ID and password contact the MHMRTC Director of
Contracts Management/Provider Relations at 817.569.4456 or
providerrelations@mhmrtc.org
2. Finding the Website
Go to web address https://gateway.mhmrtc.org/
3. User Login
Enter your assigned user ID and password. Click on the “Log In” button.
15
4. If you have logged in incorrectly, it will display the message “Null
User” and refresh the page until you enter the correct username and
password. Please contact IT if you do not have the correct log in
information.
5. If you have logged in correctly, the following service entry screen will
display.
6. Understanding Data Entry Requirements
A grid of text fields is displayed to represent data for one encounter.
All fields are required unless otherwise specified.
a. Prov ID
 Enter the 4 character provider identifier assigned by
MHMR.
 If you logged in as a provider, this field will automatically
default to your ID. If you have two provider IDs, make
16
sure this matches the one you want to use. It can be
edited.
b. Service Date
 Enter the date of service.
 Formats accepted
o mm/dd/yy
o or mmddyy
o mm/dd/yyyy
 For example, a service date of October 5, 2005 can be
entered as 100505 or 10/05/05 or 10/05/2005.
c. Time In / Time Out
 Enter the start time for the service. Enter the end time
for the service.
 Formats accepted (Time In, Time Out displayed for threethirty pm to five pm example)
o
o
o
o

hh:mm (military)
hh.mm (military)
hh:mm AM/PM
hh.mm AM/PM
15:30, 17:00
15.30, 17.00
03:30 AM, 05:00 PM
03.30 AM, 05.00 PM
Note: Must use leading zeros where necessary when
using a decimal to replace colon.
d. Service Code
 Enter the code used to bill or report the service.
 It is the service code on the claim
 It is also located on the letter of authorization.
e. Diagnosis Code * (Required for MH providers only)
 Format is XXXXX or XXXXXX
 These are the standard DSM IV codes without the
decimal points.
f. Staff Id * (Required for MH providers only)
 Enter a unique staff id of the person who provided the
service.
g. License Type
 Enter the server type of the person who provided the
service.
 Format is a 2-digit code.
 Specific values are accepted based on the codes below.
 Please contact Pam Nash at 817-569-4436 for further
questions regarding which codes to use.
17
Code
01
03
05
07
09
11
13
16
17
19
21
23
25
27
29
31
33
35
37
39
43
44
45
47
49
50
51
52
53
98
Description
Physician
Psychologist/PhD.
APN/Prescript Authority Only
LMSW-ACP
LMFT
LMFT Temporary License
LPC
LMSW
Dietician
Occupational Therapist
Physical Therapist
Speech Therapist
Music Therapist
Cert Recreational Therapist
RN
LVN
Cert. Medication Aide
QMHP-CS
QMRP
Psychological Associate
CSSP
LCDC
Counselor in Training (C.I.T)
Dentist
Other Prof/NOT LPHA
Other
EIS-EL
EIS-FQ
Residential Staff
h. Location
 Enter the location where the service took place.
 Value must be one of the 2-character codes below.
Code
HM
OF
GH
JA
SC
SF
OT
SH
SR
CS
NF
Description
Home
Office/clinic
General Medical Hospital
Jail or juvenile detention center
School
Service facility, e.g. nursing home, detox center,
sheltered workshop
Other
State mental health facility
State mental retardation facility
Community Setting not otherwise described
Nursing Facility
18
CI
Community IMD
State funded community hospital, Lubbock, Houston,
and Galveston only.
CH
i. Client ID
 Enter the 9 digit MHMR client ID.
 Must have leading zeros if less than 9 digits.
j. Provider Client ID (optional)
 Provider may choose to enter their own client ID for
tracking services
 No specific format.
k. Encounter Type – Choose from the following codes that describe
the encounter (or intended encounter type if no-show). Defaults
to “F”, if not modified.
Code
F
E
T
Description
Face to face
Video telehealth or
telemedicine
Telephone
l. Appointment Type

Please choose from the following codes that describe the
nature of the appointment.
Code
1
2
3
4


Description
Scheduled appointment for
service kept
Unscheduled service
Scheduled appointment
canceled by provider
Consumer cancellation or no
show
If a no-show is reported, the service must be marked as
non-billable and the time in/out should be the same to
indicate zero client time.
Defaults to “1” if not modified.
m. Recipient Code

Choose from the following codes to indicate the recipient
(or intended recipient) of the service.
Code
1
Description
Consumer
19
2
3
U

Collateral
Consumer and family
member/LAR simultaneously
Unknown
Defaults to “1”, if not modified.
n. Billable Check Box
 Automatically defaults to billable.
 Uncheck this box, only if you want to report encounter
data that is not billable. No-shows are considered nonbillable.
6. After you enter the data for one claim, hit the “Done” button on
the right side of the screen. A grid will display below showing the
data that has been added to the batch.

The grid displays the duration calculated in hours for the Time In
and Time Out entered. Be sure to verify this is correct.
20

The data in the text-fields defaults to what the user entered
previously to reduce the amount of entry. Only changes need to
be made before submitting another service to the batch.

As services are added they are displayed in the grid for review
before submission.

The system will not allow a duplicate entry and will display an
error message in red at the top of the screen as follows.
Client ID, Date/Time, or Service Code must be different in each
line.
 The system also does some validation on the date and time
format where possible. Error messages will display in red to
address these issues. Please contact Steven Forrester of
Information Technology if assistance is needed interpreting the
error messages.
Claim Dollar Amount will be entered.
7. Editing/Deleting Data from the Batch Before Submission


Edits can be done within the grid during review before
submission.
To make an edit hit the “Edit” button on the left side of the
claim that needs to be updated. The fields become editable in
text fields as displayed below (in line 3 of the grid) and two
buttons appear to the left of the data. “Update” and
“Delete” buttons.
21

You can make the necessary changes and hit the “Update”
button. To delete the entire entry, hit the “Delete” button
and the grid will display an empty line to confirm there was a
deletion.
8. Submitting a Batch





Once you have entered the amount of claims/encounter data
that you choose to batch together, the data can be submitted
for validation.
Hit the “Submit” button in the top left corner of the page.
The grid will be cleared and you will receive a batch reference
code filename with a .xml extension. It will display at the top
of the page above the “Submit” button.
You must record this code in case there are any issues you
need to bring to the attention of IT. It is the way the batch is
tracked.
This reference code will also be used by you to check if any
errors were caught in the validation process before any claims
are processed.
22
9. Checking Errors
 In order to catch errors early in the process, the batch data
will be validated for errors so that they can be resubmitted
and processed in a timely manner before the claim gets
denied.
 Some of the error checks include:
o Valid client ID
o Valid provider ID
o Valid service code
o Valid location code
o Valid license type
o Gateway portal will also search for the correct
authorization number for billable services. This does
not have to be entered. If the authorization number is
not found and it is marked as billable, then that will also
generate an error. Fund source is also looked up for
billable services that have an authorization.
 Within a few seconds after you have submitted a batch, your
response file will be available.
 You must hit the “Check Responses” button located in the
upper left hand corner of the page. The number of responses
available is displayed under the button. You must refresh the
page in order for this number to be updated as you submit
any batches.
23

When you hit the “Check Responses” button, the following
screen will be displayed.


This will display a list of batches submitted under your log in.
Choose the one that matches the reference code displayed
after you submitted the batch.
The text area will display the response for the batch that you
choose.
You may also choose to print the response by hitting the
“Print Response” button.
If the batch had no errors you will receive the message:
Starting processing on file:
<path name to xml reference file name>
Finished processing
Successfully wrote to CMHC file <CMHC filename with date
stamp>
If the file contained errors the response will display an error
message with the data submitted that caused the error.
Errors need to be researched and resubmitted in another
batch. Good “claims” in the batch will go on to be processed.
They do not need to be resubmitted. The response should
also display a message with the CMHC filename and date
stamp to be processed with the claims that went through. If
there is a message stating no output was sent to CMHC or
there is no CMHC file name at the end of the response file,




24
then none of the claims submitted within the batch went
through. Please contact the MHMR IT Dept. if you believe it is
a mistake.
10.
Correcting Errors
 Once you have researched the errors, the data can be
resubmitted via the web page in another batch.
 Data in the first batch that was accepted will go on to be
processed.
11.
Processing Claims
 For MHMR staff, you will find the batch in MCO waiting to be
processed. The name of the file will match the CMHC file
name in the response file for the batch.
 You can run the Edit/Check claims process to find any claim
files that need to be processed.
Using the SFTP file transfer Method
1. In this method, providers are allowed to transfer a file to MHMR
instead of manually entering the data. The file must be in a specific
format.
2. File Format
The file format for the input file will be an XML document. The root element will be
<Services>. <Provider> will be the next element with ID as an attribute. All
billable/non-billable services are child elements within the Provider element. All
service details are attributes of the service element. See below for details.
XML Schema
<?xml version="1.0" encoding="UTF-8" ?>
<Services>
<Provider ID="">
<Service MHMRClientID="" ProviderClientID="" LocationCode=""
ServerType="" StaffID="" ServiceDate="" ServiceTime=""
ServiceDuration="" ServiceCode="" TotalAmountBilled=""
DiagnosisCode="" Billable="" AppointmentTypeCode=""
EncounterTypeCode="" RecipientCode="" ProgressNotes="" />
</Provider>
</Services>
Provider element
Supplies information related to a particular provider
Attributes
1. ID (4 chars)
Service element
Supplies information about each service
Attributes
25
1. MHMRClientID (9 chars) Insert leading zeros if <9 chars
2. ProviderClientID (10 chars max) (optional field)
3. LocationCode (state defined codes, must be one of the following)
Possible
Values
Descriptions
HM
Home
OF
Office/clinic
GH
General Medical Hospital
JA
Jail or juvenile detention center
SC
SF
School
Service facility, e.g. nursing home, detox center,
sheltered workshop
OT
Other
SH
SR
CS
NF
CI
State mental health facility
State mental retardation facility
Community Setting not otherwise described
Nursing Facility
Community IMD
State funded community hospital, Lubbock, Houston,
and Galveston only.
CH
4. ServerType
The CMHC license type codes will be used and converted to the state
codes by us.
Code
Description
01
Physician
03
Psychologist/PhD.
05
APN/Prescrip Authority Only
07
LMSW-ACP
09
LMFT
11
LMFT Temporary License
13
LPC
16
LMSW
17
Dietician
19
Occupational Therapist
21
Physical Therapist
23
Speech Therapist
25
Music Therapist
27
Cert Recreational Therapist
29
RN
31
LVN
33
Cert. Medication Aide
35
QMHP/QMHP-CS
37
QMRP
39
Psychological Associate
43
QMHP-P/CSSP
Para Prof/NOT QMHPP or
44
QMRPP
26
45
47
49
50
51
52
53
98
LCDC
Counselor in Training (C.I.T)
Dentist
Other Prof/NOT LPHA
Other
EIS-EL
EIS-FQ
Residential Staff
5. StaffID – provider’s staff ID
6. ServiceDate - mmddyyyy is format required
7. ServiceTime - hh:mm AM/PM is format required
8. ServiceDuration – hh:mm
9. ServiceCode (8 chars max)
10. TotalAmountBilled (dollar format with two decimal places ex. 5.00)
11. DiagnosisCode (6 digit numeric field without decimal. The diagnosis
code cannot be more than 6 characters.
12. Billable (The value can either be “True” or “False”)
Optional Fields
13. AppointmentTypeCode
Code
1
2
3
4
Description
Scheduled appointment for
service kept
Unscheduled service
Scheduled appointment
canceled by provider
Consumer cancellation or no
show
**Values 3 and 4 must have “00:00” for service duration field**
14. EncounterTypeCode
Code
F
E
T
Description
Face to face
Video telehealth or
telemedicine
Telephone
15. RecipientCode
Code
1
2
3
U
Description
Consumer
Collateral
Consumer and family
member/LAR simultaneously
Unknown
16. ProgressNotes – free text
27
Note:
Non-billable encounters must be reported in this file.
encounters all rules apply with the following requirements.
Billable = “False”
AmountBilled= “0.00”
For non-billable
3. Once the file is in the correct format and tests have been run for
verification, a file can be transferred.
4. To transfer the file




An SFTP client must be downloaded on the machine of the person
who will transfer the file. This is only done once.
The client is an executable file that can be sent to the provider via
email.
Open the SFTP client
Enter the assigned username and password
Enter “email.mhmrtc.org” for the host name without the quotes.

Hit the “Log In” button

A screen displays with file navigation on the left side and two
directories for the provider on the right side—an inbound and
outbound.

28

You can drag the xml input file from the left side into the
inbound directory on the right side.
Note: The xml file name is not restricted so a provider is allowed
to name it anything. Be sure to use a file naming convention
that is easy to track and ensures each file has a unique name so
that no files are overwritten.
29

The above message displays after a file is dropped into the
directory. Hit the “Copy” button to copy the file to the Inbound
directory.

The outbound directory is where you will find any error
responses for the file you transfer. It will be available within an
hour after transfer. Only service data for those that have errors
need to be resubmitted after corrections are made. Do not
resubmit the whole batch. Open the response file that matched
the name of the input file with the word “response” in front of it.
30

Please contact the MHMR IT department for help
understanding the error messages or for any questions.
in
Contact Information
MHMR of Tarrant County Help Desk
ITAutomated.Helpdesk@mhmrtc.org
817-569-4357
Appeal of Denial
If a claim is denied and Provider feels the claim should be paid, Provider must resubmit the
claim and appeal the decision within 30 days of denial. Appeals or resubmission after the 90-day
window for filing with Medicaid will not be paid. Appeals of claim denials must be made in
writing to:
Kevin McClean, Director of Contracts Management/Provider Relations
MHMR of Tarrant County
P.O. Box 2603
Fort Worth, Texas 76113
31
Reporting Requirements
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Critical Incidents
Providers are required to call (817) 335-3022 with information regarding the occurrence of
any of the following critical incidents immediately:
Deaths
Suicide Attempts
Serious Injuries – injuries which require medical care
Serious Medication Errors – the incorrect or wrongful administration of a medication (such as a
mistake in dosage, route of administration or intended individual), a failure to prescribe or
administer the correct drug, medication omission, failure to observe the correct time for
administration, or lack of awareness of adverse effects of drug combinations which place the
Covered Individual’s health at risk so that immediate medical intervention or enhanced
surveillance on behalf of the Covered Individual is required.
Adverse Drug Reaction (ADR) – those responses which are above and beyond the common
side effects usually encountered with each medication (unless they are extreme cases). They
are undesired and unintended, possibly harmful responses to a drug administered at a normal
dosage. Responses may include problems related to cumulative effects, tolerances, and
dependency for single-drug administered and drug-drug interactions or multiple drugs
administered. Reportable ADRs require some change in the clinician’s care of the client,
including the option of discontinuing the medication, modifying the dose, prolonging
hospitalization, or taking action to initiate supportive care.
Allegations of Homicide, Attempted Homicide, Threat of Homicide with a Plan
Confirmed Abuse, Neglect, or Exploitation
Discovered Pharmacy Errors – a pharmacy dispensing error including one or more of the
following:
a. Incorrect Label or Directions for Use
b. Failure To Place Warning Label on Container as appropriate
c. Incorrect Medication
d. Incorrect Strength
e. Incorrect Quantity
f. Expired Medication
g. Contraindicated Drug
Hospitalizations
911 Called
Physical Aggression
Auto Accident
Fire
DNR Order (Do Not Resuscitate)
Elopement (Missing Person)
Infectious Diseases
Criminal Activity
Litigation Threat
32
Reports
Provider will submit the information on the following forms. It is recommended that Provider
use the attached report forms provided by the Local Authority. At a minimum, the following
must be reported:
a. Discharges from services during the month (list of names).
b.Critical Incidents
c. Staff added, with credentialing status
d.Results of internal reviews of risk incidents, quality, and billing audits
e. Results of audits by any external licensing or accrediting bodies
f. New Generation Medication data
Provider will submit Report(s) in writing to:
MHMR of Tarrant County
Provider Relations
P.O. Box 2603
Fort Worth, Texas 76113
Information may also be submitted by fax to (817) 569-4491.
33
MHMRTC Report
FAX to Provider Relations at 817-569-4491
Provider: ________________________________
Data for the month of ___________
1. Staff added since last report:
Name
QMHP
LPHA
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2. Number of Covered Individuals with the following incidents:
________ Deaths
________ Suicide attempts/threat with a plan
________ Serious injuries
________ Serious medication errors -- Attach a written report for each
________ Adverse Drug reactions -- Attach a written report for each
________ Alleged homicides/attempted homicides/threat of homicide with a plan
________ Confirmed Abuse, neglect, exploitation
________ Discovered Pharmacy errors
________ Complaints -- Attach a description of each and indicate when and how resolved
3. Attach the results of any internal review of the above risk incidents and describe any action planned or
taken to reduce future occurrences.
4. Attach the results of any internal quality review of the services provided under this contract. Include any
action planned or taken to resolve identified areas of concern.
5. Attach the results of internal billing audits, showing number of records reviewed and percentage of
compliance with Medicaid documentation requirements. Note: Provider is expected to review at least 10%
of all records.
1.
Number of RN or LVN peer reviews conducted regarding services to Covered Individuals and
whether findings were reported to the licensing boards.
7. Attach a copy of or summary of findings from any external audit of Provider related to services provided
under this contract. Indicate any corrective action that is required of Provider from the external review.
8. Attach a list of enrollments and discharges from covered services during the month (list by name)
Report completed by:
_________________________ _________________________ ________________________
Printed name
Signature
Date completed/submitted
_________________________________
Provider Relations
_____________________________
Date received
MHMRTC
34
Adverse Drug reaction(s)/Clinical Follow-up Report
Provider: _______________________________ Prescribing Physician: ___________________________________
Covered Individual
Name: ________________________________________________ MHMRTC ID Number: _____________
Name of drug(s) involved: ___________________________________________________________
Date drug started: _________________________
Date adverse reaction noted: _______________
List all drugs prescribed at time of adverse reaction:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
__________________________________________________________
Description of adverse reaction:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________
Impressions/Clinical response to incident (actions taken):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________
_________________________________________
Provider signature/title
_______________________________________
Date submitted
_________________________________________
MHMRTC Provider Relations
_______________________________________
Date received
_________________________________________
MHMRTC Nursing Director
_______________________________________
Date reviewed
This report must be submitted to MHMRTC by the fifth working day of each month. Report may be faxed to
Provider Relations at (817) 569-4491.
35
MHMRTC
Serious Medication Error(s)/Clinical Follow-up Report
Provider: __________________________________ Prescribing physician: ______________________________
Covered Individual
Name: ________________________________________________ MHMRTC ID Number: _________________
Name of drug(s) involved: ________________________________________________________________
Date drug started: _________________________
Date adverse reaction noted: ___________________
Description of the error:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
________________________________________________________
Clinical response to incident (actions taken):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
________________________________________________________
Overall trends/patterns related to medication error(s) identified:
____________________________________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________
_________________________________________
Provider signature/title
_______________________________________
Date submitted
_________________________________________
MHMRTC Provider Relations
_______________________________________
Date received
_________________________________________
MHMRTC Nursing Director
_______________________________________
Date reviewed
This report must be submitted to MHMRTC by the fifth working day of each month.
Report may be faxed to Provider Relations at (817) 569-4491.
(Additional forms may be found in Attachment 1)
36
Staff Training
Overview
If Provider is licensed or accredited by a state or federal regulatory agency, some training requirements may
be waived. In such cases, the Provider is required to provide external audit reports related to accreditation,
licensure or certification. If Provider is not licensed or accredited, the Provider is required to provide
training to all staff working with Local Authority clients.
Training noted as such on the following training grid must be completed on-line except for 3 courses that
will be provided through the MHMRTC Training Center or obtained from another entity. Training obtained
from other entities must be related to the required job competencies as determined by the Texas
Administrative Code and the Texas Department of State Health Services. Providers may submit training
policies, procedures and materials to verify that training requirements are met. Providers may receive
assistance, upon request, from the Local Authority with regard to training. The Local Authority will charge
for training provided to Provider staff in the classroom.
Scheduling Training with MHMRTC
Provider is responsible for ensuring all staff receives the required training prior to contact with Local
Authority clients. Provider may register staff for classes by email to at least one week prior to class
scheduled to training.request@mhmrtc.org or calling 817-569-4342. When scheduling training please
provide a list of the names of those who will attend and which classes they will be attending. A
confirmation will be sent when class is scheduled, Provider will be billed for any persons registered for
classes who do not attend unless The Training Center receives a cancellation notice by fax at least twentyfour (24) hours prior to the scheduled class MHMRTC
Training
also offers several online courses through Essential
Learning.
Required Training Elements
Provider, its employees and agents who routinely perform
any job duty in proximity to persons served must
demonstrate competency in the safe management of
verbally and physically aggressive behavior before
contact with persons served and annually thereafter.
Provider, its employees and agents must demonstrate a
thorough understanding of the relevant elements of
reporting, investigating, and preventing abuse, neglect, and exploitation (Client Rights) before contact with
persons served and annually thereafter.
Provider, its employees and agents must receive, read, and understand the MHMRTC Compliance Plan.
Provider will agree to abide by the principles contained in the Compliance Plan, including its responsibility
to report any known or suspected violations of the Plan.
37
Per the Texas Administrative Code (TAC) Title 25, Part 1, Chapters 404, 412, 414, 419 and the Fidelity Toolkit
provided by the Texas Department of State Health Services, the following training is required for all staff who
provide rehabilitative and case management services to Local Authority consumers.
Description
All Employees (1 Time)
All Employees (1 Time)
All Employees (1 Time)
All Employees (1 Time)
All Employees (1 Time)
All Employees (Annual)
All Employees (Annual)
All Employees (Annual)
All Employees (Annual)
All Employees (Annual)
All Employees (Annual)
All Employees (Annual)
Client Rights (1 Time)
COPSD
CPR (2 years)
Defensive Driving (3
years)
MH Adult Rehab (1 Time)
MH Adult Rehab (1 Time)
MH Adult Rehab (1 Time)
MH Adult Rehab (1 Time)
CourseTitle
Computer
Access
Customer
Relations
Hazardous
Chemicals
New Employee
Orientation
OJT Checklist
Abuse
Client/Patient
Rights
Confidentiality
and HIPAA
Deficit
Reduction Act
Compliance
Environmental
Safety for
Individuals with
Developmental
Disabilities
Infection
Control Part 1
Sexual
Harassment
and Workplace
Harassment
Rights &
Abuse/Neglect
COPSD/Dual
Diagnosis
CPR/First
Aid/Seizures
Defensive
Driving
Adult
CM/Rehab
Privileging
Case
Management
Basics
Overview of
412I, MH Case
Management
Services
Overview of
419L, MH
Rehab
38
Location of Training available
MHMRTC training center
MHMRTC training center
MHMRTC online course through
Essential Learning
MHMRTC training center
On-job site
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC link computer based
MHMRTC training center
MHMRTC training center
MHMRTC training center
MHMRTC training center
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MH Adult Rehab (1 Time)
MH Adult Rehab (1 Time)
MH Adult Rehab
Specialty (3 years)
MH Adult Rehab
Specialty (3 years)
MH Adult Rehab
Specialty (3 years)
MH Contact (1 Time)
MH Contact (1 Time)
MH Contact (1 Time)
MH Contact (1 Time)
MH Contact Specialty (3
years)
MH Contact Specialty (3
years)
MH Contact Specialty (3
years)
MH Contact Specialty (3
years)
MH Contact Specialty (3
years)
MH Contact Specialty (3
years)
MH Contact Specialty (3
years)
MH Contact Specialty (3
years)
MH Employees (1 Time)
MH Employees (1 Time)
MH Employees (1 Time)
Services
Skills
Curriculum
Mental Health
Pharmacology/
SAM Checklist
Medicaid-Adult
MHMRTC training center
MHMRTC online course through
Essential Learning
MHMRTC training center
Patient/Family
Ed
TIMA/TRAG
Age-Specific
Care
Bipolar
Disorder
Overview of
Personality
Disorders
Understanding
Schizophrenia
Documenting
the Treatment
Planning
Process
Intentional Peer
Support: About
Peer Support
Medication
Management
for Individuals
with
Developmental
Disabilities Part 1
Motivational
Interviewing
Overview of
412G MH
Community
Standards
Overview of
Psychopharma
cology
Overview of
Suicide
Prevention
Psychosocial
Rehabilitation
and Recovery
MHMRTC
Service Activity
Logs--The
Basics
Rights &
Abuse/Neglect
Unit Specific
39
MHMRTC training center
MHMRTC training center
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MHMRTC training center
MH Employees (3 years)
MH Employees (3 years)
SAL Code
Accessing
Local and
HHSC Benefits
& Supports
Bioterrorism
MHMRTC online course through
Essential Learning
MHMRTC online course through
Essential Learning
MH Employees (3 years)
Communicating
with People
who have
MHMRTC online course through
Disabilities
Essential Learning
MH Employees (3 years)
Crisis
MHMRTC online course through
Management
Essential Learning
MH Employees (3 years)
Cultural Issues
in Mental
Health
MHMRTC online course through
Treatment
Essential Learning
MH Employees (3 years)
Guidelines for
MHMRTC online course through
Documentation
Essential Learning
MH Employees (3 years)
Infection
MHMRTC online course through
Control Part 2
Essential Learning
MH Employees (3 years)
Overview of
Severe
Persistent
MHMRTC online course through
Mental Illness
Essential Learning
MH Employees (3 years)
Recovery and
Severe
Persistent
MHMRTC online course through
Mental Illness
Essential Learning
MH Employees (3 years)
Resilience and
MHMRTC online course through
SPMI
Essential Learning
SAMA Protection
SAMA
Assisting
MHMRTC Training Center
SAMA Protection
SAMA
Protection
MHMRTC Training Center
While all training is offered through the MHMRTC Training Center, Providers may take many of the required courses
elsewhere. If the Provider elects to complete the training elsewhere, the Provider is responsible for the following:
A) Ensuring the training meets the requirements set forth in the TAC codes
B) Keeping a record of the training for each individual staff including but not limited to
1) The date of the training
2) The name and credentials of the person who provided the training
3) A roster of persons who attended the training
4) Materials that describe the content of the training
5) A certificate of course completion and an attestation of competency in course materials
*MHMRTC Contract Monitoring department may request training records at any time for any staff to verify compliance with
the Provider’s contract.
Credentialing and Clinical Supervision
All staff must complete credentialing process.
LPHA and QMHP staff may not provide professional services until credentialed.
Provider Qualifications
All service providers must have a high school education (or GED), be 18 years of age, and not have been
convicted of a crime relevant to a person’s duties including any sexual offense, drug-related offense,
homicide, theft, assault, battery, or any crime involving personal injury or threat to another person. Provider
40
is required to provide external audit reports, if any, related to accreditation, licensure or certification.
Programs must meet the requirements of those licenses, certifications or accreditations with regard to
medication storage, handling, administration and documentation. Providers holding professional licenses
and/or certifications must maintain those licenses and/or certifications in good standing with their respective
licensing/certifying bodies.
Credentialing
LPHA -- Provider must submit an Application for Credentialing as MHMRTC Outpatient Provider
form on each LPHA person. Local Authority will then credential these individuals.
Licensed Practitioner of the Healing Arts (LPHA). An individual who is:
a. a physician (M.D. or D.O.) licensed to practice medicine in Texas;
b.a licensed or certified doctoral-level psychologist as defined in Texas Civil Statues §4495b;
c. a licensed clinical social worker (LCSW)--as defined in the Human Resources Code, Chapter 50;
or
d.a licensed professional counselor (LPC) as defined in Texas Civil Statues §4512g
e. a licensed Advanced Practice Nurse (APN) as defined in Title 22 TAC, Part II, Chapter 219; or
f. a licensed marriage and family therapist (LMFT) as defined in Title 22 TAC, Chapter 801.
QMHP - As there is no certification or credentialing process for QMHPs outside the MHMR
system, Local Authority will credential all Provider staff at the QMHP level. Provider will submit
an Application for Certification as MHMRTC QMHP and original college transcripts for persons
wishing to serve as QMHPs to Local Authority as part of the credentialing process.
QMHP-CS or qualified mental health professional-community services--A staff member who is
credentialed as a QMHP-CS who has demonstrated and documented competency in the work to be
performed and:
(A) has a bachelor's degree from an accredited college or university with a minimum number of
hours that is equivalent to a major (as determined by the LMHA or MCO in accordance with
§412.316(d) of this title (relating to Competency and Credentialing)) in psychology, social work,
medicine, nursing, rehabilitation, counseling, sociology, human growth and development, physician
assistant, gerontology, special education, educational psychology, early childhood education, or
early childhood intervention;
(B) is a registered nurse; or
(C) completes an alternative credentialing process identified by the department.
CSSP or community services specialist--A staff member who, as of August 31, 2004:
(A) received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in accordance with the law of the issuing state;
(B) had three continuous years of documented full-time experience in the provision of mental
health rehabilitative services or case management services; and
(C) demonstrated competency in the provision and documentation of mental health rehabilitative
or case management services in accordance with Chapter 419, Subchapter L of this title (relating to
Mental Health Rehabilitative Services) and Chapter 412, Subchapter I of this title (relating to
Mental Health Case Management Services).
41
Clinical Supervision
Provider is responsible for ensuring all Provider staff receive appropriate and needed clinical
supervision. The requirements shown below are minimum requirements. It is expected that a staff
needing additional supervision would receive it as necessary to ensure the quality of the services
provided. Supervision meetings, training and chart reviews must be documented and available for
review.
(a) Clinical supervision for the QMHP, CSSP, FP or PP must be accomplished by an LPHA or a
QMHP-CS as follows:
(b) Clinical Supervision Requirement Summary:
Supervision: 12 hours per year for each QMHP/CSSP, PP and FP; 4 of which must be one-on-one.
The remaining 8 hours may be provided in a group format.
Additional 12 hours per year for each PP and FP of in vivo observation.
Training: Clinical supervisor participation; 4 hours/year, at least 1 hour in area of professional
ethics and therapeutic boundaries.
Clinical Chart review: 4 chart reviews per year (1 per quarter):
First chart review must be submitted to the Credentialing Department within 90 days of
QMHP/CSSP, PP or FP being hired.
Subsequent chart reviews must be submitted to the Credentialing Department on a quarterly basis.
(a) Licensed staff member supervision. All licensed staff members must be supervised in
accordance with their practice act and applicable rules.
(b) QMHP-CS supervision. A QMHP-CS's designated clinical duties must be clinically supervised
by: (1) a QMHP-CS; or (2) an LPHA if the QMHP-CS is clinically supervising the provision of
mental health community services.
(c) CSSP supervision. A CSSP's designated clinical duties must be clinically supervised by a
QMHP-CS. The CSSP must have access to clinical consultation with an LPHA when necessary.
(d) Family partner supervision. A family partner is supervised by the mental health children's
director, clinic director, case management supervisor, or wraparound supervisor.
(e) Peer provider supervision. A peer provider's designated clinical duties must be clinically
supervised by an LPHA.
(f) Peer review. The LMHA, MCO, and provider must implement a peer review process for
licensed staff members that:
(1) promotes sound clinical practice;
(2) promotes professional growth; and
(3) complies with applicable state laws (e.g., Medical Practice Act, Nursing Practice Act,
Vocational Nurse Act) and rules.
(g) Documentation. All clinical supervision must be documented using the forms included with the
QMHP application.
42
Medications
Each Covered Individual’s medications (both prescription and over the counter) must be stored
separately from other Covered Individuals’ medications. Medications for internal use must be
stored separately from those intended for external use. A locked storage container must be
available for medication storage and if a medication requires refrigeration, it must be separated
from food in a clearly labeled, designated locked container. Avoid storing medication in locations
with extreme heat, cold, or moisture. Prescription medications must be in the original container,
labeled with the individual’s name, date, instructions, name of medication, dosage, and physician’s
name.
Programs which are licensed must meet the requirements of those licenses with regard to
medication storage, handling, administration and documentation.
For programs which are not licensed, medications may be administered only by persons licensed
under state law to administer medication or in accordance with rules of the Board of Nurse
Examiners that permit delegation of the administration of medication to unlicensed care givers.
Programs which are not licensed but which supervise Covered Individuals who self-administer must
minimally have staff trained in MHMRTC’s Supervising the Self-Administration of Medication
classes, or equivalent, and provide on site verification of staff competency, by RN, Physician or
pharmacist. Provider retains liability for handling, storage, and documentation of medications in its
possession. It is recommended that Provider have a Consulting RN who performs medication
counts (to verify accurate self-administration), verifies physician orders and verifies staff
competency with regard to self-administration and documentation.
In all training programs in which medications are administered or in which self-administration is
supervised, a copy of the physician’s orders for all current medications must be kept in the Covered
Individual’s record on site.
Provider agrees to supply to the LMHA details of any New Generation medication
prescriptions in order to track data for DSHS contractual requirements.
43
LA Quality Management/Contract Monitoring
Medicaid Billing Audits
Local Authority’s Billing Department will conduct quarterly billing audits of claims from the Provider.
These audits will focus on the Provider’s compliance with Medicaid required documentation and record
keeping. Providers are required to meet 100% compliance with the standards. Since audits will occur after
Provider has billed Local Authority and been paid for services, any findings that services were not provided
or documented within Medicaid Guidelines will result in recoupment for payment of such services from
Provider by Local Authority who will return the funds to Medicaid. The Local Authority contact person
for Medicaid Billing Department is
Dave Farrell, Director of Client Accounting, 817 569- 4396 (See Attachment 2).
Contract Monitoring






Local Authority’s Quality Management Department will conduct a variety of reviews, including but not
limited to:
Site Assessments, Infection Control, Safety, and Environmental Reviews
Clinically focused chart and program reviews
Verification of required staff training
Verification of credentialing of staff
Verification of documentation of clinical supervision
Special reviews based on complaints or other client related incidents
The Local Authority contact person for Quality Management Reviews is:
Tim Wells, MH Quality Management Manager,
(817) 569-4458
44
Provider Quality Management
Trends and Patterns
Provider is required to have a mechanism or system in place to monitor the quality of the services provided.
This includes a clinical review of records (separate from Clinical Supervision by an LPHA or QMHP) to
determine any patterns or trends, implement corrective action or training and monitor for correction. Reports
including this information must be provided to Local Authority at least quarterly.
External Survey Reports
If Provider is certified, accredited or licensed by any external agency (such as JCAHO), any findings from
that external agency, relevant to the quality of services provided under this contract must be reported to
Local Authority. Provider should send a copy or summary of the external report to Local Authority with
documentation of corrective action required.
Billing Audits
Provider is required to audit minimally 10% of all claims submitted for payment prior to billing Local
Authority. The following elements must be included in the audits:
1. Treatment Plan with goals and objectives for the client which must conform to the standards of
the Mental Health Community Services Standards, Texas Administrative Code 412 G, section 412.322
Content and timeframe of treatment plan. Each provider must develop a written treatment plan, in
consultation with the individual and their LAR (if applicable), within 10 business days after the date of
receipt of notification from the department or its designee that the individual is eligible and has been
authorized for routine care services. At minimum, a staff member credentialed as a QMHP-CS is
responsible for completing and signing the treatment plan. The treatment plan must reflect input from each
of the disciplines of treatment to be provided to the individual based upon the assessment.















2. Progress notes will conform to the following:
(1) the name of the individual to whom the service was provided, including the LAR or primary caregiver, if
applicable;
(2) the type of service provided;
(3) the date the service was provided;
(4) the begin and end time of the service;
(5) the location where the service was provided;
(6) a summary of the activities that occurred;
(7) the modality of the service provision (e.g., individual, group);
(8) the method of service provision (e.g., face-to-face, phone, telemedicine);
(9) the training methods used, if applicable (e.g., instructions, modeling, role play, feedback, repetition);
(10) the title of the curriculum being used, if applicable;
(11) the treatment plan objective(s) that was the focus of the service;
(12) the progress or lack of progress in achieving treatment plan goals;
(13) the signature of the staff member providing the service and a notation as to whether the staff member is
an LPHA, a QMHP-CS, a pharmacist, a CSSP, an LVN, a peer provider or otherwise credentialed, as
required for that service; and
(14) any pertinent event or behavior relating to the individual's treatment which occurs during the provision
of the service.
In addition, a Medicaid members ID must be on all Medicaid billable progress notes.
Results of audits must be provided to Local Authority.
45
Provider Profile
MHMR of Tarrant County will collect and maintain information about each Provider’s
performance. Such information is reviewed by the Quality Management Committee, the MH
Community Advisory Committee, and the Network Advisory Committee and will include, but is
not limited to:








Number of individuals referred for services
Number of individuals declined
Numbers of individuals currently in services
Number of confirmed abuse, neglect, or exploitation
events
Number of consumer complaints and percentage
resolved in thirty (30) days
Number of critical incidents (medication errors,
serious injuries, etc.)
Consumer satisfaction rating
Percentage compliance with documentation,
Medicaid billing standards, TDMHMR standards
outcomes, and health/safety standards
Provider profile information may be made available to Covered Individuals seeking services to
assist them in choosing a provider.
46
Complaints
Complaints from Covered Individuals
Provider must inform Covered Individuals that they may file a complaint with MHMRTC regarding
the Provider by calling:
(817) 569-4429
or
1-888-636-6344
MHMR of Tarrant County will provide notepads to Provider containing this information.
Covered Individuals may also call MHMR of Tarrant County with suspicions of rights violations,
abuse, neglect or exploitation at (817) 569-4429.
Covered Individuals may also call the Texas Department of Family and Protective Services Hotline
at 1-800-252-5400 or www.txabusehotline.org.
Complaints from Provider
MHMR of Tarrant County desires a successful partnership with Provider to best serve the Covered
Individuals. To this end, MHMRTC encourages Provider to call with concerns, problems and
complaints regarding MHMRTC’s operations and interactions with Provider. Complaints should be
directed to the Director of Contracts Management/Provider Relations at (817) 569-4456. Every
effort will be made to address the issues involved.
47
Sanctions, Appeals and Contract Termination
MHMR of Tarrant County will take punitive action for actions that pose a hazard to Covered Individuals or
potentially violate Service guidelines.
Sanctions
a.
b.
c.
d.
e.
f.
MHMR of Tarrant County will impose sanctions if Provider does not maintain quality services in
compliance with state and federal standards. Decisions regarding sanctions are reviewed by the Quality
Management Committee. Notice of Default or Notice of Termination will be sent by certified mail to the
Provider. Sanctions may include, but are not limited to:
Immediate termination of contract
Withholding of new referrals
Withholding of outstanding payments, in whole or in part
Request for recoupment of funds paid to Provider for services
Fines, charge backs or offsets against future payments
Suspension of contract and referral of existing Covered Individuals elsewhere, pending appeal
Appeal Process
If Provider wishes to appeal a decision by MHMR of Tarrant County to impose a sanction, Provider must
notify the Director of Contracts Management/Provider Relations in writing within seven (7) days of receipt
of a Notice of Default or Notice of Termination of the request for appeal. If Provider has additional
information, not taken into consideration at the time the Sanction was imposed, documentation must be
submitted with the request for appeal. Correspondence must be sent to:
Kevin McClean, Director of Contracts Management/Provider Relations
MHMR of Tarrant County
P.O. Box 2603
Fort Worth, Texas 76113
Appeals of Sanctions will be reviewed by the Network Advisory Committee. Provider may be present at the
meeting at which the appeal is discussed.
Contract Termination
If the contract is terminated, Provider is expected to cooperate with MHMRTC in the transfer of Covered
Individuals to other providers.
48
References
Texas Administrative Code:
Rules of the Texas Department of Mental Health and Mental Retardation Title 25, Part II
........................................................... Relevant Rules Grid
........................................................... Chapter 404, Subchapter E………….Rights of Persons Receiving
Mental Health Services
........................................................... Chapter 414, Subchapter A Client-Identifying Information
........................................................... Chapter 403, Subchapter B Charges for Community-Based
Services
Chapter 405, Subchapter K ............... Deaths of Persons Served by TDMHMR Facilities or Community
Mental Health and Mental Retardation Centers (rev.6/95)
Chapter 414, Subchapter L ................ Abuse, Neglect, and Exploitation in Local Authorities and
Community Centers
Chapter 411, Subchapter G ............... Community MHMR Centers
Chapter 412, Subchapter C………….Charges for Community Services
Chapter 412, Subchapter G ............... Mental Health Community Services Standards
Chapter 412, Subchapter I…… ….…Mental Health Case Management Services
Chapter 414, Subchapter K ............... Criminal History Clearances
Chapter 419, Subchapter L………….Medicaid Rehabilitative Services
49
ATTACHMENT 1
ADDITIONAL FORMS
NEW GEN MED
TRACKING FORM 050710.pdf
CLIENT NAME
UPDATE FORM.pdf
......
CLIENT ADDRESS
UPDATE FORM.pdf
CLIENT
REGISTRATION FORM.pdf
50
CLIENT DIAGNOSTIC
TRACKING FORM.pdf
MH ADULT UNIFORM
ASSMENT FOR RDM.pdf
ATTACHMENT 2
MEDICAID AUDIT CRITERION FOR REHABILITATION
AND CARD SERVICES
ITEM
A
Other
1
2
3
Com Stand
412.322(b)
Rehab
Rule
419.455
1 ( c)
1.4.10
Medicaid
Provider
Manual
1.4.10
Medicaid
Provider
Manual
412.322 (a)
(2) 412.322 (d)
(1)(A)
2
3
4
419.456
a 1 (A)
419.456,
419.465
(b) (2)
(B)
1.4.10
Medicaid
Provider
Manual
1.4.10
Medicaid
Provider
Manual
C
3
UNIFORM ASSESSMENT FOR RESILIENCY & DISEASE
MANAGEMENT
Adult & Children
Obtain authorization from the department (DSHS) (doc in CMHC or
WebCARE)
Pending
Review
23502499
Refund
2500-2900
2500
1015
1020
1025
2324
Services delivered must be within service package authorized.
2525
2540
Record documentation must be legible to others (other than author)
1060
Record must have Medicaid # and client's name on each page of significant
documents, effective 11/1/99
1065
Medical Necessity
1
2
Client is an adult with severe and persistent mental illness or a child or
adolescent with a serious emotional disturbance. MI documented covering the
time services were rendered.
Record documentation must be legible to others (other than author)
Record must have Medicaid # and client's name on each page of significant
documents, effective 11/1/99
B
1
DIAGNOSIS
Trainin
g Issue
10002310
1000
412.322 (c )(2)
419.455
(2)
419.453
(30)
1.4.10
Medicaid
Provider
Manual
1.4.10
Medicaid
Provider
Manual
D
Determination that there is a medical necessity for Medicaid MH rehabilitative
services for the individual has been made by an LPHA. Medical necessity-evidenced by LPHA signature on the DMN form E-019 or the LOC-A printed
from WebCARE.
Record documentation must be legible to others (other than author)
1170
Record must have Medicaid # and client's name on each page of significant
documents, effective 11/1/99
1180
2270
2570
2320
2620
1175
TREATMENT PLAN
1
412.322( e )
419.456
a (2)
2
3
4
5
6
412.322( e )(1)
412.322 (e) (1) (A)-(G)
412.322 (e) (1) (A)
412.322 (e) (1) (B)
412.322 (e) (1) (C)
7
8
9
10
11
412.322 (e) (1) (D)
412.322 (e) (1) (E
412.322 (e) (1) (F)
412.322 (e) (1) (G)
412.32 419.465 (a) (3)
2 (e)
(A)
(1)
Treatment plan (Present) developed within 10 day after authorization is
1220
obtained (TP signed within 10 days of LOC-A)
At a minimum a staff member credentialed as a QMHP-CS must complete and sign the plan
Description of A, B, C, D, E, F, G complete
1235
A description of the presenting problem section A
1235
A description of the individuals strengths C
1235
A description of the individuals needs arising from the mental illness section
1235
B/ E related needs
A description of the /physical health issue/COPSD section G and F
1235
A description of the expected outcomes
1235
An expected date for recovery goals to be achieved
1235
List of resources for recovery ( last section of plan after signatures or brochure)
1235
List of types of services (services to be delivered must be checked or written
1245
out code or name of service)
51
2625
2344
2645
12
(H)
412.322 (e) (1) (H)(i)
13
412.322 (e) (1) (H)(ii)
14
15
412.322 (e) (1) (H)(iii)
412.322 (e) (2) (A)
16
412.322 (e) (2) (B)
17
18
19
20
412.322 (e) (2) (C )
412.322 (e) (2)(D)
412.322 (e) (2)(E)
412.322 (e) (2) (A)
21
22
23
24
25
412.322 (e) (2) (B)
412.322 (e) (2) (C )
412.322 (e) (2)(D)
412.322 (e) (2)(E)
412.322 (e) (3)
26
412.322 (f) (1) (A)
27
28
412.322 (f) (1) (B)
412.322 (f) (1) (C)
29
412.32
2 (f)
(1)
(D)
30
31
E
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
419.456 (d) (1)
(A)
1.4.10
Medicaid
Provider
Manual
1.4.10
Medicaid
Provider
Manual
412.32
6 (2)
412.32
6 (9)
412.32
6 (8)
412.32
6(13)
412.32
6(13)
412.32
6 (6)
412.32
6 (7)
1250
Record documentation must be legible to others (other than author)
1345
Record must have Medicaid # and client's name on each page of significant
documents, effective 11/1/99
1350
1255
1260
1265
1270
1275
1280
1285
1290
1300
1305
1310
1315
1320
1325
1330
1335
2530
2730
1340
PROGRESS NOTES MUST INCLUDE:
Progress note present
2045
2345
2645
419.463 a (1)
Client's name/ recipient
2050
2350
2650
419.463 (a) (4)
Service date
2055
2355
2655
419.463 (a) (5)
Duration (Stop/Start Time)
2060
2360
2660
419.463 (a) (6)
Location/Setting
2065
2365
2665
419.465 (I)
419.463 a (2)
Client present and awake
Type of service provided is supported by sac used
2070
2075
2370
2375
2670
2675
419.463 (a) (3)
2080
2380
2680
419.465 (a) (1)
The specific skill trained on and method used to provide the training is
documented
Service is face to face to individual or primary care giver of child adolescent
2085
2385
2685
419.463 (a) (7)
Provider signature and date
2090
2390
2690
419.463 (a) (7)
Credentials of provider
2095
2395
2695
A summary of the activities that occurred;
2100
2400
2700
The modality of service provision (i.e. one-to-one or group);
2105
2405
2705
The treatment plan goal's that was the focus of the service; and
The treatment plan objective's that was the focus of the service listed on note or
2110
2111
2410
2710
1.4.10
Medicaid
Provider
Manual
412.32
6 (1)
412.32
6 (3)
412.32
6 (4)
412.32
6 (5)
List of strategies to be implemented by staff to achieve goals (Strategy
statement listed)
The frequency, number of units, and duration of each service to be provided is
present.
The credentials of staff providing the service are present.
Goals address individual s needs, preferences, experiences, and cultural
background.
Goals must address the individuals COPSD issue and or physical health
disorder.
Goals are expressed in overt, observable actions of the individual.
Goals must be objective and measurable - using quantifiable criteria.
Goals reflect individual autonomy, self direction, and desired outcomes.
Objectives address individuals needs, preferences, experiences, and cultural
background.
Objectives address the individuals COPSD issue or physical health disorder.
Objectives are expressed in overt, observable actions of the individual.
Objectives are objective and measurable using quantifiable criteria.
Objectives reflect individual autonomy, self direction, and desired outcomes.
Copy of plan provided to the individual or explanation of reason why copy is
not given.
REVIEW
Review plan prior to requesting authorization for the continuation of services.
3403 documented before 475/473
Review plan in its entirety, at least every 90 days.
Determine if the plan is addressing needs of individual. Narrative comments by
staff and client.
Document progress on all goals and objectives and any recommendation for
continuing services, change for services, discharge from services. Check box's
marked.
419.463 (b) (4)
(A)
419.463 (b) (4)
(B)
419.463 (b) (4) ©
412.326 (11)
52
16
412.326 (14)
17
412.32
6 (120
18
19
20
21
419.463 (b) (4)
(D) 419.315 (d)
419.456 (a) (1)
412.326 (10)
Agency
Additionally
1
2
419.463 (b) (1)
(A)
419.456 b (1) (A)
3
419.463 (b) (2)
4
419.459 (b) (3)
5
419.463 (b) (3)
(A)
419.463 (b) (3)
(B)
419.463 (b) (3)
(C)
6
7
8
419.453 (16)
9
10
11
12
419.465 (2) (B)
14
15
16
17
18
19
20
21
22
23
25
26
27
28
29
416.456 (1)
419.465 (2) (A-D)
A
B
C
D
419.465 (a) (2)
(A)
419.465 (a) (2)
(B)
419.465 (a) (2)
(C)
419.465 (a) (2)
(D)
419.465 (a) (2)
(E)
419.465 (a) (2)
(G)
419.465 (2) (B)
1.4.10 Medicaid Provider Manual
1.4.10 Medicaid Provider Manual
written out.
Any pertinent event or behavior relating to the individuals treatment which
occurs during the provision of service is documented within the note.
Status/progress toward treatment Goals
2112
2115
2415
2715
2116
2117
2119
2125
2416
2716
2419
2719
2130
2425
2725
If the service is a crisis - Medical necessity must be determined within 2 business days after the
provision of crisis services
Medication Training & Support Services Applies to Children 2916
For medication training and support services and skills training and
2135
2435
development services, the name of the primary caregiver or LAR to whom the
service was provided, if applicable;
Medication Related/Psychosocial services must be provided by licensed
2140
2440
medical personnel ( Dr, PA, RN, LVN, pharmacist)
Psychosocial rehabilitative coordination services Adult 2919
A description of the coordination service provided;
2145
2445
2730
If the service involves face-to-face or telephone contact, the person with
whom the contact was made; and
The outcome of the service.
Service Provided was provided in excess of LOC-A
The title of curriculum being used associated with rehab services only.
Services are rounded off to 15 minutes
Incorrect project code used/does not match srv described
Additional Requirements by service type
Crisis Services Adults 2913 Child 2914
The outcome of the individual's crisis;
2735
2740
2745
2150
2450
2750
2155
2455
2755
Non reimbursable activity
If group service code, Adult group size must be more than 1 and less than 9 clients Children's groups 2
2760
staff up to 6 kids
A Medicaid MH rehab service that is not auto's in accordance with 419.456
2770
Service code used is upcoding
2775
Service is a duplicate service
2780
Service is provided in excess of amount auth'd
2782
Department will not reimburse for more then:
2 hrs per day med training (2515,2516)
2785
4 hrs per day psychosocial rehab (2919)
2790
4 hrs per day rehab counseling/therapy (2921)
2795
4 hrs per day skills train/dev (2923, 2924)
2800
The cost of the following activities are included in the Medicaid MH rehabilitative services reimbursement rate(s) and may
not be directly billed by the Medicaid provider:
Developing and revising the treatment plan and interventions that are appropriate to an individual's
2805
needs (3403)
Staffing and team meetings to discuss the provision of Medicaid MH rehabilitative services to a specific
2810
individual;
Monitoring and evaluating outcomes of interventions, including contacts with a person other than the
2815
individual
Documenting the provision of Medicaid MH rehabilitative services (44)
2820
A staff member traveling to and from a location to provide Medicaid MH rehabilitative services (7)
2825
Administering the uniform assessment (405,406)
2830
Services incidental to another service (project codes 11,12,16, 26)
If group service code, group size must be more than 1 and less than 9 clients
A Medicaid MH rehab service that is not auth'd in accordance with 419.4556
Record documentation must be legible to others (other than author)
Record must have Medicaid # and client's name on each page of significant
documents, effective 11/1/99
2835
2840
2850
53
2305
2310