1 MEDICAID MENTAL MEDICAID MENTAL HEALTH HEALTH RULE 132 RULE 132 TRAINING TRAINING Transitions of Western Illinois Transitions of Western Illinois Last Revision 09/2009 Last Revision 09/2009 MODULE 1 MODULE 1 RULE 132 OVERVIEW RULE 132 OVERVIEW WHAT WE WILL COVER WHAT WE WILL COVER Understand purpose and vision of Rule Understand purpose and vision of Rule 132 132 Understand Rule 132 requirements for Understand Rule 132 requirements for Service Documentation Service Documentation Staff Qualifications Staff Qualifications Eligibility Eligibility Establishing Medical Necessity Establishing Medical Necessity
Understand purpose and vision of RuleUnderstand purpose and vision of Rule132132
Understand Rule 132 requirements forUnderstand Rule 132 requirements for Service DocumentationService Documentation Staff QualificationsStaff Qualifications EligibilityEligibility Establishing Medical NecessityEstablishing Medical Necessity
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WHY IS THIS IMPORTANT?WHY IS THIS IMPORTANT?
In your role at Transitions, you will be responsibleIn your role at Transitions, you will be responsiblefor:for:
Following Rule 132 standards when documenting servicesFollowing Rule 132 standards when documenting servicesyou deliver.you deliver.
Knowing how to connect clients to services available underKnowing how to connect clients to services available underthe rulethe rule
Making sure your work would pass an audit which isMaking sure your work would pass an audit which isconducted regularly to make sure we’re following the rule.conducted regularly to make sure we’re following the rule.
What is Rule 132?What is Rule 132?
Rule 132 Medicaid Community MentalRule 132 Medicaid Community MentalHealth Services ProgramHealth Services Program of Title 59of Title 59Illinois Administrative CodeIllinois Administrative Code
It spells out state rulesIt spells out state rules for how publiclyfor how publiclyfunded community mental healthfunded community mental healthservices should be delivered.services should be delivered.
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What is Rule 132?What is Rule 132? For TWI, it covers services funded by:For TWI, it covers services funded by:
Department of Human Services – Division of Mental Healthwhich funds TWI’swhich funds TWI’s OutpatientOutpatient Day Treatment (Visions)Day Treatment (Visions) Case Management Support (CSS)Case Management Support (CSS) Residential (Villa)Residential (Villa)
Department of Children and Family ServicesDepartment of Children and Family Services DCFS Counseling ContractDCFS Counseling Contract
Department of Healthcare and Family ServicesDepartment of Healthcare and Family Services Children’ Crisis Services (SASS)Children’ Crisis Services (SASS)
What is Rule 132?What is Rule 132?
Services funded under Rule 132 areServices funded under Rule 132 arealways the “payer of last resort”always the “payer of last resort”
We must bill all insurance a client mightWe must bill all insurance a client mighthave BEFORE we can bill under Rule 132.have BEFORE we can bill under Rule 132.
Clients who have insurance must use it.Clients who have insurance must use it.
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What is Rule 132?What is Rule 132? Part ofPart of MMedicaidedicaid RRehabilitativeehabilitative OOptionption
(MRO)(MRO) Assumes most services will be delivered inAssumes most services will be delivered in
community settings (not in the clinic).community settings (not in the clinic).
Covers broader range of case management andCovers broader range of case management andcommunity support services.community support services.
The good news about rehab services is that itThe good news about rehab services is that itsupports best practices.supports best practices. Case management billableCase management billable Phone and collateral contacts often billablePhone and collateral contacts often billable Includes skills trainingIncludes skills training
RecoveryRecovery refers to the process in whichrefers to the process in whichpersons are able to live, work, learn, andpersons are able to live, work, learn, andparticipate fully in their communities.participate fully in their communities.
For some individuals, recoveryFor some individuals, recovery is the ability tois the ability tolive a fulfilling and productive life despite alive a fulfilling and productive life despite adisabilitydisability..
For others, recovery implies the reduction orFor others, recovery implies the reduction orcomplete remission of symptoms.complete remission of symptoms.
ResilienceResilience refers to personal andrefers to personal andcommunity qualities that:community qualities that: enable us to rebound from adversity, trauma,enable us to rebound from adversity, trauma,
tragedy, threats, or other stressestragedy, threats, or other stresses enable us to go on with life with a sense ofenable us to go on with life with a sense of
mastery, competence, and hope.mastery, competence, and hope.
Rehabilitation Services are designed to improveRehabilitation Services are designed to improvefunctioningfunctioning, by:, by:
reducing the adverse impact of the mentalreducing the adverse impact of the mentalillness on functioning, andillness on functioning, and
restoring the individual to his/her bestrestoring the individual to his/her best priorpriorfunctional level for adults (lots of disagreementfunctional level for adults (lots of disagreementabout this) orabout this) or
age appropriate level for children/adolescents.age appropriate level for children/adolescents.
Rule 132 requires specific documentation forRule 132 requires specific documentation forreported servicesreported services Varies by serviceVaries by service Will discuss these as we review each service in laterWill discuss these as we review each service in later
modulesmodules
All Rule 132 service documentation (andAll Rule 132 service documentation (andpayments) are subject to:payments) are subject to: Annual State AuditsAnnual State Audits Potential Federal audits from Centers for MedicaidPotential Federal audits from Centers for Medicaid
and Medicare Services.and Medicare Services.
STAFF QUALIFICATIONSSTAFF QUALIFICATIONS
Staff are designated as:Staff are designated as:LPHA:LPHA: Licensed Practitioner of the Healing ArtsLicensed Practitioner of the Healing ArtsQMHP: Qualified Mental Health ProfessionalQMHP: Qualified Mental Health ProfessionalMHP: Mental Health ProfessionalMHP: Mental Health ProfessionalRSA: Rehabilitative Services AssociateRSA: Rehabilitative Services Associate
Different staff have different abilities to:Different staff have different abilities to: Deliver servicesDeliver services Approve assessments and treatment plansApprove assessments and treatment plans
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STAFF QUALIFICATIONSSTAFF QUALIFICATIONS
LPHALPHALicensed PractitionerLicensed Practitionerof the Healing Artsof the Healing Arts
Health ProfessionalHealth Professional(QMHP)(QMHP) All LPHAsAll LPHAs Licensed Social WorkerLicensed Social Worker
(LSW)(LSW) Registered Nurse (RN) withRegistered Nurse (RN) with
1 year experience in mental1 year experience in mentalhealthhealth
Occupational TherapistOccupational Therapist(OTR/L) with 1 year(OTR/L) with 1 yearexperience in mental healthexperience in mental health
Person with a master’s orPerson with a master’s ordoctoral degree in humandoctoral degree in humanservice and 1 yearservice and 1 yearexperienceexperience Experience may beExperience may be
Person with a certificate ofPerson with a certificate ofcompletion from DHScompletion from DHSapproved course andapproved course and High School Diploma orHigh School Diploma or
GEDGED 2 years experience2 years experience
ROLEROLE Assists in developing MHAsAssists in developing MHAs
Assists in developing ITPsAssists in developing ITPs
Can deliver skills training,Can deliver skills training,counseling, and casecounseling, and casemanagement type servicesmanagement type services..
To quality for services, individual must:To quality for services, individual must:
Must have aMust have a functional deficitfunctional deficit.. A diagnosis alone is not enough.A diagnosis alone is not enough. Must show how mental illness is impacting functioningMust show how mental illness is impacting functioning
Must have anMust have an MI diagnosisMI diagnosis which meets certainconditions.
Services mustServices must be expected to resultbe expected to result inin iimprovementmprovementor prevention of regressionor prevention of regression in client’s existingin client’s existingcondition.condition.
A mental health intervention is medicallyA mental health intervention is medicallynecessary if:necessary if:
The individual has a diagnosis of Mental IllnessThe individual has a diagnosis of Mental Illness
Mental Health services are identified as appropriate toMental Health services are identified as appropriate tothe individual’s need as identified in a mental healththe individual’s need as identified in a mental healthassessment andassessment and
The intervention could not have been omitted withoutThe intervention could not have been omitted withoutadversely affecting the individual’s functioning.adversely affecting the individual’s functioning. –– notnotjust conveniencejust convenience
MEDICAL NECESSITYMEDICAL NECESSITYDocumenting To SupportDocumenting To Support
MENTAL HEALTHASSESSMENT
INDIVIDUALTREATMENT
PLAN
PROGRESSNOTES
DiagnosisFunctional Deficits / Need List
GoalsObjectives
Interventions
Addressingassessed needs
AddressingGoals /objectives
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MEDICAL NECESSITY
Must be established:Must be established:
In the assessment;In the assessment; On the treatment plan;On the treatment plan; OnOn eacheach progress note.progress note.
The Golden ThreadThe Golden Thread
The rehabilitationThe rehabilitationgoal(s) should begoal(s) should beeasy to trace fromeasy to trace fromthethe assessmentassessment totothethe treatment plantreatment plan,,and addressed inand addressed inspecificspecific progressprogressnotesnotes..
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Assessment (MHA)Assessment (MHA) Mental Health relatedMental Health related needs /functional deficitsneeds /functional deficits are identifiedare identified PlannedPlanned impact of servicesimpact of services is describedis described Must be a current assessmentMust be a current assessment –– new one at least annuallynew one at least annually
Treatment Planning (ITP)Treatment Planning (ITP) Consumer Goals / Objectives related to functional deficits isConsumer Goals / Objectives related to functional deficits is
developed.developed.
Interventions & Progress (Progress Notes)Interventions & Progress (Progress Notes) Service delivered to impact functional deficits is describedService delivered to impact functional deficits is described Relationship between services delivered, goals / objectives, andRelationship between services delivered, goals / objectives, and
assessed functional deficits is described.assessed functional deficits is described.
The Golden ThreadThe Golden Thread
PROPERTIESOn passing, 'Finish' button: Goes to Next SlideOn failing, 'Finish' button: Goes to Next SlideAllow user to leave quiz: After user has completed quizUser may view slides after quiz: At any timeUser may attempt quiz: Unlimited times
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QUESTIONS?QUESTIONS?
Print your certificate andPrint your certificate andconsult with your supervisorconsult with your supervisorwith clarifications you mightwith clarifications you mightneed on any of this informationneed on any of this information
Who can consent to mental health servicesWho can consent to mental health services Explaining clients rights to themExplaining clients rights to them What rights they haveWhat rights they have
In Part II of this training…In Part II of this training… We’ll review how consent is documentedWe’ll review how consent is documented
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WHY IS THIS IMPORTANT?WHY IS THIS IMPORTANT?
Knowing consumer rights results in youKnowing consumer rights results in youbeing able to:being able to:
get consents from the right people.get consents from the right people.
protect client’s rights (because you know whatprotect client’s rights (because you know whatthey are).they are).
TO GET THE MOST OUT OF THISTO GET THE MOST OUT OF THIS
Takes notes about question you have forTakes notes about question you have foryour supervisor as you go along.your supervisor as you go along.
Pull the following form from the forms binPull the following form from the forms binto reference:to reference:
TWI 500.2 Client Rights and ResponsibilitiesTWI 500.2 Client Rights and ResponsibilitiesBrochureBrochure
CONSENT TO SERVICES Consent may be written or oralConsent may be written or oral
Who May Consent?Who May Consent? Any competent adult 18 or olderAny competent adult 18 or older Parent or guardian for child under 12Parent or guardian for child under 12 Youth 12Youth 12--18 can consent for 518 can consent for 5 -- 45 minute sessions45 minute sessions Crisis services don’t require consent.Crisis services don’t require consent.
Documentation of ConsentDocumentation of Consent On TWI 500.1 Application For ServicesOn TWI 500.1 Application For Services
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EXPLAINING CLIENT RIGHTS
Requirement:Requirement: Staff must continue to explain the rights to theStaff must continue to explain the rights to the
clientclient until as much understanding as possible isuntil as much understanding as possible isobtained.obtained. Work with the client's parent or guardian ifWork with the client's parent or guardian ifapplicable.applicable.
Documentation:Documentation: Staff should provide a statement explaining theStaff should provide a statement explaining the
circumstances and effortscircumstances and efforts to assist the client into assist the client inunderstanding their rights.understanding their rights.
TWI 500.1 Application For Services form is where toTWI 500.1 Application For Services form is where todocument this.document this.
CLIENT RIGHTSINFORMING ABOUT RIGHTS
Client Rights must be explainedClient Rights must be explained in a language clientin a language clientunderstands.understands.
The rights are listed on TWI 500.2 Client Rights andThe rights are listed on TWI 500.2 Client Rights andResponsibilities BrochureResponsibilities Brochure
Must be a signed statementMust be a signed statement by staffby staff explaining rightsexplaining rightsthat they believe the client or parent/guardian, asthat they believe the client or parent/guardian, asapplicable,applicable, understood their rightsunderstood their rights..
This statement is on the TWI 500.1 Application For ServicesThis statement is on the TWI 500.1 Application For ServicesFormForm
To be free from abuse, neglectTo be free from abuse, neglect,, andandexploitationexploitation..
This means that we at Transitions won’t abuse,This means that we at Transitions won’t abuse,neglect or exploit them.neglect or exploit them.
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CLIENT RIGHTS
To receive confidential servicesTo receive confidential servicesas governed by the Confidentiality Act andas governed by the Confidentiality Act andthe Health Insurance Portability andthe Health Insurance Portability andAccountability Act.Accountability Act.
CLIENT RIGHTS
To terminate servicesTo terminate services-- our servicesour servicesare voluntary and require yourare voluntary and require yourcooperation.cooperation.
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CLIENT RIGHTS
ToTo receive appropriate,receive appropriate, humanehumaneservices provided in the leastservices provided in the leastrestrictive settingrestrictive setting..
CLIENT RIGHTS
To participate in planningTo participate in planning youryourtreatmenttreatment
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CLIENT RIGHTS
To have your bill and specificTo have your bill and specific chargeschargesexplained to youexplained to you and toand to question anyquestion anychargescharges you believe may be in error.you believe may be in error.
CLIENT RIGHTS
To know what medication is prescribed forTo know what medication is prescribed foryouyou, why it is prescribed and possible side, why it is prescribed and possible sideeffects it may cause.effects it may cause.
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CLIENT RIGHTS
To review your recordTo review your record with thewith theassistance of program staff inassistance of program staff inaccordance with agency policy and toaccordance with agency policy and torequest that your record be amended.request that your record be amended.
CLIENT RIGHTS
To treatment without regard to age, sex,To treatment without regard to age, sex,race, religion, marital status, nationalrace, religion, marital status, nationalorigin or disabilityorigin or disability..
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CLIENT RIGHTS
To present grievances and contactTo present grievances and contactadvocacy organizations or public payersadvocacy organizations or public payersas described in the grievance procedureas described in the grievance procedureincluded in this brochure.included in this brochure.
CLIENT RIGHTS
To not be denied, suspended, orTo not be denied, suspended, orterminatedterminated from services or have servicesfrom services or have servicesreduced for exercising any rights.reduced for exercising any rights.
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CLIENT RIGHTS
To receive notification for any restrictionTo receive notification for any restrictionof your rightsof your rights and have justification for thisand have justification for thisdocumented in your record.documented in your record.
REMEMBER….REMEMBER….
To print your certificate after you takeTo print your certificate after you takethe quiz.the quiz.
Consult with your supervisor withConsult with your supervisor withclarifications you might need on any ofclarifications you might need on any ofthis information.this information.
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PROPERTIESOn passing, 'Finish' button: Goes to Next SlideOn failing, 'Finish' button: Goes to Next SlideAllow user to leave quiz: After user has completed quizUser may view slides after quiz: At any timeUser may attempt quiz: Unlimited times
Transitions of Western IllinoisTransitions of Western IllinoisLast Revision 09/2009Last Revision 09/2009
MODULE 3MODULE 3CONSENT ANDCONSENT ANDRIGHTS IIRIGHTS II
WHAT WE WILL COVERWHAT WE WILL COVER
This training is for staff who may need toThis training is for staff who may need todocument consumer:document consumer:
Consent To ServicesConsent To Services
Client RightsClient Rights
Explanation of remainder of the ClientExplanation of remainder of the ClientRights BrochureRights Brochure
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TO GET THE MOST OUT OF THISTO GET THE MOST OUT OF THIS
Takes notes about question you have forTakes notes about question you have foryour supervisor as you go along.your supervisor as you go along.
Pull the following forms from the forms binPull the following forms from the forms binto reference:to reference:
TWI 500.2 Client Rights and ResponsibilitiesTWI 500.2 Client Rights and ResponsibilitiesBrochureBrochure
TWI 500.1 Application For ServicesTWI 500.1 Application For Services
CONSENT TO SERVICES
Documentation of ConsentDocumentation of Consent
On TWI 500.1 Application For ServicesOn TWI 500.1 Application For Services
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This is the form.Go to page 3 of the form.
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EXPLAINING CLIENT RIGHTS
Requirement:Requirement: Staff must continue to explain the rights to theStaff must continue to explain the rights to the
clientclient until as much understanding as possible isuntil as much understanding as possible isobtained.obtained.
Documentation:Documentation: Staff should provide a statement explaining theStaff should provide a statement explaining the
circumstances and effortscircumstances and efforts to assist the client into assist the client inunderstanding their rights.understanding their rights.
TWI 500.1 Application For Services form is where toTWI 500.1 Application For Services form is where todocument this.document this.
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CLIENT RIGHTS BROCHURECLIENT RIGHTS BROCHURE
TWI 500.2 Consumer Rights andTWI 500.2 Consumer Rights andResponsibilitiesResponsibilities
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CLIENT RIGHTS BROCHURECLIENT RIGHTS BROCHURE
In addition to the client rights we’veIn addition to the client rights we’vealready covered, the brochure outlines:already covered, the brochure outlines:
Client ResponsibilitiesClient Responsibilities Our Grievance ProcedureOur Grievance Procedure Statement of Information PracticesStatement of Information Practices Our Code of EthicsOur Code of Ethics Equal Opportunity StatementEqual Opportunity Statement TWI’s MissionTWI’s Mission
CLIENT RIGHTS BROCHURECLIENT RIGHTS BROCHURE
Client Responsibilities:Client Responsibilities:
This section communicates what TransitionsThis section communicates what Transitionswould like to see from consumers.would like to see from consumers.
Read this section on page 2 of the ClientRead this section on page 2 of the ClientRights Brochure.Rights Brochure.
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CLIENT RIGHTS BROCHURECLIENT RIGHTS BROCHURE Grievance Procedure:Grievance Procedure:
This section communicates how consumersThis section communicates how consumersshould solve problems they may have withshould solve problems they may have withservice.service.
Read this section on page 2 of the brochure.Read this section on page 2 of the brochure.
Note that a consumer may choose to eitherNote that a consumer may choose to eitherfile a grievance at TWI or may choose to file afile a grievance at TWI or may choose to file agrievance at one of several state agencies.grievance at one of several state agencies.
CLIENT RIGHTS BROCHURECLIENT RIGHTS BROCHURE
Statement of Information Practices:Statement of Information Practices:
This statement is required by HIPAA (theThis statement is required by HIPAA (thefederal law governing confidentiality of healthfederal law governing confidentiality of healthrecords).records).
We are required to explain how we use theirWe are required to explain how we use theirprotected health information.protected health information.
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CLIENT RIGHTS BROCHURECLIENT RIGHTS BROCHURE
Code of Ethics, Equal OpportunityCode of Ethics, Equal OpportunityStatement, Mission:Statement, Mission:
Located on page 4 of the brochure.Located on page 4 of the brochure.
Read over so you know what they say.Read over so you know what they say.
REMEMBER….REMEMBER….
To print your certificate after the quiz.To print your certificate after the quiz.
Consult with your supervisor withConsult with your supervisor withclarifications you might need on any ofclarifications you might need on any ofthis information.this information.
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PROPERTIESOn passing, 'Finish' button: Goes to Next SlideOn failing, 'Finish' button: Goes to Next SlideAllow user to leave quiz: After user has completed quizUser may view slides after quiz: At any timeUser may attempt quiz: Unlimited times
