Page 14 - If the individual continues to make limited or no progress (remaining at the same Level of Need for 18 months), the LMHP Clinical Supervisor shall evaluate whether a referral to a different service may better support progress. - what other services would be recommended? Part of the intake process is to refer out to other suitable services that would be available and only approve for CPST if they are not available or the individual does not qualify? Services such as MHSB and CPST fill a gap in service and provide a lifeline to a lot of individuals. Sometimes progress is just simply the fact that with support the individual follows through with their care better. MCOs do not see it that way however and deny for "not making progress" Also, who helps these individuals during this time of bureaucratic red tape? will authorization be continued for CPST while linkage to "another service" occurs? MHSB currently is a safety net for individuals who need help but do not fit boxes for other services.
Feedback - tiers continue to seem super difficult to decipher with so many moving parts. It's like reading one huge flow chart and difficult
Paperwork/Documentation is excluded for payment. Providers shall only bill for time spent face to face with individual or individual's family/caregiver. Can a face to face session completely devoted to treatment plan creation/updating be billed? ISP creation is a lengthy process, particularly when constant updates or changes are required and a significant unpaid burden if there is no allowance for payment for that.
There are several mentions of provider expectations to contact the MCO or MCO care coordinator and directives regarding provider's expectations regarding answering calls/queries from the MCO in an expedient manner. Is there a similar guidance document that be provided that outlines the MCO's expectations in their interactions with providers, expectations of them, policies they are to follow, etc.? Currently MCOs create their own processes, and each is different. There are times when a call is received demanding a call back within a few hours - which is unrealistic and a burden on front line individuals who are in the community providing service/care and attending to the multiple duties required to keep a program running and clients being served.
Have any other providers observed increased oversight and scrutiny from MCOs regarding current authorizations for MHSB? For instance, declining to approve anyone (no matter the case made for medical necessity) to individuals who have ever had the service for a length of time in the past and frequent requests for time draining peer reviews regarding current continue stay requests? This seems to have increased since the sunsetting of MHSB was announced.
