Fillable Printable Bhs Policy 1601

Bhs Policy 1601

Arizona Departm ent of Health Services Current Effective Date: 2/25/2014

Division of Behavioral Health Services Last Review Date: 1/8/2014

Policy and Procedures Manual

SECTION: 6 CHAPTER: 1600

POLICY: 1601 Enrollment, Disenrollment and Other Data Submission

____________________________________________________________________________

1601 Enrollment, Disenrollment and Other Data Submission

Page 1 of 6

1. PURPOSE:

The collection and reporting of accurate, complete and timely enrollment, demographic,

clinical, and disenrollment data is of vital importance to the successful operation of the

Arizona Department of Health Services/Division of Behavioral Health Services

(ADHS/DBHS) behavioral health service delivery system. It is necessary for behavioral

health providers to submit specific data on each person who is actively receiving services

from the behavioral health system. As such, it is important for Tribal/Reg ional Behavioral

Health Authority (T/RBHA) and provider staff (e.g., intake workers, clinicians, data entry

staff) to have a thorough understanding of why it is necessary to collect the data, how it can

be used and how to accurately label the data. This policy has particular relevance for those

providers that conduct assessments, ongoing service planning, and annual updates.

This data in turn is used by ADHS/DBHS to:

a. Monitor and report on outcomes of individuals in active care (e.g., changes in diagnosis

or Global Assessment of Functioning (GAF)), employment/educational status, place of

residence, substance use, number of arrests);

b. Comply with federal and state funding and/or grant requirements;

c. Assist with financial-related activities such as budget development and rate setting;

d. Support quality management and utilization management activities; and

e. Respond to requests for information.

The intent of this section is to describe requirements for T/RHBAs to produce policies for

their behavioral health providers to submit the following data in a timely, complete, and

accurate manner:

a. Non-Tit le XIX enrollment and disenrollments; and

b. Demographic and clinical data, including changes in a person’s behavioral health status

2. TERMS:

Definitions for terms are located online at http://www.azdhs.gov/bhs/definitions/index.php

The following terms are referenced in this section:

Annual Update

Assessment

Behavioral Health Category Assignment

Change

Client I nformation S yst em (CI S)

Closure

Crisis Ep is od e

Arizona Departm ent of Health Services Current Effective Date: 2/25/2014

Division of Behavioral Health Services Last Review Date: 1/8/2014

Policy and Procedures Manual

SECTION: 6 CHAPTER: 1600

POLICY: 1601 Enrollment, Disenrollment and Other Data Submission

____________________________________________________________________________

1601 Enrollment, Disenrollment and Other Data Submission

Page 2 of 6

Day

Demographics

Edit

Episode of Care

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Intake / Enrollment

Outcome Measures

3. PROCEDURES:

General requirements

a. Arizona Health Care Cost Containment System (AHCCCS) enrolled individuals are

considered enrolled with the Tribal/Regional Behavioral Health Authority (T/RBHA) at the

onset of their eligibility. They are provided an AHCCCS identification card listing their

assig n e d T/ RBHA. This assignmen t is s ent da ily f r om ADHS/DBHS to the T/ RBHA.

b. For a Non-Title XIX/XXI eligible person to be enrolled, providers must submit an 834

enrollment transaction to the T/RBHA. All AHCCCS enrolled individuals with a mental

health benefit are considered enrolled with the T/RBHA at the time of their AHCCCS

eligibility.

c. For a Non-Title XIX/XXI eligible person who receives a covered behavioral health

service, he/she must be enrolled effective the date of first contact by a behavioral health

provider.

d. All persons who are served through the ADHS/DBHS behavioral health system must

have an active episode of care, even if the person only receives a single service (e.g.,

crisis intervention, one time face-to-face consultation).

e. An episode of care is the start and end of services for a behavioral health need as

documented by transmission of a demographic record. For both AHCCCS enrolled and

Non-Tit le XIX/XXI eligible individuals, the individuals must have an open episode of care

starting at the first date of service and ending with the last service.

f. Collection of Enrollment information

i. For Non-Title XIX/XXI eligible individuals, inf ormation necessary to complete an 834

transaction is usually collected during the intake and assessment process (see

Policy

105, Intake, Assessment and Service Planning). Policy Attachment 1601.1, 834

Transaction Data Requirements, contains a list of the data elements necessary to

create an 834 enrollment transaction.

ii. For AHCCCS enrolled individuals, the 834 information will be provided to the T/RBHA

by ADHS/DBHS daily for the providers to access.

iii. ADHS/DBHS has developed a flow chart that includes the timeframes for all data

submissions. See Policy Attachment 16011

g. Data included in an 834

i. The data fields that are included in the 834 transmittals are dictated by HIPAA and

consist of:

Arizona Departm ent of Health Services Current Effective Date: 2/25/2014

Division of Behavioral Health Services Last Review Date: 1/8/2014

Policy and Procedures Manual

SECTION: 6 CHAPTER: 1600

POLICY: 1601 Enrollment, Disenrollment and Other Data Submission

____________________________________________________________________________

1601 Enrollment, Disenrollment and Other Data Submission

Page 3 of 6

Key client identifiers used for file matching (e.g., person’s name, address, date of (1)

birth);

Basic demographic information (e.g., gender, marital status); and (2)

Information on third party insurance coverage. (3)

ii. For a specific list of data elements necessary to create an 834 enrollment and

disenrollment, for Non-Title XIX/XXI eligible individuals, see

Policy Attachment

1601.2.

iii. Providers must actively secure any needed information to complete the enrollment

(834 transaction) for a Non-Title XIX/XXI eligible individual. An 834 transaction will

not be accepted by the T/RBHA if required data elements are missing. For Title

XIX/XXI eligible individuals, the 834 information will be provided to the T/RBHA by

ADHS/DBHS.

h. Timeframes for submitting enrollment and disenrollment data for a Non-Title XIX/XXI

eligible individual

i. The following data submittal timeframes apply to the enrollment/disenrollment

transactions:

The T/RBHA must determine and advise the provider regarding the n umber of (1)

days within first contact with a recipient the provider has to submit the 834-

enrollment transaction. The T/RBHA must provide a name/contact to submit it to.;

Additionally The 834 disenrollment transaction must be submitted to the same (2)

T/RBHA contact within a set number of days as designated by the T/RBHA when a

person is being disenrolled from the system; and any changes to the

enrollment/disenrollment transact ion data fields (e.g., change in address, insurance

coverage) must be submitted within a set number of days determined by the

T/RBHA from the date of identifying the need for the change.

i. Other events require a submittal of an 834 transaction for a Non-Title XIX /XXI eligible

individual

i. In addition to submitting an 834 transaction at enrollment and disenrollment, an 834

transaction must also be submitted when any of the following elements of the 834

transaction have changed:

Name, (1)

Address, (2)

Date of birth, (3)

Gender, (4)

Marital status, or (5)

Third party insurance information. (6)

j. Other considerations for both Non-T itle XIX/XXI eligible and AHCCCS enrolled

individuals

Arizona Departm ent of Health Services Current Effective Date: 2/25/2014

Division of Behavioral Health Services Last Review Date: 1/8/2014

Policy and Procedures Manual

SECTION: 6 CHAPTER: 1600

POLICY: 1601 Enrollment, Disenrollment and Other Data Submission

____________________________________________________________________________

1601 Enrollment, Disenrollment and Other Data Submission

Page 4 of 6

i. For an AHCCCS enrolled individual, AHCCCS will notif y ADHS/ DBHS of changes t o

the above information. That information will be provided from ADHS/DBHS to the

T/RBHA on a daily file.

ii. When a person in an episode of care permanently re-locates from one T/RBHA’s

geographic area to another T/RBHA’s geographic area, an inter-T/RBHA transfer

must occur (see Policy 901, Inter-RBHA Coordination of Care

). The steps that are

necessary to facilitate an inter-T/RBHA transfer include the following data submission

requirements:

The home T/RBHA must submit an 834 disenrollment transaction effective on the (1)

date of transfer and end the episode of care, and

The receiving T/RBHA must submit an 834 enrollment transaction on the date of (2)

accepting the person for services and start an episode of care.

AHCCCS will notify ADHS/DBHS when a T/RBHA enrolled person is determined (3)

eligible for the Arizona Long Term Care System (ALTCS) Elderly and Physically

Disabled (EPD) Program. This information will be passed to the T/RBHA on a daily

file .

k. Technical assistance available to help with problems associated with electronic data

submission.

i. At times, technical problems or other issues may occur in the electronic transmission

of the data from the behavioral health provider to the receiving T/RBHA. The T/RBHA

must provide a contact name and telephone numbers for IT technical assistance for

provider use.

Demographic and clinical data

a. Demographic and clinical data will be collected starting at the first date of service. For

Non-Tit le XIX/XXI eligible individuals, an 834 must be completed. For both AHCCCS

enrolled and Non-Title XIX/XXI eligible individuals, a demographic record must be

collected within 45 days of the first service and submitted to ADHS/DBHS within 55

days. Additional clinical data may be collected at subsequent assessment and service

planning meetings with the person (e.g., education, vocation) as well as during periodic

and annual updates. Demographic and clinical data recorded in the person’s behavioral

health medical record must match the demographic file on record with ADHS/DBHS.

b. The ADHS/DBHS Demographic Data Set User Guide

describes the data elements that

comprise the demographic data set and the timeframe requirements for submitting the

demographic data set. T/RBHAs must ensure that providers collect required

demographic data set elements in accordance with the

ADHS/DBHS Demographic Data

Set User Guide. T/RBHAs must provide guidance and reference to required form(s) and

T/RBHA websit e hyperlink to form(s) that providers must use to collect the demographic

data set. When ADHS/DBHS issues updates to the demographic data set, T/RBHAs are

responsible for communicating changes to their providers.

Arizona Departm ent of Health Services Current Effective Date: 2/25/2014

Division of Behavioral Health Services Last Review Date: 1/8/2014

Policy and Procedures Manual

SECTION: 6 CHAPTER: 1600

POLICY: 1601 Enrollment, Disenrollment and Other Data Submission

____________________________________________________________________________

1601 Enrollment, Disenrollment and Other Data Submission

Page 5 of 6

c. The T/RBHA must establish the following t im ef rames that apply to demographic and

clinical data submissions based on ADHS/DBHS requirements and make them available

to providers as part of their Provider Manual or other reference documents (see the

ADHS/DBHS Dem o graphic Data Set Us er Guid e

i. All required demographic data submitted to the T/RBHA within t he number of days

indicated by the T/RBHA of t he initial intake for all enrolled persons.

ii. Out come measures, for children birth through age 17, submitted to the T/RBHA

specified department/person within the T/RBHA set number of days of the 6 month

anniversary date of the last demographic submission (see

Policy 105, Assessment

and Service Planning). For outcome measures submission dates that do not coincide

with the annual update, the reason for submission will be indicated as a “change” (see

specific instructions in the

ADHS/DBHS Dem og raphic Data Set Us er Guide).

iii. All requir ed demographic data submitted to the T/RBHA within the T/RBHA indicated

number of days of the annual update (see

Policy 105, Assessment and Service

Planning).

iv. All required demographic data submitted to the T/RBHA with in the T/RBHA indicated

number of days of a recorded change in the person’s demographic data record.

Providers must ensure that the person’s medical record matches the demographic

data s et o n file with ADHS /DBHS.

v. All r e quired data elements submitted to the T/RBHA within the T/RBHA indicated

number of days of the end of the episode of care. The required data elements include

the reason for the person’s disenrollment. See the

ADHS/DBHS Dem og ra ph ic Data

Set User Guide t o determine the specific data elements that must accompany a

demographic disenrollment transaction.

d. Determining a recipient’s behavioral health category assignment

i. Behavioral health providers must designate a person’s behavioral health category

assignment during the assessment process as well as at any other times that

necessitate changes to the person’s assignment (e.g., transition to adulthood).

Behavioral health categories include:

Child, (1)

Seriously Emotionally Disturbed (SED) Child (see Attachment 7.5.3, SMI and SED (2)

Qualifying Diagnoses Table),

Adult with Serious Mental Illness (SMI), (3)

Adult, non-SMI with general mental health need, and (4)

Adult, non-SMI with substance abuse (see

Policy Attachment 1601.4, Substance (5)

Abuse Disorders Qualifying Diagnoses Table

ii. Behavioral health providers must initially assign and update, as necessary, behavioral

health category assignments as follows (see the

ADHS/DBHS Dem o graphic Data Set

User Guide for more detailed instructions on assignment of behavioral health

categories):

For a child who is non-SED, enter “C”; (1)

Arizona Departm ent of Health Services Current Effective Date: 2/25/2014

Division of Behavioral Health Services Last Review Date: 1/8/2014

Policy and Procedures Manual

SECTION: 6 CHAPTER: 1600

POLICY: 1601 Enrollment, Disenrollment and Other Data Submission

____________________________________________________________________________

1601 Enrollment, Disenrollment and Other Data Submission

Page 6 of 6

For a child who is SED, enter “Z”; (2)

For a person determined to have a Serious Mental Illness in accordance with (3)

Policy 106, SMI Eligibility Dete rm in ation

, enter “S”, then enter “a” or “b”;

For an adult non-SMI person with a general mental health need (who does not (4)

have a substance abuse problem) enter “M”; and

For an adult non-SMI person with a reported substance abuse problem enter “G”. (5)

How can demographic and clinical data be used? (6)

Behavioral health providers are encouraged to utilize demographic and clinical (7)

data to improve operational eff iciency and gain information about the persons who

receive behavioral health services. Providers may consider:

Utilizing and integrating collected demographic data into the person’s (8)

assessments,

Monitoring the nature of the provider’s behavioral health recipient population, and (9)

(10) Evaluating the effectiveness of the provider’s services towards improving the

c linical outcom es of persons enrolled in the ADHS/DBHS system.

e. Technical assistance available to help with problems associated with demographic and

clinical data submission

i. At times, technical problems or other issues may occur in the electronic transmission

of the clinical and demographic data from the behavioral health provider to the

receiving T/RBHA. If a provider requires assistance for technical related problems or

issues, please contact

4. REFERENCES:

AHCCCS/ADHS Contract

ADHS/RBHA Contracts

ADHS/TRBHA IG As

Policy 104, Outreach, Engagement, Re-Engagement and Closure

Policy 105, Assessment and Service Planning

Policy 106, SMI Eligib ility Determination

Policy 901, Inter-RBHA Coordination of Care

ADHS/DBHS Demographic and Outcomes Data Set User Guide

ADHS/DBHS Covered Behavioral Health Services Guide