Injectable Psychiatric Medications

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Questions:

  • What medications are you injecting?
  • What issues are you running into (i.e., what works and what doesn’t)?
  • Are you billing for this service?
  • Does the prescriber need to see the patient for billing purposes?
  • Does anyone do bill and buy?
  • Do you allow patients to bring the prescription for the injection with them to the appointment, or do you require that the pharmacy deliver on the day of the injection?
  • How do you handle co-pays if the medication is delivered to the clinic?
  • Are there any medication storage considerations that should be taken into account?

Click here to access the PDF will all responses!

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Is the WHO Disability Assessment Schedule (WHODAS) a required component for a Diagnostic Assessment (DA)?

 

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Response from Minnesota Health Care Programs (MHCP) at DHS:

The WHODAS is no longer required, but providers are still required to capture the functional status in the DA, just like the WHODAS in accordance to federal guidelines.

Please see the provider news message published 5/30/18: https://mn.gov/dhs/assets/2018-06-26-mhcp-provider-news_tcm1053-345858.pdf

Effective July 1, 2018, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) will no longer be a required component for capturing functional status in the diagnostic assessments for adults in Minnesota Health Care Programs (MHCP). To align with the current Diagnostic and Statistical Manual (DSM), federal guidelines, and state regulations for functional impacts, providers must ensure symptom descriptions, at a minimum the frequency, intensity and impact, are integrated into the diagnostic assessment. Include this information in the clinical summary. The WHODAS 2.0 is still an acceptable method to capture functional status in a diagnostic assessment for adults. The functional status components required for children 0-5 years old (ECSII, SDQ) and 5-18 years old (CASII, SDQ) will remain the same.

Clinical Supervision of Behavioral Health Providers

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How do you handle clinical supervision of your behavioral health providers?

  • Typically licensed providers meet every other week for one hour for individual consultation (if the provider is full time) with the behavioral health director, because technically they do not require supervision as they are independently licensed. We also have weekly team meetings where we discuss cases. We try to be available for on the spot questions. Unlicensed therapists (and sometimes new providers) will need to meet more often per school or licensure board’s requirements, which is typically one hour of individual supervision and one hour group/team supervision.
  • Our clinic is small, with only 4 BH providers, including the BH Director and one Psychiatric NP and an LPN. As all of our providers are independently licensed, clinical supervision is not required for their licensure/insurance reimbursement. However, quarterly chart reviews are completed by the BH Director for all providers and feedback regarding documentation is provided at that time.

How many hours a month does each clinician meet individually with their clinical supervisor (does it differ by years of experience? If so, how?)?

  • 1-4 hours per month depending on developmental and training needs of the provider, and also depending on whether they are full or part-time. Years of experience are considered, but also if a provider is new to the clinic culture or if there’s a learning or coaching goal (especially disciplinary) to monitor and train for.
  • Each provider has a 1:1 scheduled with the BH Director to discuss clinical concerns, work flows, morale, etc. every month.
  • We have a monthly Peer Supervision meeting that is 1-2 hours. One hour a week with newest team member (SW/IBH). Times with other MH team members varies. (This question confirms we need to make that more solid and consistent). Some are contracted and received clinical supervision elsewhere.

How often does the entire group of clinicians meet for clinical supervision?

  • Behavioral health team meets weekly, but not all part-time providers can attend that frequently who work away from the main site.  The off-site provider comes once per month. We also have a monthly team education where we discuss a learning topic or watch a webinar or invite an outside speaker on a topic such as how does diabetes impact mental health, etc. Our agency also has a biweekly all-provider meeting that meets across disciplines.
  • The team meets weekly for one hour with our Psychiatric NP and her staff to consult on cases. We have a great team and work together well in doing “curbside consultations” as needed throughout the day to support one another.
  • We have a monthly meeting for the whole team to handle content like how to do crisis assessments and response and other topics; but it’s not direct clinical supervision.

 

After Hours Call Vendors

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  • We are using Citra Health. Great after-hours service.
  • We use Fairview After Hours. They do not integrate now send reports.  I would love to hear the results to see if anyone has found a better solution. We also have to contract with an interpreter service for them to use after hours for our patients. I am curious about cost too.
  • Essentia Health

Artificial Nail Policies

  1. The dress code portion of our employee handbook contains the phrase, “Clinical staff may not wear artificial nails.”
  2. Almost without exception nail extensions and artificial/acrylic nails are banned for all persons doing direct patient care due to infection risk.
  3. Natural and Artificial Nails:   Natural nail tip length should not exceed ¼ inch and, if nails are polished, they must be well maintained and must not be chipped.  Artificial nails are not permitted.

Can LMFTs be reimbursed for IBH/BH services at FQHCs?

1) LMFTs are eligible mental health providers for Minnesota Health Care Programs (MHCPs include Medical Assistance [MA], MinnesotaCare, MN Family Planning Program).

 
2) LMFTs are NOT eligible mental health providers for Medicare.

 
“But most FQHC Medicare patients are Dual Eligible (i.e., enrolled in both MA & MC). Therefore FQHCs must first bill CMS as a Medicare “billed to deny.” Once the claim is denied by Medicare, the claims should then be submitted to DHS as a Medicaid service. Medicaid will pay the claim at the Medicaid Fee for Service level. DHS will not pay the FQHC rate on claims such as these. 

Important Clarification– Medicare mental health services require a doctorate degree (with the exception of MSW licensed clinical social workers, such as LICSWs and LCSWs). So, when any other mental health professional provider (LMFT, LPCC, etc.) with a master’s degree treats a Medicare enrollee that also has Medicaid coverage, the claim follows the process described above.”

**This clarification applies to all non-Medicare eligible BH providers

Can anyone share policies, processes, documentation requirements, etc. for supervising PAs? We are considering adding them to our team. 

  • Contact the Health Plans because as a part of credentialing they can tell you the requirements of a sponsoring MD.
  • We have a physician supervise the PA and a “ Physician- Physician Assistant Delegation Agreement” needs to be completed.  You can go on line and get the MN version for current year.   We have this updated each year for the PA and supervising physician.  This is required for insurance credentialing as well.  Also attached is a policy regarding clinical privileges as well as the form used for initial and reappointment of clinical privileges.  This is updated every 2 years.
  • I have one Physician Assistant on staff; no real difference in supervision from NPs, except that they need a physician delegation agreement (which NPs don’t).  otherwise, we’ve kept all privileging/credentialing the same.
  • All PAs are required to fill out a delegation agreement and they are privileged and credentialed just the same as an MD- except verifying their different licensure of course. Then one Physician is usually in charge of the supervision portion of the arrangement- we have our associate medical directors fill that role.

This form pretty much defines who can be a supervising physician:

Physician Supervision Minn. Stat. § 147A.01, Subd. 23 defines Supervising physician as “a Minnesota licensed physician who accepts full medical responsibility for the performance, practice, and activities of a physician assistant under agreement as described in § 147A.20. Minn. Stat. § 147A.01, Subd. 24 defines Supervision as “overseeing the activities of, and accepting responsibility for, the medical services rendered by a physician assistant. The constant physical presence of the supervising physician is not required so long as the supervising physician and physician assistant are or can be easily in contact with one another by radio, telephone, or other telecommunication device. The scope and nature of the supervision shall be defined by the individual physician-physician assistant delegation agreement.”

Nominal Fees

  • Medical-$20
  • Medical-$15, Behavioral Health-$10, Dental-$50  (we also have set fees for some non-covered dental services)
  • Medical/BH-$0 at 100% of FPG, Dental-$20 at 100% FPG. The nominal fees move up as one’s % of FPG increases up to 100% of charges at 200% of FPG.
  • Medical/BH-$10, Dental-$25

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