Primary Care Provider Referral Training - Ccah-alliance
Primary Care ProviderReferral TrainingFor PCPs at FQHCs, RHCs, IHCs,Groups, and Solo PracticesOctober 2016
Training Topics1. About Beacon Health Options2. Medi-Cal Managed Care Mental Health Benefits for Mild to ModerateImpairments California Medi-Cal Behavioral Health Delivery System Overview Level of Care Screening Process3. Connecting Members to Mental Health Services: PCP Referral Form Requesting PCP Decision Support Referring Members to Beacon Network for Needs Outside PCP Scope Referring Members Under 21 with Autism Spectrum Disorder for BehavioralHealth Treatment/ABA Services4. ASD Comprehensive Diagnostic Evaluation and Psychological /Neuropsychological Testing5. Beacon’s Online PCP Toolkit6. Recap2
About Beacon Health Options3
Beacon Health Options FootprintU.K.5,000 employees nationallyand in the U.K., serving morethan 48 million peopleLEADER IN QUALITYNCQA- and URAC- AccreditedCompaniesKEY OPERATIONAL AREASAlaskaHawaiiMEMBERSHIPCENTERSOver 2.5 Million100,000 – 50,0001,000,000 – 2,500,000Under 100,000 Data Analytics Reporting Processing Sales SupportCorporate HeadquartersLINES OF BUSINESSRegional Service Centers Commercial Federal EAP Medicaid Exchange MedicareCorporate Operation Centers500,000 – 1,000,000 UM/CM QM IT CustomerServiceEngagement Centers4
Experience in California5
Beacon’s Integrated Partner Model Health care is local. Beaconhas staff in local offices in theCA communities where wework. Our teams include: Program directors who overseelocal partnerships, spearheadinitiatives, work with counties &stakeholders Network liaisons who work withcontracted providers Clinical staff to support carecoordination and referrals6
Medi-Cal Managed Care MentalHealth Benefits7
Medi-Cal Managed Care Mental Health Benefits California benefits began on 1/1/2014 Target Population: Members with DSM diagnosis and “mild to moderate”impairment in mental, emotional, or behavioral functioning State intent for mild-moderate level of care: Time-limited, solution-focused therapeutic services Goal: return patients to primary care when clinically appropriateBeacon Individual and group mentalhealth treatment (psychotherapy) Outpatient services to monitordrug therapy (med mgmt) Psychiatric consultation Psychological testing to evaluatea mental health condition (priorauthorization required)Managed Care Plan Outpatient labs, supplies andsupplements PCP Screening, Brief Intervention,and Referral to Treatment (SBIRT)for those over 18 related toalcohol misuse Prescription drugs included inMedi-Cal Managed Care Plan8
California Medi-Cal Service ResponsibilitiesDefining the “Bright Line” Between Mild to Moderate vs Significant ImpairmentsTo be eligible for County-Funded Mental Health Services ALL of the following must be true:1. Diagnosis: Must fall within one or more of the 18 specified diagnostic ranges2. Impairment. The mental disorder must result in one of the following:a) Significant impairment or probability of significant deterioration in an important area of life functioningb) For those under 21, a probability that the patient will not progress developmentally as appropriate, or when specialtymental health services are necessary to ameliorate the patient’s mental illness or condition3. Intervention: Services must address the impairment, be expected to significantly improve the condition, and the conditionwould not be responsive to physical health care–based treatment.Title 9, California Code of Regulations (CCR), Sections 1820.205, 1830.205, and 1830.2109
Level of Care Screening Process Clinician screens member using CCAH/County/Beaconscreening tool Beacon Service Center Clinician (phone) Local Beacon Clinician (FQHC, RHC, IHC, Group, Solo) Based on information provided by member an initial level ofcare is determined If mild-moderate: Service Center Screenings: member provided 3 local referrals Local Beacon Clinician Screenings: member continues services withBeacon clinician If serious: screening tool faxed to county mental health programand member advised to either call county Access line or thatcounty will contact them, depending on the county10
Primary Care: Backbone of the Delivery SystemScreening and referral often begins inprimary care settings.Beacon wants to support primary care inlinking clients to care in the appropriatesetting.Our referral pathways allow you to:1. Get care coordination support for patients2. Get a consultation with a psychiatrist to keep a patient in primary care3. Make a referral for behavioral health treatment within Beacon’s network4. Beacon can help decide if a member has mild to moderate needs to be servedby our network; or more significant needs to be best served by the county11
PCP Referrals12
Option 1: Call Beacon’s Customer Service Line855-765-970013
Option 2: PCP Referral Form: An Easy Way toLink Members to Mental Health ServicesGetting the Form:1. Download a copy from the Beacon website atwww.beaconhealthoptions.com2. Email MC CCAH@beaconhealthoptions.com torequest an electronic version.Form Completion:1. Complete information on member and PCPmaking the referral, including member eligibilityverification and email address to confirmoutcome2. Select ONE referral reason per form (use multipleforms if needed): PCP Decision Support Referral for OP BH services Referral for BHT/ABA3. Check the boxes indicating the member’ssymptoms and impairments. Provide a list ofmedications, if applicable.***Medications and symptoms/impairments areimportant to help connect members to servicesand to streamline decision support with a Beaconpsychiatrist.***Include signed member consent to allow Beaconto confirm completion of referral process.14
Confirming Referral Outcome Check box on PCPReferral Form indicatingpreferred returncommunication method Enter email address orFax # for receipt ofreferral outcome Primary Care ProviderReferral Disposition willbe emailed or faxed tothe referring provider(sample shown at right)15
Bringing BH Expertise into the Primary Care Setting:PCP Decision Support Line Telephone call (curbside consult) between Beacon Psychiatrist and member’s PCP to assist PCPswith diagnostic clarification or prescribing psychiatric medication Beacon psychiatrists available weekdays for curbside consults within the following hours: 4 to 5 pm Monday thru Thursday 2 to 5 pm FridayTwo Options for Requesting PCP Decision SupportOption 1: Fax completed PCP Referral Form with medication list 2 progress notes to 866-422-3413or send via secure email to medi-cal.referral@beaconhealthoptions.com Specify your preferred date/time for the consult and the best number to directly call the PCPOption 2: Call Member Services at 855-765-9700 and request consult with Beacon psychiatrist Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting PCPDecision Support.” Caller will be transferred to a Beacon clinician (LCSW or LMFT) to complete an internal MDreferral form (basic history medical list). Provide your preferred call back time and number16
Referring to Beacon Provider Network for NeedsOutside the PCP’s Scope of PracticePCP Referral Options:1. Fax completed PCP Referral Form to 866-422-3413 or send via secure email tomedi-cal.referral@beaconhealthoptions.com To receive referral outcome confirmation please check FAX or email on the referral form andprovide contact detailsOR2. Call, or have the member call, Beacon at 855-765-9700 during routine business hours (M-F 8:30am - 5 pm). Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting areferral for mental health services for my patient.”Beacon’s Next Steps: Beacon will contact the member to connect them to services at the appropriate level of care Beacon will contact the source of the referral to confirm completion of referral process ifprovided with FAX or email contact details17
Referring Members with Autism Spectrum Disorder forBehavioral Health Treatment/Applied Behavioral AnalysisPCP’s Referral Options:1. For members under age 21: Fax completed PCP Referral Form, Progress Note with ASD diagnosis,and MD order for BHT/ABA services to 800-596-2712 or send via secure email tocare.managers@beaconhealthoptions.com. Check the box to: Confirm inclusion of Diagnostic Evaluation Form indicating ASD identified criteria (red flags) Indicate whether a comprehensive diagnostic evaluation is recommended2. Call Beacon Service Center at 855-834-5654 during normal business hours (M-F 8:30 am- 5 pm) Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting a referralfor autism services for my patient.Beacon’s Next Steps Autism Services Care Coordinator contacts member to assist securing resources for services Beacon will contact the source of the referral to confirm completion of referral process if provided withFAX or email contact details18
ASD Comprehensive Diagnostic EvaluationandPsychological / Neuropsychological Testing19
ASD Comprehensive Diagnostic Evaluation byPsychologistPrior Authorization is not Required – 2 referral options1. PCP requests Comprehensive Diagnostic Evaluation (CDE): CDE is a State required evaluation for Medi-Cal members to access BHT services. Includes a series of preliminary observations and screening tests to determine if a particular childmeets criteria for Autism Spectrum Disorder (ASD). PCPs can initiate a CDE by: 1) completing a Diagnostic Evaluation Form, a tool with informationabout a youth with common ASD related behavioral issues, and 2) submitting it to Beacon with aPCP Referral for BHT services. PCPs can downloaded the Diagnostic Evaluation and PCP Referral Forms at: http://www.ccahalliance.org/mediCal MH benefits.htmlOR2. PCPs can have family call Beacon at 855-765-9700 between 8:30 am - 5 pm, M- F Press 2 to bypass the phone tree. Say, “I am calling on the recommendation of my PCP to request areferral for a comprehensive evaluation for Autism.” The member will get help with access to a qualified psychologist trained to complete the CDE Once the CDE is completed the member will be linked for evaluation and treatment planningincluding ABA and other recommended BHT services. NOTE: Unless the member specifically requests it, PCPs will not be informed of the referraloutcome when members contact the Service Center directly.20
Psychological & Neuropsychological TestingPrior Authorization is Required Psychological Testing: PCPs should refer members directly to Beacon if they think the member requirescomprehensive psychological testing by a qualified psychologist PhD or PsyD who completes the initial clinical evaluation submits the request to Beaconfor authorization of psychological testing Neuropsychological Testing: PCPs may directly refer members to Beacon for neuropsychological testing to betterdefine, localize, and quantify deficits, aid in diagnostic clarity, and inform appropriatetreatment planning for members who are experiencing cognitive impairments thatinterfere with day–to-day functioning For both types of testing, PCP’s should have the member call Beacon at 855765-9700 during routine business hours (M-F 8:30 am - 5 pm). Press 2 to bypass the phone tree. Say, “I am calling on the recommendation of myPCP to request a referral for psychological (or neuropsychological) testing.” Beacon behavioral health providers will determine what testing is clinicallyindicated to further assess a member’s psychological functioning, establishdiagnostic indicators, and/or to modify/revise an ongoing treatment plan21
Online PCP Toolkit22
Beacon Developed an online PCP toolkit with inputfrom PCPs and Behavioral Health physicianswww.beaconhealthoptions.com23
Beacon’s Online Toolkit toSupport Primary Care PracticesPCP toolkit ningtoolsPrescribingreferencesReference:Fact sheetsReference:APA osing rangeand :TreatmentalgorithmsBeaconaccessToll freenumber orweb-basedaccess toBeaconpsychiatristsfor diagnostic,prescription, orcrisis support24
Toolkit Includes Resources on BH ConditionsCommonly Managed by PCPs25
Each BH Condition Includes Resourcesfor PCPs and Members26
Quick Recap27
Recap: Key Takeaway Pointsfor Primary Care Providers1.Members with a DSM diagnosis and mild to moderate levels of impairmentare managed by Beacon. Members with significant impairment and/orsubstance use disorder are managed by the county mental health program.2.Beacon offers PCP’s psychiatric decision support to help with diagnosticclarification and management of psychiatric medications.3.Medi-Cal plan enrollees under age 21 with a diagnosis of Autism SpectrumDisorder can be referred to Beacon for linkage to BHT/ABA services.4.PCPs have two options to refer members to Beacon for any of theseservices.5.Beacon will confirm completion of referral process via FAX or email if contactdetails are provided on the referral form.Option 2: Call 855-765-9700Option 1: Fax a PCP Referral Form1.2.3.4.Complete formInclude clinically relevant backgroundFax to 866-422-3413BHT/ABA Fax to 800-596-27121.2.Press 2 to bypass phone treeTell customer service representativeyou are with a PCP office and specifyrequest28
Thank you29
PCP to request a referral for psychological (or neuropsychological) testing." Beacon behavioral health providers will determine what testing is clinically indicated to further assess a member's psychological functioning, establish diagnostic indicators, and/or to modify/revise an ongoing treatment plan . Psychological & Neuropsychological .
External referrals are referral orders placed to providers that are not using the OneMcLaren Cerner system. When a provider places orders an External Referral order, the referral order will generate two tasks to the Multi-Patient Task List: Referral Workup: The first task generated is a Referral Workup, which displays on the New Referrals .
6 SHS REFERRAL TOOLKIT ITEMS TO BE COMPLETED DONE SCHOOL-LEVEL PLANNING NOTES/IDEAS/RESOURCES Ensure Training for Referral Team Review entire SHS Referral toolkit sections: Rationale for SHS Related Laws and Policies School’s Referral Procedures Provider Information – SHS Provider Info
form (hereinafter “referral form”) which streamlines referrals for children who may be categorically or programmatically eligible for early care and education services. The ECE 002 referral form replaces the CS-186-D-2 Referral for Child Care and Head Start Services (CCHS) form. A copy of the referral form is attached to the policy as .
The Lawyer Referral Service does not have free attorneys. How Does the Lawyer Referral Service Work? When you call the Lawyer Referral Service's toll free number (1-800-392-5660) you will be asked to briefly state your problem. All information will be held in the strictest confidence. After listening to your problem, the Lawyer Referral .
Entering Referral Information on a CMS 1500 Form er the name of the referring provider. Locator 17B: Enter the PCP NPI. Locator 23: Enter the referral number found on the CareFirst BlueChoice referral form (RE followed by 7 digits). If the PCP used a uniform consultation referral form, enter RE0000001.
However, for all Continuity of Care Requests the Uniform Consultation Referral Form on page 5 must be completed by your current provider. Ask your current health care provider who is treating your current condition(s) to do the following: 1. Complete the Provider Section of this form 2. Complete the Uniform Consultation Referral Form 3.
2.4 Overall structure of primary care 61 2.5 Good practices and challenges for structuring primary care 63 2.6 Conclusion 65 References Chapter 3 The delivery of primary care services 67 Andrew Wilson, Adam Windak, Marek Oleszczyk, Stefan Wilm, Toralf Hasvold, Dionne Kringos 3.1 Access to primary care 67 3.2 Continuity of primary care 77
Principles of Primary Health Care Although the name of the program team reflects key service elements, it functions based on the principles of Primary Health Care. Primary health care is integrated and inter-sectoral. Primary health care emphasizes health promotion. Primary health care views the individual as a whole being.
