Performance Indicator Process Overview for Implementation
This PowerPoint presentation, shared with key stakeholders, focuses on a new indicator (#2A) tracking the completion of biopsychosocial assessments within 14 days of a non-emergency service request. The data includes populations like MI adults, MI children, IDD adults, and IDD children. Medicaid eligibility criteria and reporting responsibilities for CMHSPs and PIHPs are outlined, with additional details on population definitions provided. The slides also cover the process for categorizing individuals as MI or IDD, enhancing understanding of the performance indicator process.
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Presentation Transcript
General Notes on the Slide Deck This PowerPoint presentation was shared on October 17thand 18th to PIHP, CMHSP and other participants who have a key role in the performance indicator process including information technology staff as well as quality improvement and clinical staff. Subsequent changes in response to questions and requests for clarification from participants are in rust-colored font. The notes below each slide include additional background information. Kathy Haines will give a final overview of these slides on November 18thand 19thas a training for implementation of Indicator #2a. NEW INDICATOR #2A
Indicator #new 2a The percentage of new persons during the quarter receiving a completed biopsychosocical assessment within 14 calendar days of a non-emergency request for service (by four sub-populations: MI-adults, MI-children, IDD-adults, IDD-children. No Standard for 1st year of implementation will use information to determine baseline. NEW INDICATOR #2A
1. 2. 3. 4. % of Persons Requesting a Service Who Received a Completed BPS Assessment within 14 Calendar Days # of New Persons Who Requested Mental Health or I/DD Services and Supports and are Referred for a Biopsychosocial Assessment # of Persons Completing the Biopsychosocial Assessment within 14 Calendar Days of First Request for Service Population 1. MI-C 2. MI-A 3. IDD -C 4. IDD-A 5. Total Population NEW INDICATOR #2A
Column 1 Populations Children Children are counted as such who are less than age 18 on the last day of the reporting period. Medicaid Count as Medicaid eligible any person who qualified as a Medicaid beneficiary during at least one month of the reporting period. This includes both traditional Medicaid and Healthy Michigan. Indicators # 1, 2, 3, 4, 10, and 11 are to be reported by the CMHSPs for all their people served, and by the PIHPs for all their Medicaid beneficiaries. The PIHP reports these indicators for all the Medicaid beneficiaries in their region. This definition includes people who have both Medicaid and Medicare coverage. Populations not included People covered under OBRA are excluded from the indicator. People covered under the Medicaid autism benefit are currently excluded from the indicator. These Definitions and instructions are in the Performance Indicator Codebook. NEW INDICATOR #2A
Column 1 Populations (cont) Intellectual Disability and Developmental Disability (I/DD) as defined in the Mental Health Code Mental Illness (MI/SED) - the individual has an MI DSM Diagnosis NEW INDICATOR #2A
Process for assigning people to either MI or IDD category Individuals who have both mental illness and an intellectual or developmental disability 1. If a biopsychosocial is completed for the person: Assign person to either MI or IDD category based on primary diagnosis. If person has both MI and IDD diagnoses: Assign a person as either MI or IDD based on the primary diagnosis related to the greatest level of impairment and . the services they are being referred to or being treated for. If can t determine whether MI or IDD category is predominant, categorize the person as IDD. 2. If BPS has not (not yet) been completed for the person: Assign person to either the MI or IDD category based on the services the person requests. If the person requests both MH and IDD services, categorize the person as IDD. If it can t be determined what type of services are being requested, categorize the person as MI. REMINDER TO CLINICIANS If individual s category is different at conclusion of biopsychosocial assessment from what was entered by access screener, update the EHR accordingly so proper category is used for the indicator. NEW INDICATOR #2A
Column 2 Selection Methodology Cases selected for inclusion in Column 2 are those new Medicaid beneficiaries who made a non- emergency request for specialty mental health (MH) or intellectual and developmental disability (IDD) services and supports and were referred for a biopsychosocial assessment during the quarter. Terms to Define Initial request New consumer, reportable person Non-emergency Request for MH or IDD services & supports During the quarter, reporting quarter NEW INDICATOR #2A
Column 2 Selection Methodology (cont) Initial request The initial telephone or walk-in request for non-emergency services by the individual, parent of minor child, legal guardian, referral Non-emergency, non-urgent request Emergency and urgent requests for MH and IDD services are excluded from this indicator. Emergency and urgent are used here as defined in the Mental Health Code Requests of this type are not included in the counts for Column 2. NEW INDICATOR #2A
Column 2 Selection Methodology (cont) The reporting quarter is when: The person or their representative makes an initial request and The access system refers the person for a biopsychosocial assessment If date of request and referral date are not on the same day: The reporting quarter is based on the request date. Example: If the request is 3/31/2020 and the referral is 4/1/2020, the reporting quarter is the 2nd quarter 2020 (Jan-March 2020). NEW INDICATOR #2A
New, Reportable Person Rule #1 New, Reportable Person either The person has never been seen by the PIHP for mental health services or for services for intellectual and developmental disabilities, or Rule #1 It has been 90 days or more since the individual has received any MH or IDD service from the PIHP. Reminder Note from 10/17/2019: Person can be new to the CMHSP but not the PIHP because they were seen at another CMHSP. CMHSP indicator would report individual as new . PIHP would go through all of the new persons reported by the various CMHSPs and determine if they are new to the PIHP. For this indicator, the PIHP will only report those people who are new to the PIHP. NEW INDICATOR #2A
Column 2 Selection Methodology (cont) Request for MH or IDD services & supports Indicator 2A measures the timeliness of assessments under the PIHP s MH/IDD benefit. For this indicator, the person is considered New or reportable if they have received no MH/IDD services in the previous 90 days. If the person has received SUD services in the last 90 days, but no MH/IDD services the person is reportable for indicator 2A. If a new person is requesting services for both mental health/intellectual and developmental disability as well as substance use disorder, include the person in this current indicator (#2a) if referred for services to a CMHSP. Also include the person in the substance use disorder indicator (#2b) if the person is admitted to a licensed and accredited SUD provider. NEW INDICATOR #2A
New, Reportable Person - after stabilization from crisis New, Reportable Person Rule#2 People who are new to the system who come in with a crisis and are stabilized are counted as "new" for indicator #2a when they subsequently make a non-emergency request for MH or IDD services. The indicator will be tracked from the point of the non- emergency request forward. The non-emergency request will be the request date. Rule #2 Another way to look at it. If over the past 90 days the person has only received crisis services, they are new or reportable for indicator 2A. NEW INDICATOR #2A
Column 2 Selection Methodology (cont) Crisis services are defined by the following codes: Any service from a psychiatric inpatient stay H2011 Crisis intervention, Intensive Crisis Stabilization for Children or for Adults S9484 Intensive Crisis Stabilization T1023 Screening for Inpatient Program 90839 Psychotherapy for Crisis 90840 Psychotherapy for Crisis H0018 Crisis Residential 0912, 0913 Partial Hospitalization if T1023 reported. NEW INDICATOR #2A
Column 2 Selection Methodology (cont) People who come in with a crisis and are stabilized are counted as "new" for indicator #2A when they subsequently make a non-emergency request for MH or IDD services. Non- Emergency Request 2-1-2020 (Initial Request) Emergency Request 1-1-2020 H2011 Denominator, Column 2: 0 1 NEW INDICATOR #2A
New, Reportable Person - 60 days after the initial request New, Reportable Person Rule #3 If a new person does not receive any subsequent services following an initial request (for example due to cancelled appointments), the person is considered new if it has been 60 days or more than 60 days since the date of this initial request. Workgroup and BHDDA leadership decided that as a rule of thumb: If within the 60 days following an initial request, the person has not received any services is not scheduled for services it is good practice to rescreen the person to see if the clinical determination needs to be revised. If this person makes a subsequent request at or after 60 days of the initial request, this subsequent request is counted in the denominator, Column 2. Important to Note: A person can be counted no more4 than twice in the denominator during a quarter. Rule #3 NEW INDICATOR #2A
Column 2 Selection Methodology (cont) New, Reportable Person 60 days after 60 days from the initial request. In this example a request is reportable on or after 3-2-2019 Third Request (New Initial Request) 3-5-2020 Second Request 2-1-2020 Initial Request 1-1-2020 1-3-2020 BPS cancelled 2-3-2020 BPS cancelled 3-1-2020: 60 Days Denominator: 1 1 + 1 1 + 0 NEW INDICATOR #2A
Column 3 Numerator Methodology Cases selected for inclusion in Column 3 are those in Column 2 for which the biopsychosocial assessment was completed within 14 calendar days following the first request. Terms to Define Following the first request, counting forward Within 14 days Request Date Completion of biopsychosocial NEW INDICATOR #2A
Column 3 Numerator Methodology (cont) Counting forward Count from the date of the first request to the completion date of the biopsychosocial assessment. If BPS assessment is not completed within 14 days from the initial request, then the person is not counted in the numerator (column #3). The information for the indicator is reported for the quarter during which the request occurred. NEW INDICATOR #2A
Column 3 Numerator Methodology (cont) Determining date of request If date of request and referral date are not on the same day: The reporting quarter is based on the request date. Example: If the request is 3/31/2020 and the referral is 4/1/2020 the request is reported for the 2nd quarter 2020 (Jan-March 2020). Person difficult to reach after leaving initial request, the date of the person s first request is the request date. Important to note the request starts once the person provides their name and contact information. Example: 1/1/2020 The person calls for the first time and leaves a message, with name and call-back information, requesting services. 1/1/2020 The access center calls the person back, is unable to reach the person but leaves a message. 1/15/2020 the person calls back to request services and receives a referral for a BPS. The request date is 1/1/2020. NEW INDICATOR #2A
Column 3 Numerator Methodology (cont) Determining date of request (con t) In the case of a referral from an outside organization the request date is the date the person (or parent or guardian) agrees to the referral. If the person is referred from an inpatient psychiatric facility, the request date is the date that the person is discharged from the facility. Note from 10/17 if person is new to the PIHP, include them in this indicator (#2a). This is a subset of the people reported in indicator #4. indicator 2 is looking at request to assessment while Indicator #4 is looking at access to services after the hospitalization. Note from 10/18: A call to cancel or reschedule an appointment is not a request. NEW INDICATOR #2A
If the BPS assessment is not completed within 14 days from the initial request, then the person is not counted in the numerator (column #3). BPS Initial Request 3-1-2020 14 Days assessment 3-30-2020 3-15-2020 Denominator 2nd quarter Numerator 2nd quarter 1 0 NEW INDICATOR #2A
The information for the indicator is reported for the quarter during which the request occurred Initial Request 3-20-2020 BPS 14 Days assessment 4-3-2020 4-1-2020: Start of 3rd Quarter Denominator 2nd quarter Numerator 2nd quarter 1 1 NEW INDICATOR #2A
Calculation Methodology A call to cancel or reschedule an appointment is not counted as a request and is not the request date. Call to Reschedule BPS 1-3-2020 1-4-2020 BPS rescheduled to 1-16-2020 Initial Request 1-1-2020 1-16-2020 BPS 1-15-2020 14 Days Numerator: Denominator: 0 1 0 NEW INDICATOR #2A
Column 3 Numerator Methodology Completion of biopsychosocial assessment Professional has submitted an encounter for the assessment. and A qualified professional has determined a diagnosis for the individual. If the biopsychosocial assessment and the determination of the diagnosis occur on different dates, when both are completed and in place, use the latter date when calculating the time from the initial request to the completion of the biopsychosocial assessment. NEW INDICATOR #2A
Calculation Methodology Calculate the percentage of those persons who made a request who received a completed biopsychosocial assessment within 14 days. If a person makes multiple requests, only use the initial request date in the calculation. NEW INDICATOR #2A
Calculation Methodology Only use the initial request date in the calculation Initial Request 1-1-2020 Second Request 2-1-2020 1-3-2020 BPS cancelled 2-3-2020 BPS 1-15-2020 14 Days Numerator: Denominator: 0 1 NEW INDICATOR #2A
Mental Health Code 330.1100 (29) "Emergency situation" means a situation in which an individual is experiencing a serious mental illness or a developmental disability, or a minor is experiencing a serious emotional disturbance, and 1 of the following applies: (a) The individual can reasonably be expected within the near future to physically injure himself, herself, or another individual, either intentionally or unintentionally. (b) The individual is unable to provide himself or herself food, clothing, or shelter or to attend to basic physical activities such as eating, toileting, bathing, grooming, dressing, or ambulating, and this inability may lead in the near future to harm to the individual or to another individual. (c) The individual has mental illness that has impaired his or her judgment so that the individual is unable to understand his or her need for treatment and presents a risk of harm. (18) "Urgent situation" means a situation in which an individual is determined to be at risk of experiencing an emergency situation in the near future if he or she does not receive care, treatment, or support services NEW INDICATOR #2A
Mental Health Code 330.1100 (12) "Intellectual disability" means a condition manifesting before the age of 18 years that is characterized by significantly subaverage intellectual functioning and related limitations in 2 or more adaptive skills and that is diagnosed based on the following assumptions: (a) Valid assessment considers cultural and linguistic diversity, as well as differences in communication and behavioral factors. (b) The existence of limitation in adaptive skills occurs within the context of community environments typical of the individual's age peers and is indexed to the individual's particular needs for support. (c) Specific adaptive skill limitations often coexist with strengths in other adaptive skills or other personal capabilities. (d) With appropriate supports over a sustained period, the life functioning of the individual with an intellectual disability will generally improve. NEW INDICATOR #2A
(25) "Developmental disability" means either of the following: (a) If applied to an individual older than 5 years of age, a severe, chronic condition that meets all of the following requirements: (i) Is attributable to a mental or physical impairment or a combination of mental and physical impairments. (ii) Is manifested before the individual is 22 years old. (iii) Is likely to continue indefinitely. (iv) Results in substantial functional limitations in 3 or more of the following areas of major life activity: (A) Self-care. (B) Receptive and expressive language. (C) Learning. (D) Mobility. (E) Self-direction. (F) Capacity for independent living. (G) Economic self-sufficiency. (v) Reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are of lifelong or extended duration and are individually planned and coordinated. (b) If applied to a minor from birth to 5 years of age, a substantial developmental delay or a specific congenital or acquired condition with a high probability of resulting in developmental disability as defined in subdivision (a) if services are not provided. NEW INDICATOR #2A
(2) "Serious emotional disturbance" means a diagnosable mental, behavioral, or emotional disorder affecting a minor that exists or has existed during the past year for a period of time sufficient to meet diagnostic criteria specified in the most recent Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and approved by the department and that has resulted in functional impairment that substantially interferes with or limits the minor's role or functioning in family, school, or community activities. The following disorders are included only if they occur in conjunction with another diagnosable serious emotional disturbance: (a) A substance use disorder. (b) A developmental disorder. (c) "V" codes in the Diagnostic and Statistical Manual of Mental Disorders. NEW INDICATOR #2A
(3) "Serious mental illness" means a diagnosable mental, behavioral, or emotional disorder affecting an adult that exists or has existed within the past year for a period of time sufficient to meet diagnostic criteria specified in the most recent Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and approved by the department and that has resulted in functional impairment that substantially interferes with or limits 1 or more major life activities. Serious mental illness includes dementia with delusions, dementia with depressed mood, and dementia with behavioral disturbance but does not include any other dementia unless the dementia occurs in conjunction with another diagnosable serious mental illness. The following disorders also are included only if they occur in conjunction with another diagnosable serious mental illness: (a) A substance use disorder. (b) A developmental disorder. (c) A "V" code in the Diagnostic and Statistical Manual of Mental Disorders. NEW INDICATOR #2A
