Behavioral Health Network (BNET)

Guidelines and Requirements

Requirement:Title XXI of the United States Public Health Services Act

Frequency:N/A

Due Date:Ongoing

Description:

Summary

The Managing Entity (ME) shall:

  • Designate a BNet Coordinator on staff to coordinate with providers’ behavioral health liaisons within the region.
  • Ensure providers comply with the eligibility criteria of BNet enrollment.
  • Ensure providers comply with the set protocols outlined for BNet enrollment.
  • Develop and implement a policy for providers related to BNet protocols.

Background

Behavioral Health Network (BNet) is a statewide network of providers of Behavioral Health Services who serve Medicaid ineligible children ages 5 to 19 years of age with mental health or substance abuse disorders who are determined eligible for the Title XXI of the United States Public Health Services Act, KidCare program. It is aimed at treating the entire spectrum of mental health disorders and provides both children and their parents with intense behavioral health planning and treatment services for the duration of the child’s enrollment. The needs of the child are a focal, tailoring the services to address them through:

  • In-home and outpatient individual and family counseling
  • In-home and outpatient targeted case management
  • Psychiatry services and medication management including direct access to PEMHS’ pharmacy with no co-pays
  • Advocacy and provision for wrap-around services to meet each child’s social, educational, nutritional and physical activity needs.

Additionally, specialty services are also incorporated to include Behavioral Analysis, Trauma Therapy and Dialectical Behavior Therapy (DBT).

Policy Development and Implementation

The ME shall develop a written policy to outline key procedures related to BNet and the enrollment of children who are not eligible for Medicaid. While each ME will be responsible for their own layout of the policy, key elements will need to be included including:

  • Designation of BNet Coordinator
  • Form Review
  • Payment Review
  • Compliance reviews
  • Technical Assistance

The ME will designate a coordinator to oversee BNet compliance and enrollment completed by providers. The coordinator will be responsible for ensuring a child is still eligible and enrolled prior to the approval of invoices. Additionally, procedures need to be in place to ensure forms and tracking information is properly completed prior to any final submissions (See attached forms below).

To ensure providers are in compliance with the set protocols listed below, the ME shall complete intermittent reviews of information submitted as well as process reviews. Additionally, the ME should be able to provide technical assistance to providers for questions relating to eligibility, enrollment, disenrollment, and other areas as they relate to BNet.

The information below outlines the administrative protocol related to BNet. Also included within this guidance document are copies of the Screening and Eligibility Tracking Form and the Reverification and Request for Disenrollment Form along. The final page then provides a listing of all of the required reports and their due dates.

ADMINISTRATIVE PROTOCOL

Step I: Initial Contact with the Child

  1. The KidCare program currently accepts applications for enrollment in KidCare continuously throughout the year. Upon initial contact with the child, the Behavioral Health Liaison (Liaison) must determine whether the family has previously submitted an application for KidCare enrollment, and if so, within the past 120 days. If a current application is not on file with KidCare, the Liaison will assist the family in completing an application or reactivating a previously filed application. Concurrent with completing the application, the Liaison should administer the screening portion of the Behavioral Health Network Screening and Eligibility Tracking Form (Form).
  2. If the initial contact is made at a time when enrollment is closed for any reason, the Form should indicate that the child is not eligible for enrollment in the Behavioral Health Network (BNet) as KidCare enrollment is currently closed. The Liaison should inform the parents regarding the restrictions on enrollment and advise them to apply when enrollment reopens. Even in periods of closed enrollment, the family should submit the application form to KidCare, where it will be forwarded to the Department of Children and Family Services, Office of Economic Self-Sufficiency and screened for Medicaid eligibility.
  3. If the parent advises that the child is already enrolled in KidCare, the Liaison proceeds to Step II: Screening to determine whether an assessment is warranted.

Step II: Screening

  1. The Liaison must use the current version of the Form, attached as an exhibit to the current Behavioral Health Network contract.
  2. If the child receives a positive screen, the Liaison completes Part I of the Form and proceeds to Step III: Complete Assessment.
  3. If the child receives a negative screen, the Liaison completes only Part I of the Form, and submits the Form to the Substance Abuse and Mental Health (SAMH) regional office, with a copy to the Children’s Medical Services (CMS) area office. The SAMH regional office forwards a copy of the Form to the Children’s Mental Health State Program Office. Alternatively, the SAMH regional office may approve the Liaison to submit enrollment-related forms directly to the Children’s Mental Health State Program Office with a copy to the regional office.
  4. If the Liaison is processing a referral on a child previously screened by the Liaison/Provider, the Liaison reviews the previous screening results to determine whether the screen was negative or positive. If positive, the Liaison proceeds to Step III: Complete Assessment.
  5. If the previous screen was negative, the Liaison conducts the screen again. If the new screen is positive, the Liaison proceeds to Step III: Complete Assessment. If the new screen is negative, the Liaison completes only Part I of the Form and submits the Form to the SAMH regional office, with a copy to the CMS area office. The SAMH regional office forwards a copy to the Children’s Mental Health State Program Office. The SAMH regional office may, alternatively, approve the Liaison to submit enrollment-related forms directly to the Children’s Mental Health State Program Office with a copy to the regional office.

Step III: Complete Assessment

  1. Following a positive screen, the Liaison conducts, or arranges the conduct of, a complete assessment, which may also include one or more of the following steps:
  2. Verification of previous screening results;
  3. Face-to-face interview with the child’s family;
  4. Completion and/or review of additional assessments as needed (if an assessment has not been completed within the past six months, a new assessment must be completed); and/or
  5. Resolution of any conflicting results.
  6. If the results of the child’s assessment are positive, the Liaison completes Part II of the Form and proceeds to Step IV: Final Behavioral Health Network Determination.
  7. If the results of the child’s assessment are negative for BNet clinical eligibility, the Liaison completes Part II of the Form and submits the Form to the SAMH regional office, with a copy to the CMS area office.
  8. The SAMH regional office forwards a copy of the Form to the Office of Substance Abuse and Mental Health. Alternatively, the SAMH regional office may approve the Liaison to submit enrollment-related forms directly to the Office of Substance Abuse and Mental Health with a copy to the regional office.

Step IV: Final Behavioral Health Network Determination

  1. Following a positive assessment, the Liaison forwards the completed Behavioral Health Network Screening and Eligibility Tracking Form to the regional Behavioral Health Network Coordinator, with a copy to the area CMS office, along with a recommendation regarding acceptance of the child for BNet enrollment. The SAMH regional office may approve the Liaison to submit enrollment-related forms directly to the Office of Substance Abuse and Mental Health with a copy to the regional office, however, the regional office role in approving a child’s enrollment remains unchanged.
  2. The SAMH regional office receives the completed Form and reviews the material to determine whether it agrees with the Liaison’s recommendation regarding the child. The regional Behavioral Health Network Coordinator determines whether a slot is available in the regional’s allocation and should be designated for the child assessed BNet eligible.
  3. If the Liaison’s recommendation is to accept the child for BNet services and the regional office agrees, and a slot is available for the child, the regional encumbers the BNet slot in the child’s name and notifies the Liaison and the Office of Substance Abuse and Mental Health.
  4. TheOffice of Substance Abuse and Mental Health officially notifies CMS Headquarters.
  5. If the SAMH regional office disagrees with the Liaison’s recommendation regarding a child’s qualification for BNet enrollment, it must convene a multi-disciplinary team to review the case. The team decision is binding.
  6. If the Liaison’s recommendation is to accept the child into BNet and the region concurs, but no slot is currently available, the child is enrolled in CMS, designated behavioral health eligible, and provided all medically necessary services, both physical and behavioral, through CMS resources pending the availability of a BNet slot.

1

Prepared By: SAMH Program Office

Last Update: April 11, 2014

BEHAVIORAL HEALTH NETWORK

SCREENING AND ELIGIBILITY TRACKING FORM

Form completed by: / Date:
Telephone No.: / Lead Agency:
Referral Source: (Check one)
CMS / FHK / School / Parent / Other
If FHK Referral or FHK Active – Indicate family account Number
Client Data
Insert following data for the child:
SSN: / Gender: / Male Female
Last Name: / Date of Birth:
First Name: / County of Residence:
Middle Initial: / Legal Custodian’s Name:
Part I – Initial Screening – Clinical Eligibility
Check or complete appropriate boxes. / Yes / No
Child meets all of the Behavioral Health Network Treatability Criteria: 1)Title XXI eligible for KidCare; 2) at least 5 and not yet 19 years of age; 3) requires level of care not available in other KidCare programs and in excess of benchmark benefits in Ch. 409; 4) expected to show improvement or achieve stability from program benefits; 5) requires no more than 30 days residential treatment at time of assessment; 6) family willing to participate in treatment plan goals and objectives. Unmet Criteria: 123456
Child’s custodian has signed the Statement of Understanding.
If “YES” to both of the above, proceed to Part II, Assessment - Clinical Eligibility
Date of Screening: / Behavioral Health Liaison’s Initials:
Part II – Assessment – Clinical Eligibility
The child must meet the clinical eligibility criteria described below as determined by a certified professional designated for making clinical eligibility determinations.
Criteria: / Diagnosis
Primary / Secondary
1. Child has a primary ICD-9-CM Diagnosis of mental disorders or substance-related disorders.
2. Child demonstrates a significant level of functional impairment as measured by the Children’s Global Assessment Scale (CGAS) with a score of 50 or below. / CGASScore
Note: A child diagnosed with Attention-Deficit/Hyperactivity Disorder (Code Series 314.00) as the primary diagnosis does not qualify for Behavioral Health Network services.
Date of Assessment: / Liaison’s Initials: / Circuit Coordinator’s Initials:

BEHAVIORAL HEALTH NETWORK

REVERIFICATION AND REQUEST FOR DISENROLLMENT FORM

Form Completed By: / Date:
Telephone: / Lead Agency:
Purpose of Submission:(Check one) / Reverification / Request for Disenrollment
Client Data
Insert following data for the child:
SSN: / Gender: / Male Female
Last Name: / Date of Birth:
First Name: / County of Residence:
Middle Initial: / Legal Custodian’s Name:
Part I – Assessment – Reverification
Criteria: / Diagnosis
The child must meet the clinical eligibility criteria described below. / Primary / Secondary
1. The child has a primary ICD-9-CM diagnosis of mental disorders or substance-related disorders.
2. Child demonstrates a significant level of functional impairment as measured by the Children’s Global Assessment Scale (CGAS) with a score of 50 or below. / CGAS Score:
Note: A child diagnosed with Attention-Deficit/Hyperactivity Disorder (Code Series 314.00) as the primary diagnosis does not qualify for Behavioral Health Network services.
Date of Assessment: / Behavioral Health Liaison’s Initials:
Part II – Assessment – Request for Disenrollment
Indicate in the check box(es) the reason(s) justifying the Disenrollment action.
Note: Nonpayment of premium, Medicaid eligibility, and turning age 19 are automatic, system-driven disenrollments that do not require submission of a request for disenrollment.
Child has other insurance coverage.
Child has moved out of state.
Child has been placed in residential treatment exceeding thirty (30) days.
Indicate type of placement here:
Child is an inmate of a Public Institution.
Indicate type of institution here:
Child no longer meets the criteria for Behavioral Health Network services as evidenced by:
Declines Services / Noncompliance / CGAS >50 / Completed Tx / Other
Specify “Other” here:
Liaison’s Initials: / Date: / Circuit Coordinator’s Initials:

Behavioral Health Network

Required Reports

Name / Due Date / Number of Copies / Send to:
Monthly Data Required by CFP 155-2 / Within 15 calendar days after end of month / Electronic Submission / Office of Substance Abuse and Mental Health as appropriate
Alternative Services Provision Documentation
(Other than Pharmaceuticals) / Within 15 calendar days after end of month / One (1) hard copy, or one (1) faxed copy, or one (1) encrypted attachment to an email to each recipient. / Regional Office Contract Manager/BNet Coordinator/ Office of Substance Abuse and Mental Health
Alternative Services Provision Documentation
(Pharmaceuticals only) / Within 15 calendar days after end of month / One (1) hard copy, or one (1) faxed copy, or one (1) encrypted attachment to an email to each recipient. / Regional Office Contract Manager/BNet Coordinator /Office of Substance Abuse and Mental Health
Statement of Program Cost / September 1 following close of the contract year (June 30) / One (1) hard copy, or one (1) faxed copy, or one (1) encrypted attachment to an email to each recipient. / Regional Office Contract Manager/BNet Coordinator/Office of Substance Abuse and Mental Health
Auxiliary Aid Service Record / Monthly, by the fifth business day of the month / 1 to Circuit / Regional SAMH
Office of Substance Abuse and Mental Health