February 5, 2019 Long-Acting Injectables (LAI) Toolkit Updates

February 5, 2019 Clarification Regarding Professional Liability Insurance Requirement

January 8, 2019 Provider Personnel Roster

January 7, 2019 ASAM Level 3.5 Distinctions

December 19, 2018 Narcan/Naloxone Dispensing

December 12, 2018 EBP Enhanced Rate

December 7, 2018 Important Message from DBHIDS re: ASAM Requirement 

December 6, 2018 CBH as Primary Payer for Select Drug and Alcohol Services 

November 26, 2018 ASAM Training Requirements and Provider Attestation

November 26, 2018 Spanish-Language Services

November 2, 2018 Use of ASAM Medical Necessity Criteria

October 19, 2018 Claims ORP Prescriber and Updated Companion Guides

October 16, 2018 Third Annual Compliance Forum November 8, 2018

October 15, 2018 Einstein CRC Relocated

October 12, 2018 Reminder re: Billing for TCA Screens

September 11, 2018 BHRS and STS Packet Exceptions

August  31, 2018 Complaint Investigations to Occur at Provider Sites

August 10, 2018 Notification Regarding Letter from City Controller

August 3, 2018 Significant Incident Report Sharing Among BHMCOs

July 24, 2018 Fetanyl and Opioid Use Disorder Treatment

July 24, 2018 Guidance on Verifying Identity for Substance Use Treatment Providers

July 23, 2018 Denials Process

July 18, 2018  2018 P4P Data Request Process

July 17, 2018 City Controller Audit

June 11, 2018

June 8, 2018

Opioid Use Disorder Incentive Proposal Information

May 1, 2018 Vitals and UDS No Longer Required to Authorize Substance Use Treatment

May 1, 2018 TRWI Implementation Reminder for Residential Drug Treatment Providers

April 20, 2018 P4P Bonus for Mental Health and Substance Use Outpatient Treatment Providers

April 17, 2018 P4P Transition to Value-Based Purchasing: Webinars

April 2, 2018 DBHIDS/CBH Secure File Exchange: Removal of Inactive Accounts

March 20, 2018 City Controller Audit

January 16, 2018

Provider Personnel Roster 2018

January 4, 2017:

Children’s Crisis Services & CRC Opening

2017

December 28, 2017 DHS Guidance for Ordering, Referring and Prescribing

December 15, 2017 CBH Holiday Closures

December 12, 2017 EBP Designation Application Now Open

December 7, 2017 EDI Browser Shutdown and New Claims Testing Process

November 20, 2017 Provider Satisfaction Survey

November 20, 2017 Transition to New Clinical Information System

October 25, 2017 LAI Toolkit

October 23, 2017 Invitation to Addictions Provider Forum

October 20, 2017 Compliance Forum
October 17, 2017 EBP Designation

October 12, 2017 Invitation to Follow-up on Adult Acute Inpatient and Outpatient Psychiatric Provider Forum

October 6, 2017 EBP Enhanced Rate

October 5, 2017 Psychological Diagnosis of ASD Outside of Specialized Centers

September 8, 2017: BHRS Provider Forum FAQ

August 24, 2017: CRC Interim Plan

CRC Flyer

August 21, 2017: Provider Request for P4P Data

August 15, 2017: Intern Training and Documentation Requirements

August 15, 2017: Limited English Proficiency: MA Provider Requirements

August 9, 2017: Einstein Germantown CRC to No Longer Provide Children’s CRC Services and Interim Plan

August 2, 2017

OMHSAS Changes to BCBA and BSL Procedures

July 25, 2017

Changes to Psychiatric Emergency Services (PES) Line Pre-certification Process

May 30, 2017

Adult Inpatient and Outpatient Psychiatric Provider Forum Invite

  • Please RSVP for this event HERE

May 22, 2017

Staff Qualification Attestation

On April 11, 2017, Community Behavioral Health (CBH) issued a Provider Bulletin advising of the requirement that provider agency CEOs/Executive Directors attest, in writing, that all agency staff meets the qualifications for their respective positions.

Please complete and sign the attestation form here and return to the CBH Compliance department, by June 19, 2017. Forms may be mailed to our office address, attention Nicole Beaufort, or sent via email to CBH.ComplianceContact@phila.gov. Any questions regarding the attestation may also be directed to this email address. Thank you in advance for prompt attention to this matter.

May12, 2017

TSS Supervisor Requirements Correction

May12, 2017

Clinical Supervision Training Registration Correction

May 9, 2017

Mandatory Medication Assisted Treatment (MAT) Forums

Please click here for very important information!

May 9, 2017

Provider Applications

CBH will be launching the new Provider Application on June 1, 2017. The Provider Application will help CBH obtain accurate information for referral and network management, thereby minimizing CBH requests for provider details throughout the year.

We recognize that completing the initial application will require some time, particularly for larger providers with multiple program service locations. We request that each provider identify a Provider Application project manager to streamline the process. This person will work closely with the assigned CBH Provider Representative to lead the initiation, execution, and ongoing monitoring of the Provider Application. Please email your Provider Representative the name and contact information for the designated Provider Application project manager by May 15, 2017. Provider Applications must be submitted by July 3, 2017.

CBH will be scheduling multiple Provider Application webinars, which will address details about the process and give providers the opportunity to ask questions. Thank you for your ongoing collaboration and communication regarding this process.

April 28, 2017

CBH has engaged the Consumer Satisfaction Team, Inc. (CST) to conduct a member satisfaction survey for adult members receiving mental health outpatient (MHOP) services.  CST is a non-profit organization staffed entirely by individuals in recovery from mental illness and/or substance use and family members of individuals in recovery.  CST is authorized by the Office of Behavioral Health and CBH to assess member satisfaction with behavioral health services.

The MHOP survey is based on the Adult Mental Health Statistics Improvement Program Survey (MHSIP) developed by SAMHSA and used by state governments and other jurisdictions across the country (https://www.nri-inc.org/state-consumer-surveys). The survey results will be reported to providers, along with other MHOP performance measures, later this calendar year. In 2018, the surveys will be scored and applied to Pay-For-Performance (P4P).

Adult MHOP providers will be hearing from CST during the coming weeks to schedule a time for a CST survey specialist to visit the MHOP site and conduct the survey with CBH members in person. Please communicate to MHOP staff to make every effort to accommodate the survey specialists, so that your results can be included in the reports for MHOP P4P this year.

Please direct questions about CST, the survey, or P4P, to Susanna Kramer, Performance Evaluation, Analytics, and Research (PEAR) Program Evaluation Coordinator, at Susanna.Kramer@phila.gov.

April 26, 2017

Clinical Supervision Training for Provider Supervisors

In collaboration with the Behavioral Health Training and Education Network (BHTEN), CBH would like to announce the upcoming Effective Clinical Supervision: Part 1 training to be held on June 2, 2017. Please see the flyer for details and distribute to eligible staff.

April 26, 2017

Philadelphia 8-Hour MAT Waiver Trainings

Please see attached flyer for a MAT Waiver training to be held at CBH on April 29, 2017. This training is provided by the American Academy of Addiction Psychiatry and is open to all physicians and nurse practitioners.

April 25, 2017

To streamline communication to the provider network, CBH is implementing the following changes:

  1. The DBHIDS website will be the primary and most immediate source of CBH announcements. We will continue to post Bulletins and Notifications to the DBHIDS website to inform the provider community of new policies and procedures, upcoming trainings and events, new contracting opportunities, and other announcements.
  1. CBH will discontinue the provider-specific CBH News Blast. To reduce the number of CBH emails that provider executive directors must review and distribute, we will no longer send Blasts to directors only. If providers wish to receive the general CBH News Blast for the wider stakeholder community (described in #3 below), please sign up on the DBHIDS website here. This applies to directors who previously received the provider CBH News Blast, as CBH will not be transferring provider addresses to the general list. This will allow the option of designating specific and/ or multiple News Blast recipients moving forward, ideally reducing the burden on provider executive directors.
  1. CBH will continue to send the general CBH News Blasts to all recipients who sign up on the DBHIDS website and will limit the frequency of these Blasts to twice weekly. These blasts will include 1) a summary of CBH/ DBHIDS announcements for the stakeholder community and 2) a summary of all recent website postings, including Bulletins and Notifications (the twice-weekly general CBH News Blast is now the primary mechanism CBH will use to alert providers of new website postings). This change is also intended to reduce the number of emails recipients must manage.

These changes are effective immediately. As we transition to the above processes, please continue to check the DBHIDS website regularly for all CBH announcements, and be sure to sign up for the CBH News Blast if you would like to receive the twice weekly summaries.

Please direct all questions regarding these changes to CBHNDTechnicalAssistance@phila.gov

April 25, 2017

Please note that a RFP for EAC(s) has been posted on the DBHIDS website under Contracting Opportunities. A bidders conference will be held on Monday, May 1, 2017 at CBH 801 Market Street, Philadelphia, PA 19107 in the Large Conference Center on the seventh floor at 1:00PM. Providers interested in applying for the RFP are encouraged to send a representative to this event.

April 17, 2017

Please click here to view the notice regarding Outpatient Mental Health Service Providers Practices

April 13, 2017

Provider Notice Regarding Supervision of Therapeutic Staff Support (TSS) in Behavioral Health Rehabilitative Services (BHRS)

CBH has observed that many BHRS providers utilize their Behavior Specialist Consultants (BSC) and Mobile Therapists (MT) for the onsite component of supervision for (TSS) workers. Providers are reminded that Medical Assistance (MA) regulations indicate the following:

  1. Provider billing for TSS supervision is prohibited. Therefore, CBH Compliance Department considers billing for supervision of TSS workers a Non-Billable Activity (Audit Variance Code N) and will recoup payments during audits made for BSC and MT claims in which the documentation indicates the provision of supervision of a TSS by a BSC or MT.
  2. BSC and MT case consultation, a billable activity, cannot be counted as TSS supervision. BSC and MT case consultation activities should be clearly documented as such in the member’s chart.
  3. TSS workers should be supervised by one supervisor who:
    • Is a licensed mental health professional
    • Holds a graduate degree and at least one year of experience either
      • In a Child and Adolescent Service System Program (CASSP) as defined by MA1 or
      • Employed by a licensed mental health agency or subcontracted agency
  4. The BSC or MT for a particular child is not the supervisor for the TSS assigned to the case.
  5. Periodic on-site supervision must be part of TSS supervision, and providers may bill for TSS services delivered during on-site supervision. (Some providers have misinterpreted this stipulation to mean the BSC and MT assigned to the child can provide the supervision. This is an incorrect reading of the MA requirement).
  6. Documentation of TSS supervision must be kept in the employee file, not in a member’s chart.

Details regarding MA regulations of TSS supervision can be found in MA Bulletin 01-01-05 Revisions of Policy and Procedures Relating to Mobile Therapy, Behavioral Specialist Consultant and Therapeutic Staff Support1 and in the Frequently Asked Questions addendum to the MA Bulletin.2
Please note that TSS supervision documentation may be requested as part of Network Improvement and Accountability Collaborative (NIAC) and/or Compliance Department site visits. Questions regarding this Notification can be directed to CBH.Compliancecontact@phila.gov.

Commonwealth of PA, Department of Public Welfare. (2001). Revisions of Policy and Procedures Relating to Mobile Therapy, Behavioral Specialist Consultant and Therapeutic Staff Support. PA Department of Public Welfare. Retrieved 4/11/17 from http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/d_004396.pdf

Commonwealth of PA, Department of Public Welfare. Behavioral Health Rehabilitative Services (BHRS) Frequently Asked Questions. Retrieved 4/11/17 from

http://www.dhs.pa.gov/provider/frequentlyaskedquestions/behavioralhealthrehabilitationservicesbhrsfrequentlyaskedquestions/

March 31, 2017

P4P Measurement and Threshold Webinars: Schedule Change

On March 20, 2017, CBH posted a Notification regarding upcoming P4P Measurement and Threshold Webinars. This Notice is to inform providers of two changes in meeting dates for Behavioral Health Rehabilitative Services (BHRS) and Community Integrated Recovery Centers (CIRC) levels of care. Please see the updated schedule here.

As a reminder, if you wish to attend any of the P4P meetings, please register as follow:.

For in-person attendance, please contact Naima Ware at naima.ware@phila.gov. Meetings will be held at CBH at 801 Market Street, Philadelphia, PA 19107..

For GoToMeeting participation, it is vital to register in advance using the links provided in the schedule. Registering ensures that you receive instructions to log on to the meeting, view slides, and hear the conversation.

We routinely revise our P4P measures to ensure they are indicative of quality and consistent with good clinical practice. As we enter into the seventh year of P4P, we continue to appreciate your vital contribution to the methodology discussion.

March 27, 2017
Rate for Applied Behavior Analysis (ABA) through Behavioral Health Rehabilitative Services (BHRS)
 
As part of an ongoing initiative to expand access to evidence-based treatment for individuals with autism spectrum disorder (ASD), CBH is making every effort to assemble a network of high quality providers who deliver Applied Behavior Analysis (ABA) services. CBH has created ABA Performance Standards  and will be designating BHRS ABA providers who meet or exceed these standards, as demonstrated via the ABA Designation Application. CBH designated ABA providers will be eligible to receive ABA referrals and enhanced ABA rates. The enhanced rate for ABA is intended to acknowledge the need for specialized training, increased supervision, and ongoing workforce development to deliver high quality ABA services.

ABA rates are as follow:
ABA Behavior Specialist Consultant (BSC) – $22.50 per 15 minutes
ABA Therapeutic Support Staff (TSS) – $16.00 per 15 minutes

To assist providers in expanding ABA clinical capacity and becoming CBH ABA designated providers, a Request for Applications (RFA) has been posted to solicit in-network BHRS providers to participate in an ABA training program. The selected providers will receive 40 hours of a web-based advanced training for a predetermined number of Therapeutic Support Staff (TSS). This training corresponds with the number of required training hours for a Registered Behavior Technician (RBT) and is consistent with training requirements for TSS workers per the CBH ABA Performance Standards. There is no cost to providers for this training opportunity. However, CBH requests that providers seriously consider the organizational commitment required to successfully implement and sustain an evidence-based practice prior to applying for the RBT training hours.
CBH has prioritized expanding ABA provider capacity by June 1, 2017. If this process does not yield sufficient capacity to meet members’ needs, we will explore procurement options.
Questions regarding this Notification can be directed to your Provider Representative.

March 20, 2017

P4P Measurement and Threshold Webinars

Thank you for your collaboration around Pay-for-Performance (P4P). We are pleased to announce the opening round of provider meetings to review 2017 performance measures and thresholds for services provided in measurement year 2016. Meetings are listed here by level of care and, where applicable, specialty population group. This year, we are combining the Drug and Alcohol Outpatient (DAOP) and Intensive Outpatient (IOP) webinars, as all of our IOP providers also provide DAOP services. Providers who do not deliver IOP services are not obligated to participate in the latter portion of the webinar specific to IOP services.

As in the previous year, we will provide the option of attending these meetings in-person or online via GoToMeeting. Due to space limitations, we are asking that your register as soon as possible if you wish to attend, and send only one person from your organization to that meeting. We will be able to accommodate the first 20 respondents in each meeting; beyond that number we may need to ask you to participate via GoToMeeting.  If you need accommodations under the Americans with Disabilities Act (ADA) to participate in any meeting, please let us know; we will be sure to reserve in-person space and/or provide other accommodations needed.

If you wish to attend any of the P4P meetings, please register as follow:

For in-person attendance, please contact Naima Ware at naima.ware@phila.gov. Meetings will be held at CBH at 801 Market Street, Philadelphia, PA 19107.

For GoToMeeting participation, it is vital that you register in advance using the links provided in the meeting schedule. Registering ensures that you receive instructions to log on to the meeting, view slides, and hear the conversation. We recommend that GoToMeeting participants dial-in to the meeting on the telephone rather than using the integrated audio option, as this seems to provide the best experience.

We routinely revise our P4P measures to ensure they are indicative of quality and consistent with good clinical practice. As we enter into the seventh year of P4P, we continue to appreciate your vital contribution to the methodology discussion.

March 13, 2017

CBH Administrative offices will be closed Tuesday, March 14, 2017

Due to the impending winter storm that is forecasted for our area tomorrow, CBH will close it’s Administrative Offices.

The Psychiatric Emergency Service (PES) and Member Services lines will be fully operational and will not be impacted by the administrative office closure. Electronic claims submissions will also not be affected.

March 13, 2017

Daily Inpatient Bed Availability and Substance Use Disorder Treatment Capacity Survey

CBH implemented Provider Bulletin #16‐06 entitled Daily Psychiatric and Substance Abuse Open Bed Registry on February 20, 2017. Please remember that provider implementation of survey requirements is essential to ensure accurate assessment of network capacity and access to treatment for our members. Surveys must be completed daily.

The survey requirements are mandatory for all Inpatient and Substance Use Disorder Treatment providers.  Please complete by noon each day.

CBH staff will be hosting three form.com webinars to train identified staff to complete the InpatientSubstance Use Availability Survey. Please pass this notification to involved staff, so they can participate in one of the three webinar training sessions.

InpatientSubstance Use Availability Surveys Webinar

  • March 22, 2017  Webinar     1:00 PM – 2:00 PM ET
  • March 23, 2017  Webinar     2:00 PM – 3:00 PM ET
  • March 24, 2017  Webinar     11:00 AM – 12:00 PM ET

Webinar Login for CBH Provider Survey Training

Please join my meeting from your computer, tablet or smartphone.
https://global.gotomeeting.com/join/559483493 

You can also dial in using your phone.
United States: +1 (646) 749-3112

Access Code: 559-483-493

Alternate Option:

https://www.gotomeeting.com/meeting/join-meeting

Meeting ID:  559-483-493

CBH Guide for the use of Provider Capacity Surveys

 

March 7, 2017
P4P Advisory Committee Selection

On February 8, 2017, an email was sent to all Executive Directors formally announcing the upcoming formation of a Pay-for-Performance (P4P) Advisory Committee. In this announcement, providers were asked to submit by Friday, February 17, 2017 names and contact information of staff members who would be interested in participating in the committee.  Following this announcement, CBH received a high number of staff members proposed for participation in the committee. In order to ensure the committee is effective and efficient, we must limit the number of participants. Please note that not every provider agency could be offered the opportunity to participate given the volume of responses.  We aimed to ensure a broad representation of individuals across providers and levels of care, capturing the diversity of our network. Selected organizations were limited to one staff member who plays a role in quality, performance improvement, or compliance. The staff members selected will receive direct correspondence inviting them to the first Advisory Committee meeting. Please contact Susanna Kramer at susanna.kramer@phila.gov if you have any questions.

February 23, 2017

Staff Roster Reminder

On December 28, 2016, the CBH Compliance Department released the 2017 staff roster template with a submission due date of January 31, 2017. Executive directors were contacted by email and a Provider Notice was also posted on the CBH Compliance page of the DBHIDS website

If your agency has not yet submitted a staff roster, or if you have been notified that your roster is incomplete, it is essential that you submit the complete roster to CBH.ComplianceContact@phila.gov immediately, but no later than March 10, 2017. Failure to submit a complete roster by March 10 will result in an Event of Default under the CBH Provider Agreement and applicable sanctions will be applied.

The 2017 roster template can be found on the CBH Compliance page of the DBHIDS website. If you have any questions related to the roster, please contact Mark Miller at Mark.D.Miller@phila.gov or Amy Cruz at Amy.Cruz@phila.gov

February 23, 2017

Connectivity Update

CBH is continuing to have connectivity issues to the City, preventing providers from submitting EDI claims, Electronic Packets or receiving response files, 835s, authorization reports, and other files sent or received through the EDI Browser.

Please send BHRS Packets, using Secure Email (Protected Trust)

Send to:
CBH.CBCAFS.Insufficients@phila.gov
We will update you daily and as we receive more information.
CBH providers using the IPSwitch solution can continue to send EDI Claims.
We apologize for any inconvenience.

February 22, 2017

Due to a mishap related to construction outside our building, we have temporarily lost connectivity to the City, preventing providers from submitting EDI claims or receiving response files, authorization reports, and other files received through the EDI Browser. We will update you tomorrow, as we receive more information.,

February 13, 2017

Provider Notice on CBH Fraud, Waste, and Abuse Hotline Posting

CBH providers are reminded that CBH maintains a hotline for reporting fraud, waste, and abuse by CBH employees, vendors, contractors, members, and network providers. Per the CBH Provider Manual, it is mandatory that providers display the hotline posting in a location visible to CBH members and provider staff.

Updated versions of the posting in English and Spanish are linked below. Reports can be made anonymously via phone or email. CBH on-site audits may include requests to view the posting. Please contact the CBH Compliance Department at CBH via ComplianceContact@phila.gov for any questions regarding this Provider Notice.

Hotline Posting – English
Hotline Posting – Spanish

February 13, 2017

Packet Exemption

Consistent with our goal at CBH to operate economically and efficiently, we are adopting a new approach this year for requests for summer supports which are commensurate with services approved during the school year. This change will be effective March 13, 2017.

If the summer services requested fall within the timeframe of the most recent evaluation, and if the amount of services prescribed for summer supports is commensurate to, or less than, the amount delivered in the school setting, CBH does not need to receive the request in the form of a packet. Instead, providers may submit a list of members needing summer supports in a recreational or academic setting to their Clinical Care Manager using the Summer Services Request Form provided by CBH. All elements of the form must be completed, which includes:

• Child’s name and Medical Assistance ID #
• Current services authorized
• Name, location, dates, and hours of camp or educational program attending
• Prescribed services for summer including hours per week, dates, and provider agency
• Name of prescribing agency, prescriber, and prescribing agency point of contact
• Caregiver name and contact information

While CBH will not require a packet submission, providers still must maintain essential documentation in files to establish medical necessity and to meet state requirements. Providers are free to prescribe any level of service that is medically necessary over the summer months. CBH will continue to require packet submission for any request that falls outside the parameters outlined below, including for children that are prescribed an increased level of support for summer programming than is authorized in school.
Please use this guide to determine what CBH considers a summer request that is commensurate with services authorized in school.

• STS level 1 or TSS-S 16 to 30 hours is commensurate to LC 2, Group TSS 20 in community camp.
• STS level 2 or TSS S up to 15 hours is commensurate to LC 2, Group TSS 10 in community camp.
• STS level 1 is commensurate to TSS-NS 20 in a community camp without a Group TSS program.
• STS level 2 is commensurate to TSS-NS 10 in a community camp without a Group TSS program.
• We will also support maintaining the same or reduced number of hours of TSS support in a community camp without a Group TSS program or in Extended School Year.

Questions regarding this Notice can be directed to providers’ assigned Clinical Care Manager.

February 13, 2017

Use of Therapeutic Support Staff (TSS) Scheduler Form

Effective March 13, 2017, CBH will require the use of the TSS Scheduler Form for all requests for TSS-School (TSS-S) and TSS-Nonschool (TSS-NS). This form should reflect how TSS services will be used at times of targeted need, as identified in the Comprehensive Biopsychosocial Evaluation, Re-evaluation, or Addendum. The TSS Scheduler Form can be found via the link below.

Requests that are received after the above date that do not include the TSS Scheduler form will be deemed insufficient. Questions regarding this Notice can be directed to providers’ assigned Clinical Care Manager.

TSS Scheduler Form

February 13, 2017

Daily Inpatient Bed Availability and Substance Use Disorder Treatment Capacity Survey

CBH will fully implement Provider Bulletin #16‐06 entitled Daily Psychiatric and Substance Abuse Open Bed Registry on February 20, 2017. Please remember that provider implementation of survey requirements is essential in ensuring accurate assessment of network capacity and access to treatment for our members; daily surveys must be completed to keep with the Provider Agreement.

CBH staff will be hosting three form.com webinars as an opportunity to train your identified staff on how to complete the InpatientSubstance Use Availability Survey. Please pass this notification onto your appropriate staff, so they can participate in one of the three webinar training sessions.

InpatientSubstance Use Availability Surveys Webinar

February 15, 2017 1:00 PM – 2:00 PM
February 16, 2017 2:00 PM – 3:00 PM
February 17, 2017 11:00 AM – 12:00 PM

CBH Provider Survey Training 

Please join my meeting from your computer, tablet or smartphone. 
https://www.gotomeet.me/cbhmco 

You can also dial in using your phone. 
United States: +1 (872) 240-3412

Access Code: 312-020-877 

Provider Login Procedure

This is the procedure to login to the Inpatient Bed Availability and Substance Use Treatment Capacity surveys. The start date for this requirement is Feb 20, 2017.
In addition, please review the Community Behavioral Health Daily Inpatient Bed Availability and Substance Use Disorder Treatment Capacity Survey: Guide for Use for detailed instructions.

1) Go to the CBH Survey Website using the URL: https://app.keysurvey.com/portal/#1087617
2) Login and Password (Assigned via email)
3) Please Choose the appropriate survey from the left side menu
a. ‘Inpatient Bed Availability’ or
b. ‘Substance Use Disorder Treatment Availability’
4) Click the ‘+ Add New’ button to begin a new survey.
a. Complete all appropriate fields for your service location.
b. Please do not count the same available bed or treatment opening in more than one section.
c. Click the ‘Submit’ button to complete your survey by noon each day.

Questions regarding this notification can be directed to your Provider Relations Representative.

February 7, 2017

CBH is upgrading the system that providers use to submit claims files, and receive 835RA, Schedule A, acknowledgements. It is also planned that this new secure file transfer (SFTP) solution will be utilized for all types of file transfers in the future.  This new system will provide a more streamlined and secure method for all file transfers between providers and CBH/DBHIDS. We will be contacting every provider, in small groups, starting 2/9/2017.  Each group will be provided full training and testing support for the transition.

January 27, 2017

Child and Adolescent Inpatient Performance Standards DRAFT: Request for Provider Feedback

As you are aware, CBH is endeavoring to enhance services available to children and adolescents admitted to Inpatient Psychiatric Treatment. To this end, CBH has collaborated with the Child and Adolescent Inpatient providers, as well our system partners to create Child and Adolescent Inpatient Performance Standards for providers in the CBH network based on current best practices in the field. These Standards are intended to bring uniformity and quality to inpatient treatment. CBH is very interested in feedback from providers, stakeholders, and families regarding the draft in its current stage. Please note that the Standards are currently a working document, and we will adapt it to include both provider input based on a consensus process, as well as any changes in state regulations. The Standards will also be expanded to include oversight and monitoring procedures before final publishing.

Please take a moment to read the Child and Adolescent Inpatient Performance Standards and provide your feedback via the linked survey on or before close of business February 6, 2017: https://www.surveymonkey.com/r/7TQPZ25

January 26, 2017

CBH Administrative Offices Closed for 20th Anniversary.

CBH administrative offices will be closed Wednesday, February 1, 2017 in recognition of our 20th anniversary.

As CBH celebrates 20 years of uninterrupted service to the community of Philadelphia, we would like to take this opportunity to thank our provider partners for helping us make the past 20 years so successful. We look forward to our ongoing partnership to support the wellness, resilience, and recovery of all Philadelphians.The Psychiatric Emergency Service (PES) and Member Services will be fully operational and will not be impacted by the administrative office closure.

January 25, 2017

Treatment Capacity Forms

On November 3, 2016 a DBHIDS/CBH Provider Bulletin (#16-06) was issued entitled Daily Psychiatric and Substance Abuse Open Bed Registry. This Bulletin indicated that the daily report of acute psychiatric inpatient bed availability will be effective as of December 5, 2016; however, on December 2, 2016, a Provider Notice followed this Bulletin to announce a webinar for the children and adolescent inpatient providers.

This Notice is to announce that all adult psychiatric inpatient and substance use providers shall begin completing the daily treatment capacity forms effective Monday, February 20, 2017.  The providers required to complete the daily Substance Use Treatment Capacity Form include the following levels of care: medically managed and medically monitored detox programs, medically managed and medically monitored short-term rehab programs, long-term rehab programs, specialized rehab programs, and halfway houses; this does not apply to outpatient and intensive outpatient substance use programs.

CBH will conduct a webinar for the adult inpatient psychiatric providers and substance use providers. A date for the webinar, along with an invitation and web link will be forthcoming. Additionally, you will be asked to submit a primary and secondary contact for the completion of the forms. Please direct inquiries regarding this Notice to your Provider Relations representative.

January 20, 2017

Staff Roster Reminder

On December 28, 2016, the CBH Compliance Department released the 2017 staff roster template with a submission due date of January 31, 2017. Executive directors were contacted by email and a Provider Notice was also posted on the CBH Compliance page of the DBHIDS website.

If your agency has not yet returned a completed staff roster, it is essential that you submit the roster to CBH.compliancecontact@phila.gov by January 31, 2017.  As a reminder, failure to submit the roster will result in an Event of Default.

The new roster template can be found on the CBH Compliance page of the DBHIDS website. Any questions regarding the roster should be directed to Mark Miller at Mark.D.Miller@phila.gov or Amy Cruz at Amy.Cruz@phila.gov

2016

December 28, 2016

CBH Compliance has released the 2017 personnel roster template. While there have been changes to the 2017 version, key elements of the 2016 roster remain, so that content can be transferred to the new version without the loss of fidelity. The new roster incorporates the following revisions:

  • Newly labeled tabs: Previously the tabs reflected only Employed and Contracted status. These have been expanded to include the following three categories for clarity: W2 (employed), 1099 (contracted/FFS/per Diem), and Temp (from temp agency).
  • A new column has been added for CBH Provider Number, the use of which affiliates the staff person with a specific CBH contracted program. This number can be found on the Schedule A.
  • The Program column has been changed to Level of Care.
  • Other changes include expanded drop-downs and clearer language in existing fields and in the instructions.

The roster can be found on the CBH Compliance page of the DBHIDS website. Please complete the roster and submit to CBH by January 31, 2017. It is essential that the roster is completed entirely and submitted to CBH on time. Failure to submit the completed roster by the due date may result in an Event of Default. The completed roster should be submitted by email to cbh.compliancecontact@phila.gov. Any questions should be directed to Mark Miller at mark.d.miller@phila.gov or Amy Cruz at amy.cruz@phila.gov.

.December 2, 2016

Open Bed Registry Start Date Postponed

On November 3, 2016 a DBHIDS/CBH Provider Bulletin (#16-06) was issued entitled Daily Psychiatric and Substance Abuse Open Bed Registry. This Bulletin indicated that the effective date for implementation of this registry would be December 5, 2016; however, the effective date has been postponed until further notice. CBH will conduct a web-based training on December 14, 2016 at 11:00am to demonstrate how to use the registry. An invitation and web link will be forthcoming. Please note that the use of this registry will go live first with children and adolescent inpatient providers, and therefore only those providers will receive the invitation. Adult psychiatric inpatient and substance use providers will begin implementation at a later date, and a separate notice will follow to announce that date. Also as a reminder, this secure cloud-based registry was created to collect, aggregate, and review data on the availability of inpatient beds for all in-network facilities on a daily basis; this registry is not intended to eliminate existing requirements to call facilities to review the member’s clinical presentation and to ensure the appropriateness of the admission.

November 18, 2016

PROVIDER NOTICE: GROUP THERAPY SIZE LIMITATIONS

Community Behavioral Health (CBH) is issuing this Provider Notice as a reminder regarding the limitations on the number of participants in Group Therapy in Outpatient Mental Health and Addictions Services. Medicaid restricts the number of participants, as noted below. Billing for services provided in excess of these parameters is subject to repayment for all CBH participants, not just those exceeding the limits.  CBH will be adding this element to Compliance Department reviews in future audits.  It is important that documentation allows for group size to be ascertained.  Progress notes should clearly indicate the number of participants in the group, without listing names or identifiers of other group members.

Please review the relevant regulations as well as your program policies and procedures to ensure that you are not in violation of this standard; policies and procedures should be revised accordingly to ensure alignment with these regulations. CBH will be holding providers for which Group Therapy is a Supplemental Service to these same standards. Other programs such as Community Integrated Recovery Centers (CIRCs) utilizing group therapy services should follow the relevant Commonwealth regulations.

Group Therapy:

Medical Assistance regulations for both Mental Health and Addictions Services limit Group Therapy size to 10. This is the maximum number of TOTAL participants, not just CBH members. This number also excludes any treatment staff and may not be increased by using co-facilitators.

Mental Health, MA Regulations Title 55, CHAPTER 1153. OUTPATIENT PSYCHIATRIC SERVICES; GENERAL PROVISIONS:

  • 1153.2. Definitions

Group psychotherapy—Psychotherapy provided to no less than two and no more than ten persons with diagnosed mental disorders for a period of at least one hour. These sessions shall be conducted by a clinical staff person.

Drug and Alcohol, MA Regulations Title 55, CHAPTER 1223. OUTPATIENT DRUG AND ALCOHOL CLINIC SERVICES, GENERAL PROVISIONS:

  • 1223.2. Definitions

Group psychotherapy—Psychotherapy provided to no less than two and no more than ten persons with diagnosed drug/alcohol abuse or dependence problems for a minimum of one hour. These sessions shall be conducted by drug/alcohol clinic psychotherapy personnel under the supervision of a physician.

Psychoeducational Groups:

Often, valuable and medically necessary group treatment occurs outside of the traditional group psychotherapy models. Typically these groups are labeled as “psychoeducational.” Psychoeducational groups are permissible as a limited adjunct to more traditional therapy modalities (Individual, Group, and Family).  Psychoeducational groups are permitted as part of a treatment course in programs such as Partial Hospital Programs, Intensive Outpatient Programs (IOP), Residential Treatment Facilities, Inpatient and Non-Hospital Detoxification and Rehabilitation Units, and Halfway Houses. Psychoeducational groups are not billable as stand-alone services.

Examples of Psychoeducational Group topics include, but are not limited to:

Vocational and Occupational training
Life skills
Parenting/Family Reunification
Structured Social Activities
Dynamics and Medical Aspects of Addiction
Abstinence and Its Role in Recovery
Use of Self Help and Support Group
Nutrition
Sex and Sexuality
Family Dynamics of Addiction
Confrontation Skills
Refusal Skills
Avoiding and Defusing Triggers for Relapse
HIV and STDs

The maximum group size for psychoeducational groups in order to be reimbursed by CBH is 15 participants. This number excludes any treatment staff and may not be increased by using co-facilitators. In order to be eligible for CBH reimbursement, psychoeducational groups must be conducted by staff appropriately credentialed to provide this service in the relevant level of care.  Appropriately credentialed interns may conduct psychoeducational groups as long as the fully credentialed supervisor co-signs all notes by the intern. Certified Peer Specialists may also lead psychoeducational groups so long as the provisions set forth in the Medical Assistance Handbook are followed:

Provider agrees that it will typically provide peer support services on an individual (1:1) basis but may offer group services for several individuals together when such services are beneficial, provided that group services may not include social, recreational or leisure activities. To receive peer support services in a group, individuals must share a common goal, and each individual must agree to participate in the group. Services such as psychoeducation or WRAP (Wellness Recovery Action Planning) are the types of services that may be provided in groups.

(http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/d_004594.pdf)

Questions regarding this Notification can be directed to CBH.ComplianceContact@phila.gov.

October 14, 2016

Closed: North Philadelphia Health System (NPHS) Behavioral Assessment Center (BAC)

Effective immediately and until further notice, the North Philadelphia Health System (NPHS) Behavioral Assessment Center (BAC) located at 801 W. Girard Ave, Philadelphia PA 19122 is closed. All other NPHS mental health and substance abuse services located at this site remain fully operational, which include: outpatient, drug and alcohol detoxification and residential services, and acute psychiatric units.

Please utilize the Crisis Response Centers (CRC) (Temple Episcopal, Einstein Medical Center at Germantown, Friends, Hall Mercer, and Mercy) or one of the following substance abuse assessment centers during regular business hours when referring CBH members for a substance abuse assessment:

  • Kensington Hospital- 215-426-8100
  • Kirkbride Center – 215-471-2600
  • Fairmount Behavioral Health Center – 215-487-4100
  • Presbyterian Addiction Assessment Center – 215-662-8747

If you have questions or concerns, please contract Smeeta Kothari, Clinical Care Manager Supervisor at 267-602-2269, and for BHSI contact Carl Pray at 215-546-1200.

September 20, 2016

CBH Compliance Forum

CBH would like to inform our provider community about an opportunity to learn more about the Compliance department:
WHAT
Community Behavioral Health (CBH) is hosting its inaugural Compliance Forum this fall. The forum is designed to provide an opportunity for the CBH Compliance Department to share information related to:
• Relevant current trends
• Enforcement focus
• Practical examples of implementing/improving provider compliance plans
• Best compliance practices
To accomplish this, we are excited to have several speakers, highly experienced in a broad range of compliance functions, to address these topics. The forum will also give our network providers the chance to interact with the presenters and CBH Compliance staff in a more informal setting.
WHEN
The forum is scheduled for Wednesday, November 9, 2016 from 9AM to 1PM. We are asking that providers arrive between 8:30AM and 9:00AM to register and enjoy complimentary light refreshments.
WHO
Provider staff functioning in the roles of compliance and/or privacy officers, and senior level compliance/privacy staff are invited to attend. We are limiting attendees to TWO per provider.

For your convenience, when registering, please use the direct link here:  www.eventbrite.com/e/community-behavioral-health-compliance-forum-tickets-27551759053

Please feel free to contact Nicole Beaufort with any questions and/or concerns at nicole.beaufort@phila.gov.

August 31, 2016

ABA Performance Standards
CBH is endeavoring to enhance services available to children, adolescents, and young adults who are diagnosed with autism spectrum disorder (ASD). To this end, CBH has collaborated with a team of local autism experts and researchers to create Applied Behavioral Analysis (ABA) Performance Standards for BHRS providers in the CBH network based on current best practices in the field. The intention of these Standards is to bring uniformity and quality to ABA being provided in Philadelphia; the document will also be used as a starting point for identifying strengths and needs in current ABA programming. CBH is very interested in feedback from providers, stakeholders and families regarding the draft in its current stage. Please note that the Standards are currently a working document, and we will adapt it to include both provider input based on a consensus process, as well as any changes in state regulations. The Standards will also be expanded to include oversight and monitoring procedures before final publishing.
Please provide your feedback via the linked survey – https://www.surveymonkey.com/r/ABAStandardsFeedback

August 18, 2016

ABA Medical Necessity Criteria

The Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS) has released the Medical Necessity Criteria for Applied Behavioral Analysis using Behavioral Specialist Consultant- Autism Spectrum Disorder and Therapeutic Staff Support Services for children and adolescents with Autism Spectrum Disorder. CBH will use the ABA Medical Necessity Guidelines Bulletin and the MNC for ABA Using BSC-ASD and TSS when reviewing requests for ABA through BHRS. Please direct any questions regarding this Notification to Lauren Dellacava at lauren.dellacava@phila.gov or 215-413-8583.

August 1, 2016

Social (Pragmatic) Communication Disorder
The DSM-5 added a new diagnosis of Social (Pragmatic) Communication Disorder 315.39 (F80.89). This diagnosis requires that Autism Spectrum Disorder (ASD) has been ruled out. It is most commonly diagnosed and treated by a speech-language pathologist. In the event that a child with Social (Pragmatic) Communication Disorder is approved for BSC services, the BSC must be a Licensed Psychologist, Licensed Behavior Specialist, Licensed Social Worker, Licensed Marriage and Family Therapist, Licensed Clinical Social Worker, or Licensed Professional Counselors and meet all the requirements of a BSC treating a child with Autism Spectrum Disorder to account for the similarities between Autism Spectrum Disorder and Social (Pragmatic) Communication Disorder. This is effective September 27, 2016. Questions regarding this Notice may be directed to Lauren Dellacava at lauren.dellacava@phila.gov or 215-413-8583.

August 1, 2016

Requesting BSC-ASD services
CBH received clarification from the Children’s Bureau regarding requests for services for children with Autism. When requesting Behavioral Specialist Consultant (BSC) service for a child with an Autism Spectrum Disorder (ASD) diagnosis, the request must be for BSC-ASD. If a request is made for BSC (without specifying ASD), CBH will deny the service. BSC and BSC-ASD are different services and children with ASD must be provided a service delivered by staff qualified to treat ASD. For additional information, please see the CMCS Informational Bulletin dated July 7, 2014 and OMHSAS memo dated March 18, 2015. Both documents are attached below for your convenience. This is effective September 27, 2016. Questions regarding this Notice may be directed to Lauren Dellacava at lauren.dellacava@phila.gov or 215-413-8583
Memo
CMS Informational Bulletin

July 28, 2016

CBH Provider Refusal Policy (updated from February 16, 2016)

The CBH Provider Agreement requires that CBH network providers accept all CBH members who are authorized to receive a medically necessary level of care offered by a network provider (see CBH Provider Agreement Section II(A)(8)).

When CBH learns that a contracted provider has refused to accept a member who has been authorized for a given level of care, it will initiate a request for rationale which, if determined by CBH to be unsatisfactory, shall result in an Event of Default under the Provider Agreement. If the Event of Default is not cured within the time permitted under the Provider Agreement, the resulting penalty will be a $5000 fine.

The February 16, 2016 notice indicated that CBH may employ any and all remedies under the CBH Provider Agreement. The current notice defines the remedy as the above referenced monetary sanction.

Providers are encouraged to review the CBH Provider Agreement and to direct any inquiries on this matter to CBH’s Assistant Counsel at shloka.joshi@phila.gov.

July 18, 2016

Case Consultation Training Series

Community Behavioral Health (CBH) will host an information session to provide details about the Case Consultation Training Series RFA: Improving Clinical Skills with Children and Families. Anyone considering submitting a response to this RFA is encouraged to attend this event. The information session will take place on July 25, 2016 from 10:00 am – 11:30 am at CBH, 801 Market St. Philadelphia, PA 19107, on the 11th floor in conference room 1154 “B”. An RSVP is not required.

July 7, 2016

PCIT RFA: Information Session

Community Behavioral Health (CBH) will host an information session to provide details about the recently issued Request for Applications (RFA) for participants in the Parent-Child Interaction Therapy (PCIT) Training Program. Anyone considering submitting a response to this RFA is encouraged to attend this event. The information session will take place on July 14, 2016 from 2:30pm to 4:00pm at CBH, 801 Market St. Philadelphia, PA 19107, on the 7th floor in the large conference room. An RSVP is not required.

June 21, 2016

CBH reminds providers that the CBH Provider Agreement requires providers to conduct and maintain records of monthly checks for excluded individuals and entities on the three exclusion lists noted below and to report exclusions to CBH within three (3) business days.
In 2011, the Commonwealth’s Office of Medical Assistance Programs issued MA Bulletin 99-11-05, “Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation.” Available at http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/d_005732.pdf.

This Bulletin outlined the payment ban and the screening and self-audit process.  The Bulletin reminds providers that, per the Code of Federal Regulation 42 CFR § 1001.1901(b),

No payment will be made by Medicare, Medicaid or any of the other Federal health care programs for any item or service furnished, on or after the effective date [of an exclusion], by an excluded individual or entity, or at the medical direction or on the prescription of a physician or other authorized individual who is excluded when the person furnishing such item or service knew or had reason to know of the exclusion.

Non-payable services include not only those provided by clinicians and physicians, but also indirect services provided by administrators, billing agents, accountants, claims processors, utilization reviewers, and others not directly involved in the care of members.  Per the Bulletin,
Examples of individuals or entities that providers should screen for exclusion include, but are not limited to: Individual or entity who provides a service for which a claim is submitted to Medicaid; Individual or entity who causes a claim to be generated to Medicaid; Individual or entity whose income derives all, or in part, directly or indirectly, from
Medicaid funds; Independent contractors if they are billing for Medicaid services;
Referral sources, such as providers who send a Medicaid recipient to another provider for additional services or second opinion related to medical condition.

Upon discovery of an exclusion, it is not sufficient for a provider to solely terminate the employment or contract with the excluded individual or entity.  Providers must notify CBH within three (3) days of discovery and conduct a self-audit to determine the amount of the repayment to CBH, as CBH is unable to make or retain payments for services provided by excluded individuals and entities.  Per the Bulletin, The amount of the Medicaid overpayment for such items or services is the actual amount of Medicaid dollars that were expended for those items or services. When Medicaid funds have been expended to pay an excluded individual’s salary, expenses, or fringe benefits, the amount of the overpayment is the amount of those expended Medicaid funds.

Reports of exclusions should be made to the CBH Compliance Operations Specialist at CBH.ComplianceContact@phila.gov.  Failure to conduct monthly checks or report exclusions to CBH will result in a violation of the CBH Provider Agreement (see Section II(A)(16)) and may result in remedies or sanctions consistent with the CBH Provider Agreement. Future CBH Compliance Department audits may include reviews of the monthly exclusion list check documentation.

The three lists providers must check include:

List of Excluded Individuals and Entities (LEIE)  http://oig.hhs.gov/fraud/exclusions.asp
System for Award Management (SAM)
(formerly Excluded Parties List System (EPLS)) https://www.sam.gov
Department of Human Services’ Medicheck List http://www.dhs.state.pa.us/publications/medichecksearch/

Questions regarding this Notification can be directed to CBH.ComplianceContact@phila.gov.

June 16, 2016

National Practitioner Databank Report: Requirement for Residents

Effective immediately, CBH will not require resident physicians working under a training license to obtain National Practitioner Databank (NPDB) reports, as long as they are not a member of the medical staff.

Per the U.S. Department of Health and Human Services (HHS)

Whether a hospital is required to query on an intern or resident depends upon whether the intern or resident is a member of the medical staff. Health care entities are not required to query the NPDB on medical and dental residents, interns, or staff fellows (collectively referred to as housestaff), even though they are often licensed, when they are trainees in structured programs of supervised graduate medical education and not members of the medical staff.

However, hospitals are required to query on housestaff when such individuals are appointed to the medical staff or granted clinical privileges to practice outside the parameters of the formal medical education program (e.g., moonlighting in the intensive care unit or emergency department of that hospital).

 HHS NPDB Guidebook, D 5-7, 2015.

Physicians with full privileges continue to be required to obtain an NPDB report. This requirement applies to all physicians working in the CBH network, regardless of level of care.  Please direct any questions regarding this Notification to CBH.ComplianceContact@phila.gov.

May 16, 2016

Community Behavioral Health (CBH) will host a bidder’s conference to provide details about the recently issued Request for Applications (RFA) for participants in the Beck Community Initiative Cognitive Therapy Training for Adult Drug and Alcohol Intensive Outpatient Programs. Anyone considering submitting a response to this RFA is encouraged to attend this event. The bidder’s conference will take place on May 24, 2016 from 3:00pm to 4:00pm at CBH, 801 Market St. Philadelphia, PA 19107, on the 11th floor in conference room 1154B. An RSVP is not required.

May 11, 2016

Applied Behavior Analysis (ABA) Attestations

As many of you know, CBH is looking at the best way to identify which of our BHRS providers can offer Applied Behavior Analysis (ABA) to fidelity. Quickly developing requirements from the Office of Mental Health and Substance Abuse Services (OMHSAS) complicate this endeavor. As an initial step to meeting the OMHSAS requirement of posting our providers who offer ABA on our website, we have listed some of our providers who specialize in Autism treatment, including ABA.

Our next step is to work with outside subject matter experts, providers, and the Bureau of Autism Services (BAS) to develop Practice Standards for ABA. Once we publish these standards, we will offer our providers a chance to demonstrate that they meet these standards. We will list the providers who meet these standards on our website as ABA providers. Providers who do not meet ABA Practice Standards but wish to use ABA science within their BHRS programs are free to do so but CBH will not identify them as offering an ABA program.

As BHRS providers may be aware, we shared the letter from OMHSAS regarding attestations and said we would be putting out a formal notification to providers with instructions. For now, we are advising that staff providing services that include ABA to a child with Autism Spectrum Disorder sign the individual attestation titled “Confirmation of Knowledge and Skills to Provide ABA.” This was included in our last communication. Providers should keep these attestations in staff personnel files.

At this time, CBH is not requiring that providers submit the provider attestation titled “Attestation for Behavioral Health Rehabilitation Services Providers that Provide Applied Behavioral Analysis using Behavioral Specialist Consultant-Autism Spectrum Disorder and Therapeutic Staff Support Services.” CBH will revisit the submission of the provider attestations following the publication of ABA Practice Standards.

Recent bulletins from OMHSAS can be found here:
TSS ABA Bulletin
BSC ABA Training
ABA Attestation Memo
ABA Provider Attestation Form
Questions regarding this Notice may be directed to Lauren Dellacava at lauren.dellacava@phila.gov or 215-413-8583.

April 19, 2016

Bidder’s Conference 4/21/16: Mental Health Outpatient Services RFP

Community Behavior Health (CBH) will host a bidder’s conference to provide details about the upcoming issuance of a Request for Proposals (RFP) to provide Mental Health Outpatient Services to persons living in North Philadelphia. Anyone considering submitting a response to this RFP is encouraged to attend this event. The bidder’s conference will take place on April 21, 2016 from 9:30am to 11:00am at CBH, 801 Market St. Philadelphia, PA 19107, on the 11th floor in conference room 1154A. An RSVP is not required.

April 13, 2016

Insufficient Notice

Effective April 15, 2016, Community Behavioral Health (CBH) is refining its process for response to requests for services when the information provided by a provider is insufficient to make a clinical determination.

Under the HealthChoices Program, if a provider requests a non-acute level of care without providing sufficient information to allow CBH to render a medical necessity determination, CBH shall notify the member and provider of the missing elements by sending an insufficient letter. The provider then has up to 14 calendar days to respond with the requested information at which point CBH will make a medical necessity determination. Additional information should be provided as it is for initial requests (fax, electronically, phone, etc).

For acute levels of care, CBH will verbally inform the provider of the missing elements. The provider then has 24 hours to respond with the requested information, at which point a CBH will make a medical necessity determination.

If the provider does not respond within the outlined timeframe, or the information is still inadequate for CBH to make a medical necessity determination, CBH will deny the request due to insufficient information.

Questions regarding this Notice may be directed to your Provider Relations Representative.

April 8, 2016

Third Party Liability

This notification is to alert providers of their responsibilities and CBH expectations in instances when a CBH member is dually eligible (has Medicare or other commercial insurance as well as CBH) and CBH is the payer of last resort.

Beginning April 11, 2016, CBH will only review cases for medical necessity criteria when the service the provider is requesting is not a covered benefit under the member’s primary insurance coverage, the member has exhausted Medicare inpatient benefits, or the member’s primary insurer denies services. In cases when the member’s primary insurer denies services, the provider must complete denial procedures of the primary insurer prior to contacting CBH for a medical necessity determination.

If none of these scenarios are applicable, no precertification is required. However, the admitting provider must notify CBH of the admission.

Providers are required to submit discharge information to CBH within one business day of discharge, at which time an authorization will be generated. If the primary insurer denies part of the treatment stay, and the provider did not contact CBH, the provider must submit the member’s chart for a retrospective clinical review. CBH will then make an authorization decision.

If a provider requests a service that is not part of the member’s primary benefit plan, the provider is required to contact CBH for medical necessity determination.

March 31, 2016

Dear Providers,

Thank you for your collaboration around Pay-for-Performance. We are pleased to announce the opening round of provider meetings to review P4P measures and thresholds for 2016 performance assessment on services provided in measurement year 2015. Meetings are listed below by level of care and, where applicable, specialty population group. As in the previous year, we wish to provide you with the option of attending these meetings in-person or online via GoToMeeting. Due to space limitations, we are asking that if you wish to attend in-person that you RSVP to us as soon as possible, and send only one person from your organization to that meeting. We will be able to accommodate the first 20 respondents in each meeting; beyond that number we may need to ask you to participate via GoToMeeting only. If for any reason you need accommodations under the ADA in order to participate in any of these meetings, please let us know; we will be sure to reserve in-person space and/or provide any other accommodations that are necessary to meet that need.

For GoToMeeting participation, it is vital that you register in advance using the link provided below. Registering through this link ensures that you get the information necessary to enable you to log on to the meeting, see slides, and hear the conversation. We recommend that GoToMeeting participants dial-in to the meeting on the telephone rather than using the integrated audio option, as this seems to provide the best experience.

In our efforts to ensure that we have measures that are indicative of quality and consistent with good clinical practice, our measurements are continually revised. The resultant technical specifications translate into complex data processing logic. As we enter into the seventh year of Pay-for-Performance, these data procedures are increasingly complex, and we appreciate your input into the methodology discussion at these webinars. These meetings are part of that process, and we would like to acknowledge your contribution to this collaborative process.

2016 P4P Schedule

For RSVP to attend the meetings in person, please contact Naima Ware at naima.ware@phila.gov. Thank you.

March 9, 2016

Changes to the CBH Compliance Department Audit Response Process

The CBH Compliance Department has historically allowed providers to submit missing documentation and/or new paper claims as part of the provider’s response to the audit. Two changes will go into effect for audits scheduled as of April 8, 2016, thirty (30) days from the date of this notice:

  1. Decrease in Allowable Time for Submission of Missing Documentation in CBH Compliance Audits:

Providers are responsible for ensuring that documentation of services is present in the clinical record once services have been billed. Previously, providers have had until 5:00pm of the business day after the daily on-site audit to submit progress note and treatment plan documentation listed as missing at the audit. Providers will now only have until 10:00am the following business day to submit the documentation. It may still be submitted via hard copy, fax to 215-413-7552, or secure (Protected Trust) e-mail to the audit Team Leader. Providers may not create new documentation to replace that which is unable to be located. Also, please do not send original progress notes for review.

  1. Discontinuation of Re-Billing for Date and Service Type Errors on New Paper Claims as Part of CBH Compliance Audit Response:

Providers are responsible for making sure that services are billed accurately. Previously, providers have been allowed to submit new paper claims to correct errors in date and type of service found by CBH Compliance Analysts during audits. CBH is no longer accepting new paper claims for the correct dates and types of service as part of the provider’s response. Claims appeals will also not be accepted for these billing errors.

Questions regarding this Notice may be directed to CBH.ComplianceContact@phila.gov.

March 3, 2016

CBH Compliance is introducing an updated staff roster template. The new template has additional fields for tracking information on education and licensure, as well as aligning job titles to CBH standards. The completed roster will also serve as the tool used during staff file audits, and allow providers to better prepare for our visits.

In an effort to determine the breadth of network provider resources, and to plan more efficiently for audits, the CBH Compliance Department requests that all network providers submit a current staff roster using the updated template, which can be found on the CBH Compliance page of the DBHIDS website. Please submit the completed roster in the current format to CBH by March 25, 2016. The roster should be submitted by email to cbh.compliancecontact@phila.gov. Any questions regarding the roster should be directed to Mark Miller at mark.d.miller@phila.gov or Tracey Robinson at tracey.robinson@phila.gov.

February 16, 2016
Dear Providers:
This is a reminder that the CBH Provider Agreement requires contracted providers to accept all CBH members who are authorized to receive a medically necessary level of care offered by said providers (CBH Provider Agreement section II (A) (8)). When a provider refuses to accept a member who has been authorized for a given level of care, and has provided an unsatisfactory clinical rationale for the denial of admission, CBH will consider this a breach of the Provider Agreement. Pursuant to the Provider Agreement, a Notice of Event of Default will be sent to the provider. Should a provider fail to cure, CBH may employ any and all remedies under the CBH Provider Agreement.

Providers are encouraged to review the CBH Provider Agreement and to direct any inquiries on this matter to CBH’s Assistant Counsel at shloka.joshi@phila.gov.

January 20, 2016
The CBH requirements for obtaining Child Abuse Clearances, Criminal History Reports, and FBI Background Checks will change, effective February 19, 2016. All required documentation must be obtained before the commencement of employment or service, and updated every five (5) years. This replaces the previous requirement that all Clearances and Criminal Background Checks be updated every three (3) years. These changes are in line with the current State regulations and will also be updated in the forthcoming revision of the Manual for Review of Provider Personnel Files.

The new requirements are described in full in Bulletin #16-01, which is available on the CBH Provider section of the DBHIDS website.

January 11, 2016
The Manual for Review of Provider Personnel Files (MRPPF), Draft Version 1.2, was posted to the CBH website on April 27, 2015. The comment period ended June 8, 2015. Feedback was provided by 14 CBH provider agencies and the Philadelphia Coalition. The CBH Compliance Team will finalize the revision in 2016, while ensuring that provider comments to the draft are considered and the latest State regulations and guidelines are being incorporated. Changes around clearance requirements and Child Protective Services trainings are among the revisions to the MRPPF. In the meantime providers should check CBH Bulletins section of the DBHIDS website for updates. The provider comments can be viewed on the CBH Compliance page of the DBHIDS website.

2015

December 17, 2015
This is a reminder that the deadline for submission of Re-enrollment/Revalidation of Medical Assistance Providers of March 24, 2016 is quickly approaching.

As a provision of the Affordable Care Act (ACA), all providers participating in the PA Medical Assistance (MA) program are required to re-enroll each of their service locations in PROMISe no later than March 24, 2016.  Service locations that have not completed the re-enrollment process by the March 24, 2016 deadline date will expire and their PROMISe enrollment records will be closed. The provider will not be paid for services delivered to MA recipients after the date of closure. It is important to note that effective dates of the new enrollment will not be retroactive to cover any lapses in enrollment. This includes payment for all services contracted with Community Behavioral Health (CBH).

CBH is committed to working closely with providers to avoid any possible service interruptions for our members. CBH is recommending that all PROMISe re-enrollment applications be submitted no later than January 1, 2016 to allow for processing time.  This includes applications submitted directly to the PA Department of Human Services, Office of Medical Assistance Programs and Supplemental Service applications that are required to be submitted to CBH prior to processing by the State.  Current State processing time for applications is a minimum of 45 days.

PROMISe applications for MA Revalidation for In Plan services should be sent directly to the Office of Medical Assistance Programs.  These services include:

Inpatient Psychiatric Hospitals (both freestanding and for units located within a general hospital)
Outpatient Psychiatric Clinics
Outpatient Drug and Alcohol Clinics
Mental Health Partial Hospitalization Programs
Family Based Mental Health Services
Targeted Case Management programs (Intensive Case Management, Resource Coordination and Blended Case Management)
Crisis Intervention Services
Certified Peer Specialist Services
Behavioral Health Rehabilitation Services for Children
Individual practitioner applications, including licensed psychiatrists and psychologists

PROMISe applications for Supplemental Services should be sent directly to your CBH Provider

Relations Representative. CBH is recommending that providers send their initial application(s) to CBH electronically to avoid any going back and forth if any errors are identified on the application(s).   These services include:

D&A Intensive Case Management and Resource Coordination Services
Residential Treatment Facility for Adults (RTF-A)
Long Term Structured Residential Programs (LTSR)
Assertive Community Treatment (ACT) and Community Treatment Team (non-fidelity ACT) programs
Psychiatric Rehabilitation Services
D&A Intensive Outpatient Programs (IOP)
D&A Partial Hospitalization Programs
D&A Inpatient Programs – Halfway House, Detoxification, and Short and Long Term, Rehab programs
Other Supplemental Services requiring a unique Service Description, including programs enrolled as Provider Type 11, Specialty Code 119 (Community Mental Health, Other)

Related Documentation:

OMHSAS Bulletin – ACA Re-enrollment Guidance for Behavioral Health Providers
MA Revalidation FAQ – October 2015
MA Bulletin – Re-enrollment Revailidation of MA Providers
HealthChoices Behavioral Health Supplemental Services Provider Enrollment Application and Required Forms
HealthChoices Behavioral Health Supplemental Services – Provider Enrollment Application Checklist

December 14, 2015

Dear Providers,

This is a compliance reminder that unit based services (non per diem and non event services) must be documented using clock times. The start and end clock times for the service must be documented (i.e. 7:15 AM to 8:15 AM).   It is NOT sufficient to document only the duration, the start, or the end time.  Through the audit process, CBH Compliance has, and will continue to, recoup payment made for unit based services lacking clock times.  Providers must also designate AM/PM or utilize military style time (1:00 PM = 1300) in the documentation of start and end times for the service.  Failure to document AM/PM or military time will also result in recoupment of payment for those services.

Medical Assistance Bulletins 99-97-06 (Accurate Billing for Units of Service Based on Periods of Time) and 29-02-03, 33-02-03, 41-02-02 (Documentation and Medical Record Keeping Requirements) support this requirement.

Please e-mail CBH.compliancehotline@phila.gov with any additional questions.

Thank you for your ongoing support.

November 4, 2015

Dear Providers,

CBH has decided to no longer reject claims that do not have open cases, and will now automatically open cases for CBH-eligible Members.  As a result, our procedure for opening cases has changed, and is now solely focused on the collection of Performance Outcomes Measurement System (POMS; demographic codes on “Case Open Request form) data, which is required from the State.  The new form will be called the “POMS Collection form” and is available from our Operations Support Services and Provider Relations staff. It is our hope that this change will lessen the administrative burden and redundancy that our Providers and staff had experienced with the old process.  Please click here for more information.

October 19, 2015

Dear Providers,

The webinar to review results of the STS Family Engagement Survey for Pay-for-Performance has been rescheduled for Tuesday, October 20, 2015 from 2:00-4:00 pm. As in previous years, we wish to provide you with the option of attending these meetings in-person or online via GoToMeeting. Due to space limitations, we are asking that if you wish to attend in-person that you RSVP to us as soon as possible, and send only one person from your organization to that meeting. We will be able to accommodate the first 20 respondents in each meeting; beyond that number we may need to ask you to participate via GoToMeeting only. If you for any reason need accommodations under the ADA in order to participate in any of these meetings, please let us know; we will be sure to reserve in-person space and/or provide any other accommodations that are necessary to meet that need.

For GoToMeeting participation, it is vital that you register in advance using the link provided below. Registering through this link ensures that you get the information necessary to enable you to log on to the meeting, see slides, and hear the conversation. We recommend that GoToMeeting participants dial-in to the meeting on the telephone rather than using the integrated audio option, as this seems to provide the best experience.

For RSVP to attend the meetings in person, please contact Naima Ware at naima.ware@phila.gov.

https://attendee.gotowebinar.com/register/2392503587101466626

Sincerely,

Susanna Kramer, M.A.
Program Evaluation Coordinator
Community Behavioral Health
801 Market Street, 11th Floor
Philadelphia, PA 19107
215.413.7657

October 13, 2015

Dear Providers,

This is a friendly reminder that the deadline to request 2015 P4P data for certain Levels of Care is approaching. Please see the attached schedule to determine the deadline for requesting data for you Level(s) of Care, as well as the form to be used to request your data. As a reminder, only one form should be completed for each Parent ID requesting data. Data for more then one Level of Care may be requested from each Parent Provider at a time. Please send the completed form and any questions to: CBH_DBHIDS_P4P@phila.gov.

October 6, 2015

CBH Provider Notices

2017

April 13, 2017

Provider Notice Regarding Supervision of Therapeutic Staff Support (TSS) in Behavioral Health Rehabilitative Services (BHRS)

CBH has observed that many BHRS providers utilize their Behavior Specialist Consultants (BSC) and Mobile Therapists (MT) for the onsite component of supervision for (TSS) workers. Providers are reminded that Medical Assistance (MA) regulations indicate the following:

  1. Provider billing for TSS supervision is prohibited. Therefore, CBH Compliance Department considers billing for supervision of TSS workers a Non-Billable Activity (Audit Variance Code N) and will recoup payments during audits made for BSC and MT claims in which the documentation indicates the provision of supervision of a TSS by a BSC or MT.
  2. BSC and MT case consultation, a billable activity, cannot be counted as TSS supervision. BSC and MT case consultation activities should be clearly documented as such in the member’s chart.
  3. TSS workers should be supervised by one supervisor who:
    • Is a licensed mental health professional
    • Holds a graduate degree and at least one year of experience either
      • In a Child and Adolescent Service System Program (CASSP) as defined by MA1 or
      • Employed by a licensed mental health agency or subcontracted agency
  4. The BSC or MT for a particular child is not the supervisor for the TSS assigned to the case.
  5. Periodic on-site supervision must be part of TSS supervision, and providers may bill for TSS services delivered during on-site supervision. (Some providers have misinterpreted this stipulation to mean the BSC and MT assigned to the child can provide the supervision. This is an incorrect reading of the MA requirement).
  6. Documentation of TSS supervision must be kept in the employee file, not in a member’s chart.

Details regarding MA regulations of TSS supervision can be found in MA Bulletin 01-01-05 Revisions of Policy and Procedures Relating to Mobile Therapy, Behavioral Specialist Consultant and Therapeutic Staff Support1 and in the Frequently Asked Questions addendum to the MA Bulletin.2
Please note that TSS supervision documentation may be requested as part of Network Improvement and Accountability Collaborative (NIAC) and/or Compliance Department site visits. Questions regarding this Notification can be directed to CBH.Compliancecontact@phila.gov.

Commonwealth of PA, Department of Public Welfare. (2001). Revisions of Policy and Procedures Relating to Mobile Therapy, Behavioral Specialist Consultant and Therapeutic Staff Support. PA Department of Public Welfare. Retrieved 4/11/17 from http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/d_004396.pdf

Commonwealth of PA, Department of Public Welfare. Behavioral Health Rehabilitative Services (BHRS) Frequently Asked Questions. Retrieved 4/11/17 from

http://www.dhs.pa.gov/provider/frequentlyaskedquestions/behavioralhealthrehabilitationservicesbhrsfrequentlyaskedquestions/

March 31, 2017

P4P Measurement and Threshold Webinars: Schedule Change

On March 20, 2017, CBH posted a Notification regarding upcoming P4P Measurement and Threshold Webinars. This Notice is to inform providers of two changes in meeting dates for Behavioral Health Rehabilitative Services (BHRS) and Community Integrated Recovery Centers (CIRC) levels of care. Please see the updated schedule here.

As a reminder, if you wish to attend any of the P4P meetings, please register as follow:.

For in-person attendance, please contact Naima Ware at naima.ware@phila.gov. Meetings will be held at CBH at 801 Market Street, Philadelphia, PA 19107..

For GoToMeeting participation, it is vital to register in advance using the links provided in the schedule. Registering ensures that you receive instructions to log on to the meeting, view slides, and hear the conversation.

We routinely revise our P4P measures to ensure they are indicative of quality and consistent with good clinical practice. As we enter into the seventh year of P4P, we continue to appreciate your vital contribution to the methodology discussion.

March 27, 2017
Rate for Applied Behavior Analysis (ABA) through Behavioral Health Rehabilitative Services (BHRS)
 
As part of an ongoing initiative to expand access to evidence-based treatment for individuals with autism spectrum disorder (ASD), CBH is making every effort to assemble a network of high quality providers who deliver Applied Behavior Analysis (ABA) services. CBH has created ABA Performance Standards  and will be designating BHRS ABA providers who meet or exceed these standards, as demonstrated via the ABA Designation Application. CBH designated ABA providers will be eligible to receive ABA referrals and enhanced ABA rates. The enhanced rate for ABA is intended to acknowledge the need for specialized training, increased supervision, and ongoing workforce development to deliver high quality ABA services.

ABA rates are as follow:
ABA Behavior Specialist Consultant (BSC) – $22.50 per 15 minutes
ABA Therapeutic Support Staff (TSS) – $16.00 per 15 minutes

To assist providers in expanding ABA clinical capacity and becoming CBH ABA designated providers, a Request for Applications (RFA) has been posted to solicit in-network BHRS providers to participate in an ABA training program. The selected providers will receive 40 hours of a web-based advanced training for a predetermined number of Therapeutic Support Staff (TSS). This training corresponds with the number of required training hours for a Registered Behavior Technician (RBT) and is consistent with training requirements for TSS workers per the CBH ABA Performance Standards. There is no cost to providers for this training opportunity. However, CBH requests that providers seriously consider the organizational commitment required to successfully implement and sustain an evidence-based practice prior to applying for the RBT training hours.
CBH has prioritized expanding ABA provider capacity by June 1, 2017. If this process does not yield sufficient capacity to meet members’ needs, we will explore procurement options.
Questions regarding this Notification can be directed to your Provider Representative.

March 20, 2017

P4P Measurement and Threshold Webinars

Thank you for your collaboration around Pay-for-Performance (P4P). We are pleased to announce the opening round of provider meetings to review 2017 performance measures and thresholds for services provided in measurement year 2016. Meetings are listed here by level of care and, where applicable, specialty population group. This year, we are combining the Drug and Alcohol Outpatient (DAOP) and Intensive Outpatient (IOP) webinars, as all of our IOP providers also provide DAOP services. Providers who do not deliver IOP services are not obligated to participate in the latter portion of the webinar specific to IOP services.

As in the previous year, we will provide the option of attending these meetings in-person or online via GoToMeeting. Due to space limitations, we are asking that your register as soon as possible if you wish to attend, and send only one person from your organization to that meeting. We will be able to accommodate the first 20 respondents in each meeting; beyond that number we may need to ask you to participate via GoToMeeting.  If you need accommodations under the Americans with Disabilities Act (ADA) to participate in any meeting, please let us know; we will be sure to reserve in-person space and/or provide other accommodations needed.

If you wish to attend any of the P4P meetings, please register as follow:

For in-person attendance, please contact Naima Ware at naima.ware@phila.gov. Meetings will be held at CBH at 801 Market Street, Philadelphia, PA 19107.

For GoToMeeting participation, it is vital that you register in advance using the links provided in the meeting schedule. Registering ensures that you receive instructions to log on to the meeting, view slides, and hear the conversation. We recommend that GoToMeeting participants dial-in to the meeting on the telephone rather than using the integrated audio option, as this seems to provide the best experience.

We routinely revise our P4P measures to ensure they are indicative of quality and consistent with good clinical practice. As we enter into the seventh year of P4P, we continue to appreciate your vital contribution to the methodology discussion.

March 13, 2017

CBH Administrative offices will be closed Tuesday, March 14, 2017

Due to the impending winter storm that is forecasted for our area tomorrow, CBH will close it’s Administrative Offices.

The Psychiatric Emergency Service (PES) and Member Services lines will be fully operational and will not be impacted by the administrative office closure. Electronic claims submissions will also not be affected.

March 13, 2017

Daily Inpatient Bed Availability and Substance Use Disorder Treatment Capacity Survey

CBH implemented Provider Bulletin #16‐06 entitled Daily Psychiatric and Substance Abuse Open Bed Registry on February 20, 2017. Please remember that provider implementation of survey requirements is essential to ensure accurate assessment of network capacity and access to treatment for our members. Surveys must be completed daily.

The survey requirements are mandatory for all Inpatient and Substance Use Disorder Treatment providers.  Please complete by noon each day.

CBH staff will be hosting three form.com webinars to train identified staff to complete the InpatientSubstance Use Availability Survey. Please pass this notification to involved staff, so they can participate in one of the three webinar training sessions.

InpatientSubstance Use Availability Surveys Webinar

  • March 22, 2017  Webinar     1:00 PM – 2:00 PM ET
  • March 23, 2017  Webinar     2:00 PM – 3:00 PM ET
  • March 24, 2017  Webinar     11:00 AM – 12:00 PM ET

Webinar Login for CBH Provider Survey Training

Please join my meeting from your computer, tablet or smartphone.
https://global.gotomeeting.com/join/559483493 

You can also dial in using your phone.
United States: +1 (646) 749-3112

Access Code: 559-483-493

Alternate Option:

https://www.gotomeeting.com/meeting/join-meeting

Meeting ID:  559-483-493

CBH Guide for the use of Provider Capacity Surveys

 

March 7, 2017
P4P Advisory Committee Selection

On February 8, 2017, an email was sent to all Executive Directors formally announcing the upcoming formation of a Pay-for-Performance (P4P) Advisory Committee. In this announcement, providers were asked to submit by Friday, February 17, 2017 names and contact information of staff members who would be interested in participating in the committee.  Following this announcement, CBH received a high number of staff members proposed for participation in the committee. In order to ensure the committee is effective and efficient, we must limit the number of participants. Please note that not every provider agency could be offered the opportunity to participate given the volume of responses.  We aimed to ensure a broad representation of individuals across providers and levels of care, capturing the diversity of our network. Selected organizations were limited to one staff member who plays a role in quality, performance improvement, or compliance. The staff members selected will receive direct correspondence inviting them to the first Advisory Committee meeting. Please contact Susanna Kramer at susanna.kramer@phila.gov if you have any questions.

February 23, 2017

Staff Roster Reminder

On December 28, 2016, the CBH Compliance Department released the 2017 staff roster template with a submission due date of January 31, 2017. Executive directors were contacted by email and a Provider Notice was also posted on the CBH Compliance page of the DBHIDS website

If your agency has not yet submitted a staff roster, or if you have been notified that your roster is incomplete, it is essential that you submit the complete roster to CBH.ComplianceContact@phila.gov immediately, but no later than March 10, 2017. Failure to submit a complete roster by March 10 will result in an Event of Default under the CBH Provider Agreement and applicable sanctions will be applied.

The 2017 roster template can be found on the CBH Compliance page of the DBHIDS website. If you have any questions related to the roster, please contact Mark Miller at Mark.D.Miller@phila.gov or Amy Cruz at Amy.Cruz@phila.gov

February 23, 2017

Connectivity Update

CBH is continuing to have connectivity issues to the City, preventing providers from submitting EDI claims, Electronic Packets or receiving response files, 835s, authorization reports, and other files sent or received through the EDI Browser.

Please send BHRS Packets, using Secure Email (Protected Trust)

Send to:
CBH.CBCAFS.Insufficients@phila.gov
We will update you daily and as we receive more information.
CBH providers using the IPSwitch solution can continue to send EDI Claims.
We apologize for any inconvenience.

February 22, 2017

Due to a mishap related to construction outside our building, we have temporarily lost connectivity to the City, preventing providers from submitting EDI claims or receiving response files, authorization reports, and other files received through the EDI Browser. We will update you tomorrow, as we receive more information.,

February 13, 2017

Provider Notice on CBH Fraud, Waste, and Abuse Hotline Posting

CBH providers are reminded that CBH maintains a hotline for reporting fraud, waste, and abuse by CBH employees, vendors, contractors, members, and network providers. Per the CBH Provider Manual, it is mandatory that providers display the hotline posting in a location visible to CBH members and provider staff.

Updated versions of the posting in English and Spanish are linked below. Reports can be made anonymously via phone or email. CBH on-site audits may include requests to view the posting. Please contact the CBH Compliance Department at CBH via ComplianceContact@phila.gov for any questions regarding this Provider Notice.

Hotline Posting – English
Hotline Posting – Spanish

February 13, 2017

Packet Exemption

Consistent with our goal at CBH to operate economically and efficiently, we are adopting a new approach this year for requests for summer supports which are commensurate with services approved during the school year. This change will be effective March 13, 2017.

If the summer services requested fall within the timeframe of the most recent evaluation, and if the amount of services prescribed for summer supports is commensurate to, or less than, the amount delivered in the school setting, CBH does not need to receive the request in the form of a packet. Instead, providers may submit a list of members needing summer supports in a recreational or academic setting to their Clinical Care Manager using the Summer Services Request Form provided by CBH. All elements of the form must be completed, which includes:

• Child’s name and Medical Assistance ID #
• Current services authorized
• Name, location, dates, and hours of camp or educational program attending
• Prescribed services for summer including hours per week, dates, and provider agency
• Name of prescribing agency, prescriber, and prescribing agency point of contact
• Caregiver name and contact information

While CBH will not require a packet submission, providers still must maintain essential documentation in files to establish medical necessity and to meet state requirements. Providers are free to prescribe any level of service that is medically necessary over the summer months. CBH will continue to require packet submission for any request that falls outside the parameters outlined below, including for children that are prescribed an increased level of support for summer programming than is authorized in school.
Please use this guide to determine what CBH considers a summer request that is commensurate with services authorized in school.

• STS level 1 or TSS-S 16 to 30 hours is commensurate to LC 2, Group TSS 20 in community camp.
• STS level 2 or TSS S up to 15 hours is commensurate to LC 2, Group TSS 10 in community camp.
• STS level 1 is commensurate to TSS-NS 20 in a community camp without a Group TSS program.
• STS level 2 is commensurate to TSS-NS 10 in a community camp without a Group TSS program.
• We will also support maintaining the same or reduced number of hours of TSS support in a community camp without a Group TSS program or in Extended School Year.

Questions regarding this Notice can be directed to providers’ assigned Clinical Care Manager.

February 13, 2017

Use of Therapeutic Support Staff (TSS) Scheduler Form

Effective March 13, 2017, CBH will require the use of the TSS Scheduler Form for all requests for TSS-School (TSS-S) and TSS-Nonschool (TSS-NS). This form should reflect how TSS services will be used at times of targeted need, as identified in the Comprehensive Biopsychosocial Evaluation, Re-evaluation, or Addendum. The TSS Scheduler Form can be found via the link below.

Requests that are received after the above date that do not include the TSS Scheduler form will be deemed insufficient. Questions regarding this Notice can be directed to providers’ assigned Clinical Care Manager.

TSS Scheduler Form

February 13, 2017

Daily Inpatient Bed Availability and Substance Use Disorder Treatment Capacity Survey

CBH will fully implement Provider Bulletin #16‐06 entitled Daily Psychiatric and Substance Abuse Open Bed Registry on February 20, 2017. Please remember that provider implementation of survey requirements is essential in ensuring accurate assessment of network capacity and access to treatment for our members; daily surveys must be completed to keep with the Provider Agreement.

CBH staff will be hosting three form.com webinars as an opportunity to train your identified staff on how to complete the InpatientSubstance Use Availability Survey. Please pass this notification onto your appropriate staff, so they can participate in one of the three webinar training sessions.

InpatientSubstance Use Availability Surveys Webinar

February 15, 2017 1:00 PM – 2:00 PM
February 16, 2017 2:00 PM – 3:00 PM
February 17, 2017 11:00 AM – 12:00 PM

CBH Provider Survey Training 

Please join my meeting from your computer, tablet or smartphone. 
https://www.gotomeet.me/cbhmco 

You can also dial in using your phone. 
United States: +1 (872) 240-3412

Access Code: 312-020-877 

Provider Login Procedure

This is the procedure to login to the Inpatient Bed Availability and Substance Use Treatment Capacity surveys. The start date for this requirement is Feb 20, 2017.
In addition, please review the Community Behavioral Health Daily Inpatient Bed Availability and Substance Use Disorder Treatment Capacity Survey: Guide for Use for detailed instructions.

1) Go to the CBH Survey Website using the URL: https://app.keysurvey.com/portal/#1087617
2) Login and Password (Assigned via email)
3) Please Choose the appropriate survey from the left side menu
a. ‘Inpatient Bed Availability’ or
b. ‘Substance Use Disorder Treatment Availability’
4) Click the ‘+ Add New’ button to begin a new survey.
a. Complete all appropriate fields for your service location.
b. Please do not count the same available bed or treatment opening in more than one section.
c. Click the ‘Submit’ button to complete your survey by noon each day.

Questions regarding this notification can be directed to your Provider Relations Representative.

February 7, 2017

CBH is upgrading the system that providers use to submit claims files, and receive 835RA, Schedule A, acknowledgements. It is also planned that this new secure file transfer (SFTP) solution will be utilized for all types of file transfers in the future.  This new system will provide a more streamlined and secure method for all file transfers between providers and CBH/DBHIDS. We will be contacting every provider, in small groups, starting 2/9/2017.  Each group will be provided full training and testing support for the transition.

January 27, 2017

Child and Adolescent Inpatient Performance Standards DRAFT: Request for Provider Feedback

As you are aware, CBH is endeavoring to enhance services available to children and adolescents admitted to Inpatient Psychiatric Treatment. To this end, CBH has collaborated with the Child and Adolescent Inpatient providers, as well our system partners to create Child and Adolescent Inpatient Performance Standards for providers in the CBH network based on current best practices in the field. These Standards are intended to bring uniformity and quality to inpatient treatment. CBH is very interested in feedback from providers, stakeholders, and families regarding the draft in its current stage. Please note that the Standards are currently a working document, and we will adapt it to include both provider input based on a consensus process, as well as any changes in state regulations. The Standards will also be expanded to include oversight and monitoring procedures before final publishing.

Please take a moment to read the Child and Adolescent Inpatient Performance Standards and provide your feedback via the linked survey on or before close of business February 6, 2017: https://www.surveymonkey.com/r/7TQPZ25

January 26, 2017

CBH Administrative Offices Closed for 20th Anniversary.

CBH administrative offices will be closed Wednesday, February 1, 2017 in recognition of our 20th anniversary.

As CBH celebrates 20 years of uninterrupted service to the community of Philadelphia, we would like to take this opportunity to thank our provider partners for helping us make the past 20 years so successful. We look forward to our ongoing partnership to support the wellness, resilience, and recovery of all Philadelphians.The Psychiatric Emergency Service (PES) and Member Services will be fully operational and will not be impacted by the administrative office closure.

January 25, 2017

Treatment Capacity Forms

On November 3, 2016 a DBHIDS/CBH Provider Bulletin (#16-06) was issued entitled Daily Psychiatric and Substance Abuse Open Bed Registry. This Bulletin indicated that the daily report of acute psychiatric inpatient bed availability will be effective as of December 5, 2016; however, on December 2, 2016, a Provider Notice followed this Bulletin to announce a webinar for the children and adolescent inpatient providers.

This Notice is to announce that all adult psychiatric inpatient and substance use providers shall begin completing the daily treatment capacity forms effective Monday, February 20, 2017.  The providers required to complete the daily Substance Use Treatment Capacity Form include the following levels of care: medically managed and medically monitored detox programs, medically managed and medically monitored short-term rehab programs, long-term rehab programs, specialized rehab programs, and halfway houses; this does not apply to outpatient and intensive outpatient substance use programs.

CBH will conduct a webinar for the adult inpatient psychiatric providers and substance use providers. A date for the webinar, along with an invitation and web link will be forthcoming. Additionally, you will be asked to submit a primary and secondary contact for the completion of the forms. Please direct inquiries regarding this Notice to your Provider Relations representative.

January 20, 2017

Staff Roster Reminder

On December 28, 2016, the CBH Compliance Department released the 2017 staff roster template with a submission due date of January 31, 2017. Executive directors were contacted by email and a Provider Notice was also posted on the CBH Compliance page of the DBHIDS website.

If your agency has not yet returned a completed staff roster, it is essential that you submit the roster to CBH.compliancecontact@phila.gov by January 31, 2017.  As a reminder, failure to submit the roster will result in an Event of Default.

The new roster template can be found on the CBH Compliance page of the DBHIDS website. Any questions regarding the roster should be directed to Mark Miller at Mark.D.Miller@phila.gov or Amy Cruz at Amy.Cruz@phila.gov

2016

December 28, 2016

CBH Compliance has released the 2017 personnel roster template. While there have been changes to the 2017 version, key elements of the 2016 roster remain, so that content can be transferred to the new version without the loss of fidelity. The new roster incorporates the following revisions:

  • Newly labeled tabs: Previously the tabs reflected only Employed and Contracted status. These have been expanded to include the following three categories for clarity: W2 (employed), 1099 (contracted/FFS/per Diem), and Temp (from temp agency).
  • A new column has been added for CBH Provider Number, the use of which affiliates the staff person with a specific CBH contracted program. This number can be found on the Schedule A.
  • The Program column has been changed to Level of Care.
  • Other changes include expanded drop-downs and clearer language in existing fields and in the instructions.

The roster can be found on the CBH Compliance page of the DBHIDS website. Please complete the roster and submit to CBH by January 31, 2017. It is essential that the roster is completed entirely and submitted to CBH on time. Failure to submit the completed roster by the due date may result in an Event of Default. The completed roster should be submitted by email to cbh.compliancecontact@phila.gov. Any questions should be directed to Mark Miller at mark.d.miller@phila.gov or Amy Cruz at amy.cruz@phila.gov.

.December 2, 2016

Open Bed Registry Start Date Postponed

On November 3, 2016 a DBHIDS/CBH Provider Bulletin (#16-06) was issued entitled Daily Psychiatric and Substance Abuse Open Bed Registry. This Bulletin indicated that the effective date for implementation of this registry would be December 5, 2016; however, the effective date has been postponed until further notice. CBH will conduct a web-based training on December 14, 2016 at 11:00am to demonstrate how to use the registry. An invitation and web link will be forthcoming. Please note that the use of this registry will go live first with children and adolescent inpatient providers, and therefore only those providers will receive the invitation. Adult psychiatric inpatient and substance use providers will begin implementation at a later date, and a separate notice will follow to announce that date. Also as a reminder, this secure cloud-based registry was created to collect, aggregate, and review data on the availability of inpatient beds for all in-network facilities on a daily basis; this registry is not intended to eliminate existing requirements to call facilities to review the member’s clinical presentation and to ensure the appropriateness of the admission.

November 18, 2016

PROVIDER NOTICE: GROUP THERAPY SIZE LIMITATIONS

Community Behavioral Health (CBH) is issuing this Provider Notice as a reminder regarding the limitations on the number of participants in Group Therapy in Outpatient Mental Health and Addictions Services. Medicaid restricts the number of participants, as noted below. Billing for services provided in excess of these parameters is subject to repayment for all CBH participants, not just those exceeding the limits.  CBH will be adding this element to Compliance Department reviews in future audits.  It is important that documentation allows for group size to be ascertained.  Progress notes should clearly indicate the number of participants in the group, without listing names or identifiers of other group members.

Please review the relevant regulations as well as your program policies and procedures to ensure that you are not in violation of this standard; policies and procedures should be revised accordingly to ensure alignment with these regulations. CBH will be holding providers for which Group Therapy is a Supplemental Service to these same standards. Other programs such as Community Integrated Recovery Centers (CIRCs) utilizing group therapy services should follow the relevant Commonwealth regulations.

Group Therapy:

Medical Assistance regulations for both Mental Health and Addictions Services limit Group Therapy size to 10. This is the maximum number of TOTAL participants, not just CBH members. This number also excludes any treatment staff and may not be increased by using co-facilitators.

Mental Health, MA Regulations Title 55, CHAPTER 1153. OUTPATIENT PSYCHIATRIC SERVICES; GENERAL PROVISIONS:

  • 1153.2. Definitions

Group psychotherapy—Psychotherapy provided to no less than two and no more than ten persons with diagnosed mental disorders for a period of at least one hour. These sessions shall be conducted by a clinical staff person.

Drug and Alcohol, MA Regulations Title 55, CHAPTER 1223. OUTPATIENT DRUG AND ALCOHOL CLINIC SERVICES, GENERAL PROVISIONS:

  • 1223.2. Definitions

Group psychotherapy—Psychotherapy provided to no less than two and no more than ten persons with diagnosed drug/alcohol abuse or dependence problems for a minimum of one hour. These sessions shall be conducted by drug/alcohol clinic psychotherapy personnel under the supervision of a physician.

Psychoeducational Groups:

Often, valuable and medically necessary group treatment occurs outside of the traditional group psychotherapy models. Typically these groups are labeled as “psychoeducational.” Psychoeducational groups are permissible as a limited adjunct to more traditional therapy modalities (Individual, Group, and Family).  Psychoeducational groups are permitted as part of a treatment course in programs such as Partial Hospital Programs, Intensive Outpatient Programs (IOP), Residential Treatment Facilities, Inpatient and Non-Hospital Detoxification and Rehabilitation Units, and Halfway Houses. Psychoeducational groups are not billable as stand-alone services.

Examples of Psychoeducational Group topics include, but are not limited to:

Vocational and Occupational training
Life skills
Parenting/Family Reunification
Structured Social Activities
Dynamics and Medical Aspects of Addiction
Abstinence and Its Role in Recovery
Use of Self Help and Support Group
Nutrition
Sex and Sexuality
Family Dynamics of Addiction
Confrontation Skills
Refusal Skills
Avoiding and Defusing Triggers for Relapse
HIV and STDs

The maximum group size for psychoeducational groups in order to be reimbursed by CBH is 15 participants. This number excludes any treatment staff and may not be increased by using co-facilitators. In order to be eligible for CBH reimbursement, psychoeducational groups must be conducted by staff appropriately credentialed to provide this service in the relevant level of care.  Appropriately credentialed interns may conduct psychoeducational groups as long as the fully credentialed supervisor co-signs all notes by the intern. Certified Peer Specialists may also lead psychoeducational groups so long as the provisions set forth in the Medical Assistance Handbook are followed:

Provider agrees that it will typically provide peer support services on an individual (1:1) basis but may offer group services for several individuals together when such services are beneficial, provided that group services may not include social, recreational or leisure activities. To receive peer support services in a group, individuals must share a common goal, and each individual must agree to participate in the group. Services such as psychoeducation or WRAP (Wellness Recovery Action Planning) are the types of services that may be provided in groups.

(http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/d_004594.pdf)

Questions regarding this Notification can be directed to CBH.ComplianceContact@phila.gov.

October 14, 2016

Closed: North Philadelphia Health System (NPHS) Behavioral Assessment Center (BAC)

Effective immediately and until further notice, the North Philadelphia Health System (NPHS) Behavioral Assessment Center (BAC) located at 801 W. Girard Ave, Philadelphia PA 19122 is closed. All other NPHS mental health and substance abuse services located at this site remain fully operational, which include: outpatient, drug and alcohol detoxification and residential services, and acute psychiatric units.

Please utilize the Crisis Response Centers (CRC) (Temple Episcopal, Einstein Medical Center at Germantown, Friends, Hall Mercer, and Mercy) or one of the following substance abuse assessment centers during regular business hours when referring CBH members for a substance abuse assessment:

  • Kensington Hospital- 215-426-8100
  • Kirkbride Center – 215-471-2600
  • Fairmount Behavioral Health Center – 215-487-4100
  • Presbyterian Addiction Assessment Center – 215-662-8747

If you have questions or concerns, please contract Smeeta Kothari, Clinical Care Manager Supervisor at 267-602-2269, and for BHSI contact Carl Pray at 215-546-1200.

September 20, 2016

CBH Compliance Forum

CBH would like to inform our provider community about an opportunity to learn more about the Compliance department:
WHAT
Community Behavioral Health (CBH) is hosting its inaugural Compliance Forum this fall. The forum is designed to provide an opportunity for the CBH Compliance Department to share information related to:
• Relevant current trends
• Enforcement focus
• Practical examples of implementing/improving provider compliance plans
• Best compliance practices
To accomplish this, we are excited to have several speakers, highly experienced in a broad range of compliance functions, to address these topics. The forum will also give our network providers the chance to interact with the presenters and CBH Compliance staff in a more informal setting.
WHEN
The forum is scheduled for Wednesday, November 9, 2016 from 9AM to 1PM. We are asking that providers arrive between 8:30AM and 9:00AM to register and enjoy complimentary light refreshments.
WHO
Provider staff functioning in the roles of compliance and/or privacy officers, and senior level compliance/privacy staff are invited to attend. We are limiting attendees to TWO per provider.

For your convenience, when registering, please use the direct link here:  www.eventbrite.com/e/community-behavioral-health-compliance-forum-tickets-27551759053

Please feel free to contact Nicole Beaufort with any questions and/or concerns at nicole.beaufort@phila.gov.

August 31, 2016

ABA Performance Standards
CBH is endeavoring to enhance services available to children, adolescents, and young adults who are diagnosed with autism spectrum disorder (ASD). To this end, CBH has collaborated with a team of local autism experts and researchers to create Applied Behavioral Analysis (ABA) Performance Standards for BHRS providers in the CBH network based on current best practices in the field. The intention of these Standards is to bring uniformity and quality to ABA being provided in Philadelphia; the document will also be used as a starting point for identifying strengths and needs in current ABA programming. CBH is very interested in feedback from providers, stakeholders and families regarding the draft in its current stage. Please note that the Standards are currently a working document, and we will adapt it to include both provider input based on a consensus process, as well as any changes in state regulations. The Standards will also be expanded to include oversight and monitoring procedures before final publishing.
Please provide your feedback via the linked survey – https://www.surveymonkey.com/r/ABAStandardsFeedback

August 18, 2016

ABA Medical Necessity Criteria

The Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS) has released the Medical Necessity Criteria for Applied Behavioral Analysis using Behavioral Specialist Consultant- Autism Spectrum Disorder and Therapeutic Staff Support Services for children and adolescents with Autism Spectrum Disorder. CBH will use the ABA Medical Necessity Guidelines Bulletin and the MNC for ABA Using BSC-ASD and TSS when reviewing requests for ABA through BHRS. Please direct any questions regarding this Notification to Lauren Dellacava at lauren.dellacava@phila.gov or 215-413-8583.

August 1, 2016

Social (Pragmatic) Communication Disorder
The DSM-5 added a new diagnosis of Social (Pragmatic) Communication Disorder 315.39 (F80.89). This diagnosis requires that Autism Spectrum Disorder (ASD) has been ruled out. It is most commonly diagnosed and treated by a speech-language pathologist. In the event that a child with Social (Pragmatic) Communication Disorder is approved for BSC services, the BSC must be a Licensed Psychologist, Licensed Behavior Specialist, Licensed Social Worker, Licensed Marriage and Family Therapist, Licensed Clinical Social Worker, or Licensed Professional Counselors and meet all the requirements of a BSC treating a child with Autism Spectrum Disorder to account for the similarities between Autism Spectrum Disorder and Social (Pragmatic) Communication Disorder. This is effective September 27, 2016. Questions regarding this Notice may be directed to Lauren Dellacava at lauren.dellacava@phila.gov or 215-413-8583.

August 1, 2016

Requesting BSC-ASD services
CBH received clarification from the Children’s Bureau regarding requests for services for children with Autism. When requesting Behavioral Specialist Consultant (BSC) service for a child with an Autism Spectrum Disorder (ASD) diagnosis, the request must be for BSC-ASD. If a request is made for BSC (without specifying ASD), CBH will deny the service. BSC and BSC-ASD are different services and children with ASD must be provided a service delivered by staff qualified to treat ASD. For additional information, please see the CMCS Informational Bulletin dated July 7, 2014 and OMHSAS memo dated March 18, 2015. Both documents are attached below for your convenience. This is effective September 27, 2016. Questions regarding this Notice may be directed to Lauren Dellacava at lauren.dellacava@phila.gov or 215-413-8583
Memo
CMS Informational Bulletin

July 28, 2016

CBH Provider Refusal Policy (updated from February 16, 2016)

The CBH Provider Agreement requires that CBH network providers accept all CBH members who are authorized to receive a medically necessary level of care offered by a network provider (see CBH Provider Agreement Section II(A)(8)).

When CBH learns that a contracted provider has refused to accept a member who has been authorized for a given level of care, it will initiate a request for rationale which, if determined by CBH to be unsatisfactory, shall result in an Event of Default under the Provider Agreement. If the Event of Default is not cured within the time permitted under the Provider Agreement, the resulting penalty will be a $5000 fine.

The February 16, 2016 notice indicated that CBH may employ any and all remedies under the CBH Provider Agreement. The current notice defines the remedy as the above referenced monetary sanction.

Providers are encouraged to review the CBH Provider Agreement and to direct any inquiries on this matter to CBH’s Assistant Counsel at shloka.joshi@phila.gov.

July 18, 2016

Case Consultation Training Series

Community Behavioral Health (CBH) will host an information session to provide details about the Case Consultation Training Series RFA: Improving Clinical Skills with Children and Families. Anyone considering submitting a response to this RFA is encouraged to attend this event. The information session will take place on July 25, 2016 from 10:00 am – 11:30 am at CBH, 801 Market St. Philadelphia, PA 19107, on the 11th floor in conference room 1154 “B”. An RSVP is not required.

July 7, 2016

PCIT RFA: Information Session

Community Behavioral Health (CBH) will host an information session to provide details about the recently issued Request for Applications (RFA) for participants in the Parent-Child Interaction Therapy (PCIT) Training Program. Anyone considering submitting a response to this RFA is encouraged to attend this event. The information session will take place on July 14, 2016 from 2:30pm to 4:00pm at CBH, 801 Market St. Philadelphia, PA 19107, on the 7th floor in the large conference room. An RSVP is not required.

June 21, 2016

CBH reminds providers that the CBH Provider Agreement requires providers to conduct and maintain records of monthly checks for excluded individuals and entities on the three exclusion lists noted below and to report exclusions to CBH within three (3) business days.
In 2011, the Commonwealth’s Office of Medical Assistance Programs issued MA Bulletin 99-11-05, “Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation.” Available at http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/d_005732.pdf.

This Bulletin outlined the payment ban and the screening and self-audit process.  The Bulletin reminds providers that, per the Code of Federal Regulation 42 CFR § 1001.1901(b),

No payment will be made by Medicare, Medicaid or any of the other Federal health care programs for any item or service furnished, on or after the effective date [of an exclusion], by an excluded individual or entity, or at the medical direction or on the prescription of a physician or other authorized individual who is excluded when the person furnishing such item or service knew or had reason to know of the exclusion.

Non-payable services include not only those provided by clinicians and physicians, but also indirect services provided by administrators, billing agents, accountants, claims processors, utilization reviewers, and others not directly involved in the care of members.  Per the Bulletin,
Examples of individuals or entities that providers should screen for exclusion include, but are not limited to: Individual or entity who provides a service for which a claim is submitted to Medicaid; Individual or entity who causes a claim to be generated to Medicaid; Individual or entity whose income derives all, or in part, directly or indirectly, from
Medicaid funds; Independent contractors if they are billing for Medicaid services;
Referral sources, such as providers who send a Medicaid recipient to another provider for additional services or second opinion related to medical condition.

Upon discovery of an exclusion, it is not sufficient for a provider to solely terminate the employment or contract with the excluded individual or entity.  Providers must notify CBH within three (3) days of discovery and conduct a self-audit to determine the amount of the repayment to CBH, as CBH is unable to make or retain payments for services provided by excluded individuals and entities.  Per the Bulletin, The amount of the Medicaid overpayment for such items or services is the actual amount of Medicaid dollars that were expended for those items or services. When Medicaid funds have been expended to pay an excluded individual’s salary, expenses, or fringe benefits, the amount of the overpayment is the amount of those expended Medicaid funds.

Reports of exclusions should be made to the CBH Compliance Operations Specialist at CBH.ComplianceContact@phila.gov.  Failure to conduct monthly checks or report exclusions to CBH will result in a violation of the CBH Provider Agreement (see Section II(A)(16)) and may result in remedies or sanctions consistent with the CBH Provider Agreement. Future CBH Compliance Department audits may include reviews of the monthly exclusion list check documentation.

The three lists providers must check include:

List of Excluded Individuals and Entities (LEIE)  http://oig.hhs.gov/fraud/exclusions.asp
System for Award Management (SAM)
(formerly Excluded Parties List System (EPLS)) https://www.sam.gov
Department of Human Services’ Medicheck List http://www.dhs.state.pa.us/publications/medichecksearch/

Questions regarding this Notification can be directed to CBH.ComplianceContact@phila.gov.

June 16, 2016

National Practitioner Databank Report: Requirement for Residents

Effective immediately, CBH will not require resident physicians working under a training license to obtain National Practitioner Databank (NPDB) reports, as long as they are not a member of the medical staff.

Per the U.S. Department of Health and Human Services (HHS)

Whether a hospital is required to query on an intern or resident depends upon whether the intern or resident is a member of the medical staff. Health care entities are not required to query the NPDB on medical and dental residents, interns, or staff fellows (collectively referred to as housestaff), even though they are often licensed, when they are trainees in structured programs of supervised graduate medical education and not members of the medical staff.

However, hospitals are required to query on housestaff when such individuals are appointed to the medical staff or granted clinical privileges to practice outside the parameters of the formal medical education program (e.g., moonlighting in the intensive care unit or emergency department of that hospital).

 HHS NPDB Guidebook, D 5-7, 2015.

Physicians with full privileges continue to be required to obtain an NPDB report. This requirement applies to all physicians working in the CBH network, regardless of level of care.  Please direct any questions regarding this Notification to CBH.ComplianceContact@phila.gov.

May 16, 2016

Community Behavioral Health (CBH) will host a bidder’s conference to provide details about the recently issued Request for Applications (RFA) for participants in the Beck Community Initiative Cognitive Therapy Training for Adult Drug and Alcohol Intensive Outpatient Programs. Anyone considering submitting a response to this RFA is encouraged to attend this event. The bidder’s conference will take place on May 24, 2016 from 3:00pm to 4:00pm at CBH, 801 Market St. Philadelphia, PA 19107, on the 11th floor in conference room 1154B. An RSVP is not required.

May 11, 2016

Applied Behavior Analysis (ABA) Attestations

As many of you know, CBH is looking at the best way to identify which of our BHRS providers can offer Applied Behavior Analysis (ABA) to fidelity. Quickly developing requirements from the Office of Mental Health and Substance Abuse Services (OMHSAS) complicate this endeavor. As an initial step to meeting the OMHSAS requirement of posting our providers who offer ABA on our website, we have listed some of our providers who specialize in Autism treatment, including ABA.

Our next step is to work with outside subject matter experts, providers, and the Bureau of Autism Services (BAS) to develop Practice Standards for ABA. Once we publish these standards, we will offer our providers a chance to demonstrate that they meet these standards. We will list the providers who meet these standards on our website as ABA providers. Providers who do not meet ABA Practice Standards but wish to use ABA science within their BHRS programs are free to do so but CBH will not identify them as offering an ABA program.

As BHRS providers may be aware, we shared the letter from OMHSAS regarding attestations and said we would be putting out a formal notification to providers with instructions. For now, we are advising that staff providing services that include ABA to a child with Autism Spectrum Disorder sign the individual attestation titled “Confirmation of Knowledge and Skills to Provide ABA.” This was included in our last communication. Providers should keep these attestations in staff personnel files.

At this time, CBH is not requiring that providers submit the provider attestation titled “Attestation for Behavioral Health Rehabilitation Services Providers that Provide Applied Behavioral Analysis using Behavioral Specialist Consultant-Autism Spectrum Disorder and Therapeutic Staff Support Services.” CBH will revisit the submission of the provider attestations following the publication of ABA Practice Standards.

Recent bulletins from OMHSAS can be found here:
TSS ABA Bulletin
BSC ABA Training
ABA Attestation Memo
ABA Provider Attestation Form
Questions regarding this Notice may be directed to Lauren Dellacava at lauren.dellacava@phila.gov or 215-413-8583.

April 19, 2016

Bidder’s Conference 4/21/16: Mental Health Outpatient Services RFP

Community Behavior Health (CBH) will host a bidder’s conference to provide details about the upcoming issuance of a Request for Proposals (RFP) to provide Mental Health Outpatient Services to persons living in North Philadelphia. Anyone considering submitting a response to this RFP is encouraged to attend this event. The bidder’s conference will take place on April 21, 2016 from 9:30am to 11:00am at CBH, 801 Market St. Philadelphia, PA 19107, on the 11th floor in conference room 1154A. An RSVP is not required.

April 13, 2016

Insufficient Notice

Effective April 15, 2016, Community Behavioral Health (CBH) is refining its process for response to requests for services when the information provided by a provider is insufficient to make a clinical determination.

Under the HealthChoices Program, if a provider requests a non-acute level of care without providing sufficient information to allow CBH to render a medical necessity determination, CBH shall notify the member and provider of the missing elements by sending an insufficient letter. The provider then has up to 14 calendar days to respond with the requested information at which point CBH will make a medical necessity determination. Additional information should be provided as it is for initial requests (fax, electronically, phone, etc).

For acute levels of care, CBH will verbally inform the provider of the missing elements. The provider then has 24 hours to respond with the requested information, at which point a CBH will make a medical necessity determination.

If the provider does not respond within the outlined timeframe, or the information is still inadequate for CBH to make a medical necessity determination, CBH will deny the request due to insufficient information.

Questions regarding this Notice may be directed to your Provider Relations Representative.

April 8, 2016

Third Party Liability

This notification is to alert providers of their responsibilities and CBH expectations in instances when a CBH member is dually eligible (has Medicare or other commercial insurance as well as CBH) and CBH is the payer of last resort.

Beginning April 11, 2016, CBH will only review cases for medical necessity criteria when the service the provider is requesting is not a covered benefit under the member’s primary insurance coverage, the member has exhausted Medicare inpatient benefits, or the member’s primary insurer denies services. In cases when the member’s primary insurer denies services, the provider must complete denial procedures of the primary insurer prior to contacting CBH for a medical necessity determination.

If none of these scenarios are applicable, no precertification is required. However, the admitting provider must notify CBH of the admission.

Providers are required to submit discharge information to CBH within one business day of discharge, at which time an authorization will be generated. If the primary insurer denies part of the treatment stay, and the provider did not contact CBH, the provider must submit the member’s chart for a retrospective clinical review. CBH will then make an authorization decision.

If a provider requests a service that is not part of the member’s primary benefit plan, the provider is required to contact CBH for medical necessity determination.

March 31, 2016

Dear Providers,

Thank you for your collaboration around Pay-for-Performance. We are pleased to announce the opening round of provider meetings to review P4P measures and thresholds for 2016 performance assessment on services provided in measurement year 2015. Meetings are listed below by level of care and, where applicable, specialty population group. As in the previous year, we wish to provide you with the option of attending these meetings in-person or online via GoToMeeting. Due to space limitations, we are asking that if you wish to attend in-person that you RSVP to us as soon as possible, and send only one person from your organization to that meeting. We will be able to accommodate the first 20 respondents in each meeting; beyond that number we may need to ask you to participate via GoToMeeting only. If for any reason you need accommodations under the ADA in order to participate in any of these meetings, please let us know; we will be sure to reserve in-person space and/or provide any other accommodations that are necessary to meet that need.

For GoToMeeting participation, it is vital that you register in advance using the link provided below. Registering through this link ensures that you get the information necessary to enable you to log on to the meeting, see slides, and hear the conversation. We recommend that GoToMeeting participants dial-in to the meeting on the telephone rather than using the integrated audio option, as this seems to provide the best experience.

In our efforts to ensure that we have measures that are indicative of quality and consistent with good clinical practice, our measurements are continually revised. The resultant technical specifications translate into complex data processing logic. As we enter into the seventh year of Pay-for-Performance, these data procedures are increasingly complex, and we appreciate your input into the methodology discussion at these webinars. These meetings are part of that process, and we would like to acknowledge your contribution to this collaborative process.

2016 P4P Schedule

For RSVP to attend the meetings in person, please contact Naima Ware at naima.ware@phila.gov. Thank you.

March 9, 2016

Changes to the CBH Compliance Department Audit Response Process

The CBH Compliance Department has historically allowed providers to submit missing documentation and/or new paper claims as part of the provider’s response to the audit. Two changes will go into effect for audits scheduled as of April 8, 2016, thirty (30) days from the date of this notice:

  1. Decrease in Allowable Time for Submission of Missing Documentation in CBH Compliance Audits:

Providers are responsible for ensuring that documentation of services is present in the clinical record once services have been billed. Previously, providers have had until 5:00pm of the business day after the daily on-site audit to submit progress note and treatment plan documentation listed as missing at the audit. Providers will now only have until 10:00am the following business day to submit the documentation. It may still be submitted via hard copy, fax to 215-413-7552, or secure (Protected Trust) e-mail to the audit Team Leader. Providers may not create new documentation to replace that which is unable to be located. Also, please do not send original progress notes for review.

  1. Discontinuation of Re-Billing for Date and Service Type Errors on New Paper Claims as Part of CBH Compliance Audit Response:

Providers are responsible for making sure that services are billed accurately. Previously, providers have been allowed to submit new paper claims to correct errors in date and type of service found by CBH Compliance Analysts during audits. CBH is no longer accepting new paper claims for the correct dates and types of service as part of the provider’s response. Claims appeals will also not be accepted for these billing errors.

Questions regarding this Notice may be directed to CBH.ComplianceContact@phila.gov.

March 3, 2016

CBH Compliance is introducing an updated staff roster template. The new template has additional fields for tracking information on education and licensure, as well as aligning job titles to CBH standards. The completed roster will also serve as the tool used during staff file audits, and allow providers to better prepare for our visits.

In an effort to determine the breadth of network provider resources, and to plan more efficiently for audits, the CBH Compliance Department requests that all network providers submit a current staff roster using the updated template, which can be found on the CBH Compliance page of the DBHIDS website. Please submit the completed roster in the current format to CBH by March 25, 2016. The roster should be submitted by email to cbh.compliancecontact@phila.gov. Any questions regarding the roster should be directed to Mark Miller at mark.d.miller@phila.gov or Tracey Robinson at tracey.robinson@phila.gov.

February 16, 2016
Dear Providers:
This is a reminder that the CBH Provider Agreement requires contracted providers to accept all CBH members who are authorized to receive a medically necessary level of care offered by said providers (CBH Provider Agreement section II (A) (8)). When a provider refuses to accept a member who has been authorized for a given level of care, and has provided an unsatisfactory clinical rationale for the denial of admission, CBH will consider this a breach of the Provider Agreement. Pursuant to the Provider Agreement, a Notice of Event of Default will be sent to the provider. Should a provider fail to cure, CBH may employ any and all remedies under the CBH Provider Agreement.

Providers are encouraged to review the CBH Provider Agreement and to direct any inquiries on this matter to CBH’s Assistant Counsel at shloka.joshi@phila.gov.

January 20, 2016
The CBH requirements for obtaining Child Abuse Clearances, Criminal History Reports, and FBI Background Checks will change, effective February 19, 2016. All required documentation must be obtained before the commencement of employment or service, and updated every five (5) years. This replaces the previous requirement that all Clearances and Criminal Background Checks be updated every three (3) years. These changes are in line with the current State regulations and will also be updated in the forthcoming revision of the Manual for Review of Provider Personnel Files.

The new requirements are described in full in Bulletin #16-01, which is available on the CBH Provider section of the DBHIDS website.

January 11, 2016
The Manual for Review of Provider Personnel Files (MRPPF), Draft Version 1.2, was posted to the CBH website on April 27, 2015. The comment period ended June 8, 2015. Feedback was provided by 14 CBH provider agencies and the Philadelphia Coalition. The CBH Compliance Team will finalize the revision in 2016, while ensuring that provider comments to the draft are considered and the latest State regulations and guidelines are being incorporated. Changes around clearance requirements and Child Protective Services trainings are among the revisions to the MRPPF. In the meantime providers should check CBH Bulletins section of the DBHIDS website for updates. The provider comments can be viewed on the CBH Compliance page of the DBHIDS website.

2015

December 17, 2015
This is a reminder that the deadline for submission of Re-enrollment/Revalidation of Medical Assistance Providers of March 24, 2016 is quickly approaching.

As a provision of the Affordable Care Act (ACA), all providers participating in the PA Medical Assistance (MA) program are required to re-enroll each of their service locations in PROMISe no later than March 24, 2016.  Service locations that have not completed the re-enrollment process by the March 24, 2016 deadline date will expire and their PROMISe enrollment records will be closed. The provider will not be paid for services delivered to MA recipients after the date of closure. It is important to note that effective dates of the new enrollment will not be retroactive to cover any lapses in enrollment. This includes payment for all services contracted with Community Behavioral Health (CBH).

CBH is committed to working closely with providers to avoid any possible service interruptions for our members. CBH is recommending that all PROMISe re-enrollment applications be submitted no later than January 1, 2016 to allow for processing time.  This includes applications submitted directly to the PA Department of Human Services, Office of Medical Assistance Programs and Supplemental Service applications that are required to be submitted to CBH prior to processing by the State.  Current State processing time for applications is a minimum of 45 days.

PROMISe applications for MA Revalidation for In Plan services should be sent directly to the Office of Medical Assistance Programs.  These services include:

Inpatient Psychiatric Hospitals (both freestanding and for units located within a general hospital)
Outpatient Psychiatric Clinics
Outpatient Drug and Alcohol Clinics
Mental Health Partial Hospitalization Programs
Family Based Mental Health Services
Targeted Case Management programs (Intensive Case Management, Resource Coordination and Blended Case Management)
Crisis Intervention Services
Certified Peer Specialist Services
Behavioral Health Rehabilitation Services for Children
Individual practitioner applications, including licensed psychiatrists and psychologists

PROMISe applications for Supplemental Services should be sent directly to your CBH Provider

Relations Representative. CBH is recommending that providers send their initial application(s) to CBH electronically to avoid any going back and forth if any errors are identified on the application(s).   These services include:

D&A Intensive Case Management and Resource Coordination Services
Residential Treatment Facility for Adults (RTF-A)
Long Term Structured Residential Programs (LTSR)
Assertive Community Treatment (ACT) and Community Treatment Team (non-fidelity ACT) programs
Psychiatric Rehabilitation Services
D&A Intensive Outpatient Programs (IOP)
D&A Partial Hospitalization Programs
D&A Inpatient Programs – Halfway House, Detoxification, and Short and Long Term, Rehab programs
Other Supplemental Services requiring a unique Service Description, including programs enrolled as Provider Type 11, Specialty Code 119 (Community Mental Health, Other)

Related Documentation:

OMHSAS Bulletin – ACA Re-enrollment Guidance for Behavioral Health Providers
MA Revalidation FAQ – October 2015
MA Bulletin – Re-enrollment Revailidation of MA Providers
HealthChoices Behavioral Health Supplemental Services Provider Enrollment Application and Required Forms
HealthChoices Behavioral Health Supplemental Services – Provider Enrollment Application Checklist

December 14, 2015

Dear Providers,

This is a compliance reminder that unit based services (non per diem and non event services) must be documented using clock times. The start and end clock times for the service must be documented (i.e. 7:15 AM to 8:15 AM).   It is NOT sufficient to document only the duration, the start, or the end time.  Through the audit process, CBH Compliance has, and will continue to, recoup payment made for unit based services lacking clock times.  Providers must also designate AM/PM or utilize military style time (1:00 PM = 1300) in the documentation of start and end times for the service.  Failure to document AM/PM or military time will also result in recoupment of payment for those services.

Medical Assistance Bulletins 99-97-06 (Accurate Billing for Units of Service Based on Periods of Time) and 29-02-03, 33-02-03, 41-02-02 (Documentation and Medical Record Keeping Requirements) support this requirement.

Please e-mail CBH.compliancehotline@phila.gov with any additional questions.

Thank you for your ongoing support.

November 4, 2015

Dear Providers,

CBH has decided to no longer reject claims that do not have open cases, and will now automatically open cases for CBH-eligible Members.  As a result, our procedure for opening cases has changed, and is now solely focused on the collection of Performance Outcomes Measurement System (POMS; demographic codes on “Case Open Request form) data, which is required from the State.  The new form will be called the “POMS Collection form” and is available from our Operations Support Services and Provider Relations staff. It is our hope that this change will lessen the administrative burden and redundancy that our Providers and staff had experienced with the old process.  Please click here for more information.

October 19, 2015

Dear Providers,

The webinar to review results of the STS Family Engagement Survey for Pay-for-Performance has been rescheduled for Tuesday, October 20, 2015 from 2:00-4:00 pm. As in previous years, we wish to provide you with the option of attending these meetings in-person or online via GoToMeeting. Due to space limitations, we are asking that if you wish to attend in-person that you RSVP to us as soon as possible, and send only one person from your organization to that meeting. We will be able to accommodate the first 20 respondents in each meeting; beyond that number we may need to ask you to participate via GoToMeeting only. If you for any reason need accommodations under the ADA in order to participate in any of these meetings, please let us know; we will be sure to reserve in-person space and/or provide any other accommodations that are necessary to meet that need.

For GoToMeeting participation, it is vital that you register in advance using the link provided below. Registering through this link ensures that you get the information necessary to enable you to log on to the meeting, see slides, and hear the conversation. We recommend that GoToMeeting participants dial-in to the meeting on the telephone rather than using the integrated audio option, as this seems to provide the best experience.

For RSVP to attend the meetings in person, please contact Naima Ware at naima.ware@phila.gov.

https://attendee.gotowebinar.com/register/2392503587101466626

Sincerely,

Susanna Kramer, M.A.
Program Evaluation Coordinator
Community Behavioral Health
801 Market Street, 11th Floor
Philadelphia, PA 19107
215.413.7657

October 13, 2015

Dear Providers,

This is a friendly reminder that the deadline to request 2015 P4P data for certain Levels of Care is approaching. Please see the attached schedule to determine the deadline for requesting data for you Level(s) of Care, as well as the form to be used to request your data. As a reminder, only one form should be completed for each Parent ID requesting data. Data for more then one Level of Care may be requested from each Parent Provider at a time. Please send the completed form and any questions to: CBH_DBHIDS_P4P@phila.gov.

October 6, 2015