WOMHA President
MODA DATA COLLECTION
- Clients can at any time elect to not participate in Feedback Informed Treatment. Each ScreeningWare survey reminds of that option. (In the circumstance of a client regularly seeing more than one AMHA-NW provider. That client only needs to complete surveys for one.) Document these choices in CarePaths EHR.
- MH Comprehensive Screening, MH Brief Progress & Alliance, and MH Comprehensive Progress may be administered to all able clients 14 years and over.
- Therapists who screen patients before treatment begins and use Progress and Alliance measures frequently throughout treatment will demonstrate improved outcomes according to research.
- The ACE study by Kaiser Permanente and CDC has demonstrated that use of ACE “reveals staggering proof of the health, social, and economic risks that result from childhood trauma.” ACE results provide important overall health information for discussing risk.
- Therapists may measure less or more than the Suggested Frequency based on clinical judgment.
For General ScreeningWare access: https://www.screeningware.com
To give ScreeningWare live in the office use: https://www.screeningware.com/takescreening.aspx
Obtain the client-specific access key code from your ScreeningWare dashboard.
Help: Admin Guide, upper right corner, ScreeningWare administrator dashboard.
WHEN TO DO WHAT...SCREENINGWARE
Administer MH Comprehensive Screening
before or at visit 1
Recommended, not required
Indication of Adverse Childhood Experiences ACE at or between early sessions
If
mild to moderate depression and/or anxiety scores are present, administer the MH Brief Progress & Alliance on visit 2 or every other session
If
mild to moderate depression and/or anxiety scores are present after visit 6 through treatment duration, administer the MH Brief Progress & Alliance screening at least once a month or every session if visits are less frequent than monthly.
When
severe depression and/or anxiety scores are present, administer the MH Brief Progress & Alliance every session (until severity drops to moderate, then follow directions for moderate screenings).
With
severe scores with the
risk of suicide, administer the MH Brief Progress & Alliance every session (until severity drops to moderate, then follow directions for moderate screenings).
With
severe scores and
bipolar disorder diagnosis, administer the MH Brief Progress & Alliance every session (until severity drops to moderate, then follow directions for moderate screenings).
MODA INCENTIVE DETAILS
See Exhibit B of the MODA contract 12/2015: pages 22-27 from which these definitions and incentives are excerpted:
"Performance Incentive Reporting Period, means March l, 2016 through August 31, 2016
"Outcome Informed Treatment" means:
- Members with two visits to the same provider in the measurement period have one or more completed screening or outcome
- assessments documented in the EHR during the measurement period;
- Members with three to five visits to the same provider in the measurement period have two or more completed screening or
- outcome assessments documented in the EHR during the measurement period;
- Members with six to eight or more visits to the same provider in the measurement period have three or more completed screening or outcome assessments documented in the EHR during the measurement period.
"Requesting urgent outpatient services, means a member or member's representative (including family member, caregiver, school representative, healthcare provider, health plan representative, or other responsible party) contacts the AMHA-NW telephone access line requesting outpatient mental health services and waiting more than 48 hours to receive services either:
- Could seriously jeopardize the life, health or safety of the member or others, due to the member's psychological state, or
- In the opinion of a practitioner with knowledge of the member's medical or behavioral condition, would subject the member to adverse health consequences without the care or treatment that is the subject of the request.
"Standard #1" means 75% of members (excluding members under age 18, non-English speaking members, members with Intellectual Disability, and those who decline to be screened) seen for two or more visits with the same AMHA-NW Participating Provider within the Performance Incentive Reporting Period receive Outcome Informed Treatment.
"Standard #2, means 90% of members requesting urgent outpatient services within the Performance Incentive Reporting Period are offered an appointment within 48 hours of requesting services during the measurement period.
Reimbursement for licensed psychologists, licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists and licensed psychologist associates is set according to the following formula:
1. IF AMHA-NW collectively achieves or exceeds the metrics specified in Standard# I and Standard #2 during the Performance Incentive Reporting Period:
a. Reimbursement for individual AMHA-NW Participating Providers who individually meet or exceed Standard #1 is set at the greater of:
i. 110% of fee schedule specified in Exhibit 8.1 "Reimbursement Effective Date 12/15/2015" or
ii.100% of fee schedule specified in Exhibit 8.1 "Reimbursement Effective Date 12/15/2015" plus an adjustment equal to the Medical Consumer Price Index change from September, 2015 through August, 2016
b. Reimbursement for individual AMHA-NW Participating Providers who individually do not meet the metrics specified in Standard#1 is set at the greater of:
i. 105% of fee schedules specified in Exhibit 8.1 "Reimbursement Effective Date 12/15/2015"; or
ii.100% of fee schedule specified in Exhibit 8.1 "Reimbursement Effective Date 12/15/2015" plus an adjustment equal to the Medical Consumer Price Index change from September, 2015 through August, 2016
c. Individual AMHA-NW Participating Providers who have zero patients meeting criteria to be counted in Standard #I are deemed to meet Standard # 1.
2. If AMHA-NW collectively fails to achieve the metrics specified in Standard #I or Standard #2 during the Performance Incentive Reporting Period:
a. Reimbursement for individual AMHA-NW Participating Providers who individually meet or exceed Standard #I is set at the greater of:
i. 105% of fee schedule specified in Exhibit 8.1 "Reimbursement Effective Date 12/15/2015"; or
ii.100% of fee schedule specified in Exhibit 8.1 "Reimbursement Effective Date 12/15/2015" plus an adjustment equal to the Medical Consumer Price Index change from September, 2015 through August, 2016
b. Reimbursement for individual AMHA-NW Participating Providers who individually do not meet the metrics specified in Standard #I is set at 100% of fee schedules specified in Exhibit 8.1 "Reimbursement Effective Date 12/15/2015."
c. Individual AMHA-NW Participating Providers who have zero patients meeting criteria to be counted in Standard #1 are deemed to meet Standard #1.
SURVEY PARTICIPATION
Thank you to those of you who have already completed the WOMHA Questionnaire. If you have not had a chance to complete yet, please do so now. As a board, we are very interested in your feedback and direction fro the remainder of 2016. To access the survey,
click here.
LEGISLATIVE UPDATE
The Legislative Committee has been active since the last update. The committee plans to meet twice monthly until August to prepare for the 2017 legislative session.Our priorities are to pass Fair Reimbursement legislation in 2017. The deadline to submit any Bill is 9/26/16. J.L. anticipates that we will be developing a legislative concept in the coming months. Here are some of the new developments:
New lobbyist added to the team:
We now have two lobbyists working for us, which is PAC’s new policy. Justen Rainey will also be working with JL Wilson.
Working with the OID:
O.I.D. (Oregon Insurance Division) put out a mandatory data call to health insurers requiring them to report mental health reimbursement data between the dates of 1/1/2007 and 12/31/2015. Insurance companies must produce their data by 5/21/16. It will then be analyzed. At the last Legislative Committee meeting of 3/18/16, we were introduced to Theresa Van Winkle, a Senior Policy Adviser with the State of Oregon, Department of Consumer and Business Services (of which O.I.D. is under). Van Winkle stated she will “work with us to do a bill right” if that is what we plan to pursue.
J.L. translated that this was very good news as it would mean we would have “vetted data”, a developed legislative concept and involvement of interested parties which would put us in a much stronger position. We would then need to find a sponsor for the bill. J.L. has continued to identify potential legislative allies and he does not see this as problematic. Potential legislative allies include Duane Stark, Joe Gallegos, and Bill Kennemer.
Pat Mooney asked whether the data would compare mental health care reimbursement rates to the increase in rates of primary care providers. Van Winkle thought that she had that data already, but would check.
J.L. was very encouraged at this development and wants to see what the data shows before pursuing other strategies (such as a recent proposal by Senator Gelser indicating her intention to ask for an interim work group on mental health reimbursement and other mental health issues). J.L. felt the vetted data would allow us to collaborate from a stronger position once the true state of mental health reimbursement was brought to light.
Familiarizing the OPA with our value-added IPA model:
Leslie Carter and Larry Veneska will be presenting the Connecting Care model to Oregon Health Authority (OHA) this spring. Dr. Jim Rickards, newly appointed Chief Medical Officer for OHA will also be invited. His wife is a social worker and he oversees Primary Care and Behavioral Health Homes for the State of Oregon.
The value of a lobbyist:
Our strategy has been to work both the administrative and legislative angles in support of independent mental health practice, whether it involves promoting the IPA, traditional practice, or both. J.L. has given this committee access to several new influential contacts. We would have had limited access to them without a lobbyist. He has kept us abreast of new developments and continues to develop strategies with us. J.L. has been instrumental in encouraging us to build coalitions and has initiated contact with lobbyists of other mental health organizations that share our interests. He has stressed that these months are the time to do the homework so we are prepared to put forward legislation by September. There are upcoming Legislative Days in May and in September; we will be looking at ways to participate in them.
The committee continues to feel that PAC is working very hard for our interests and that this is a good value for our money. For more information about the Oregon Legislature
click here.
(Adapted from the transcripts of Anne Emmett, Legislative Committee secretary, AMHA Metro member)
GO FUND ME FOR DAWN HILL
One of our WOMHA members, Dawn Hill, is fighting cancer and will be out of work while she receives treatment. Dawn and her spouse are both self employed. If you would like to donate or would like to support her in this time of need, please click here.
