Process for 513 Discharge Appointments/Authorizations

In approved markets, members can be set up with a Discharge Appointment as they are preparing to leave the hospital following an inpatient psychiatric stay. The purpose of this appointment is to review the discharge plan, follow up appointments that have been arranged, medication prescribed, etc. There are two ways facilities can receive authorization for this appointment. 1. The facility will fax the Discharge Consultation to the identified fax number on the form within 24 hours of discharge. The Intake team will complete the 513 authorization in CCMS for the member/facility, and will then forward the fax to the appropriate CC/ICM through RightFax. The Intake team will fax the authorization information to the facility. The assigned ICM/CC will save a copy of the Discharge Consultation fax in the appropriate market/facility folder located in G:\Clinical\UM\Discharge Consultation Faxes. 2. The facility will call to the appropriate 1-800 number located on the Discharge FAQ while with the member immediately following the discharge order, but prior to the member leaving the facility. When calling, they will provide the following information to the Customer Service Representative: I am Joe Smith from (Mental Health Hospital) in (State) calling in for a 513 authorization. This alerts the CSR to the state the member resides in, and also indicates this is a call that is NOT to be transferred to voice mail. The CSR pulls open the member information, identifies which CC/ICM is assigned the case by looking at the most current Mental Health case open. **If there is no current Mental Health case open, CSR will IM the CC assigned to that market, and proceed according to the plan below. The CSR IMs that CC/ICM to check availability. If the assigned CC/ICM is not available, the CSR IMs another CC/ICM in that market to check for availability. If there is no other staff in that market, the CSR will IM another CC/ICM from another market who will take the call, as these calls must be warm transferred, and not sent to voice mail. Expectations of the Discharge Appointment: The CC/ICM and DC planner will introduce the member to the purpose of the appointment (i.e. review DC notes, intro CC/ICM services, and update contact information). The DC planner will review the medication prescribed if applicable. Issues to be addressed include: What supply does the member have on hand when leaving the facility? Does the member have a script for a refill of medication? Reviewed/Revised 6/16/2011 AC

What supply does that script call for (week supply, 30 days, etc)? Does the member have any questions about their medication, dosages, directions, etc? This is also a good time to review if the medication available to the member will last until the appointment they have with their prescribing provider. The DC planner will review any future appointments that are set up with therapists and/or psychiatrists, to include: Who is the appointment with, what date, and time? Does the member have directions on getting there, and a phone number to reach the provider if needed? Does the member have transportation? If not, the CC/ICM can flag this for follow up and arrange if a covered benefit. CC/ICM will introduce incentives that are available to the member if they attend their appointment within 7 days. Does the member have any questions or concerns about the appointments? Is the member satisfied with whom the appointments are arranged with or if no appointments are set up, can the CC/ICM assist with setting appointments for follow up? The CC/ICM can then introduce CC/ICM services in a brief scenario, to include offering reminder calls for appointments that have been set up, assistance with locating providers if the member does not have one, and follow up after appointments to ensure satisfaction, and make sure the member receives any incentives they qualify for. The CC/ICM will also: Validate the demographic information located in CCMS address, phone, etc. If the information is incorrect, the CC/ICM will gather correct information. Inform the member that an introduction letter and brochure were sent to the member while they were in the hospital that contains information about our services, as well as contact information for the assigned CC/ICM (if this is not who is on the call). If the demographic information was noted to be incorrect, the CC/ICM on the call will alert the assigned staff to resend this information. Give the member the contact information for the assigned CC/ICM including the 800 number and the extension. CC/ICM will also ask the member for the best time to reach them for future calls. If the CC/ICM determines the member does not have a valid phone number themselves, or that of a friend/family member where they can be reached, the CC/ICM can introduce the Caring Voices program, and encourage the member to either call the CC/ICM assigned to give phone numbers, or offer a location where they can be reached to discuss further (friends phone, family member, provider, etc). After the call is complete, the CC/ICM will create the authorization in CCMS and fax to the facility.

Reviewed/Revised 6/16/2011 AC

 The CC/ICM will complete a Note with Phone Call as the Note Type, and Discharge Planning as the Note Reason. All information obtained during the call will be noted via the Quick Note format. The CC/ICM on the call will email the assigned CC/ICM to alert them to the notes being available.

Reviewed/Revised 6/16/2011 AC

CREATING 513 AUTHORIZATIONS IN CCMS

Authorizations will be created for any facilities that are contracted to provide 513 Discharge Consultation appointments in all markets. The following process will be followed to authorize by this Procedure Code. In CCMS, click on the Admission event tab to locate the correct affiliation # for the facility that is calling for the auth. Double click on the current admission for the facility that is calling. In the Overview tab copy the facility # as circled in the image below. You will need it for your authorization.

Reviewed/Revised 6/16/2011 AC

To create the 513 authorization, click on the Referral event tab, and click the Add button along the bottom:

Authorization Tab Please enter the following information for each required field: Referral Status: Approved Status Reason: Pay Request Date: Date authorization was completed. Referral Reason: Outpatient Services Decision Date: (Auto populated with todays date) Start Date: Start Date for Authorization Date the 513 occurred. Referring Provider: PCP Provider (For foster care the PCP affiliation is TX11247IM03 You must choose or enter this affiliation) Refer To Provider: Facility requesting the authorization use the affiliation number that matches that in the Admission event tab. Special Request Type: Not Applicable

Reviewed/Revised 6/16/2011 AC

Line Items Tab Please enter the following information in each required field. Service Type: Leave Blank when authorizing by Procedure Code Procedure: Enter the Procedure Code authorized - 513 Units: 1 Units Requested: 1 Type: More than One Provider Start Date: Start Date for Authorization, should match the Start Date entered in the Authorization Tab End Date: Date the Authorization ends. In this case, it will be the same as the start date. Comments: Not required if authorizing by Procedure Code leave blank.

Reviewed/Revised 6/16/2011 AC

Once all the required fields are complete on the Authorization Tab and the Line Items tab, you will need to close the authorization. Return to the Authorization tab and click on the drop down for Event Mgmt Status. Choose CLOSED. At that time, another box will appear asking for a Close Reason. Always choose EVENT COMPLETE.

Reviewed/Revised 6/16/2011 AC

Quick Note for 513 Discharge Appointments

Medication: What supply does the member have when leaving the facility? Does the member have a prescription for a refill to last until their MD appt? Follow up appointment details: Therapist Name: Phone: Appt date/time: Psychiatrist Name: Phone: Appt date/time: Transportation needed: Incentive for children discussed: Introduce CC/ICM services: Notified member/parent that the ICM/CC will give reminder calls for appointments that have been set up, and will follow up after appointments to ensure satisfaction. Assigned CC/ICM name/contact information were given to the member/parent.

Reviewed/Revised 6/16/2011 AC