Course 1B - It's Not Your Grandpa's Chevy - Intro to Goals, Clinical Concerns, and Opportunities In Behavioral Health Managed Care

This is a FREE COURSE with a FREE CEU CERTIFICATE - 1 CREDIT HOUR. This free course is a quick introduction to our online quiz and certificate process. It's also an introduction to our 'SLIDE SHOW' course format. (Not all of our courses are in a slide show format; some are in a 'Quiz Only' format and some are in-house PDF documents. See FREE Course 1D, for a free introduction to our 'Quiz Only' course format.)

This mini-course provides a quick overview of the transition of Mental Health and AOD counseling to a MANAGED SYSTEM OF CARE .... which has gained renewed relevance with the expansion of Health Care Reform. It's important to understand that Care Management is not only a process; it's a PHILOSOPHY which approaches approval for behavioral health services in a whole new way, and requires justification which surpasses that which was required in the past

Understanding of the 'Care Management' approach is important for those delivering intensive treatment, as well as to those REFERRING TO intensive treatment, and to most individuals delivering short term counseling which is usually not considered to be "medical" in nature. The issue here, is that the APPROACH to authorization is essentially one of "medical necessity", even if what we are delivering is not "medical".

Our Managed Care series is applicable to all behavioral health providers - those in private practice who are participating in a "panel" or network, as well as those who work for a public or private agency involved in Medicare or Medicaid or Block Grant services or other such contracts - including the EAP provider, whose work is now often done under the auspices of a managed system of care, i.e., a contract manager.

The first half of this course focuses upon the impact that Health Care Reform and Managed Systems of Care have upon providers and their clients. The second half of this short course focuses upon "Understanding How Managed Care ‘Thinks’ . . . An Introduction to the Clinical and Therapeutic Issues Which Drive the Care Management Process".

GOALS OF COURSE 1B – ‘Intro to Goals, Clinical Concerns, and Opportunities In Behavioral Health Managed Care – It's Not Your Grandpa's Chevy’

1. Understanding the Scope and Impact of the Health Care Reform Movement Toward a Managed System of Care

2. Introduction to Clinical Concerns and Opportunities for Behavioral Health Professionals under a Managed System of Care

3. Understanding the Concept of Care Management and Utilization Review – It’s a 'Medical Model' - even if we are delivering short term counseling which is typically not considered to be "medical" in nature. It's important to understand that Care Management is a PHILOSOPHY which approaches approval for behavioral health services in a whole new way, and required justification from those who deliver services which surpasses that which was required in the past.

4. Identify Clinical Approaches and Intervention Programs Which Are Workable and Appropriate Under a Managed System of Care.

Ethics 4D - When Insurance and State Contracts Are Paying the Bill – The Ethics of Treatment Documentation and Other Ethical Dilemmas in Today’s World.

$28.00 - A Four (4) Credit Hour Ethics Course Approved/Accepted for Professional Counselors, MFTs, Social Workers, Substance Abuse Counselors, EAP providers, and other behavioral health practitioners in ALMOST EVERY STATE.

Ethics 4D is a fast-paced SLIDESHOW with content that's easy to understand and never boring - regarding the ETHICAL DILEMMAS (and pressures) encountered on a daily basis by those whose clients' fees or services are paid by insurance, managed care, Employee Assistance Programs, self-insured companies, or other closely monitored state or local contracts.

NOTE: Ethics 4D contains the same core material as the 3 credit-hour Ethics Course 3D, except that 4D includes additional material regarding these ethical issues.

This course is a close-up view of that sticky issue ... what to write (and not write) in a client's treatment record, from an ETHICS perspective, in this new era of tightly controlled health care costs. How much do you divulge about your ASSESSMENT of the client's DIAGNOSIS(ES), his prognosis, his functional status, and his response to treatment? What's ETHICAL - when the payor is demanding details? What's NECESSARY?

Is such scrutiny legitimate and ethical, or is it an invasion of your (and your client's) privacy? And is it ethical to provide the requested information? Do most states’ licensure standards SUPPORT - or OVERRULE - this type of documentation of a client's treatment information? The answer may surprise you.

SUMMARY OF GOALS:

1. Understand the ETHICAL AND PRACTICAL impact of CARE MANAGEMENT upon WHO gets treatment or related services, WHAT treatments and related services they may receive, and HOW MUCH of each intervention is allowed.

2. Identify the ETHICAL ISSUES faced by providers due to this new approach to authorization - in both the delivery of treatment or related services AND in the DOCUMENTATION of the ASSESSMENT, DIAGNOSIS, and RESPONSE TO TREATMENT OR INTERVENTION.

3. Learn how we can ETHICALLY accommodate these new service and documentation requirements, while simultaneously meeting the requirements of our Provider Agreements.

4. Identify additional ETHICAL DILEMMAS encountered in assessment and treatment of mental health and substance abuse clients, including the ethics of the Quality Management - Treatment Effectiveness scrutiny which HMOs and other such contract managers place upon the work we do. Is it ETHICAL activity, or is it invasive?

[Want to watch a short Ethics COURSE DEMO, with material from Ethics 4D and 3D? Click the Ethics Course Preview here.]

Ethics 3D - When Insurance and State Contracts Are Paying the Bill – The Ethics of Treatment Documentation in Today’s World.

$24.00 - A Three (3) Credit Hour Ethics Course Approved/Accepted for Professional Counselors, MFTs, Social Workers, Substance Abuse Counselors, EAP providers, and other behavioral health practitioners in ALMOST EVERY STATE.

Ethics 3D is a fast-paced SLIDESHOW with content that's easy to understand and never boring - regarding the ETHICAL DILEMMAS (and PRESSURES) encountered on a daily basis by those whose clients' fees or services are paid by insurance, managed care, Employee Assistance Programs, self-insured companies, or other closely monitored state or local contracts.

NOTE: Ethics 3D contains the same core material as the 4 credit-hour Ethics Course 4D, except that 4D includes additional material regarding these ethical issues.

This course is a close-up view of that sticky issue ... what to write (and not write) in a client's treatment record, from an ETHICS perspective, in this new era of tightly controlled health care costs. How much do you divulge about your ASSESSMENT of the client's DIAGNOSIS(ES), his prognosis, his functional status, and his response to treatment? What's ETHICAL - when the payor is demanding details? What's NECESSARY?

Is such scrutiny legitimate and ethical, or is it an invasion of your (and your client's) privacy? And is it ethical to provide the requested information? Do most states’ licensure standards SUPPORT - or OVERRULE - this type of documentation of a client's treatment information? The answer may surprise you.

SUMMARY OF GOALS:

1. Understand the ETHICAL AND PRACTICAL impact of CARE MANAGEMENT upon WHO gets treatment or related services, WHAT treatments and related services they may receive, and HOW MUCH of each intervention is allowed.

2. Identify the ETHICAL ISSUES faced by providers due to this new approach to authorization - in both the delivery of treatment or related services AND in the DOCUMENTATION of the ASSESSMENT, DIAGNOSIS, and RESPONSE TO TREATMENT OR INTERVENTION.

3. Learn how we can ETHICALLY accommodate these new service and documentation requirements, while simultaneously meeting the requirements of our Provider Agreements.

Course 2B - 'They're Coming to Audit WHEN?' - a.k.a, 'What Can Go WRONG in That Chart?'

$17.50 - [2 CREDIT HOURS] Want to pass that TREATMENT RECORD AUDIT? Want to avoid RECOUPMENT of claims payments already paid to you, when the MCO calls for a client's record, or their auditors show up at your door? Here's how! This fast-paced slide show clearly describes 'what's DIFFERENT' about how we must DOCUMENT TREATMENT in MH and CD/AOD client records today, under the new behavioral health contracts. And we give you useful and do-able tips on how to audit your own records - so that you are ready BEFORE the MCO or State auditor arrives.

For example, we tell you how to avoid 12 deadly 'documentation syndromes' which will sabotage even the best clinicians working within the new Behavioral Health Care Reform initiative .... including The ‘POORLY DOCUMENTED LEVEL OF CARE’ Syndrome, The ‘ZOMBIE CLIENT’ Syndrome, The ‘PERPETUAL CARE’ Syndrome, The ‘ANY-PATIENT ITP’ Syndrome, The ‘FAILURE TO MODIFY’ Syndrome, and several more.

This valuable course also provides a clear explanation about HOW managed care contract administrators make pre-authorization decisions to approve or deny your requests for treatment .... and WHAT you must write in the client's chart to support that authorization.

Course 2C - Intro to Professional & Clinical Issues in Managed Care - Necessary Shifts in Program Design and Treatment Approach

$17.50 - [2 Credit Hours] For Mental Health and Chemical Dependency Treatment Providers. Some of this course's material overlaps 2B material (related to managed care goals, how managed care companies THINK, and how we have to change what we write in treatment records) . . . but then the course moves ahead to include professional, clinical, and programmatic CHANGES in store for professionals who are working under a Managed Care Provider Agreement.

GOALS:

1. Overview of basic goals of managed care -- 'Why Are They Doing This To Us?'

2. Understanding The Impact Of The New Healthcare Industry Goals Upon Us (The Providers) and Our Clients.

3. How To Think Like A Managed Care Company Or Care Management Organization (It's Essential For Survival) – Understanding What Drives Those 'Level Of Care' (LOC) Decisions!

4. How the Insurance Company or Plan Administrator’s RISK Affects Providers In Their Professional Operations -- The Positives, The Challenges, and Examples Of Creative Service and Treatment Approaches.

5. Provider Networks As A Way To Survive The Shifts – Referral and Sharing the Task of Service Delivery
Are you interested in this material, but want more credits than this course offers? Some of this material appears in MiniCourse 3A (3 credit hours total), and in FlexiCourse 5A (5 credit hours), and FlexiCourse 10A (10 credit hours).

Course 3B - The Big Transition in the AOD Field: Assessment and Documentation of ‘Need for Treatment’ and 'Treatment Interventions' - How They've Changed!

$23.00 - [3 CREDIT HOURS] 3 Credit hours. In most states, it's goodbye to flexible addiction Block Grants and other 'open access' State contracts for substance abuse and chemical dependency – which makes access to AOD services even more difficult. This course addresses the 'nitty gritty' of the major CHANGES in SA-CD programs – referral criteria, treatments and interventions available, documentation of need for treatment and response, and philosophy – due to the new health care reform environment. Applies to single AOD diagnosis and to Dual MH-AOD diagnoses.

This course is appropriate for chemical dependency counselors, social workers, mental health counselors, marriage and family therapists, case managers, rehabilitation workers, EAP providers, school psychologists and counselors, , and others who work with persons who have AOD issues which need assessment, treatment, or referral for same.

FOR EAP COUNSELORS who may or may not be delivering the actual AOD treatment for their clients (in many programs, you will be referring and ensuring continuity rather than treating), it is nevertheless critical that you document your client’s need for treatment in the same thorough and clinically acceptable way that the treatment program must do. Otherwise, the insurance company or other behavioral health administrator will focus upon the disparity in the EAP record vs. the treatment record, and approval for services may then be at risk.

Offers a bird's eye view of how ASSESSMENT of the client's NEED FOR TREATMENT must be documented to secure an authorization, and HOW the treatment or interventions must be delivered and documented under managed systems of care ..... and how to CONSTRUCTIVELY ADAPT to these changes when it's ethically possible.

This course includes material on the following:

1. the BACKGROUND of why treatment approach and documentation of need for treatment have changed so significantly in the AOD field.

2. understanding how HMOs, BHOs, MCOs, self-insured companies, EAP provider companies, state operated plans such as Medicaid, and commercial insurance companies (i.e., managed care contractors) THINK about WHO needs treatment and WHAT kind of treatment they need ..... in other words, what are the new criteria for establishing the need for treatment, and how can we accommodate to it?

3. the role that assessment and treatment DOCUMENTATION play in obtaining and maintaining treatment authorization and funding for our clients, and learn the four KEY CONCEPTS in authorization and documentation of assessment and treatment.

4. how AOD treatment and intervention programs and individual service plans are designed, within the new health care reform environment …. and what will likely be approved by the contractor ….. and what type of programs will get the OUTCOME results that insurance carriers and state programs are looking for.

Course 3B presents some specialized treatment and case management scenarios which can be discussed with an MCO or other contractor for services, which can provide effective services and treatment to recidivistic AOD clients, under a 'Care Management' system.

Also provides an understanding of HOW the health care contractors make those controversial treatment DECISIONS for substance abusing and chemically dependent individuals - and HOW TO ASK for 'WHAT' in terms of services and/or referral for your clients with AOD issues. Maximize your client’s chances of getting what he or she actually needs, based upon competent assessment in a new health care environment.

For EAP workers who may or may not be delivering the actual AOD treatment for their clients (in many programs, you will be referring and ensuring continuity rather than treating), it is nevertheless critical that you document your client’s need for treatment in the same thorough and clinically acceptable way that the treatment program must do. Otherwise, the insurance company or other behavioral health administrator will focus upon the disparity in the EAP record vs. the treatment record, and approval for services may then be at risk.

We also present clear 1-2-3 guidance on how to DOCUMENT both your assessment and the services you deliver under a managed system of care – and an introduction to RECOUPMENT of funds already paid to you (which typically occurs due to inadequate DOCUMENTATION OF SERVICES in client records). The course explains how to AUDIT your own professional documentation, so that it fits in well with the new CARE MANAGEMENT or Utilization Review (UR) process.

Some material in this course is included in MiniCourses 1B and 1C and elsewhere, but this course does it from the AOD perspective.

THE GOALS OF THIS COURSE:

The goals of Course 3B focus upon managing change within the traditional chemical and substance dependency culture under managed systems of care, i.e., understanding how it affects our interpretation of ‘need for treatment’ and our interventions to promote sobriety.

1. Understanding the New Managed Care Treatment Contracts and How They Affect Us and Our Clients.

2. The Essential Clinical Shifts Imposed Upon the CD Treatment Professional and Traditional CD Programming, Under a Care Management System

3. Changing Expectations for Documentation in Service Records.

4. Know Some Workable and Creative Service Options Which CD Treatment Professionals May Negotiate with Health Care Contractors, Given the Provider’s Greater Autonomy In Referral and Treatment Decisions.

Course 3A - Managed Care - Is There Anything GOOD About It? a.k.a., 'The Good, The Bad, and The Ugly of Providing Treatment Under Managed Care - The Perils and The Good Stuff.'

$23.00 - [3 CREDIT HOURS] All of the material in 1B and 1C is included in this course, and then we expand on the clinical opportunities and perils for providers. We attempt to put to rest the question, 'So Is there really anything GOOD about Managed Care for Mental Health and Chemical Dependency professionals?' Oh yes indeed, there is!

We take a look at what programmatic contract and treatment opportunities to pursue (and which to avoid) when you work with an HMO or other managed care administrator - what types of treatment fit with a managed care system - and how innovative, non-traditional treatment services (especially for children and adults with major mental illness) can be provided under the new managed care models for difficult high-risk clients.

The final lesson in this course focuses upon the clinical details of how Care Management departments make treatment decisions which impact your clients' recovery process, and how providers can accommodate to this shift in clinical emphasis.

NOTE: Part of the material in this course is similar to some of the material found in MODULE 201 of FlexiCourses 4A, 5A, and 10A. Thus, if you purchase 4A, 5A, 10A - and then decide to also purchase 3A - please do so only with this understanding. You will also find some similar information in Course 2B, but 2B goes into greater detail about audit issues and self-audit of your clients’ records.


GOALS OF THIS COURSE AS THEY APPEAR ON YOUR CERTIFICATE:

Course 3A – “Managed Care – Is There Anything GOOD About It?”

1. Intro to goals and objectives of managed care - a.k.a. 'Why are they doing this to us and our clients?'

2. The Good, The Bad, And The Ugly of managed care plans, and how to adapt your clinical approach constructively.

3. How does Managed Care (and the 'Care Management' treatment approval and review process) affect the way that we deliver treatment to Mental Health and Chemical Dependency clients?

4. Identifying some creative service options for treatment providers to explore which allow more autonomy under a ‘Care Management’ system

.

Course 5B - Where The Rubber Meets The Road: The Nitty Gritty of How To Have More Professional Gain and Less Pain From Those Managed Care Companies!

$28.00 - [5 CREDIT HOURS] Same as Module 401 in FlexiCourse 10A. Negotiating for good professional and clinical options and needed changes in contracts (even after the ink is dry on your basic Provider Agreement); how to collect on denied claims and dealing with HMO claims errors; and how to avoid those 'duh!' errors that can cost you dearly. When to say NO to an MCO, when to say YES, and when to say 'How about if I do THIS?' Examples of some GREAT service options to pursue with a managed care company, including CREDENTIALING flexibility. GOALS FOR Module 401: 1. Review of "How The Managed Care Company Thinks - What Is 'Medical Necessity of Treatment' At A Practical Level" 2. Why DOCUMENTATION in your clients' records must reflect the 'Level of Care’ decision factors. 3. How to work effectively within a MCO Care Management system and contract - how to deal with multiple issues which affect the treatment we are allowed to provide to clients and the funding we receive to do it. 4. how to AVOID making ERRORS that cause providers to lose AUTHORIZATION to provide treatment. 5. Expansion of examples of creative ways we can serve CD and MH clients under a Managed System of Care.

FlexiCourse 5A - Welcome to Care Management! a.k.a., 'Do They REALLY Need Treatment?'

FlexiCourse 4A - This Is Managed Behavioral Health Care - and It's Impact on YOU! ('The Little Managed Care Course' Modules 101 & 201)

FlexiCourse 10A - The Big Course On Managed Care for Professionals (Modules 101, 201, 301, & 401)

Course 1C - Understanding That State or Managed Care Company 'Capitation' Thing - AND How It Impacts Providers!

$10.00 - [1 CREDIT HOUR] Some of the same introductory material as in 1B, but also explains how these managed care contracts work - i.e., should mental health and addiction providers take on ANY of these employment arrangements, working as a provider for an HMO, MCO, EAP company, or other such contractor which utilizes a care management model? What kind of risk are they taking? And can treatment providers succeed in any of these arrangements? Can they have any autonomy? Can they use creativity in their service programs? (Answer: Yes.)

Also, you will learn 'which' programmatic designs have 'which' major implications for providers and their clients.

GOALS:

1. Understanding The Impact Of This New Health Care Approach Upon Providers and Clients - It's Called 'Care Management'!

2. Review of Risk Based Contracts – and How Providers Can Adjust Their Approach to Clients Services, Constructively.

3. Several Creative Service Delivery Approaches Which Promote Greater Autonomy In Programming For Mental Health And CD/SA Clients’ Providers.

IMPORTANT NOTE: If you buy this course 1C, please be aware that the material is also present in FlexiCourses 4A, 5A, and 10A. What's the difference? The FlexiCourses have a lot more material and more credits!