Medicaid 1115 Waiver-Ready

As states look to move toward changes in Substance Abuse Treatment funding, WITS can support new initiatives such as Section 1115 Demonstration Waivers, Medicaid Eligibility and Medicaid Billing.

In California, WITS supports the State of California Department of Health Care Services’ Section 1115 Bridge to Reform Demonstration Waiver, including the Drug Medi-Cal Eligibility and Delivery System (DMC-ODS). FEI is currently supporting other states as they move toward meeting the goals and reporting requirements contained in the waiver, using the modules contained within WITS today for data collection and reporting. These include items such as:

ASAM Assessment Integration

CMS has required that individuals who are being placed in residential treatment are assessed using ASAM Criteria. WITS supports the use of the ASAM CONTINUUMTM Assessment tool, which is the only approved electronic assessment for determining level of care placements using ASAM criteria. WITS allows users to track the ASAM recommended level of care, as well as a different level of care and reason for the discrepancy.

Authorization of Services

Through WITS billing modules, an authorization for care for residential services or other levels of care can be officially recorded and stored as part of the client’s record.

Manage Provider Continuum of Care

WITS tracks the number and types of providers within the agency’s catchment area, helping a county or state determine needs for improved access to providers geographically. This includes tracking of certification criteria for providers in the network.

State or Countywide Waitlist Capability

View beds/slots across all providers; Manage according to Block Grant priorities

Timely Access to Care

Track the time it takes for a client to access services, and the reasons for delays in access to care.

Case Management and
Utilization Management

Track clients as they move through the continuum of care, ensuring they receive the appropriate services at the appropriate time. Prevent fraud, waste, and abuse.

Program Review and Improvement

Utilize data directly from the reporting modules to understand where people are getting better, using what level of funds and resources, so that care can be improved.

OUTCOMES

  • Enhance county and provider decision making based on data
  • Compare expenditures to level of care and results
  • Provide all state and federal reporting criteria data
  • Robust Microsoft-based reporting tool

MEDICAID BENEFITS

Continuum of Care:

  • WITS allows a customer to easily track the number and variety of programs at each level of care within the continuum, for a particular geographic area, or for the entire county. County-wide waitlist management allows governing bodies and providers to monitor the availability of beds or slots in scarce programs, and to manage the selection of individuals for program admission based on pre-defined priority criteria

Assessment:

  • WITS currently allows for capture of the risk and care levels across all six dimensions of ASAM, as well as the recommended and actual level of care, at a variety of points throughout the client’s case. A direct link to the electronic version of the ASAM CONTINUUM tool is also available, allowing results to be pulled directly into the electronic record in WITS.

Case Management and Residency:

  • State or County management as well as provider management may use tools and reports to monitor the flow of clients throughout the continuum of care, and to ensure that clients are enrolled in the best level of care.

Selective Provider Contracting:

  • WITS Provider Accreditation module allows the State or County to track the onboarding process of all providers, ensuring that those contracted meet a robust set of standards. Once contracted, users may help beneficiaries choose from available providers by service and by area.

Provider Appeals Process:

  • Provider appeals and issues may be tracked and monitored.

Provider Certification:

  • WITS Provider Accreditation module allows the State or County to track the on-boarding process of all providers, ensuring that those contracted meet a robust set of standards. Certification status can be tracked and recorded directly in the system.

Coordination:

  • WITS supports the integration of multiple systems of care, including involvement of the courts and criminal justice with treatment providers. States or counties may also coordinate with managed care plans, as needed.

Authorization and Utilization Management:

  • States or counties may create authorizations for clients to obtain services from contracted providers. The county can monitor the burn rate of authorized services, as well as the utilization of services by client, by provider, by level of care or by regional area.

Workforce:

  • All providers may be categorized by types of services provided, allowing the State or county to monitor the breadth of services available to beneficiaries.

Program Improvement:

  • The State or county can monitor the mix of services provided to beneficiaries, and can monitor the array of providers available for youth as well as other important demographic groups.

Let’s Work Together

Interested in learning more about our solutions? Use the contact form and we’ll get back to you!

Jenifer Conrad

Jennifer Conrad

VP, Behavioral Health

GPRA Tools and Upload

WITS’ current version of the Discretionary Services GPRA tool supports data collection for the SOR program. This includes the intake, 3 month, 6 month, and discharge CSAT GPRA interviews. The system currently includes an automated, nightly upload of all completed GPRA data to the SPARS system, and it is assumed that SAMHSA will allow the same upload for SOR GPRA data.

WITS includes a follow-up due screen and related alerts to ensure that each provider, oversight agency, and the State can monitor the GPRA follow ups that are coming due, as well as monitor overall compliance with the grant’s rules regarding 80% completion of follow ups within the specified timeframe.

FEI will keep pace with changes to the GPRA as they are introduced by SAMHSA to ensure continued compliance.

Evidence Based Practices

WITS will allow the tracking of a client that is placed into any program of care, including the evidence based criteria that are used for that particular program of care. The program record also includes the level of care or service level. The system will record the length of time (days) that a client is treated in that particular program and the reasons for disenrollment/discharge.

Additional tracking is allowed for the medication used when Medication Assisted Therapy (MAT) is part of the care. WITS allows for the use of evidence based screeners and assessments, including the ASI, ASI Lite, and other ASAM criteria based tools. Modules allow the capture of all workflow and payment data related to services, core functions supporting treatment, prevention and recovery services.

Reporting of each service paid for by SOR funding is also available, by client and date, if desired. The State may track the burn rate and monitor trends in spending by provider, by client type, or by type of service.

Reporting

FEI will provide help gathering as much information possible for the semi-annual and final progress reports, as well as for the annual and final financial status reports and yearly sustainability report, as soon as the reporting requirements become available. Details will be available after award, WITS addresses these reporting requirements, as it has with many discretionary CSAT grants over the past decade. Whenever possible, prescribed reports are available in WITS to help compliance with CSAT progress and financial reports. The WITS platform also includes robust ad-hoc reporting in real time, allowing the State and its providers to access and analyze data to understand the impact of the services and outcomes.

Structured Reporting System

Prevention WITS gives you ready access to all data through a structured reporting system. Easily and rapidly generate formal reports, such as Block Grant reports. Create and run ad‐hoc reports to answer questions from state officials, legislators, or providers. Review SPF data entered and run QA and progress reports at any point in time. Compare data from Prevention WITS against state or national numbers to better understand community needs. Prevention WITS robust reporting puts the data for decision‐making in your hands at all times.

Workflow Driven

All screens center around the user’s workflow, guiding the user to the next step. See how Prevention WITS can be configured to support your user workflows.

Third Party Billing for Prevention Services

WITS allows providers or states to manage a variety of third party billing, establishing billable services, rates, and the method of billing for each payor. Tracking of EOBs, payments and client balance and payments is also available.

Addresses the SPF SIG Logic Model

Admission

Admits the client into the program and gathers additional information on the client’s background and legal history. The information entered creates a snapshot of the client at the time of intake/admission, which can be used to compare to similar data captured at Discharge to measure client progress.

Eligibility

Using industry standard tools, such as ORAS for criminogenic risk, and other screeners and assessments (such as ASAM’s CONTINUUM™) for appropriate placement in a level of care in the community, the court can place individuals in the best setting for treatment success.

Case Management

Records all case management and related events, referrals and services provided to the drug court client. By tracking each case management activity, it is possible to identify ancillary services provided to the client and to track the client’s progress and participation. This includes detailed reporting of employment and education milestones, sanctions and incentives, new charges, community service hours, as well as court and other criminal justice events.

Drug Testing

Allows the tracking of drug test results and attendance. HL7 messaging can pull in drug test results from a lab or lab hub.

Fee Tracking

Track fees (charges and corresponding payments) for any type of financial transaction associated with the client.

Treatment Encounters

Records all treatment related services provided to the drug court client. These are coded against standard procedure codes, and may be exported to an external billing system. Treatment encounters may reference goals and objectives from the client’s treatment plan.

Treatment Planning

Allows the treatment provider to enter a comprehensive plan including problems, goals, objectives, and planned interventions, and update those plans as needed with coordinated reviews.

Integrated Scheduling and Group Notes

Includes scheduling of groups, management of the client roster and attendance at sessions, streamlined integration with progress note reporting.

System Generated User Alerts

Provider alerts to case managers for upcoming client activities.

Discharge

This module mirrors Admission in that it collects the same data for clients at the time of discharge that was collected during the client’s drug court admission.

Health Care Environment

The health care industry is moving toward greater interoperability and pervasive health information exchange. Health care organizations and systems must ensure that behavioral health patient data is shared in compliance with Federal and State confidentiality laws, such as 42 CFR Part 2 and the Health Insurance Portability and Accountability Act (HIPAA). At the same time, patients have the legal right to control which aspects of their information are shared with or withheld from providers within a health information exchange environment.

Need for Consent2Share

Federal and State laws regarding sharing sensitive health information are driving the need for data segmentation, capturing patient consent, and enforcing patient preferences. Federal and expert stakeholders developed standards and guidelines to enable data segmentation and patient consent management. Thus, there is a need for health care organizations and systems to use online systems that segment data, elicit patient consents, comply with patient preferences, comply with confidentiality and privacy laws, and use national interoperability standards.

Solution: Consent2Share

FEI Systems developed Consent2Share as an open source application for consent management and data segmentation. It integrates with existing electronic health record (EHR) and health information exchange (HIE) systems via interoperability standards. Consent2Share enables electronic implementation of sensitive health information disclosure policies by applying the information-sharing rules needed to constrain the disclosure of sensitive data according to patient preferences. It supports Federal and State requirements related to specially protected health information, including 42 CFR part 2 and Health Insurance Portability and Accountability Act (HIPAA). It puts control of information exchange in the hands of the person in the healthcare system that has a right to decide who has access to their data: the patient.