Orientation for Evaluation & Treatment Services Contractors

Click on speaker Icons for Audio version of slides

Procurement: 530-13-0006

Linda Tavel, Region 8 Contracts Program Director

Orientation Table of Contents

Slide 1: Slide 2: Slide 3: Slide 4: Slide 5: Slide 6: Slide 7: Slide 8: Slide 9 : Slide 10: Slide 11: Slide 12: Slide 13: Slide 14: Slides15-17: Slide 18: Slides19-22: Slides23-26: Slide 27: Slide 28: Slides29-33: Slide 34: Slide 35: Welcome to Orientation of Evaluation & Treatment Contractors Orientation Table of Contents Introduction to Orientation and Tools used in Orientation Region 8 Contract Management Staff Contact Information Contracting with DFPS Statement of Work for Evaluation & Treatment Purchased Client Services within Evaluation & Treatment Contract Psychological Services & Psychological Testing Services Treatment Services Treatment Services continued. Non-Optional Services DFPS Referral & Services Documentation Requirements Billing, Invoicing and Reimbursement for Services DFPS Billing & Invoicing Key Points Traditional Medicaid & Managed Care Organizations Sub-Contractors Providing Services Goals and Performance Measures & Reporting Contract Evaluation Contract Changes Complaints DFPS Region 8 Contract Management Division Technical Assistance Survey & Acknowledgement of Training Form Questions?????

Instructions for Orientation

During the review of slides there will by hyperlinks that you can highlight and right click on your mouse open hyperlink to access detailed information discussed during the orientation.

There will also be a speaker icon embedded on each of the slides which provides an audio overview of the slide instead of reading each line on the slide. Highlighting the speaker icon opens allowing you to turn on the audio, and to adjust the volume of the speaker. Our main DFPS website contains a lot of information to assist you during the course of doing business with DFPS. http://www.dfps.state.tx.us/pcs/ After clicking on this hyperlink above, the right side of webpage on the top black strip highlight with your mouse the Contract with DFPS. This will open up a menu bar to many options, the ones you will be primarily concerned with will be the DFPS Policies and Procedures, and CPS Contracting. I will provide additional sites to check during this Orientation that will be beneficial during the course of conducting business with DFPS. During the Orientation if you have any questions or need further information please contact one of the Contract Managers or Program Director. For Billing and Invoicing information the Region 8 Contract Technicians can assist you in this area and can provide technical assistance as your needs arise. At the end of this Orientation there is a short survey that we in Region 8 Contracts Management Division would like you to complete, It is a hyperlink with Survey Monkey; your feedback helps us improve out presentations and provide additional information that you and your staff may perceive as helpful as you conduct business with DFPS. We value our Contractors who provide essential and needed client services.

3 Region 8 Contract Management Division

Thank You,

Contacts
DFPS CPS/PCS Regional Contracts Region 8 Contacts
Contract Managers
Shelly Grunewald tel# 210-337-3573 Shelly.grunewald@dfps.state.tx.us

Contract Technicians
Linda Bernal tel# 210-337-3597 Linda.bernal@dfps.state.tx.us

Victoria Navarette tel# 210-3132 Victoria.navarette@dfps.state.tx.us

Sandra Levrie tel# 210-304-3887 Sandra.levrie@dfps.state.tx.us

Samuel Garcia tel# 210-337-3400 Samuel.garcia@dfps.state.tx.us

Contract Program Director Linda Tavel

Phone (210) 3373362

Email Linda.tavel@dfps.state.tx.us

Contracting with DFPS

The Road to a Successful Contract
Meets Client Needs

Meets DFPS Needs

Fulfills Contract Terms

The following tools will be presented during this orientation;

1) Provider Enrollment (PEN) for Evaluation & Treatment

2) DFPS Uniform Terms & Conditions http://www.dfps.state.tx.us/PCS/About_PCS/contracting_procurement_forms.asp 3) DFPS Client Services Contractor Reference Guide http://www.dfps.state.tx.us/pcs/ 4) DSHS Professional Licensing and Certification Unit; a) Professional Code of Ethics http://www.dshs.state.tx.us/counselor/lpc_ethics.shtm b) Professional Scope of Practice based on TAC Code Title 22, Chapter 681 http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?PagelD=35818&id=4329&terms=LPC+rules

c) Texas State Board of Examiners of Professional Counselors-Licensure Complaint Division http://www.dshs.state.tx.us/plc/plc_complain.shtm

Statement of Works
Statement of Work (SOW): This describes the purchased clients services by DFPS requested by the Evaluation & Treatment Contract. The Texas Department of Family & Protective Services (DFPS) mission is to protect Children, the Elderly, and People with Disabilities from Abuse, Neglect, and Exploitation by working with Clients, Families, and the Community. Region 8 CPS Contract Management Division approves, manages and monitors Purchased Client Services Contracts executed within the 28 Region 8 counties. Utilizing the following Rules, Regulations, Statutes, and DFPS Policies, the Contract Management Division ensures that Competent, Quality, and Valued Based services are provided to DFPS Clients by Contractors. DFPS Contract Policies DFPS Client Services Contractor Reference Guide DFPS Uniform Contract Terms & Conditions State of Texas Contract Management Guide Texas Department of State Health Services; a. Facility licensure division, (for business entities providing Substance Abuse Treatment) b. Professional licensure divisions (LPC, LCSW, LCDC) c. Professional licensing scope of practice for LPC, LCSW, LCDC d. Professional Disciplinary-Enforcement lists of disciplined professional counselors (LPC,LCSW, LCDC) Texas Business & Commerce Codes Texas Administrative Codes HHSC Uniform Managed Care Terms & Conditions

Purchased Client Services within Evaluation & Treatment Services Contracts

Key Program Purposes 1. Prevent further harm to children and to keep children with their families when possible; 2. Provide permanence for children in substitute care by resolving safety threats or enhancing parental protective capabilities and returning children to their families; 3. Provide permanence for children who cannot return to their families. Evaluation & Treatment Services Contract; I. Psychological Services (this is optional for contractors) if this service is selected, this includes psychological testing. Psychological Testing includes a private individualized clinical interview, the use of standardized tools, diagnosis and treatment recommendations. II. Treatment Services; includes Psychosocial Assessments; Individual Counseling; Group Counseling; and Family Counseling Services. III. Non- Optional Services; includes Court Related Services; Diagnostic Consultation; and Translation & Interpretation Services. Initiating Services; Contractor Must provide authorized service(s) within (10) business days of receipt of form 2054. Emergency situations may arise requiring Expedited Services per DFPS request, 7 Missed appointments-Contractor to contact DFPS Caseworker by 5pm next business day

Psychological Services
DFPS requests the following information from a psychological evaluation; Clients level of functioning Clients ability to protect child/children Identification of Clients strengths, weaknesses, identified problems

Development of an individualized Service Plan addressing clients problems, establishing measureable goals, objectives, and strategies that enhances clients strengths, and moves toward resolution of identified problems. Perform Psychological Testing using standardized tools, providing a narrative summary to include level of cognitive functioning, emotional functioning, underlying mental health issues or disorders, substance use disorders, resulting in a formulated diagnostic impression and treatment recommendations and the following categories.

A complete typewritten report is required within 10 business days, sent to CPS Caseworker. The report should contain the following areas; a. Reason for evaluation; presenting problem b. History of present illness, c. Psychiatric history, as well as family history of mental illness d. History of alcohol, drug and/or other substance usages, as well as family history of addiction e. Medical history f. Developmental psychosocial, and sociocultural history, g. Relationship history to include familial, extended family, associates, friends h. Parenting history, i. Occupational and military history, j. Legal history k. Mental status exam l. Behavioral observations during session

Treatment Services
The Goals for Treatment Services are to; 1. Prevent or reduce the occurrence of abuse and neglect; 2. Assist Children and Families in overcoming the effects of abuse and neglect; 3. Provide Parents/Caregivers with knowledge and skills needed to recognize and change behaviors that impact their ability to effectively and appropriately protect their children; 4. Assist CPS Caseworkers in developing Service Plans that enhance the diminished Parent/Caregivers protective capacities and ensure child safety.

Treatment Services Intake Procedures & Techniques should address the client(s) presenting issues in a competent,
culturally sensitive, clinically directed manner. Treatment Services begins with a thorough Psychosocial Assessment identifying client(s) strengths, weaknesses, and significant problematic issues that require intervention and treatment to achieve stability, and an adaptive level of functioning to benefit from education, counseling, and other treatment services.

Psychosocial Assessment; should consist of the following -presenting problem/reason for DFPS referral; identified

Parent/Caregivers protective strengths & weaknesses, their perception of problem, level of cognitive functioning (thinking errors, distortions) and comprehension of problem; family & extended family support system; history of substance usagesindividual/family; history of mental illness-individual/family; history of violence, criminality and legal issues/status; analysis of family system & family members (bonding, attachments) where child/children need protecting (safety & threats). The Psychosocial Assessment results in a typewritten report that is organized into a clinical format that ends with a DSM IV-TR/DSM V diagnosis; and formulation of a clinical summary with recommendations for specific services (i.e., education, individual, group, family counseling, psychiatric referral, substance abuse treatment referral, etc.) This report is due within 10 days from date of clients first session.

Treatment/Service Plan; should be completed by the 2nd session spent with Professional Counselor and contain;

issues to be addressed supporting format (individual, group, family sessions) as well as clinical justification for In-Home, Out of Office settings; CPS referral information and status; Specific Goals, Objectives, and measurable Strategies that indicate projected length of time and duration to achieve; Signature and Date of Client(s) and Professional Counselor. This Treatment Plan is to be reviewed within 90 days of this initial Treatment Plan identifying goals met, additions and editing of Goals, Objectives, and Strategies, signed and dated by Client(s) and Professional Counselor.

Treatment Services Continued

Progress Notes should contain the Client (s) name, date, location, time start and time end, signature of Professional Counselor creating note with date and credentials listed for all Client-Professional Counselor contacts that shall be billed to DFPS. The Progress Note should contain; current DSM IV-TR/DSM diagnosis, symptoms, impressions, narrative describing observed attitudes, behaviors, and summarized verbalizations during the session, ending with Professional Counselors clinica l impression(s) and recommendations. There are 5 Types of Treatment Oriented Progress Notes; Individual Counseling Notes; consists of a private face-to-face session that guides the client toward meeting their treatment goals.

Group Counseling Notes; consists of a group of at least (2)non-related individuals but no more than 12 individuals. Group content for this clinical modality requires no less than eight (8) participant hours of evidenced based curriculum and no more than (25) participant hours. A Group Counseling Note functions similar to the individual progress note with the difference being the individual observation documents the interaction and transactions of the individual with members within the group. Each group member in attendance would have a completed group counseling session. The Group Counseling Note should contain; date, time start/time end, topic(s), summary of clients participation, clinical observations, clinical impressions, and recommendations. Family Counseling Notes; consists of (2) or more members in a family working toward mutually agreed upon goals, and objectives. The Family Counseling Notes follows the same content documentation requirements as a Group Counseling Note. Monthly Progress Reports; (if services will not continue in the following month, a Discharge/Closure Summary Report will be required in lieu of the Monthly Progress Report. The Monthly Progress Report should contain; Name of Client(s) seen; date and hours of sessions; locations; type of session(s) individual, group, or family, any missed appointments, progress on treatment plan Goals & Objectives and recommendations for continuance or closure.

10 Discharge/Closure Summary Report; is completed signaling the end of services for the next month. This report must be submitted within 10 business days to CPS Caseworker. The content is similar to the Monthly Progress Report.

Non-Optional Services & Translator & Interpreter Services

Diagnostic Consultation; consists of the request by CPS Caseworker inviting the participation of the Professional Counselor in a formal meeting to discuss the referred case for Evaluation & Treatment Services. (DFPS accepts licensures accepted by Texas Medicaid currently Licensed Psychologist, Licensed Psychological Associate, Licensed Professional Counselor, Licensed Marriage & Family Counselor, Licensed Clinical Social Worker).

Diagnostic Consultation Services Case Note; is the required documentation on form 2057 requiring a DFPS staff signature on the date of service delivery. The note should consist of ; the oldest Medicaid eligible family member in attendance, if no Medicaid eligible individual then the oldest family member. The note should contain the travel time to and from site of service delivery (which is not billable). Translator & Interpreter Services; are provided when a clients ability to communicate is diminished due to Limited English Proficiency (LEP) or some other communication disability; hearing, vision, speech etc. Form 2057 is used (if applicable court subpoena). Same documentation that is used for Diagnostic Consultation is also used for Translator & Interpreter Services.

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DFPS Referral & Services Documentation Requirements

Therapist, Client(s) & DFPS Caseworker discuss completion or continuance of services
DFPS Initiates Referral with Form 2054 and selects Contractor Caseworker provides Referral information on Case

Contractor reviews # of units authorized for billing; assigns case to Clinical Staff.

Individual/Group/Family Counseling provided and documented till completion of recommended course of treatment. Closure/Discharge Summary Ends treatment episode

Contractor must provide authorized service(s) within 10 business days

Missed appts.. Contractor to contact CPS Caseworker by 5pm next business day. 12

Initial Treatment Plan/Service Plan developed which guides treatment; reviewed every 90 days

Psychosocial Assessment completed and submitted to CPS Caseworker typewritten in 10 Business Days

Thorough Psychosocial provides the clinical recommendation for location of treatment services; office, in-home/out of office .must have CPS Caseworker approval & be on treatment/service plan.

Billing, Invoicing & Reimbursement for Services

A Pre-Bill will be emailed to Contractors from DFPS Region 8 Contract Technicians at the beginning of each month. Contractor is to complete and return for processing and payment.
DEPARTMENT OF FAMILY & PROTECTIVE SERVICES PRE-BILL FOR DELIVERED SERVICES REGION 8 PAGE 1 DATE; 11/04/14 TIME: 8:05 AM PROVIDER NAME & ADDRESS ACE COUNSELING SERVICES 1225 NORTH MAIN, SUITE 400 SAN ANTONIO, TEXAS 78212 VENDOR ID NUMBER: 9999999 CONTRACT NUMBER: 12121212 INVOICE NUMBER: 296XXXXX INVOICE MO/YR: 10/2013 CODES: IO-IN OFFICE; HB-HOME BASED; OO-OUT OF OFFICE LCSW, LMFT, LPC LICENSURE CATEGORY PSYCHOSOCIAL INDIVIDUAL SRV CODE 86U 86C 88K FAMILY 86F LOC.&RATE IO $67.15 IO-$67.15 OO93.88 HB-93.88 IO-55.95 OO-78.22

GROUP
COURT REL.SRV

86E
CRT TES-86H DEPOS-86H MEDIAT-86H

IO-16.46 OO-23.01
63.82

RETURN TO CONTRACT MANAGER Shelly Grunewald 3635 SE Military Drive P.O. Box 23990 San Antonio, Texas 78223-4042 ______________________________________________________________________________________

DIAG.CONSULT LICENSED PSYCHOLOGIST INDIVIDUAL FAMILY 86C 88K 86F 88K IO-95.93/OO-134.11 HB-134.11 IO-79.93/OO-111.75 HB-111.75

Lin Last First Clien Cnty Me CS SV Aut Begi Term Srv Rate Q Fee Pd Amt No. Nam Nam t No Cod dic L C h ID n Typ TY 1 Deer Jake 2 Deer Jake 3 Deer Jake 4 Deer Jake 4 Apple Jane 4444 4444 4444 4444 15 15 15 15 0 0 0 2 273 1152 2 273 1152 1/5 1/6 1/31 86c 67.15 1 1/31 86c 67.15 1 1/31 86c 67.15 1 1/31 86c 67.15 1 1/31 86H 63.82 1 0 0 0 0 0 67.15 67.15 67.15 67.15 63.82 332.42 0

2 273 1152 1/12 2 273 1152 1/14 4 273 1159 1/12

GROUP
COURT REL.SRV DIAG. CONSULT

86E
CRT TES;DEPO;MED 86H 81H ALL CONTRACTORS

IO-23.52/OO-32.88
91.19 IO-65.22/OO-91.19

555 126

pre-bill subtotal form(s)2016 total

NOTE: CLAIMING FOR SERVICES NOT ACTUALLY PROVIDED CONSTITUTES FRAUD.

PROVIDER SIGNATURE:_________________________________ DATE:_____________________

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TRANSL/INTERP

COST REIM

DFPS CM AUTH

DFPS Billing & Invoicing Key Points

According to DFPS Client Services Contractor Reference Guide pg. 26-27; and the Evaluation and Treatment PEN Contract; the following policies and procedures are stated; http://www.tmhp.com/Workshop_Materials/Medicaid%20Basics/2013%20MedBasics_PG.pdf Expenses only incurred at the time of service with an authorized 2054 form will be paid Billing should occur within the contract year period Billing forms are to be completed by contractor i.e. Pre-Bill, form 2015 supplemental to Pre-Bill, or other billing forms applicable to specific programs Incorrect billing will be returned to contractor to correct and when resubmitted by contractor should be clearly marked as "Rebill". All supplemental billing should be clearly marked "supplemental" DFPS requires that Texas Medicaid (traditional fee-for services and Medicaid Managed Care) be the first source of payment for eligible clients who receive covered services. Pg.38 of Evaluation & Treatment(E&T) PEN Proof of Medicaid Denial is required, attach to Pre-Bill in order to bill DFPS via contract. Denial due to Medicaid invoicing error - contractor will not be eligible for DFPS payment. Pg. 38 E&T PEN Contractor will bill for appropriate unit of service based on type of service and applicable number of units provided in form 2054 pr. 24 E&T PEN Only services authorized on a Valid Service Authorization Form 2054 may be billed; following claims will be subject to non-payment; service types not authorized; services delivered by a person not meeting the minimum qualifications or not approved by Contract Manager listed on a PCS-102 form; service claims that exceed the number of units or fall outside timeframes specified on Form 2054; Medicaid eligible without an acceptable denial; or missed appointments. Pg. 9 of E&T PEN. In Region 8, incorrect billings shall be returned to Contractors, with email to Contractor notifying of error(s) with a cc email to Contract Manager of error(s) and recommended remedy. Contract Manager will discuss with Contractor via technical assistance on how to correctly comply with DFPS billing and invoicing policies and procedures.

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Traditional Medicaid & Managed Care Organizations

Key Points for Behavioral Health Care Providers to be able to bill Traditional Medicaid services to TMHP.
http://www.tmhp.com/Pages/Medicaid/Medicaid_Publications_Provider_manual.aspx

The facility (business entity) needs a NPI number which is required, if sole practitioner, then that person has to secure their NPI number, Facility bills but the therapist must be listed under the facility as qualified provider doing the services. These issues could result in denial of claims. See pg. 52 of Medicaid Basics Manual;
http://www.tmhp.com/Workshop_Materials/Medicaid%20Basics/2013%20MedBasics_PG.pdf

Behavioral Health Care Manual for Medicaid can be found on TMHP website In Traditional Medicaid almost all services require Pre-Authorizations from TMHP before services could be allowed and billable. The exception are Substance Abuse Assessments and Mental Health Assessments. All other services must have a pre-authorization and Medicaid assigns units of service to each service type; individual counseling, group counseling, family counseling etc. http://www.tmhp.com/TMPPM/2011/Vol2_Behavioral_Health_Handbook.pdf

Who is eligible for Medicaid? Page 4-5 of Medicaid Basics Manual describes Medicaid programs ; i.e., THSteps, CHIPS,
TANF, QMB (supplement with Medicare) etc.. Pg. 8 of Medicaid Basics Manual describes the MCO programs; i.e., Star, Star+Plus, etc. Low income families Non-disabled children Related caretakers of dependent children Pregnant women Elderly People with disabilities

Health & Behavioral Health Care Providers; Medicaid 15 & MCOs under oversight of Texas Health & Human Services Commission

Texas Medicaid & Healthcare Partnership (TMHP) aids providers in third party recovery activities by providing technology, program management, data center operations, performance engineering expertise, infrastructure etc.

Continued- Medicaid & MCOs

Providers must first enroll in Texas Medicaid through TMHP then can enroll in MCO to provide services to clients in these programs Enroll online TMHP using Provider Enrollment Portal (PEP), once application complete is sent to Office of Inspector General, criminal background check completed and sends back ok to TMHP and TMHP sends welcome email to provider which signals provider is enrolled. Providers must re-enroll every 5 years website: www.tmhp.com see pg. 37 in Medicaid Basics Manual for screen shot step by step instructions. Accept reimbursement for Medicaid services as payment in full, cannot submit a bill to DFPS for any difference in bill Verify Client Eligibility at online website where Medicaid Providers can get up to date information on a client's eligibility, history of services and treatment that have been reimbursed by Medicaid, # of units used for the year in Behavioral Health Care services. TexMedConnect located at top right of main page of below log on menu boxhttp://www.tmhp.com/Pages/Medicaid/Medicaid_home.aspx see pg. 46-48 of Medicaid Basics Manual for information and screen shots. Traditional Medicaid clients require a pre-authorization from TMHP for most services. If a service requires prior authorization and provider fails to obtain it the claim for the service will be denied. Prior authorization requests can be submitted electronically to TMHP or faxed. For more information see pg. 53 -63 of Medicaid Basics Manual, screen shots explain electronic submission method and form. Providers need to obtain a National Provider Identifier (NPI) number. See pg 57 for more information; Medicaid Basics Manual Providers submitting claims to TMHP can do so weekly must be under same Provider Identifier (NPI) and Program to be reimbursed. Denials are reported by TMHP and explained in codes on the Remittance and Status (R&S) Report. The R&S will identify specific claims as "pending, paid, denied, or adjusted pg. 67-68 Medicaid Basics Manual

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Continued Traditional Medicaid & MCOs

Common Rejections of Claims occur when client information does not match i.e.; 1. Error in Client Patient Control Number(PCN), 2. Error in Medicaid Identification(ID), 3. Error in DOB, clients exact name on TMHP eligibility record, 4. If provider does not have an NPI # and left blank on form will return with a denial, Correcting claim and resubmitting, will have 95 days to resubmit from date of service, and appealing a rejected claim the provider has 120 days to resubmit with additional proof to be reimbursed and may receive reimbursement of claim, for more info see pg. 68 Medicaid Basics Manual & pg. 85-95 for Remittance and Status Report details, and screen shots. Behavioral Health Care Providers LPC, LCSW use CMS-1500 Claim Form, see pg. 77 of Medicaid Basics Manual for examples and instructions on completing form.

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Sub Contractors Providing Services

Contractors who will be using Sub Contractors to provide services must establish written policies and procedures. pg. 16-17 of the DFPS Client Services Contractor Reference Guide provides more detailed information. These policies & procedures must be submitted no later than 90 days after contract in effect. Verifying the competency and reputable standing in professional licensure; a. Verify current professional license with DSHS occupational licensure; b. Ensure Professional Counselor is not listed on disciplinary or Enforcement lists within DSHS Professional Licensing Dept. c. Ensure Criminal Background Check completed & approval from assigned Contract Manager prior to therapist seeing DFPS client's All Sub Contractors must be listed on PCS-102 form, their license #, Date of expiration, Medicaid # and copy of license(s attached to the PCS-102 submitted to Contract Manager for approval after criminal background check has been completed. All service related Sub Contractors must meet the same contractual requirements as the primary contractor a. Contractors must identify proposed Sub Contractors; use of PCS-102 form; b. Sub Contractor is at the expense of Contractor; c. Contractor must establish a term specified contract with Sub Contractor; Monitoring Sub Contractors is the primary responsibility of Contractor, tasks may consist of and not limited to; a. Evaluating Sub Contractors knowledge, skills and abilities; b. Verify services provided and submitted billing with supported documentation; c. Ensure that content of progress notes, reports etc., are not cut and pasted across clients cases; 18Ensure that therapy is clinically driven from identified issues from the comprehensive psychosocial assessment, that d. established the foundation for the development of an individualized/family treatment plan/service plan which is reviewed and updated as needed every 30 days.

Goals, Performance Measures & Reporting

Page 36-37 of Evaluation & Treatment PEN; Pursuant to Texas Human Resources Code 40.058, states that all contracts for client services must include clearly defined goals and outcomes that can be measured to determine whether the objectives of the program are being achieved.

The Performance of the Contractor will be evaluated during the life of the contract through the Performance Measures contained in Attachment A-1 PEN and through monitoring of additional contract requirements.
Inadequate Contractor Performance shall be reported to the Vendor Performance Tracking System (VPTS) located within the Texas Comptroller of Public Accounts; Texas Government Code 2155.073-77. This system provides the state procurement community a comprehensive tool for evaluating vendor performance to reduce risk in the contract award process. Unsatisfactory performance shall be reported to VPTS.

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Performance Measures
Psychological and Treatment Services

Outcome #1
Authorized services provided by the Contractor meet Caseworkers expectations.

Target
At least 90%.

Quarterly Performance Periods

September 1 November 30 December 1 February 28/29

March 1 May 31 June 1 August 31

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Performance Measures
Psychological and Treatment Services

Methodology
How Will Performance Be Calculated?
Data will be obtained by DFPS from CPS Caseworker Satisfaction Survey Questionnaires. Performance will be calculated for each performance period, wholly or partially, depending on the contract start and end dates.

The aggregated number of favorable responses to the Caseworker Satisfaction Survey Questionnaires obtained from Caseworkers for the Outcome Performance Period. The aggregated number of all responses, excluding Not Applicable (NA) responses, to the Caseworker Satisfaction Survey Questionnaires obtained from Caseworkers for the Outcome Performance Period.
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X 100 = %

Contract Evaluation

Monitoring Methods

On-Site Monitoring

Planned

Notice of Monitoring Activity Inform of Goals and Objectives

Conducted with Least Disruption to Day-to-Day Operations as Possible Results Communicated During Exit Conference

Desk Review Administrative Programmatic Fiscal

Monitoring Scope

Monitoring Results A Formal Monitoring Report Provided to Contractor Performance Measures

Pursuant to Texas Human Resources Code 40.058(b) all Contracts for client services must include clearly defined goals and outcomes that can be measured to determine whether the objectives of the program are being achieved.
Performance Measure results will be provided to the Contractor in order to assist the Contractors compliance with the terms of the contract, DFPS policies, and applicable state and federal regulations.

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Contract Evaluation
Administrative Monitoring

Documentation of subcontractor compliance with DFPS Policies and Procedures

Insurance, License, Background Checks, Clearance Emails

Programmatic Monitoring

Documentation of a Psychosocial Assessment that has been appropriately completed and is unique to the Client Documentation of an initial and revised Treatment Plan that is unique to the Client and representative of the specific needs of the Client Documentation of clear and complete Monthly Progress Reports Documentation exists for Diagnostic Consultation, Court Related Services, discharge summary/ closure summaries, missed appointment, and cancellation of group counseling sessions Interpreter and Translation Services were provided when needed The caseworker special instructions as noted in the Comments section of Form 2054 were followed, or justification for not doing so is documented Documentation of timely submission and the manner of submission of applicable items to the caseworker or contract manager 23

Contract Evaluation
Monitoring Results

All material errors or questionable items found in fiscal and/or programmatic monitoring or the Administrative Review will be addressed in a written Monitoring Report. The written Monitoring Report will be provided within 30 days of the conclusion of the monitoring. The Contractor will be asked to respond

Agreement or disagreement Actions to be taken to remedy

Time frames for correction

Reimbursement of disallowed costs

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Contract Evaluation
Fiscal Monitoring
Valid Service Authorization Form 2054 Received prior to providing services Receipt of the 2054 is easily identified

Services within the number of units authorized

Services delivered within the time frames authorized Court Related Services were at the request of DFPS, not the defense attorney Documentation to Support the Unit of Service Billed Service provided by approved staff or approved subcontractor Service begin and end time Location of service Type of service delivered was authorized Medicaid denial Contract Manager Approvals Appropriate Claims If family, billed under one family member only Travel time is not included in any claim

Documentation time is not included in any claim

Group claims are appropriate to location of service or makeup of attendees Services delivered in appropriate time of the day Home-based services provided only when authorized and the type of service was identified Amount of services delivered by any one clinician is reasonable Services delivered by any one clinician do not overlap times or Clients being served at any one location Interpreter or Translation services not provided by a staff, volunteer, or child victim.

Prior approval for Interpreter and Translator Services

Service provider

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NOTE: Contractor is to ensure service providers are aware of the contract requirement to cooperate with any audit or monitoring. This includes making records available or being available for interviews.

Contract Changes

DFPS and Contractor may make changes to this Contract according to Section 4.35 of the Contract.

Section 4.35.1 Bilateral Amendment

Incorporates a substantive change into the existing contractual agreement.

May be initiated by either party. Requires mutual agreement. Requires signatures of BOTH parties.

Section 4.35.2 Unilateral Amendment

Only for circumstances listed in Section 4.35.2 of the Contract

Signed by DFPS Contract Manager. Provided to the Contractor with ten (10) days notice prior to execution of the amendment.

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Complaints

Process

DFPS Receives a Complaint

DFPS Notifies the Contractor

DFPS Determines Who Investigates

DFPS Investigates Contractor Investigates

Report Preliminary Information to DFPS within 5 Business Days of Receiving the Complaint

Investigation Completed Determination Reached

Complaint Not Validated Complaint Validated

Contractor Notified of Determination and Findings

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DFPS Region 8 Contract Management Technical Assistance

Contract Management Staff are here to provide Technical Assistance that improves Contractors efficiency and ability to deliv er Quality Services to DFPS clients. Some areas of Technical Assistance are;

Strategies in developing internal policies and procedures; fiscal & operational; Orientation and Individualized trainings in areas such as billing, invoicing, etc. Locating State of Texas Corporations section business organizational information; Understanding state licensing policies, procedures, and licensing rules and regulations

Reference Materials provided in the form of electronic manuals, hyperlinks to websites with specific information that increases the business or individuals knowledge, skills, and abilities. Refer to Contract Management Contact slide for the names, telephone numbers and email addresses of Region 8 Contract Management staff.

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DFPS Internet Site

DFPS Internet Homepage
http://www.dfps.state.tx.us

Select Contracting with DFPS

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DFPS Internet Site

http://www.dfps.state.tx.us/PCS/
Select to access Regional CPS Contracts

Contracting with DFPS Homepage

Select Contracting and Procurement Forms to Obtain the 2970c and 2971c

Select to Open the Client Services Contractor Reference Guide

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DFPS Internet Site

http://www.dfps.state.tx.us/PCS/Regional_Contracts/default.asp

Regional CPS Contracts Homepage

Select Regional CPS Contracting Forms to obtain Service-specific documents

31

DFPS Internet Site

http://www.dfps.state.tx.us/PCS/Regional_Contracts/forms.asp

Regional CPS Contracting Forms Homepage

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Survey & Acknowledgement of Training Form

Thank you for your participation in the Contractor Orientation Event, below is a hyperlink if you highlight and right click with your mouse, a menu box opens and click on open hyperlink and it will take you to a specific survey that we are gathering your feedback on.

https://www.surveymonkey.com/s/KHJMLV8 An Acknowledgement of Contractor Orientation Form will be emailed to you from your Contract Manager for you to sign, date and return. There is a comments section on this form for requesting additional information or technical assistance.
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Evaluation & Treatment Services

Questions ???
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