Living will, living will directive, advance directive, and directive are all terms used to describe a document that provides directions regarding health care to be provided to the person executing the document. In Kentucky, advance directives are governed by the Kentucky Living Will Directive Act codified in KRS 311.621 to 311.643, and as otherwise defined in 42CFR, 489.100.
A member who is 18 years of age or older and who is of sound mind may make a written living directive that does any or all of the following:
- Directs the withholding or withdrawal of life-prolonging treatment
- Directs the withholding or withdrawal of artificially provided nutrition or hydration.
- Designates one or more adults as a surrogate or successor surrogate to make health care decisions on his or her behalf.
- Directs the giving of all or any part of his or her body upon death for any of the following reasons: medical or dental education, research, advancement of medical or dental science, therapy, or transplantation.
A form of a living will is included in KRS 311.625. The form can be reviewed at www.lrc.state.ky.us/KRS/311-00/625.PDF. Advance directives may be revoked in writing, by an oral statement, or by tearing up the written living will.
The revocation is effective immediately.
In addition to reviewing the Kentucky Living Will Directives Act, providers should:
- On the first visit, as well as during routine office visits when appropriate, discuss the member’s wishes regarding advance directives for care and treatment;
- Document in the member’s medical record the discussion and whether the member has executed an advance directive;
- If asked, provide the member with information about advance directives;
- Upon receipt of an advance directive from the member, file the advance directive in the member’s record;
- Not discriminate against a member because he or she has or has not
- executed an advance directive; and,
- Communicate to the member if the provider has any conscientious objections to the advance directive as indicated above.
Notice to Providers Regarding the Plan’s Utilization Management (UM) Policies and Procedures
Smoking Cessation CEUs, register by February 10 for Discount! Info is here: https://smokingcessationleadership.ucsf.edu/webinar/engaging-health-professionals-and-strengthening-smoking-cessation-interventions-success
Clinical Criteria Available to Providers
Utilization Management (UM) strives to ensure our members use their benefits as needed and as appropriate. To assist us, we use Milliman Care Guidelines®, InterQual® Criteria, Medicare, and/or Medicaid criteria/guidelines to evaluate the necessity of medical services. These guidelines support the delivery of quality health care and assist us in evidence-based clinical decision making and reviewer consistency.
In addition, we utilize Passport’s medical policy in the decision making process. We involve actively practicing providers with like or similar expertise in the adoption of criteria, the development of policies, and the review of procedures for applying the criteria.
A copy of the Passport medical policy are available to providers upon request by calling (800) 578-0636.
Culturally and Linguistically Appropriate Services (CLAS) and Title VI
Under Title VI of the 1964 Civil Rights Act, no person in the United States shall be excluded from participation in or discriminated against on the basis of race, color or national origin. All recipients, directly or indirectly, of federal funds (such as, but not limited to, Medicaid, SCHIP and Medicare payments, NIH grants, and CDC monies) are required by Executive Order 13166 to ensure that their own programs provide equal access to persons with Limited English Proficiency (LEP).
Culturally & Linguistically Appropriate Services (CLAS Standards)
U.S. Department of Health and Human Services (HHS) –Office of Minority Health
The CLAS Standards are mandated by HHS to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages (verbal and written), health literacy, and other communication needs.
CLAS Standards require you to provide qualified interpretive services and professionally translated materials for your non-English speaking patients. Bilingual speakers do not necessarily qualify as medical interpreters, nor do friends, children, or other family members of the patients.
Face to-face interpretation is usually best, but tele-interpreter services are also acceptable and cost-effective. For discounted teleinterpreter services, please call (800) 305-9673, ext. 59105 (client services) or ext. 55316 (new users).
For a language assistance poster, click here.
Americans with Disabilities Act
Public entities and those receiving HHS funding must:
- Provide auxiliary aids at no additional cost to individuals with disabilities, where necessary, to ensure effective communication with individuals with hearing, vision or speech impairments.
- Auxiliary aids include, but are not limited to, services or devices such as: qualified interpreters on-site or through video remote interpreting (VR I) services, note takers, assistive listening devices, television captioning and decoders, telecommunication products and systems, qualified readers, taped texts, Braille materials, and large print materials.
For a language assistance brochure, click here.
For the Culturally Competent Use of Language Services power point, click here.
Helping Members Make the Most of Their Benefits
It is important for all members to know about the Plan’s decision-making policies. Many members have questions about their benefits and how the Plan decides what benefits are authorized for payment.
We hope you will join us in reminding members of the following important points:
- The purpose of UM is to validate that services are medically necessary and covered by the Plan.
- Passport Health Plan does not reward anyone, including practitioners, for denying services to members.
- The Plans do not compensate associates or practitioners to make decisions that keep members from getting the care they need.
Like you, our first concern is that members receive appropriate care in a timely manner. Therefore, if members who visit your office have questions about the UM process or benefit decisions, please refer them to Member Services at 1-800-578-0603 (TDD/TTY 1-800-691-5566). We will be happy to assist them.
- Kentucky Medical Association ICD-10 Bootcamp
- Kentucky REC ICD-10 Coder & Physician Training
- CMS Medicaid Training Tools
- GLMS Resources and Training Opportunities
- CMS Preparation Videos
- ICD-10 Frequently Asked Questions
- Let us know how ready you are!
- Test Your ICD-10 Readiness for a Smooth Transition
- Provider Testing Sign-Up Form (Please sign up by July 1, 2015)
- CMS ICD-10 Go Live October 1, 2015
- Inpatient: Transitioning from ICD-9 to ICD-10 (video)
- General Equivalency Mappings
- AHIMA ICD-10 Documentation Tips
CHECK YOUR STATUS
Need to Talk About Denials?
Passport providers may speak with Medical Directors regarding Utilization Management (UM) decisions and specific cases or service requests at any time. If you disagree with a UM decision, you can discuss the decision by telephone with the medical director who rendered it.
Whenever a denial is verbally issued, the UM staff provides the name, telephone number, and title of the Medical Director who rendered the decision. The provider may then call the Medical Director directly to discuss the denial. Appeals information is included with each denial letter.
If you have questions about the UM process or a UM issue, please call (800) 578-0636.
Passport Health Plan offers annual Provider Workshops to educate our provider network on recent or upcoming changes as well as new initiatives and yearly compliance training. Please see below for previous workshop materials as well as information regarding any upcoming workshops.
2017 Workshop – TPA Transition Training
For information on the New Claims System, click here
Integrating care to improve health outcomes for our members, your patients
To further our mission of improving the health and quality of life for our members and your patients, Passport Health Plan has adopted an evidence-based public health initiative to aid in the prevention, identification, and treatment of alcohol and substance use disorders called Screening, Brief Intervention, and Referral to Treatment (SBIRT).
SBIRT is a practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and other substances. SBIRT is provided in a primary care setting to allow opportunities for early intervention with at-risk alcohol and other substance use behavior before more severe consequences occur.
- Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
- Brief Intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
- Referral to Treatment provides those identified as needing more extensive treatment with access to specialty care
Who is the target for SBIRT?
All Passport members are required to have an annual SBIRT screening. SBIRT may be completed by primary care providers including physicians, nurse practitioners, and physician assistants who have completed SBIRT training. The recommended age to begin screenings is 9-years-old.
What is SBIRT?
Screening is a quick, simple method of identifying patients who use alcohol or other substances who are at-risk of or who may already have disorders. The screening instruments provide specific information and feedback to the patient related to his or her alcohol or substance use. The typical screening process involves the administration of validated screening tools. If a patient screens positive on one of the screening tools, he or she is then given a longer alcohol or drug use evaluation, using a standardized risk assessment tool. The screening and risk assessment instruments are easily administered and provide patient-reported information about substance use that any healthcare professional can easily score for the provider to use with the patient.
Passport providers who are implementing the SBIRT into their practices should build the screening instruments into their Electronic Medical Record (EMR) for easy access. Others should train their office staff to assist with the administration of SBIRT to be conducted prior to the provider’s face-to-face review with the patient, such as during registration or routine vitals. Please refer to the training for specifics about administering the SBIRT.
For this age category, there are a number of validated screenings tools available free of charge as part of the standardized SBIRT administration. Following your training, these screening tools will be made available.
- Resources: National Institute on Alcohol Abuse and Alcoholism [NIAAA]
- A Practioner’s Guide: Alcohol Screening and Brief Intervention for Youth (2011 edition for ages 9-18)
- CRAFFT (Car, Relax, Alone, Forget, Friends or Family, and Trouble) or CRAFFT 2.0 including questions about tobacco, alcohol, and drug use
Passport providers have the flexibility to choose which validated tool to use in the SBIRT service. Please see training sites and tools that follow.
For the adult patient, there are a number of validated screenings tools available free of charge as part of the standardized SBIRT administration.
- NIAAA Resources for Providers
- ASSIST Manual / ASSIST Tool
- AUDIT Manual / AUDIT Tool
Passport providers have the flexibility to choose which validated tool to use in the SBIRT service. Please ensure you are screening for both alcohol and other substance problems. Please see training sites and tools that follow.
Brief intervention is a time-limited, patient-centered strategy that focuses on changing a patient’s behavior by increasing insight and awareness regarding substance use. Depending on severity of use and risk for adverse consequences, a brief discussion provides the patient with personalized feedback showing concern over drug and/or alcohol use. The topics discussed can include how substances can interact with medications, cause or exacerbate health problems, and/or interfere with personal responsibilities.
Brief intervention is designed to motivate patients to change their behavior and prevent the progression of substance use. During the intervention, patients are:
- Given information about their substance use based on their risk assessment scores.
- Advised in clear, respectful terms to decrease or abstain from substance use.
- Encouraged to set goals to decrease substance use and to identify specific steps to reach those goals.
- Taught behavior change skills that will reduce substance use and limit negative consequences.
- Provided with a referral for further care, if needed.
Brief interventions are typically provided to patients with less severe alcohol and substance use problems who do not need a referral to additional treatment and services. In addition to behavioral health professionals, medical personnel (e.g., doctors, nurses, physician assistants, or nurse practitioners) can conduct these interventions and need only minimal training. In the case of patients with addictions, more intensive interventions may be needed. While medical personnel who have received additional training may conduct intensive interventions, behavioral health professionals often conduct these longer counseling sessions.
Referral to Treatment
In some cases, a more advanced treatment option is necessary and the patient is referred to a higher level of care. The referral to treatment process consists of helping patients access specialized treatment, selecting treatment facilities, and facilitating the navigation of any barriers such as cost of treatment or lack of transportation that would hinder them from receiving treatment in a specialty setting. Handling the referral process properly and ensuring that the patient receives the necessary care coordination and follow-up support services is critical to the treatment process and to facilitating and maintaining recovery.
If the Passport member experiences any difficulties in obtaining a referral or accessing care, please encourage them to contact the Passport Health Plan Behavioral Health Hotline at 1-855-834-5651 or check Passport’s Provider Directory. Our team will assist Passport members in finding a behavioral health provider.
When is SBIRT done?
Passport recommends SBIRT is completed during a visit to a primary care provider annually beginning 1/1/15. This may be completed at the time of a well-child visit or physical when other screenings are completed. It may also be completed when a patient is being seen for a routine visit but has not yet been screened this year.
How is SBIRT reported?
Reporting an Alcohol and/or Drug Screen
Healthcare Common Procedural Coding System (HCPCS) code H0049 may be utilized to report the separate and distinct service provision of a structured alcohol and/or drug screen with feedback by the provider conducted during the same clinical session (i.e., date of service) as any other Evaluation & Management (E/M) services. Documentation of the administration and results of the screen should be recorded in the clinical record. When further time is required for a brief intervention secondary to a positive screen, an SBIRT can be completed instead and reported as noted below.
Current Procedural and Terminology Code 99408 may be utilized to report the separate and distinct service provision of the SBIRT for up to 30 minutes of time during the same clinical session (i.e., date of service) as any other Evaluation & Management (E/M) services. Documentation of the administration and results of the SBIRT should be recorded in the clinical record.
Reporting an Extended SBIRT
Current Procedural and Terminology Code 99409 may be utilized to report the separate and distinct service provision of the SBIRT when the service takes in excess of 30 minutes during the same clinical session (i.e., date of service) as any other Evaluation & Management (E/M) service. Documentation of the administration and results of the SBIRT including the reason for the extended visit should be recorded in the clinical record.
Providers should be prepared to demonstrate the completion of a course in the standardized administration of the SBIRT.
As is customary, please follow the standard Medicaid guidelines for documentation. Please denote start/stop time or total face-to-face time with the patient (since codes are time-based).
Specific for SBIRT, please document:
- Reason for encounter and any relevant history;
- Assessment, patient response to service, clinical impression, and diagnosis (only if appropriate as this is an universal screening and may not be appropriate);
- Date and legible identity of provider;
- Plan of care including any referrals to treatment or planned follow-up; and
- Sign all services provided/ordered.
Reporting of Passport Provider Participation
Levels of participation by Passport providers in the administration of the SBIRT will be summarized and shared quarterly with Passport providers and also with the Kentucky Department of Medicaid Services and Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), as required.
Providers are required to complete training for the standardized administration process of the SBIRT prior to implementing in their practice.
Free on-line training course: https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZS5vcmcvdmlld2FydGljbGUvODMwMzMx&ac=401
Providers are not limited to participation in this training course. Other training courses are available either on-line or in-person, some resources are free of charge, others may have a nominal fee. Providers may participate in other trainings in the standardized administration of SBIRT. Providers will need to keep a certificate of completion on-file for the completion of the training.
SBIRT Core 4-hour training, $50 fee
SBIRT Training Catalogue (Pacific Southwest ATTC) lists all the training available and costs, if any
Institute for Research Education & Training (IRETA)
- Training Opportunities http://ireta.org/what-we-do/training/
- SBIRT Info for Healthcare Professionals http://ireta.org/improve-practice/health-and-human-service-professionals/
Yale Training videos
UCLA free training
Free training & CEUs
NIDA online tool for adults
Upcoming National Conference and CEUs
SBIRT Screening Tools
Please make sure you have completed SBIRT training and have a certificate on file before administering any of the following tools:
- ER Utilization Presentation
- Medication Assisted Treatment for Opioid Dependency
- Understanding Credentialing and Enrollment