Below is a summary of ongoing updates in the state regarding insurance company collaborations and healthcare reform. If there are additional state advocacy concerns that you have, please reach out to us at: firstname.lastname@example.org.
Call for the Development of State Advocacy Special Interest Groups
The Expanded Concussion Law
- o In September 2016, DE passed the Expanded Concussion Law regulating “return to play” requirements involving protection to all youth involved in any athletic program.
- o This law is more stringent and will ultimately result in the need for increased access to health professionals who make the “return to play,” determination.
- o The law is likely to go into effect the first week of September 2017.
- o Are you interested in contributing to the developing Expanded Concussion Law?
- o Consider participating in an Expanded Concussion Law Special Interest Group
- o The purpose of this Special Interest Group will involve researching existing laws in other states, and advocating at the level of the DE Department of Public Health to make recommendations on the type(s) of health professional(s) to be designated in the law as decision makers.
Advocacy Event Attendance
- o There are various meetings held throughout the state which focus on health care reform.
- o Various members of the healthcare community, government officials, and business and legal representatives are present at these meetings in meaningful numbers.
- o Unfortunately, psychologists are largely underrepresented, despite the efforts of the existing SA committee members.
- o Are you interested in increasing the voice of psychologists at these meetings?
- o Consider participating in an Advocacy Event Special Interest Group.
- o Your participation in this Special Interest Group will entail attending relevant meetings, advocating on behalf of your state psychology colleagues, and reporting back to the SA committee on the outcome of the meeting.
Payment Reform Meeting in Delaware
- - The Delaware Center for Health Innovation (DCHI) cross-committee meeting was held on June 28th, 2017 at The Outlook Center, 500 West Loockerman St, Dover, DE 19904
- - Our very own Traci Bolander, PsyD, CEO/Licensed Psychologist, Mid-Atlantic Behavioral participated as a moderator for the second Panel on Research/National Perspectives on Payment Reform
- - You can review the meeting at www.facebook.com/DEHealthInnovation for additional details
Blue Cross and Change Healthcare (Billing and Coding) Educational Webinar
The SA committee hosted an educational webinar focused on a general discussion about the auditors’ expectations for CPT psychotherapy coding and documentation. This webinar was facilitated by Joan Warner, RHIT,CCS,COS, Manager of Coding Compliance, of the Change Healthcare team, on June 23rd. from 12 noon – 1 p.m.The Change Healthcare team is a Highmark contracted company which provides coding trending and education). Joan provided feedback about the following:
- o Redacted records are accepted from Highmark providers.
- o Health and Behavior Assessment codes 96160 and 96161 (which replaced code 99420):
- o Codes 96160 and 96161 are used when a patient risk-assessment instrument is administered to either the patient or the caregiver/parent in order to assess the risk of conditions, such as mental disorders
- o The instrument must be administered in conjunction with an E/M (a service provided by the physician or other qualified health care professional).
- o The separately reported E/M service includes interpreting the rating scale, discussing the results with the patient and/ or caregiver, documenting the patient/caregiver discussion in the patient’s medical record, and providing any referrals to the parent’s or caregiver’s primary care provider or mental health provider.
- o Codes 96160 and 96161 do not include physician work which may be reported for the patient encounter.
- o NOTE: Additional alcohol and/ or substance abuse screening services cannot be reported in conjunction with either code 96160 or 96161.
- o Joan and her team are continuing to research use of the psychotherapy crisis code, as well as procedure codes 96127 and 99408.
Proposed Behavioral Health Legislation in Delaware:
DE Lt. Governor, Bethany Hall-Long presented legislation on June 8th announcing the development of the Behavioral Health Consortium. This consortium is designed to facilitate a coordinated behavioral health system (involving mental health and substance abuse concerns) within the state of Delaware. The committee is involved in these stakeholder meetings, and will notify the DPA body as these initiatives become public with the hope that others will offer their insight and participate in the committees that may be formed as a result of these initiatives. Please review DE House Bill (220) and Senate Bill (111), and review the link below about further details on the newly announced legislation.
Please save the date for the bill signing of Senate Bill 111 and House Bill 220. Governor Carney will sign both pieces of legislation, which create the Behavioral Health Consortium and Addiction Action Committee. Preliminary details are below:
When: Wednesday, August 16th, 2017
Where: SUN Behavioral Health
21655 Biden Ave
Georgetown, DE 19947
Uniting our Efforts
DPA Federal Advocacy coordinator, Barbara Giardina, PhD has agreed to provide listserv updates and Capwiz training to the SA committee in order to disseminate Federal Call to Action Alerts to the DPA membership.
Critical Incident Reporting: Highmark Health Options Blue Cross Blue Shield (HHOBCBS) of Delaware
The DPA State Advocacy and Executive Council remain committed to gaining clear and concise feedback from the Director of Clinical and Service Quality of HHOBCBS of DE, (hereafter referred to as “director”) regarding the behavioral health practitioners’ responsibility in notifying HHOBCBS of DE about critical incidents. Unfortunately, we have not received clear directives from HHOBCBS to date, and have proposed a plan to submit a follow-up letter per the approval of the DPA Executive Council requesting clear directives within a specified timeframe.