Frequently Asked Questions
Authorizations
What happens if I don’t get my authorization in on
time?
Authorizations are mailed out to Network Contract Providers
twice a month. When the Provider receives their letter with out
authorization for a covered child/family the provider should not
deliver any services to that child/family until authorization is
verified through the External
Resource Coordinator. If authorization is entered after the
due date the Care Coordinator should notify the External
Resource Coordinator by email and an updated authorization will
be mailed out to the Provider.
What should I do if I have been asked to provide a service
to a client but have no written authorization from the Care Coordinator
to do so?
Services should not be provider with out prior authorization. However,
if services have started on a crisis basis and no authorization
has been submitted you should contact the Care Coordinators supervisor
for assistance.
Billing
Can I bill mentoring while a child is doing community restitution?
Generally, not, unless there is a specific mentoring goal being
addressed, other than completion of CR hours, that can best be met
within the context of a specific CR activity. If a child requires
supervision during CR due to behavioral difficulties, the appropriate
service to authorize would be behavioral aide.
Delivery of Service
If I have a question about service delivery or service
definitions whom should I contact?
If you have questions about the definition of a service or the expectations
and guidelines for the delivery of a service, please refer to the
Service Definitions and Billing Guidelines or contact the Contract
Monitor @ (512) 483-5891
If I have a question about service delivery or service definitions
whom should I contact?
If you have questions about the definition of a service or the expectations
and guidelines for the delivery of a service, please refer to the
Service Definitions and Billing Guidelines
or contact the Contract
Monitor @ (512) 483-5891.
What kind of services does the MSO fund?
The MSO funds a comprehensive array of services for eligible children
and families that include traditional and nontraditional therapies
as well as community and family support services. Traditional therapies
include nursing, speech language pathology, audiology, dietary,
physical therapy, occupational therapy, behavioral therapy, counseling,
psychological and psychiatric assessment and evaluation, medication
management, and substance abuse outpatient services. Nontraditional
therapies include recreation therapy, art therapy, dance/movement
therapy, and music therapy. Community support services such as life
skills training, tutoring, mentoring, behavioral aide, crisis intervention
and support, transportation, and camp are also available based on
the individual needs of the child/family. Family support services
include parent coaching, case management, advocacy, respite, and
group after school supports. Therapeutic foster care, in-patient
substance abuse services, and shelter care may also be funded for
eligible children/families. A limited amount of funding exists to
meet short-term basic needs of children/families receiving services
through the MSO. Please refer to the Service Definitions and Billing
Guidelines for a more comprehensive description of MSO funded services
and supports.
Who do I talk to about the quality of a service or problems
with the delivery of a service as authorized?
If you are a Covered Individual, Family Member, Child and Family
Team Member, or Advocate you should first address your concern with
the Care Coordinator. If you feel your concern is not being addressed
to your satisfaction you can make a complaint to the Contract Monitor
@ (512) 483-5891. Care Coordinators can also make a complaint to
the Contract Monitor on behalf of a Covered Individual/Family by
calling the above number or submitting a Complaint Form describing
the nature of the complaint.
What do I do if I have a family that is complaining about
a provider?
If the complaint is of a minor nature and easily resolvable, you
should first try and negotiate a solution between the family and
provider. If the complaint is more serious and/or attempts at resolution
are unsuccessful, you should offer the family the option to change
providers. You should also contact the Contract
Monitor @ (512) 483-5891. A written complaint using the Complaint
Form may also be submitted to the Contract
Monitor. If the complaint is such that it involves risk to the
health, safety, and welfare of a child, contact the Texas
Department of Family and Protective Services immediately, complete
an ATCMHMR Incident Report,
and contact the ATCMHMR Contract
Monitor.
When mentoring
is provided can the provider take the client to their home?
No. Mentoring is intended to be a community-based service. The risk
and potential liability of having a child in a Mentor’s home
is considerable. The Care Coordinator, under special circumstances
and with supervisory approval, could authorize mentoring in the
provider’s home; however it would need to be explicitly stated
in the Plan of Care why this was clinically in the child’s
best interest. Such approval would be rare, short term, and closely
monitored.
How will I know if a provider is not providing a service?
The Care Coordinator should communicate with the family to determine
that they are receiving appropriate services. The Care Coordinator
should also read the progress notes that providers submit. If the
Care Coordinator feels services are not being provided after communicating
with the family and reading the progress notes, they should speak
with their supervisor and contact the Contract
Monitor @483-5891.
If I feel that a client was put in an unsafe situation
by a provider what should I do?
First, report the incident to DFPS,
fill out the ATCMHMR
incident report and contact the Contract
Monitor for further assistance.
What do I do if I am uncertain whether the services and/or
supports I am providing meet the service definitions?
In order to avoid a possible billing denial, it is a good
idea to attempt to get clarification of a definition you are uncertain
about prior to actually delivering the service. Always check the
Service Definitions and Billing Guidelines
first. If you are still unsure after checking the Billing Guidelines
discuss your concerns with the Care Coordinator. The MSO Contract
Monitor is also available to give you technical assistance and
answer questions about service definitions and service delivery.
Family Select Providers
What is the difference between a Family-Select Provider
and a Network Contract Provider?
A Network Contract Provider maintains a contract with ATCMHMR for
the provision of one or more of an array of services and supports
funded through ATCMHMR, but not provided directly by our agency
staff. When a consumer/family needs and wants a particular service
or support, the consumer/family selects from among the Contract
Providers on the ATCMHMR Network. This allows the consumer/family
to have a choice of providers. Network Contract Providers are not
guaranteed referrals because it is each consumer’s/family’s
decision as to which provider will deliver services. ATCMHMR pays
the Contract Provider directly for authorized services and supports
delivered to a consumer/family.
Family-Selected Providers do not have a contract with ATCMHMR. Rather
the consumer/family directly hires the individual they have selected
to provide the services and supports to the consumer/family. The
family generally selects the provider because the provider has experience
providing the services and supports needed by the consumer/family
or because the provider has first – hand knowledge of the
consumer/family. With Family-Selected Providers, the family is responsible
for paying the provider. ATCMHMR then reimburses the family at an
agreed upon rate for authorized services.
Can the MSO deny a Family-Select Provider?
Yes. Even though the family hires the provider, ATCMHMR must be
assured that the provider is qualified to provide the designated
services and supports in the Child and Family Plan. ATCMHMR may
deny a family selected provider if they do not meet minimum requirements,
which also includes a criminal
background check.
Potential Providers
How do I become a Contact Provider on the ATCMHMR Network?
If you or someone you know are interested in providing services
and/or supports to individuals with developmental disabilities or
to children with serious emotional disturbances and their families,
please contact the ATCMHMR Network
Contract Coordinator @483–5892. The Network
Contract Coordinator can answer your questions about how to
become a provider, can describe the types of services that can be
provided, can assist you in understanding the contracting process,
and can ensure that you receive the correct provider application.
Am I required to have a valid Texas driver’s license
or Texas Identification Card if I am not going to transport consumers
or families?
Yes, Texas law requires that a new resident obtain a Texas Driver’s
License or a Texas Identification Card within 30 days of becoming
a resident of Texas. These documents are used in the process of
checking a potential provider’s background and criminal history,
even if the provider is not going to be transporting children or
families. A driving record may also be requested from the state
of former residence if the potential provider has been in Texas
for a short period of time.
I know of someone that would make a great provider, how
do I get that information to the MSO?
You may either call or email the Contract
Manager @483-5892 and give her the potential providers information.
The Contract Manager with either have a Network Provider Application
mailed out or contact the potential provider.
If I become a contract provider, how long is the contract
good for? Is it automatically renewed?
Generally the Network Contracts are approved for a initial term
length of two years with a one - time automatic renewal of two additional
years.
Provider
If I need training on filling out an invoice or Provider
Service Delivery Record whom do I contact?
For initial invoice
and Service
Delivery Record Training, contact the Contract
Manager @483-5892. For ongoing technical assistance with questions/problems
involving the completion of these documents contact the Contract
Monitor @ 483-5891.
Request for Funds
I need to request a vendor check in a short turn around
time to assist a family in crisis, how do I get a check the same
day or in 24 hours?
You may request an emergency check for a short turn around if you
have a family in crisis. A Request
for Funds (RFF) must be filled out and signed by the appropriate
supervisor. The RFF must include the reason why the check is an
emergency. It’s always a good idea to include a copy of a
disconnect notice or delinquent statement for emergency request
for utilities. After the form is filled out and signed it must be
faxed to the External Resource
Coordinator @804-3169.
Service Definitions
What is the difference between parent coaching and case
management?
Parent coaching is a service
provided to the parent/primary care giver of a child that teaches
the parent a set of parenting skills and behavior management techniques
that will assist the parent in more effectively managing the behaviors
and symptoms of their covered child or children. The Provider “coaches”
the parent in the acquisition, development, and implementation of
these skills and strategies. Case
management is an outcome- focused, needs-based activity that
assists families in locating and accessing needed community resources
and services. Unlike a provider of parent coaching who models and
facilitates the development of effective parenting skills, the case
managers primary focus is on linkage and coordination of community
services and supports and not on the direct delivery of those services
by the Case
Management provider.
What is the difference between recreation therapy and mentoring?
Recreation therapy
is a therapeutic intervention that uses recreation and leisure activities
as the primary modality of treatment for health restoration, remediation,
and habilitation of an eligible child or family member who has a
limitation in his/her functional ability due to illness, maladaptation,
or disability. In recreation therapy specific symptoms are targeted
for reduction and /or specific functional skills are targeted for
acquisition. The therapist uses recreation and leisure activities
as a tool to achieve these clinical outcomes. The reduction of these
symptoms and/or acquisition of functional skills must require the
expertise of a professional certified in recreation therapy in order
to be achieved. Mentoring
is a community based service in which a positive adult role model
engages the covered individual in a one-to-one relationship thereby
creating a bond of trust that enables the mentor to function as
a friend, advisor, advocate, and life coach for the eligible child.
While recreation activities are typically a part of mentoring, the
mentor is not acting as “therapist” and the purpose
of participation in recreation activities is not to achieve an identified
therapeutic outcome as with recreation therapy.
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