Mobile Crisis - 2023 CalMHSA (2024)

This protocol is now live. It has been updated from the draft. The full red-line changes can be found in this document.

The Step-by-Step instructions for all clinical workflows and documents can be found on the Clinical Documentation page under the Mobile Crisis section. Links are also found below.

Initial Dispatch Call and Screening:

1. When a call comes into the Mobile Crisis Dispatch Phone Line, this call will be documented on the Inquiry screen.
   1. Staff should designate the Mobile Crisis program in the “Inquiry Handled By” section for better tracking.
   2. Caller and Client information are both entered in the General tab. Make sure to link or create a client if the person in crisis is not currently a client in SmartCare.
   3. Make sure to enter the date AND time of the call, as well as getting a call-back number in case the call is disconnected.
2. Click the “Crisis” checkbox at the top of the General tab.
3. In the Crisis tab, enter the Crisis Line program and select Mobile Crisis Dispatch Screening as the procedure code. This will bring up the Mobile Crisis Dispatch Screening note.
4. Complete the Mobile Crisis Dispatch Screening in the note section of the Crisis tab.
   1. Alerts will pop-up as you complete the screening based on the answers you provide. Take the steps indicated in the alerts, which may include contacting 911 and/or law enforcement.
5. Add the end date and time and click Save.
6. In the Crisis Tab, click on the link to the Service Note.
   1. This will take you to a service note with all of your information already entered.
   2. DO NOT change any service information in the service tab that has been pulled forward.
   3. Complete any empty fields in the service tab.
   4. Review the Mobile Crisis Dispatch Screening note in the Note tab and then click Sign.
7. Enroll the client in the Mobile Crisis program by going to “Client Programs (Client)”.

Mobile Crisis Team Dispatched Encounter

1. Respond to the crisis. Note the time you received the dispatch call and the time you arrived on the scene.
2. Complete the Mobile Crisis Assessment and determine the appropriate next steps.
   1. If you end up transporting the client to a treatment facility note the time spent during the transportation, as well as the miles driven
   2. If you accompany a client who is being transported to a treatment facility, note the time spent during the transportation.
3. At the completion of the encounter, note the time you ended and the time you spent returning to your main office.
4. Upon returningto the office, upload or complete the Mobile Crisis Assessment.
   1. If you completed the assessment in the field on paper, you can scan in your assessment using SmartCare’s scanning/uploading function. Select Mobile Crisis Assessment (Scanned) as your document type.
5. Create a New Service for the client. Enter the date and time you were dispatched as the date of this service and the start time for this service.
   1. Enter your travel time (the time you spent traveling to and from the scene of the crisis)
   2. Enter your service time (the time you arrived on the scene to the time you ended the encounter)
6. Select Mobile Crisis as your program.
7. Select Mobile Crisis Encounter as your procedure code.
8. Select Mobile Unit as your location if both Mobile Team members were present onsite. Select Mobile Unit with Telehealth as your location if only one Mobile Team member was onsite and the other was telehealth. The actual address/location of the crisis will be documented in the note itself.
   1. Note that you cannot bill for a Mobile Crisis encounter at certain locations, such as inpatient hospitals, emergency departments, or residential treatment facilities. If done in a non-billable location, select Crisis Intervention as the procedure code instead and document as you would a regular crisis intervention service.
9. Complete the Mobile Crisis Encounter note. This note includes all necessary tracking information, including timeliness tracking and a full crisis assessment.
   1. Document all interventions provided, including any warm hand-offs or coordination with agencies.
   2. Document any problems you identified during the encounter on the Problem List.Note: The Problem List is not currently embedded in the Mobile Crisis Service Note. Staff will have to enter problems via the standalone problem list.
10. Navigate to the Billing Diagnosis tab and add an ICD-10 code to the service.
11. Sign the note to complete the service.
12. If you transported the client, create a new service note using the procedure code “Transportation Mileage” to document the mileage driven. Enter the number of miles, rounded to the nearest whole mile, in the Service Time field. No note is required for this service.
13. If you transported the client, or accompanied the client while they were being transported to a treatment facility, create a new service note using the procedure code “Transportation, Staff Time”. No note is required for this service.

Mobile Crisis Encounter Follow-Up

1. Create a New Service for the client. Enter the date and time you completed your follow-up, or follow-up attempt.
2. Select Mobile Crisis as your program.
3. Select the appropriate procedure code.
   1. If your county is tracking attempted versus successful follow-ups, use “Non-Billable Attempted Contact” for an attempt that was unsuccessful and “Brief Contact” for an attempt that was successful.
   2. If your county is NOT tracking attempted versus successful follow-ups, use “Mobile Crisis Follow Up” regardless of whether the attempt was successful or not.
4. Document your follow-up, including any interventions provided. If you were not able to contact the person for a follow-up, indicate your attempts to contact the client.
5. Once you have successfully completed your follow-up, navigate to the Disposition tab and indicate that you are closing this client to the Mobile Crisis program. This will automatically discharge the client from this program. If this is not available to you, you can discharge the client from the Mobile Crisis program through Client Programs.

Programs

You will need a Mobile Crisis Program.

• On the general tab, in the program “Type” field, you can enter anything except “no episode”.
• On the rules tab, make sure the following fields are setup:
  • Procedures: (these have already been created by CalMHSA and should only need to be associated with this program)
    • Mobile Crisis Encounter
    • Transportation Mileage
    • Transportation, Staff Time
    • Mobile Crisis Follow Up*
    • Brief Contact Note*
    • Non-Billable Attempted Contact*

*In order to track the required follow-ups, you will need to include either “Mobile Crisis Follow Up” or “Brief Contact” AND “Non-Billable Attempted Contact”. If you want to track the difference between when follow-up was successful and when it was unsuccessful, we recommend using #5 and #6 jointly. If you do not want to track attempted v. successful, you may use #4 only. DHCS does not currently have the regular reporting requirements published yet.

• Locations: (these have already been created by CalMHSA and should only need to be associated with this program)
  • Mobile Unit
  • Mobile Unit with Telehealth

You will also need a Mobile Crisis Dispatch no-episode program. This can be the same as your current Crisis Line no-episode program, or it can be separate. Make sure the procedure code “Mobile Crisis Dispatch Screening” is associated to this program. When setting up this program, make sure the program “Type” is “no episode.” This allows the use of the Mobile Crisis Dispatch Screening tool in the Inquiry screen.

Global Codes

XMobileCrisisLoc is a global code that will populate into the Mobile Crisis Progress Note. This is a global code that counties will populate with areas of their county. This is to help counties better track where crises are occurring without having to use specific addresses. Follow instructions on the System Administration Document page under the section Global Codes to make edits to this global code. Update 6/6/24: In the External Code 1 field of each global code, enter either “Rural” or “Urban”. This will allow us to track response times.

Example:

• Downtown Sacramento
• East County
• Arden Way
• Oldtown Sacramento

In CalMHSA Prod, we have a single value in this global code, “County”. It’s expected that counties will deactivate this option and create their own.

Procedure Codes and Billing

CalMHSA will be creating the following Mobile Crisis procedure codes:

1. Mobile Crisis Dispatch Screening
   • This will use a new custom progress note type based on the DHCS-created Mobile Crisis Dispatch Screening Tool
   • This procedure code should be added to your Crisis Line “no-episode” program that will be receiving your dispatch requests.
2. Mobile Crisis Encounter
   • This will use a new custom progress note type based on the requirements outlined in BHIN-23-025.
   • Some fields will include logic that impacts billing. For example, if the location of the 2^nd provider is marked as “telehealth” then the GT modifier will be added to the claim.
   • This will also include tracking of involuntary holds, per request of counties.
   • The service tab will allow tracking of time spent on encounters, but the claim will bill the same encounter rate regardless of the time documented.
3. Mobile Crisis Follow-Up
   • This will use the Narrative note type
   • This will be used to help track the required follow-up by Mobile Crisis teams that are required as part of the encounter and cannot be billed separately from that encounter.

All licenses/degrees will be allowed to use all of the procedure codes above.

When one of the mobile crisis team members is engaging via telehealth, the GT modifier needs to be added. In these scenarios, the provider should use location “Mobile Unit with Telehealth”. You will need to set up your procedure rates to add the modifier in this scenario, as every county has different rates.

The actual location of the beneficiary will be documented in the progress note. CalMHSA recommends that “Mobile Unit” and “Mobile Unit with Telehealth” be the only Locations associated with your Mobile Crisis Program to avoid billing errors. Both of these locations point to “15 – Mobile Unit” for the place of service. CalMHSA also recommends that Mobile Crisis staff be trained on the limitations of billing Mobile Crisis Encounters, as there are some locations that are lock-outs, including emergency departments, inpatient hospitals, and residential treatment facilities.

Administrative Time

To track administrative time related to implementing the Mobile Crisis program, we will be using Calendar Events. The following have been added to the Calendar Events global code:

1. Mobile Crisis – Coordination
2. Mobile Crisis – Dispatch Activities
3. Mobile Crisis – Data Reporting
4. Mobile Crisis – Implementation Planning

CalMHSA will be creating a report that will aggregate the time spent on these activities in order to bill DHCS through the Administrative Claiming Process.

Clinical Documents

CalMHSA will be adding the following Mobile Crisis documents to SmartCare:

1. Mobile Crisis Dispatch Screening
   • This will be a type of progress note that will be associated with the procedure code “Mobile Crisis Dispatch Screening”.
   • This is modeled on the DHCS-created MTAC Dispatch Screening Tool.
2. Mobile Crisis Assessment
   • This will be a standalone document.
   • This is modeled on the DHCS-created MTAC Crisis Assessment Tool.
3. Mobile Crisis Assessment (scanned)
   • This will be a label for a scanned document, in case the mobile crisis team completes a document on paper in the field. If a mobile crisis assessment is scanned into SmartCare, the SmartCare version doesn’t need to be completed.
4. Mobile Crisis Encounter
   • This will be a type of progress note that will be associated with the procedure code “Mobile Crisis Encounter”.
   • This includes tracking
5. Mobile Crisis Safety Plan
   • This will be a standalone document.
   • This is modeled on the DHCS-created MTAC Safety Plan Tool.
6. Mobile Crisis Safety Plan (scanned)
   • This will be a label for a scanned document, in case the mobile crisis team completes a document on paper in the field. If a mobile crisis safety plan is scanned into SmartCare, the SmartCare version doesn’t need to be completed.

Update 1/5/24

Clarification:

We have had counties asking us where the “Provider 2” and “Supervisor/LPHA Consulted (if applicable):” fields pull from.

Provider 2 – This is a list of staff that have this program associated with them in Staff Details.

Supervisor/LPHA Consulted (if applicable) – This is a list of staff with one of the following licenses/degrees in Staff Details. This list was based on the Mobile Crisis BHIN.

• MFT Marriage and Family Therapist (25200)
• LPCC Licensed Professional Clinical Counselor (25201)
• LCSW Licensed Clinical Social Worker (25198)
• MD Medical Doctor (25204)
• DO Doctor of Osteopathy (25781)
• Licensed Psychiatrist (25661)
• PhD Doctor of Philosophy,Clinical Psychologist (25237)
• PsyD Doctor of Psychology,Clinical Psychologist (25659)
• Psy Psychologist (Waivered) (25242)
• NP Nurse Practitioner (25208)
• PA Physician Assistant (25210)
• RN Registered Nurse (25209)
• LVN Licensed Vocational Nurse (25199)
• PT Psychiatric Technician (25660)
• Registered Pharmacist or Advanced Practice Pharmacist (25241)
• AMFT Associate Marriage and Family Therapist (11134497)
• APCC Associate Professional Clinical Counselor (25240)
• ASW Associate Social Worker (25663)
• Medical Resident (11136312)
• Psych Associate/RPS (11136343)