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We have some middle manager saying that providers need to do it. Is this common?
Do you guys ever have to fill out a CALOCUS-CASII or ECSII?
- Thread starter borne_before
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I'm guessing that your state's Medicaid program requires HealthCare Quality performance measures, and this meets that requirement.
It's like when you're treating Medicare patients and you have to document that you advised them to not smoke and lose some weight. If you don't, you lose 3% per year.
(Keep in mind that I rarely see clinical patients anymore, and my knowledge base is pretty limited) .
It's like when you're treating Medicare patients and you have to document that you advised them to not smoke and lose some weight. If you don't, you lose 3% per year.
(Keep in mind that I rarely see clinical patients anymore, and my knowledge base is pretty limited) .
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This takes me back. Back at the CMHC, we did these often as tool to determine the appropriate level of care for patients on Medicaid. The higher the score, the greater the likelihood of authorization for the intensity of services (e.g., outpatient, IOP, residential and so on). You can imagine that there are absolutely no problems at all with having a bunch of burnt out master's level clinicians, with zero ulterior motives, completing these so they doubled as objective indicators of patient functioning. Probably the best the field has to offer really.
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I wanted to update everyone on the CALOCUS situation we've been dealing with at our practice.
Our "physician practice transformation manager" has been pushing for us to implement CALOCUS assessments. During our previous training in 2022, a trainer at a local agency acknowledged that "psychologists don't typically do this" and the CALOCUS trainer was "weirded out by having so many psychiatrists/psychologists in a training."
After investigating our Medicaid website and reading the official guidance documents, I found that fee-for-service (FFS) members are explicitly exempted from CALOCUS requirements. This is significant because our organization operates under the FFS model.
My Actions:
My Boss's Response: "Thank you for all the information. I will also reach out to our provider reps to confirm" and confirmed we are FFS.
It's ironic that after our organization paid for an entire three-day training in 2022 and we've faced ongoing administrative pressures about this issue, the requirement likely doesn't even apply to us. None of us have been doing the assessments anyway, which was fine until this recent renewed push.
Will update when we get final confirmation from the insurance representatives.
Wondering what my next moves should be, if I am correct? At the very least: I might request a meeting with your boss to discuss how this approach creates inefficiency, provider burnout, and potentially compromises care quality.
Our "physician practice transformation manager" has been pushing for us to implement CALOCUS assessments. During our previous training in 2022, a trainer at a local agency acknowledged that "psychologists don't typically do this" and the CALOCUS trainer was "weirded out by having so many psychiatrists/psychologists in a training."
After investigating our Medicaid website and reading the official guidance documents, I found that fee-for-service (FFS) members are explicitly exempted from CALOCUS requirements. This is significant because our organization operates under the FFS model.
My Actions:
- I've documented all the relevant policy language with screenshots
- Emailed my boss (I was recently made department head, unfortunately) with this information
- My boss is now confirming with our insurance provider representatives
My Boss's Response: "Thank you for all the information. I will also reach out to our provider reps to confirm" and confirmed we are FFS.
It's ironic that after our organization paid for an entire three-day training in 2022 and we've faced ongoing administrative pressures about this issue, the requirement likely doesn't even apply to us. None of us have been doing the assessments anyway, which was fine until this recent renewed push.
Will update when we get final confirmation from the insurance representatives.
Wondering what my next moves should be, if I am correct? At the very least: I might request a meeting with your boss to discuss how this approach creates inefficiency, provider burnout, and potentially compromises care quality.
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