Daily Living Activities (©DLA-20) Questions and Answers

Daily Living Activities (©DLA-20)Questions and AnswersQ: Can a provider bill TCM for the time it takes to administer the DLA20, if a child is inTCM as opposed to CPR?A: You are able to bill TCM for the administration of the DLA20. The samerequirements for billing the DLA20 to community support apply to the billing of theDLA20 to TCM. The actual time for the administration of the DLA20 can be billed up to30 minutes.Q: The DLA-20 is supposed to be done at discharge from rehab by a QMHP. The DLAis also supposed be done based on contact within the last 30 days with the client. AQMHP will rarely have seen/talked with the client in the last 30 days. Even for planneddischarges, the CSS is the one that has made regular contact. In cases where the Qhasn’t had contact in the 30 days prior to discharge, is it acceptable for the CSS tocomplete the DLA?A: YesQ: Is it required that a DLA be completed when transferring a client from Rehab toMaintenance?A: A DLA is not required to be completed when transferring a client between levels,though you may decide that it would be beneficial to complete a DLA at that time.Q: Also, when completing a DLA at the time of transfer from Rehab to Maintenance,would we have Rehab staff complete a transfer DLA and then Maintenance staffcomplete an admitting DLA?A: No, one DLA would sufficeQ: You indicated that CSSs do not need to do a DLA at the time of the annualassessment as the Q will be doing it. Would it be okay for us to have our CSSs alsocomplete one and bill for it so that we can have a measure of interrater reliability?A: You can complete a second DLA at the same point in time, but should not bill for it.09/26/13

Daily Living Activities (©DLA-20)Questions and AnswersQ: Are we to enter GAF or mGAF scores (from DLA 20) into the CPS status reports?A: Yes, there is a box on the status report where the GAF is entered. You can use GAFor mGAF.Q: Is it the DLA score we use or the mGAF score that is derived from the DLA score?A: The estimated mGAF score is used.Q: Will the quarterly DLA assessment be required on people in maintenance level ofCPRC?A: Quarterly assessments of the DLA-20 are only required in the maintenance level ifthe consumer is also residing in an RCF and requires a quarterly treatment plan review.Consumers in the maintenance level that do not require a quarterly treatment planreview do not require a DLA-20 on a quarterly basis.Q: Someone sent me “Summary of Assessment Workshop to date May 14, 2013”. Itsays DLA 20 score of 40 or below is required to determine eligibility to the CPRCprogram. I thought it was 50 or below.A: This information is a reference to work we are doing for the adult DLA-20 score andCPR eligibility for adults. The adult work is still in development and has not beenimplemented until an official policy memo is issued by the DBH. You are correct that thescore for children and youth is 50 and there is already current policy out on that.Q: Is the billing for DLA 20 part of the bundle in the intake and annual (so only QMHPcan do it and billed in the bundle rate)? But CSS can bill H0036 during the quarterlyDLA 20? Or can the CSS also bill one at the time of intake and annual time for theQMHP and bill H0036 for it?A: At the time of an intake evaluation, annual evaluation and discharge the QMHPcompletes the DLA-20 and bills to Behavioral Health Assessment. The CSS maycomplete the DLA-20 at the time of a quarterly treatment plan review and billCommunity Support. See sections 4 and 5 of the policy bulletin.09/26/13

Daily Living Activities (©DLA-20)Questions and AnswersQ: Do all rehab clients need to have a DLA completed in July even if there is not aninitial/annual/treatment plan revision due? If so, does the first administration (forestablished rehab clients) have to be by a QMHP or would a CSS suffice?A: All rehab clients do not need to have a DLA completed in July. Complete a DLA oneach client’s particular schedule for initial/annual/treatment plan reviews. If the DLA iscompleted initially or annually a QMHP would complete, a CSS may complete with aquarterly review – even if the first DLA completed for that client is with a quarterlyreview.Q: RE: 3.5 If the mGAF score from the DLA is different from the psychiatrist’s GAFscore, which do we use?A: Please consult with the psychiatrist for agreement with the scoring. This new agreedupon mGAF score then becomes the current score. Hopefully the psychiatrist has alsoreceived training on administration of the DLA and will realize that scores may changebased on use of this standardized instrument.Q: RE: 3.5 Is the mGAF score entered into CIMOR at each administration of the DLA oronly initial/annual/discharge?A: If the mGAF score changes after administration of the DLA at any point in time, thenew score would be entered in CIMOR, as you would with a change in diagnosis on anyother AXIS.Q: RE: 5.1, 5.2, and 5.3 – Does the DLA have to be completed in the presence of aclient to bill for it?A: NoQ: If a client has disengaged from services and we are working on reengagement, myassumption is that we would not do a DLA as we would not have data from the previous30 days. Is this accurate?A: Correct, but be sure to document in the record the reason for not completing theDLA.09/26/13

Daily Living Activities (©DLA-20)Questions and AnswersQ: What if it is the discharge DLA and we have not had contact with the client in theprevious 30 days?A: The DLA is a rating for the person over the past 30 days. If you provided servicesduring the 30 days prior to discharge, complete a DLA at discharge. If the person didnot receive services during the most recent 30 day period then refer to the ModifiedGAF score and criteria (mGAF) and assign a score.Q: If the modified GAF score has decimal points, do we put in the decimals/roundup/round down?A: Do not use decimal point. Round down. We believe this is in line with Willa’sinstruction to use the lower score when in doubt.Q: To clarify-We are required to implement the DLA for Individuals in the REHABprogram but not the maintenance program. Is that correct?A: The DLA would be used for all clients enrolled in CPRC including both maintenanceand rehab levels of care.Q: My assumption is that DLAs would be completed for clients in the Maintenance-Program at Admission/Annual/Discharge only, as quarterly treatment plan reviews arenot done on these clients unless they are a RCF client and have a quarter treatmentplan review. Is this correct?A: Yes, that is correct.Q: For Maintenance clients in RCFs, would we need to complete a dla20 with thequarterly treatment plan review?A: Yes, that is correct.09/26/13

Daily Living Activities (©DLA-20)Questions and AnswersQ: Are we supposed to begin tracking DLA 20 scores for DMH?A: Yes, but not necessarily for DMH. DLA information helps to target interventions forindividuals based on the areas they are assessed to need help. Each time a DLAscore is entered into CIMOR the previous score becomes a “history” score so is trackedin CIMOR. Additionally, the score sheet for the DLA shows multiple scores for eachitem across time, so changes (or lack of change) for an individual will be evident. It ishelpful to compare scores across time so you know if service interventions are effectiveor if they need to be revised.Q: How do we get discharge DLA 20 scores from clients who drift out of services? Arewe supposed to do DLA 20 assessments with clients or can it be for the last knowncontact and how they were doing at that time?A: The DLA is a rating for the person over the past 30 days. If you provided servicesduring the 30 days prior to discharge, complete a DLA at discharge. If the person didnot receive services during the most recent 30 day period then refer to the ModifiedGAF score and criteria (mGAF) and assign a score.Q: How are other agencies managing the quarterly review of the DLA (in hard copyversion)? Do they keep working off of the one DLA score sheet or continually fill out anew score sheet at each quarterly review and annual?A: We are recommending that, when using a paper form, the same form is used acrosstime, filling all the score areas on the right of the form, before moving to another form.Q: One question that came up is related to clients that are currently in CPRP servicesand when we would do the first DLA on them. Do we do it in conjunction with their firstquarterly review that occurs after July 1? If so, would it be marked as an initial or areview? If we need to mark it as initial, then I assume a Q would need to be the onedoing it? Or, do we just do the DLA on clients as they are being admitted to CPR (whichwe have implemented) and the first time they are due for their annual review after 7/1?A: For clients already in CPR, do the DLA at the next appropriate time for that client. Ifit is a quarterly review it may be the first (initial) DLA for that client but can still becompleted by a CSS because it is associated with the quarterly treatment plan review.09/26/13

Daily Living Activities (©DLA-20)Questions and AnswersIf you choose to have the QMHP do the first DLA on folks it’s fine, but not required. AQMHP would complete the DLA when associated with an initial or annual psychosocialassessment.Q: Would we need to put the gaf/mgaf on the DLA or just in the discharge summary?A: Both. The DLA ends with a GAF/mGAF score. The discharge summary calls fordiagnosis, which includes Axis V.Q: We often do intakes where the clients aren’t put into the maintenance or rehabprograms until after they see the psychiatrist and have an appropriate diagnosis. Forthese clients, would we wait to do the DLA until we were admitting them to themaintenance or rehab program, not when they are first a client at the agency?A: Yes, that would be appropriate - upon admission to the CPR program.Q: Are we required to do the DLA every quarter, and have it signed by a Q?A: The CSS can complete the DLA-20 at quarterly reviews and those do not need to besigned by the QMHP. The QMHP completes the DLA-20 at intake, annually anddischarge. See sections 4 and 5 of the attached Community Treatment Bulletin.Q: I was reviewing the new memo that came out for the adult procedure for the DLAseffective 7/1/13 and I thought I should review the youth memo to make sure we are stilldoing everything correctly on that side. After reviewing the youth memo, I have a coupleof questions:1) Do we need to do a separate progress note for the youth DLA as it describes inthe adult memo? We currently have the DLA in our EMR system and we add thecode, start time/end time, etc. to the form itself. If we need to do a separate note,we can do that. I just didn’t see it in the youth memo.2) Is there an exclusion for billing for completing the DLA if the youth is currently inIntensive CPR? I saw there was an exclusion for the DLA on the adult side if theyare in Intensive CPR Non-residential.A: You do not need to do a separate progress note for the youth as long as the starttime and end time are on the form and also an indication of the staff person who09/26/13

Daily Living Activities (©DLA-20)Questions and Answerscompleted the DLA. For billing purposes, we should be able to see from the form thelength of time that it took to complete.In regards to the exclusion of billing if the child is in the Intensive Level H0037, youcannot bill for the DLA. Community support is built into the intensive rate.Q: Can you tell me what the expectation regarding completion of a quarterly DLA is forsomeone who is on inactive status?A: The DLA is a rating for the person over the past 30 days. If you provided servicesduring the 30 days, complete a DLA. If the person did not receive services during themost recent 30 day period then you would not complete a DLA, but be sure to documentin the record the reason for not completing the DLA.Q: For months where there is an annual assessment completed by a QMHP and aquarterly review completed by a CSS, would we have both of them complete and bill fora DLA-20?A: No, at the time of the annual assessment and new treatment plan there isn’t aquarterly review of the treatment plan. The new treatment plan takes the place of that.The QMHP would complete the DLA at the time of the annual paperwork. We expect atreatment plan (for example in January) and then 3 quarterly reviews each year (in thisexample April, July, October).Q: We were discussing the DLA requirement at discharge. Unfortunately we had aclient pass away so the supervisor asked about completing a DLA. Ultimately thequestion is do we need to complete the DLA on somebody deceased?A: We recommend you complete the DLA at discharge when the reason for discharge isthat the client passed away. For data purposes it will be important for examine DLAscores across time and perhaps even related to reasons for discharge. Follow thegeneral guidelines for whether to complete a DLA at discharge. If services wereprovided within the most recent period of time before discharge, then a DLA would becompleted. If the person did not receive services during the most recent 30 day periodthen refer to the Modified GAF score and criteria (mGAF) and assign a score.09/26/13

Daily Living Activities (©DLA-20)Questions and AnswersQ: In the DMH bulletin in December regarding implementation of the DLA 20, at thebottom of the first page of the bulletin, it indicates that we submit the mGAF score inCIMOR within 30 days of the admission date. Can you tell me if we are to enter allquarterly, annual and discharge scores into CIMOR as well?A: Yes. Anytime the score changes it should be updated in CIMOR.Q: If a person (child or adult) is in Targeted Case Management, can we bill up to 2 unitsof targeted case management for completing the DLA?A: Yes, if the targeted case manager is administering the DLA they would bill targetedcase management. If the QMHP is administering the DLA, bill the POS code forBehavioral Health Assessment.09/26/13