FASAMS Frequently Asked Questions Service Event Data Set
Q: Does the ExpenditureOcaCode correspond to the current Modifier 4 value to indicate the OCA or is it the actual expenditure OCA once the ME has paid?
A: The ExpenditureOCACode will correspond to the actual expenditure OCA codes.
Q: Can you provide examples and further clarification around the use of the different modifier entities on the service event record?
A: Modifiers can be used on covered service codes, HCPCS codes and expenditure codes to further describe that code. For example, HCPCS modifier ‘HN’ (Bachelor’s degree level) can be used with HCPCS code ‘H0031’ (Mental health assessment, by non-physician). Modifiers used with covered services and expenditure codes will not be validated at this time. Any combination of codes and modifiers can be used. However, modifiers used with HCPCS codes will be validated. Only valid combinations will be allowed.
The modifiers that can be used with HCPCS codes will be provided in the next update to the Appendix 5 Data Code Values.
Q: Will services be validated against the Provider records based on the site ID, treatment setting, covered service?
A: No, the services will not be validated against the provider data at the time of import. It will be validated via a management report at a later time during the month. However, each covered service must be valid for the treatment setting, program area and event type.
Q: In Service Event- Chapter 6, what is the difference between the Episode Source Record Identifier and Admission Source Record Identifier (page 14)?
A: A client-specific service event (ServiceEvent) record is a child of an Admission record, and a grand-child of a provider treatment episode (ProviderTreatmentEpisode).
The admission SRI (AdmissionSourceRecordIdentifier)is used to link the client- specific service event (ServiceEvent) record back to the specific parent Admission record, and the episode SRI (EpisodeSourceRecordIdentifier) is used to link the client- specific service event (ServiceEvent) record back to the specific grand-parent ProviderTreatmentEpisode record.
Q: Can the ExpenditureOCACode differ from the reported ServiceEventExpenditureModifier? My interpretation is that the ServiceEventExpenditureModifier would be populated by the provider indicating the OCA from which they expect payment, whereas the ExpenditureOCACode would be populated by the ME reflecting the actual expenditure OCA that paid for the service (for example: a restricted OCA is exhausted so the service is paid out of an unrestricted OCA).
A: As discussed in the 8/23/2018 Strategic Meeting, the use of the Expenditure OCA was an oversight and these should have been identified as (Budget) OCAs. The change to the modify the label of the ExpenditureOCACode in FASAMS will happen after the DDI phase.
Q: Would the ServiceEventCoveredServiceModifier be used for things like reporting the medication a client is receiving under the STR grant or that a client is in the care coordination program? If not this modifier, how are these types of things to be reported?
A: Yes. In regards to the STR grant the Appendix 5 Data Code Values Chapter has modifiers (S1-S5) that relate specifically to STR.
Q: According to Chapter 6, for client-specific events, with Collection Unit of Measure of “Direct Staff Minutes” and which involve more than one individual and/or more than one staff, the total number of minutes spent by the staff should be divided by the number of individuals involved to get the number of units per client per event. If we are calculating this correctly, for services provided with one staff person, like our PSR groups, the state would essentially pay for one member in attendance. This seems not only very difficult to do (because the system would have to calculate this based on members in attendance at varying times), but is contrary to how other funders pay for services such as these. Moreover, our groups are mixed (meaning that they have different funders- some are Medicaid, others SAMH). Can you please provide some clarification or direction about the unit requirement?
A: The unit of measure requirement for each covered service is defined in the Financial Rule 65E-14.021.
Your calculation is correct for reporting the total number of minutes for client-specific service event, which is measured in direct staff hour and involves more than one client and more than one staff. For example, an outpatient service provided by two staff to a group of five individuals for 60 minutes, would require the submission of five client-specific service events (one per client). The number of service units (ServiceUnitCount) reported in each individual service event record would be 24 minutes (60 minutes X 2 staff = 120 minutes /5 clients = 24 minutes per client).
In case where the group is mixed (e.g., 2 of the 5 service events are funded by Medicaid and 3 are funded by DCF, then only the 3 service events funded by DCF would be submitted in FASAMS.
As always, DCF welcomes the ME recommendations to improve the process for reporting direct staff hours for service events involving more than one individual and/or more than one staff.