Mental Health Assessments

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Mental Health Uniform Assessments (CANS/ANSA) (MH UAs)

This section of the Clinical Management for Behavioral Health Services (CMBHS) online Help provides information about documenting the Health and Human Services Commission (HHSC) Mental Health Uniform Assessment (MH Assessment or MH UA) in CMBHS online. This information applies to both the Adult and Child Uniform Assessments.

There are five types of MH Assessments:

Crisis MH Assessment

This assessment type is selected when the client is in crisis. This assessment type is unique because it can be completed by any provider for any client at any time the client is in crisis. The crisis assessment is conducted outside of an episode of care and its use is not limited when another provider is serving the client.

Initial MH Assessment

Initial (Non-Admission) MH Assessment

This type of assessment is a sub-type of the Initial MH Assessment. This type is selected after the full Assessment is completed but, for some reason, the client will not receive services.

Update MH Assessment

The frequency with which MH Assessments must be updated is according to the level of care (LOC) and some service types.

Discharge MH Assessment

This assessment type is used only at Discharge and the number of questions vary depending on the type of Discharge. When the client has successfully completed treatment/services, the entire CANS or ANSA must be completed. If the client leaves services unexpectedly, only three fields need to be completed.

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How to Enter an MH Assessment into CMBHS

Sequence for Entry of MH UAs into CMBHS

MH UAs must be entered in to CMBHS in a certain sequence, within and between episodes of care (EOC), according to the Assessment Type. An EOC for MH services is the time between an Initial MH UA in Closed Complete status and a Discharge MH UA in Closed Complete status.
Crisis, Initial (Non-Admission), and Update MH UAs do not begin or end an EOC.
When a new MH UA of any type is created, CMBHS will display all fields either as blank or None Selected except Assessment Type, Performed By, and Document Status. More information about this is provided in the Data Fields section below.
CMBHS will not allow you to save an Update or Discharge MH UA in Closed Complete status if the Initial MH UA is in Draft or Ready for Review status. The Initial MH UA must be in Closed Complete status.
If an Update MH UA is still in Draft Status, the Update MH UA can be changed to a Discharge MH UA. The data you have entered will not be changed or deleted. Only a user at the provider that created the MH UA can Edit or Delete it.
For a planned discharge with services complete, a full MH UA, to include the CANS or ANSA, must be completed. For an unplanned discharge with services not complete, a full MH UA is not required.
Only a user at the provider entity that created the MH UA can Edit or Delete it.

Entering into CMBHS Two MH UAs with the Same Date

CMBHS determines when to allow the entry of two MH UAs with the same date, depending on the type of and status of the previous MH UA and the new type to be entered.

CMBHS will allow:

a Crisis MH UA to be entered with the same date as an existing Crisis MH UA, if there is also a Discharge MH UA in Closed Complete status. The Discharge MH UA may have any of the Discharge Reasons selected.
an Initial MH UA to be entered into CMBHS on the same date as a Crisis MH UA as long as the Crisis MH UA is in Closed Complete status.
a Discharge MH UA to be entered into CMBHS with the same date as an Initial MH UA.
The CANS/ANSA Date can be same date for an Initial MH UA and Discharge MH UA for the same client.

CMBHS will NOT allow:

a Crisis or Update MH UA to be completed on the same date if there is an Initial or Update MH UA in any status.
a Crisis MH UA to be entered if there is already a Crisis MH UA in any status on the same date.
an Initial MH UA with the same date as a Crisis MH UA in Closed Complete status.
a Discharge MH UA with the same date as an Update MH UA in any status.

Before You Start to Document an MH Assessment

Your organization must have a contract with HHSC to provide mental health (MH) services, with a managed care organization (MCO), or other agreement with HHSC.
You must be logged into a CMBHS MH service location and the Services Offered page must be setup.
You must have a role that allows documenting an MH Assessment. Click here for a list of Page Rights by Roles in CMBHS.
The person to be assessed must have a Client Profile in CMBHS with a valid Local Case Number (LCN).
You must be in the client’s CMBHS health record, at the Client Workspace, to document an MH UA.
Always verify that you have the correct client by checking the client’s name and at least one other identifier at the top of the page before you begin entering data into the MH Uniform Assessment.
A Diagnosis must have been entered into CMBHS for the client and it must be less than one-year-old.

Action Buttons on the MH Uniform Assessment

Action Buttons display in the top right and bottom right corners of the screen. The buttons that display depend on your role , location, the number of days since the last change to the document, document status, and whether it is in View or Edit mode.
When the MH Uniform Assessment is within the seven-day Edit/Delete time frame, and in EDIT mode, the following buttons will display: Save and Continue, Save, Cancel, and Spell check.
When the MH Uniform Assessment is in VIEW mode and the Document Status is Draft, Ready for Review, or Closed Complete (up to seven days after being placed in Closed Complete) the following buttons display: Edit, Close, Delete, Print, and Attachments.
When the MH Uniform Assessment is past the Edit/Delete timeframe of seven days since the last document change, the following buttons will display: Close, Print, and Attachments.

Document an MH UA in CMBHS

Login to CMBHS. CMBHS will take you to the Home page for your primary role.
Search for the individual using the Find/Add Client function on the Client Services Toolbar on the left side of your screen. If you do not locate the individual, create a new Client Profile using the New Client button found below the Search Results table.
After creating the Client Profile, or if you find your client’s Profile, CLICK on the Client Workspace button located below the Search Results.
Once you are at the Client’s Workspace, select “Assessment” from the Client Services Toolbar on the left side of your screen.
CMBHS will determine if a previous assessment exists for this individual and if so, what type. If CMBHS determines that NO previous assessments exist for this person or that the most recent assessment type is Crisis, Discharge, or Initial (Non-Admission), CMBHS will then display the appropriate version of the assessment, an Initial, or an Update. If the appropriate type is Initial, CMBHS will display an assessment with the “Assessment Type” defaulted to “Initial.”
Complete the appropriate fields of the CANS/ANSA tab beginning with the Assessment Information section. Then enter all required fields in the CANS/ANSA.
Next, CLICK on the Calculate LOC-R button. CMBHS will display the Calculated Level of Care Recommendation (LOC-R) based on the CANS/ANSA answers and the HHSC defined business rules.
Next, select Performed By and Save the document in Ready for Review status.
CMBHS will perform validation checks. If no errors are found, the document is saved in Ready for Review status. This validation check will not occur if you save the document in Draft status.
If there are errors or if you have missed a question, a message will display informing you of the problem.
Complete all the required fields in the Community Data tab; enter the Assessment Date, and Comments if needed. You may complete the Community Data Tab, now or at another time. To complete it now, CLICK on the Community Data Tab. Complete the appropriate fields in the Community Data section.
Select Performed By and Save the document in Ready for Review status.
The MH UA will now display in the Client Document List on the Client Workspace.

Sequence for Entry of MH Uniform Assessments into CMBHS

Last MH UA Type Documented	MH UA Type Default	MH UA Types Allowed
None	Initial	Initial, Crisis, Initial (Non-Admission)
Initial	Update	Update, Discharge
Update	Update	Update, Discharge
Discharge	Initial	Initial, Crisis, Initial (Non-Admission)
Crisis	Initial	Initial, Crisis, Initial (Non-Admission)
Initial (Non-Admission)	Initial	Initial, Crisis, Initial (Non-Admission)

How to Edit/Delete an MH Uniform Assessment

Only a user who created the MH UA can Edit or Delete it, with one exception; users with the role of MH Assessment Delete can delete an MH Assessment. You cannot Edit or Delete it from the administrative/parent level of your business entity .
If a client has multiple MH UAs and you want to Delete an MH UA in Closed Complete status that is not the most recently completed, you must Delete the MH UAs in reverse order. In other words, if there is an MH UA in any status that is more recent than the one you want to Delete, the most recent one must be Deleted first, then the next most recent and lastly the oldest, using the Authorization Date in the Authorization tab.
The most recent MH UA in Closed Complete can be Edited or Deleted up to seven days from the date it was last changed. After seven days, the Edit and Delete buttons no longer display. After seven days, a Discharge MH UA may only be edited by HHSC Administrators and/or HHSC System Support, if it is the most recent MH UA for the person.

Exception: If the Authorization Date is more than seven days in the future, then the MH UA can be edited or deleted up to the future "Authorization Date."

Printing an MH Uniform Assessment

You can print the MH Uniform Assessment (MH UA) in a printer friendly format after it has been Saved in any status, by selecting the Print button.
The printed document does not display the tab headers. The MH UA sections print one after another whether the questions have been answered or not.
When the MH UA is printed in Closed Complete status, a "Certification Signature Block" section prints on the last page:

"As a Licensed Professional of Healing Arts (LPHA), I verify that the services authorized in the Authorized Level of Care (LOC-A) section above are medically necessary and I concur with the plan of care."

Signature of LPHA
LPHA Credentials
Date

Data Fields Common to All MH Uniform Assessment Types

CANS/ANSA Tab

Assessment Number (System Generated)

Will be blank when the assessment is first opened.
CMBHS displays a randomly selected number after the document has been saved.

Assessment Type (System Generated)

One or more Assessment types will display in the dropdown list. CMBHS limits the types that display according to the rules established by HHSC.
Select the appropriate type.

Assessment Date (Required)

The Assessment Date can be up to 30 days in the past. A future date cannot be entered.
If the client has one or more MH UA for this episode of care in any document status, then the Assessment Date must be after the Assessment Date on the most recent of those MH UAs.

CANS/ANSA Date (Required)

This field defaults to blank.
The CANS/ANSA Date must reflect the date that the CANS/ANSA was performed with the client. It cannot be a future date, but it can be dated up to 30 days in the past.
The CANS/ANSA Date must be on or after the previous MH UA's Authorization Date. If the date does not meet this rule, an error message will display.
The date can be entered as eight (8) numbers mmddyyyy or in the mm/dd/yyyy format.

TCOOMMI Consumer (Optional)

If the client is a TCOOMMI funded consumer, CLICK in the check box.

Calculated Level of Care Recommendation (LOC-R) (Required)

Select this button to Calculate a TRR LOC-R.

Performed By (Required)

Performed By displays the name of the person who administered the CANS/ANSA to the client.

Notes (Optional)

The Notes field is unique to each tab. CMBHS will display a history of the Notes text box from one document status to another with the user name, date, and time stamp, labeled Prior Notes .

Document Status (Required)

The following Document Statuses display in the dropdown list:

Draft – This is the default document status when a new MH UA is opened from the Client Services Toolbar on the left side of the page. When saved in this status, CMBHS does not validate any fields. When an MH UA is saved in this status, it can be deleted.

Ready for Review – This document status validates the data in all the tabs of the MH UA except the Authorization tab. If data is entered in the Authorization tab, then CMBHS will validate all the data in all the tabs.

Closed Complete – Validates all the data in all the MH UA tabs. All required fields must be completed to Save the document in this status.

CAUTION: MH Assessors should always save the MH UA in Ready for Review status when they are finished entering information into the document. Ready for Review indicates to CMBHS that the MH UA is ready to be sent to the MH Approver for Authorization. Exception: Discharge Assessments should be placed in Closed Complete status by the MH Assessor, as they do not require Authorization.

Document Status Date (System Generated)

CMBHS will display the date that the Document Status was saved.

Community Data Tab

Community Data Date

Defaults to blank. Enter as eight (8) numbers mmddyyyy or in the mm/dd/yyyy format.
Must be within 30 days before or after the CANS/ANSA Assessment Date . An error message will display if the rule is not met.
The Community Data Date cannot be a future date. The Community Data Date cannot be more than 30 days before the Authorization Date. An error message will display if the rule is not met.

Notes (Optional)

The Notes field is unique to each tab. CMBHS will display a history of the Notes text box from one document status to another with the user name, date and time stamp, with the label of Prior Notes.

Comments (Optional)

The “Comments” textbox will display on each tab. The history of the Comments from one document status to another with user name, date and time stamp, displays with the label of “Prior Comments.”

Document Status (Required)

The following Document Statuses display in the dropdown list:

Draft – This is the default document status when a new MH UA is opened from Client Services Toolbar on the left side of the page. When saved in this status, CMBHS does not validate any fields. When an MH UA is saved in this status, it can be deleted.

CAUTION: MH Assessors should always save the MH UA in Ready for Review status when they are finished entering information into the document. Ready for Review indicates to CMBHS that the MH UA is ready to be sent to the MH Approver for Authorization. Exception: Discharge Assessments should be placed in Closed Complete status as they do not require Authorization.

Clinical Rating Scales Tab

The Clinical Rating Scales are required only for the Adult MH Assessment, and only for the Initial, and Update Assessments.

No Data Fields are Common to all assessment types.

Authorization Tab

The authorization tab is only used for Crisis, Initial, and Update Assessments.

Document Status (Required)

When an assessment has been completed by the clinician and placed in Ready for Review, it now displays on the Authorization List.
An MH Approver at an MH UM location can go to the Authorization List, select the client record, and enter the authorization information.
When complete, the only document status that displays in the dropdown list is Closed Complete.
When selected, this document status validates the data in the Authorization tab. All required fields must be completed to Save the document in this status.

For HCBS-AMH Program, staff who have been assigned as ‘HCBS-AMH Referral Specialist’ role on the Provider Locations would be displayed in ‘Authorized By’ drop-down on ‘Authorization’ tab.

Navigation details: In order to view drop-down values (names of HCBS-AMH Referral Specialist), the user have to save the ‘MH Assessment’ in draft status. When the document is in draft status, then click on ‘Edit’ control button on the screen and then the system would display the names in the drop-down. Select the name and then save the MH Assessment in ‘Closed Complete’ status.

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Discharge MH Uniform Assessment

To document a Discharge Mental Health Uniform Assessment (MH UA) in CMBHS, go to the Client Workspace for the client to be discharged. From the Client Services Toolbar on the left side of the page, select Assessment.

Once the MH Assessment document has opened, from the Assessment Type dropdown list, select Discharge.

If the Assessment Type dropdown list does not include Discharge, do the following:

Look on the Client Workspace, in the Client Document List, for the most recently completed MH Uniform Assessment (MH UA).
What is the MH UA type? If it is any type other than an Initial or Update, a Discharge MH UA cannot be documented. Create the missing MH UA and place it in Closed Complete. If the most recent MH Uniform Assessment is an Update and it is still within seven days of the last change to that MH UA, the Update can be converted to a Discharge Assessment. Select the Edit button and change the Assessment Type from Update to Discharge. In some situations, it may be appropriate to delete the MH UA.
What is the MH UA document status? If the MH UA is not in Closed Complete Status, complete the document and put it in Closed Complete.
What if you do not find an MH UA in Draft or Ready for Review in the Client Workspace? A CMBHS user with the “View LMHA Network” privilege must look in the Client Workspace to see if there is an MH UA not in Closed Complete somewhere in the system. If you do not find a MH UA in Draft or Ready for Review in the Client Workspace, call the HHSC CMBHS Help Line at 1-866-806-7806.

If, while trying to document a Discharge MH UA, you receive the following error message “ A new Assessment cannot be created because there is an existing Initial Assessment that is not in Closed Complete status,” determine which provider created the most recent Initial MH UA so you can contact the provider and request that they discharge the client.

To do this, go to the client’s Client Workspace. Put a check in the check box labeled “Show All Columns,” located above the list of client documents. The columns will expand to display the name of the provider and location where each document was created and the user name. If only MH UAs from your business entity display in the list, you will need to be a CMBHS user with the “View LMHA Network” role.
Contact the provider and request that they move the MH UA through their process to Closed Complete status. If the provider is a batching provider, it may take up to 48 hours for the MH UA in Closed Complete to display in CMBHS. If they make the change online in CMBHS, the change will display immediately. After the provider places the document in Closed Complete, you may document a Discharge MH UA.

Discharge Date (Required)

The Discharge Date can be dated up to 30 days in the past from today's date.
The Discharge Date on the Discharge MH UA can be future dated up to 30 days from today's date regardless of the Discharge Reason. Exception: When Discharge Reason is “Incarceration,” in ANSA, or “Texas Juvenile Justice Department (TJJD),” in CANS, the Discharge Date cannot be future dated.
The Discharge Date may be on or after the previous MH UA's Authorization Date.
Enter the Discharge Date as eight (8) numbers mmddyyyy or in the mm/dd/yyyy format.

Discharge Reason (Required)

Select the reason for the discharge from the dropdown list.

The Discharge Reason selected determines how much of the Assessment must be completed before you can save it in Closed Complete.

LOC Service Complete – represents a planned discharge, with services complete. Requires completion of a full MH UA. Discharge Assessments can be placed in Closed Complete status by the MH Assessor as they do not require Authorization.

All Other Discharge Reasons – represent an unplanned discharge with services not complete, therefore completion of a full MH UA is not required. Discharge Assessments can be placed in Closed Complete status by the MH Assessor as they do not require Authorization.

Referred to: (Required)

The Discharge Referral represents the primary organization where the client is being referred for mental health services or other services, after discharge.
Select the discharge referral from the dropdown list.

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Auto Closure of MH Uniform Assessments

CMBHS automatically creates and saves, in Closed Complete status, a Discharge MH Uniform Assessment on the 31st day after the "End Date" of the MH Authorization, if a new MH UA, Authorization, or Discharge is not completed.

For Auto-Closed Discharge Assessments the following data fields are completed by CMBHS with this information:

Discharge Reason: defaults to: Auto – Closed.

Referred To: defaults to: Unknown

Discharge Date: defaults to one day after the End Date of the last MH UA Authorization.

User Name: a User Name does not display in the Audit Information fields at the bottom of the page.

Created on Date: displays the same date as the Discharge Date.

Rules for Crisis Assessments

Online Data Entry

The MH Assessor must complete the full ANSA and press the “Calculate LOC-R” button. This will result in a LOC-R=9 if the individual does not have an active diagnosis.

In order to authorize LOC-0, the clinician must change the assessment type to “Crisis,” and push the calculate button. The system will set the LOC-R to 0.

The system will allow the assessment to be authorized and saved in Closed Complete status without requiring the clinician to complete the clinical rating scales tab or community data tab. No diagnosis is required.

Batch Data Exchange

Once the clinician finishes the assessment, they must send the assessment type as “Crisis” and the LOC-R = 0. Do not include an LOC-D.

Send the LOC-A = 0. If the individual does not meet the crisis threshold, then all required ANSA fields must be populated.