Financial and Services Accountability Management System – FASAMS

FAQs - Treatment Episode Data Set Questions

Q: A crosswalk is needed for SAMHIS to FASAMS Discharge Codes.

A:

Crosswalk for SAMHIS to FASAMS Discharge Codes"

FASAMS Code

FASAMS Discharge Reasons

SAMHIS SA Discharge Reason Codes

 SAMHIS MH Discharge Reason Codes

1

Successfully completed Treatment

[01] Completed Episode of Care - No Substance use
[10] Completed Non-Treatment Service(s)

[01] Completed Episode of Care 

2

Dropped out of treatment (lost contact, administrative discharge, left against medical advice, eloped, failed to return from leave, and individual choice)

[15] Left Voluntarily Before Completing Treatment
[16] Administrative Discharge (Initiated by the agency)

[15] Left Voluntarily Before Completing Treatment
[16] Administrative Discharge (Initiated by the agency)

3

Terminated by facility

[06] Non-Compliant with Agency’s Rules

[06] Non-Compliant with Agency’s Rules

4

Successfully completed Transfer to another treatment program or facility

[02] Completed Treatment - Some Substance use (some impairment)

 

5

Incarcerated or released by or to courts

[08] Incarcerated

[08] Incarcerated

6

Death

[09] Died

[09] Died

7

Other (includes aging out of the children's MH system, extended placement (conditional release), and all other reasons)


[11] Did Not Complete Non-Treatment Service(s)
[07] Left before completing treatment (Involuntary)
[17] Agency Closed with no Referral

[07] Left before completing treatment (Involuntary)
[17] Agency Closed with no Referral

14

Transferred to another treatment program or facility but individual is no show or transfer not successfully completed

 

 

24

Successfully completed Transfer to another treatment program or facility that is not in the SSA or SMHA reporting system

[13] Referred Outside Of Agency -  Episode Of Care Completed
[14] Referred Outside of Agency –  Episode Of Care Not Completed

[13] Referred Outside Of Agency -  Episode Of Care Completed
[14] Referred Outside of Agency –  Episode Of Care Not Completed

34

Discharged temporarily to an acute medical facility for medical services (MH only)

 

 

96

Not applicable

 

 

97

Unknown

 

 

 

Q: For some of the child nodes there seems to be no indication of a date the information was recorded nor a maximum number of occurrences.

For example, if multiple records for stable housing were submitted under the same performance measure outcome node how would we be able to identify which record for stable housing is newer?

A: Each database table records the date a record is created and last updated. All of the subsections under the performance outcome measure, except for SubstanceUseDisorders only expect and will ultimately allow 1 occurrence.

Q: What provider site ID would be used for in-home on-site service episodes utilize?

A: Use the provider site associated with the staff member who provided the in-home service.

Q: Will the DLA-20 be added to the outcome measures in the Treatment Episode dataset?

A: Yes. We will be adding the DLA-20 and possibly other evaluation tools.

Q: How do you report Treatment Episode data for a client who is receiving services in multiple settings simultaneously? (For example: Day Treatment and MAT or Residential and HIV Intervention)

a. Q: Do you do a transfer admission to each treatment setting?

The short answer is YES. There are eight mutually exclusive Treatment Settings, each comprising various covered services, as specified in Appendix 5. For example, Day Treatment is a covered service under treatment setting “06 for Ambulatory Intensive Outpatient”. Residential is a covered service under treatment setting “05 for Rehabilitation/Residential Long-term”. Intervention is a covered service under treatment setting “07 for Ambulatory non-Intensive Outpatient”.

Each admission to provider must start with an “Initial Admission” into the “highest intensity” treatment setting in which the client received the first covered service. Using the example above, the treatment setting in which the client received the first covered service would be used for “Initial Admission”, and the other would be used as “Transfer Admission”.

b. Q: Do you only admit at the highest intensity setting? – If only the highest setting, how does this related to the treatment setting reported on the service event?

A: Depending on the unique needs of the client, one “Initial Admission” and multiple “Transfer Admissions” may occur sequentially or concurrently from different treatment settings. For example, at the time of admission to provider, a client may have the “Initial Admission” to receive “Room and Board with Supervision Level I” services under treatment setting “05 for Rehabilitation/Residential Long-term”. While receiving Room & Board services, the client may also have a “Transfer Admission” to receive Day Treatment services under treatment setting “06 = Ambulatory Intensive Outpatient” and another “Transfer Admission” to receive Intervention services under treatment setting “07 for Ambulatory non-Intensive Outpatient”.

You do the initial admission based on the first treatment setting in which the client received the covered service. If the client is initially admitted to receive covered services simultaneously in multiple treatment settings, then the highest intensity treatment setting should be used for “Initial Admission”, and the other settings should be used for “Transfer Admissions”. Using the example above, “Rehabilitation/Residential Long-term” would be the highest intensity treatment setting, followed by “Ambulatory Intensive Outpatient”, and “Ambulatory non-Intensive Outpatient”.

The TreatmentSettingCode in Service Event must match the related Admission’s TreatmentSettingCode if TypeCode is 1 for Client-Specific.

Q: Can a client be in two different treatment settings at the same time under a single treatment episode? If so:

  • If a client is receiving services for MH and SA concurrently (program area 5 or 6), can they be in two separate Treatment Settings at the same time? Meaning can they have two admissions, one for each treatment settings?

    A: This question assumes that the provider is dually licensed to provide both SA and MH services to clients with co-occurring SA and MH problems.

    If this assumption is true, then a client can have two admissions, one for SA treatment setting and one for MH treatment setting. However, based on client’s primary diagnosis/problem, only one of these two settings must be used for “Initial Admission” and the other setting for “Transfer Admission”.

    For example, if the client’s primary diagnosis/problem at the time of admission is SA, then the “Initial Admission” would be in SA treatment setting and the “Transfer Admission” would be in MH treatment setting. Otherwise, if the client’s primary diagnosis/problem is MH, then the “Initial Admission” would be in MH treatment setting and the “Transfer Admission” would be in SA treatment setting.

  • Can a client be in 2 separate Treatment Settings at the same time under the same Program Area Code, i.e. both MH or both SA?

    A: Yes, but only one of them can be used for “Initial Admission” to provider.

  • Can a client be in 2 separate Treatment Settings at the same time under different Program area codes, i.e. one MH and one SA?

    A: Yes, but only the setting in which the client received the first covered service would be used for “Initial Admission” to provider.

Q: If a client receives an immediate discharge, would the AdmissionSourceRecordIdentifier be the SourceRecordIdentifier for the Immediate Discharge record?

A: If a provider determines to immediately discharge a client after an evaluation, the provider would not be required to submit an admission record. The Treatment Episode and the Immediate Discharge would be all that is required to be submitted into FASAMS.

Q: Is there a crosswalk for the current ASAM placements to the levels of care values in Appendix 5?

A: See table below for recommended crosswalk between ASAM Levels in FASAMS and ASAM Placement in SAMHIS.

ASAM Code ASAM Levels in FASAMS ASAM Placements in SAMHIS
1 0.5 Early Intervention [14] Intervention
2 1 Outpatient Services [11] Outpatient
3 2.1 Intensive Outpatient Services [12] Day Treatment
4 2.5 Partial Hospitalization Services [12] Day Treatment
5 3.1 Clinically Managed Low-Intensity Residential Services [04] Residential Level 4
6 3.3 Clinically Managed Population Specific High-Intensity Residential Services
Note: This level is not designated for adolescent populations.
[03] Residential Level 3
7 3.5 Adults - Clinically Managed High-Intensity Residential Services [02] Residential Level 2
8 3.5 Adolescents - Medically Managed Medium-Intensity Residential Service [02] Residential Level 2
9 3.7 Adults - Medically Monitored Intensive Inpatient Services [01] Residential Level 1
10 3.7 Adolescents - Medically Monitored Intensive Inpatient Services [01] Residential Level 1
11 4 Medically Managed Intensive Inpatient Services [07] Residential Detox
12 OTP Opioid Treatment Program (Level 1).
Note: OTP's not specified here for adolescent populations.
[17] Outpatient Methadone
13 1 WM - Ambulatory Withdrawal Management without Extended On-Site Monitoring [09] Outpatient Detox
14 2 WM - Ambulatory Withdrawal Management with Extended On-Site Monitoring. [09] Outpatient Detox
15 3.2 WM - Clinically Managed Residential Withdrawal Management [07] Residential Detox
16 3.7 WM - Medically Monitored Inpatient Withdrawal Management [07] Residential Detox
17 4 WM - Medically Managed Intensive Inpatient Withdrawal Management [07] Residential Detox

Q: Does the Source Record Identifier tied to the Admission carry forward to other Treatment Episodes and the Service Data?

A:  An unique Admission SRI can be used with more than one Treatment Episode.  The Service Event data file will use the Treatment Episode SRI and Admission SRI to tie client- specific Service Events back to the specific admission and Treatment episode.

Q: In Treatment Episode identifier the Source Record Identifier described on page 31- is this a new identifier created each time you send a new outcome record?

A: This is correct

Q: In Evaluation, how do we prioritize the TypeCode? What if the outcome is being used for all 3 cases or any combination of the 2?

A: If an individual has been evaluated using more than one type code (i.e. Level of Care, Level of Functioning or Competency to Proceed to Trial) a unique source record identifier would have to be submitted for each evaluation.

Q: There are some definitions about settings and admissions and transfers into those settings. What happens if a client is receiving services in more than one setting simultaneously? Would two admissions then be created?

A:  Yes, multiple transfer admissions can be created. For detailed information, please see the Treatment Episode section on the FASAMS FAQ page, i.e., How do you report Treatment Episode data for a client who is receiving services in multiple settings simultaneously? (For example: Day Treatment and MAT or Residential and HIV Intervention)

Q: Can a client be in 2 separate Treatment Settings at the same time under the same Program Area Code, i.e. both MH or both SA?

A: Yes, but only one of them can be used for “Initial Admission” to provider.

Q: Can a client be in 2 separate Treatment Settings at the same time under different Program area codes, i.e. one MH and one SA?

A: Yes, but only the setting in which the client received the first covered service would be used for “Initial Admission” to provider.

Q: Discharge Question by way of example:

  1. Client is admitted for the first time to an agency in ProgramTreatmentSetting “A” with an Admission record.
  2. Client is subsequently admitted into ProgramTreatmentSetting “B” with a Transfer record.
  3. Client is subsequently admitted into ProgramTreatmentSetting “C” with a Transfer record.
  4. Client completes treatment from ProgramTreatmentSetting “B” and is discharged with a Transfer Discharge record.
  5. Client completes treatment from ProgramTreatmentSetting “A” and is discharged with a Transfer Discharge record.

Q: Client continues in treatment in ProgramTreatmentSetting “C”. However, there is no longer an active Admission record is there? Wasn’t the Admission record closed by the discharge from “A”?

Or did the discharge from “A” just close the ProgramTreatmentSetting and the Admission remains open until a Final Discharge?

A:  In this scenario, a transfer discharge record would be submitted for ProgramTreatmentSetting “A” to indicate when the services ended in this treatment setting

Q: If a Transfer Admission must be added with a date before existing Performance Outcome Measures, Evaluations, Diagnoses dates that are attached to the previous Admission record are we required to delete the existing affected Performance Outcome Measures, Evaluations, Diagnoses and then associate them with the Transfer Admission and submit them again? This can occur because a client’s services may be paid by another payor source, but then get rejected.

A: The requirement for the PerformanceOutcomeMeasureDate field relates to Admission and Discharge records, not to Transfer Admission and Transfer Discharge records.  When the Initial Admission is created the PerformanceOutcomeMeasureDate should either be the same date as the Initial Admission or after.  A Transfer Admission will not be affected by this requirement.   There isn’t any requirement for the Evaluation date as it is understood that an Evaluation can take place before an individual is admitted. The Diagnosis Start Date requirement is the same as the PerformanceOutcomeMeasureDate.

Q: What is the corollary in the current chapter with Administrative Discharges from the Pamphlet? Or, more to the point, what is the minimum data required to discharge a patient who has dropped out of treatment and for whom we have very limited information?

A: If a client drops out of treatment after the initial admission or after a transfer admission, then a Final Discharge record should be submitted using DischargeReasonCode = 2 for Dropped out. In the absence of any other most recent information, the information from the last record submitted, e.g., initial admission, transfer admission, or transfer discharge, would be used to populate the Final Discharge record.

Q: The IsCodependentCode description on page 28 is very confusing.

  • What do we respond for a Substance Abuse admission?
    • A: This field identifies whether the record is for a client receiving treatment for substance use disorder (Client), or for someone seeking services because of problems arising from his or her relationship with a substance user (Codependent/Collateral).

      This is the same field as “Collateral” previously reported in SAMHIS PAM 155-2, Chapter 6A (SA ADMSN).
  •  How about a client with a co-occurring disorder?
    • A:  A client with a co-occurring disorder is someone with both SA and MH disorders/problems, either because he/she has SA and MH diagnoses and/or receives services in both SA and MH programs.

      In Chapter 5, the ProgramAreaCode for a client with co-occurring SA and MH disorder is 5 for Adult SA and MH and 6 for Child SA and MH.

Q: In Chapter 5, there are references to ScoreNumbers and ScoreCodes (page 62) for the different types of evaluations that are permissible. For FARS, which is what we would utilize, there is a range listed. However, the FARS as an instrument does not provide a total score. However, the FARS does not provide a total score nor does it give guidance on how to make placement determinations based on any of the scores on the FARS domains. Will the state be providing further information about this?

A: FARS has 18 scales that are ranked according to problem severity score of 1 through 9.  The Total Score Number, for all 18 scales, at a minimum can only be 18 (1 for every scale) and 162 (9 for every scale) for the maximum. The MEs are required to submit the total score number (ScoreNumber) for FARS. 

Table 7 for Evaluation Level in Appendix 5 Data Code Values provides guidance on how to make placement determination (ActualLevelCode) based on ScoreNumber. For example, if the ScoreNumber is from 91 to 108, then the ActualLevelCode = 6; if it is from 145 to 162, then the ActualLevelCode = 9, and so on.

AnnualPersonalIncome – does this include Income from Pay, Income from Govt sources, and Income from Other on PERF?

A: Yes

Q: What should be used for new fields that don’t appear to have ways of deriving from existing values?

PrimaryPaymentSourceCode:

  • 5 for Other Gov’t Payments (Includes payment by DCF)
  • 97 for Unknown

HealthInsuranceCode:

  • 97 for Unknown

DependentsKnown for MH:

  • 0 for No

UnableToPerformDailyLivingActivities for SA:

  • 3 for Unknown

LegalStatusCode:

  • 97 for Unknown

LegalGuardianRelationshipCode for CMH:

  • Use the Table 2. Dependency / Criminal Status Codes from A5 Data Code Tables
LegalGuardianRelationshipCode Info
PAM FASAMS

[04] Dependent, not in physical custody

[09] Under custody & supervision of family relatives or guardian

1 for Parent

2 for Other Relative

3 for Non-relative

 

 

4 for Emancipated minor

[01] Delinquent, in physical custody

[02] Delinquent, not in physical custody

[03] Dependent, in physical custody

[05] Dependent & Delinquent, in physical custody

[07] “Children in Need of Services” (CINS), not in physical custody

[08] Other DCF program status

5 for State or public agency

 

6 for Not Applicable

CompetencyStatusCode:

CompetnecyStatusCode Info
PAM FASAMS

[10] Competent, no charges Use this code for all clients not involved with the criminal justice system and for clients on probation.  

[11] Civil incompetence of person or property Not involved with the criminal justice system/incompetence is of person or property.

1 for The individual is not under the jurisdiction of the court and is not involved in criminal justice system

[12] Incarcerated-Competent

[13] Release pending hearing-Competent

2 for The individual is deemed by the court to be competent to proceed in criminal offenses and is not adjudicated "Not Guilty by Reason of Insanity"

[16] Release pending hearing-ITP [17] Involuntarily hospitalized (direct commit) – ITP [18] Incarcerated-ITP [19] Involuntarily hospitalized – revocation of conditional release-ITP [20] This code is no longer used [21] Conditionally released-ITP

3 for The individual is adjudicated by the court as incompetent to proceed (ITP) at a material stage of a criminal proceeding

[22] Involuntary hospital – direct commit – NGI

[25] Conditionally released – NGI

[23] Involuntary hospital – revocation of conditional release – NGI

[26] Incarcerated – NGI

[24] Released pending hearing – NGI

[29] Incompetent to Proceed – Age 21+

4 for The individual is adjudicated by the court as "Not Guilty by Reason of Insanity" on criminal charges

 

5 for Other (None of the above)

BakerActRouteCode:

  • 7 for Unknown – (if not provided)

Q: Postpartum validation edits. It’s not crystal clear what the edits are here.

If the client is female, are all values permissible?

A: Yes

Q: If the client is male, then is the only permissible value 6?

A: Yes

Q: What about the case in which a transgender female client has been reported as male but is postpartum?

A: The question would be answered as Yes. 

Q: UnabletoPerformDailyActivitiesCode – the wording of the question yields a double-negative with the answer. In order to indicate that a client is able to perform their ADLs, a user must select the negative. That’s rather confusing.  SUGGESTION: Reword the question to what is actually being asked: AbletoPerformDailyActivities and leave the value codes the same. If you need to report it the other way to the Feds, do that on your side rather than trusting a couple hundred agencies to do it correctly.

A: The wording in FASAMS Chapter 5 is a verbatim transcription of the wording in SAMHIS DCF Pamphlet 155-2 Chapter 5 (PERF), which MEs and their network providers have used for years. Changing the wording at this stage of DDI would be a non-critical and unnecessary change request that could delay the project.

Q: Chapter 5 – AnnualFamilyIncomeAmount

How is family defined for this question? This question appears to replace the Annual Household Income question and the definition of household seems likely to be more broad than the definition of family. And, what if the client is supported by the family but not living with the family (e.g., college student) – Would the entire family be counted or only what the client living away from home has (that is, PersonalIncomeAmount = FamilyIncomeAmount)?

A: If the client is supported by the family but not living with the family (e.g., college student), then the entire family income would be counted.

Q: The Diagnosis Start Date description sounds like you’re asking for the onset. Most of the time, we don’t know that. A person is already sick when we first get them, especially in CSU, detox, and Inpatient settings. Our doctors don’t try to guess at the date of onset. At *best* they’ll get an approximate age of onset based upon patient and ancillary report. This is probably semantics but what I *think* that you may find acceptable is the initial date of diagnosis at the agency level.

A: The initial date of diagnosis at the agency level would be acceptable.

Q: Should the diagnosis be resolved, the EndDate or resolution? However, even there we get into more semantics. Note that the ICD-10 moved toward a focused problem list. We may see a patient and list 5 Problems per the DSM5 / ICD10. A patient may still have an anxiety disorder and will probably continue to have it, but we may move it off the problem list as it’s no longer a focus of clinical care. This would be the EndDate that we’d report to you. However, it would be inaccurate to say that the “individual no longer had the diagnosis” – strictly speaking.

A:  There should be a record for each diagnosis code with required StartDate and optional EndDate. If the client continues to have a diagnosis (e.g., anxiety disorder) and that diagnosis is no longer the focus of clinical care, then that diagnosis record would be submitted without an EndDate. In this scenario, the EndDate for the “anxiety disorder” diagnosis record would be submitted if and when the client no longer exhibit the symptoms for that disorder.

Q: The values for the TreatmentSettingCode correspond to the SA codes for TEDS – but what about the MH TEDS setting codes, 72-76. Why would we not make use of those and how does the state intend to cross-walk our MH programs (could we see a recommended crosswalk similar to the ASAMS level to TreatmentSetttingCode)? OR, is the intent that all MH programs go under the TreatmentSettingCode, 97 – Other (Non-TEDS Tx Serice Settings)?

A: the values for the FASAMS TreatmentSettingCode, in combination with ProgramAreaCode, and ContractualRelationshipCode, are used by the system to derive TEDS codes for MDS 18 and DIS 7, as specified in the table below. 

TreatmentSettingCode information

Type of Treatment Service/Setting for TEDS MDS 18 and TEDS DIS 7

FASAMS algorithm for deriving TEDS codes based on TreatmentSettingCode, ProgramAreaCode, and ContractualRelationshipCode

01

Detoxification, 24-hour service, Hospital Inpatient

 

 

02

Detoxification, 24-hour service, Free-Standing Residential

02

TreatmentSettingCode is 02 and ProgramAreaCode is 2 or 4 or 5 or 6 and ContractualRelationshipCode is 1 or 2 or 4

03

Rehabilitation/Residential - Hospital (other than Detoxification)

03

TreatmentSettingCode is 03 and ProgramAreaCode is 2 or 4 or 5 or 6 and (ContractualRelationshipCode is 1 or 2 or 4

04

Rehabilitation/Residential - Short term (30 days or fewer)

04

TreatmentSettingCode is 04 and ProgramAreaCode is 2 or 4 or 5 or 6 and ContractualRelationshipCode is 1 or 2 or 4

05

Rehabilitation/Residential - Long term (more than 30 days)

05

TreatmentSettingCode is 05 and ProgramAreaCode is 2 or 4 or 5 or 6 and ContractualRelationshipCode is 1 or 2 or 4

06

Ambulatory - Intensive outpatient

06

TreatmentSettingCode is 06 and ProgramAreaCode is 2 or 4 or 5 or 6 and ContractualRelationshipCode is 1 or 2 or 4

07

Ambulatory - Non-intensive outpatient

07

TreatmentSettingCode is 07 and ProgramAreaCode is 2 or 4 or 5 or 6 and ContractualRelationshipCode is 1 or 2 or 4

08

Ambulatory - Detoxification

08

TreatmentSettingCode is 08 and ProgramAreaCode is 2 or 4 or 5 or 6 and ContractualRelationshipCode is 1 or 2 or 4

72

State psychiatric hospital

72

TreatmentSettingCode is 03 and ProgramAreaCode is 1 or 3 and ContractualRelationshipCode is 3

73

SMHA funded/operated community-based program

73

TreatmentSettingCode is 06 or 07 and ProgramAreaCode is 1 or 3 and ContractualRelationshipCode is 1 or 2 or 4

74

Residential treatment center

74

TreatmentSettingCode is 04 or 05 and ProgramAreaCode is 1 or 3 and ContractualRelationshipCode is 1 or 2 or 4

75

Other psychiatric inpatient

75

TreatmentSettingCode is 03 and ProgramAreaCode is 1 or 3 and ContractualRelationshipCode is 1 or 2 or 4

76

Institutions under the justice system

 

 

96

Not Applicable (use only for codependents or collateral clients (SA) and for MH clients receiving MH assessments, evaluation, or screening only)

96

IsCodependentCode is 1 OR there is at least one immediate discharge record

Q: Because we provide both residential and outpatient services, our clients receive services from more than one site at a time. For example, they receive room and board services from one of our licenses level 2’s, which will have one site code. They may also participate in group and case management services at our Palmetto Bay site. How do we link one client to two sites? Will we need two separate Treatment Episode datasets for this client?

A: If the client is initially admitted to receive covered services simultaneously in multiple treatment settings, then the highest intensity treatment setting should be used for Initial Admission, and the other settings should be used for Transfer Admissions. Under the above scenario, the site for Residential setting would be used for Initial Admission and the site for Outpatient setting would be used for Transfer Admission.

Q: If a client receives an immediate discharge, would the AdmissionSourceRecordIdentifier be the SourceRecordIdentifier for the Immediate Discharge record?

A: If a provider determines to immediately discharge a client after an evaluation, the provider would not be required to submit an admission record.  The Treatment Episode and the Immediate Discharge would be all that is required to be submitted into FASAMS.

Q: What information is required in the 90 day PERF? I have not seen any information on the requirements for this export.

A: The 90 day Perf will be an update to the Chapter 5 Treatment Episode Data Performance Outcome Measure. This will include any changes that may have happened to an individual as related to the following sub-entities of the Performance Outcome Measures:

3.3.4.1 ClientDemographic
3.3.4.2 FinancialAndHousehold
3.3.4.3 Health
3.3.4.4 EducationAndEmployment
3.3.4.5 StabilityOfHousing
3.3.4.6 Recovery
3.3.4.7 SubstanceUseDisorder
3.3.4.8 MentalHealth
3.3.4.9 Medication
3.3.4.10 Legal