Transcript ICG COMMUNICATION FORUM

ICG COMMUNICATION
FORUM
Seth Harkins, EdD, Director ICG Program
Bill White, LCSW, Clinical Director Illinois
Mental Health Collaborative for Access and
Choice
December 18, 2008
Goals for Today’s Webcast
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To update residential and SASS providers on
changes in the ICG program (unbundling of
rates, care managers and SASS roles, Annual
Reviews
To provide an overview of Rule 132 and how it
applies to the ICG program
To clarify certain ICG procedures (Family
income requirement, UIRs, Quarterly Reports,
Annual Reviews, 94R and Medicaid eligibility)
Why Unbundling ?
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Rule 132 Required
Fee for service billing categories
Enhanced service tracking
Survey data regarding RTC services
Clinically-focused and family centered
provision of care
Consumer-focused
Focus on recovery and resiliency
Emphasis on skill building in natural
environments
Fee for Service Categories
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Case management – client centered
Case management – mental health
Case management – transition and
linkage
Community residential support
individual
Community residential support group
Crisis intervention
Fee for Service Categories
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Mental health assessment
Psychological evaluation
Psychotropic medication administration
Psychotropic medication monitoring
Psychotropic medication training
Therapy/individual
Therapy/group
Therapy/family
Treatment planning
Fee for Service Categories Group
C Services (Non Medicaid)
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Oral interpretation and sign language
Job finding
Job retention
Job Leaving/termination
Vocational assessment
Vocational engagement
Vocational services
What Did We Learn from the
Fee for Service Survey
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Survey Monkey data collected in April and May
Incomplete data led to further surveying
Trends noted: 1) community support
residential individual and group varied
considerably; 2) limited vocational services
reported; 3) individual, group, and family
therapy tended to below for clients requiring
intensity of services; 4) case management
services were relatively low, particularly
transition and linkage, averaging one hour a
month; 5) various ratios of MHPs to RSAs.
What Did We Learn from the
Fee for Service Survey?
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Clinical standards need to be established.
Increased provisions of case management
services at certain times to facilitate
individualized care and transition to home and
the community (e.g. case management
transition and linkage).
Two hours per week of individual therapy
provided by QMHP is considered a minimum
standard.
Three hours per week of group therapy
facilitated by a QMHP is considered a standard.
One hour per week of family therapy provided
by a QMHP is considered a standard.
For clients ages 16 – 21 vocational services
should be provided at least one hour per week.
How Does Rule 132 Apply?
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Billing will be according to fee for
service categories and service
definitions
An objective is to increase FFP so
that Illinois receives enhanced
Medicaid reimbursement
Increased Medicaid eligibility
94R
Fee for Service Billing
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During FY2009 residential
providers will be paid their
Illinois Purchase Care Review
Board rate.
Fee for Service Billing
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Residential providers will be required to
make application for RTC clients eligible
for Medicaid under 94R.
It will be important for residential
providers to work with SASS-ICG
workers and parents to complete the
necessary paperwork.
It behooves the residential provider to
establish a close relationship with its
local DHS office.
Fee for Service Billing Target
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Based on the survey data and the medical
necessity of the average ICG client, we
conclude that 40% of the Illinois Purchase of
Care Review Board rate is an appropriate
target for FY2009.
Average ICG client is “high need” and thus
requires medically necessary residential
services.
The ICG program is committed to working with
providers to assist them in optimal billing for
medically necessary services.
Enhanced Clinical Care
Management
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Collaborative Clinical Care
Managers will play a supportive
role for families and SASS-ICG
providers.
DMH intends to use the services of
clinical are managers in
increasingly significant roles.
The specifics of enhanced clinical
care manager role will be provided
in a future webinar.
One-to- One Staffing
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DMH will no longer reimburse
providers to one-to-one staffing.
DMH expects this service will be
available when clinically necessary
and included in the costs
submitted to the Illinois Purchase
Care Review Board.
Family Income
Requirement
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ICG applicants must indicate their
family income and submit copies of
federal income tax returns.
The family income requirement is a
requirement for other DHM
programs. This addition to the ICG
application brings ICG into
alignment with other DMH
program.
Unusual Incident Reports
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UIRs are reserved for truly unusual incidents.
Verbal aggression and property destruction are
not considered unusual for the ICG population
and thus UIRs are not required.
Any sentinel event must be immediately reported
to ICG via phone with follow-up paper work
within 24 hours.
Other incidents (e.g. severe aggression, selfinjurious behavior resulting in medical attention
in a hospital or clinic, elopement, behavior
involving police intervention, etc. shall be
reported within 2 business days.
Unusual Incident Reports
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Not all elopements need to be
reported. Elopements that involve
the client leaving the property of
the facility for more than an hour
and out of the control of staff shall
result in a UIR.
UIRs should be sent to Chumiach
Houston at 4200 N. Oak Park
Avenue/Annex, Chicago, IL.
Annual Eligibility Reviews
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Annual Reviews are now being referenced
as Annual Eligibility Reviews to emphasize
the fact that the outcome and an AR is an
eligibility decision.
Funding will be terminated when ICG
clients who no longer meet the clinical
criteria for the program.
The Ohio Scales and the Columbia
Impairment Scale are to be included in the
Annual Eligibility Report.
Quarterly Reports
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Quarterly Reports are required for
all ICG clients.
A quarter is defined as 90 days
from the date of grant anniversary.
Include Ohio Scales and Columbia
Impairment Scale information in
the Quarterly Report.
Quarterly Reports
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Quarterly Reports shall answer the 10 items
contained in the Quarterly Report
Questionnaire:
Briefly describe the reason for admission.
Describe the treatment goals you hope to
accomplished.
Describe the current efforts you are making to
prepare the client for discharge. Give a
tentative discharge date.
List the discharge criteria that need to be met
before discharge can occur.
List current diagnoses. Include CGAS, Ohio
Scales, and Columbia Impairment Scale.
Quarterly Reports
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Progress of psychotherapy and number of
sessions per week .
Progress in family therapy and number of
sessions per month.
Progress in any specialized therapy, if
appropriate.
Family involvement in the client’s
treatment.
Anything else considered relevant to the
client’s treatment.
UPDATING RESIDENTIAL
INFORMATION
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Information regarding residential
services frequently changes.
SASS-ICG providers will submit a
monthly list of residential clients
on their case loads to the
Collaborative.
Updated lists will help keep the
Collaborative current regarding
changes in placements.
APPENDIX
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For detailed description of all Rule 132
services, go to:
http://www.hfs.illinois.gov/assets/070107_c
mph_guide.pdf for the State of Illinois
Community Mental Health Services Service
Definition and Reimbursement Guide
The appendix provides service definitions,
examples, and minimal credentials for
providing services from the reimbursemet
guide.
Service Definitions
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CASE MANAGEMENT - CLIENT-CENTERED
CONSULTATION: “An individual client-focused
professional communication between provider
staff, or staff of other agencies, or with other
professionals or systems who are involved
with providing services to the client.”
Examples: Face-to-face contacts, staffing with
school personnel, contacts with legal or
medical system
Minimum staff requirement - RSA
Service Definitions
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CASE MANAGEMENT - MENTAL
HEALTH: Services include assessment,
planning, coordination, and advocacy services
for clients who need multiple services and
require assistance in gaining access to and in
using mental health, social, vocational,
educational, housing, public income
entitlements and other community services to
assist the client in the community. Case
management activities may also include
identifying and investigating available
resources, explaining options to the client and
linking them with necessary resources.
Service Definitions
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CASE MANAGEMENT - MENTAL
HEALTH EXAMPLES:
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Helping the client access appropriate mental
health services, including the ICG program,
apply for public entitlements, locate
housing, obtain medical or dental care or
obtain other social, educational, vocational,
or recreational services.
Assessing the need for service, identifying
and investigating available resources,
explaining options to the client and
assisting in the application process.
Service Definitions
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CASE MANAGEMENT - MENTAL
HEALTH minimum staff
requirement - RSA
Service Definitions
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CASE MANAGEMENT - TRANSITION
LINKAGE AND AFTERCARE:
“Services are provided to assist in
an effective transition in living
arrangement consistent with the
client’s welfare and development.
Fee for Service and
Treatment
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The lack of intensity of services,
particularly in regard to individual,
group, and family therapy may
explain ICG’s average length of
stay as 2.5 years.
Research indicates that after two
years of residential placement, it is
unlikely that the client will return
to home and the community.
Service Definitions
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CASE MANAGEMENT - TRANSITION
LINKAGE AND AFTERCARE Examples:
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Services to clients being discharged inpatient
psychiatric care, transitioning to adult services;
time spent planning with the staff of the client’s
current living arrangement or the receiving
living arrangement;
Time locating client-specific placement
resources;
Time spent developing aftercare service plan;
Assisting the client or the client’s family or
caregiver with the transition.
Service Definitions
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CASE MANAGEMENT - TRANSITION
LINKAGE AND AFTERCARE
minimum staff requirement - MHP
Service Definitions
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COMMUNITY SUPPORT RESIDENTIAL
(INDIVIDUAL, GROUP): Services and support
for children, adolescents, adults, and families
necessary to assist a client to achieve and
maintain rehabilitative, resiliency, and
recovery goals. The service consists of
therapeutic interventions that facilitate illness
self-management, skill building, identification
and use of natural supports , and use of
community resources.
Service Definitions
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COMMUNITY SUPPORT (RESIDENTIAL)
EXAMPLES:
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Coordination and assistance with the identification of
individual strengths, resources, preferences, and
choices.
Assistance with the identification of existing natural
supports for the development of a natural support
team.
Assistance with the development of crisis management
plans.
Service Definitions
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Skill building in order to assist the client in
the development of functional,
interpersonal, family, coping and
community living skills that are negatively
impacted by the client’s mental illness.
Assistance with risk factors related to
relapse prevention and prevention plans.
Support and promotion of client selfadvocacy and participation in decisionmaking, treatment, and treatment planning
Service Definitions
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COMMUNITY SUPPORT (RESIDENTIAL)
minimum staff requirement - RSA
Service Definitions
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CRISIS INTERVENTION: Activities or
services provided to a person who is
experiencing a psychiatric crisis that are
designed to interrupt the crisis
experience including assessment, brief
supportive therapy or counseling and
referral and linkage to appropriate
community services to avoid more
restrictive levels of treatment, with the
goal being symptom reduction,
stabilizing and restoration to a previous
level of functioning
Service Definitions
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CRISIS INTERVENTION EXAMPLES:
 All activities must occur within the context of a
potential psychiatric crisis.
 Face-to-face or telephone contact with the client for
the purpose of preliminary assessment of need for
mental health services.
 Face-to-face or telephone contact to provide
immediate, short-term, crisis-specific therapy or
counseling with client, and, as necessary, with
client’s caretaker or family.
 Referral to other applicable mental health services.
Including pre-hospitalization screening.
 Face-to-face consultation with a physician or
hospital staff regarding need for psychiatric
consultation.
Service Definitions
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CRISIS INTERVENTION minimal
staff requirement - MHP with
immediate access to a QMHP.
Service Definitions
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JOB FINDING: Activities for a specific
client, directed toward helping them find a
and procure a job, when provided under the
following conditions: placement based on
consumer job preferences, competitive
employment in integrated work settings, ongoing supports as needed and integration of
supported employment services with other
mental health services.
Service Definitions
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JOB FINDING EXAMPLES:
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Helping the client identify job leads.
Reviewing the client’s network of job leads.
Contacting employers about a job for a specific
client.
Assisting a client in completing employment
applications.
Arranging a job interview
Evaluating a job site to determine if it is a good fit for
the client.
Facilitating a group where clients exchange job leads
and their experience using various job-finding
strategies with one another.
Service Definitions
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JOB FINDING minimum staff
requirement - RSA.
Service Definitions
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JOB RETENTION SUPPORTS:
Activities for a specific client directed toward
helping them keep their job, when provided
under the following conditions: placement
based on consumer job preferences,
competitive employment in integrated work
settings, on-going supports as needed and
integration of supported employment services
with other mental health services.
Service Definitions
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JOB RETENTION SUPPORTS
EXAMPLES:
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Helping the client identify and make use of
their support system to manage their
concerns about work.
Frequently talking with client about changes
in health, work environment, or personal
environment to identify needed support
categories.
Helping the client identify and implement
strategies that improve job performance or
relationships at work.
Service Definitions
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JOB RETENTION SUPPORTS
minimum staff requirement - RSA.
Service Definitions
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JOB LEAVING/TERMINATION
SUPPORTS: Activities for a specific client, who is
employed, directed toward helping them leave a job in good
standing, when provided under the following conditions:
placement based on consumer job preferences, competitive
employment in integrated work settings, on-going supports as
needed and integration of supported employment services
with other mental health services. Job Leaving/Termination
Supports may also be provided to help the client see
unplanned job loss as a transitional and a learning experience
that will help them with their next job. Job
Leaving/Termination Supports are provided to ensure that a
job loss due to termination is not seen as a reason to
discontinue participation in the supported employment
program.
Service Definitions
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JOB LEAVING/TERMINATION
SUPPORTS EXAMPLES:
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Using motivational interviewing to help client
identify the pros and cons of leaving their job.
Deciding how much notice is required to leave in
good standing.
Coaching on talking to a supervisor about resigning.
Helping write a letter of resignation.
Coaching on how to obtain a letter of reference.
Service Definitions
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JOB LEAVING/TERMINATION
SUPPORTS minimal staffing
requirement - RSA.
Service Definitions
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ORAL INTERPRETATION AND SIGN LANGUAGE:
Sign language/oral interpreter services necessary
to ensure the provision of services for individuals
with hearing impairments or in the primary
language of non-English speaking individuals.
Interpreters shall be linguistically appropriate in
English and in the primary language of the
individual and be able to translate critical
information effectively.
Service Definitions
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ORAL INTERPRETATION AND SIGN
LANGUAGE minimal staff
requirement - specialist.
Service Definitions
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MENTAL HEALTH ASSESSMENT: The
formal process of gathering into written
reports information on the client - including,
but not limited to, individual characteristics,
presenting problems, history or cause of
illness, history of treatment, psychosocial
history and current functioning in emotional,
cognitive, and behavior domains through faceto-face or personal contact with client or
collaterals. The service results in identification
of the client’s mental health service needs and
recommendations for treatment and may
include a tentative diagnosis.
Service Definitions
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MENTAL HEALTH ASSESSMENT EXAMPLES:
 Face-to-face meeting with the client in order to
assess the client’s needs.
 Face-to-face meeting or telephone contact with the
client or client’s family to collect social history
information.
 Administering CGAS/GAF or other acceptable
instruments to the client to document substantial
impairment in role functioning.
 Annual update of the assessment
Service Definitions
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MENTAL HEALTH ASSESSMENT
minimal staff requirement - MHP
under the direct supervision of a
QMHP. QMHP and LPHA must sign
the mental health assessment
report and annual update.
Service Definitions
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PSYCHOLOGICAL EVALUATION: A
psychological evaluation
conducted and documented by the
provider consistent with the
Psychologist Licensing Act (225
ILCS 15), using nationally
standardized psychological
assessment instruments.
Service Definitions
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PSYCHOLOGICAL EVALUATION
EXAMPLES:
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Client interview or clinical
observation. Interview with parent or
guardian, if indicated.
Administration of nationally
recognized psychological assessment
instruments as part of a psychological
evaluation.
Service Definitions
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PSYCHOLOGICAL EVALUATION
minimum staff requirement - The
evaluation must be conducted and
signed by a licensed clinical
psychologist.
Service Definitions
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PSYCHOTROPIC MEDICATION
ADMINISTRATION: Time spent
preparing the client and the
medication for administration,
administering psychotropic meds,
observing the client or possible
adverse reactions, and returning
medications to proper storage.
Service Definitions
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PSYCHOTROPIC MEDICATION
ADMINISTRATION EXAMPLE: In
addition to the activities in the
service definition, drawing blood
per established protocol for a
particular psychotropic medication.
Service Definitions
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PSYCHOTROPIC MEDICATION
ADMINISTRATION minimum staff
requirement - LPN under RN
supervision.
Service Definitions
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PSYCHOTROPIC MEDICATION
MONITORING: Monitoring and
evaluating target symptom
response, adverse effects include
tardive dyskinesia screens, and
new target symptoms or
medication.
Service Definitions
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PSYCHOTROPIC MEDICATION
MONITORING EXAMPLES:
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Face-to-face interview with clients reviewing response to
psychotropic medications.
Medication monitoring may include clinical
communication by phone or face-to-face between staff of
the (same) provider agency, under situations which
constitute an appropriate release of information,
emergency medical, life safety intervention, or consulting
therapist relationships regarding the client’s psychotropic
medication.
Review laboratory results with clients that are related to
the client’s psychotropic medication.
Service Definitions
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PSYCHOTROPIC MEDICATION
MONITORING minimum staff
requirement - Staff designated in
writing by a physician or advanced
practice nurse per a collaborative
agreement.
Service Definitions
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PSYCHOTROPIC MEDICATION
TRAINING: Includes training the
client or the client’s family or
guardian to administer the client’s
medication, to monitor proper
levels and dosage, and to watch for
side effects.
Service Definitions
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PSYCHOTROPIC MEDICATION TRAINING EXAMPLES:
When indicated based on client’s condition and included
in the ITP, face-to-face meetings with individuals clients
to discuss the following:
 Purpose of taking the medications.
 Psychotropic medications, effects, side effects, and
adverse reactions.
 Self-administration of medications.
 Storage and safeguarding of medications.
 How to communicate with MH professionals
regarding medication issues.
 How to communicate with family/caregivers
regarding medication issues.
Service Definitions
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PSYCHOTROPIC MEDICATION
TRAINING minimum staff
requirement - staff designated in
writing by a physician or advanced
practice nurse per a collaborative
agreement.
Service Definitions
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THERAPY/COUNSELING:
Treatment to provide emotional,
cognitive, behavioral or
psychological changes using
psychotherapy theory and
techniques.
Service Definitions
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THERAPY/COUNSELING EXAMPLES:
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Formal face-to-face or videoconference
meetings or telephone contacts with the client
or client’s family as specified in the ITP.
Conducting form face-to-face group
psychotherapy sessions with the client or
his/her family, addressing a specific problem
such as low self-esteem, poor impulse control,
depression, etc.
CBT, Functional Family Therapy, Motivation
Enhancement Therapy, Trauma Counseling,
Anger Management, Sexual Offender Treatment.
Service Definitions
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THERAPY/COUNSELING minimum
staff requirement - MHP. ICG staff
requirement - QMHP
Service Definitions
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TREATMENT PLANNING: The development of a plan,
in conjunction with the client and parent/guardian as
applicable, to deliver specific mental health services to a
client, base on the service needs identified in the mental
health assessment, which includes goals, objectives,
specific mental health services, frequency and
identification of staff responsible for delivering these
services. The LPHA and QMHP shall review the ITP no
less frequently than every six months and make any
modification if necessary.
Service Definitions
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TREATMENT PLANNING
EXAMPLES:
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Meeting with the client or parent/guardian to discuss,
develop, or review treatment plan.
Face-to-face meetings with family members, collaterals or
other persons essential to the development or review of
the treatment plan, with client’s permission.
Treatment team meetings used for ITP development
and/or formalized review of the effectiveness of the entire
plan. LPHA or QMHP must be present.
Time spent y the QMHP/MHP reviewing the assessment
materials and developing ITP with others (but not time
spent writing/typing the document).
Service Definitions
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VOCATIONAL ENGAGEMENT:
Activities for a specific client to
engage the client in making a
decision to actively seek
competitive employment or formal
credit/certificate bearing
education.
Service Definitions
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VOCATIONAL ENGAGEMENT EXAMPLES:
 Using motivational interviewing to assist client
in identifying pros and cons of working.
 Educating the family on the benefits of
employment to the client.
 Leading groups that explore concerns raise by
clients considering employment.
 Going to job sites with the client to explore
that world of work.
Service Definitions
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VOCATIONAL ASSESSMENT: Developing a
vocational profile to guide client choices in
seeking and maintaining competitive
employment. A vocational profile typically
includes information pertaining to work
history, interests, skills, strengths, education,
the impact of symptoms on the ability to use
strengths, job preferences, etc. Vocational
assessment is continuous during all phases of
obtaining and maintaining employment. New
information from experience is incorporated to
guide modification of the vocational plan.
Service Definitions
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VOCATIONAL ASSESSMENT EXAMPLES:
 Using interest and preference inventories to
increase client’s personal knowledge of
employment-related interests and preference.
 Administering a test to determine basic reading
and math abilities.
 Visiting competitive work sites with client.
 Gathering information that an employer might
find on background check.
Questions or Concerns
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[email protected]
[email protected]