Transcript Document

The Illinois Mental Health
Collaborative for Access and Choice
Overview of the Authorization Process and Fidelity Monitoring for
Best Practices
CST Team Leader Meeting
March 26, 2008
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Agenda
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Introductions
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Purpose of Monthly Meetings
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Recommended Attendance
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Topic Selection
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Agenda (Cont.)
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Today’s Topic
- authorization process in brief
- overview of fidelity monitoring
- fidelity to best practices for CST
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Introductions
The Illinois Department of Human Services/Division of Mental
Health (DHS/DMH) has engaged an administrative services
organization (ASO) to provide support and resources to
improve access and choice in the mental health system. The
Illinois Mental Health and Choice will be referred to as “the
Collaborative”.
The presenters are:
 DMH:
• Jackie Manker, LCSW
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Collaborative’s Clinical Team:
• Sandy Potter, LCSW – Vice President of Operations
• Bill White, LCSW - Clinical Director
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DMH Overview
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Overarching Themes for 4th Quarter FY08
– this year is an introduction to how monitoring will be
conducted in the future
– a coordinated team approach with DHS/DMH, Bureau of
Accreditation, Licensure and Certification (BALC), and
Collaborative staff
– no duplication of reviews
– no extrapolation this year (no penalties)
– compliance with both Rule 132 and the contract
– evolving process – so we learn and adjust as we go
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A Goal of the Collaborative
Under the direction of DHS/DMH the
Collaborative will perform provider monitoring
activities starting in 4th Quarter FY08.
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as a coordinated team approach with DHS/DMH
contract managers and BALC
this is an evolving process- need to establish a
baseline
Purpose of the Monthly Meetings
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Improve Adherence to Both Rule 132 and
Contract
Learning Opportunities
Share Best Practices
Keep Communication Open
Attendance is Recommended for Team
Leader and others
Identify Topics for Discussion
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Authorization Process
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CST services require prior authorization
Providers submit a “Request for CST Prior
Authorization”
Submit
- authorization request form
- treatment plan
- crisis plan
Submit Documents by Fax
Coming Soon: “ProviderConnect” Web-Based
Submission Capabilities
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Submitting Authorization Requests
Collaborative Contact Information:
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www.IllinoisMentalHealthCollaborative.com
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Telephone: 866-359-7953
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New Fax Number: 866-928-7177
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The Collaborative verifies eligibility and provider
status
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Authorization Review Time Frame
Completed requests response time:
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Within one (1) business day for initial authorizations
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Within three (3) business days for reauthorizations
Revised “Authorization Protocol Manual” is due out in April
2008
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Provider Monitoring Overview
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Rule 132
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Contract
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coordination of benefits
non-Medicaid services
Moving Mental Health System Towards RecoveryOriented Services
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clinical record review
post payment review
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consumer participation
crisis plans
ACT/CST fidelity reviews
Overview of Fidelity Monitoring
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Ensuring Appropriateness of Service
Key Elements of Fidelity Reviews:
- evidence of “best practice” components
- compliance with eligibility requirements
- implementation of team based service
Team Based Review
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Fidelity to Best Practices
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Consumers’ Needs Drive Service Times and
Locations
Client Staff Ratio = 18:1
60% of Services Provided in the Community
Multiple Staff Involvement With Each
Consumer
Full Time Team Lead (at least a QMHP)
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Fidelity to Best Practices (Cont.)
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Available 24 Hour Support
Crisis Planning
Family Involvement as Appropriate
Clinical Rationale Supporting LOCUS Score
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Service Components
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Therapeutic Interventions Facilitate Skill
Building In:
- wellness self-management
- identification and use of natural
supports
- use of community resources
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Service Components (Cont.)
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Coordination to Assist Consumer to Identify
Strengths, Resources and Personal Choice
Assist Consumer to Identify and Use Natural
Supports
Assistance With Crisis Management
Self Advocacy, Decision Making in Tx Plans
Community Based Vs Office Based Services
Use of Group Modalities for Dually Diagnosed
High Intensity of Services as Needed
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Fidelity Tool
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Developed From DHS/DMH Mental Health
Service Definitions
Contains Program-Specific Items Required
by Rule 132
Measures Degree of Service Implementation
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Staffing Requirements
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No Fewer Than Three (3) FTE’s
At Least One (1) Active Member is in Recovery From
a Mental Illness (Preferred Certified Recovery
Support Specialist – CRSS)
Practicing Team Lead (QMHP)
Staff Training Before Services Are Provided
Multiple Staff Involved in Providing Services
On-Going Supervision of Staff (Weekly Staff
Meetings)
Staffing Ability to Provide 24/7 Coverage
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Questions?
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Posting of the Presentation
Today’s presentation will be available online in April 2008
http://www.IllinoisMentalHealthCollaborative.com/providers/Training/Trai
ning_Workshops_Archives.htm
Be sure to share this information with your staff!
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Thank you!
Illinois Mental Health Collaborative for
Access and Choice
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