Transcript Document

The Illinois Mental Health
Collaborative for Access and Choice
Overview of the Authorization Process and Fidelity Monitoring
ACT Team Leader Meeting
March 27, 2008
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AGENDA
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Introductions
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Purpose of Monthly Meetings
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Topic Selections
- authorization process in brief
- overview of fidelity monitoring
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Questions
Introductions
The Illinois Department of Human Services/Division of Mental Health
(DHS/DMH) has engaged an administrative service organization
(ASO) to provide support and resources to improve access and
choice in the mental health system. The Illinois Mental Health
Collaborative for Access and Choice will be referred to as “the
Collaborative”.
The presenters are:
 DMH:
• Jackie Manker, LCSW
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Collaborative Clinical Team:
• Todd Kasdan, MD - Medical Director
• Bill White, LCSW - Clinical Director
• Sandy Potter, LCSW - Vice President of Operations
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DMH Overview
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,
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 4th Quarter FY08
- as a coordinated team approach with
DHS/DMH Contract Managers and BALC
- this is an evolving process
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Purpose of the monthly meetings
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Improve Adherence to Both Rule 132 and Contract
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Learning Opportunities
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Share Evidence-Based Practices (EBP)
Monthly Topic Selection Area
Keep Communication Open
(Attendance Recommended)
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Authorization Process
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ACT Services Require Prior Authorization
Providers Submit a Request for ACT Prior to Start of Services
Submit
- authorization request form
- treatment plan
- crisis plan
Submit Documents by Fax
Coming Soon: “ProviderConnect” Web-Based Submission
Capabilities
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
Authorization Review Time Frame
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Completed Requests Response Time:
- Within one (1) business day for initial
authorizations
- Within three (3) business days for
reauthorizations
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Provider Monitoring Overview
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Rule 132
- clinical record review
- post payment review
Contract
- coordination of benefits
- non-Medicaid services
Moving Mental Health System Towards Recovery Oriented
Services
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consumer participation
crisis plans
ACT fidelity
Overview of Fidelity Monitoring
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Ensuring Appropriateness of Services
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Key Elements of Fidelity Reviews:
- demonstration of EBP models in service delivery
- adherence with eligibility requirements (Rule 132)
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Team Based Review
Fidelity to EBP for ACT
Some of the Highlighted Elements:
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Consumers’ Needs Drive Service, Time, and
Location
Consumer Staff Ratio of 10:1
Team Approach - All (or Most) Staff Members
Interact With Consumer
Available 24/7 Support
Crisis Planning
Fidelity to EBP- ACT (Cont.)
Some of the Highlighted Elements:
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Full Time Practicing Team Leader
Psychiatrist and Nurse on Staff
Staffing Continuity and Capacity
Intake Rate
Appropriate Family Involvement
Service to Defined Population
ACT Fidelity Tool
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Based on Dartmouth Assertive Community
Treatment Scale (DACTS)
(available online at www.samhsa.gov)
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Contains 28 Program Specific Items
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structure and composition
organizational boundaries
nature of service
Designed to Measure the Degree of Implementation
of ACT Programs
Service Objectives
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Promote Symptom Stability and Appropriate Use of
Medications
Restore Personal, Community Living, and Social
Skills
Promote Physical Health
Establish Access to Entitlements, Housing, Work,
and Social Opportunities
Promote the Highest Possible Level of Functioning in
the Community
Questions?
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Posting of the Presentation
Today’s presentation will be available online in April
2008
http://www.IllinoisMentalHealthCollaborative.com/pr
oviders/Training/Training_Workshops_Archives.ht
m
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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