The Illinois Mental Health Collaborative for Access and Choice Overview of the Authorization Process and Fidelity Monitoring for Best Practices

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The Illinois Mental Health Collaborative for
Access and ChoiceOverview of the Authorization
Process and Fidelity Monitoring for Best Practices
CST Team Leader Meeting

• March 26, 2008

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Agenda

• Introductions
• Purpose of Monthly Meetings
• Recommended Attendance
• Topic Selection

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Agenda (Cont.)

• Todays 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
• Collaboratives Clinical Team
• Sandy Potter, LCSW Vice President of Operations
• Bill White, LCSW - Clinical Director

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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, 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.
• as a coordinated team approach with DHS/DMH
  contract managers and BALC
• this is an evolving process- need to establish a
  baseline

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Purpose of the Monthly Meetings

• 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

• 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
• www.IllinoisMentalHealthCollaborative.com
• Telephone [phone]
• New Fax Number 866-928-7177
• The Collaborative verifies eligibility and
  provider status

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Authorization Review Time Frame

• Completed requests response time
• Within one (1) business day for initial
  authorizations
• Within three (3) business days for
  reauthorizations
• Revised Authorization Protocol Manual is due
  out in April 2008

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Provider Monitoring Overview

• Rule 132
• clinical record review
• post payment review
• Contract
• coordination of benefits
• non-Medicaid services
• Moving Mental Health System Towards
  Recovery-Oriented Services
• consumer participation
• crisis plans
• ACT/CST fidelity reviews

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Overview of Fidelity Monitoring

• 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

• Consumers Needs Drive Service Times and
  Locations
• Client Staff Ratio 181
• 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.)

• Available 24 Hour Support
• Crisis Planning
• Family Involvement as Appropriate
• Clinical Rationale Supporting LOCUS Score

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Service Components

• 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.)

• 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

• 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

• No Fewer Than Three (3) FTEs
• 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

• Todays presentation will be available online in
  April 2008
• http//www.IllinoisMentalHealthCollaborative.co
  m/providers/Training/Training_Workshops_Archives.h
  tm
• Be sure to share this information with your staff!

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Thank you!
Illinois Mental Health Collaborative for Access
and Choice