The Illinois Mental Health Collaborative for Access and Choice Overview of the Authorization Process

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

• March 27, 2008

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AGENDA

• Introductions
• Purpose of Monthly Meetings
• Topic Selections
• - authorization process in brief
• - overview of fidelity monitoring
• Questions

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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
• 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

• Improve Adherence to Both Rule 132 and Contract
• Learning Opportunities
• Share Evidence-Based Practices (EBP)
• Monthly Topic Selection Area
• Keep Communication Open
• (Attendance Recommended)

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Authorization Process

• 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

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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

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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 fidelity

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Overview of Fidelity Monitoring

• Ensuring Appropriateness of Services
• Key Elements of Fidelity Reviews
• - demonstration of EBP models in service
  delivery
• - adherence with eligibility requirements
  (Rule 132)
• Team Based Review

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Fidelity to EBP for ACTSome of the Highlighted
Elements

• Consumers Needs Drive Service, Time, and
  Location
• Consumer Staff Ratio of 101
• Team Approach - All (or Most) Staff Members
  Interact With Consumer
• Available 24/7 Support
• Crisis Planning

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Fidelity to EBP- ACT (Cont.)Some of the
Highlighted Elements

• Full Time Practicing Team Leader
• Psychiatrist and Nurse on Staff
• Staffing Continuity and Capacity
• Intake Rate
• Appropriate Family Involvement
• Service to Defined Population

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ACT Fidelity Tool

• Based on Dartmouth Assertive Community Treatment
  Scale (DACTS)
• (available online at www.samhsa.gov)
• Contains 28 Program Specific Items
• structure and composition
• organizational boundaries
• nature of service
• Designed to Measure the Degree of Implementation
  of ACT Programs

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Service Objectives

• 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

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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