1 the illinois mental health collaborative for access and choice overview of the authorization...
TRANSCRIPT
1
The Illinois Mental Health Collaborative for Access and Choice
Overview of the Authorization Process and Fidelity Monitoring
March 27, 2008
ACT Team Leader Meeting
2
AGENDA
Introductions
Purpose of Monthly Meetings
Topic Selections- authorization process in brief
- overview of fidelity monitoring
Questions
3
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
4
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
5
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
6
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)
7
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
8
Submitting Authorization Requests
Collaborative Contact Information:
www.IllinoisMentalHealthCollaborative.com
Telephone: 866-359-7953
NEW Fax Number: 866-928-7177
The Collaborative Verifies Eligibility and Provider Status
9
Authorization Review Time Frame
Completed Requests Response Time:
- Within one (1) business day for initial authorizations
- Within three (3) business days for reauthorizations
10
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
11
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
12
Fidelity to EBP for ACTSome of the Highlighted Elements:
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
13
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
14
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
15
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
17
Today’s presentation will be available online in April 2008
http://www.IllinoisMentalHealthCollaborative.com/providers/Training/Training_Workshops_Archives.htm
Be sure to share this information with your staff!
Posting of the Presentation