Accessing Services Through the Louisiana Behavioral Health Partnership

School Climate Institute: June 4-6, 2013

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Outcome Goals:

Participants will:

• Increase their understanding of the Louisiana Behavioral Health Partnership(LBHP) and the Coordinated System of Care (CSoC);

• Increase their understanding of Magellan’s role in LBHP and CSoC;

• Develop an understanding of the services that eligible children can receive;

• Increase their understanding on how to make a referral to LBHP and CSoC; and

• Learn that school districts can claim Medicaid reimbursement for behavioral health services provided to students with IEPs.

DHH Office of Behavioral Health and LA Medicaid have collaborated with:

Department of Children and Family Services (DCFS)

Office of Juvenile Justice (OJJ) Department of Education (DOE)

To restructure LA’s behavioral health services into a system which is now managed statewide by:

Magellan Health Services.

A Collaborative Partnership

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One Service System

Uninsured children and adults who have serious

mental illness and/or addictive disorders.

Medicaid-eligible children with medically necessary

behavioral health needs who need coordinated care.

Adults with serious mental illness and/or addictive

disorders who are Medicaid-eligible.

Children with extensive behavioral health needs either in or at risk of out-

of-home placement.LBHP

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Who is Magellan?

A health care management company that:Works with government agencies, health plans and employers to offer consumers a choice in finding the most appropriate and effective health care services.

Provides access to expanded behavioral health services that focus on personal strengths and build hope.

Provides care and services that respect the behavior, ideas, attitudes, values, beliefs and language of the individuals served

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Magellan’s RoleIncreasing Access to Care• Single point of entry: 24-hour/7-day phone line• Network of Providers• Determine clinical eligibility for HCBS waiver services• Assist members with eligibility

Coordinating Care• Review and authorize based on individual needs and set criteria• Conduct Follow-Up• Provide Intensive Case Management for Special Health Populations• Manage services within the Coordinated System of Care• Coordinate with Physical Health plans.• Dedicated Care Management for DCFS, OJJ, DOE

Managing the Program• Process and Pay Claims• Electronic BH Record• Data for federal reporting

Improving Quality• Data infrastructure to support data-informed decisions• Quality care metric audits and provider profiles• Technical support for providers to achieve highest quality care

Transforming the System• Peer Specialists• Cultural Competency• Member Centricity• Focus on Recovery

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Magellan’s Task in Louisiana

• Manage Care for Behavioral Health (mental health and substance abuse services) for Louisiana citizens covered by Medicaid (all ages) and some without Medicaid.Adult Behavioral Health Program (21+)Children’s Behavioral Health (Non-CSoC)Coordinated System of Care (CSoC)

Eligibility

The LBHP-eligible populations - Children & Youth (50,000)

There are two populations of children and youth eligible for LBHP services: Children and youth with behavioral health needs

eligible for services from OJJ, DCFS, DHH and DOE, including those served by Medicaid (approximately 50,000 children)

Children and youth with significant behavioral health challenges or co-occurring mental illness and addictions in, or at risk of, out-of-home placements, eligible for the CSoC (about 2,400 children)

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Coordinated System of Care (CSoC) Youth• Children with significant behavioral health challenges.

– Students with an IEP or General Education Students– Positive Behavior Interventions and Support (PBIS) “Tier 3” Students

• Students at-risk of out-of-home placement– Detention– Secure Care Facilities– Psychiatric hospitals– Residential treatment facilities– Developmental disabilities facilities– Addiction facilities– Foster care– Alternative schools– Homeless

The Louisiana Behavioral Health PartnershipThe Nuts and Bolts – Children’s System 11

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Children’s Services – What You Need to Know

Louisiana Behavioral Health Partnership Coordinated System of Care (in LBHP) (Up to 2400 Children)

• All children with significant behavioral health difficulties

• Youth with serious emotional/behavioral disorders in or at-risk of out of home placement

• Ages: birth – adulthood • Ages: birth – 21New Medicaid definition of a child:No longer birth – 18, now birth - 21

• Wraparound Approach• Wraparound Agency• Family Support Organization • (Child & Family Team)

• State Plan services • State Plan and five additional services: Parent Support & Training, Youth Support & Training, Crisis Stabilization, Respite, Independent Living/Skills Building

• Statewide • Phased in– 5 regions initially

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Children’s Services – What You Need to Know

Service(or LOC)

MedicaidChildren

OBH Children

OJJ andDCFS w/agency OK

CHIP CSoC Children

Psych Hosp YES YES (OBH facility)

YES YES YES

Psychiatrist (no auth)

YES YES YES YES YES

PRTF, TGH,TFC, & NMGH

YES NO YES YES YES

LMHP OP tx – up to 24 (no auth)

YES YES (OBH provider)

Some, butwith limits

NO YES

Psych Testing YES Yes (OBH provider)

YES NO YES

Addiction Rehab

YES YES (OBH provider)

YES NO YES

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Children’s Services – What You Need to KnowService(LOC)

Medicaid Children

OBH Children OJJ & DCFS w/agency OK

CHIP CSoC Children

Detox YES YES YES NO YES

MHRehab: CPST, CI, PSR

YES YES YES NO YES

Case Conf YES YES YES NO YES

MST, FFT, Homebuilders (age)

YES YES YES YES NO for MST& FFT

ACT NO NO NO NO NO

ECT YES If OK’d by OBH

NO NO YES

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Students with an IEP• The IEP must include behavioral health services

• The IEP serves as the authorization for select services

• Licensed Clinical Social Worker, Certified School Social Worker, Certified School Psychologist, Licensed Professional Counselor, etc. provide the related services

• These professionals are considered “service providers” for the LEA and are required to enter the related services that they provide in the DOE electronic tracking system (RSMS)

• The school system is able to claim a portion of Medicaid reimbursement for these authorized services through DHH

This is the first time schools are able to claim reimbursement for behavioral health services!

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Billable Services in Schools

• Four (4) categories of billable services1. Case Conferences2. Addiction Services3. Community Psychiatric Support and

Treatment4. Other Licensed Practitioner Outpatient

Therapy

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Accessing Services for a Child in Need

1-800-424-439924/7 phone line for all LBHP members

• More than 57,000 calls received in the first 150 days, with an abandonment rate of less than 1 percent

• Referral services – for assessment or to Magellan Network service provider• Authorization of services – Care Managers work with providers to review

for Medical Necessity and determine appropriate levels of care based on individual level of need and Service Authorization Criteria

Coordinated System of Care Implementation (2,400)

What are the Goals of CSoC?

1. Improve overall outcomes for children/youth and their caregivers.

2. Decrease the number of youth in out of home placement settings.

3. Reduce the state’s cost for providing services by leveraging Medicaid and other funding sources

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What are the Education Related Goals for CSoC?

1. Improve student attendance

2. Increase student achievement

3. Decrease classroom disruptions - more time on-task for all students

4. Decrease suspensions and expulsions

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Who is Eligible for CSoC?

• Any general education or special education student that has significant behavioral health challenges and co-occurring disorders that are in or at-risk of an out of home placement and live in an implementing Region.

• Out of Home Placements are:• Detention/Secure Care

Facilities• Psychiatric Hospitals• Residential Treatment

Facilities

• Foster Care• Alternative Schools• Homeless as defined by DOE

CSoC Implementing Regions

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Implementing Regions

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Implementing Regions by parish• Region 1 – Jefferson parish

• Region 2 - East Baton Rouge (includes Zachary, City of Baker and Central Community school systems) and West Baton Rouge parishes, East and West Feliciana, Iberville, and Pointe Coupee parishes.

• Region 7 - Avoyelles, Grant, LaSalle, Vernon, Rapides, Catahoula, Concordia, and Winn parishes.

• Region 8 - Caddo, DeSoto, Natchitoches, Red River, Sabine, Bienville, Bossier, Claiborne, Jackson, and Webster parishes.

• Region 9 - Morehouse and Ouachita (includes the City of Monroe School System), East and West Carroll, Franklin, Lincoln, Madison, Richland, Tensas, and Union parishes.

(Note: CSoC uses Act 1225 Regions)

Eligibility Criteriaand

How to Make a Referral

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Eligibility Criteria1 - Clinical Eligibility criteria:

– Must be between 0 and through the age of 21 years old– Lives, or for those in placement will be living, in a CSoC implementing

region– Has a DSM Axis I diagnosis or is exhibiting behaviors indicating that a

diagnosis may exist– Meets clinical eligibility on the CANS Comprehensive assessment

which determines Level of Care (LOC) and Level of Need (LON) and in conjunction with the Independent Behavioral Health Assessment

– Currently in an out of home placement (OOH), or at imminent risk of OOH placement

– Generally involved with multiple state agencies– Identified family or adult resource that is or will be responsible for the

care of the child/youth who is willing to engage in wraparound.

2. Financial Eligibility is determined by DHH/Medicaid.

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What Services are Available?

1. All students enrolled in CSoC receive wraparound services.

2. The five specialized services that are only available to CSoC eligible students are:

• Parent Support and Training• Youth Support and Training• Individual Living/Skills Building• Respite Care• Crisis Stabilization

3. State Plan Amendment Services

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How to make a referral… What is needed:Reason for referral

(Needs assessment, assistance with placement if needed, CSoC, other plan services)

Demographic information on child

Caregiver/Legal Guardian name and contact information

DSM diagnosis or child exhibiting signs/behaviors that would warrant a clinical comprehensive assessment

As much clinical information as available about the child

Services requested

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CALL Magellan1-800-424-4399

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Screening process…Once Magellan receives a call or fax…

The Member Service Representative (MSR) will conduct a preliminary screening by asking the following three risk questions: Over the past month:

1. Has the child ever talked about or actually tried to hurt him/herself or acted in a way that might be dangerous to him/her such as reckless behaviors like riding on top of cars, running away from home or promiscuity? Y/N/U

2. Has the child ever been a danger to others, such as threatening to kill or seriously injure another person, fighting to the point of serious injury, been accused of being sexually aggressive, or engaging in fire setting? Y/N/U

3. Has the child deliberately or purposefully behaved in a way that has gotten him/her in trouble with the authorities such as breaking rules at school or laws in your community? Y/N/U

Based on the results of this preliminary screening, the caller may be transferred to a Magellan Care Manager (CM) for additional clinical determination for appropriate services.

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Screening process continued…

• The Care Manager (CM) will conduct the CANS Brief Screening to determine initial eligibility for CSoC.

• If the child/youth does not meet initial eligibility criteria, other appropriate LBHP services and resources will be explored

• If the child/youth does meet initial eligibility criteria, the CM submits a referral to the CSoC team

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Coordination of Care…• CSoC team processes referral

– To the appropriate Wraparound Agency (WAA)– To the Statewide Family Support Organization (SFSO)– To Certified Provider (CP) for CANS Comp/IBHA (1915c) assessments – Final Clinical Eligibility is determined by Magellan’s internal

Independent Evaluator– Final Financial Eligibility is determined by Medicaid

• Access to the 5 specialized services in CSoC: Parent Support/Training

Youth Support/Training Crisis Stabilization Short Term Respite Care Independent Living/Skills Building

The Wraparound Process

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What does the WAA do?In Coordination with the Child, Family, and Family Support Organization (FSO):

• Develops an individualized plan of care (POC) for children/youth enrolled in the Coordinated System of Care (those children referred to the WAA by Magellan).

• Works with the formal and informal supports in the child’s life

• Identifies the services and supports in the community

• Respects the family’s culture, values, and religious beliefs

• Coordinates services in the least restrictive or intrusive environment possible

• Assigns a Wraparound Facilitator (WF) to every family. The WF, in coordination with the Parent Support Specialist from the FSO, helps guide the family through the wraparound process.

What does the Statewide Family Support Organization do?• Provides direct family-to-family peer support, youth mentoring,

education, and advocacy services to family members of children with emotional and behavioral health challenges and enrolled in CSoC.

• Matches parents/caregivers and youth with Youth Support Training Specialists who have first-hand knowledge on navigating systems for themselves and/or family members.

• Provides a Parent and Youth Support Training Specialist to walk side-by-side with parents/caregivers and youth to help them better understand and work collaboratively with the Wraparound process.

Questions?36

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For Additional Information:

Coordinated System 0f Care Website:

http://www.csoc.la.gov

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ContactsMagellan Behavioral Health•Foley Nash, 225-367-3000 ext. 43006, flnash@magellanhealth.com

•Donna Herrin, 225-367-3000 ext. 43011 DLHerren@magellanhealth.com

•Mary Ann Donovan-Mason, 226-367-3000 ext. 43010, mdmason@magellanhealth.com

•Donna Nola-Ganey, 225-367-3014, dnolaganey@magellanhealth.com

Department of Health and Hospitals

•Janice Zube, 225-342-4373, janice.zube2@la.gov

Department of Education• Janice Fruge, 225.342.3338, janice.fruge@la.gov