Magellan Behavioral Health: Central Region Behavioral Health Organization (BHO)
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1 Magellan Behavioral Health: Central Region Behavioral Health Organization (BHO) Serious Emotional Disturbance (SED) Tracking Specialty Clinic Provider Training December 2011 THE MAGELLAN HEALTH COMPANIES Behavioral Health Specialty Pharmacy Management Radiology Medicaid Administration
2 Program Tasks/Scope of Services Task 1: Monitor, review and assess the use of behavioral health inpatient care Concurrent review of hospital admissions for BH Monitor discharge planning activities and ambulatory follow-up Enhanced discharge planning for individuals identified by the state as disengaged from care Enhanced discharge planning for individuals who are readmitted Enhanced discharge planning for individuals with 3 or more detox admissions Task 2: Outpatient tracking for children with SED Track children newly diagnosed having a SED by specialty clinics Report monthly to the state Task 3: Provider profiling (inpatient, detox and rehab providers) Quarterly provider profiles Share information with stakeholders Biannual meetings with stakeholders to provide information Task 4: Facilitate cross-system linkages Meet quarterly with stakeholders Encourage IP providers to develop linkages with health homes Develop relationships with health homes Assure discharge plans address individuals physical health needs Magellan Health Services, Inc. 2
3 SED Information Definitions Serious emotional disturbance (SED) means a child or adolescent has a designated mental illness diagnosis according to the most current Diagnostic and Statistical Manual of Mental Disorders (DSM) and has experienced functional limitations due to emotional disturbance over the past 12 months on a continuous or intermittent basis. The functional limitations must be moderate in at least two of the following areas or severe in at least one of the following areas: Magellan Health Services, Inc. 3
4 SED Information Definitions (1) ability to care for self (e.g., personal hygiene; obtaining and eating food; dressing; avoiding injuries); or (2) family life (e.g., capacity to live in a family or family like environment; relationships with parents or substitute parents, siblings and other relatives; behavior in family setting); or (3) social relationships (e.g., establishing and maintaining friendships; interpersonal interactions with peers, neighbors and other adults; social skills; compliance with social norms; play and appropriate use of leisure time); or (4) self-direction/self-control (e.g., ability to sustain focused attention for a long enough period of time to permit completion of age-appropriate tasks; behavioral self-control; appropriate judgment and value systems; decisionmaking ability); or (5) ability to learn (e.g., school achievement and attendance; receptive and expressive language; relationships with teachers; behavior in school). NYS OMH Clinic Treatment Program regulations 14NYCRR Part 599.4(ay) Magellan Health Services, Inc. 4
5 Magellan Health Services, Inc. 5
6 Provider Sign In Page Magellan Health Services, Inc. 6
7 SED Tracking Web based application Magellan Health Services, Inc. 7
8 SED Tracking: Search for Child in Eligibility Magellan Health Services, Inc. 8
9 SED Tracking: Select Child from Eligibility Magellan Health Services, Inc. 9
10 SED Tracking: Web Based Form Magellan Health Services, Inc. 10
11 Web Based Form Detail: Child and Provider Magellan Health Services, Inc. 11
12 Web Based Form Detail: Diagnoses and Functional Impairments Magellan Health Services, Inc. 12
13 Web based SED Tracking Form: Preview Page Magellan Health Services, Inc. 13
14 Web based SED Tracking Form: Completion Page Magellan Health Services, Inc. 14
15 SED Tracking Form Instructions Providers must notify Magellan of newly diagnosed children as having Serious Emotional Disturbance (SED) Begin SED tracking with admissions on or after January 1, 2012 Youth up to (but not including) their 19th birthday Send by the end of the week Online submission of SED tracking forms at will be coming in January ~ until then ~ Complete the SED Tracking Form in the Excel or PDF versions Send the completed Excel or PDF form to Quality Manager Joann Linnenbach at: JMLinnenbach@MagellanHealth.com Or FAX to Magellan Health Services, Inc. 15
16 SED Tracking Form Instructions Information needed in the completed SED Tracking Form: Name of beneficiary, DOB, and identifiers Medicaid number Date of service Provider Name and information Diagnoses on Axis I and II Functional Impairment(s) You will be notified when the website opens in January 2012 You will then use your User Account to access the on-line SED Tracking application
17 Site Location Office Location 300 South State Street, Syracuse, NY Hours of Operation Monday - Friday 9:00 am 7:00 pm Toll-Free Number (beginning 1/1/12) available 24/7 Magellan Health Services, Inc. 17
18 Syracuse Care Management Center Staff General Manager: Kate O Connell QI Manager: Joanne Linnenbach Care Managers Tracy Carmody Ann Frigolette Mary Peterson Carin Skapars Magellan Health Services, Inc. 18
19 Questions? Magellan Health Services, Inc. 19
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