Residential Level Transitions: Levels III and IV

Transcription

1 Residential Level Transitions: Levels III and IV Joint Legislative Oversight Committee on MH/DD/SAS September 8, 2010 Mark J. O Donnell, O M.P.H. DMH/DD/SAS 1

2 Why Changes Were Made? FY budget greatly reduces funding levels (42%) for Child Residential Level III and Level IV services for both Medicaid and state funded consumers. FY reduces funding another 18%. Many of these children were inappropriately placed in these LIII or LIV residential facilities, with medical necessity and clinical applications being in question. 2

3 What Did We Do? System of Care Response By mutual agreement, the Department of Health and Human Services, the Department of Juvenile Justice and Delinquency Prevention, the Department of Public Instruction and the Administrative Office of the Courts embraced a System of Care (SOC) approach to providing services to children, youth and families. 3

4 What Did We Do? LME Role: Triage The LME has been the lead agency coordinating and overseeing the transition. LME System of Care Coordinators and other LME care coordination staff triaged the initial list of currently placed youth based on severity of need and authorization timelines. SOC coordinators, LME care coordinators, or Community Support providers gathered clinical information from the most recent ITR, the current person centered plan (PCP), and the Risk Questionnaire along with other helpful information to assist in the triage and Child and Family Team meetings processes. 4

5 What Did We Do? LME Role: Best Practice LME System of Care Coordinators and/or other LME care coordination staff attend all Child and Family Team meetings for youth in their catchment areas. In cases when this is not possible, a care coordinator is in close contact with the Community Support Qualified Professional convening the team. LME System of Care Coordinators ensure that the Child and Family Team process that occurs for each child/youth follows the best practice principles of the System of Care model. 5

6 State Guidance Before a child can be admitted to Level III or Level IV placement the following shall apply: 1. Placement may be a transition from a Psychiatric Residential Treatment Facility (PRTF) or inpatient setting OR 2. Multisystemic Therapy (MST) or Intensive In-Home (IIH) services did not meet the youth s treatment needs within the last six months and severe functional impairments persist; AND 3. The CFT has reviewed all other alternatives and recommendations and recommends Level III or IV residential placement due to maintaining the health and safety of the child. 6

7 State Guidance Cont d For all new admissions to child residential services, length of stay is limited to no more than 120 days. All requests for a new admission must include a discharge plan signed by the SOC Coordinator in order for the request to be considered complete. 7

8 State Guidance Cont d The psychiatric assessment justifying the request and a revised discharge plan must be submitted to DHHS Vendor with the ITR and Person Centered Plan revision including documentation of the review of the CFT. Requests for Level III and Level IV residential services for children must follow the established Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) procedures and requirements. 8

9 What Happened? Residential III and IV Results: Recipients In Level III and Level IV Residential Services 9/7/10 9/7/10 Recipients in Level III residential services Recipients in Level IV residential services. 133 Recipients in Level III residential services 620 Recipients in Level IV residential services 29 Difference of 2608 Difference of 160 9

10 What Happened? Residential III and IV Results: Recipients who have been Paper Triaged 2538 Discharge Percentage 80% Recipients who have had an initial Child and Family Team (CFT) 2546 Discharge Percentage 81% Recipients who have had a follow-up Child and Family Team (CFT) meeting 2866 Discharge Percentage 91% Recipients who have been discharged from Level III residential services 2321 Discharge Percentage 78% Recipients who have been discharged from Level IV residential services 155 Discharge Percentage 92% 10

11 What Happened? Residential III and IV Results: Where CFTs are referring children (in order of need): Medication Management Outpatient Individual Therapy Outpatient Family Therapy Intensive In Home Natural Supports Therapeutic Foster Care PRTF Day Tx Residential Level II MST Residential Level III Residential Level IV SAIOP Outpatient Group Respite 11

12 What Happened? Residential III and IV Results: Services in which some catchment areas require expansion: Respite Intensive In Home MST SAIOP Day Tx Therapeutic Foster Care PRTF 12

13 What Happened? Residential III and IV Results: Level III beds as of August 1, Level III beds in catchment areas as of the date of this report 1124 Percentage Remaining: 47% Level IV beds as of August 1, Level IV beds as of the date of this report 12 Percentage Remaining: 9% 13

14 What Happened? DMH, working with the UNC Behavioral Health Research Program and Dr. Barbara Burns of Duke University, is conducting a follow-up study to determine the status of the children thus far discharged. 14

15 What Happened Cont d? Working with Paid Claims data, 91% of the children discharged have remained stable in their discharge placement. 9% have returned to a LIII or LIV placement. Some of these have subsequently returned to their community placements. Children have been safe in their discharge placement. 15