Independent Assessment, Certification and Coordination Team: Process Overview. Magellan of Virginia May 15, 2018

Transcription

1 Independent Assessment, Certification and Coordination Team: Process Overview Magellan of Virginia May 15, 2018

2 Training Objectives Identify and describe important roles in the Independent Assessment, Certification and Coordination Team (IACCT) process Review of IACCT process and special situations that may occur during this process Review the IACCT Service request process Review Magellan CANS 2016

3 IACCT Members and Roles

4 Independent Assessment, Certification & Coordination Team (IACCT) Magellan will serve as a single point of entry for youth at risk of admission to residential treatment. For all Medicaid funded residential admissions, referrals must be made to Magellan, and the admission will be coordinated by the Independent Assessment, Certification and Coordination Team (IACCT). This team will consist of various professionals who will collaborate to provide assessments or assist in gathering medical and behavioral health treatment records that will be used to fully assess the youth and family needs in order to formulate a preliminary plan of care.

5 IACCT Team Members Other Participants Youth & Family Magellan Family Support Coordinator (FSC) LMHP Magellan Residential Care Manager (RCM) Physician

6 IACCT Member Roles and Responsibilities Youth and Family Youth and family or legal guardian serve as full partners in making decisions about their treatment needs. This includes the IACCT working with the family in: Identifying strengths and needs Participating in face to face assessments Setting goals Choosing culturally and linguistically competent supports, services and providers Partnering in decision making processes related to service options Identifying natural supports and viable family options

7 IACCT Team Member Roles and Responsibilities Licensed Mental Health Professional (LMHP) Meets face to face with the family to conduct the assessment Provides a comprehensive psychosocial assessment which shall include a thorough review of an individual s current mental health status. A psychosocial addendum can be completed if the member has had a comprehensive psychosocial assessment within the last year. Child and Adolescent Needs and Strengths Assessment (CANS) Adverse Childhood Experiences (ACEs): C ACES *until 5/31/18* Identify strengths and needs, and risk level and describe the severity of symptoms. Make recommendations to include level of care, treatment modalities, and cultural and family nuances Engage in care coordination with others involved in the youth s care

8 IACCT Team Member Roles and Responsibilities Physician It is intended that the physician member of the I!T will be a youth s existing primary care physician, or psychiatrist if applicable, since it is expected that these physicians will be familiar with the youth. Psychiatrists (MD or DO) must be credentialed with Magellan for reimbursement if the member has FFS, otherwise they will bill the activity through the MCO as a covered physician service IACCT may utilize a specific centralized physician familiar with the service system, e.g., a psychiatrist at the local CSB. This can be determined by the IACCT in order to meet the needs of each individual youth and family It is best practice that the physician signing the Certificate of Need will have personal knowledge of the youth s physical and mental health condition; This means that the physician would have had a face-to-face evaluation with the youth in order to assess the youth s clinical needs prior to signing the ertificate of Need; Magellan and the DM!S MO s will help coordinate physician involvement in the I!T process *If necessary, the physician can utilize telemedicine as an option*

9 IACCT Team Member Roles and Responsibilities Magellan - Residential Care Manager (RCM) Receives the inquiry and completes an education session with the guardian. The RCM will send the IACCT referral to the IACCT provider with guardian permission Assign the family support coordinator Review the results from the assessments and recommendations of the IACCT and apply the established medical necessity criteria to determine Medicaid funding authorization and the need for a recommendation meeting Assist the family in developing facility referrals if residential is recommended or collaborate with the rest of the IACCT to develop a community based plan of care if residential is not recommended. Collaborate with family support coordinators to monitor family engagement, strengths, and needs throughout the course of treatment

10 IACCT Team Member Roles and Responsibilities Magellan Family Support Coordinator (FSC) Provide education for informed decision making regarding treatment, and offer any other support or assistance to the family throughout the course of the independent assessment process and treatment Promoting family engagement throughout the course of treatment whether the plan of care is residential treatment or community based services In cases where the plan of care is community based, the FSC will remain engaged with the family to support the community based plan of care and help identify supports After discharge from residential, the FSC will continue to remain in contact at least monthly to provide ongoing support to the youth and family

11 IACCT Team Member Roles and Responsibilities Other Participants: These members will vary based on each individual s specific needs and involvement in services. Case Manager CSA/FAPT Teacher DSS Worker Private Providers

12 IACCT Process

13 Inquiry Process Magellan receives a residential inquiry Inquiry can be submitted by anyone Inquiries are commonly submitted by: the parent/guardian, the child's private provider, FAPT/CSA, residential facility, inpatient acute facility; Inquiry form is located here: Residential Program Process page

14 Inquiry to Education Session The timeline for completing the education session is 5 business days. This timeline changes to 1 business day if the member is in an acute inpatient facility The RCM reaches out to the guardian and provides education on the IACCT process, available community based services and resources, FAPT, and ensures that the guardian is aware of emergency services in their community if needed If the RCM is unable to reach the guardian after multiple attempts the inquiry will be closed The RCM proceeds with the IACCT process if the guardian provides verbal permission to move forward with the IACCT referral

15 Referral Process The RCM sends the IACCT referral form and information about due dates via secure and the timeline begins on the next business day Specific timeline for each aspect of the IACCT process IACCT Assessment: conducted within 2 business days Physician engagement: within 5 business days of the IACCT assessment IACCT recommendation: within 10 business days. The process can take up to 16 business days if the two 3-business days extensions are used

16 Proposed Communication following submission of Referral Form

17 Assessment Process The IACCT LMHP schedules a face-to-face assessment with the youth and parent/guardian and notifies the RCM of the assessment date If the youth is in an inpatient facility, the LMHP will contact the facility to arrange the assessment and obtain any assessments completed by the facility The face-to-face assessment can take place in the LMHP's office, the home, an inpatient facility, or via telemedicine The IACCT LMHP should ask that the parent/guardian bring supplemental documentation (e.g., IEP or other relevant school records, and any FAPT or legal records) The IACCT LMHP should engage the guardian in completing relevant release forms

18 Assessment Process: Telemedicine The IACCT face-to-face assessment requirement can be met through the use of telemedicine Please see DMAS Medicaid Memo: Updates to Telemedicine Coverage posted May 13, 2014 The IACCT Provider determines if they will complete the IACCT assessment in person or via an approved telemedicine technology If using telemedicine The LMHP will coordinate the telemedicine assessment with the guardian The IACCT LMHP will determine the process of getting release of information forms completed

19 Assessment Process Continued Assessments/Forms completed The Psychosocial Assessment form: IACCT Psychosocial Assessment Template If a face to face assessment was completed within the last year then a face to face is not required and the Psychosocial Assessment Addendum form can be completed IACCT Psychosocial Assessment Addendum Template Magellan CANS 2016 Magellan CANS 2016 Resources: See Residential Program Process page ACES ACES 1-11 Scoring Tool and Aces Scoring Tool See additional CANS Resources on Residential Program Process page Effective June 1, 2018, the ACEs will no longer be completed as part of the IACCT process. The IACCT LMHP will include their recommendation, as well as the level of care that the guardian and youth are requesting, in the Psychosocial Assessment or Psychosocial Assessment Addendum form

20 Physician Engagement The IACCT LMHP or a designated administrative staff will contact the youth's Psychiatrist or PCP to request his or her participation in providing information regarding the appropriate level of care for the youth. Within five business days of the face-to-face assessment, the IACCT LMHP will engage in care coordination with the identified physician and obtain the physician s recommendation. This should be added to the Physician Recommended Level of Care section of the Psychosocial!ssessment or Psychosocial!ssessment Addendum form. If the physician is recommending residential treatment services, the appropriate residential level of care Certificate of Need (CON) can be signed by the physician at this time.

21 Physician Engagement Continued If the Psychiatrist or physician has not had prior contact with youth, a face-to-face or telemedicine appointment must take place before recommendations can be provided. If either of these physicians is not able to make recommendations regarding the appropriate level of care, or if the youth does not have a Psychiatrist or PCP, the LMHP will contact the RCM. IACCT Physician Engagement Guide

22 Recommendation and Recommendation Meeting A Recommendation Meeting will not be required when: The physician and I!T LMHP s recommendation align with the level of care the guardian and youth are requesting; the LMHP will submit the IACCT Service Authorization Request to Magellan within one business day of obtaining the physician s recommendation. The Residential Care Manager (RCM) will review to determine if Medical Necessity Criteria (MNC) appears to be met. If MNC is met and there is consensus agreement between the family, physician and LMHP, no recommendation meeting is needed.

23 Recommendation and Recommendation Meeting Continued A Recommendation Meeting will be required when: The Recommendation Meeting is required within the ten business day timeline in situations where there is not consensus on the recommendation from the guardian and youth, IACCT LMHP, and physician, or MNC does not appear to be met The RCM may recommend that a recommendation meeting occur in complex cases or cases where a care coordination discussion would be beneficial The IACCT LMHP must submit the IACCT assessment documents to Magellan prior to the recommendation meeting.

24 Service coordination following IACCT recommendation IACCT LMHP The legal guardian completes a consent for the IACCT LMHP to share IACCT Assessment documents. If residential placement is recommended, the LMHP will send the IACCT assessment and Certificate of Need (CON) to the selected residential facility within one calendar day of the facility selection. The NPI number must be included on the CON for any child entering a PRTF. RCM The RCM develops a residential referral list with the family, taking into consideration the proximity of the service provider to the family's residence. If community services are selected, the RCM will work with the family to coordinate community based services.

25 IACCT Special Considerations ER Foster Care Placements Youth in foster care who are placed in residential according to the Emergency Placement definition by DSS The inquiry should be submitted within 5 days of the member being placed or 5 days of the member becoming eligible for Medicaid. The inquiry can be submitted by anyone. In this situation the CON is completed by the treatment team at the residential placement. The residential facility will provide a copy of the CON to the RCM and the RCM will provide a copy of the CON to the IACCT LMHP Other aspects of the IACCT process remain the same

26 IACCT Special Considerations Retro Special Consideration Youth who are already in residential treatment under an alternative funding or commercial insurance and become Medicaid eligible after being placed at the residential facility The inquiry should be submitted within 5 days of the member becoming eligible for Medicaid In this situation the CON is completed by the treatment team at the residential placement. The residential facility will provide a copy of the CON to the RCM and the RCM will provide a copy of the CON to the IACCT LMHP Other aspects of the IACCT process remain the same

27 IACCT Special Considerations Retro Special Consideration and youth in DJJ Youth who are held in detention for criminal activity are eligible for Medicaid payment limited to services received during an inpatient hospitalization. For youth who are held in detention for criminal activity, upon release from detention, the youth regains full Medicaid eligibility. If the member goes straight to a residential from detention, the provider should submit the IACCT inquiry and the Retro Special Consideration process should be followed. See Clarification IACCT Inquiries and Youth Residing in DJJ:

28 IACCT Special Considerations Inpatient Special Consideration The residential inquiry should be submitted to Magellan within one business day of determining that residential treatment services will be an aspect of the youth's discharge plan Youth who are in an acute inpatient facility and the treatment team at the inpatient facility determines that the member cannot safely be maintained in the community while waiting for residential placement The treatment at the inpatient facility will complete the CON The member can be placed at an identify residential facility prior to the IACCT process being completed Other aspects of the IACCT process would remain the same Youth who are in an acute inpatient facility and the treatment team at the inpatient facility determines the member can safely be maintained in the community while waiting for a residential placement The IACCT process is followed and the IACCT LMHP will complete the CON. The Inpatient physician can be engaged in signing the CON.

29 Reassessment Process In cases where the youth is receiving residential treatment, the IACCT LMHP will conduct a reassessment at 90 days or earlier Thirty days prior to the due date of the reassessment, the RCM will a reassessment referral form to the LMHP indicating the reassessment due date The LMHP will coordinate with the residential facility in order to complete the requirements of the reassessment The reassessment can be completed face to face, by telemedicine, or telephonically The re-assessment process includes An updated CANS submitted by a person certified to complete the CANS A review of the CANS individualized outcome report A psychosocial addendum if deemed clinically necessary by the IACCT LMHP

30 IACCT Service Request Process

31 Registration Request Process Submit IACCT Assessment SRA to Magellan within 1 Business Day Initial Request Complete the SRA Attach the psychosocial assessment, ACES Submit Magellan CANS 2016 through Managed Outcomes CPT Code: HK for initial IACCT assessment Reassessment Request Complete the SRA Attach the 2016 IACCT Clinical Re-Assessment and Recommendations Tool and psychosocial addendum (if completed) Submit Magellan CANS 2016 through Managed Outcomes CPT Coded: TS for IACCT reassessment IACCT Provider Training

32 SRA for IACCT Independent Assessment Certification and Coordination Team (IACCT) SRA This for m can b e uploaded on the provider webs ite ( nprovider.com). MtMI:H::t< INt-Ut<MA IIUN 1-'t<UVIUI::.t< INt-Ut<MA I IUN Member First Name IACCT Provider Name Member Last Name LMHP Contact Name Medicaid Number _J IACCTMIS# I Member Date of Birth IACCT Tax 10# I IACCTNPI J Sex DMale DFemale LMHP Phone I Member Phone LM HP I Member Address Service Address City, State & Zip Code City, Stale & Zip Code _j CLINICAL INt-URMA TION Procedure Code [] HK [] TS Primary Diagnosis Secondary Diagnosis Requested Units 1 Assessment Date I I 1. Please attach a copy of the Psychosocial Assessment and Adverse Childhood Expe rie.nces (ACEs) with this request. 2. For IACCT providers: Enter the Child and Adolescent Needs and Strengths Assessment (201.6 CANS) on www. magellan p rovide.-.com under "Manage Outcomes Reports". For IACCT locality Partners (MOU with DMAS): Attach a copy of the CANVas with this request. FOR REASSESSMENT ONL V 3. Was a Child and Adolescent Needs and Strengths Assessment (CANS) completed within the last 90 days? O ves O No a. If yes, were outcome measures completed? I:J Yes I:J No b. For IACCT Providers: Enter the CANS 2016 assessment on com. Attach the 2016 IACCT d inica'l Re-Assessment and Recommendations Tool with this request. For IACCT locality Partners (MOU with DMAS): Attach the latest CANVas and the 2016 IACCT dinical Re-assessment and Recommendations Tool with this request. Magellan HEALTH CARE.

33 Magellan CANS 2016

34 CANS Certification: Private Provider IACCT LMHPs Private Provider LMHPs will be expected to be certified in the Magellan CANS Private providers should certify directly on the Magellan CANS 2016 Certification in the Magellan CANS 2016 If the LMHP is from a Private Provider, after Jan 1, 2017, the Magellan CANS 2016 training and certification should be completed on Select the jurisdiction Magellan and the entity Virginia. All IACCT youth will have a Magellan CANS 2016 entered into the Magellan platform. 34 CANS 2016 for IACCT LMHP

35 CANS Certification: Other Questions If the LMHP has a certification in another CANS version: Certification in the CANS VA Comprehensive will be accepted. Other versions, please contact Magellan. If the LMHP is not the administrator: Your MagellanHealth.com/Provider website administrator will need to give you access to the Manage Outcomes application. If you are the admin, you automatically have access. If the administrator or LMHP has questions about administrator access please contact Magellan s Network department. 35 CANS 2016 for IACCT LMHP

36 Magellan CANS 2016: Access to Magellan Portal MagellanHealth.com/Provider 36 CANS 2016 for IACCT LMHP

37 Magellan CANS 2016: Within the Provider Portal Manage Outcomes Application 37 CANS 2016 for IACCT LMHP

38 Magellan CANS 2016: Within Manage Outcomes Search for CANS by youth or date range View completed CANS by date 38 CANS 2016 for IACCT LMHP

39 Magellan CANS 2016: Find Member by Eligibility Must include Last name, at least the first initial, the DOB, and the state. Note: If member cannot be found, check with your billing office on tips for finding members in the eligibility function. 39 CANS 2016 for IACCT LMHP

40 Magellan CANS 2016: Select the Member or Search Again 40 CANS 2016 for IACCT LMHP

41 Magellan CANS 2016: Select CANS CANS If CANS is a gray button, certification is not active 41 CANS 2016 for IACCT LMHP

42 Starting the Magellan CANS 2016 in Manage Outcomes Member Name Address here Default date today but can be dated earlier. Have the diagnosis code available before you start the CANS. 42 CANS 2016 for IACCT LMHP

43 Magellan CANS 2016: Use diagnosis search Drop down as enter diagnosis code 43 CANS 2016 for IACCT LMHP

44 Magellan CANS 2016: Complete the CANS Each Domain title will expand when clicked Each Item has a 0-3 rating with a brief anchor text with more for additional text to improve reliability Please use the Magellan CANS 2016 Manual for complete anchor definitions 44 CANS 2016 for IACCT LMHP

45 After Clicking Submit, a PDF will Pop-Up The PDF can be printed or saved. 45 CANS 2016 for IACCT LMHP

46 Access to Magellan Portal and CANS 2016 Application All IACCT LMHPs will need to have an active MagellanProvider.com account to access to the Magellan CANS 2016 application LMHPs who are Magellan certified providers will already have an account. Provider administrators will need to create accounts for LMHPs if not Magellan certified. The account should be given permission to Manage Outcomes; The administrator will need to enter the CANS certification date and keep a copy of the CANS certification in the personnel file. For the CANS 2016 application to remain open, the CANS certification date must be within the year. 46 CANS 2016 for IACCT LMHP

47 Access to CANS 2016 on Magellan Portal: Other Questions Your MagellanHealth.com/Provider website administrator will need to give you access to the Manage Outcomes application. If you are the admin, you automatically have access. If the administrator or LMHP has questions about administrator access please contact Magellan s Network department; Entry of the Magellan CANS 2016 does not replace any requirement the CSA or CSB may have to complete and enter into CANVaS a CANS VA Comprehensive. 47 CANS 2016 for IACCT LMHP

48 Additional upcoming information, training, and resources

49 Upcoming trainings There will be a series of three BBI webinars focused on successfully engaging and partnering with families. May 14, 2018, 10:00 a.m. 11:30 a.m. EST Building Bridges Initiative Part 1 Foundation: Engaging & Partnering with Families: One Program s Transformation, including usiness, linical and Family!dvocate Perspectives June 11, 2018, 1:30 p.m. 3:00 p.m. EST Building Bridges Initiative, Part 2 Advanced: Successful Strategies for Engaging & Partnering with Families July 12, 2018, 10:00 a.m. 11:30 a.m. EST Building Bridges Initiative, Part 3 Advanced: Successful Strategies for Residential and hild Welfare Partnerships to Support Permanency & Family Engagement

50 Additional Information and Resources Magellan of Virginia Website Residential Program Process Page Building Bridges Initiative

51 Legal disclaimers

52 Confidentiality Statement for Educational Presentations By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment. *If the presentation includes legal information (e.g., an explanation of parity or HIPAA), add this: The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors.

53 Confidentiality Statement for Providers The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. *If the presentation includes legal information (e.g., an explanation of parity or HIPAA), add this: The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors.

54 Thanks