Residential Mental Health Treatment for Children and Adolescents

Transcription

1 Residential Mental Health Treatment fr Children and Adlescents Requirement: Frequency: Due Date: Chapter 394, F.S. Sectin , F.S. Fla. R. Juv. P Chapter 65E-9, F.A.C. Chapter 65E-10, F.A.C. Onging Nt Applicable PROGRAM DESCRIPTION Residential Mental Health Treatment Defined The behaviral health system f care includes a cntinuum f services that vary in intensity frm cmmunity based services and supprts prvided in the hme and cmmunity t residential mental health treatment prvided in an ut f hme placement. Residential treatment prgrams prvide 24 hur live-in care and include the fllwing levels f care: Therapeutic fster hme means a residential prgram in a cmmunity-based setting where ne r tw minrs live in a licensed fster hme with adults wh receive specialized mental health training and supprt. Such supprt is als prvided t natural parents and thers as determined in the treatment plan. Therapeutic grup hme means a 24 hur residential prgram prviding cmmunity-based mental health services in a hme-like setting fr up t twelve children wh may safely attend schl and participate in activities in the cmmunity. Residential treatment center means a 24 hur residential prgram that prvides 24-hur inpatient and highly structured level f care. These are nt cnsidered crisis placements. In accrdance with s , F.S., the purpse f a residential treatment center is t prvide mental health assessment and treatment services pursuant t ss , , and , F.S. t children and adlescents wh meet the target ppulatin criteria specified in s (1)(a), (b), r (c), F.S. Licensure Bth therapeutic grup hmes and residential treatment center levels f care are defined as residential treatment centers in s (21), F.S. and licensed as such by AHCA under 65E-9, F.A.C. A residential mental health treatment prvider may als be licensed as a hspital by AHCA, under the prvisins f Chapters 395, Part I, and 408, Part II, F.S. SIPP prviders must be licensed by AHCA as a hspital in accrdance with Chapter 395, F.S., and Chapter 59A-3, F.A.C., r as a residential treatment center fr children and adlescents in accrdance with Chapter 394, F.S. and Chapter 65E-9, F.A.C. Updated 7/1/2017, Page 1

2 Funding Residential mental health treatment services are funded by a variety f surces that include but are nt limited t: private pay; private insurance; and public funds including Department general revenue and Medicaid. Placement f children and yuth in therapeutic ut f hme settings with Department general revenue funds is dependent n the availability f funds, per , F.S. Residential treatment services funded by private pay r private insurance may be accessed directly by the family. Publically funded residential mental health treatment has prcedural guidelines regarding eligibility, the prcess fr accessing services, and payment established in statute and administrative rule. Medicaid funded SIPP services include a utilizatin management cmpnent that requires prir-authrizatin and cntinued authrizatin fr services regarding medical necessity and active treatment. Eligibility Publically funded residential mental health treatment is intended t serve children and adlescents wh have been assessed and diagnsed as being emtinally disturbed by a psychiatrist r clinical psychlgist wh has specialty training and experience with children, per s , F.S., and wh meet the fllwing criteria, per Chapters 65E-9 and 65E-10, F.A.C.: (a) Be under the age f 21 fr SIPP services; (b) Be currently assessed (within 90 days prir t placement) by a psychlgist r a psychiatrist licensed t practice in the State f Flrida, with experience r training in children s disrders; wh attests, in writing, that: 1. The child has an emtinal disturbance as defined in s (5), F.S., r a serius emtinal disturbance as defined in s (6), F.S.; 2. The emtinal disturbance r serius emtinal disturbance requires treatment in a residential treatment setting; 3. A less restrictive setting than residential treatment is nt available r clinically recmmended; 4. The treatment prvided in the residential treatment setting is reasnably likely t reslve the child s presenting prblems as identified by the psychiatrist r psychlgist; and 5. The nature, purpse, and expected length f treatment have been explained t the child and the child s parent r guardian. (c) Have been reviewed at a minimum by the child and family team and been presented with all available ptins fr treatment. A child and family team staffing is ptinal fr children referred fr SIPP services and may be waived by the family. The purpse f a child and family team staffing fr these children is t discuss apprpriate alternatives t residential treatment and nt t determine eligibility fr the service.. Cmplete SIPP referral packets must be frwarded by the Managing Entity and Cmmunity Based Care prviders t the SIPP prvider fr all children being cnsidered fr SIPP services t allw the prir authrizatin prcess Updated 7/1/2017, Page 2

3 established by Mediaid t ccur. Recipients wh are enrlled in a Managed Medical Assistance (MMA) plan will receive authrizatin thrugh the MMA plan. Refer t the Specialized Therapeutic Services Cverage and Limitatins Handbk at the link internet address belw fr specific eligibility requirements fr Therapeutic Grup Care services. c_services_cverage_and_limitatins_handbk_adptin.pdf Referral Prcess fr Publically Funded Residential Mental Health Treatment Dependent children must be assessed fr suitability fr residential treatment thrugh the suitability assessment prcess described in s , F.S. All ther children r adlescents being cnsidered fr mental health residential treatment (hspital, residential treatment center, therapeutic grup hme) funded by Medicaid r General Revenue funds must be assessed by and have a written recmmendatin frm a psychlgist r psychiatrist stating they meet the eligibility criteria utlined in the Eligibility sectin, regardless f the funding surce. The fllwing prcess applies fr a nn-dependent child r adlescent whse family is seeking Medicaid funded SIPP and Therapeutic Grup Care services r general revenue funds frm the Department t purchase residential treatment services. The referral prcess fr SIPP is as fllws: A child and family staffing is scheduled with the family t discuss all treatment ptins, unless the family waives/declines the staffing, which is nt required fr the SIPP packet t be sent frward t the SIPP prvider. The SIPP packet is reviewed fr cmpleteness and submitted by the Cmmunity Based Care r Managing Entity prvider, r designee t the SIPP prvider t seek prir-authrizatin thrugh the utilizatin management prcess. Fr recipients enrlled in a Managed Medical Assistance (MMA) plan, prir authrizatin and utilizatin management is cmpleted by the MMA plan. The referral prcess fr families requesting Department general revenue funds t purchase residential treatment center and therapeutic grup hme services is as fllws: A child and family staffing is scheduled with the family t determine the mst apprpriate and least restrictive treatment ptins available t meet the child s needs. Per Chapter 65E- 10, F.A.C., a Child and family specific team is required fr families requesting financial assistance frm the Department fr residential treatment services. If residential treatment is determined t be necessary as the least restrictive treatment ptin and funds are available, the Department may assist the family t purchase services. Eligibility, referral and apprval guidelines fr Medicaid funded Specialized Therapeutic Grup Care and Specialized Therapeutic Fster Care services can be referenced in the Medicaid Specialized Therapeutic Services Cverage and Limitatins Handbk at the link Updated 7/1/2017, Page 3

4 belw: rapeutic_services_cverage_and_limitatins_handbk_adptin.pdf Prir t placing dependent children/adlescents in a residential mental health treatment center, Cmmunity Based Care agencies must fllw CFOP , Chapter , F.S. and Flrida Rule f Juvenile Prcedure 8.350, as applicable. Dependent children are staffed by the Cmmunity-Based Care (CBC) rganizatin prir t requesting residential placement, and CBC and/r its designated team is respnsible fr cmpleting their prcess fr review, apprval and securing f placement, if needed. Fr children nt in the dependency system r fr children withut third party insurance cverage r Medicaid, and prir t the submissin f a SIPP referral and packet, the families are t attend a lcal child and family staffing (CFS) team meetings crdinated by the Managing Entity and the Netwrk Service Prvider serving the child. The child and family staffing may be waived by the family. The purpse f this staffing meeting shall be t ensure that all least restrictive means f treatment have been explred, exhausted, r are unavailable. Written verificatin f this staffing shall be included in the SIPP packet. The lcal FSPT (Family Service Planning Team) meeting may serve as this staffing. If it has been determined that the child is in need f residential placement in a SIPP placement, the SIPP packet will be sent t the Managing Entity, r its cntracted prvider fr review. At a minimum, the fllwing infrmatin shuld be cntained in the SIPP packet: Clinical Recrds: 1. Psychiatric evaluatin with recmmendatin cmpleted within the last year 2. Psychlgical evaluatin (including full-scale IQ) cmpleted within the last year r a. Mst recent schl Psychlgical Evaluatin if the child is under ESE classificatin b. Other perfrmance factrs may help a child s intellectual capacity 3. Psychscial Evaluatin, if applicable 4. Previus clinical infrmatin frm Baker Acts, residential and in-patient admissins, partial hspitalizatins, utpatient treatment, etc. 5. Baker Act reprts (admissin, discharge, histry, physical) 6. Previus residential infrmatin 7. Psychiatric ntes/medicatin lg Medical and Schl Recrds: 1. Birth Certificate 2. Immunizatin recrds 3. Medical stability r medical clearance (physical within the last 90 days) 4. IEP if applicable 5. Last reprt card 6. Dental recrds Financial wrksheet (nn-medicaid children and Medicaid children recmmended fr RTC r STGH Managing Entity frms fr cmpletin: 1. Family Invlvement Cmmitment Letter 2. LSF Health Systems Cnsent Frm 3. LSF Health Systems Release f Infrmatin Updated 7/1/2017, Page 4

5 4. Sunshine Medicaid Administratin Release f Infrmatin 5. LSF Health Systems Residential Applicatin frm 6. LSF Health Systems sliding fee scale/financial wrksheet (nn-medicaid children and Medicaid children recmmended fr RTC r STGH) Upn review fr cmpleteness utilizing the SIPP Packet Cmpnent Checklist, the Managing Entity, r its designated cntracted prvider, will schedule a Child and Family Staffing (CFS). A cpy f the cmpleted packet will be frwarded t the apprpriate AHCA r MMA representative with ntificatin f the scheduled staffing. The CFS team may be cmprised f the fllwing: AHCA/Medicaid, Department s SAMH prgram ffice r designee, Parent/Guardian, Child, the treating Netwrk Service Prvider, and ther invitees such as the Department f Juvenile Justice (DJJ), Schl Liaisn (SEDNET), Family Advcate, r persns invited by the child r family. At the CFS staffing, the parent, guardian, r family member will be tld the availability f treatment prgrams in their area. The yuth s respnsible party will be prvided infrmatin regarding hw t request a tur f the facilities and receive a determinatin as t if this is an acceptable curse f treatment (medical necessity). The packet will then be frwarded t the identified SIPP prviders and nce the SIPP prvider determines that admissin is apprpriate, the SIPP prvider will cntact the referring entity, the Managing Entity (r designated cntracted prvider), r parent t advise, schedule and crdinate admissin. The Netwrk Service Prvider serving the child shall nt clse the case t case management services slely based upn admissin t SIPP. After admissin t a SIPP, the Netwrk Service Prvider staff may be asked t participate in n-ging Child and Family Staffing/Quality f Care reviews with AHCA and Medicaid regarding the yuth. These reviews shall be cnducted n less than every 30 days when the child is age 10 and under, and n less than every 90 days fr a child age 11 and ver. The Netwrk Service Prvider shall be present at these nging staffing t update the team regarding the child s prgress in treatment and t assist the SIPP prvider and family in planning fr discharge and aftercare services. The rle f Managing Entity staff during the quality f care review is t evaluate the residential treatment prvider s cmpliance with federal and state requirements n the use f restraint and seclusin in children s residential mental health treatment facilities. Rule 65E-9.008(4). F.A.C. specifies the prcess f residential placement. It states, Children placed by the department and funded in full r in part by state, Medicaid, r lcal matching funds shall be admitted nly after they have a recmmendatin frm the apprpriate multidisciplinary team and been persnally examined and assessed fr suitability fr residential treatment. Depending n wh hlds custdy f the child and where the child is residing, determines the requirements fr placement in residential treatment including therapeutic grup hme. This dcument is t prvide a guideline fr the suitability assessment prcess and residential placement fr cmmunity children. 1 1 Fr further guidance n suitability assessments fr children in the dependency, criteria fr the placement f children in department s custdy, utline f steps t achieve placement fr these children in a residential treatment center, and designatin fr regularly scheduled reviews f the treatment center, cmmunity based care rganizatin (CBC), and the curts, see s , F.S., r the CBC Suitability Assessment and Residential Placement Guidelines. Updated 7/1/2017, Page 5

6 Suitability Assessments The purpse f the independent evaluatin is t determine the suitability fr residential treatment and apprpriateness f treatment. In rder fr a child/adlescent t be cnsidered fr admissin, a psychlgist r psychiatrist licensed t practice in the state f Flrida must cnduct an examinatin and assessment f the child/adlescent and prvide written findings n the fllwing: The child has an emtinal disturbance as defined in s (5), F.S., r a serius emtinal disturbance as defined in s (6), F.S.; The emtinal disturbance r serius emtinal disturbance requires treatment in a residential treatment center; All available treatment that is less restrictive than residential treatment has been cnsidered r is unavailable; The treat prvided in the residential treatment center is reasnably likely t reslve the child s presenting prblems as identified by the qualified evaluatr; The prvider is qualified by staff, prgram and equipment t give the care and treatment required by the child s cnditin, age and cgnitive ability; The child is under the age f 18; and The nature, purpse and expected length f the treatment have been explained t the child and the child s parent r guardian. A cpy f the written findings f the evaluatin r the suitability assessment must be prvided t Medicaid within five (5) wrking days f the date the child was seen. They will then frward the assessment t the lcal Single Pint f Access (SPOA) within three (3) wrking days f receipt. Prir t sending the cmpleted reprt t the SPOA, Medicaid staff must review fr crrectins, additins and cmpliance with statutry and Agency fr Health Care Administratin (AHCA) standards. The SPOA is then respnsible fr disseminating, as required. Suitability Assessment Referral Prcess A suitability assessment can be achieved in tw different ways: 1. The family can btain the suitability assessment and letter frm their psychlgist r psychiatrist recmmending residential care; r 2. The multidisciplinary team can request and refer a family fr a suitability assessment nce the determinatin has been made that residential care is needed. A family r treatment prvider can request a multidisciplinary team (MDT) meeting t identify cmmunity resurces t prevent the need fr residential care. These meetings are held in lcal cmmunities and may be cmprised f the fllwing: AHCA/Medicaid, department s SAMH prgram ffice r designee, Parent/Guardian, Child, the treating prvider, and the invitees such as the Department f Juvenile Justice (DJJ), Schl Liaisn (SEDNET), Family Advcate, r ther persns invited by the child r family. Updated 7/1/2017, Page 6

7 Prcess fr Placement f Child Based On Suitability Assessment Results All children referred t a SIPP must have an applicatin cmpleted. The multidisciplinary staff can help the family gather the required infrmatin and navigate the intake prcess. Families have the right t waive this staffing ptin. Children being referred t a Therapeutic Grup Hme must attend a MDT Staffing and may nt utilize the waived staffing ptin. Once an Applicatin is cmpleted with required dcuments, the applicatin shuld be frwarded t the lead MDT Facilitatr which is identified by the MDT. The Team will read thrugh the infrmatin prvided by the family and assist the family in clarifying what has and has nt wrked therapeutically. The team may identify resurces that are available in the cmmunity that have nt been tried and wuld be apprpriate and helpful fr the family. If n less restrictive ptins are available, the applicatin packet will be cmpleted and submitted t Magellan Medicaid Administratin. This ffice will review the packet fr admissin criteria and the family will be cntacted by the SIPP prgram. Once the packet is cmplete, a designated staff persn in the reginal SAMH ffice cmpletes referrals t SIPP. The parent, guardian, r family member will be tld the availability f treatment prgrams in their area. The yuth and the yuth s respnsible party will be able t tur the facility and receive an assessment frm the prvider t determine if all parties invlved agree that this is an acceptable curse f actin. Once the SAMH staff, the yuth, respnsible party, and the prvider determine that admissin is apprpriate, the SIPP prvider will cntact the state utilizatin management cntractr fr prir authrizatin f the admissin. Then scheduled admissin is discussed. PROGRAM GOALS AND OBJECTIVES Residential mental health treatment is prvided t children/adlescents fr the specific purpse f addressing their mental health needs thrugh bservatin, diagnsis, and treatment in a therapeutic setting. Residential mental health treatment services are nt intended t be used fr emergency placements r t prvide secure shelter fr a child/adlescent. Children/adlescents in acute psychiatric crisis shuld be referred t a crisis stabilizatin unit fr emergency screening and stabilizatin. MONITORING Residential treatment centers are licensed and mnitred by AHCA. Facilities may chse t be accredited and may ask the Agency t accept their accreditatin, in lieu f receiving rutine n-site licensure surveys, by submitting the required dcumentatin frm a recgnized r apprved accreditatin rganizatin. Additinal infrmatin regarding the licensing and accreditatin requirements can be referenced n the AHCA website at the fllwing link: RESIDENTIAL TREATMENT PROVIDER RESPONSIBILITIES AND EXPECTATIONS Residential treatment prviders are required t cmply with relevant federal and state statutes, accreditatin requirements, and licensure and cntract requirements. Updated 7/1/2017, Page 7