The Division of Mental Health and Addiction s 1915(i) Child Mental Health Wraparound

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1 The Indiana Family and Social Services Administration The Division of Mental Health and Addiction s 1915(i) Child Mental Health Wraparound

2 Welcome! Gina Doyle, Asst. Deputy Director Julie Bandy, Provider Specialist Heidi Gross, Lead Site Coach

3 CMHW Services Module A CMHW Services Program Module (previously referred to as manual) is available at /dmha%20cmhw.pdf The Module gives detailed explanation on a wide variety of topics including participant eligibility, expectations of providers, service definitions, enrollment procedures, billing and claims, incident reporting, complaints, and more.

4 Systems of Care Systems of Care has a multi-level approach Indiana System of Care Governance Board Local (county) SOC Governance Board Child and Family Teams Community decisions that make an impact on our youth are dependent upon community members, local services, representation from the silos and youth and family and are made at these meetings.

5 Silos represented in our communities Child Welfare Behavioral Health Medicaid Juvenile Justice Education

6 High Fidelity Wraparound High Fidelity Wraparound is a process that builds on the collective action of a committed group of family, friends, community, professional, and cross-system supports and resources to develop a Plan of Care (POC) that is the best fit between the family vision and story, team mission, and youth and family strengths, needs, and strategies. High Fidelity Wraparound provides youth and their families with access, voice, and ownership in the development and implementation of their POCs. One Plan to Rule Them All

7 Access Site: Point of Entry Referrals for CMHW services should be made to the Access Site Each county has an Access Site. The Access Site list is maintained on the DMHA IN System of Care website.

8 CMHW Eligibility Target Group Criteria Ages 6-17 Meets criteria of two or more DSM V diagnoses not excluded below (ICD-10) Borderline level of intellectual function or above Exclusionary Diagnoses Primary Substance Abuse Disorder Primary or Secondary Pervasive Developmental Disorder Primary Attention Deficit Hyperactivity Disorder Level of Care met through CANS assessment (4,5,6) Medicaid eligible Traditional Managed Care Residential Requirements Must live in a family or foster home in the community Must NOT live in a facility or residential placement of any kind Homeless youth are eligible

9 CMHW Eligibility Transition by the time the youth turns 18. Services will NOT be covered once the youth is 18. The CMHW program will renew July 1, At that time, it is anticipated that approved eligibility reviews completed on 17-year-olds will provide a full 12-months of services so long as other eligibility criteria continue to be met.

10 CMHW Services Wraparound Facilitation (WF) Required Habilitation (HAB) Training and Support for the Unpaid Caregiver (FST) Hourly Fees Respite (RES) Hourly Facility-Based

11 Wraparound Facilitation The Wraparound Facilitator Manages the entire wraparound process and ensures that the participant and family s voice, preferences, and needs are central in developing the POC and throughout service delivery. Ensures that care is delivered in a manner consistent with strength-based, family-driven, and culturally competent values. Receive ongoing coaching and training throughout their practice Must have case loads of twelve (12) or fewer, regardless of service provided. (e.g. Services provided through MRO, or Skills training and Development are included in the case load count.

12 Wraparound Facilitation (WF) Procedure Code/Modifier: T2022 HA Description: Case management; per month Unit: 1 unit = 1 month Unit Restriction: 1 unit per month Rate: $ per unit

13 Habilitation (HAB) Habilitation = Skill Building Habilitation services are provided with the goal of enhancing the youth s level of functioning and quality of life. Building the youth and family s strengths, resilience and positive outcomes Habilitation vs. Rehabilitation Rehabilitation is relearning a skill that has already been demonstrated by the person Habilitation is learning a new skill to be able to improve overall functioning

14 Habilitation Skills Identification of feelings and responses during interactions Anger and emotional management How to give and receive feedback, criticism, or praise Problem-solving and decision making Learning to resist negative peer pressure and to develop prosocial peer interactions Improvement of communication skills Building and promoting positive coping skills Learning how to have positive interactions with peers and adults

15 Training and Support for the Unpaid Caregiver (FST) Intent Provide education and supports to the UNPAID caregiver that preserves the family unit and increases confidence, stamina, and empowerment. An unpaid caregiver is any person who provides uncompensated care, training, guidance, companionship or support to the youth. Family member Neighbor Family friend Coworker Companion Paid caregivers are not eligible to receive this service. Foster parent/s Coach Teacher

16 Training & Support for the Unpaid Caregiver (FST) Services allowed may include but are not limited to teaching the following: Practical living and decision-making skills Child development parenting skills Home management skills Use of community resources and development of informal support Conflict resolution Coping Skills Gaining an understanding of the youth s mental health needs Learning communication and crisis de-escalation skills geared for working with the youth s mental health and behavioral needs

17 Service Provision (FST) Hourly One to one with unpaid caregiver Face to face Non-Hourly Family Group activities, conferences, classes based on the cost of the activity. Home care training for the family. Non-Hourly Non-Family Group activities, conferences, classes based on the cost of the activity. Home care training for non-family caregiver.

18 Training & Support for the Unpaid Caregiver (FST) Procedure Code/Modifier: H2015 HA Description: Comprehensive community support services; per 15 minutes Unit: 1 unit = 15 minutes Unit Restriction: Maximum of 8 units per day Rate: $15.00 per unit EOB Codes: I CHILD TRAINING & SUPPORT SERVICE FOR UNPAID CAREGIVER (COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES) LIMITED TO 8 UNITS PER DAY

19 Training & Support for the Unpaid Caregiver (FST) Procedure Code/Modifier: H2015 HA Description: Comprehensive community support services; per 15 minutes Unit: 1 unit = 15 minutes Unit Restriction: Maximum of 8 units per day Rate: $15.00 per unit EOB Codes: I CHILD TRAINING & SUPPORT SERVICE FOR UNPAID CAREGIVER (COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES) LIMITED TO 8 UNITS PER DAY

20 Respite (RES) Respite is a service provided due to the regular caregiver s absence or need for relief. Intent: To provide a break for the caregiver. Not a substitute for regular childcare to allow parent or caregiver to hold a job, attend school, or engage in job-related activities.

21 Activities Allowed (RES) Assistance with daily living skills, like accessing and transporting youth to and from community activities Assistance with grooming and personal hygiene Meal preparation, serving, and cleanup Administration of medications Supervision

22 CMHW Services Rates Wraparound Facilitation (WF) Unit= 1 month Rate: $ per unit Habilitation (HAB) Unit= 15 minutes Rate: $19.26 per unit Training and Support for the Unpaid Caregiver (FST) Hourly Unit= 15 minutes Rate: $15.00 per unit Fees Up to $500 per year per participant

23 CMHW Services Rates Respite (RES) Community-Based Routine Hourly Unit= 15 minutes Rate: $4.00 per unit Community and Facility-Based Routine Daily Unit= 1 day Rate: $100 per unit Community and Facility-Based Crisis Daily Unit= 1 day Rate: $120 per unit Facility-Based in a Medicaid Certified PRTF Unit= 1 day Rate: $321.52

24 CMHW Provider Qualifications Provider types Accredited Agencies Non-accredited Agencies Individuals Rendering providers must be approved individually by DMHA prior to enrollment Agency approval is contingent upon approval of the rendering provider no blanket approvals For additional information, consult the Child Mental Health Wraparound module

25 DMHA s 1915 (i) Child Mental Health Wraparound services Thank you!