UCARE MODEL OF CARE SUMMARY FOR MH-TCM (February 2009)

Size: px
Start display at page:

Download "UCARE MODEL OF CARE SUMMARY FOR MH-TCM (February 2009)"

Transcription

1 UCARE MODEL OF CARE SUMMARY FOR MH-TCM (February 2009) The UCare Model of Care for Mental Health Targeted Case Management is designed to provide care for the child member and their families and adult members, working in conjunction with the counties and qualified, appropriate providers and agencies. Historically, care for members with mental health needs has been fragmented, with little or no coordination between health care, social service, and community providers. Up to this point, MH-TCM has been the responsibility of the Counties in Minnesota. Effective July 1, 2009, this responsibility will transition to the MCOs for members in the MHCP programs. I. Goals UCare s MH- TCM Model of Care has the following goals: Employ interventions to improve health outcomes and quality of life for members with mental health needs (SPMI or SED). Support adult access to medical, social, educational, vocational and other necessary services relating to member s mental health needs. Assist child and family to obtain needed mental health, social, educational, health, advocacy, transportation and legal services. II. Criteria for MH TCM The MH-TCM Model of Care follows the Minnesota Statutes defining criteria for members qualifying for targeted case management. Children with a diagnosis of SED (Severe Emotional Disturbance as defined in MN Statute ;subd 6) and adults with SPMI (Severe and Persistent Mental Illness as defined in MN Statute, section subd 20) will be offered the choice of being assigned a case manager to work with them. SPMI: Severe and Persistent Mental Illness. (MN Statute, section subd 20) means an adult who has a mental illness and meets at least one of the following criteria: 1. Has undergone two or more episodes of inpatient care for a mental illness within preceding 24 months. 2. Has experienced continued psychiatric hospitalization or residential treatment exceeding 6 months duration within preceding 12 months. 1

2 3. Been treated by a crisis team two or more times within the preceding 24 months. (Pending Federal approval). 4. The adult: A. Has a diagnosis of schizophrenia, bipolar disorder, major depression or borderline personality disorder. B. Indicates significant impairment in functioning, or C. Has a written opinion from a mental health professional within the last 3 years, stating the adult is reasonably likely to have future episodes requiring inpatient or residential treatment (of a frequency described in (1) or (2) above) unless ongoing CM (case management) or community support services are provided. 5. Has, within the last 3 years, been committed by a court as person who is mentally ill under Chapter 253B or commitment has been stayed or continued. 6. Eligible under above bullet points but specified time has expired or adult was eligible as child (sec ;subd 6) and as noted in 4C above. SED Severe Emotional Disturbance (MN Statute ;subd 6) a child who has an emotional disturbance and who meets one of the following criteria: 1. Has been admitted within the last three years or is at risk of being admitted to inpatient treatment or residential treatment for an emotional disturbance. 2. Is a Minnesota resident and is receiving inpatient treatment or residential treatment for an emotional disturbance through the Interstate Compact. 3. Has one of the following as determined by a mental health professional: A) Psychosis or clinical depression. B) Risk of harming self or others as a result of an emotional disturbance, or C) Psychopathological symptoms as a result of being a victim of physical/sexual abuse or of psychic trauma within past year, or D) As a result of an emotional disturbance has significantly impaired home, school, or community functioning lasting more than one year or in written opinion of mental health professional, presents substantial risk of lasting at least one year. 2

3 III. Case Management Process 1) Referral to County 2) County determines eligibility. 8) ICSP/IFCSP reviewed every 180 days 3) Diagnostic Assessment completed 7) Services delivered; CM monitoring 4) CM Functional Assessment completed 6) Create IFCSP/ICSP 5) Collect Data (as appropriate) A. Role of Case Manager: UCare supports CMS s definition of Case Management: Services that will assist the individuals eligible under the State plan in gaining access to needed medical, social, educational, and other services and to include the following: o Assessment. o Development of specific care plan. o Referral and related activities to obtain needed services. o Monitoring and follow up activities. 3

4 Appropriate identification of the member is a critically important success factor in achieving optimal clinical outcomes. The case management model must consist of a comprehensive assessment of the member to determine the need for any medical, educational, social or other services. It also includes development of a specific care plan based on information gathered during the assessment. The care plan must include goals and actions addressing the medical, educational, social and other services needed by the member. Appropriate and timely referral to assist the member in obtaining needed services and monitored follow up are required as well. B. Authorization/Notification: No changes will be made to this process. Utilization review will continue to be provided by BHP or MMSI. Providers must contact BHP or MMSI, as appropriate, for authorization/notification of services as outlined on UCare s provider web site page. NOTE: Counties are required to notify BHP or MMSI when a UCare member is assigned to a case manager and enrolled in TCM. C. What TCM does not include: Direct delivery: medical, educational, social or other services. Activities regarding administration of foster care programs. Activities paid for by third parties. Services that are components of other Medicaid services: ie, rehabilitation, therapy, diagnostic assessment, medication management. Treatment or therapy. Legal advocacy. Performing a diagnostic assessment. Administration, management, or monitoring medications. D. Case Load Average caseload of a CM providing services to children with SED shall not exceed the ratio of 15 clients to one FTE Case Manager.* Average caseload of a CM providing services to an adult with SPMI shall not exceed the ratio of 30 clients to one FTE case manager. * Caseload standards apply to counties and health plans. DHS will monitor caseload ratios. 4

5 *Reference: MN Rules , subd. 2 and 3; Bulletin # , pg 12, #15 E. Documentation Requirements 1. Assessment Tools: Children s functional assessment CASII (recommended by DHS). This is currently the DHS recommended tool and has not been mandated by DHS at this time. Expectations are that it will be the required tool in the near future. Adult functional assessment DHS Functional Assessment (or current tool used by county). There is no DHS recommended tool at this time. 2. Plan of Care: Establish IFCSP/ICSP. Goals and actions (medical, educational, social, other). Participation. Monitor effectiveness of plan. 3. Case Notes: Documentation of face to face visit every 30 days or as stated in contract agreement. Document progress or lack of progress toward goals. Document review of IFCSP/ICSP every 180 days (or more often if requested). IV. Case Management Staff and Supervisor Qualifications: UCare follows the requirements set forth by DHS for staff conducting case management for the MH TCM member population. Services must be provided consistent with Rule 79, parts to , MN Statutes sections to and 256B.0625 subd 20 and to A. Child Case Manager: Except as provided in subpart 3, a case manager providing case management services to a child with SED must have a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university and have at 5

6 least 2,000 hours of supervised experience in the delivery of mental health services to children with emotional disturbance, be skilled in identifying and appraising the child's needs, be skilled in setting and monitoring appropriate service outcomes, and be knowledgeable about local community resources and how to use the resources for the benefit of the child and the child's family. A person from any professional discipline that is part of the local system of care serving children or who is employed by or under contract to the local agency is eligible to serve as a case manager for children with SED if the person meets the above qualifications. B. Adult Case Manager. Except as provided in subpart 3, a case manager providing case management services to an adult with SPMI must have a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university and have at least 2,000 hours of supervised experience in the delivery of services to adults with mental illness, must be skilled in the process of identifying and assessing a wide range of client needs, must be skilled in setting and monitoring appropriate service outcomes, and must be knowledgeable about local community resources and how to use those resources for the benefit of the adult with serious and persistent mental illness. C. Supervision: Case Manager. If the mental health professional is providing clinical supervision of a case manager who provides case management services to children, the mental health professional must be qualified as specified in Minnesota Statutes, section , subdivision 27, and must be skilled and knowledgeable about children with emotional disturbance. The mental health professional providing the clinical supervision must document the clinical supervision in the client's record. 1. Clinical supervision is not required for a case manager who is qualified as a mental health professional. 2. Case managers who are not qualified as mental health professionals under Minnesota Statutes, section , subdivision 27, for services to children with emotional disturbance or under Minnesota Statutes, section , subdivision 18, for services to adults with mental illness, and who have at least 2,000 hours of supervised experience in the delivery of mental health services, as appropriate, to 6

7 children or adults must meet in person with a mental health professional at least once each month to obtain clinical supervision. 3. Case managers who have a bachelor's degree in one of the behavioral sciences or a related field from an accredited college or university but who do not have 2,000 hours of supervised experience in the delivery of mental health services as appropriate to children with emotional disturbance or adults with serious and persistent mental illness, must receive clinical supervision regarding individual service delivery from a mental health professional at least once each week until the requirement of 2,000 hours of experience is met. V. Conclusion: UCare will establish a collaborative relationship with counties and providers. This will include monitoring and reporting of progress toward established outcome measures. We support the need for better coordination and case management of physical health, mental health and social services and to work collaboratively with the counties and other providers to improve outcomes for this population. VI. References: Minnesota Statutes, section 256B.0625, subd. 20 Comprehensive Adult and Children s Mental Health Acts, Minnesota Statutes, sections Minnesota Statutes, sections Minnesota Statutes, sections Minnesota Statutes, sections Minnesota Statutes, sections Minnesota Rules, parts Minnesota Statute, chapter 253B (Minnesota Commitment and Treatment Act) Minnesota Statute, section Adult Mental Health Services: Activities that are coordinated with the community support services program and are designed to help adults with serious and persistent mental illness in gaining access to needed medical, social, educational, vocational and other necessary services as they relate to the client s mental health needs. Includes: Functional assessment. ICSP (Individual community support plan). 7

8 Referring/assisting member to obtain needed mental health and other services. Coordination of services. Monitoring the delivery of services. Minnesota Statute, section Child Mental Health Services: Activities that are coordinated with the family community support services and are designed to help the child with severe emotional disturbance and the child s family obtain needed mental health, social, educational, health, vocational, recreational services and related services in the areas of volunteer services, advocacy, transportation and legal services. Includes: Assistance in obtaining a comprehensive diagnostic assessment as needed. Developing a functional assessment. Developing an IFCSP (Individual family community support plan). Assistance to child and family to obtain needed services by coordination with other agencies. Assure continuity of care. Assess/reassess delivery, appropriateness and effectiveness of services over time. Minnesota Rule: * Also referred to as RULE 79: establishes standards and procedures for providing mental health CM services. Must be read in conjunction with applicable Minnesota statutes. *Also reference: MHCP Provider Manual (Chapter 8

Mental Health Certified Family Peer Specialist (CFPS)

Mental Health Certified Family Peer Specialist (CFPS) Mental Health Certified Family Peer Specialist (CFPS) Policy Number: SC170065A1 Effective Date: May 1, 2018 Last Updated: PAYMENT POLICY HISTORY VERSION DATE ACTION / DESCRIPTION Version 1 5/1/2018 The

More information

CHILDREN'S MENTAL HEALTH ACT

CHILDREN'S MENTAL HEALTH ACT 40 MINNESOTA STATUTES 2013 245.487 CHILDREN'S MENTAL HEALTH ACT 245.487 CITATION; DECLARATION OF POLICY; MISSION. Subdivision 1. Citation. Sections 245.487 to 245.4889 may be cited as the "Minnesota Comprehensive

More information

IDAHO SCHOOL-BASED MENTAL HEALTH SERVICES (EFFECTIVE JULY 1, 2016) PSYCHOTHERAPY & COMMUNITY BASED REHABILITATION SERVICES (CBRS)

IDAHO SCHOOL-BASED MENTAL HEALTH SERVICES (EFFECTIVE JULY 1, 2016) PSYCHOTHERAPY & COMMUNITY BASED REHABILITATION SERVICES (CBRS) IDAHO SCHOOL-BASED MENTAL HEALTH SERVICES (EFFECTIVE JULY 1, 2016) PSYCHOTHERAPY & COMMUNITY BASED REHABILITATION SERVICES (CBRS) IMPORTANT Medicaid providers are required to provide services in accordance

More information

The PrimeWest Health County-Integrated Care Management Program

The PrimeWest Health County-Integrated Care Management Program The PrimeWest Health County-Integrated Care Management Program PrimeWest Health (PrimeWest) developed and utilizes a comprehensive member-centered care management process called the County-Integrated Care

More information

Assertive Community Treatment (ACT)

Assertive Community Treatment (ACT) Assertive Community Treatment (ACT) Assertive Community Treatment (ACT) services are therapeutic interventions that address the functional problems of individuals who have the most complex and/or pervasive

More information

Bulletin. DHS Provides Policy for Certified Community Behavioral Health Clinics TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE

Bulletin. DHS Provides Policy for Certified Community Behavioral Health Clinics TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE Bulletin NUMBER 17-51-01 DATE February 27, 2017 OF INTEREST TO County Directors Social Services Supervisors and Staff Case Managers and Care Coordinators Managed Care Organizations Mental Health Providers

More information

Medical Assistance Home Care Ratings of EN, MT, CS

Medical Assistance Home Care Ratings of EN, MT, CS #02-56-07 Bulletin June 7, 2002 Minnesota Department of Human Services # 444 Lafayette Rd. # St. Paul, MN 55155 OF INTEREST TO! County Directors! County Social Service Supervisors! Public Health Nursing!

More information

INTEGRATED CASE MANAGEMENT ANNEX A

INTEGRATED CASE MANAGEMENT ANNEX A INTEGRATED CASE MANAGEMENT ANNEX A NAME OF AGENCY: CONTRACT NUMBER: CONTRACT TERM: TO BUDGET MATRIX CODE: 32 This Annex A specifies the Integrated Case Management services that the Provider Agency is authorized

More information

Mental Health Targeted Case Management. What is MH-TCM the basics. What is MH-TCM the basics

Mental Health Targeted Case Management. What is MH-TCM the basics. What is MH-TCM the basics Mental Health Targeted Case Management Managed Care Programs: Case Management, Care Coordination, and Care Management In Managed Care July 23, 2009 Videoconference Richard Seurer, DHS-Adult Mental Health

More information

256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS.

256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS. 1 MINNESOTA STATUTES 2016 256B.0943 256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS. Subdivision 1. Definitions. For purposes of this section, the following terms have the meanings given them. (a)

More information

Florida Medicaid. Statewide Inpatient Psychiatric Program Coverage Policy

Florida Medicaid. Statewide Inpatient Psychiatric Program Coverage Policy Florida Medicaid Statewide Inpatient Psychiatric Program Coverage Policy Agency for Health Care Administration December 2015 Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority...

More information

DHS Requires Standardized Outcome Measures and Level of Care Determinations for Children s Mental Health

DHS Requires Standardized Outcome Measures and Level of Care Determinations for Children s Mental Health #09-53-02 Bulletin April 22, 2009 Minnesota Department of Human Services -- P.O. Box 64941 -- St. Paul, MN 55164-0941 OF INTEREST TO County Directors Tribal Directors Social Services Supervisors and Staff

More information

Florida Medicaid. Therapeutic Group Care Services Coverage Policy

Florida Medicaid. Therapeutic Group Care Services Coverage Policy Florida Medicaid Therapeutic Group Care Services Coverage Policy Agency for Health Care Administration July 2017 Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal

More information

Critical Time Intervention (CTI) (State-Funded)

Critical Time Intervention (CTI) (State-Funded) Critical Time (CTI) (State-Funded) Service Definition and Required Components Critical Time (CTI) is an intensive 9 month case management model designed to assist adults age 18 years and older with mental

More information

(c) A small client to staff caseload, typically 10:1, to consistently provide necessary staffing diversity and coverage;

(c) A small client to staff caseload, typically 10:1, to consistently provide necessary staffing diversity and coverage; 309-019-0225 Assertive Community Treatment (ACT) Overview (1) The Substance Abuse and Mental Health Services Administration (SAMHSA) characterizes ACT as an evidence-based practice for individuals with

More information

CHAPTER 24 ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, MENTAL RETARDATION, AND DEVELOPMENTAL DISABILITIES PREAMBLE

CHAPTER 24 ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, MENTAL RETARDATION, AND DEVELOPMENTAL DISABILITIES PREAMBLE Human Services[441] Ch 24, p.1 CHAPTER 24 ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, MENTAL RETARDATION, AND DEVELOPMENTAL DISABILITIES PREAMBLE The mental health, mental retardation,

More information

Psychosocial Rehabilitation Medical Necessity Criteria

Psychosocial Rehabilitation Medical Necessity Criteria Program Description Psychosocial Rehabilitation Medical Necessity Criteria Psychosocial Rehabilitation (PSR) is a community-based program that promotes recovery, community integration, and improved quality

More information

Macomb County Community Mental Health Level of Care Training Manual

Macomb County Community Mental Health Level of Care Training Manual 1 Macomb County Community Mental Health Level of Care Training Manual Introduction Services to Medicaid recipients are based on medical necessity for the service and not specific diagnoses. Services may

More information

# December 29, 2000

# December 29, 2000 #00-53-3 December 29, 2000 Minnesota Department of Human Services 444 Lafayette Rd. St. Paul, MN 55155 OF INTEREST TO! County Social Service Directors/Supervisors! County Designated LMHA for PASRR! County

More information

CTSS Community Primary Application Information Session 1 Administrative Infrastructure Minnesota Department of Human Services (DHS)

CTSS Community Primary Application Information Session 1 Administrative Infrastructure Minnesota Department of Human Services (DHS) CTSS Community Primary Application Information Session 1 Administrative Infrastructure Minnesota Department of Human Services (DHS) Children s Mental Health Division CTSS is: A flexible set of mental health

More information

Sustaining Open Access. Annie Jensen LCSW Clinical Consultant, MTM Services

Sustaining Open Access. Annie Jensen LCSW Clinical Consultant, MTM Services Sustaining Open Access Annie Jensen LCSW Clinical Consultant, MTM Services Annie.Jensen@mtmservices.org Healthcare Reform Context Under an Accountable Care Organization Model the Value of Behavioral Health

More information

Final Report. UCare Minnesota 2005

Final Report. UCare Minnesota 2005 Minnesota Department of Health Compliance Monitoring Division Managed Care Systems Section Final Report UCare Minnesota 2005 Quality Assurance Examination For the period May 1, 2002 through February 28,

More information

Division of Mental Health, Developmental Disabilities & Substance Abuse Services NC Mental Health and Substance Use Service Array Survey

Division of Mental Health, Developmental Disabilities & Substance Abuse Services NC Mental Health and Substance Use Service Array Survey Table 1 Service Name Include any subcategories of service on a separate line In Table 2, please add service description and key terms Outpatient Treatment Behavioral Health Urgent Care (a type of outpatient)

More information

Targeted Case Management- Mental Health

Targeted Case Management- Mental Health KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Targeted Case Management- Mental Health Part II TARGETED CASE MANAGEMENT-MENTAL HEALTH PROVIDER MANUAL Introduction Section 7000 7010 8100 8300 8400 Forms

More information

2. Payment for Prescribed Drugs. Payment for prescribed drugs will be available as described in Subsection of these rules.

2. Payment for Prescribed Drugs. Payment for prescribed drugs will be available as described in Subsection of these rules. IDAHO ADMINISTRATIVE CODE Department of Health & Welfare IDAPA 16.03.09 Medicaid Basic Plan Benefits 2. Payment for Prescribed Drugs. Payment for prescribed drugs will be available as described in Subsection

More information

Program of Assertive Community Treatment (PACT) BHD/MH

Program of Assertive Community Treatment (PACT) BHD/MH Program of Assertive Community Treatment () BHD/MH Luis Marcano, x5343 Alan Orenstein, x0927 Program Purpose Program Information Help individuals with serious mental illness achieve and maintain community

More information

Name: Intensive Service Array Responsible Department: Lane County Health and Human Services- Trillium Behavioral Health

Name: Intensive Service Array Responsible Department: Lane County Health and Human Services- Trillium Behavioral Health Procedure Name: Responsible Department: Lane County Health and Human Services- Trillium Behavioral Health Plans: Medicaid Medicare Marketplace PEBB Current Effective Date: 1-26-16 Scheduled Review Date:

More information

ILLINOIS 1115 WAIVER BRIEF

ILLINOIS 1115 WAIVER BRIEF ILLINOIS 1115 WAIVER BRIEF STATE TESTING FOR THE FOLLOWING ACHIEVED RESULTS: 1. Increased rates of identification, initiation, and engagement in treatment 2. Increased adherence to and retention in treatment

More information

I. General Instructions

I. General Instructions Contra Costa Behavioral Health Services Request for Proposals (RFP) Outpatient Mental Health Services September 30, 2015 I. General Instructions Contra Costa Behavioral Health Services (CCBHS, or the County)

More information

Wyoming CME Clinical Eligibility Criteria

Wyoming CME Clinical Eligibility Criteria Wyoming CME Clinical Eligibility Criteria Version 1.0 Effective Date: Nov. 16, 2016 Wyoming CME Clinical Eligibility Criteria 2016 Magellan Health, Inc. Table of Contents Wyoming CME Clinical Eligibility

More information

Mental Health and Substance Abuse Services Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE. Effective Date:

Mental Health and Substance Abuse Services Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE. Effective Date: Mental Health and Substance Abuse Services Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE Date of Issue: July 30, 1993 Effective Date: April 1, 1993 Number: OMH-93-09 Subject By Resource

More information

In Arkansas 02/20/2014 1

In Arkansas 02/20/2014 1 In Arkansas 02/20/2014 1 Procedures for Determination of Medical Need for Nursing Home Services I. Medical Need Assessments A. Nursing Facility Procedures B. OLTC Procedures II. Pre-Admission Screening

More information

State Recognition of the CPRP Credential

State Recognition of the CPRP Credential State Recognition of the CPRP Credential ARIZONA AHCCCS (the state Medicaid authority) and the Arizona Department of Health Services officially recognized the CPRP in a letter directed to T/RBHA agencies

More information

Dialectical Behavioral Therapy (DBT) Level of Care Guidelines

Dialectical Behavioral Therapy (DBT) Level of Care Guidelines Page 1 of 5 Category: Code: Subject: Purpose: Policy: Utilization Management Dialectical Behavioral Therapy () Level of Care Guidelines The purpose of this policy is to describe the criteria used by BHP

More information

Florida Medicaid. Behavioral Health Therapy Services Coverage Policy. Agency for Health Care Administration [Month YYYY] Draft Rule

Florida Medicaid. Behavioral Health Therapy Services Coverage Policy. Agency for Health Care Administration [Month YYYY] Draft Rule Florida Medicaid Behavioral Health Therapy Services Coverage Policy Agency for Health Care Administration [Month YYYY] Draft Rule Florida Medicaid Table of Contents 1.0 Introduction... 1 1.1 Description...

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE ISSUE DATE EFFECTIVE DATE NUMBER September 8, 1995 September 8, 1995 1153-95-01 SUBJECT Accessing Outpatient Wraparound

More information

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 21 MENTAL HYGIENE REGULATIONS Chapter 27 Community Mental Health Programs Respite Care Services Authority: Health-General Article, 10-901 and 10-902,

More information

Medical Assistance Adult Rehabilitative Mental Health Services (ARMHS) Updates and Clarifications

Medical Assistance Adult Rehabilitative Mental Health Services (ARMHS) Updates and Clarifications Bulletin September #06-53-03 25, 2006 Minnesota Department of Human Services P.O. Box 64941 St. Paul, MN 55164-0941 OF INTEREST TO County Directors Tribal Health Services Directors Social Services Supervisors

More information

Clinical Utilization Management Guideline

Clinical Utilization Management Guideline Clinical Utilization Management Guideline Subject: Therapeutic Behavioral On-Site Services for Recipients Under the Age of 21 Years Status: New Current Effective Date: January 2018 Description Last Review

More information

Florida Medicaid. Behavioral Health Community Support and Rehabilitation Services Coverage Policy. Agency for Health Care Administration [Month YYYY]

Florida Medicaid. Behavioral Health Community Support and Rehabilitation Services Coverage Policy. Agency for Health Care Administration [Month YYYY] Florida Medicaid Behavioral Health Community Support and Rehabilitation Services Coverage Policy Agency for Health Care Administration [Month YYYY] Draft Rule Table of Contents 1.0 Introduction... 1 1.1

More information

Psychology Externship Information

Psychology Externship Information November 20, 2017 Psychology Externship 2018-2019 Information Contact information for externship: o Address: 720 N St. Asaph St. Alexandria, VA 20314 o Psychology Externship director: Kirimi Fuller, Psy.D.;

More information

The CCBHC: An Innovative Model of Care for Behavioral Health

The CCBHC: An Innovative Model of Care for Behavioral Health The CCBHC: An Innovative Model of Care for Behavioral Health B R E N D A G O G G I N S, J D V I C E P R E S I D E N T O A K S I N T E G R A T E D C A R E M I C H A E L D A M I C O, L C S W D I R E C T

More information

NETWORK180 PROVIDER MANUAL SECTION 1: SERVICE REQUIREMENTS TARGETED CASE MANAGEMENT

NETWORK180 PROVIDER MANUAL SECTION 1: SERVICE REQUIREMENTS TARGETED CASE MANAGEMENT NETWORK180 PROVIDER MANUAL SECTION 1: SERVICE REQUIREMENTS TARGETED CASE MANAGEMENT Provider will comply with regulations and requirements as outlined in the Michigan Medicaid Provider Manual, Behavioral

More information

Provider Frequently Asked Questions

Provider Frequently Asked Questions Provider Frequently Asked Questions Strengthening Clinical Processes Training CASE MANAGEMENT: Q1: Does Optum allow Case Managers to bill for services provided when the Member is not present? A1: Optum

More information

Service Review Criteria

Service Review Criteria Client Name: SAR#: Administrative Review Process notes: When documenting call outs to provider, please document the call in a patient note in Alpha the day the call is made. tes should be coded as Care

More information

HEALTH SERVICES POLICY & PROCEDURE MANUAL

HEALTH SERVICES POLICY & PROCEDURE MANUAL PAGE 1 of 7 References Related ACA Standards 4 th Edition Standards for adult Correctional Institutions 4-4368, 4-4369, 4-4370, 4-4371, 4-4372 PURPOSE To provide guidelines for prioritizing immediacy and

More information

As of June. Psychiatric Rehabilitation. referred to. ARIZONAA officially FLORIDA. Certification GEORGIA. for each service: and advocacy. community.

As of June. Psychiatric Rehabilitation. referred to. ARIZONAA officially FLORIDA. Certification GEORGIA. for each service: and advocacy. community. State Recognitionn of the CPRPP Credential As of June 2013, the Certified Psychiatric Rehabilitation Practitioner (CPRP) credential is recognized by the statess listed below. Please note: The Psychiatric

More information

Rule 132 Training. for Community Mental Health Providers

Rule 132 Training. for Community Mental Health Providers Rule 132 Training for Community Mental Health Providers October 2013 Goals for training Understand purpose and vision of Rule 132 Understand Rule 132 requirements Understand the appropriate application

More information

ROSIE D. V. ROMNEY PLAINTIFFS FINAL REMEDIAL PLAN. August 18, 2006

ROSIE D. V. ROMNEY PLAINTIFFS FINAL REMEDIAL PLAN. August 18, 2006 ROSIE D. V. ROMNEY PLAINTIFFS FINAL REMEDIAL PLAN August 18, 2006 TABLE OF CONTENTS SECTION 1: SCOPE AND PRINCIPLES 1 1. Purpose and Scope of Plan 1 A. Purpose and Goals of the Plan 1 B. Scope of the Plan

More information

SUPPLEMENTAL GUIDELINES FOR MENTAL HEALTH UTILIZATION MANAGEMENT AND TREATMENT PLANNING

SUPPLEMENTAL GUIDELINES FOR MENTAL HEALTH UTILIZATION MANAGEMENT AND TREATMENT PLANNING SUPPLEMENTAL GUIDELINES FOR MENTAL HEALTH UTILIZATION MANAGEMENT AND TREATMENT PLANNING Produced for the Magellan Mental Health Guidelines for the Pennsylvania HealthChoices Project Magellan Behavioral

More information

Eau Claire County Mental Health Court. Presentation December 15, 2011

Eau Claire County Mental Health Court. Presentation December 15, 2011 Eau Claire County Mental Health Court Presentation December 15, 2011 Collaboration State & County Government Eau Claire County Mental Health & Jail Diversion Task Force First Brought State & County Agencies

More information

To Access Community Center Rehabilitative Behavioral Health Services (RBHS)

To Access Community Center Rehabilitative Behavioral Health Services (RBHS) To Access Community Center Rehabilitative Behavioral Health Services (RBHS) I. Who Can Make Referrals Representatives from the following South Carolina State agencies may make referrals/authorize Rehabilitative

More information

Acute Crisis Units. Shelly Rhodes, Provider Relations Manager

Acute Crisis Units. Shelly Rhodes, Provider Relations Manager Acute Crisis Units Shelly Rhodes, Provider Relations Manager Shelly.Rhodes@beaconhealthoptions.com Training Agenda Agenda: Transition and Certification Coverage of Services Service Code Definition Documentation

More information

Comprehensive Community Services (CCS) File Review Checklist Comprehensive

Comprehensive Community Services (CCS) File Review Checklist Comprehensive This is a sample form developed by the "CCS Statewide QA/QI Work Group", and is available to CCS sites as a sample for consideration of use, modification, and customization. There is no implicit or explicit

More information

BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care

BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care Acute Inpatient Hospitalization I. DEFINITION OF SERVICE: Acute Inpatient Psychiatric Hospitalization is a 24-hour secure and protected, medically

More information

BERKELEY COMMUNITY MENTAL HEALTH CENTER (BCMHC) OUTPATIENT PROGRAM PLAN 2017

BERKELEY COMMUNITY MENTAL HEALTH CENTER (BCMHC) OUTPATIENT PROGRAM PLAN 2017 BERKELEY COMMUNITY MENTAL HEALTH CENTER (BCMHC) OUTPATIENT PROGRAM PLAN 2017 REVIEWED AND UPDATED NOVEMBER 2017 OUR MISSION PHILOSOPHY The staff of the Berkeley Community Mental Health Center, in partnership

More information

VSHP/ Behavioral Health

VSHP/ Behavioral Health VSHP/ Behavioral Health Deb Dukes & Dr Kelly Askins The contact numbers in the presentation apply to WEST Member Services ONLY. New numbers for EAST Member Services will be published and distributed by

More information

Rehabilitation (PSR/CPST) & Habilitation. November 13 th & 16 th The Managed Care Technical Assistance Center of New York

Rehabilitation (PSR/CPST) & Habilitation. November 13 th & 16 th The Managed Care Technical Assistance Center of New York Rehabilitation (PSR/CPST) & Habilitation November 13 th & 16 th 2015 The Managed Care Technical Assistance Center of New York Welcome MCTAC Overview Business/Billing Rules Services Definition Service Components

More information

The Oregon Administrative Rules contain OARs filed through December 14, 2012

The Oregon Administrative Rules contain OARs filed through December 14, 2012 The Oregon Administrative Rules contain OARs filed through December 14, 2012 OREGON HEALTH AUTHORITY, ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES 309-016-0605 Definitions DIVISION 16

More information

Clinical Services. Substance Abuse Specialists (FACT Program)

Clinical Services. Substance Abuse Specialists (FACT Program) Clinical Services Vocational Specialist (FACT Program) Job Function: Supervise and provide direct services with a focus on vocational services on a mobile, multi-disciplinary treatment team for persons

More information

Rule 31 Table of Changes Date of Last Revision

Rule 31 Table of Changes Date of Last Revision New 245G Statute Language Original Rule 31 Language Language Changes 245G.01 DEFINITIONS 9530.6405 DEFINITIONS 245G.01, subdivision 1. Scope. 245G.01, subdivision 2. Administration of medication. 245G.01,

More information

Medicaid Funded Services Plan

Medicaid Funded Services Plan Clinical Communication Bulletin 007 To: From: All Enrollees, Stakeholders, and Providers Cham Trowell, UM Director Date: May 10, 2016 Subject: Medicaid Funded Services Plan benefit changes, State Funded

More information

Clinical Services. clean NYS Driver s License, fingerprinting, criminal record check, and approval from NYS Office of Mental Health.

Clinical Services. clean NYS Driver s License, fingerprinting, criminal record check, and approval from NYS Office of Mental Health. Clinical Services Clinical Social Worker- Fee for Service Location: Wyandanch- Clinic Job Function: Provide direct clinical care to clients as needed as a member of a multi-disciplinary treatment. Qualifications:

More information

CCBHC Standards of Care

CCBHC Standards of Care CCBHC Standards of Care Mark Disselkoen, MSW, LCSW, LADC CASAT March 7, 2017 Disclaimer The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or

More information

Specialized Therapeutic Foster Care and Therapeutic Group Home (Florida)

Specialized Therapeutic Foster Care and Therapeutic Group Home (Florida) Care1st Health Plan Arizona, Inc. Easy Choice Health Plan Harmony Health Plan of Illinois Missouri Care Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona OneCare (Care1st Health

More information

Transition Management Services (TMS) (Previously known as Tenancy Support Team) Revised 6/3/16

Transition Management Services (TMS) (Previously known as Tenancy Support Team) Revised 6/3/16 Transition Management Services (TMS) (Previously known as Tenancy Support Team) Revised 6/3/16 Service Definition and Required Components Transition Management Services (TMS) is a service provided to individuals

More information

Program of Assertive Community Treatment (PACT) BHD/MH

Program of Assertive Community Treatment (PACT) BHD/MH Program of Assertive Community Treatment () BHD/MH Luis Marcano, x5343 Alan Orenstein, x0927 Program Purpose Help individuals with serious mental illness achieve and maintain community integration through

More information

Pre-Admission Screening and Resident Review

Pre-Admission Screening and Resident Review Pre-Admission Screening and Resident Review Mary Heim LICSW June 2017 PASARR Topics Covered Purpose Regulations MN PASARR Process Services Survey Process Resources Why does the PASARR program exist? PASARR

More information

ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-41 PSYCHIATRIC TREATMENT FACILITIES TABLE OF CONTENTS

ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-41 PSYCHIATRIC TREATMENT FACILITIES TABLE OF CONTENTS ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-41 PSYCHIATRIC TREATMENT FACILITIES TABLE OF CONTENTS 560-X-41-.01 560-X-41-.02 560-X-41-.03 560-X-41-.04 560-X-41-.05 560-X-41-.06 560-X-41-.07

More information

Sherri Proffer, RN, Program Manager. Dorothy Ukegbu, RN Coordinator, 02/20/2014 1

Sherri Proffer, RN, Program Manager. Dorothy Ukegbu, RN Coordinator, 02/20/2014 1 Sherri Proffer, RN, Program Manager Dorothy Ukegbu, RN Coordinator, 02/20/2014 1 Procedures for Determination of Medical Need for Nursing Home Services I. Medical Need Assessments A. Nursing Facility Procedures

More information

Region 1 South Crisis Care System

Region 1 South Crisis Care System Region 1 South Crisis Care System Region 1 South Crisis Care System Presenters: Lee Ann Reinert, LCSW Clinical Policy Specialist, DHS/DMH Patricia Palmer, LCSW, CADC Clinical Director, Collaborative Author:

More information

Alliance Behavioral Healthcare Level of Care Guidelines for State Funded Adult Mental Health and Substance Abuse Services

Alliance Behavioral Healthcare Level of Care Guidelines for State Funded Adult Mental Health and Substance Abuse Services Alliance Behavioral Healthcare of Care Guidelines for State Funded Adult Mental Health and Substance Abuse s Mental Health (Effective 10/1/2012) The levels of care criteria provide a framework for the

More information

Medicaid Rehabilitation Option Provider Manual

Medicaid Rehabilitation Option Provider Manual H P P r o v i d e r R e l a t i o n s U n i t I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Medicaid Rehabilitation Option Provider Manual L I B R A R Y R E F E R E N C E N U M B E R : P R

More information

Appendix 1: Business Rules by Section

Appendix 1: Business Rules by Section Appendix 1: Rules by Section Child/Adolescent Uniform Assessment Header: Last Name, etc. 1 Access to WebCARE screens is restricted to authorized users only. 2 Component Code entered must be valid, non-blank,

More information

Intensive In-Home Services Training

Intensive In-Home Services Training Intensive In-Home Services Training Intensive In Home Services Definition Intensive In Home Services is an intensive, time-limited mental health service for youth and their families, provided in the home,

More information

Behavioral Health Services ( )

Behavioral Health Services ( ) Behavioral Health Services ( 483.40) Presenter: Sabine Dettlinger-Metropoulos Summary New Section CMS became aware of concerns that behavioral health services Were either not always being addressed or

More information

907 KAR 10:014. Outpatient hospital service coverage provisions and requirements.

907 KAR 10:014. Outpatient hospital service coverage provisions and requirements. 907 KAR 10:014. Outpatient hospital service coverage provisions and requirements. RELATES TO: KRS 205.520, 42 C.F.R. 447.53 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3), 205.560, 205.6310,

More information

Dazed and Confused. It s getting better.. Bi-annual licensing surveys. We are here to: 10/27/09

Dazed and Confused. It s getting better.. Bi-annual licensing surveys. We are here to: 10/27/09 Dazed and Confused Twenty three most cited violations in Rule 31 programs MARRCH Fall Conference 2009 Presented by Rick Moldenhauer, MS, LADC, ICADC, LPC Treatment Services Consultant/State Opioid Treatment

More information

Adult BH Home & Community Based Services (HCBS) Foundations Webinar JUNE 29, 2016

Adult BH Home & Community Based Services (HCBS) Foundations Webinar JUNE 29, 2016 Adult BH Home & Community Based Services (HCBS) Foundations Webinar JUNE 29, 2016 June 30, 2016 Introduction & Housekeeping Housekeeping: Slides are posted at MCTAC.org Questions not addressed today will

More information

Contemporary Psychiatric-Mental Health Nursing. Deinstitutionalization. Deinstitutionalization - continued

Contemporary Psychiatric-Mental Health Nursing. Deinstitutionalization. Deinstitutionalization - continued Contemporary Psychiatric-Mental Health Nursing Chapter 12 Creating Hospital and Community-Based Therapeutic Environments Deinstitutionalization Began in the post World War II period Large public mental

More information

MN Youth ACT. Foundations, Statute & Process. Martha J. Aby MBA, MSW, LICSW

MN Youth ACT. Foundations, Statute & Process. Martha J. Aby MBA, MSW, LICSW MN Youth ACT Foundations, Statute & Process Martha J. Aby MBA, MSW, LICSW Martha.J.Aby@state.mn.us Agenda Foundations of Assertive Community Treatment MN Youth ACT Statute MN Youth ACT Development Process

More information

Person-Centered Treatment Plan and Managing Outpatient & Home- and Community-Based Services

Person-Centered Treatment Plan and Managing Outpatient & Home- and Community-Based Services Person-Centered Treatment Plan and Managing Outpatient & Home- and Community-Based Services Agenda Person-Centered Treatment Plan Overview Eligibility Process Person-Centered Treatment Plan Process Descriptions

More information

PRIMARY CARE PHYSICIAN MANUAL FOR BEHAVIORAL HEALTH SERVICES

PRIMARY CARE PHYSICIAN MANUAL FOR BEHAVIORAL HEALTH SERVICES PRIMARY CARE PHYSICIAN MANUAL FOR BEHAVIORAL HEALTH SERVICES Version 2013 2014 CLIENT PRIMARY CARE PHYSICIAN MANUAL SURVEY, V. 2013-2014 Dear Client Primary Care Physician: Psychcare annually distributes

More information

Children, Adults and Families

Children, Adults and Families Policy Title: Children, Adults and Families Target Planning and Consultation Committee Policy Policy Number: I-B.3.2.3 Effective Date: 01-07-2003 Approved By: on file Date Approved: Reference(s): MHDDSD/CSD

More information

Draft Children s Managed Care Transition MCO Requirements

Draft Children s Managed Care Transition MCO Requirements Draft Children s Managed Care Transition MCO Requirements OVERVIEW On February 1 st, New York State released for stakeholder feedback a draft version of the Medicaid Managed Care Organization (MCO) Children

More information

October 5 th & 6th, The Managed Care Technical Assistance Center of New York

October 5 th & 6th, The Managed Care Technical Assistance Center of New York October 5 th & 6th, 2015 The Managed Care Technical Assistance Center of New York What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health

More information

NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Comprehensive Case Management for AMH/ASU.

NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Comprehensive Case Management for AMH/ASU. NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Comprehensive Case Management for AMH/ASU Table of Contents 1.0 Description of the Procedure, Product, or Service...

More information

State of Connecticut REGULATION of. Department of Social Services. Payment of Behavioral Health Clinic Services

State of Connecticut REGULATION of. Department of Social Services. Payment of Behavioral Health Clinic Services R-39 Rev. 03/2012 (Title page) Page 1 of 17 IMPORTANT: Read instructions on back of last page (Certification Page) before completing this form. Failure to comply with instructions may cause disapproval

More information

Home and Community Based Services (HCBS) Presented by: Meredith L. Ray-LaBatt, MA, MSW Douglas P. Ruderman, LSCW-R

Home and Community Based Services (HCBS) Presented by: Meredith L. Ray-LaBatt, MA, MSW Douglas P. Ruderman, LSCW-R Home and Community Based Services (HCBS) Presented by: Meredith L. Ray-LaBatt, MA, MSW Douglas P. Ruderman, LSCW-R 2 Meredith Ray-LaBatt CHILDREN S HCBS SERVICES Children s Transition Timelines 3 Children

More information

Oregon Health Authority DIVISION OF MEDICAL ASSISTANCE PROGRAMS Medicaid Policy & Program Section

Oregon Health Authority DIVISION OF MEDICAL ASSISTANCE PROGRAMS Medicaid Policy & Program Section Oregon Health Authority DIVISION OF MEDICAL ASSISTANCE PROGRAMS Medicaid Policy & Program Section Service Definition and Reimbursement Guide Assertive Community Treatment 2014-06-09 This guide describes

More information

POLICY TITLE: CONTINUED STAY REVIEWS EFFECTIVE DATE REVISED DATE. (Signature)

POLICY TITLE: CONTINUED STAY REVIEWS EFFECTIVE DATE REVISED DATE. (Signature) Policy 5.13 Page 1 of 2 POLICY TITLE: CONTINUED STAY REVIEWS EFFECTIVE DATE REVISED DATE CHAPTER: SYSTEMS OF CARE Approved by: LRE BOARD OF DIRECTORS Approval Date: Maintained by: LRE Clinical Director,

More information

Treatment Foster Care-Case Management (TFC-CM) TFC Overview provided by Clinical and Quality teams Quarter

Treatment Foster Care-Case Management (TFC-CM) TFC Overview provided by Clinical and Quality teams Quarter Treatment Foster Care-Case Management (TFC-CM) TFC Overview provided by Clinical and Quality teams Quarter 1 2016 After today s training you will be able to: Determine DMAS Medical Necessity Criteria (MNC)

More information

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 07 Medical Day Care Services Authority: Health-General Article, 2-104(b), 15-103, 15-105, and 15-111, Annotated

More information

In the most recent County Health Rankings & Roadmaps, Red Lake County Ranked 14 th out of 87 Minnesota Counties in overall Health Outcome.

In the most recent County Health Rankings & Roadmaps, Red Lake County Ranked 14 th out of 87 Minnesota Counties in overall Health Outcome. Red Lake County: County Administration: Agency Name: Red Lake County Social Services Director s Name: Kristi Nelson Address: 125 Edward Ave. PO Box 356 Red Lake Falls, MN 56750 Telephone Number: 218-253-4131

More information

STATE OF KANSAS DEPARTMENT FOR AGING AND DISABILITY SERVICES OSAWATOMIE STATE HOSPITAL OPERATIONS ASSESSMENT EXECUTIVE SUMMARY

STATE OF KANSAS DEPARTMENT FOR AGING AND DISABILITY SERVICES OSAWATOMIE STATE HOSPITAL OPERATIONS ASSESSMENT EXECUTIVE SUMMARY STATE OF KANSAS DEPARTMENT FOR AGING AND DISABILITY SERVICES OSAWATOMIE STATE HOSPITAL OPERATIONS ASSESSMENT Prepared by: THE BUCKLEY GROUP, L.L.C. OVERVIEW The Osawatomie State Hospital (OSH) in Osawatomie

More information

PART 512 Personalized Recovery Oriented Services

PART 512 Personalized Recovery Oriented Services PART 512 Personalized Recovery Oriented Services (Statutory authority: Mental Hygiene Law 7.09[b], 31.04[a], 41.05, 43.02[a]-[c]; and Social Services Law, 364[3], 364-a[1]) Sec. 512.1 Background and intent.

More information

Ryan White Part A. Quality Management

Ryan White Part A. Quality Management Quality Management Mental Health Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part A grant

More information

Substance Abuse Services Published Date: December 1, 2015 Table of Contents

Substance Abuse Services Published Date: December 1, 2015 Table of Contents Table of Contents 1.0 Description of the Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 2 2.1 Provisions... 2 2.1.1 General... 2 2.1.2 Specific... 2 3.0 When the Service Is Covered...

More information

Minnesota Hospice Bill of Rights PER MINNESOTA STATUTES, SECTION 144A.751

Minnesota Hospice Bill of Rights PER MINNESOTA STATUTES, SECTION 144A.751 Combined Minnesota & Federal Hospice Bill of Rights Minnesota Hospice Bill of Rights PER MINNESOTA STATUTES, SECTION 144A.751 The language in BOLD print represents additional consumer rights under federal

More information

JOB OPENINGS PIEDMONT COMMUNITY SERVICES

JOB OPENINGS PIEDMONT COMMUNITY SERVICES JOB OPENINGS PIEDMONT COMMUNITY SERVICES Our Excellent full time benefits package offers: Virginia Retirement with Employer match Paid Life Insurance = 2X Your Salary Partially Paid Medical Insurance +

More information