NETWORK180 PROVIDER MANUAL SECTION 1: SERVICE REQUIREMENTS SUPPORT AND SERVICE COORDINATION Provider will comply with regulations and requirements as outlined in the Michigan Medicaid Provider Manual, Behavioral Health and Intellectual and Developmental Disability Supports and Services chapter, as well as the Lakeshore Regional Entity Contract Attachment A: Service Description for Support and Service Coordination. In addition to these, Provider must adhere to the following specific requirements. CHILDREN S SUPPORTS COORDINATION Services 1. Provider is required to update demographics, financials, and health measures when a significant change occurs, or minimally annually. 2. Provider must coordinate Respite Services and successfully manage allotted budget amounts. Respite Services must be provided in accordance with the Lakeshore Regional Entity Attachment A: Service Description for Respite Services. For Respite Only services, Supports Coordinators will have a minimum of two in-person contacts per year and/or a total of 15 units of Supports Coordination for the purpose of coordinating Respite Services. 3. Provider must utilize and encourage the integration of Community Living Supports (CLS) Services into treatment. The use of these services must be clearly documented in the individual plan of service (IPOS), and training of CLS staff must be clearly documented in the IPOS prior to staff having contact with the child. CLS Services must be provided in accordance to the Lakeshore Regional Entity Attachment A: Service Description for Community Living Supports Services. 4. If the child is in foster care, Provider must coordinate with the foster care agency a minimum of once monthly, document this contact using the Foster Care-Therapist Coordination Form (as relevant to this population), and keep a copy of it in the child s file. 5. For youth who are transitioning into adulthood, the Supports Coordinator will assist the child/family in contacting the Network180 Access Center to access Adult Intellectual/ Developmental Disability services. To ensure proper planning, three months prior to the youth s 18 th birthday, the Supports Coordinator will ensure the youth/family has made contact with the Access Center if adult services are warranted. 6. Provider must complete the Child Health and Developmental Screening form. 7. Provider must provide psychiatric evaluations within 30 day of identified need, as well as monitoring and provision of medications for children authorized for these services. a. Psychiatric coverage will remain the responsibility of the referring provider for up to 30 days post discharge. 8. Provider must have face-to-face contact with the child within seven days following discharge from Psychiatric Inpatient Hospitalization, Partial Hospitalization or Crisis Residential Services. 9. If a child/family is seeking placement in a residential setting, or the child is placed in a residential setting, Provider is responsible for following the guidelines set forth in the Out of Home Placement referral and requirement documents. 10. If a child is placed in Hawthorn, Provider must: a. Orchestrate the admission with the family. b. Maintain weekly contact with the Hawthorn therapist. c. Provide a weekly email update to the Child and Family Ombudsperson referencing psychiatric stabilization and discharge planning. d. Maintain contact with the family and plan for discharge to the family home. 1 Revised 10/1/2017
11. Agencies providing Children s Waiver Program must comply with all rules, regulations, and policies set forth by the Michigan Department of Health and Human Services (MDHHS), as written in the Children s Waiver Program (CWP) Technical Assistance Manual, and follow the guidelines set forth by the Waiver Support Application: Children s Waiver Program User Training Manual. a. It is expected that Provider will utilize their Network180 CWP Liaison when requiring support. b. Provider must keep the Network180 CWP Liaison informed when a child enters a restrictive setting where it is expected they will not be receiving a waiver service for more than one month (e.g., residential placement or hospital). 12. For children receiving the Autism Benefit: a. It is expected that Provider will coordinate with the ABA Provider. b. Provider is expected to attend the treatment planning meeting with the ABA Provider. c. The IPOS is due within 30 days of the completion of the extended evaluation. The extended evaluation begins with ADOS testing and ends with the determination of level of ABA services. d. Provider is responsible for the addendum to add ABA services to the IPOS and to complete any addendums related to changes in ABA services. This will require open communication by both providers. e. The clinical team and the family will review the IPOS quarterly using the universal Child and Family Service Plan Review and adjust the service intensity and setting(s) as necessary. f. ABA Aides are expected to be trained on the IPOS. Access and Authorization 1. Individuals seeking Children s Supports Coordination services through the public mental health system must access these services through the Network180 Access Center or via the open access process. 2. A child/family requesting a screening for eligibility must be seen within 14 days from the request for service. 3. The open access site will authorize an appropriate level of service based on: a. The results of an in-person clinical screening, and b. Supportive documentation including diagnostic eligibility requirements are met. 4. The open access site will fax an authorization request, Demographic Intake and Financial Intake Forms, and DD Proxy Measures to the Network180 Reimbursement Unit. Provider must also complete the Health Measures in the ERC. An authorization will be faxed to Provider. 5. Initial authorization shall not exceed one year. 6. For those children requiring specialized supports, access to Enhanced Mental Health Services can be sought by following the requirements set forth in the Enhanced Mental Health Services Request Form. 7. If requesting services for a sibling of an authorized child, the Sibling Services Brief Screening Form and Demographic Intake and Financial Intake Forms must be included with the request for services. The Network180 Utilization Management (UM) Department will review the authorization request and authorize as appropriate. Reauthorization 1. Reauthorization determination will be based on the following criteria: a. High probably of decompensation without continued Supports Coordination services. b. Child/family continues to meet all program eligibility criteria. c. Child/family are consistently and actively engaged in treatment. d. Treatment goals have not been completed but progress is anticipated. e. Transitioning children that potentially meet Adult Supports Coordination services. 2 Revised 10/1/2017
f. Provider has identified ineffective interventions and has identified alternative interventions to facilitate successful termination of services. 2. Provider will submit a reauthorization request to the Network180 Reimbursement Unit 14 to 30 days prior to the expiration date of the current authorization. 3. Provider will annually submit to Network180 or update in the ECR the DD Proxy Measures and Health Measures. 4. If eligible, reauthorization will be given for at least one month with 16 15-minute units but not more than two months with 32 15-minute units. 5. At the time of the reauthorization request, Provider will verify and document the individual's eligibility for Network180 services by providing updated Demographic Intake and Financial Intake Forms (including Ability to Pay) to the Reimbursement Unit, and documenting medical necessity to the UM Department. 6. Network180 staff will enter a reauthorization into the Network180 system and notify Provider. 7. Network180 will send Notice of Action and appeal information to the individual or guardian as appropriate. Provider shall be available to the individual or guardian to discuss the rationale for the utilization decision, assist with other options as suggested, and, if requested, provide assistance with filing a local appeal and/or requesting a Medicaid Fair Hearing. Discharge 1. The discharge date must be submitted to the Network180 Access Center within seven calendar days of discharge. The Access Center will enter the discharge date based on the information given by Provider. 2. Provider will complete and send all discharge summaries to the Access Center within 30 calendar days of discharge. 3. The discharge summary shall provide discharge recommendations. If Provider is recommending less intensive services or other community service, discharge recommendations shall include the service, the service provider, and the appointment date/time. ADULT SUPPORTS COORDINATION Services 1. Individuals must be provided choice of providers upon initial enrollment and on an ongoing basis. This includes the choice of Support and Service Coordinator (SC). 2. All services shall be provided as determined through the person-centered planning process. SCs will determine medical necessity and will define amount, scope, and duration of face-to-face contacts through the person-centered planning process. When defining amount, scope, and duration the SC shall take into consideration all mental health related service areas as well as the supports provided through natural supports. 3. The SC will meet face-to-face with individuals as indicated by the individual plan of service (IPOS). The SC will monitor service provision, face-to-face, at least quarterly in the individual s home environment. Visits shall occur face-to-face when the individual is engaged in normal activities in the home environment to ensure monitoring of interaction with staff and other residents. The SC will monitor service provision, face-to-face, on a monthly basis for all Habilitation Support Waiver (HSW) recipients. The SC must provide more frequent contacts at times of increased need. The SC will coordinate staff training on the IPOS and monitor progress toward the IPOS goals at the frequency indicated by multiple and or complex service needs. 4. The SC will make a recommendation for level of care through the person-centered planning process. When making a recommendation for high, medium, or low CLS daily level of care, the SC will consider the level of intensity and staff interventions necessary based on recommendations 3 Revised 10/1/2017
of information gathered through assessments including, but not limited to, the Psychosocial Assessment, the Support Intensity Scale, and other professional evaluations. 5. Services must support the maximum level of self-determination in the least restrictive environment desired by individuals through established procedures. 6. Provider shall ensure ongoing evaluation of readiness for referral to the least restrictive environment for the individual to meet his or her needs or discharge from services. 7. Provider shall provide Representative Payee service options as required by individuals. 8. Provider shall ensure a benefits specialist is available to provide consultation to SCs who are responsible for ensuring that individuals are enrolled and receiving all available benefits. For individuals who receive CLS in licensed residential settings with a specialized certification, the SC provider shall also ensure the full fee assessment is completed to determine the individual s ability to pay. 9. Provider is responsible for updating the Network180 electronic health record (EHR) including: demographics, financials, and diagnostic screens prior to reauthorization and as changes occur. 10. Habilitation Supports Waiver (HSW): Provider will submit certification packets for those individuals enrolled on the HSW to Network180 for review and certification of HSW participation. Provider will maintain certification packets and materials associated with the certification process, in accordance with MDCH requirements. Only SCs who qualify as Qualified Intellectual Disability Professionals (QIDPs) can provide services to HSW beneficiaries. A QIDP is an individual with specialized training or one year experience in treating or working with a person who has Intellectual and Developmental Disability; and is a psychologist, physician, educator with a degree in education from an accredited program, social worker, physical therapist, occupational therapist, speech-language pathologist, audiologist, registered nurse, registered dietician, therapeutic recreation specialist, or a licensed of limited-licensed professional counselor. An individual with a bachelor s degree in a human service field who was hired prior to January 1, 2008 and performed in the role of a QIDP prior to January 1, 2008 would also qualify. 11. The SC may coordinate enhanced mental health services such as environmental modifications, assistive technology, specialized supply, specialized medical equipment, and/or van lifts as indicated in the Medicaid Provider Manual. 12. Agencies providing Supports Coordination shall participate in all Interagency Clinical Team meetings for collaborative system resource management. 13. Services must be provided in an environment that supports the central purpose of teaching a feeling of companionship, connectedness, and community. 14. Provider will nurture a culture for delivering supports and guidance to help people feel safe, valued, value others, and become engaged with others. This includes: individualized schedule of activities for opportunities to build relationship (rather than skill development); individualized schedule of activities that builds structure and predictability; and use of words, eyes, touch, and presence to teach companionship. 15. Provider will facilitate psychiatric and medical referrals and discharges as needed. 16. The SC shall maintain an open authorization for individuals in correctional facilities when there is a reasonable expectation that the individual will be returning to the community within six months. Consideration shall be given to transferring care to jail-based services during the incarceration. Individuals sentenced to prison shall be closed with the discharge date as the date of incarceration or the date the agency was made aware the individual was sentenced to prison. 17. Provider will ensure that individuals receive timely access to psychiatric services and appropriate levels of psychiatric monitoring and participation in treatment planning based on individuals needs. Provider will provide more frequent contacts during periods of instability. 18. Provider will coordinate psychotropic medication for 30 days after discharge from Supports Coordination unless a subsequent service provider assumes this responsibility. 19. Provider will ensure on-call and crisis intervention services 24 hours/day, 7 days/week, including evenings, weekends, and holidays. 4 Revised 10/1/2017
a. On-call SC will respond within 10 minutes to a request for a return phone call. b. SC on-call is expected to provide crisis and face-to-face support during after-hours, weekends and holidays. When the Access Center determines that a face-to-face intervention is required, SC on-call will respond to the request in person within one hour. If the individual has a primary insurance other than Medicaid, the SC on-call is required to coordinate with that insurance for assessment purposes. c. If the Access Center has been involved, SC on-call will notify the Access Center of the resolution of the intervention. 20. Network180 expects providers to demonstrate a model of supervision that promotes Supports Coordination core competencies, and provides support and oversight to individuals providing Supports Coordination. 21. Network180 reserves the right to limit referrals and authorizations if Provider does not meet program expectations. Limitations will remain in effect until Network180 and Provider agree that program expectations are being met. 22. Provider must participate in discharge planning for individuals during an Inpatient, or hospital admission (in the case of medical hospitals, the SC may contact the family instead of the program discharge planner if the family is coordinating the discharge). a. SC will make telephone contact with the program discharge planner within one business day following the date of admission. b. SC will make a minimum of one in-person visit to the program for the purpose of discharge planning with the individual and program staff within two business days following the date of admission for existing consumers. c. SC will continue to make telephone contact with program discharge planners throughout the individual s admission as appropriate to assist in discharge planning. d. Provider must ensure follow-up after discharge from inpatient, hospitalization or short term residential services: 23. Provider shall conduct a face-to-face visit with the individual within three days of discharge. This follow-up visit can be conducted by the SC or Nurse. During this visit, individuals will be assisted in adhering to their discharge plan and receive supports to prevent readmission. 24. Provider must participate in coordination and discharge planning for an individual during Crisis Residential Services. a. Provider must create a discharge plan and provide the Crisis Residential Services Program Manager the discharge plan for the individual within three business days of the individual s admission. This discharge plan will include transition timelines and a plan to support the individual; it will be based on the philosophy of the Culture of Gentleness. b. The Crisis Residential Services Program Manager will contact the SC every business day to receive an update on the progression towards the individual s discharge plan. c. If an individual s authorization for Crisis Residential Services exceeds 14 days, additional authorization must be approved through the Network180 DD Ombudsperson. Provider will need to contact the Network180 DD Ombudsperson for this request and communicate with the Crisis Residential Services Program Manager that this has been completed. d. SCs will attend weekly clinical meetings at the Crisis Residential Services program for the purpose of discharge planning with the individual and staff. 25. Provider will participate in inpatient treatment team meetings in person or by telephone if requested, and relay content of meetings to other care providers (e.g., agency psychiatrist). For individuals who are hospitalized in a facility outside of the community for more than ten days, it is expected that SC s will participate in more frequent treatment team meetings each week. 26. New Service Need Identified: a. If a new service is identified during the social assessment, the SC shall start the referral process immediately so that a provider will be identified and ready to start when the new IPOS begins. 5 Revised 10/1/2017
b. If a provider is not identified before the IPOS meeting or if a new service need is identified at the IPOS meeting, the following steps must be followed: i. Do not put this service on the IPOS grid. Instead, write the information in the section titled Services to start at a later date. ii. Identify potential provider. For most services, have the individual choose at least two providers. iii. Within two business days of the IPOS meeting, the SC must send the referral pack to all the providers identified. iv. An intake meeting shall be scheduled within 14 days of the IPOS. (a) The SC shall document if provider does not accept the referral. (b) If more than one provider accepts the referral, have the individual make a choice. (c) SC or their supervisor plan to attend the intake meeting. (d) Develop goals at the intake meeting. (e) Determine actual agreed upon start date. (f) If the intake meeting cannot be scheduled within 14 days of the IPOS, the SC must document rationale and frequently document what steps/ communication they have had to address this, in addition to documenting the regular communication that is happening with the individual/family regarding the service. v. The SC will complete an addendum to add the service. vi. The SC will request authorization for the new service. vii. The SC will send a copy of the addendum to the new provider before the service start date. viii. If services do not start on the agreed upon start date, the SC must document rationale and frequently document what steps/communication they have had to address this, in addition to documenting the regular communication that is happening with the individual/family that is happening regarding the service. c. Annually the SC will encourage the individual to invite the service provider to his or her IPOS meeting. If the individual chooses not to have Provider attend, the SC will work with the individual to determine the best way to gather needed information. 6 Revised 10/1/2017