ConsumerLink Network Written by: Approved by: Provider Manual Update: Transitioning Youth Document No. Effective Date September 1, 2016 Revision Date Revision No. 1 Page No. 1. POLICY It is the policy of ConsumerLink that youth transitioning to adult behavioral health services receive prior notice if turning 18 will impact their services and/or choice of provider; that they be offered the opportunity to include transition as part of their person-centered Individual Plan of Service (IPOS); and that their demographic (BH-TEDS) information is updated in MH-WIN within 30 days of their 18 th birthday. 2. PURPOSE To improve the transitioning process from youth to adult services [see NCQA guidelines (CC 1B.4 and CC 3C.2)] 3. APPLICATION This Provider Manual Update applies to all Care Coordinators under ConsumerLink Network. 4. STANDARDS Youth with special health care needs are those who experience significant health conditions that affect functioning on a daily basis, and require specialized accommodations or medical treatment (www.nichq.org, 2009) (www.nichq.org/cyshn/index.html). They have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions that persist into adulthood. Approximately 30 percent of adolescents experience at least one or more of these conditions. Behavioral Health care providers can join or build a transition team composed of multiple agencies and individuals capable of: 1) assessing an individual s and family s knowledge, resources and abilities; 2) coordinating and communicating about information and resources; and 3) developing action steps to overcome barriers and facilitate transitioning in all aspects of the youth s life. Well-defined and coordinated action steps should be developed to address the transition needs that exist within the context of the family and within the behavioral health care, physical health care, educational, and vocational systems. Page 1 of 5
5. DEFINITIONS BH-TEDS - Behavioral Health Treatment Episode Data Set Care Coordinator A synonymous term with Supports Coordinating Agency (SCA) or Clinically Responsible Service Provider (CRSP). Those entities under contract with ConsumerLink to provide Supports Coordination and/or Targeted Case Management. 6. PERFORMANCE REQUIREMENTS 6.1 Care Coordinators working with children must routinely track active children s cases by birthdate to identify those individuals who will be reaching the age of 18 in the near future (e.g. in the next 30 to 90 days). 6.2 At a minimum, transition plans must be included in the IPOS of all children who will reach the age of 18 prior to the next scheduled update of their plan. 6.3 Transition plans should identify and address expected changes that will occur as a result of reaching the age of majority. These may include but are not limited to: Applying for Medicaid Aging out of the foster care system Losing benefits specific to children s services (e.g. adoption benefits, Children s Waiver, SED Waiver, etc.) Changing their Care Coordinator Agency Changing the staff within the assigned Care Coordinator Agency Adding Employment goals Adding Housing goals Signing new consent forms as their own responsible party Learning about guardianship services and the alternatives to guardianship 6.4 To aid in the transition process, ConsumerLink will send correspondence to the families of active children who are receiving services from Care Coordination Agencies that primarily serve children. The correspondence will alert them to their choices of Care Coordination Agencies that serve adults within the network and offer additional assistance, as needed, through their Member Services Department. 6.5 As one measure of successful transition, Care Coordination Agencies shall update the BH-TEDS information in the Detroit Wayne Mental Health Authority s MH-WIN system within 30 calendar days of a member s 18 th birthday as part of a new or updated Integrated Biopsychosocial Assessment. This measure will be evidence of continued contact and service provision for transitioning youth because: Input from the member, their family and/or legal representative is needed to complete the BH-TEDS update, there is an expectation that there will be a face-to-face, billable service on the same day as the BH- TEDS update (e.g. H0031 for the Integrated Biopsychosocial Assessment) For youth transitioning to a new Care Coordination Agency, the BH- TEDS update should be also completed as part of a new Integrated Biopsychosocial Assessment Page 2 of 5
7. QUALITY ASSURANCE ConsumerLink s Quality Assurance Department will review and monitor contractor adherence to these standards as one element in its program. 8. CROSS REFERENCES Person-Centered Planning Best Practices ConsumerLink Network Provider Manual 9. ATTACHMENTS A. What is BH-TEDS? B. Sample Letter Member Notice When Transitioning to Adult Services Revision History Page 3 of 5
Attachment A What is BH-TEDS? Before 10/1/15, the State collected demographics on consumers with the information in the demographics tab. The entire demographics tab was sent to the State with every single service (claim) reported The State would then run audits to see if too many areas/forms were left blank Starting 10/1/15, the State began to collect demographic (and other) information with BH-TEDS submissions Rather than sending the entire tab with every single service, nowa record is sentonly at admission, at least once a year, and at discharge If anything is missing in a BH-TEDS submission, that BH-TEDS submission will not be accepted by the State Important things to know about BH-TEDS ORDER. The submissions have to be in this order: Admission, Update, Discharge. Providers cannot submit an update or discharge unless the State has a valid admission for that consumer. For consumers who are already open on 10/1/15, an ADMISSION record is sent at their first annual biopsychosocial assessment (BPS). Even if they have been open for years, an admission record has to be sent prior to any updates. There is an expectation that there will be a face-to-face, billable service on the same day as the admission. CONSUMER TYPES. There are five types of consumers, and there is a different BH-TEDS process for each CMH Consumers. These are consumers who are eligible for CMH services. Provider staff need to submit BH-TEDS admissions and updates during the initial and annual biopsychosocial assessments. i. Integrated MH/SUD treatment. If the consumer s substance abuse disorder is being actively treated at the provider level, and they have an SUD goal in their IPOS beyond will attend AA/NA they qualify in this area ii. NON-Integrated MH/SUD treatment. If a substance abuse disorder is not being actively treated at the provider level, then the consumer is not receiving integrated treatment. Assessment Only Consumers. These are consumers who come in for intake, but will not go on to receive services. Generally speaking, these consumers will have a BPS disposition of "Not Eligible", "GF wait list", "pending", or "refused service". Provider staff need to submit both their BH-TEDS admission and discharge on the same day, at intake. Crisis only Consumers. These consumers have one service for a crisis or community hospitalization, but are not (or not yet) eligible for CMH services. Provider staff need to submit the BH-TEDS admission and discharge on the same day.. State Inpatient Consumers. These are consumers who are in state psychiatric inpatient facilities. BH- TEDS admission and discharge submissions can be done in the BH-TEDS module. Page 4 of 5
Attachment B Member Notice When Transitioning to Adult Services Date: To: Dear, Our records show that (name of Member) will be turning 18 in the next few months. It may be that the people currently helping you do not work with adults. If this is true in your case, you will need to change to a different provider or maybe just a different staff person within your current agency. In any case we are here to help if you need us. We can help you find a provider who specializes in working with adults. If you need help, or have any questions, please call us at 1-888-711-5465 during normal business hours. Our Member Services staff can give you information and help you connect with a new provider if needed to ensure you have no interruptions in needed services. Sincerely, ConsumerLink Page 5 of 5