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The Illinois Mental Health Collaborative for Access and Choice

Overview of the Authorization Process and Fidelity Monitoring

March 27, 2008

ACT Team Leader Meeting

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AGENDA

Introductions

Purpose of Monthly Meetings

Topic Selections- authorization process in brief

- overview of fidelity monitoring

Questions

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Introductions

The Illinois Department of Human Services/Division of Mental Health (DHS/DMH) has engaged an administrative service organization (ASO) to provide support and resources to improve access and choice in the mental health system. The Illinois Mental Health Collaborative for Access and Choice will be referred to as “the Collaborative”.

The presenters are: DMH:

• Jackie Manker, LCSW Collaborative Clinical Team:

• Todd Kasdan, MD - Medical Director• Bill White, LCSW - Clinical Director• Sandy Potter, LCSW - Vice President of Operations

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DMH Overview

Overarching Themes for 4th Quarter FY08- this year is an introduction to how monitoring will

be conducted in the future- a coordinated team approach with DHS/DMH,

BALC and Collaborative staff- no duplication of reviews- no extrapolation this year (no penalties)- compliance with both Rule 132 and the contract- evolving process - so we learn and adjust as we go

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A Goal of the Collaborative

Under the direction of DHS/DMH the Collaborative will perform provider monitoring

activities starting 4th Quarter FY08

- as a coordinated team approach with DHS/DMH Contract Managers and BALC

- this is an evolving process

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Purpose of the monthly meetings

Improve Adherence to Both Rule 132 and Contract

Learning Opportunities– Share Evidence-Based Practices (EBP)– Monthly Topic Selection Area

Keep Communication Open

(Attendance Recommended)

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Authorization Process

ACT Services Require Prior Authorization Providers Submit a Request for ACT Prior to Start of Services Submit

- authorization request form

- treatment plan

- crisis plan Submit Documents by Fax Coming Soon: “ProviderConnect” Web-Based Submission

Capabilities

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Submitting Authorization Requests

Collaborative Contact Information:

www.IllinoisMentalHealthCollaborative.com

Telephone: 866-359-7953

NEW Fax Number: 866-928-7177

The Collaborative Verifies Eligibility and Provider Status

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Authorization Review Time Frame

Completed Requests Response Time:

- Within one (1) business day for initial authorizations

- Within three (3) business days for reauthorizations

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Provider Monitoring Overview

Rule 132- clinical record review- post payment review

Contract- coordination of benefits- non-Medicaid services

Moving Mental Health System Towards Recovery Oriented Services

– consumer participation – crisis plans– ACT fidelity

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Overview of Fidelity Monitoring

Ensuring Appropriateness of Services

Key Elements of Fidelity Reviews:

- demonstration of EBP models in service delivery

- adherence with eligibility requirements (Rule 132)

Team Based Review

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Fidelity to EBP for ACTSome of the Highlighted Elements:

Consumers’ Needs Drive Service, Time, and Location

Consumer Staff Ratio of 10:1 Team Approach - All (or Most) Staff Members

Interact With Consumer Available 24/7 Support Crisis Planning

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Fidelity to EBP- ACT (Cont.)Some of the Highlighted Elements:

Full Time Practicing Team Leader Psychiatrist and Nurse on Staff Staffing Continuity and Capacity Intake Rate Appropriate Family Involvement Service to Defined Population

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ACT Fidelity Tool

Based on Dartmouth Assertive Community Treatment Scale (DACTS)

(available online at www.samhsa.gov)

Contains 28 Program Specific Items– structure and composition– organizational boundaries– nature of service

Designed to Measure the Degree of Implementation of ACT Programs

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Service Objectives

Promote Symptom Stability and Appropriate Use of Medications

Restore Personal, Community Living, and Social Skills

Promote Physical Health Establish Access to Entitlements, Housing, Work,

and Social Opportunities Promote the Highest Possible Level of Functioning in

the Community

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Questions?

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Today’s presentation will be available online in April 2008

http://www.IllinoisMentalHealthCollaborative.com/providers/Training/Training_Workshops_Archives.htm

Be sure to share this information with your staff!

Posting of the Presentation

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Thank you!

Illinois Mental Health Collaborative for Access and Choice