ICG COMMUNICATION FORUM

1. ICG COMMUNICATION FORUM Seth Harkins, EdD, Director ICG Program Bill White, LCSW, Clinical Director Illinois Mental Health Collaborative for Access and Choice December 18, 2008

2. Goals for Today’s Webcast • To update residential and SASS providers on changes in the ICG program (unbundling of rates, care managers and SASS roles, Annual Reviews • To provide an overview of Rule 132 and how it applies to the ICG program • To clarify certain ICG procedures (Family income requirement, UIRs, Quarterly Reports, Annual Reviews, 94R and Medicaid eligibility)

3. Why Unbundling ? • Rule 132 Required • Fee for service billing categories • Enhanced service tracking • Survey data regarding RTC services • Clinically-focused and family centered provision of care • Consumer-focused • Focus on recovery and resiliency • Emphasis on skill building in natural environments

4. Fee for Service Categories • Case management – client centered • Case management – mental health • Case management – transition and linkage • Community residential support individual • Community residential support group • Crisis intervention

5. Fee for Service Categories • Mental health assessment • Psychological evaluation • Psychotropic medication administration • Psychotropic medication monitoring • Psychotropic medication training • Therapy/individual • Therapy/group • Therapy/family • Treatment planning

6. Fee for Service Categories Group C Services (Non Medicaid) • Oral interpretation and sign language • Job finding • Job retention • Job Leaving/termination • Vocational assessment • Vocational engagement • Vocational services

7. What Did We Learn from the Fee for Service Survey • Survey Monkey data collected in April and May • Incomplete data led to further surveying • Trends noted: 1) community support residential individual and group varied considerably; 2) limited vocational services reported; 3) individual, group, and family therapy tended to below for clients requiring intensity of services; 4) case management services were relatively low, particularly transition and linkage, averaging one hour a month; 5) various ratios of MHPs to RSAs.

8. What Did We Learn from the Fee for Service Survey? • Clinical standards need to be established. • Increased provisions of case management services at certain times to facilitate individualized care and transition to home and the community (e.g. case management transition and linkage). • Two hours per week of individual therapy provided by QMHP is considered a minimum standard. • Three hours per week of group therapy facilitated by a QMHP is considered a standard. • One hour per week of family therapy provided by a QMHP is considered a standard. • For clients ages 16 – 21 vocational services should be provided at least one hour per week.

9. How Does Rule 132 Apply? • Billing will be according to fee for service categories and service definitions • An objective is to increase FFP so that Illinois receives enhanced Medicaid reimbursement • Increased Medicaid eligibility • 94R

10. Fee for Service Billing • During FY2009 residential providers will be paid their Illinois Purchase Care Review Board rate.

11. Fee for Service Billing • Residential providers will be required to make application for RTC clients eligible for Medicaid under 94R. • It will be important for residential providers to work with SASS-ICG workers and parents to complete the necessary paperwork. • It behooves the residential provider to establish a close relationship with its local DHS office.

12. Fee for Service Billing Target • Based on the survey data and the medical necessity of the average ICG client, we conclude that 40% of the Illinois Purchase of Care Review Board rate is an appropriate target for FY2009. • Average ICG client is “high need” and thus requires medically necessary residential services. • The ICG program is committed to working with providers to assist them in optimal billing for medically necessary services.

13. Enhanced Clinical Care Management • Collaborative Clinical Care Managers will play a supportive role for families and SASS-ICG providers. • DMH intends to use the services of clinical are managers in increasingly significant roles. • The specifics of enhanced clinical care manager role will be provided in a future webinar.

14. One-to- One Staffing • DMH will no longer reimburse providers to one-to-one staffing. • DMH expects this service will be available when clinically necessary and included in the costs submitted to the Illinois Purchase Care Review Board.

15. Family Income Requirement • ICG applicants must indicate their family income and submit copies of federal income tax returns. • The family income requirement is a requirement for other DHM programs. This addition to the ICG application brings ICG into alignment with other DMH program.

16. Unusual Incident Reports • UIRs are reserved for truly unusual incidents. Verbal aggression and property destruction are not considered unusual for the ICG population and thus UIRs are not required. • Any sentinel event must be immediately reported to ICG via phone with follow-up paper work within 24 hours. • Other incidents (e.g. severe aggression, self-injurious behavior resulting in medical attention in a hospital or clinic, elopement, behavior involving police intervention, etc. shall be reported within 2 business days.

17. Unusual Incident Reports • Not all elopements need to be reported. Elopements that involve the client leaving the property of the facility for more than an hour and out of the control of staff shall result in a UIR. • UIRs should be sent to Chumiach Houston at 4200 N. Oak Park Avenue/Annex, Chicago, IL.

18. Annual Eligibility Reviews • Annual Reviews are now being referenced as Annual Eligibility Reviews to emphasize the fact that the outcome and an AR is an eligibility decision. • Funding will be terminated when ICG clients who no longer meet the clinical criteria for the program. • The Ohio Scales and the Columbia Impairment Scale are to be included in the Annual Eligibility Report.

19. Quarterly Reports • Quarterly Reports are required for all ICG clients. • A quarter is defined as 90 days from the date of grant anniversary. • Include Ohio Scales and Columbia Impairment Scale information in the Quarterly Report.

20. Quarterly Reports • Quarterly Reports shall answer the 10 items contained in the Quarterly Report Questionnaire: • Briefly describe the reason for admission. • Describe the treatment goals you hope to accomplished. • Describe the current efforts you are making to prepare the client for discharge. Give a tentative discharge date. • List the discharge criteria that need to be met before discharge can occur. • List current diagnoses. Include CGAS, Ohio Scales, and Columbia Impairment Scale.

21. Quarterly Reports • Progress of psychotherapy and number of sessions per week . • Progress in family therapy and number of sessions per month. • Progress in any specialized therapy, if appropriate. • Family involvement in the client’s treatment. • Anything else considered relevant to the client’s treatment.

22. UPDATING RESIDENTIAL INFORMATION • Information regarding residential services frequently changes. • SASS-ICG providers will submit a monthly list of residential clients on their case loads to the Collaborative. • Updated lists will help keep the Collaborative current regarding changes in placements.

23. APPENDIX • For detailed description of all Rule 132 services, go to: http://www.hfs.illinois.gov/assets/070107_cmph_guide.pdf for the State of Illinois Community Mental Health Services Service Definition and Reimbursement Guide • The appendix provides service definitions, examples, and minimal credentials for providing services from the reimbursemet guide.

24. Service Definitions • CASE MANAGEMENT - CLIENT-CENTERED CONSULTATION: “An individual client-focused professional communication between provider staff, or staff of other agencies, or with other professionals or systems who are involved with providing services to the client.” • Examples: Face-to-face contacts, staffing with school personnel, contacts with legal or medical system • Minimum staff requirement - RSA

25. Service Definitions • CASE MANAGEMENT - MENTAL HEALTH: Services include assessment, planning, coordination, and advocacy services for clients who need multiple services and require assistance in gaining access to and in using mental health, social, vocational, educational, housing, public income entitlements and other community services to assist the client in the community. Case management activities may also include identifying and investigating available resources, explaining options to the client and linking them with necessary resources.

26. Service Definitions • CASE MANAGEMENT - MENTAL HEALTH EXAMPLES: • Helping the client access appropriate mental health services, including the ICG program, apply for public entitlements, locate housing, obtain medical or dental care or obtain other social, educational, vocational, or recreational services. • Assessing the need for service, identifying and investigating available resources, explaining options to the client and assisting in the application process.

27. Service Definitions • CASE MANAGEMENT - MENTAL HEALTH minimum staff requirement - RSA

28. Service Definitions • CASE MANAGEMENT - TRANSITION LINKAGE AND AFTERCARE: “Services are provided to assist in an effective transition in living arrangement consistent with the client’s welfare and development.

29. Fee for Service and Treatment • The lack of intensity of services, particularly in regard to individual, group, and family therapy may explain ICG’s average length of stay as 2.5 years. • Research indicates that after two years of residential placement, it is unlikely that the client will return to home and the community.

30. Service Definitions • CASE MANAGEMENT - TRANSITION LINKAGE AND AFTERCARE Examples: • Services to clients being discharged inpatient psychiatric care, transitioning to adult services; • time spent planning with the staff of the client’s current living arrangement or the receiving living arrangement; • Time locating client-specific placement resources; • Time spent developing aftercare service plan; • Assisting the client or the client’s family or caregiver with the transition.

31. Service Definitions • CASE MANAGEMENT - TRANSITION LINKAGE AND AFTERCARE minimum staff requirement - MHP

32. Service Definitions • COMMUNITY SUPPORT RESIDENTIAL (INDIVIDUAL, GROUP):Services and support for children, adolescents, adults, and families necessary to assist a client to achieve and maintain rehabilitative, resiliency, and recovery goals. The service consists of therapeutic interventions that facilitate illness self-management, skill building, identification and use of natural supports , and use of community resources.

33. Service Definitions • COMMUNITY SUPPORT (RESIDENTIAL) EXAMPLES: • Coordination and assistance with the identification of individual strengths, resources, preferences, and choices. • Assistance with the identification of existing natural supports for the development of a natural support team. • Assistance with the development of crisis management plans.

34. Service Definitions • Skill building in order to assist the client in the development of functional, interpersonal, family, coping and community living skills that are negatively impacted by the client’s mental illness. • Assistance with risk factors related to relapse prevention and prevention plans. • Support and promotion of client self-advocacy and participation in decision-making, treatment, and treatment planning

35. Service Definitions • COMMUNITY SUPPORT (RESIDENTIAL) minimum staff requirement - RSA

36. Service Definitions • CRISIS INTERVENTION: Activities or services provided to a person who is experiencing a psychiatric crisis that are designed to interrupt the crisis experience including assessment, brief supportive therapy or counseling and referral and linkage to appropriate community services to avoid more restrictive levels of treatment, with the goal being symptom reduction, stabilizing and restoration to a previous level of functioning

37. Service Definitions • CRISIS INTERVENTION EXAMPLES: • All activities must occur within the context of a potential psychiatric crisis. • Face-to-face or telephone contact with the client for the purpose of preliminary assessment of need for mental health services. • Face-to-face or telephone contact to provide immediate, short-term, crisis-specific therapy or counseling with client, and, as necessary, with client’s caretaker or family. • Referral to other applicable mental health services. Including pre-hospitalization screening. • Face-to-face consultation with a physician or hospital staff regarding need for psychiatric consultation.

38. Service Definitions • CRISIS INTERVENTION minimal staff requirement - MHP with immediate access to a QMHP.

39. Service Definitions • JOB FINDING: Activities for a specific client, directed toward helping them find a and procure a job, when provided under the following conditions: placement based on consumer job preferences, competitive employment in integrated work settings, on-going supports as needed and integration of supported employment services with other mental health services.

40. Service Definitions • JOB FINDING EXAMPLES: • Helping the client identify job leads. • Reviewing the client’s network of job leads. • Contacting employers about a job for a specific client. • Assisting a client in completing employment applications. • Arranging a job interview • Evaluating a job site to determine if it is a good fit for the client. • Facilitating a group where clients exchange job leads and their experience using various job-finding strategies with one another.

41. Service Definitions • JOB FINDING minimum staff requirement - RSA.

42. Service Definitions • JOB RETENTION SUPPORTS: Activities for a specific client directed toward helping them keep their job, when provided under the following conditions: placement based on consumer job preferences, competitive employment in integrated work settings, on-going supports as needed and integration of supported employment services with other mental health services.

43. Service Definitions • JOB RETENTION SUPPORTS EXAMPLES: • Helping the client identify and make use of their support system to manage their concerns about work. • Frequently talking with client about changes in health, work environment, or personal environment to identify needed support categories. • Helping the client identify and implement strategies that improve job performance or relationships at work.

44. Service Definitions • JOB RETENTION SUPPORTS minimum staff requirement - RSA.

45. Service Definitions • JOB LEAVING/TERMINATION SUPPORTS: Activities for a specific client, who is employed, directed toward helping them leave a job in good standing, when provided under the following conditions: placement based on consumer job preferences, competitive employment in integrated work settings, on-going supports as needed and integration of supported employment services with other mental health services. Job Leaving/Termination Supports may also be provided to help the client see unplanned job loss as a transitional and a learning experience that will help them with their next job. Job Leaving/Termination Supports are provided to ensure that a job loss due to termination is not seen as a reason to discontinue participation in the supported employment program.

46. Service Definitions • JOB LEAVING/TERMINATION SUPPORTS EXAMPLES: • Using motivational interviewing to help client identify the pros and cons of leaving their job. • Deciding how much notice is required to leave in good standing. • Coaching on talking to a supervisor about resigning. • Helping write a letter of resignation. • Coaching on how to obtain a letter of reference.

47. Service Definitions • JOB LEAVING/TERMINATION SUPPORTS minimal staffing requirement - RSA.

48. Service Definitions • ORAL INTERPRETATION AND SIGN LANGUAGE: Sign language/oral interpreter services necessary to ensure the provision of services for individuals with hearing impairments or in the primary language of non-English speaking individuals. Interpreters shall be linguistically appropriate in English and in the primary language of the individual and be able to translate critical information effectively.

49. Service Definitions • ORAL INTERPRETATION AND SIGN LANGUAGE minimal staff requirement - specialist.

50. Service Definitions • MENTAL HEALTH ASSESSMENT: The formal process of gathering into written reports information on the client - including, but not limited to, individual characteristics, presenting problems, history or cause of illness, history of treatment, psychosocial history and current functioning in emotional, cognitive, and behavior domains through face-to-face or personal contact with client or collaterals. The service results in identification of the client’s mental health service needs and recommendations for treatment and may include a tentative diagnosis.