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The Illinois Mental Health Collaborative for Access and Choice Overview of the Authorization Process and Fidelity Monito

The Illinois Mental Health Collaborative for Access and Choice Overview of the Authorization Process and Fidelity Monitoring. March 27, 2008. ACT Team Leader Meeting. AGENDA. Introductions Purpose of Monthly Meetings Topic Selections - authorization process in brief

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The Illinois Mental Health Collaborative for Access and Choice Overview of the Authorization Process and Fidelity Monito

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  1. The Illinois Mental Health Collaborative for Access and ChoiceOverview of the Authorization Process and Fidelity Monitoring March 27, 2008 ACT Team Leader Meeting

  2. AGENDA • Introductions • Purpose of Monthly Meetings • Topic Selections - authorization process in brief - overview of fidelity monitoring • Questions

  3. 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

  4. 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

  5. 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

  6. 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)

  7. 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

  8. 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

  9. Authorization Review Time Frame • Completed Requests Response Time: - Within one (1) business day for initial authorizations - Within three (3) business days for reauthorizations

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. . Questions?

  17. Posting of the Presentation 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!

  18. Thank you! Illinois Mental Health Collaborative for Access and Choice

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