Presentation on theme: "What Timberlands RSN is and does Annual Report Priorities by Contract and Client Services and for 2013 by Functional Area."— Presentation transcript:
What Timberlands RSN is and does Annual Report Priorities by Contract and Client Services and for 2013 by Functional Area
Regional Support Networks (RSN), as Prepaid Inpatient Health Plans (PIHP): Provide mental health services through contracted licensed providers agencies (Community Mental Health Agency, CMHA) For children and adults who are eligible Medicaid-covered enrollees. Specifically adults who are acutely mentally ill, chronically mentally ill, or seriously disturbed and children who are acutely mentally ill, severely emotionally disturbed, or seriously disturbed. Per Washington Revised Code of Washington (RCW) : The regional support network shall have the flexibility, within the funds appropriated by the legislature for this purpose, to design the mix of services that will be most effective within their service area of meeting the needs of people with mental disorders and avoiding placement of such individuals at the state mental hospital. Regional support networks are encouraged to maximize the use of evidence-based practices and alternative resources with the goal of substantially reducing and potentially eliminating the use of institutions for mental diseases. Mental health services are also provided, as funds allow, to non-Medicaid clients. Any person regardless of funding source is eligible for Crisis Services. What is an RSN?
Timberlands Regional Support Network (TRSN) is: A quasi governmental entity, Created through an Interlocal Agreement, Into a legal partnership, between Lewis, Pacific and Wahkiakum Counties. Timberlands RSN stretches from the Pacific Ocean to east of Mt. Rainier in the Cascade mountain range encompassing 3,947 square miles and a community population of approximately 101,000 people. Who is TRSN?
TRSN provides funding for, and oversight of, direct mental health services delivered by its contracted providers. TRSN staff themselves do not provide any direct mental health services to clients. TRSN contracts with Cascade Mental Health Care, Willapa Behavioral Health and Wahkiakum Mental Health Services to provide direct mental health services for each of Timberlands RSN Counties, Lewis, Pacific and Wahkiakum. What does an RSN do?
Timberlands Regional Support Network is committed to ensuring : That all eligible citizens of the communities we represent include all age groups experiencing mental illness: Can better manage their illness; Achieve their personal goals; And live, work and participate in their communities. Mission Statement
Who do we contract with? Timberlands RSN contracts with Washingtons Department of Social and Health and Services(DSHS) and monitored by the Department of Behavioral Health and Recovery (DBHR) Contracts include: PIHP Contract(Medicaid) and STATE Contract (Non-Medicaid), Federal Block Grant and other misc contracts. TRSN contracts with Provider Agencies in each of the counties represented. These contracts are an extension of the services responsibilities, policies and procedures, program specification, qualifications, credentialing and requirements of TRSNs contract with DSHS. Timberlands RSN also contracts with: Medical Director Ombudsman (Grievance System) Quality Review Team, LLC (Services Quality) Behavioral Healthcare Options Inc. (Authorizing Client Services) ProtoCall Services Inc. (After hours Crisis Services) Wahkiakum County Treasury and a local Accountant Contracts
PRIORITIES IN MEETING AND MONITORING CONTRACTS DSHS/DBHR Contract with TRSN: Federal External Quality Review Organization ( EQRO ) annual evaluation (June 2013) Washington State DSHS/DBHR contract monitoring and contract deliverables through out the year. Legislative sponsored targeted reviews of services and fiscal responsibility Federal sponsored targeted audits and reviews Fraud and Abuse and On going changes and requirements as a result of Healthcare Reform TRSN contract with Provider Agency includes Annual contract monitoring of Administration, Clinical and Quality Management, Fiscal, Fraud and Abuse and Information Systems. Contract Deliverables monitoring Quality Assurance Activities Quality Assessment Chart reviews Clinical Utilization Data Reports – Contract Performance, Standard, Specification, and Outcome Measurements Quality Indicators Contract Requirements Contract Monitoring
TRSN Contracted Services Outpatient Treatment Services Assessment to determine eligibility, including the medical necessity, for additional services. Individual, Family and Group Counseling, Case Management Psychiatric evaluation and medication management. Childrens Wrap Around type services Peer Support Services Intensive Services including in the home where appropriate Crisis Services – Available 24/7 to anyone Crisis triage and stabilization services Crisis and Inpatient Diversion support including and Step-down bed resources Evaluation and Treatment Facilities Community Hospital Psychiatric Inpatient Care Involuntary Detention Services and Court Hearings Community Based Services Residential Services, Transitional Housing, Step Down bed support Prison and Jail Treatment and Transition services Peer Recovery Centers Ombudsmen Services
TRSN SPECIAL PROJECTS that create Enhanced Services for RSN Eligible Clients High-Utilizer Clients - Clients whose services represent a large percent of resources expended Non-Medicaid Client increased Case Load - Clients who do not meet Medicaid eligibility criteria and are prioritized by acuity level or agency defined need Peer Support - Alumni Clients that can be trained and hired back to work with Clients Pain Management and Crisis Plan Protocol and Development Agency Clinicians working with High Risk and/or Clients with evidence of needed pain management and integrated care coordination. And Training Child Wraparound Intensive care Coordination Jail Services Upgrades Open Border Program – Allows clients living on County borders service location choice Coordination of Care with Health Plans Information Services Resources / Personnel upgrade to meet Health Care Reform and Electronic Health Records (EHR) and Telehealth requirements Homeless Support, Referral and Placement Added ARNP, High Intensive Resources Added staff resources for secondary service sites School Programs and Groups for Kids Trainings including Mental Health First Aid and Law Enforcement Crisis Intervention Training
How do we Track, Monitor and Report TRSN client services are meeting standards and clients are satisfied? Quality Management Plan, Utilization Management Plan and Quality and Performance Monitoring On site Client Chart reviews and Service Utilization Reviews Monthly and Quarterly Data Reports reviewed at Clinical Director and Quality Management Committee meetings. Quality and Performance Indicators Incident Reports Ombuds Services Report (Grievance) Quality Review Team (QRT) Surveys Mental Health Statistics Improvement Project Survey (MHSIP) Client Services Monitoring
Timberlands RSNs would like to announce and introduce the new client run business Quality Review Team, LLC The QRT provides service monitoring through the TRSN region and the team consists of Rolly Armstrong, Wahkiakum County, Manager Tracy McDougall, Pacific County LaRonna Lorber, Lewis County Kat Erskine, Pacific County
TRSN PRIORITES CONTRACT REQUIREMENTS CLIENT SERVICES and OUTCOMES
Responsible for the overall operations and administration of Timberlands RSN. Responsible for development of plans, policies, procedures, standards, budget and fiscal operations, personnel and information system functions for TRSN, as approved by the TRSN Governing Board. Some of these responsibilities are carried out in conjunction with other TRSN staff. The Administrator develops provider contracts, oversees funding, monitors providers for contract compliance, quality, capacity and manages the appropriate allocation of resources in accord with contract expectations and Governing Board direction Assures appropriate service and responsible for ongoing review of service system; Makes adjustments to assure high quality, accessible and cost effective service delivery system. Builds productive relationships and works closely with provider network and business associates; responsible for annual and ongoing contract monitoring. Develops and monitors agreements and MOUs with other systems, as required or needed Represents TRSN at the State Level (DSHS, Division of Behavioral Health and Recovery, Association of County Human Services, etc.), and with citizen groups, allied service providers, advocates, service recipients, etc. TRSN Administrator
TRSN Administrator Priorities Contract Client Service Special Projects – Continue to do service gap analysis and implement enhanced services to meet the unmet needs of TRSN clients, while prioritizing funding resources Open Borders Contracting for added Crisis Stabilization Beds Finding or creating alternative housing resources for hard to house clients Hospital Relationship Building Quality Review Team and Ombuds Services Collaboration Customer Service across the network Incident trending and service upgrades Authorizing System Upgrades Tribal relationship building Telehealth implementation Jail and Crisis System Upgrades Medicaid Expansion – Planning, Organizing and Positioning TRSN structure to meet needs of increased client population HealthCare Reform – Integrated and Coordinated Care – Planning for Health Homes, Dual Eligible services and increasing Healthcare requirements.- Sharing Information Developing Relationships with Community Organizations and Alliances and Health Plans and their facilities Contract Management-Contract Deliverables BUDGET Planning RSN Merging and new Legislative Requirements Internal business systems upgrades Regional Partnering to leverage resources on common goals and objectives Planning for decreased Western State Hospital (WSH) Bed Allocation Planning for Lack of Inpatient Beds and finding alternative resources Planning and Coordinating for Federal, State and Fiscal Audits and Reviews. Impact on Hospital Association on RSNs QRT and Ombuds, Accountant Contract Coordination Federal Block Grant Planning and Coordination Judicial Cost Planning TRSN Utilization and Reporting System Upgrades New Grievance System requirements New Medical Loss Ratio requirements New Performance Based Contracts Working on new Report Card System New DSHS emphasis on Evidence Based and Outcome Planning for New Mental Health WAC requirement New Emphasis on Integrating Crisis Services HR Planning and Follow up
TRSN Administrator 2013 Priorities Medicaid Expansion – Planning, Organizing and Positioning TRSN structure to meet needs of increased client population. HealthCare Reform – Integrated and Coordinated Care – Planning for Health Homes, Dual Eligible services and increasing Healthcare requirements.- Sharing Information. New DSHS required Performance based Contracts with emphasis on Evidence Base Practice, Outcome Measurements and Medical Loss Ratio Requirements. Special Projects – Continue to do service gap analysis and implement enhanced services to meet the unmet needs TRSN clients, while prioritizing resources. Regional Partnering to leverage resources toward common goals and objectives. Continue to develop relationships with Community Organizations, Alliances and Health Plans and their facilities. Planning for the continued lack of Inpatient beds and finding alternative resources. Planning for new legislative bills impact on TRSN business Budgeting, fiscal planning, monitoring and adjusting to priorities.
Quality Manager / Clinical Director The Quality Manager (QM) is responsible for planning, designing, implementing, coordinating, analyzing and evaluating Quality Management activities. QM activities include, but are not limited to: monitoring performance indicators, implementing performance improvement projects, performance improvement measures and continuous quality improvement initiatives. The Quality Manager leads development of plans and needed actions in response to annual contract monitoring, certification reviews, EQRO or other DSHS monitoring reviews as well as instituting and ensuring follow-up as appropriate. The Quality Manager facilitates the Quality Management Committee (QMC). The Clinical Director reviews client charts to ensure appropriate service delivery and efficient utilization management. The Clinical Director facilitates Clinical Directors meetings.
Coordinate quality management activities (Medical Director, Behavioral Healthcare Options Inc., Quality Management Committee, Quality Review Teac, Ombuds), facilitate Clinical Directors meetings and Quality Management Committee. Quality Management Review Client Satisfaction Treatment outcome measures Quality Initiatives Performance Improvement Projects Recovery and Resilience Focus Coordination of Care Primary Care / Health Homes Jail Services Health Plan Coordination Community Referrals Allied Providers Home and Community Services Continuum of Care Crisis Inpatient Outpatient Discharge Client Services Complete required reports, participate in External Quality Review Organization review and Contract Monitoring Quality Management / Clinical Oversight Clinical Policy and Procedure Training and consultation as needed Review and analysis of data Evidence Based Practice Practice Guidelines Care Management / Utilization Management Care Coordination Case Management Resource Management Childrens Care Coordinator Risk Management Performance Monitoring Clinical Chart Audits Utilization Reviews Contract Monitoring Grievance and Appeal Incidents review Contract Quality Manager/Clinical Director
Quality Manager / Clinical Director 2013 Priorities Medicaid Expansion Resource Management Evaluation LOCUS (Adult Level of Care Utilization System) / CALOCUS (Child & Adolescent Level of Care Utilization System) Healthcare Reform Coordination Health Homes Health Plans Hospital Discharge Protocol Childrens Services Children focused Performance Improvement Project (PIP)
The IS Administrator is responsible for the reporting of client data to the State. The IS Administrator is responsible for assuring that data and reports needed to carry out activities and monitor compliance are available. The IS Administrator also monitors the quality and completeness of TRSNs data system (data integrity). The Compliance Officer manages issues related to Fraud and Abuse and HIPAA compliance. IS Administrator/ Compliance Officer
IS Administrator/Compliance Officer Contract Quality of Data Manage Medicaid Management Information System (AVATAR) State Encounter Data Reporting Encounter Data Validation Washington State Consortium (Avatar) State Meeting Representation Policy and Procedures IS Implementations Training & Support Compliance HIPAA Fraud and Abuse Breach Notifications Data Security Contract Monitoring Policy and Procedures Client Services Quality of Data Agency IS Support Facilitate Information System Quality Committee Quality Indicator Reports Development Customized Report Development Quality Management Committee Electronic Health Record Implementation, Training and Support Compliance Compliance Reports Client Privacy and Data Security Reporting Fraud and Abuse Verification of Services
IS Administrator / Compliance Officer 2013 Priorities Health Care Reform Electronic Health Record Meaningful Use Health Information Exchange ProtoCall Services Inc. Data Quality Agency Training / Support Data Timeliness Standards Compliance Fraud and Abuse Program Monitoring Reports HIPAA
The Executive Coordinator provides office management and coordination to the Administrator, Governing & Advisory Boards. The Executive Coordinator is responsible for assuring that materials needed to carry out activities and monitor compliance are available and accurate. The Executive Coordinator completes delegated tasks such as: Jail Roster Cross Reference – checks daily Inpatient Hospital and Health Plan Notifications – daily admits and discharges to each agency Excluded Parties List System – Fraud and Abuse - monthly Provider Licenses & Certifications Executive Coordinator
Executive Coordinator Priorities Contract Provider Licenses and Certification Excluded Parties List System Provider Staff Rosters and Changes Governing Board and Advisory Board members coordinator Advisory Board Recruitment Open Public Meeting Act contact Client Service Client Service Calls Client Services Logs Coordination / Follow up regarding information requests TRSN webpage manager Jail Rosters Cross Reference Cross Systems Reports Inpatient Hospital Notification 2013 Priorities Update Contract Deliverables Coordinate Audits, Reviews, Mtgs Inform TRSN Network Structure on Contract related information Update Website to meet Health Reform Add Community resource referral sources Assist in Care Integration notification Clients and Communities Communication and Coordination
Provider Priorities The concern whenever contrasting these two areas is that the hope should always be that the work under the contract supports the work with the client. Unfortunately that is not always the case. Both are very important to consider and its important to try to reconcile the two as best as possible. Contract Access (First contactstandards do not include client choice. Trying to find balance between client choice and contract. Clients do not always understand the importance of accepting appointments right away vs. next week) Hospitalization follow up Hospital Recidivism Evidence Based Practice implementation Special Population consults (quality vs. timeliness is something the contract does not take into consideration. Hope new WAC will allow for better results) Jail Services making services meaningful (real engagement vs. meeting contract language with completing certain number of assessments, etc.) Upgrade LOC guidelines (these are not particularly meaningful because the standards seem arbitrary and do not take into account fluctuating care needs for clients. Seems to be a structure designed to justify itself) Paperwork (Developing way to meet requirements without becoming overly burdensome) Client Services Access (first contact and follow up)clients that do not show up for intakes, clients that do not show up for follow up, better manner of using crisis services (non- crisis services option) Exiting services developing better plans to transition out of care Decreased dependency Focusing clients on getting better as a solution not as another problem Crisis services -being client and community friendly (as much as possible) Hospitalization making hospital stays and transitions meaningful experiences. Focusing Care Management toward clients developing skills to meet basic needs (workload necessitates expediency vs. quality) Preventative services Education of community and clients Improved coordination efforts Primary Care Providers (PCPs) physical health Community Partners Family QUALITY in everything we do
Timberlands RSN 2012 Success Stories As we come to the end of our Annual Report presentation we hope this has demonstrated how important each and everyone at the table is to making up the TRSN TEAM as we continue to deliver quality mental health services in Lewis, Pacific and Wahkiakum Counties. We like to focus on the following quotation... Clients recover, Clinicians facilitate recovery. Systems and communities support recovery. We would now like to present 2012 success stories !