1. Timberlands Regional Support Network
What Timberlands RSN is and does
Annual Report
Priorities by Contract and Client Services and for 2013 by Functional Area
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2. What is an RSN?
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.
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3. Timberlands Regional Support Network (TRSN) is:
Who is TRSN?
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.
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4. brian?

5. What does an RSN do?
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.
trisha

6. Mission Statement
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.
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7. Contracts Who do we contract with?
Timberlands RSN contracts with Washington’s 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 TRSN’s 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
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8. Contract Monitoring 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
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Organizations are evaluated to verify that they are meeting contract requirements.

9. 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.
Children’s “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
3 way split
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trisha
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10. that create Enhanced Services for RSN Eligible Clients
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
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11. Client Services Monitoring
How do we Track, Monitor and Report TRSN client services are meeting standards and client’s 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)
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12. Quality Review Team, LLC
Timberlands RSN’s 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
sandy – LIGHTS ON

13. TRSN 2012 Annual Report
lights on annual report hard copy

14. CLIENT SERVICES and OUTCOMES CONTRACT REQUIREMENTS
TRSN PRIORITES
CLIENT SERVICES and OUTCOMES
CONTRACT REQUIREMENTS
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15. TRSN Administrator
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 MOU’s 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.
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16. TRSN Administrator Priorities
Contract
Client Service
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
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
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Discuss one goal for 2013 and how it addresses contract requirements and customer service

17. 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.
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18. 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.
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19. Quality Manager/Clinical Director
Contract
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
Children’s Care Coordinator
Risk Management
Performance Monitoring
Clinical Chart Audits
Utilization Reviews
Contract Monitoring
Grievance and Appeal
Incidents review
Coordinate quality management activities (Medical Director, Behavioral Healthcare Options Inc., Quality Management Committee, Quality Review Teac, Ombuds), facilitate Clinical Director’s 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
trisha
Discuss one goal for 2013 and how it addresses contract requirements and customer service

20. 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
Children’s Services
Children focused Performance Improvement Project (PIP)
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21. IS Administrator/ Compliance Officer
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 TRSN’s data system (data integrity).
 The Compliance Officer manages issues related to Fraud and Abuse and HIPAA compliance.
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22. IS Administrator/Compliance Officer
Contract
Client Services
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
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
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Discuss one goal for 2013 and how it addresses contract requirements and customer service
EHR implementations
Assessments
Order Connect
Document Imaging
Data Quality Indicators
Care Outcome Data
Fraud and Abuse Monitoring Reports
Avatar System Training for Clinical and IS
Proto Call Encounter Data
Continue to build IT Infrastructure
Training of Avatar Super Users
Agency Networks and equipment
HIPAA Electronic Transactions
Meaningful Use
Health Plan Coordination

23. 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
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24. Executive Coordinator
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
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25. Executive Coordinator Priorities
Contract
Client Service
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 Calls
Client Services Logs
Coordination / Follow up regarding information requests
TRSN webpage manager
Jail Rosters Cross Reference
Cross Systems Reports
Inpatient Hospital Notification
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2013 Priorities
Update Website to meet Health Reform
Add Community resource referral sources
Assist in Care Integration notification
Clients and Communities Communication and Coordination
Update Contract Deliverables
Coordinate Audits, Reviews, Mtgs
Inform TRSN Network Structure on Contract related information

26. 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 it’s important to try to reconcile the two as best as possible.
Contract
Client Services
Access (First contact—standards do not include client choice. Trying to find balance between client choice and contract. Client’s 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)
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
brian

27. 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!