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U NVEILING A CCESS TO C HILDREN ’ S S YSTEM S ERVICES An Answer to Some of Your Questions…

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Presentation on theme: "U NVEILING A CCESS TO C HILDREN ’ S S YSTEM S ERVICES An Answer to Some of Your Questions…"— Presentation transcript:

1 U NVEILING A CCESS TO C HILDREN ’ S S YSTEM S ERVICES An Answer to Some of Your Questions…

2 “A T THE TOP OF THE P YRAMID ” Intensive Intervention: When it is time to seek help for problem behaviors that are outside the expertise/role of program staff and ECMH

3 K EY P OINTS IN A CCESSING MH S ERVICES If there is a primary insurance (ex: BCBS) the family should call them to locate in network providers: this typically applies to MHIP, MH- PHP, MH/SA OP, psychological, and psychiatric services. BHRS (and FBMHS, RTF, CRR, etc) is not covered by primary insurers (with the exception of Act 62 when applicable). The family would need to apply for MA. MA is always the “payor of last resort” when a primary insurance is established.

4 W HO ARE THE BH-MCO S IN PA? CBHNP (Community Behavioral Health Network of PA) CCBHO (Community Care Behavioral Health) VBH (Value Behavioral Health) CBH (Community Behavioral Health) Magellan



7 A CCESS P OINTS ARE NOT LIMITED TO : Get MH services Through MHMR Through CYS Through self referral Through a human service provider Through Juvenile Justice Through Education

8 O BTAINING M EDICAL A SSISTANCE Apply online at: Obtain paper form of application at the local county assistance office. Obtain printable copy of application at uments/form/s_001562.pdf uments/form/s_001562.pdf Family will be notified within 30 days after they receive the COMPLETED application whether or not the family member is eligible. Sometimes this can impact access to BHRS due to the MA regulation that psychological evaluations for this level of care expire after 60 days and can no longer be accepted for MNC review. Families will need a re-evaluation with a psychologist for new recommendations to submit to the BH-MCO

9 T HE APPLICATION PROCESS FOR C ATEGORY PH 95 ( LOOPHOLE ) o There is a common misconception that all children with a disability or all children with an IEP (Individual Education Plan) or all children with a particular diagnosis qualify for Medical Assistance. This is not the case because the “rules” are not that simple. o This loophole allows for documentation of the “disability standard” for non-SSI disabled child provision. o “Childhood Listings of Impairments” for mental health disorders can be found at /112.00-MentalDisorders-Childhood.htm /112.00-MentalDisorders-Childhood.htm o There are additional descriptions of impairments other than MH issues on this site as well. o You can access more detailed information on the loophole at the PA Health Law Project website,, under the “Recent Publications” section.

10 CASSP (C HILD AND A DOLESCENT S ERVICE S YSTEM P ROGRAM ) PA adheres to the CASSP Principles Child-centered, family-focused, community-based, multi- system, culturally competent, least restrictive/least intrusive (for introduction to CASSP and a current list of Coordinators) At the county level, integrated children’s services planning is required by DPW. CASSP Coordinators serve as the contact person for children with multi-system needs. Children with serious emotional and behavioral needs often require services from more than one child-serving system School services, child welfare, juvenile justice, healthcare system, family system

11 C HILDREN ’ S S ERVICES C ONTINUUM Restrictive and Intrusive RTF CRR-HH MHIP PHP FBMHS Least restrictive for BHRS would be to begin with a single clinician NOT a clinician/TSS combination (in most cases) BHRS *MT/BSC/TSS *ASP *STAP Least Restrictive/Least Intrusive IOP OP TCM

12 S ERVICES AT YOUR LOCAL MH/MR Mental Health Case Management Services Goals of this service: To connect individuals with the appropriate services To improve level of functioning To provide continuity of care To identify necessary resources Available for Adults and Children Three Levels of Case Management (*) Administrative Blended Case Management Intensive Case Management Intellectual Disabilities (MR/ASD) Services (*) Crisis Intervention Services (*)

13 A CCESSING S ERVICES AT YOUR MHMR Contact the county MHMR to discuss what their services are and how families can access them. or your local county webpage Typical Intake session could include the following: Answering questions that determine eligibility for services Filling out several forms Determine Liability (who pays for the service) through review of Insurance and Financial information After the Intake: Evaluation (through a community agency) Disposition (development of individualized service plan based on recommendations made)

14 B EHAVIORAL H EALTH R EHABILITATION S ERVICES ( AKA BHRS) The most commonly recommended services for small children are: Mobile Therapy (MT): The role of the mobile therapist is to provide intensive therapeutic services to the child and family, and must be individualized for the child and family and based upon the Member’s needs. The services include all forms of psychotherapy and include conducting behavioral therapies such as, creating behavior modification plans. Behavior Specialist Consultant (BSC): The role of a behavior specialist consultant is to design and direct the implementation of a behavior modification intervention plan, which is individualized to each child or adolescent and to family needs. Consultations are specific to the individual needs of the Member and should result in the BSC giving direction to the team to reduce the symptoms of the client

15 B EHAVIORAL H EALTH R EHABILITATION S ERVICES ( AKA BHRS), CONTINUED Therapeutic Staff Support (TSS): The role of a TSS is one on one intervention to a child or adolescent at home, school, and community when the behavior without this intervention would require a more restrictive treatment or educational setting. Specific therapeutic staff support services include: crisis intervention techniques, behavior modification interventions, implementing reinforcements, emotional support, time structuring activities, time out strategies, and passive restraints when necessary, and additional psychosocial rehabilitative activities as prescribed in the treatment plan or behavior plan designed by the qualified clinician. In general, The TSS must use specific interventions or methods as listed on the treatment plan to stabilize the child, teach, and transfer the skills to the family, natural environment, and other team members. Overall, the task of the TSS is to support the family’s and team member’s efforts to stabilize the child or adolescent and promote age appropriate behavior by giving the natural supports the skills to support child needs.

16 T YPICAL P ROCESS IN O BTAINING BHRS Psychological or Psychiatric evaluator makes recommendations. Evaluation is sent to family’s preferred provider (see individual BH-MCO’s website for a list of these). Initial ISPT (interagency services planning team) meeting is scheduled and held by an identified BHRS provider. Packet items are submitted for review by a care manager according to Health Choices Appendix T Medical Necessity Criteria. Denial of services can only be completed by a Psychiatrist or a Psychologist-NOT the Care Manager at the BH-MCO.

17 A CCESSING P ROVIDER I NFORMATION IN THE R EGION YOU ARE WORKING IN Suggestions: Contact the Provider Relations Representative for identified Primary Insurance or BH-MCO for a current list of in network providers for the identified service. Seek provider list on the Primary Insurance or BH- MCO’s website Contact the MHMR office, they typically have this information available for families. They should also have a summary of all community resources available in their county Contact a local BHRS provider, they will have this list because families have to fill out the preferred provider form to submit with a packet.


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