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Northwest Crisis Care System System of Care Overview Policy and Procedures Illinois Department of Human Services Division of Mental Health September 12,

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Presentation on theme: "Northwest Crisis Care System System of Care Overview Policy and Procedures Illinois Department of Human Services Division of Mental Health September 12,"— Presentation transcript:

1 Northwest Crisis Care System System of Care Overview Policy and Procedures Illinois Department of Human Services Division of Mental Health September 12, 2012: Dan Wasmer, MS Associate Director, Regional Services Updated

2 Materials for today Calendar Calendar Presentation Slides Presentation Slides Updated

3 Objectives of OVERVIEW Understand the flow of new Crisis Care System Understand the flow of new Crisis Care System Understand key policies Understand key policies Understand procedures Understand procedures Understand any interim policies and procedures Understand any interim policies and procedures Updated

4 DHS/DMH Intent To enhance the existing Crisis Care system in Regions 2W and 3N by providing equivalent access to necessary levels of care that are: Community-based Community-based Recovery oriented Recovery oriented Trauma informed Trauma informed Outcome validated Outcome validated These services have historically been provided by Singer Mental Health Center. Updated

5 Services Enhanced Crisis Response Enhanced Crisis Response Community Hospital Inpatient Psychiatric Services (CHIPS) Community Hospital Inpatient Psychiatric Services (CHIPS) Mental Health Crisis Residential Mental Health Crisis Residential Acute Community Services (ACS) Acute Community Services (ACS) Transportation Transportation Updated

6 Enhanced Crisis Response DHS/DMH expects that community providers in Region 2W and 3N will continue to respond to mental health crisis situations within their communities DHS/DMH expects that community providers in Region 2W and 3N will continue to respond to mental health crisis situations within their communities DHS/DMH is funding enhancements to this system to ensure timely access. DHS/DMH is funding enhancements to this system to ensure timely access. Updated

7 Eligibility Disposition Assessment (EDA) EVALUATORS Minimum credential of Qualified Mental Health Professional (QMHP) Minimum credential of Qualified Mental Health Professional (QMHP) Available 24/7 Available 24/7 Respond within (1) hour of call Respond within (1) hour of call Determines financial and clinical eligibility Determines financial and clinical eligibility Updated

8 EDA EVALUATOR Conducts clinical evaluation and documents on DMH Uniform Screening and Referral Form (USARF) Conducts clinical evaluation and documents on DMH Uniform Screening and Referral Form (USARF) Completes level of care assessment using the Level of Care Utilization System (LOCUS) Completes level of care assessment using the Level of Care Utilization System (LOCUS) Updated

9 EDA EVALUATOR Determines if individual meets 2 clinical criteria for Region NCCS Diagnosis of: Diagnosis of: Schizophrenia (295.xx) Schizophreniform D/O (295.4) Schizophrenia (295.xx) Schizophreniform D/O (295.4) Schizo-affective D/O (295.7) Delusional D/O (297.1) Shared Psychotic D/O (297.3) Brief Psychotic D/O (298.8) Psychotic D/O NOS (298.9) Cyclothymic D/O (301.13) Major Depression (296.2x, 296.3x) Obsessive-Compulsive D/O (300.30) Anorexia Nervosa (307.1) Bulimia Nervosa ( ) Post Traumatic Stress D/O (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, , , ) LOCUS Level of Care Recommendation of 4 or greater LOCUS Level of Care Recommendation of 4 or greater Updated

10 EDA EVALUATOR Individual does NOT meet clinical criteria Inform referral source as appropriate Inform referral source as appropriate Provide any alternative treatment Provide any alternative treatment or service recommendation e.g. DMH Non-Medicaid benefit package Updated

11 EDA EVALUATOR Individual does meet clinical criteria Evaluator determines individual is a resident of Region 2W/3N No – refer to Elgin/McFarland Yes – recommend level of care and service needs CHIPS Mental Health Crisis Residential ACS Transportation Updated

12 EDA EVALUATOR Is the individual willing? Is the individual willing? Individual is NOT willing to engage? Individual is NOT willing to engage? Does he/she meet criteria for involuntary hospitalization? Yes – proceed with process No – explain outcome of assessment, recommend level of care to individual, referral source and others of individuals choice Updated

13 EDA EVALUATOR Individual is willing to Engage Inform referral source as appropriate of recommended level of care Inform referral source as appropriate of recommended level of care If individual is in Emergency Department, assure that ED physician/staff concur If individual is in Emergency Department, assure that ED physician/staff concur Evaluator calls the ACCESS line for Evaluator calls the ACCESS line for Authorization Authorization Available services Available services Authorization number Authorization number Updated

14 Service Authorization Illinois Mental Health Collaborative for Access and Choice Illinois Mental Health Collaborative for Access and Choice DMHs Administrative Service Organization (ASO) DMHs Administrative Service Organization (ASO) Toll free ACCESS Line (866) Updated

15 Service Authorization Clinical Care Managers (CCM) available 24/7 Clinical Care Managers (CCM) available 24/7 Evaluator provides information to ACCESS CCM Evaluator provides information to ACCESS CCM Demographics Demographics Clinical presentation Clinical presentation Recommended disposition Recommended disposition CCM reviews for medical necessity CCM reviews for medical necessity Updated

16 Service Authorization When medical necessity is present for recommended level of care, the CCM: When medical necessity is present for recommended level of care, the CCM: Provides authorization number Provides authorization number Provides location and contact information for Provides location and contact information for service provider service provider Updated

17 EDA EVALUATOR Evaluator Evaluator Contacts service provider to make referral. Contacts service provider to make referral. Makes needed transportation arrangements using authorization number. Makes needed transportation arrangements using authorization number. Ensures required documentation (USARF, LOCUS, disposition and recommendations) is complete; distributes copies to ED (if involved) and accepting service provider (USARF, LOCUS, disposition and recommendations). Ensures required documentation (USARF, LOCUS, disposition and recommendations) is complete; distributes copies to ED (if involved) and accepting service provider (USARF, LOCUS, disposition and recommendations). Confirms linkage occurred within 24 hours. Confirms linkage occurred within 24 hours. Registers individual in DHS/DMH consumer registration system. Registers individual in DHS/DMH consumer registration system. Updated

18 Service Authorization Alternative Level of Care If the CCM would propose a different level of care based on medical necessity or capacity If the CCM would propose a different level of care based on medical necessity or capacity Evaluator discusses alternatives with the individual and ED physician/staff (if in an ED) Evaluator discusses alternatives with the individual and ED physician/staff (if in an ED) If in agreement, authorization and referral process is initiated If in agreement, authorization and referral process is initiated Updated

19 Service Authorization If Not in agreement: Collaborative CCM provides clinical presentation, Collaborative CCM provides clinical presentation, treatment recommended and capacity to Elgin/McFarland Elgin/McFarland physician reviews information and discusses with ED physician (if involved). Elgin/McFarland physician reviews information and discusses with ED physician (if involved). Elgin/McFarland considers option and determines most appropriate level of care and informs both CCM and ED physician (if involved). Elgin/McFarland considers option and determines most appropriate level of care and informs both CCM and ED physician (if involved). CCM contacts Evaluator with determination and authorizes services as appropriate. CCM contacts Evaluator with determination and authorizes services as appropriate. Updated

20 Disposition Options Community Hospital Inpatient Psychiatric Services (CHIPS) DMH funded, short-term inpatient treatment at community hospital. DMH funded, short-term inpatient treatment at community hospital. Serve those experiencing psychiatric crises and exhibiting acute behaviors or symptoms requiring inpatient setting. Serve those experiencing psychiatric crises and exhibiting acute behaviors or symptoms requiring inpatient setting. Updated

21 Hospitals with CHIPS Contracts Updated Swedish American Hospital, Rockford Rockford Memorial Hospital, Rockford OSF St. Elizabeths, Ottawa Trinity Medical Center, Moline Provena Mercy Center, Aurora

22 Mental Health Crisis Residential DMH funded, short-term 24/7 continuous supervision and treatment in a provider controlled facility. DMH funded, short-term 24/7 continuous supervision and treatment in a provider controlled facility. Rosecrance is the current provider. Rosecrance is the current provider. Updated

23 Acute Community Service (ACS) Any services and supports needed by the individual to continue stabilization from crisis. Any services and supports needed by the individual to continue stabilization from crisis. Grant funding allows the provider ultimate flexibility in determining type, amount, frequency, etc., including medication Grant funding allows the provider ultimate flexibility in determining type, amount, frequency, etc., including medication Services must be initiated within 24 hours of the EDA Services must be initiated within 24 hours of the EDA Services must be initiated within 48 hours of discharge CHIPS, crisis residential, or SOH. Services must be initiated within 48 hours of discharge CHIPS, crisis residential, or SOH. Updated

24 Acute Community Service (ACS) Individual eligible for services up to 12 months of initial assessment Individual eligible for services up to 12 months of initial assessment Provider agrees to serve all referred/enrolled individuals Provider agrees to serve all referred/enrolled individuals Provider required to assist individual with application for medical assistance Provider required to assist individual with application for medical assistance Provider required to register each individual through DHS/DMH information system Provider required to register each individual through DHS/DMH information system Individuals will be referred to provider in their geographic proximity but will have choice if requested Individuals will be referred to provider in their geographic proximity but will have choice if requested Updated

25 Elgin and McFarland Mental Health Centers Will serve as safety net when other services are not appropriate or available. Will serve as safety net when other services are not appropriate or available. Updated

26 Elgin/McFarland Mental Health Centers When an individual presents with the following, Elgin/McFarland may be consulted for consideration of DMH admission. When an individual presents with the following, Elgin/McFarland may be consulted for consideration of DMH admission. History indicating need for extended inpatient treatment History indicating need for extended inpatient treatment Presents challenges in discharge from inpatient Presents challenges in discharge from inpatient setting, such as experiencing homelessness. Updated

27 Transportation DMH will purchase transportation services between site of EDA, CHIPS hospitals, and MH Crisis Residential DMH will purchase transportation services between site of EDA, CHIPS hospitals, and MH Crisis Residential Individual must meet all eligibility criteria Individual must meet all eligibility criteria The Authorization number received from the Collaborative will serve as authorization for transportation The Authorization number received from the Collaborative will serve as authorization for transportation Transportation provider must respond within 90 minutes of request Transportation provider must respond within 90 minutes of request Updated

28 Phone Contacts Complaint Resolution/Help Line McFarland Mental Health Center Elgin Mental Health Center Alternate Phone: – have operator connect you to the Admissions staff person. Alternate Phone: – have operator connect you to the Admissions staff person. Questions can also be sent to: Questions can also be sent to: Updated

29 Northwest Crisis Care System System of Care Overview Policies and Procedures Thank you!! Thank you!! Questions?? Questions?? Updated


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