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Region 1 South Crisis Care System System of Care Overview Policy and Procedures Illinois Department of Human Services Division of Mental Health Jackie.

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Presentation on theme: "Region 1 South Crisis Care System System of Care Overview Policy and Procedures Illinois Department of Human Services Division of Mental Health Jackie."— Presentation transcript:

1 Region 1 South Crisis Care System System of Care Overview Policy and Procedures Illinois Department of Human Services Division of Mental Health Jackie Manker, LCSW Associate Director Community Services June 6, /6/2012 1

2 Materials for today Region 1 South Crisis Care System Policies and Procedure Chapter of Provider Manual Calendar Presentation Slides 6/6/20122

3 Objectives of OVERVIEW Understand the flow of new Crisis Care System Understand key policies Understand procedures Understand any interim policies and procedures 6/6/20123

4 4

5 DHS/DMH Intent To replace services previously provided by Tinley Park Mental Health Center with a re-balanced system and services that are: Community-based Recovery oriented Trauma informed Outcome validated 6/6/20125

6 Services Eligibility and Disposition Assessments (EDA) Community Hospital Inpatient Psychiatric Services (CHIPS) Mental Health Crisis Residential DASA Residential Crisis Stabilization Acute Community Services (ACS) Transportation 6/6/20126

7 Eligibility Individual presents in Region 1 South E.D. 6/6/20127

8 Region 1 South Area City of Chicago South of 67 th Street South Suburban Cook County Kankakee County Will County Grundy County 6/6/20128

9 Region 1 South AreaCommunity Hospitals to be Served City of Chicago South of 67 th StreetRoseland Community Hospital St. Bernard Hospital South Suburban Cook CountyFranciscan St. James Health Metro South Medical Center Advocate South Suburban Hospital Palos Community Hospital Little Company of Mary Hospital Advocate Christ Medical Center Ingalls Memorial Hospital Kankakee County Riverside Medical Center Provena St. Marys Hospital Will County Provena St. Joseph Medical Center Silver Cross Hospital Adventist Bolingbrook Hospital Grundy County Morris Hospital 6/6/20129

10 General Eligibility determined by E.D. Uninsured with no other resources Preliminary diagnosis of mental illness or mental illness and substance use disorder No acute medical illness or excluded medical condition 6/6/201210

11 When all criteria are met, E.D. calls for an Eligibility and Disposition Assessment conducted by a DMH funded evaluator assigned to that E.D. 6/6/201211

12 6/6/ Region 1 South Area Community Hospitals to be Served Assigned Eligibility & Disposition Assessment Agency City of Chicago South of 67 th Street Roseland Community HospitalHuman Resource Development Institute St. Bernard HospitalTo Be Determined (TBD) South Suburban Cook County Franciscan St. James Health Metro South Medical Center Advocate South Suburban Hospital Grand Prairie Services Palos Community Hospital Little Company of Mary Hospital TBD Advocate Christ Medical Center Ingalls Memorial Hospital Kankakee CountyRiverside Medical Center Provena St. Marys Hospital Helen Wheeler Mental Health Center Will CountyProvena St. Joseph Medical Center Silver Cross Hospital Adventist Bolingbrook Hospital Will County Behavioral Health Grundy CountyMorris HospitalGrundy County Health Department

13 EDA EVALUATORS Minimum credential of Qualified Mental Health Professional (QMHP) Available 24/7 Respond within (1) hour of call Confirms general eligibility 6/6/201213

14 EDA EVALUATOR Conducts clinical evaluation and documents on DMH Uniform Screening and Referral Form (USARF) For individuals with suspected substance use, also assesses using ASAM Patient Placement Criteria Completes level of care assessment using the Level of Care Utilization System (LOCUS) 6/6/201214

15 EDA EVALUATOR Determines if individual meets 2 clinical criteria for Region 1S CCS Diagnosis of: Schizophrenia (295.xx)Schizophreniform Disorder (295.4) Schizo-affective Disorder (295.7)Delusional Disorder (297.1) Shared Psychotic Disorder (297.3)Brief Psychotic Disorder (298.8) Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13) Major Depression (296.2x, 296.3x)Obsessive-Compulsive Disorder (300.30) Anorexia Nervosa (307.1)Bulimia Nervosa(307.51) Post Traumatic Stress Disorder (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, , , ) LOCUS Score of 4 or greater 6/6/201215

16 EDA EVALUATOR Individual does NOT meet clinical criteria Inform ED physician/staff Provide any alternative treatment or service recommendation e.g. DMH Non-Medicaid benefit package 6/6/201216

17 EDA EVALUATOR Individual does meet clinical criteria Evaluator determines individual is a resident of Region 1 South geographic area No – refer to Madden Intake Yes – recommend level of care and service needs CHIPS Mental Health Crisis Residential DASA Residential Crisis Stabilization ACS Transportation 6/6/201217

18 EDA EVALUATOR Is the individual willing? 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, ED physician/staff and others of individuals choice 6/6/201218

19 EDA EVALUATOR Individual is willing to Engage Inform ED physician/staff of recommended level of care ED physician/staff concur Evaluator calls the ACCESS line for Authorization Available services Authorization number 6/6/201219

20 Service Authorization Illinois Mental Health Collaborative for Access and Choice DMHs Administrative Service Organization (ASO) Toll free ACCESS Line (866) /6/201220

21 Service Authorization Clinical Care Managers (CCM) available 24/7 Evaluator provides information Demographics Clinical presentation Recommended disposition CCM reviews for medical necessity 6/6/201221

22 Service Authorization When medical necessity is present for recommended level of care, the CCM: Provides authorization number Provides location and contact information for service provider 6/6/201222

23 EDA EVALUATOR Evaluator Contacts service provider to make referral. Makes needed transportation arrangements using authorization number. Ensures required documentation is complete and copy to ED and accepting service provider (USARF, LOCUS, ASAM, disposition and recommendations). Confirms linkage occurred within 24 hours. Registers individual in DHS/DMH consumer registration system. 6/6/201223

24 Hospital-Based EDA Evaluator (Advocate Christ and Ingalls Memorial) All previous elements required PLUS Physician conducts evaluations May provide active treatment if applicable (e.g. extended observation, Medication administration/monitoring, crisis intervention) DMH will provide training on registration 6/6/201224

25 Service Authorization Alternative Level of Care If the CCM would propose a different level of care based on medical necessity or capacity Evaluator discusses alternatives with ED physician/staff If in agreement, authorization and referral process is initiated 6/6/201225

26 Service Authorization If Not in agreement: Collaborative CCM provides clinical presentation, treatment recommended and capacity to Madden Intake. Madden Intake physician reviews information and discusses with ED physician. Madden Intake physician considers option and determines most appropriate level of care and informs both CCM and ED physician. CCM contacts Evaluator with determination and authorizes services as appropriate. 6/6/201226

27 Disposition Options Community Hospital Inpatient Psychiatric Services (CHIPS) DMH funded, short-term (less than 6 days), inpatient at community hospital. Serve those experiencing psychiatric crises and exhibit acute behaviors or symptoms requiring inpatient setting. 6/6/201227

28 CHIPS Individual has symptoms consistent with a diagnosis of one of the following mental illnesses: Schizophrenia (295.xx)Schizophreniform Disorder (295.4) Schizo-affective Disorder (295.7)Delusional Disorder (297.1) Shared Psychotic Disorder (297.3)Brief Psychotic Disorder (298.8) Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13) Major Depression (296.2x, 296.3x)Obsessive-Compulsive Disorder (300.30) Anorexia Nervosa (307.1)Bulimia Nervosa(307.51) Post Traumatic Stress Disorder (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, , , ) 6/6/201228

29 Hospitals with CHIPS Contracts Advocate Christ Medical Center, Oak Lawn Ingalls Memorial Hospital, Harvey MacNeal Hospital, Berwyn Mt. Sinai Hospital, Chicago Riverside Hospital, Kankakee St. Anthonys Hospital, Chicago St. Bernard Hospital & Health Care Center, Chicago Provena St. Marys, Kankakee University of Illinois Hospital, Chicago 6/6/201229

30 Mental Health Crisis Residential DMH funded, short-term 24/7 continous supervision and treatment in a provider controlled facility. Grand Prairie Services is the current provider. 6/6/201230

31 Mental Health Crisis Residential Individuals symptoms require psychiatric stabilization services. Individual has symptoms consistent with a diagnosis of one of the following diagnosis. Schizophrenia (295.xx)Schizophreniform Disorder (295.4) Schizo-affective Disorder (295.7)Delusional Disorder (297.1) Shared Psychotic Disorder (297.3)Brief Psychotic Disorder (298.8) Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13) Major Depression (296.2x, 296.3x)Obsessive-Compulsive Disorder (300.30) Anorexia Nervosa (307.1)Bulimia Nervosa (307.51) Post Traumatic Stress Disorder (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, , , ) 6/6/201231

32 DASA Residential Crisis Stabilization Short term (5-10 days) residential treatment that targets: Stabilization of problems related to biomedical, emotional, behavior, or cognitive conditions as described in ASAM Dimensions 1-3. Diagnosis of mental illness and substance use disorder. Planned regimen of care of at least 3 hours of treatment services per day. Must link with Acute Community Service provider upon discharge. 6/6/201232

33 DASA Residential Crisis Stabilization Providers The Haymarket Center, Chicago Healthcare Alternative Systems, Chicago The South Suburban Council on Alcoholism & Substance Abuse, East Hazel Crest The Womens Treatment Center, Chicago 6/6/201233

34 Acute Community Service (ACS) 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 Services must be initiated within 24 hours of discharge from ED Services must be initiated within 48 hours of discharge CHIPS, crisis residential, or SOH, and those discharged from DASA residential with co-occurring disorder. 6/6/201234

35 Acute Community Service (ACS) Individual eligible for services up to 12 months of initial assessment Provider agrees to serve all referred individuals Provider required to assist individual with application for medical assistance 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 6/6/201235

36 Acute Community Care Service Providers Region 1 South AreaAcute CCS Provider City of Chicago South of 67 th StreetHuman Resource Development Institute Metropolitan Family Services South Suburban Cook County Township Bremen, Thornton, Rich, BloomGrand Prairie Services Lemont, Calumet, Palos, Worth, OrlandMetropolitan Family Services Kankakee CountyHelen Wheeler Mental Health Center Will CountyWill County Behavioral Health Cornerstone Services Grundy CountyGrundy County Health Department 6/6/201236

37 Madden Mental Health Center Services Will serve as safety net when other services are not appropriate or available. 6/6/201237

38 Madden Mental Health Center Services When an individual presents with the following, Madden may be consulted for consideration of DMH admission. History indicating need for extended inpatient treatment Presents challenges in discharge placement from inpatient setting, such as being homeless Co-occurring substance use disorder requiring medical observation that exceeds the capability of available community inpatient psychiatric services 6/6/201238

39 Madden Mental Health Center Intake Responsible for managing the referrals to DMH hospitals to ensure available capacity For individuals from Region 1 Central who presents at one of the four DMH contracted CHIPS hospitals, Madden Intake may choose to utilize CHIPS, Mental Health Crisis Residential or SA Residential Crisis Stabilization beds when appropriate and needed to manage DMH hospital capacity 6/6/201239

40 Transportation DMH will purchase transportation services between Emergency Departments, CHIPS hospitals, MH Crisis Residential and DASA Residential Crisis Stabilization Individual must meet all eligibility criteria The Authorization number received from the Collaborative will serve as authorization for transportation Transportation provider must respond within 60 minutes of request 6/6/201240

41 Region 1 South Crisis Care System System of Care Overview Policies and Procedures Thank you!! Questions?? 6/6/201241


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