Policy and Procedures Illinois Department of Human Services - - PowerPoint PPT Presentation

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Policy and Procedures Illinois Department of Human Services - - PowerPoint PPT Presentation

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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 June 6, 2012: Jackie Manker, LCSW Associate Director, Community Services June 13, 2012: Dan

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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 June 6, 2012: Jackie Manker, LCSW Associate Director, Community Services June 13, 2012: Dan Wasmer, LCSW Associate Director, Regional Services

updated 6/15/2012 1

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Materials for today

  • Region 1 South Crisis Care System Policies and

Procedure Chapter of Provider Manual

  • Calendar
  • Presentation Slides
  • Crisis Care System Flow Chart

updated 6/15/2012 2

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Objectives of OVERVIEW

  • Understand the flow of new Crisis Care System
  • Understand key policies
  • Understand procedures
  • Understand any interim policies and procedures

updated 6/15/2012 3

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SLIDE 4

updated 6/15/2012 4

ACCESS

Authorization

DMH Crisis Residential DMH Hospital DMH Acute Community Services DASA Residential Crisis Stabilzation

13 EDs No Behavioral Health Assessment Capacity YES NO Post discharge referral and linkage

Region 1 South Uninsured Community Population

CMHC ED-based Eligibility & Disposition Assessment

Community Stabilization CRISIS CARE SYSTEM 15 Community Hospitals Emergency Department Presentation

Clinical Disposition

Region 1 South Crisis Care System

Non Medicaid Benefit Package

Psychiatric Crisis

Is Consumer eligible Crisis Care Alternatives?

2 EDs with Behavioral Health Assessment Capacity

CHIPS

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SLIDE 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

updated 6/15/2012 5

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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

updated 6/15/2012 6

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Eligibility

  • Individual presents in Region 1 South E.D.

updated 6/15/2012 7

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

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Region 1 South Area Community Hospitals to be Served

City of Chicago South of 67th Street Roseland Community Hospital

  • St. Bernard Hospital

South Suburban Cook County Franciscan 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. Mary’s Hospital Will County Provena St. Joseph Medical Center Silver Cross Hospital Adventist Bolingbrook Hospital Grundy County Morris Hospital

updated 6/15/2012 9

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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

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SLIDE 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.

updated 6/15/2012 11

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updated 6/15/2012 12

Region 1 South Area

Community Hospitals to be Served Assigned Eligibility & Disposition Assessment Agency

City of Chicago South of 67th St. Roseland Community Hosp Human Resource Development Institute

  • St. Bernard Hosp

Human Resource Development Institute South Suburban Cook County Franciscan St. James Health Metro South MedCenter Advocate South Suburban Hosp Grand Prairie Services Palos Community Hospital Little Company of Mary Hosp Grand Prairie Services Advocate Christ Medical Center Advocate Christ Med Center Ingalls Memorial Hosp Ingalls Memorial Hosp Kankakee County Riverside Med Center Provena St. Mary’s Hosp Helen Wheeler Mental Health Center Will County Provena St. Joseph Med Center Silver Cross Hospital Adventist Bolingbrook Hosp. Will County Behavioral Health Grundy County Morris Hosp. Grundy County Health Dept

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EDA EVALUATORS

  • Minimum credential of Qualified Mental

Health Professional (QMHP)

  • Available 24/7
  • Respond within (1) hour of call
  • Confirms general eligibility

updated 6/15/2012 13

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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)

updated 6/15/2012 14

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EDA EVALUATOR

Determines if individual meets 2 clinical criteria for Region 1S CCS

  • Diagnosis of:

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 (307.51) Post Traumatic Stress D/O

(309.81)

Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)

  • LOCUS Score of 4 or greater

updated 6/15/2012 15

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EDA EVALUATOR

Individual does NOT meet clinical criteria

  • Inform ED physician/staff
  • Provide any alternative treatment
  • r service recommendation

e.g. DMH Non-Medicaid benefit package

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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

updated 6/15/2012 17

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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 individual’s choice

updated 6/15/2012 18

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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

updated 6/15/2012 19

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Service Authorization

  • Illinois Mental Health Collaborative for

Access and Choice

  • DMH’s Administrative Service Organization

(ASO) Toll free ACCESS Line (866) 359-7953

updated 6/15/2012 20

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Service Authorization

  • Clinical Care Managers (CCM) available 24/7
  • Evaluator provides information
  • Demographics
  • Clinical presentation
  • Recommended disposition
  • CCM reviews for medical necessity

updated 6/15/2012 21

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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

updated 6/15/2012 22

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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.

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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
  • bservation, medication administration/monitoring, crisis

intervention)

  • DMH will provide training on registration

updated 6/15/2012 24

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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

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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.

updated 6/15/2012 26

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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.

updated 6/15/2012 27

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CHIPS

Individual has symptoms consistent with a diagnosis of one of the following mental illnesses:

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 Disorder 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 (307.51) Post Traumatic Stress D/O (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)

updated 6/15/2012 28

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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. Anthony’s Hospital, Chicago
  • St. Bernard Hospital & Health Care Center, Chicago

Provena St. Mary’s, Kankakee University of Illinois Hospital, Chicago

updated 6/15/2012 29

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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.

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Mental Health Crisis Residential

  • Individual’s symptoms require psychiatric stabilization services.
  • Individual has symptoms consistent with a diagnosis of one of

the following diagnosis.

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 (307.51) Post Traumatic Stress D/O (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)

updated 6/15/2012 31

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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.

updated 6/15/2012 32

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SLIDE 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 Women’s Treatment Center, Chicago

updated 6/15/2012 33

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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.

updated 6/15/2012 34

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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

updated 6/15/2012 35

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Acute Community Care Service Providers

Region 1 South Area Acute CCS Provider

City of Chicago South of 67th Street Human Resource Development Institute Metropolitan Family Services South Suburban Cook County Township Bremen, Thornton, Rich, Bloom Grand Prairie Services Lemont, Calumet, Palos, Worth, Orland Metropolitan Family Services Kankakee County Helen Wheeler Mental Health Center Will County Will County Behavioral Health Cornerstone Services Grundy County Grundy County Health Department

updated 6/15/2012 36

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Madden Mental Health Center Services

  • Will serve as safety net when other services

are not appropriate or available.

updated 6/15/2012 37

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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
  • bservation that exceeds the capability of available community

inpatient psychiatric services

updated 6/15/2012 38

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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

  • r SA Residential Crisis Stabilization beds when

appropriate and needed to manage DMH hospital capacity

updated 6/15/2012 39

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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

updated 6/15/2012 40

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Region 1 South Crisis Care System System of Care Overview Policies and Procedures

 Thank you!!  Questions??

updated 6/15/2012 41