Portal of Entry and Communications Presenters: Sandra Hernandez, - PowerPoint PPT Presentation

Portal of Entry and Communications Presenters: Sandra Hernandez, LCSW Mikelle Le, LMFT Mental Health Full Board Meeting July 8, 2013

PORTAL OF ENTRY  Key programs and clinics that serve as entry points to SCCMH Services:  Call Center (CC) ◦ 1-800-704-0900  Mental Health Urgent Care (MHUC) ◦ 408-885-7855  Central Wellness and Benefit Center (CWBC) ◦ 408-885-6220  Suicide and Crisis Hotline (SACS) ◦ 1-855-278-4204

Call Center (1-800-704-0900)  Hours: ◦ 8 a.m. - 5 p.m. Monday – Friday ◦ After 5 p.m. on weekdays/weekends/holidays, the main Call Center number is a Crisis Line only.  Staff ◦ 11 Licensed Clinicians  Roles/responsibilities : ◦ Screening (crisis eval., clinical eval., mandated reports) ◦ Linkage and resources ◦ Verify benefits ◦ UniCare Documentation ◦ Refer to Providers based on clinical needs, age, culture, language, benefit status, capacity, proximity

Screening criteria:  Levels of acuity: ◦ Level 1 : hospital discharged, crisis (seen in 5 business days) ◦ Level 2: Significantly impaired; need support (seen in 10 business days) ◦ Level 3: Minimally impaired; minimal support (seen in 15 business days)

Referral determination  Immediate Crisis, Hospital Discharge, Crisis Residential, FSP Project 90 (Level 1)  MediCal or MediMedi adult callers needing MD or counseling services (L 1-3)  Parents/guardians calling for children w/ MediCal or Healthy Kids (L 1-3)  Uninsured adult callers with history of SMI or current severe symptoms (L 1,2)  Uninsured children at risk of losing placement or decompensating. (L 1,2)

Current Timeliness to access  Past years average wait time = 45:00 minutes, to 25-30 minutes  5/2013 Average wait time Eng Adult =1:36  5/2013 Average wait time Eng Child = 1:12  5/2013 Average wait time Spanish Adult = 4:09  5/2013 Average wait time Spanish Child = 1:01  Overall Average wait time all callers = 2:08

Call Volumes:  5/2013: ◦ Calls received = 2, 567 ◦ Calls answered = 2,050 ◦ Of the 2,050 calls  982 referred (48% referred) = (530 kids, 452 adults)  1,068 calls = information/referral calls (opened, returned calls to follow up, resources/referrals, no capacity, etc.) ◦ Level 1 = 161 ◦ Level 2 = 528 ◦ Level 3 = 294 ◦ Paper referrals = 250-300/per month, all age groups all levels  4/2013: ◦ Calls received = 2,744 ◦ Calls answered = 1, 980  1,004 referred (575 kids, 429 adults) ◦ Level 1 = 151 ◦ Level 2 = 523 ◦ Level 3 = 330

Referral Volume:

Culture/Languages served :  Threshold languages served: English, Spanish, Vietnamese, Tagalog and Cantonese  T op 3 language calls: English, Spanish, Vietnamese  Others: Mandarin, Farsi, Portuguese

Population served:

Obligations to Medi-Cal Beneficiaries/Managed Care  MHD serves Medi-Cal beneficiaries.  Must meet the Title 9 medical necessity criteria ◦ Axis I Dx, Impairment/life functioning, able to benefit from treatment. ◦ Specialty services not available by PCPs  Coordinate care among providers for appropriate treatment  MHD provides: ◦ 1) Choice of providers ◦ 2) Culturally competent treatment ◦ 3) Ease of access ◦ 4) Best possible care

Table on MediCal/NonMediCal info Fiscal Year MediCal Non MediCal (FY) FY 09 13,112 5,087 FY 10 12,680 5,781 FY 11 13,457 5,087 FY 12 13,817 5,948

Mental Health Urgent Care (MHUC) 408-885-7855  Hours: ◦ 8am-10pm everyday/7 days a week ◦ Walk-in clinic  Staff : ◦ 2 Psychiatrists ◦ 5 LMFTs/LCSWs ◦ 2 LPTs ◦ 2 MH Workers ◦ 4 HSRs

Roles/Responsibilities:  Crisis/clinical assessment & interventions  Bridge medications  5150 Legal hold  Clinical consultations/Calls from community  Visitor areas for EPS families  Resources/referrals ◦ NAMI and Family Affairs resource tables  Linkage/Transfer ◦ CWBC/Call Center  Mobile Crisis

Mobile Crisis:  Provide consults to Law Enforcement  Field/home visit with Crisis Intervention T eam (CIT) officers  Nov. 2012- current: 15 Visits  Communication/Linkage/Continuation of care/After care

Volume Served:  Urgent Care Results: Fiscal Year 2009 to 2012 ◦ Data Source: Unicare (Ucode: U-777) All Fiscal All Fiscal FY09 FY10 FY11 FY12 Year Total Year Total % Age Group Child & Youth (0-15) 18 36 46 40 140 2.00% Transition Age Youth (16-25) 187 384 301 365 1237 17.30% 75.30% Adult (26-59) 740 1477 1346 1805 5368 Older Adult (60+) 43 101 100 144 388 5.40% Total 988 1998 1793 2354 7133 100.00%

Volume Served:  Urgent Care Results: Fiscal Year 2009 to 2012 ◦ Data Source: Unicare (Ucode: U-777) All Fiscal All Fiscal Year Ethnicity FY09 FY10 FY11 FY12 Year Total Total % Asian/Pacific Islander 94 221 220 203 738 10.30% Black/African American 62 160 127 154 503 7.10% Hispanic 294 565 542 695 2096 29.40% Mixed Race 1 8 6 6 21 0.30% Native American 14 21 20 41 96 1.30% Other 30 69 57 79 235 3.30% Unknown 77 126 153 313 669 9.40% White 416 828 668 863 2775 38.90% Total 988 1998 1793 2354 7133 100.00%

Central Wellness and Benefits Center (CWBC) 408-885-6220  Hours: ◦ 8 a.m. - 5 p.m. Monday – Friday • Assist Adult and Older Adult consumers to access health benefits • Underserved and uninsured • Manage their medication needs • Once qualified for benefits assistance or health coverage….. • Linkage to more extensive mental health outpatient services within Santa Clara County

Goal of CWBC  Basic mental health services  Ongoing medication services  Crisis intervention  Benefit Enrollment – Access to a Financial Counselor  CWBC is not a traditional Service T eam

Types of Coverage Assistance Provided  APD, Valley Care II, Medi-Cal, SSI, Medicare  Assistance with Medicare Part D  Minor Consent Medi-Cal  Low Income Subsidy (LIS)

Staffing  Multidisciplinary ◦ Psychiatrists ◦ LCSW/LMFT ◦ Rehab. Counselors ◦ Community Workers ◦ MH Peer Support Workers ◦ SSI Advocates ◦ Financial Counselors ◦ Health Services Rep.’s

Culturally and Linguistically Competent Staff  Languages served ◦ English ◦ Spanish ◦ Vietnamese ◦ Russian ◦ Portuguese ◦ Farsi ◦ Tamil ◦ Telugu

Current Caseload – as of 7/1/13  1,943 open cases  2,204 closed cases  Average open caseload per clinical staff person – 243  (7 clinical staff and 1 clinical Lead)

Benefits  UMDAP/Self-Pay  APD  Valley Care II  Minor Consent Medi-Cal  Medicare A

Benefits Enrollment Data  1,960 clients are open to CWBC as of 07/02/13 Type of Benefits 10% Valley Care II APD - Undocumented & Restricted M/C 30% Medi-Cal, Minor Consent 60% M/C

SSI/SSDI  SSI Approvals  SSI Denials  SSI Pending  SSI Appeals  SSI Presumptive  SSI Reconsideration  SSI Administrative Law Judge  SSDI - Medicare

When an individual files for SSI/SSDI two applications are taken:  1) SSI which is Title 16 benefits, this benefit is based on need, meaning the individual has never worked or does not have enough work history, has no resources above $2000 and is disabled. When they are approved for SSI they get MediCal. There is no waiting period, they will receive their benefits the following calendar month.  2) SSDI which is Title 2 benefits. This is when an individual has work history and is considered “insured” because they have paid into the system. They do not have a resource limitation meaning they can own a home and a car. When they are approved they will receive MediCare 2 years from the date found disabled. Their waiting period to receive benefits is 5 months from when the decision has been made.

The following are the SSI/SSDI “steps” :  Initial Application : client files for SSI/SSDI this decision takes 4 to 6 months.  Reconsideration Appeal : If client is denied SSI/SSDI this is the first “appeal” step which must be filed within 60 days of the denial date, again this decision takes 4 to 6 months.  Administrative Law Judge or ALJ Hearing : If client is denied once again at the Reconsideration Appeal level then they have 60 days from the denial date to file for a Hearing before an Administrative Law Judge. This is when they obtain a SSI attorney. A hearing date can take up to 1 year.  Initial → Reconsideration Appeal → Hearing

SSI Advocacy at CWBC  10/2009- started referrals only, no approvals or denials were initially tracked. ◦ Applications initiated at CWBC ◦ Clients can apply on their own ◦ Clients can contact an attorney to process application

Numbers Served at CWBC  CWBC All Fiscal Year All Fiscal FY07 FY08 FY09 FY10 FY11 FY12 Total Year Total % Age Group Transition Age Youth 0 0 34 173 196 237 640 12.80% Adult (26-59) 0 0 214 1026 1248 1643 4131 82.40% Older Adult (60+) 0 0 14 56 73 97 240 4.80% Total 0 0 262 1255 1517 1977 5011 100.00%