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

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

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

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

CRISIS CARE SYSTEM 15 Community Hospitals Psychiatric Crisis Emergency Department Presentation Region 1 South 2 EDs with 13 EDs No Behavioral Health Behavioral Health Crisis Assessment Capacity Assessment Capacity Care CMHC System ED-based Eligibility & Disposition Assessment ACCESS Authorization Region 1 South Clinical Disposition Uninsured Community Population Non Is Consumer eligible Medicaid NO Crisis Care Benefit Alternatives? Package YES DMH DASA DMH DMH Acute Residential CHIPS Crisis Hospital Community Crisis Residential Services Stabilzation Post discharge updated 6/15/2012 Community Stabilization 4 referral and linkage

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

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

Eligibility  Individual presents in Region 1 South E.D. updated 6/15/2012 7

Region 1 South Area City of Chicago South of 67 th Street South Suburban Cook County Kankakee County Will County Grundy County updated 6/15/2012 8

Region 1 South Area Community Hospitals to be Served City of Chicago South of 67 th 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

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 updated 6/15/2012 10

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

Region 1 South Community Hospitals to be Assigned Eligibility & Area Served Disposition Assessment Agency City of Chicago Roseland Community Hosp Human Resource Development South of 67 th St. Institute St. Bernard Hosp Human Resource Development Institute South Suburban Franciscan St. James Health Grand Prairie Services Cook County Metro South MedCenter Advocate South Suburban Hosp Palos Community Hospital Grand Prairie Services Little Company of Mary Hosp Advocate Christ Medical Center Advocate Christ Med Center Ingalls Memorial Hosp Ingalls Memorial Hosp Kankakee County Riverside Med Center Helen Wheeler Mental Health Provena St. Mary’s Hosp Center Will County Provena St. Joseph Med Center Silver Cross Hospital Will County Behavioral Health Adventist Bolingbrook Hosp. Grundy County Morris Hosp. Grundy County Health Dept updated 6/15/2012 12

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

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

EDA EVALUATOR Determines if individual meets 2 clinical criteria for Region 1S CCS  Diagnosis of: Schizophreniform D/O (295.4) Schizophrenia (295.xx) 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

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 updated 6/15/2012 16

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

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

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

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

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

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

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. updated 6/15/2012 23

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 updated 6/15/2012 24

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 updated 6/15/2012 25

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

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

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) O bsessive- C ompulsive 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