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Illinois Mental Health Collaborative For Access And Choice Presents

Illinois Mental Health Collaborative For Access And Choice Presents. March 25, 2008. Introduction to Provider Monitoring. Agenda. Introductions Background Provider Monitoring Process Post Payment Review Clinical Review ACT Review CST Review. DMH Presenters.

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Illinois Mental Health Collaborative For Access And Choice Presents

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Presentation Transcript

  1. Illinois Mental Health CollaborativeFor Access And ChoicePresents March 25, 2008 Introduction to Provider Monitoring

  2. Agenda • Introductions • Background • Provider Monitoring Process • Post Payment Review • Clinical Review • ACT Review • CST Review

  3. DMH Presenters • Christopher T. Power, Ph.D. • Jackie Manker, LCSW • Tom Miller, MHSA

  4. Collaborative Presenters • Mike Mulvany, Director of Provider Relations • Dee Durant, Director, Clinical Operations • Sandy Potter, VP, Clinical Operations

  5. DMH Overview • Overarching Themes for 4Q FY08 • This year is an introduction to how monitoring will be conducted in the future. • A coordinated team approach with DHS/DMH, BALC, and Collaborative staff. • No duplication of reviews • No extrapolation this year – so no penalty • Compliance with both Rule 132 and the contract • Evolving process – so we learn and adjust as we go

  6. The Goals of the Collaborative • Under the direction of DHS/DMH the Collaborative will perform provider monitoring activities starting in 4Q, FY08. • as a coordinatedteam approach with DHS/DMH contract managers and BALC. • this is an evolving process.

  7. Provider Monitoring • Rule • Clinical Record Review • Post Payment Review • Contract • Coordination of benefits • Non-Medicaid services • Moving mental health system towards recovery-oriented services • ACT/CST Fidelity reviews • Crisis Plans • Consumer participation

  8. Post Payment Review • Process to ensure that the service billed is the service that was provided by matching claims with the documentation in the clinical record. • The sample for review will be based on claims submitted for services provided during FY08. • The review will be on the same sample for either ACT/CST Fidelity or clinical record reviews. • The review will be only for those providers that have not had a post payment review by BALC in the past 6 months.

  9. Overview of Fidelity Monitoring • One of the goals of the Collaborative is to ensure appropriate level of care • Record review- not contract review • ACT Fidelity will be based on the Dartmouth Assertive Community Treatment Scale (DACTS), recommended by SAMHSA (available on line at http//:samhsa.hhs.gov/)

  10. Overview of Fidelity Monitoring (cont) • CST fidelity will be based on the DHS/DMH mental health service definitions • There will be on-going Team leader conference calls held by DHS/DMH and the Collaborative to support the ACT and CST Teams • Fidelity monitoring is Team based (not agency based)

  11. CST Fidelity Monitoring • The CST Fidelity tool: • developed from the DHS/DMH mental health service definitions • contains program-specific items required by the rule • measures the degree of implementation of CST services

  12. ACT Fidelity Monitoring • The ACT Fidelity tool • contains 28 program-specific items • designed to measure the degree of implementation of ACT programs

  13. Next Steps • Review Tools • will be posted on the Collaborative website • Scheduling Site Visits • advance notification of reviews • Monitoring Activities • 4th quarter- FY08 • verbal results shared with providers • written results within 30 days of completion of the review • Follow-up with providers

  14. Questions and Answers

  15. Presentation Today’s presentation will be available online within 2 weeks at: http://www.IllinoisMentalHealthCollaborative.com/providers/Training/Training_Workshops_Archives.htm Be sure to share this information with your staff!

  16. For More Information Today’s presentation will be available online at: http://www.illinoismentalhealthcollaborative.com You can follow these steps: Step 1: Go towww.illinoismentalhealthcollaborative.com Step 2: Click on “Providers” Step 3: Click on “Education Center” Step 4: Click on “Trainings/Workshops” Step 5: Click on “Archive Forums”

  17. Thank you! Illinois Mental Health Collaborative for Access and Choice

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