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Northwest Crisis Care System System of Care Overview Policy and Procedures

Northwest Crisis Care System System of Care Overview Policy and Procedures

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Northwest Crisis Care System System of Care Overview Policy and Procedures

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  1. Northwest Crisis Care SystemSystem of Care OverviewPolicy and Procedures Illinois Department of Human Services Division of Mental Health September 12, 2012: Dan Wasmer, MS Associate Director, Regional Services

  2. Materials for today • Calendar • Presentation Slides

  3. Objectives of OVERVIEW • Understand the flow of new Crisis Care System • Understand key policies • Understand procedures • Understand any interim policies and procedures

  4. DHS/DMH Intent To enhance the existing Crisis Care system in Regions 2W and 3N by providing equivalent access to necessary levels of care that are: • Community-based • Recovery oriented • Trauma informed • Outcome validated These services have historically been provided by Singer Mental Health Center.

  5. Services • Enhanced Crisis Response • Community Hospital Inpatient Psychiatric Services (CHIPS) • Mental Health Crisis Residential • Acute Community Services (ACS) • Transportation

  6. Enhanced Crisis Response • DHS/DMH expects that community providers in Region 2W and 3N will continue to respond to mental health crisis situations within their communities • DHS/DMH is funding enhancements to this system to ensure timely access.

  7. Eligibility Disposition Assessment (EDA)EVALUATORS • Minimum credential of Qualified Mental Health Professional (QMHP) • Available 24/7 • Respond within (1) hour of call • Determines financial and clinical eligibility

  8. EDA EVALUATOR • Conducts clinical evaluation and documents on DMH Uniform Screening and Referral Form (USARF) • Completes level of care assessment using the Level of Care Utilization System (LOCUS)

  9. EDA EVALUATOR Determines if individual meets 2 clinical criteria for Region NCCS • Diagnosis of: Schizophrenia (295.xx)SchizophreniformD/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 Level of Care Recommendation of 4 or greater

  10. EDA EVALUATOR Individual does NOT meet clinical criteria • Inform referral source as appropriate • Provide any alternative treatment or service recommendation e.g. DMH Non-Medicaid benefit package

  11. EDA EVALUATOR • Individual does meet clinical criteria • Evaluator determines individual is a resident of Region 2W/3N No – refer to Elgin/McFarland Yes – recommend level of care and service needs • CHIPS • Mental Health Crisis Residential • ACS • Transportation

  12. 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, referral source and others of individual’s choice

  13. EDA EVALUATOR Individual is willing to Engage • Inform referral source as appropriate of recommended level of care • If individual is in Emergency Department, assure that ED physician/staff concur • Evaluator calls the ACCESS line for • Authorization • Available services • Authorization number

  14. Service Authorization • Illinois Mental Health Collaborative for Access and Choice • DMH’s Administrative Service Organization (ASO) Toll free ACCESS Line (866) 359-7953

  15. Service Authorization • Clinical Care Managers (CCM) available 24/7 • Evaluator provides information to ACCESS CCM • Demographics • Clinical presentation • Recommended disposition • CCM reviews for medical necessity

  16. 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

  17. EDA EVALUATOR • Evaluator • Contacts service provider to make referral. • Makes needed transportation arrangements using authorization number. • Ensures required documentation (USARF, LOCUS, disposition and recommendations) is complete; distributes copies to ED (if involved) and accepting service provider (USARF, LOCUS, disposition and recommendations). • Confirms linkage occurred within 24 hours. • Registers individual in DHS/DMH consumer registration system.

  18. Service AuthorizationAlternative Level of Care • If the CCM would propose a different level of care based on medical necessity or capacity • Evaluator discusses alternatives with the individual and ED physician/staff (if in an ED) • If in agreement, authorization and referral process is initiated

  19. Service Authorization If Not in agreement: • Collaborative CCM provides clinical presentation, treatment recommended and capacity to Elgin/McFarland • Elgin/McFarland physician reviews information and discusses with ED physician (if involved). • Elgin/McFarland considers option and determines most appropriate level of care and informs both CCM and ED physician (if involved). • CCM contacts Evaluator with determination and authorizes services as appropriate.

  20. Disposition Options Community Hospital Inpatient Psychiatric Services (CHIPS) • DMH funded, short-term inpatient treatment at community hospital. • Serve those experiencing psychiatric crises and exhibiting acute behaviors or symptoms requiring inpatient setting.

  21. Hospitals with CHIPS Contracts • Swedish American Hospital, Rockford • Rockford Memorial Hospital, Rockford • OSF St. Elizabeth’s, Ottawa • Trinity Medical Center, Moline • Provena Mercy Center, Aurora

  22. Mental Health Crisis Residential • DMH funded, short-term 24/7 continuous supervision and treatment in a provider controlled facility. • Rosecranceis the current provider.

  23. 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 the EDA • Services must be initiated within 48 hours of discharge CHIPS, crisis residential, or SOH.

  24. Acute Community Service (ACS) • Individual eligible for services up to 12 months of initial assessment • Provider agrees to serve all referred/enrolled 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

  25. Elgin and McFarland Mental Health Centers • Will serve as safety net when other services are not appropriate or available.

  26. Elgin/McFarland Mental Health Centers • When an individual presents with the following, Elgin/McFarland may be consulted for consideration of DMH admission. • History indicating need for extended inpatient treatment • Presents challenges in discharge from inpatient setting, such as experiencing homelessness.

  27. Transportation • DMH will purchase transportation services between site of EDA, CHIPS hospitals, and MH Crisis Residential • Individual must meet all eligibility criteria • The Authorization number received from the Collaborative will serve as authorization for transportation • Transportation provider must respond within 90 minutes of request

  28. Phone Contacts Complaint Resolution/Help Line • 312-814-0930 McFarland Mental Health Center • 217-786-6857 Elgin Mental Health Center • 847-847-6239 • Alternate Phone: 847-742-1040 – have operator connect you to the Admissions staff person. • Questions can also be sent to: • Dhs.R2ccs@illinois.gov

  29. Northwest Crisis Care SystemSystem of Care OverviewPolicies and Procedures • Thank you!! • Questions??