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The Illinois Mental Health Collaborative for Access and Choice Overview of the Authorization Process and Fidelity Monitoring for Best Practices. March 26, 2008. CST Team Leader Meeting. Agenda. Introductions Purpose of Monthly Meetings Recommended Attendance Topic Selection. Agenda (Cont.).

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march 26 2008

The Illinois Mental Health Collaborative for Access and ChoiceOverview of the Authorization Process and Fidelity Monitoring for Best Practices

March 26, 2008

CST Team Leader Meeting

  • Introductions
  • Purpose of Monthly Meetings
  • Recommended Attendance
  • Topic Selection
agenda cont
Agenda (Cont.)
  • Today’s Topic

- authorization process in brief

- overview of fidelity monitoring

- fidelity to best practices for CST


The Illinois Department of Human Services/Division of Mental Health (DHS/DMH) has engaged an administrative services organization (ASO) to provide support and resources to improve access and choice in the mental health system. The Illinois Mental Health and Choice will be referred to as “the Collaborative”.

The presenters are:

  • DMH:
    • Jackie Manker, LCSW
  • Collaborative’s Clinical Team:
    • Sandy Potter, LCSW – Vice President of Operations
    • Bill White, LCSW - Clinical Director
dmh overview
DMH Overview
  • Overarching Themes for 4th Quarter FY08
    • this year is an introduction to how monitoring will be conducted in the future
    • a coordinated team approach with DHS/DMH, Bureau of Accreditation, Licensure and Certification (BALC), and Collaborative staff
    • no duplication of reviews
    • no extrapolation this year (no penalties)
    • compliance with both Rule 132 and the contract
    • evolving process – so we learn and adjust as we go
a goal of the collaborative
A Goal of the Collaborative

Under the direction of DHS/DMH the Collaborative will perform provider monitoring activities starting in 4th Quarter FY08.

  • as a coordinatedteam approach with DHS/DMH contract managers and BALC
  • this is an evolving process- need to establish a baseline
purpose of the monthly meetings
Purpose of the Monthly Meetings
  • Improve Adherence to Both Rule 132 and Contract
  • Learning Opportunities
  • Share Best Practices
  • Keep Communication Open
  • Attendance is Recommended for Team Leader and others
  • Identify Topics for Discussion
authorization process
Authorization Process
  • CST services require prior authorization
  • Providers submit a “Request for CST Prior Authorization”
  • Submit

- authorization request form

- treatment plan

- crisis plan

  • Submit Documents by Fax
  • Coming Soon: “ProviderConnect” Web-Based Submission Capabilities
submitting authorization requests
Submitting Authorization Requests

Collaborative Contact Information:

  • Telephone: 866-359-7953
  • NewFax Number:866-928-7177
  • The Collaborative verifies eligibility and provider status
authorization review time frame
Authorization Review Time Frame

Completed requests response time:

  • Within one (1) business day for initial authorizations
  • Within three (3) business days for reauthorizations

Revised “Authorization Protocol Manual” is due out in April 2008

provider monitoring overview
Provider Monitoring Overview
  • Rule 132
    • clinical record review
    • post payment review
  • Contract
    • coordination of benefits
    • non-Medicaid services
  • Moving Mental Health System Towards Recovery-Oriented Services
    • consumer participation
    • crisis plans
    • ACT/CST fidelity reviews
overview of fidelity monitoring
Overview of Fidelity Monitoring
  • Ensuring Appropriateness of Service
  • Key Elements of Fidelity Reviews:

- evidence of “best practice” components

- compliance with eligibility requirements

- implementation of team based service

  • Team Based Review
fidelity to best practices
Fidelity to Best Practices
  • Consumers’ Needs Drive Service Times and Locations
  • Client Staff Ratio = 18:1
  • 60% of Services Provided in the Community
  • Multiple Staff Involvement With Each Consumer
  • Full Time Team Lead (at least a QMHP)
fidelity to best practices cont
Fidelity to Best Practices (Cont.)
  • Available 24 Hour Support
  • Crisis Planning
  • Family Involvement as Appropriate
  • Clinical Rationale Supporting LOCUS Score
service components
Service Components
  • Therapeutic Interventions Facilitate Skill Building In:

- wellness self-management

- identification and use of natural supports

- use of community resources

service components cont
Service Components (Cont.)
  • Coordination to Assist Consumer to Identify Strengths, Resources and Personal Choice
  • Assist Consumer to Identify and Use Natural Supports
  • Assistance With Crisis Management
  • Self Advocacy, Decision Making in Tx Plans
  • Community Based Vs Office Based Services
  • Use of Group Modalities for Dually Diagnosed
  • High Intensity of Services as Needed
fidelity tool
Fidelity Tool
  • Developed From DHS/DMH Mental Health Service Definitions
  • Contains Program-Specific Items Required by Rule 132
  • Measures Degree of Service Implementation
staffing requirements
Staffing Requirements
  • No Fewer Than Three (3) FTE’s
  • At Least One (1) Active Member is in Recovery From a Mental Illness (Preferred Certified Recovery Support Specialist – CRSS)
  • Practicing Team Lead (QMHP)
  • Staff Training Before Services Are Provided
  • Multiple Staff Involved in Providing Services
  • On-Going Supervision of Staff (Weekly Staff Meetings)
  • Staffing Ability to Provide 24/7 Coverage
posting of the presentation
Posting of the Presentation

Today’s presentation will be available online in April 2008

Be sure to share this information with your staff!

thank you

Thank you!

Illinois Mental Health Collaborative for Access and Choice