Residential Treatment Facilities Overview June 28, 2006

2 At-a-Glance—RTF Funding and Children Served Fee-for-Service  In FY , $56.4 million was spent on RTF services  A total of 1,588 children received RTF services HealthChoices  In calendar year 2000, $55.9 million in HC was spent on RTF services  $28.3 million in HC spent for CISC for RTF services  A total of 1,701 children received RTF services, of which 824 were CISC

3 RTF Funding continued In HealthChoices in CY 2004 Total $115,184,693 spent on RTF care In Fee for Service in CY 2003 Total $58,986,182

4 Historical Background  Scott Lawsuit  Lawrence K. Settlement  Medicaid (Medical Assistance)  Accreditation / Non-Accreditation distinction  Cross system Licensing and approval process

5 Current Picture  In-State—138 MA enrolled RTFs (96 Accredited and 42 Non-Accredited)  Bed capacity of 4,751

6 RTFs Vary in Scope and Size  Locally based providers  Larger statewide providers  Some RTFs admit out of state residents

7 Current RTF Provider Requirements  RTF must be licensed by OCYF (Chapter 3800 regulations)  RTF must be enrolled as a MA provider (MA Bulletins and )  RTF must meet the DPWs Interim Guidelines for RTFs (Attachment 4 to above Bulletins)  Adhere to CASSP Principles for Children’s Services (Attachment 5)  RTF must submit rate setting information to OMAP for the establishment of a payment rate

8 OMHSAS RTF Approval Procedures  Initial Contact coordinated with OCYF Regional Office  Service description (outlined in Interim Guideline 1) demonstrating the provider’s ability to meet needs of children with severe/persistent psychiatric disability must be submitted to OMHSAS regional Field Office  Population to be served/number, characteristics  Goals, objectives and outcomes of the program

9 OMHSAS RTF Approval Procedures (continued)  Specific ways (mechanisms) needs are addressed  Specific disciplines/procedures to meet the needs of the population related to the overall goals and services of the program  Types and amounts of services the program will provide (staffing levels/clinical services)  Provider is held accountable to implementing the approved service description

10 OMHSAS RTF Approval Procedures (continued)  Each Field Office has children’s MH Program Reps designated to review RTF  OMHSAS lead team conducts on-site visit using Interim Guidelines as measure  Team may include representatives from Regional OCYF, OMAP, a family member, and CASSP Coordinator and OMHSAS regional psychiatric consultant  Treatment Record Requirements (Interim Guideline 2)  Staff Credentials (Interim Guideline 3)

11 OMHSAS RTF Approval Procedures (continued)  Entitlements (Interim Guideline 4)  Medical director (Interim Guideline 5)  Information to family re: Advocacy Groups (Interim Guideline 6)  Individualized Treatment Plans/ Educational Services (Interim Guidelines 7)

12 OMHSAS RTF Approval Procedures (continued)  Treatment Plan Reviews (Interim Guideline 8)  Educational Placement (Interim Guideline 9)  Additional Services (Interim Guideline 10)  Physical Plant (Interim Guideline 11)  Visitation cannot be limited for disciplinary reasons (Interim Guideline 12)  Restrictive Procedures (Interim Guideline 13)  Transfer to Higher Level of Care (Interim Guideline 14)

13 OMHSAS RTF Approval Procedures (continued)  Survey Report sent to the provider outlining areas of the Guidelines not met  Provider responds in writing with their plan for correction or improvement  OMHSAS FO sends a letter to the provider outlining that the facility has been certified under the MA Bulletin  Annual Recertification Process

14 Timeframes  Timeframes for approval—Approximately 3-6 months  Issues that impact timeframe  Zoning/Labor and Industry Approval  Agreement for Educational Services  Provider ability to comply with Interim Guidelines  New providers to PA unfamiliar with system

15 Residential Treatment Facilities Survey Report Form  Service Description  Philosophy of the program  Population served  Goals, objectives, and expected outcomes of the program.  Mechanisms by which the needs of persons with multiple disorders or disabilities are addressed.  Specific disciplines and procedures to support interdisciplinary team interaction.  Types and amounts of services the program will provide to the children.

16 Residential Treatment Facilities Survey Report Form- Continued  Treatment Record  Strengths of the individual  Presenting problems  History of previous mental health service  Medical history and status  Diagnosis  Mental status  Emotional and behavioral functioning  Social history  Drug-use profile, if applicable  Role of the family within the development process

17 Residential Treatment Facilities Survey Report Form- Continued  Staff Credentials  Entitlements  Medical Director  Coordinates and advises on medical matters  Trained/experience in dealing with the needs of children and adolescents with MH service needs  Provides direction/consultation  Information on Advocacy Groups  Treatment Plans and Educational Services

18 Residential Treatment Facilities Survey Report Form- Continued  Treatment Plan Reviews  Educational Placement  Services (case management, partial hospitalization, outpatient therapy services etc…)  Physical Plant  Visitation  Transfer to a higher level of care  Restrictive Procedure/Seclusion (OMHSAS Bulletin /ACT)  Policies meet the federal and state requirements and are consistent with the Special Transmittal.

19 Alternatives to Coercive Techniques (ACT)  Special Transmittal  Core Strategies  Leadership toward Organizational Change  Use of Data to Inform Change  Workforce Development  Use of Seclusion/Restraint Reduction Tools  Child and Family Roles  Debriefing Techniques