1. Agency Introduction Detailed Session – Day 2

2.  Intake Evaluations/Assessments ◦ Clinical eligibility  Diagnostic Justification Rationale ◦ Risk assessment ◦ GAIN (Global Appraisal of Individual Needs)  Self-report & Clinician-assigned rating ◦ Identifies goals and strengths ◦ Initial treatment recommendations

3.  Recovery & Resiliency Plan (aka, Treatment Plan, Individual Service Plan) ◦ Addresses needs – Treat, Refer, Defer ◦ Consumer voice ◦ Goals consumer-identified and mutually agreed upon ◦ Strength-based ◦ Measurable ◦ Identifies interventions ◦ Developed and implemented within 30 days of first ongoing appointment

4.  RRP Review (aka, 180 day review, Treatment Plan Review) ◦ Minimum of every 6 months  RRP addresses transition planning issues ◦ Individual nearing completion of treatment episode ◦ RRP reflects goals/objectives to support this

5.  Crisis Plan ◦ Level of Care 4 or higher (mental health only), when clinically indicated, or when requested by individual ◦ Elements  Signs of impending crisis  Coping skills  System and natural supports including contact info ◦ Complete as thorough a plan as possible even if consumer does not want to participate

6.  Progress Notes ◦ “Golden Thread” Concept ◦ Address progress  Discharge Summary ◦ Summary of treatment episode ◦ Identifies meds and supports upon discharge ◦ How to get back into services

7.  On North Sound BHO website  Based on regional needs  Primarily diagnosis-related ◦ American Psychiatric Association and American Academy of Child & Adolescent Psychiatry ◦ 3 non-diagnosis related guidelines  Core Elements

8.  Discharge from Treatment ◦ Policy #1540 ◦ Discharge planning starts at admission ◦ When to initiate  RRP goals substantially met  Per ACS, no covered diagnosis, not meeting functional impairment criteria  Lack of individual’s participation (without risk) compromises successful outcome with continued treatment  No expected benefit  Individual enters institutional setting 8

9.  Discharge from Treatment (cont) ◦ Not permitted when  Individual is on LR/CR  Individual is engaged in grievance, appeal, or fair hearing process ◦ Planned discharges ◦ Re-engagement efforts 9

10.  Critical Incident Review Committee  2 Categories ◦ Category I – requires same day phone or email notification to NSMHA, followed by report ◦ Category II – requires submission of report by next business day  Reporting ◦ Form on website 10

11.  Schedule ◦ North Sound BHO conducts reviews most months ◦ Annual or biennial cycle ◦ Not all reviews apply to all providers  Types ◦ Apply to most OP providers  Routine Utilization Review, Cultural Competence, Encounter Validation Review, Focused Review ◦ Program specific reviews  Residential, intensive programs, crisis

12.  Randomly selected sample of a minimum of 822 encounters from 200 individual charts  Review, at minimum, of: ◦ Date of service ◦ Name of service provider ◦ Procedure code ◦ Service units/duration ◦ Service location ◦ Provider type ◦ Service code agrees with treatment described

13.  General responsibilities ◦ Allied system coordination (CA, DDA, DOC, Tribes, PCP, community hospital, school, etc) ◦ Problem solve difficult placements and plans of care for Medicaid individuals with the most risk factors, highest utilization  Community Initiated & BHO Initiated Care Coordination

14.  Activities ◦ Participate in systemic care planning at an individualized level of care ◦ Consultation & facilitation regarding local resources ◦ Coordinate discharge plans with community hospitals ◦ Screen for Children's Long-term Inpatient Program (CLIP) and Western State Hospital (WSH) placements

15.  Coordination with Other Health Care Providers ◦ Early Periodic Screening, Diagnosis & Treatment (EPSDT) ◦ Referrals for co-morbid conditions ◦ Ongoing communication  Initiation of care  Initiation of and subsequent changes in medications  Changes in clinical condition that impact overall medical care

16. Q & A 16

17.  Clinical Guidelines ◦ http://nsmha.org/PDFs/Clinical_Guidelines/Clinical _Guidelines_Manual.pdf http://nsmha.org/PDFs/Clinical_Guidelines/Clinical _Guidelines_Manual.pdf  Forms ◦ http://nsmha.org/Forms/index.asp http://nsmha.org/Forms/index.asp  Policies ◦ http://nsmha.org/Policies/Complete_TOC.aspx http://nsmha.org/Policies/Complete_TOC.aspx  Regional Training Modules ◦ Relias – contact Mandy Iverson at North Sound BHO 17