1. CST Team Leader Meeting
11/21/2018
The Illinois Mental Health Collaborative for Access and Choice Overview of the Authorization Process and Fidelity Monitoring for Best Practices
CST Team Leader Meeting
March 26, 2008
11/21/2018

2. Agenda Introductions Purpose of Monthly Meetings
11/21/2018
Agenda
Introductions
Purpose of Monthly Meetings
Recommended Attendance
Topic Selection
11/21/2018

3. Agenda (Cont.) Today’s Topic - authorization process in brief
- overview of fidelity monitoring
- fidelity to best practices for CST
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4. Introductions
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
11/21/2018

5. 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
11/21/2018

6. 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 coordinated team approach with DHS/DMH contract managers and BALC
this is an evolving process- need to establish a baseline
11/21/2018

7. 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
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8. 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
11/21/2018

9. Submitting Authorization Requests
Collaborative Contact Information:
Telephone:
New Fax Number:
The Collaborative verifies eligibility and provider status
11/21/2018

10. 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
11/21/2018

11. 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
11/21/2018

12. 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
11/21/2018

13. 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)
11/21/2018

14. Fidelity to Best Practices (Cont.)
Available 24 Hour Support
Crisis Planning
Family Involvement as Appropriate
Clinical Rationale Supporting LOCUS Score
11/21/2018

15. Service Components
Therapeutic Interventions Facilitate Skill Building In:
- wellness self-management
- identification and use of natural supports
- use of community resources
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16. 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
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17. Fidelity Tool Developed From DHS/DMH Mental Health Service Definitions
Contains Program-Specific Items Required by Rule 132
Measures Degree of Service Implementation
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18. 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
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19. Questions?
11/21/2018

20. Posting of the Presentation
11/21/2018
Posting of the Presentation
Today’s presentation will be available online in April 2008
Be sure to share this information with your staff!
Need to confirm archive location for presentation
11/21/2018

21. Thank you! Illinois Mental Health Collaborative for Access and Choice
11/21/2018
Thank you!
Illinois Mental Health Collaborative for Access and Choice
11/21/2018