1. Welcome Milwaukee WIser Choice Clinical Providers Wednesday December 12, 2007

2. WIsconsin Supports Everyone’s Recovery Choice

3. Why are we here today? Learn the differences between ATR 1 and ATR 2 Review requirements of ATR 2 Review of provider obligations Changes in 2008 agreements

4. ATR 1 vs. ATR 2 ATR 1ATR 2 -22.8 million-14.4 million -7,344 (duplicated) - 7,626 (unduplicated)-3 years-GPRA-intervals Intake, 30 days, statusIntake, discharge, follow up and discharge80% -Quarterly data upload -7 day data upload -No client incentives-Client incentives

5. ATR 1 vs. ATR 2, cont. ATR 1ATR 2 -RSC-RSC & DCS (Data Collection Specialist) -Multiple screens -Limited screens -Screen w/o regard to-Benefits coordination insurance TANF, insurance, etc. -Methamphetamine client focus -IDP & Methadone -Negative screens

6. Entry into WIser Choice CIU staff screen client using ASI and ASAM Recommended level of care Chosen level of care Chooses clinical treatment provider Chooses RSC/DCS agency –St. Charles, UCC, MHYH, ATTIC & WCS –A percentage of consumers will only receive a DCS (Outpatient) CIU assigns RSC or DCS provider RSC starts contact with client within 24 hours of assignment DCS begins contact with client at first clinical appointment

7. When a DCS is Assigned DCS will contact the provider to introduce themselves If appointment date changes, it is the responsibility of the provider to inform the DCS that the appt. has changed and the new appointment date and time DCS will also contact client to introduce themselves and schedule the GPRA intake interview which corresponds with the initial clinical appointment DCS informs client to contact them should anything change

8. On Date of 1 st Appointment Client presents for treatment Call is made to RSC/DCS agency to state that client showed for treatment Provider Feedback form faxed back to referring CIU and RSC/DCS agency Client does not present for treatment Provider Feedback form faxed to CIU and RSC/DCS agency (keep them in the loop) RSC attempts to re-engage client

9. GPRA (Government Performance Results Act) GPRA Intake interview must be collected within 4 days of the start of clinical treatment services (Outpatient or Day treatment) or w/in 3 days of residential treatment services GPRA Discharge Guidelines Must inform RSC/DCS when discharge is being planned or when the client has not shown for treatment: Inform RSC/DCSDischarge Client -1 st day gone from Res.-2 days for residential -Missed 3 days-5 days for day treatment -Missed 2 appointments-14 days for outpatient

10. GPRA, cont. GPRA Follow up, 6 months post intake (completed within 30 days before or 60 days after) 80% of all follow up GPRA’s must be collected for all GPRA intakes completed Providers, RSC’s, DCS’s are all responsible for the tracking and locating of clients All GPRA interviews must be entered into CMHC system within 72 hours of being conducted

11. RSCs versus DCSs RSC Episode Primary responsibility is care coordination Paid at daily rate Attends Team Meetings Maintains SCCP Submits SARs to BHD Clinical services Ancillary services DCS Episode Primary responsibility is GPRA collection Paid for completed face- to-face interviews No Team Meetings No SCCP Does NOT do SARs NO ancillary services

12. If your client has a DCS… The clinical provider: Submits the SAR for continuation of service, if needed. Submits the SAR for change in Level of Care, if needed. Submits the SAR for RSC services if the client needs ancillary support services that cannot be met with natural supports. Cooperates with the DCS in GPRA collection.

13. Clinical Provider should call the RSC or DCS (within 1 business day) 1.If RSC/DCS calls provider 2.If client misses and/or reschedules first appointment date 3.If client status changes in a way that affects RSC/DCS: - Client is incarcerated - Client is hospitalized - Client leaves the county - Client changes residence or has new contact information - Client dies 4.If clinical provider intends to discharge client from clinical services

14. RSC or DCS should call the Clinical Provider (within 1 business day) 1.When a specific RSC or DCS is first assigned the case 2.If clinical provider calls RSC/DCS 3.If client is switched from one RSC or DCS to another 4.If client is transferred to a different RSC/DCS agency 5.If client status changes in a way that affects treatment: - Client is incarcerated - Client is hospitalized - Client leaves the county - Client changes residence or has new contact information - Client dies 6.Prior to discharging client from RSC services

15. Discharge Guidelines In general, discharge is guided by LOC: Residential: Discharge if client missing 2 days Day Treatment: Discharge if client misses 5 days Outpatient: Discharge if missing for 14 days Regardless, keep RSC/DCS informed about plans to discharge and date discharge will occur.

16. Other ways Clinical Providers can assist RSC/DCS agencies Make sure all staff (including clerical, reception): Know what an RSC and DCS are Understand that Milwaukee WIser Choice clients have signed consent forms that permit clinical providers to share client information with RSC/DCS agencies. If possible, allow the RSC/DCS to do interviews in the treatment facilities (in a separate conference room or private office space).

17. Other ways Clinical Providers can assist RSC/DCS agencies Develop procedures to discover and communicate changes in client status, for example, by updating contact information when clients come in and sharing any changes with RSC/DCS agencies. Organize or sponsor ongoing activities that promote client contact. Support group meetings Alumni events Agency events Activities and celebrations

18. What’s new in 2008 Agreements? Agency automobile insurance rider is required Professional Liability is required for all clinical providers- either agency or personal coverage Billing 60 days vs. weekly Discharge Submit within 1 business day of discharge Payor of last resort

19. WIser Choice needs to be a System of Cooperation Cooperation is the common effort of a group for their mutual benefit Cooperation is teamwork Cooperation is working together peacefully When spider webs unite, they can tie up a lion. (Ethiopian proverb) A single arrow is easily broken, but not ten in a bundle. (Japanese proverb)

20. Episodes “Completed Treatment” Per Month, July 2004-Sept 2007

21. Questions

22. Contact Information Janet Fleege MCBHD – SAIL (Service Access to Independent Living) Milwaukee WIser Choice Project Director Office #414-257-6925 E-mail: jfleege@milwcnty.com