The Indiana Family and Social

Services Administration

The Division of Mental Health and

Addiction’s

1915(i) Child Mental Health

Wraparound

Welcome!

• Gina Doyle, Asst. Deputy Director– Gina.Doyle@fssa.in.gov

• Julie Bandy, Provider Specialist– Julie.Bandy@fssa.IN.gov

– 317.232.7892

• Heidi Gross, Lead Site Coach– Heidi.Gross@fssa.in.gov

CMHW Services Module

• A CMHW Services Program Module (previously referred to as manual) is available at http://provider.indianamedicaid.com/media/155601/dmha%20cmhw.pdf

• The Module gives detailed explanation on a wide variety of topics including participant eligibility, expectations of providers, service definitions, enrollment procedures, billing and claims, incident reporting, complaints, and more.

Systems of Care

Systems of Care has a multi-level approach

– Indiana System of Care Governance Board

– Local (county) SOC Governance Board

– Child and Family Teams

Community decisions that make an impact

on our youth are dependent upon

community members, local services,

representation from the silos and youth and

family and are made at these meetings.

Silos represented in our

communities

Child Welfare

Behavioral Health

MedicaidJuvenile Justice

Education

High Fidelity Wraparound

High Fidelity Wraparound is a process that builds on the

collective action of a committed group of family,

friends, community, professional, and cross-system

supports and resources to develop a Plan of Care (POC)

that is the best fit between the family vision and story,

team mission, and youth and family strengths, needs,

and strategies.

High Fidelity Wraparound provides youth and their

families with access, voice, and ownership in the

development and implementation of their POCs.

“One Plan to Rule Them All”

Access Site: Point of Entry

Referrals for CMHW services should be

made to the Access Site

Each county has an Access Site. The

Access Site list is maintained on the

DMHA IN System of Care website.

http://www.in.gov/fssa/dmha/2773.htm

CMHW Eligibility

Target Group Criteria

• Ages 6 -17

• Meets criteria of two or more DSM V diagnoses not excluded below (ICD-10)

• Borderline level of intellectual function or above

Exclusionary Diagnoses

• Primary Substance Abuse Disorder

• Primary or Secondary Pervasive Developmental Disorder

• Primary Attention Deficit Hyperactivity Disorder

Level of Care met through CANS assessment (4,5,6)

Medicaid eligible

• Traditional

• Managed Care

Residential Requirements

• Must live in a family or foster home in the community

• Must NOT live in a facility or residential placement of any kind

• Homeless youth are eligible

CMHW Eligibility

Transition by the time the youth turns 18. Services will NOT be covered once the youth is 18.

The CMHW program will renew July 1, 2018. At that time, it is anticipated that approved eligibility reviews completed on 17-year-olds will provide a full 12-months of services so long as other eligibility criteria continue to be met.

CMHW Services

Wraparound Facilitation (WF)• Required

Habilitation (HAB)

Training and Support for the Unpaid Caregiver (FST)• Hourly• Fees

Respite (RES)• Hourly• Facility-Based

Wraparound Facilitation

The Wraparound Facilitator

Manages the entire wraparound process and ensures that the participant and family’s voice, preferences, and needs are central in developing the POC and throughout service delivery.

Ensures that care is delivered in a manner consistent with strength-based, family-driven, and culturally competent values.

Receive ongoing coaching and training throughout their practice

Must have case loads of twelve (12) or fewer, regardless of service provided. (e.g. Services provided through MRO, or Skills training and Development are included in the case load count.

Wraparound Facilitation (WF)

Procedure Code/Modifier: T2022 HA

Description: Case management; per month

Unit: 1 unit = 1 month

Unit Restriction: 1 unit per month

Rate: $850.00 per unit

Habilitation (HAB)

• Habilitation = Skill Building

– Habilitation services are provided with the goal of enhancing the youth’s level of functioning and quality of life.

– Building the youth and family’s strengths, resilience and positive outcomes

• Habilitation vs. Rehabilitation

– Rehabilitation is relearning a skill that has already been demonstrated by the person

– Habilitation is learning a new skill to be able to improve overall functioning

Habilitation Skills

Identification of feelings and responses during interactions

Anger and emotional management

How to give and receive feedback, criticism, or praise

Problem-solving and decision making

Learning to resist negative peer pressure and to develop pro-social peer interactions

Improvement of communication skills

Building and promoting positive coping skills

Learning how to have positive interactions with peers and adults

Training and Support for the

Unpaid Caregiver (FST)• Intent

– Provide education and supports to the UNPAID caregiver that preserves the family unit and increases confidence, stamina, and empowerment.

• An unpaid caregiver is any person who provides uncompensated care, training, guidance, companionship or support to the youth.– Family member

– Neighbor

– Family friend

– Coworker

– Companion

• Paid caregivers are not eligible to receive this service.– Foster parent/s

– Coach

– Teacher

Training & Support for the

Unpaid Caregiver (FST)

• Services allowed may include but are not limited to teaching the

following:

– Practical living and decision-making skills

– Child development parenting skills

– Home management skills

– Use of community resources and development of informal

support

– Conflict resolution

– Coping Skills

– Gaining an understanding of the youth’s mental health needs

– Learning communication and crisis de-escalation skills geared

for working with the youth’s mental health and behavioral

needs

Service Provision (FST)

Hourly

• One to one with unpaid caregiver

• Face to face

Non-Hourly Family

• Group activities, conferences, classes based on the cost of the activity. Home care training for the family.

Non-Hourly Non-Family

• Group activities, conferences, classes based on the cost of the activity. Home care training for non-family caregiver.

Training & Support for the

Unpaid Caregiver (FST)

Procedure Code/Modifier: H2015 HA

Description: Comprehensive community support services; per 15

minutes

Unit: 1 unit = 15 minutes

Unit Restriction: Maximum of 8 units per day

Rate: $15.00 per unit

EOB Codes:

• 9116 – 1915I CHILD TRAINING & SUPPORT SERVICE FOR UNPAID CAREGIVER (COMPREHENSIVE COMMUNITY

SUPPORT SERVICES, PER 15 MINUTES) LIMITED TO 8 UNITS PER DAY

Training & Support for the

Unpaid Caregiver (FST)

Procedure Code/Modifier: H2015 HA

Description: Comprehensive community support services; per 15

minutes

Unit: 1 unit = 15 minutes

Unit Restriction: Maximum of 8 units per day

Rate: $15.00 per unit

EOB Codes:

• 9116 – 1915I CHILD TRAINING & SUPPORT SERVICE FOR UNPAID CAREGIVER (COMPREHENSIVE COMMUNITY

SUPPORT SERVICES, PER 15 MINUTES) LIMITED TO 8 UNITS PER DAY

Respite (RES)

• Respite is a service provided due to the regular caregiver’s absence or need for relief.

• Intent: To provide a break for the caregiver.

• Not a substitute for regular childcare to allow parent or caregiver to hold a job, attend school, or engage in job-related activities.

Activities Allowed (RES)

• Assistance with daily living skills, like accessing and

transporting youth to and from community activities

• Assistance with grooming and personal hygiene

• Meal preparation, serving, and cleanup

• Administration of medications

• Supervision

CMHW Services—Rates

Wraparound Facilitation (WF)• Unit= 1 month• Rate: $850.00 per unit

Habilitation (HAB)• Unit= 15 minutes• Rate: $19.26 per unit

Training and Support for the Unpaid Caregiver (FST)• Hourly

• Unit= 15 minutes• Rate: $15.00 per unit

• Fees—Up to $500 per year per participant

CMHW Services—Rates

Respite (RES)• Community-Based Routine Hourly

• Unit= 15 minutes

• Rate: $4.00 per unit

• Community and Facility-Based Routine Daily• Unit= 1 day

• Rate: $100 per unit

• Community and Facility-Based Crisis Daily• Unit= 1 day

• Rate: $120 per unit

• Facility-Based in a Medicaid Certified PRTF• Unit= 1 day

• Rate: $321.52

CMHW Provider Qualifications

Provider types• Accredited Agencies

• Non-accredited Agencies

• Individuals

Rendering providers must be approved individually by DMHA prior to enrollment

Agency approval is contingent upon approval of the rendering provider—no blanket approvals

For additional information, consult the Child Mental Health Wraparound module

DMHA’s 1915 (i) Child Mental

Health Wraparound services

Thank you!