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YOUR FAMILY AND THEINDIVIDUAL CARE GRANT IMPROVEMENTS

Seth Harkins, Ed.D.Director, ICG Program

Department of Human ServicesDivision of Mental Health

Bill White, LCSW, DCSWClinical Director

Illinois Mental HealthCollaborative for Access and Choice

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Along with:

Dr. Todd Kasdan, Medical Director of theCollaborativeDr. Constance Williams, Associate DeputyClinical Director, DMH Child andAdolescent ServicesBryce Goff, Director of Recovery andResilience for the Collaborative

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A Brief History of the ICG Program

Founded in 1967. ICG Program has served children and families for 42years.Initially served residential clients only.1987 RR v. Kiley resulted in a consent decree that required thepromulgation of Rule 135.1999 Rule 135 was opened for changes, and the community-basedICG program was included in the Rule.2004 Recovery and resilience focus begins along with the beginningdialogues about fee for service conversation2008 Federal Government required that residential per diem ratesneeded to be unbundled in order to participate in federal dollarmatching. DMH contracts with the Illinois Collaborative for Access andChoice (Collaborative) to provide more resources to the ICG program.April 1, 2008 Collaborative assumed ICG administrative functions.April 1,2009 application of Rule 132 to the ICG Program.

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ICG AccomplishmentsICG Program has served hundreds of children and families over theyears.ICG Program has been there to support severely mentally ill children insafe, supportive, and therapeutic environments.The ICG Program has developed an extensive network of relationshipswith residential and community providers.Each year the community-based ICG Program has grown to 40% inFY2008.ICG Program, providers, and families have successfully partnered toreintegrate children with their families and communities.The ICG Advisory Council, consisting of parents, providers, and ICGstaff, has been a communication forum for an exchange dialogue andfeedback about the ICG Program.Introduced the Collaborative into the partnership to enhance ICGProgram operations with more staff, resources, technology, andmonitoring compliance with Medicaid and emerging regulations.

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IMPROVEMENTS WITHPURPOSE

Increase Family Participation⁄ Family involvement in treatment is essential

⁄ Children and families have a higher rate of recovery whenfamilies are consistently involved in their treatment

⁄ Family participation throughout, including quarterlytreatment planning and regularly scheduled family therapysessions are keys to the success of treatment

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IMPROVEMENTS WITH PURPOSE(cont’d)

Enhance Recovery and Resilience Focus⁄ Resilience Defined

Resilience means the personal and community qualities that enableus to rebound from adversity, trauma, tragedy, threats, or otherstresses – and to go on with life with a sense of mastery,competence, and hope. We now understand from research thatresilience is fostered by a positive childhood and includes positiveindividual traits, such as optimism, good problem-solving skills, andtreatments. Closely-knit communities and neighborhoods are alsoresilient, providing supports for their members.

⁄ Recovery DefinedRecovery refers to the process in which persons are able to live,work, learn, and participate fully in their communities. For someindividuals, recovery is the ability to live a fulfilling and productive lifedespite a disability. For others, recovery implies the reduction orcomplete remission of symptoms. Science has shown that havinghope plays an integral role in an individual’s recovery. (New FreedomCommission on Mental Health)

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IMPROVEMENTS WITH PURPOSE(cont’d)

Focus on Least RestrictiveEnvironment⁄ Services are most effective when provided in the most natural

and supportive setting possible

⁄ The environment a youth is in affects their view of their place insociety and their potential for independence

⁄ Returning youth to their family and community settings as soonas they are ready facilitates recovery and resilience

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IMPROVMENTS WITH PURPOSE(cont’d)

Pursue Successful Outcomes⁄ Improvements to the ICG program will help us identify clear,

meaningful outcomes

⁄ The Ohio and Columbia Scales of Impairment are tools we useto measure the effectiveness of treatment toward achievement ofindividualized goals

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IMPROVEMENTS WITH PURPOSE(cont’d)

Enhance Clinical CareManagement⁄ Services that fit the youth and family’s medical

needs

The Right ServicesThe Right AmountThe Right Time

⁄ Family involvement and clinical support are keysto this decision making process

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IMPROVEMENTS WITH PURPOSE(cont’d)

Reimburse through Fee-for-Service

⁄ Building a more person-centered and accountablechild and adolescent mental health system

⁄ Making the best use of limited funds to servepersons in need of publicly funded mental healthservices

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IMPROVEMENTS WITH PURPOSE(cont’d)

Resume Medicaid BillingThe DHS/DMH was required by the federalgovernment to discontinue Medicaid billingfor bundled residential services in 2006. InJune 2008, a year was given to bring theICG residential billing in to compliance byJune 30, 2008.ICG changes in billing, both for communityand residential services, will permit theDHS/DMH to resume Medicaid billing foreligible clients and services, therebygarnering federal match for these services.

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DEFINING THE IMPROVEMENTS

⁄ DHS hired a consulting group to review our operations and it wasrecommended that DMH hire an Administrative Service Organization(ASO) to perform multiple management functions for DMH, includingbut not limited to the ICG Program. The Illinois Mental HealthCollaborative for Access and Choice (the Collaborative) is the ASOhired by DHS/DMH and provides administrative and clinical services:

Sending, receiving and reviewing applications

Making initial eligibility and continuing eligibility determinations

Authorization of residential ICG nights of stay approximately everyninety (90) days

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DEFINING THE IMPROVEMENTS(cont’d)

Collaborative Clinical Care Managers inpartnership with parents, ICG/ScreeningAssessment and Support Services (SASS)providers, and residential providers

Eligibility and levels of care are based onmedical necessity

According to Medicaid rule 94R, ICG clients areeligible for Medicaid after 90 days of residentialcare

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DEFINING THE IMPROVEMENTS(cont’d)

The Same⁄ Active parent and family

role in treatmentplanning (enhanced)

⁄ Application process &requirements

⁄ ICG eligibility criteria anddetermination process

⁄ Quarterly and annualreviews under Rule 135

⁄ Rates for servicesexcept for applicationassistance and casecoordination

Different⁄ Claims submitted to the

Collaborative⁄ Service billed using the DMH

Service Matrix and the old ICGcodes are no longer valid

⁄ Residential nights of carerequire authorization for claimpayment

⁄ Residential providers requiredto submit encounters fortreatment services providedduring the residential day -encounters equal to at least 40%of the per diem rate required

⁄ Improved consumerregistration system

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DEFINING THE IMPROVEMENTS(cont’d)

The Same⁄ Payments to providers by

the DHS/DMH⁄ Case coordination role of

ICG/SASS worker⁄ Providers required to

assist with Medicaidapplications

Different⁄ Collaborative Clinical Care

Manager in placementdecisions and treatmentplanning

⁄ Human Capital Development(HCD) field offices aware ofICG program and exclusion offamily income for Medicaideligibility at 90th day oftreatment

⁄ All providers and sites requiredto be certified for Rule 132services

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WHAT IS A QUARTERLY REPORT?The Quarterly Report contains informationabout the youth’s progress in treatment andindividual needs.The Quarterly Report is used to help theClinical Care Manager make a decision torecommend continuation of the current level ofcare or a higher or lower level of care.The Quarterly Report, along with the AnnualReview Report, provides an assessment oftreatment progress and treatment needsacross time. This allows evaluators to trackpatterns of behavior over time.

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WHY IS THE QUARTERLYSTAFFING IMPORTANT?

The Quarterly Staffing is where the Child andFamily Team participate in a review of theyouth’s treatment progress and needs.The Child and Family Team consists of theparent/guardian, the youth, the ICG/SASSprovider, the treatment provider, and theClinical Care Manager.Everyone hears the same information at thesame time and has the opportunity to discussprogress and future planning.

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WHAT IS MEANT BYAUTHORIZATION OF SERVICES?

Based on the Quarterly Report, the ClinicalCare Manager makes a decision torecommend clinical services in the:

Current level of careHigher level of care, orLower level of care

The Quarterly Report occurs approximatelyevery ninety days.

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WHAT CLINICAL INFORMATION IS INVOLVEDIN THE ANNUAL REVIEW REPORT?

Mental health diagnosesCurrent medicationsPsychological testing information from themost recent psychological evaluationDescription of current behavioral and/oremotional problems that warrant the need forcontinued placementStaff’s clinical opinion of the youth’s need fortreatment at this time

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WHAT CLINICAL INFORMATION IS INVOLVEDIN THE ANNUAL REVIEW REPORT? (cont’d)

Progress toward attainment of individualtreatment plan goalsProgress in individual, group, and familytherapyProgress in functioning regarding peers andthe communityDescription of current and/or past year medicalconcerns and issues, if any

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WHAT INFORMATION IS INVOLVEDIN THE ANNUAL REVIEW REPORT?

Parent participationIndividual strengthsList of discharge criteria to be met in order forthe youth to be ready for a step down or stepupType of discharge planning that the youthreceived/will requireEducational progressLegal circumstances

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CAN ADDITIONAL INFORMATION BEINCLUDED IN THE ANNUAL REVIEW?

Yes. While parents are not required to submit anythingother than the Annual Review Parent Statement, parentscan add information if they choose to do so. Of particularimportance is home visits, progress in therapy, and inmeeting treatment goals.The provider can include additional information he/shethinks will help add to the total clinical picture.With the help of the DMH C & A Family and ConsumerSpecialists, a subcommittee of the ICG AdvisoryCouncil is revising the Parent Statement.

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Importance of Parental Input

It’s vitally important that parents participate inthe Annual Review process.Parents have a unique perspective and role inachieving successful treatment outcomes.Rule 135 requires parental participation.Progress is still needed from some parents inobtaining all Annual Review information.

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WHAT WERE THE“CONDITIONAL LETTERS”?Thirty-eight letters were sent to ICG families, whichsome have come to refer to as “conditional letters.”The letter was not a non renewal of the ICG.The letter was intended to let the family know that theyshould be aware that they would need to ensure, andthat on the next review, they and the provider submittedevidence in support of continuing the ICG.The letters stated that eligibility would continue until thenext grant renewal and that progress of the youth wouldbe monitored through Quarterly Reports.

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REQUESTING AN APPEAL

To request an appeal of an Individual CareGrant denial, you may write a letter to:

⁄ Myra M. Kamran MD Deputy Clinical Director Child and Adolescent Services Division of Mental Health c/o Illinois Mental Health Collaborative for

Access and Choice P.O. Box 06559 Chicago, IL 60606

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FAMILY SUPPORTRESOURCES

Consumer and Family Handbook (2nd edition)Recovery and ResilienceUnderstanding Services (Child and Adult)Getting Involved in Treatment

The Consumer and Family Care Line: 1 (866) 359-7953Main Menu: Select “2” for Consumers and Families

Then…

Questions about Individual Care Grants Press “1”Referral to a Mental Health Provider Press “2”Questions About Mental Health Services Press “3”Concerns or Complaints Press “4”The Warm Line (Emotional Support Recovery Education)

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CONTACT US

Seth Harkins, EdD, Director, ICG ProgramPhone: 773-794-4870E-mail: seth.harkins@illinois.gov

Bill White, LCSW, Collaborative Clinical DirectorPhone: 312-453-9031E-mail: william.white@valueoptions.com

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GUIDELINES FORQUESTIONS AND ANSWERS

All Speakers Will Use Person-First LanguageAll Acronyms Will Be Spelled Out and DefinedDiverse Experiences Will Be Heard and ValidatedLimit to One Question per Person, then Pass to theNext PersonQuestions and answers must respect confidentiality.We are unable to address specific personalcircumstances

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THANK YOU!