Northwest Crisis Care Northwest Crisis Care System System System of Care Overview System of Care Overview Policy and Procedures Policy and Procedures Illinois Department of Human Services Illinois Department of Human Services Division of Mental Health Division of Mental Health September 12, 2012: Dan Wasmer, MS September 12, 2012: Dan Wasmer, MS Associate Director, Regional Services Associate Director, Regional Services Updated 09-11-2012 1
Transcript
Northwest Crisis Care SystemNorthwest Crisis Care SystemSystem of Care OverviewSystem of Care Overview
Policy and ProceduresPolicy and Procedures
Illinois Department of Human Services Illinois Department of Human Services Division of Mental Health Division of Mental Health
September 12, 2012: Dan Wasmer, MSSeptember 12, 2012: Dan Wasmer, MSAssociate Director, Regional ServicesAssociate Director, Regional Services
Updated 09-11-2012
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Materials for todayMaterials for today
CalendarCalendar
Presentation SlidesPresentation Slides
Updated 09-11-2012 2
Lee Reinert
Objectives of OVERVIEWObjectives of OVERVIEW
Understand the flow of new Crisis Care SystemUnderstand the flow of new Crisis Care System Understand key policiesUnderstand key policies Understand procedures Understand procedures
Understand any interim policies and proceduresUnderstand any interim policies and procedures
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DHS/DMH IntentDHS/DMH Intent
To enhance the existing Crisis Care system in To enhance the existing Crisis Care system in Regions 2W and 3N by providing equivalent Regions 2W and 3N by providing equivalent access to necessary levels of care that are:access to necessary levels of care that are:
These services have historically been provided by Singer These services have historically been provided by Singer Mental Health Center.Mental Health Center.
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ServicesServices
Enhanced Crisis ResponseEnhanced Crisis Response Community Hospital Inpatient Psychiatric Community Hospital Inpatient Psychiatric
Services (CHIPS)Services (CHIPS) Mental Health Crisis ResidentialMental Health Crisis Residential Acute Community Services (ACS)Acute Community Services (ACS) TransportationTransportation
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Enhanced Crisis ResponseEnhanced Crisis Response
DHS/DMH expects that community providers DHS/DMH expects that community providers in Region 2W and 3N will continue to respond in Region 2W and 3N will continue to respond to mental health crisis situations within their to mental health crisis situations within their communitiescommunities
DHS/DMH is funding enhancements to this DHS/DMH is funding enhancements to this system to ensure timely access.system to ensure timely access.
Minimum credential of Qualified Mental Minimum credential of Qualified Mental Health Professional (QMHP)Health Professional (QMHP)
Available 24/7Available 24/7
Respond within (1) hour of callRespond within (1) hour of call
Determines financial and clinical eligibilityDetermines financial and clinical eligibility
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EDA EVALUATOREDA EVALUATOR
Conducts clinical evaluation and documents Conducts clinical evaluation and documents on DMH Uniform Screening and Referral on DMH Uniform Screening and Referral Form (USARF)Form (USARF)
Completes level of care assessment using the Completes level of care assessment using the Level of Care Utilization System (LOCUS)Level of Care Utilization System (LOCUS)
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EDA EVALUATOREDA EVALUATORDetermines if individual meets 2 clinical criteria for Region NCCSDetermines if individual meets 2 clinical criteria for Region NCCS
LOCUS Level of Care Recommendation of 4 or greaterLOCUS Level of Care Recommendation of 4 or greater
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EDA EVALUATOREDA EVALUATOR
Individual does Individual does NOTNOT meet clinical criteria meet clinical criteria
Inform referral source as appropriateInform referral source as appropriate
Provide any alternative treatmentProvide any alternative treatment
or service recommendationor service recommendation
e.g. DMH Non-Medicaid benefit e.g. DMH Non-Medicaid benefit packagepackage
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EDA EVALUATOREDA EVALUATOR
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EDA EVALUATOREDA EVALUATOR Is the individual willing?Is the individual willing?
Individual is Individual is NOTNOT willing to engage? willing to engage?Does he/she meet criteria for involuntary Does he/she meet criteria for involuntary
hospitalization?hospitalization?
Yes – proceed with processYes – proceed with processNo – explain outcome of assessment, No – explain outcome of assessment, recommend level of care to individual, recommend level of care to individual, referral source and others of referral source and others of
individual’s choice individual’s choice
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EDA EVALUATOREDA EVALUATOR
Individual Individual is is willing to Engagewilling to Engage
Inform referral source as appropriate of recommended level of careInform referral source as appropriate of recommended level of care
If individual is in Emergency Department, assure that ED If individual is in Emergency Department, assure that ED physician/staff concurphysician/staff concur
Evaluator calls the ACCESS line forEvaluator calls the ACCESS line for• AuthorizationAuthorization• Available servicesAvailable services• Authorization numberAuthorization number
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Service Authorization Service Authorization
Illinois Mental Health Collaborative for Illinois Mental Health Collaborative for Access and ChoiceAccess and Choice• DMH’s Administrative Service DMH’s Administrative Service
Organization (ASO)Organization (ASO)
Toll free ACCESS Line (866) 359-7953Toll free ACCESS Line (866) 359-7953
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Service AuthorizationService Authorization
Clinical Care Managers (CCM) available 24/7Clinical Care Managers (CCM) available 24/7
Evaluator provides information to ACCESS Evaluator provides information to ACCESS CCM CCM • DemographicsDemographics• Clinical presentationClinical presentation• Recommended dispositionRecommended disposition
CCM reviews for medical necessityCCM reviews for medical necessityUpdated 09-11-2012 15
Service AuthorizationService Authorization
When medical necessity is present for When medical necessity is present for recommended level of care, the CCM:recommended level of care, the CCM:
• Provides authorization number Provides authorization number • Provides location and contact information for Provides location and contact information for service providerservice provider
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EDA EVALUATOREDA EVALUATOR EvaluatorEvaluator
• Contacts service provider to make referral.Contacts service provider to make referral.• Makes needed transportation arrangements using Makes needed transportation arrangements using
disposition and recommendations) is complete; disposition and recommendations) is complete; distributes copies to ED (if involved) and accepting distributes copies to ED (if involved) and accepting service provider (USARF, LOCUS, disposition and service provider (USARF, LOCUS, disposition and recommendations).recommendations).
• Confirms linkage occurred within 24 hours.Confirms linkage occurred within 24 hours.• Registers individual in DHS/DMH consumer Registers individual in DHS/DMH consumer
registration system.registration system.
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Service AuthorizationService AuthorizationAlternative Level of CareAlternative Level of Care
If the CCM would propose a different level of If the CCM would propose a different level of care based on medical necessity or capacitycare based on medical necessity or capacity• Evaluator discusses alternatives with the individual Evaluator discusses alternatives with the individual
and ED physician/staff (if in an ED)and ED physician/staff (if in an ED)• If in agreement, authorization and referral process If in agreement, authorization and referral process
is initiatedis initiated
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Service AuthorizationService Authorization
If If NotNot in agreement: in agreement: Collaborative CCM provides clinical presentation, Collaborative CCM provides clinical presentation,
treatment recommended and capacity to treatment recommended and capacity to Elgin/McFarlandElgin/McFarland
Elgin/McFarland physician reviews information and Elgin/McFarland physician reviews information and discusses with ED physician (if involved).discusses with ED physician (if involved).
Elgin/McFarland considers option and determines most Elgin/McFarland considers option and determines most appropriate level of care and informs both CCM and appropriate level of care and informs both CCM and ED physician (if involved).ED physician (if involved).
CCM contacts Evaluator with determination and CCM contacts Evaluator with determination and authorizes services as appropriate.authorizes services as appropriate.
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Disposition OptionsDisposition Options
Community Hospital Inpatient Psychiatric Community Hospital Inpatient Psychiatric Services (CHIPS)Services (CHIPS)
DMH funded, short-term inpatient treatment at DMH funded, short-term inpatient treatment at community hospital.community hospital.
Serve those experiencing psychiatric crises Serve those experiencing psychiatric crises and exhibiting acute behaviors or symptoms and exhibiting acute behaviors or symptoms requiring inpatient setting. requiring inpatient setting.
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Hospitals with CHIPS ContractsHospitals with CHIPS Contracts
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Swedish American Hospital, Rockford Rockford Memorial Hospital, RockfordOSF St. Elizabeth’s, OttawaTrinity Medical Center, Moline Provena Mercy Center, Aurora
Mental Health Crisis ResidentialMental Health Crisis Residential
DMH funded, short-term 24/7 continuous DMH funded, short-term 24/7 continuous supervision and treatment in a provider controlled supervision and treatment in a provider controlled facility.facility.• Rosecrance is the current provider.Rosecrance is the current provider.
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Acute Community Service (ACS)Acute Community Service (ACS)
Any services and supports needed by the individual to Any services and supports needed by the individual to continue stabilization from crisis.continue stabilization from crisis.
Grant funding allows the provider ultimate flexibility in Grant funding allows the provider ultimate flexibility in determining type, amount, frequency, etc., including determining type, amount, frequency, etc., including medicationmedication
Services must be initiated within 24 hours of the EDAServices must be initiated within 24 hours of the EDA Services must be initiated within 48 hours of discharge Services must be initiated within 48 hours of discharge
CHIPS, crisis residential, or SOH.CHIPS, crisis residential, or SOH.
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Acute Community Service (ACS)Acute Community Service (ACS)
Individual eligible for services up to 12 months of initial Individual eligible for services up to 12 months of initial assessmentassessment
Provider agrees to serve all referred/enrolled individualsProvider agrees to serve all referred/enrolled individuals Provider required to assist individual with application for Provider required to assist individual with application for
medical assistancemedical assistance Provider required to register each individual through Provider required to register each individual through
DHS/DMH information systemDHS/DMH information system Individuals will be referred to provider in their geographic Individuals will be referred to provider in their geographic
proximity but will have choice if requestedproximity but will have choice if requested
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Elgin and McFarland Elgin and McFarland Mental Health CentersMental Health Centers
Will serve as safety net when other services Will serve as safety net when other services are not appropriate or available.are not appropriate or available.
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Elgin/McFarland Mental Health CentersElgin/McFarland Mental Health Centers
When an individual presents with the following, When an individual presents with the following, Elgin/McFarland may be consulted for consideration of DMH Elgin/McFarland may be consulted for consideration of DMH admission.admission.
• History indicating need for extended inpatient treatmentHistory indicating need for extended inpatient treatment•Presents challenges in discharge from inpatient Presents challenges in discharge from inpatient
setting, such as experiencing homelessness.setting, such as experiencing homelessness.
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TransportationTransportation
DMH will purchase transportation services DMH will purchase transportation services between site of EDA, CHIPS hospitals, and MH between site of EDA, CHIPS hospitals, and MH Crisis ResidentialCrisis Residential
Individual must meet all eligibility criteriaIndividual must meet all eligibility criteria The Authorization number received from the The Authorization number received from the
Collaborative will serve as authorization for Collaborative will serve as authorization for transportationtransportation
Transportation provider must respond within 90 Transportation provider must respond within 90 minutes of requestminutes of request
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Phone ContactsPhone Contacts
Complaint Resolution/Help LineComplaint Resolution/Help Line 312-814-0930312-814-0930
McFarland Mental Health CenterMcFarland Mental Health Center 217-786-6857217-786-6857
Elgin Mental Health CenterElgin Mental Health Center 847-847-6239847-847-6239 Alternate Phone: 847-742-1040 – have operator connect Alternate Phone: 847-742-1040 – have operator connect
you to the Admissions staff person.you to the Admissions staff person. Questions can also be sent to:Questions can also be sent to:
