Clinical Hub or Medical Home?

Boy, you can tell I am no longer "on the ground" in Massachusetts. I am on break this week from my Fellowship, and going through my e-mails, when I spied this one, highlighting Provider Alert #78 from the Massachusetts Behavioral Health Partnership :

Beginning October 1, 2009, as part of the Children’s Behavioral Health Initiative (CBHI), outpatient providers serving youth under the age of 21 who are enrolled in MassHealth Standard and CommonHealth will be responsible for assuming the role of “clinical hub,” and will play a key role in the coordination of three new “hub dependent” services for their clients.

Therapeutic Mentoring, In-Home Behavioral Services, and Family Support and Training are new services available to youth under age 21 with behavioral health needs who are enrolled in MassHealth Standard and CommonHealth. As with all CBHI services, these services are designed to promote Systems of Care values and ensure that the care provided is:

• Family-Driven, Child-Centered, and Youth Guided

• Strengths-Based

• Culturally Responsive

• Collaborative and Integrated

• Continuously Improving

This Alert includes information on all six CBHI services so that outpatient providers are aware of the entire CBHI continuum.

Role of the Clinical Hub

Clinical Hub providers are responsible for coordinating care and collaborating with other service providers (e.g., making regular phone calls to collaterals, holding meetings with the family and other treatment providers, or convening care planning teams for ICC). Clinical Hub services in order of intensity are: Intensive Care Coordination (ICC), In-Home Therapy (beginning November 1, 2009), and Outpatient Therapy. When more than one Clinical Hub service provider is involved with a family, care coordination is provided by the most intensive service. Clinical Hub providers may refer for services that require a hub (i.e., “hub dependent” services). These services include: Therapeutic Mentoring, In-Home Behavioral Services, and Family Support and Training. Hub dependent services require a referral from one of the three Clinical Hubs (i.e., outpatient, In-Home Therapy, Intensive Care Coordination) and will not be authorized as a “stand-alone” service. There must be a goal identified on the existing outpatient or IHT treatment plan, or on the individual care plan (ICP) for youth in ICC, which corresponds directly with the need for a “hub dependent” service. It is the responsibility of the Clinical Hub provider to regularly connect with those “hub dependent” service providers to which you make referrals in order to coordinate care and obtain and provide updates on the youth’s progress.

Outpatient providers will be reimbursed for coordination activities related to their Clinical Hub responsibilities including participation in care plan team meetings and collateral contacts. Providers can be reimbursed by billing for Case Consultation or Collateral Contacts. See Provider Alert #74, dated August 20, 2009, on MBHP expanding the parameters for case consultations.

Now that sounds an awful lot like the kind of care coordination that we want to see in the Medical Home. If we can do it for kids with SED, why not for the rest of them? How will this mesh with the various Medical Home projects under development within the Commonwealth and throughout the nation? When the Medical Home comes, we will have a good model off of which to work.

Progress. More progress is always a good thing.

A Note from Sam Leadholm, HLA

INTERAGENCY REVIEW TEAMS Under Chapter 321 of the Acts of 2008

Prepared by Samuel Leadholm, Staff Attorney at Health Law Advocates – October 2009

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Landmark legislation passed in August of 2008 entitled “An Act Relative to Children’s Mental Health” (“Act”) restructures how the Commonwealth oversees, provides and coordinates children’s behavioral health services. Among other things, the Act creates Interagency Review Teams (“Interagency Teams”) and a hearing process to improve coordination of services for children with complex needs. The Act defines children with complex needs as those individuals under age 22 who are disabled or have special needs and may qualify for services from multiple state agencies, i.e., DMH, DCF or DDS.

These Interagency Teams must be geographically-based and consist of necessary state agency representatives from departments within the Commonwealth’s Executive Office of Health and Human Services, the Department of Early Education and Care, and the Department of Elementary and Secondary Education according to the needs of the child. If appropriate and where consent is provided, the Interagency Teams may include representatives from schools. An Interagency Team may be convened upon the request of a state agency, the juvenile court, or a parent or legal guardian.

The role of the Interagency Team is to determine what services are appropriate to the child. In doing so, the Interagency Team may evaluate whether the current services are sufficient and whether case management is needed. However, the Act does not create any new services provided by the agencies. If you are seeking a service that the agencies do not already provide, the Interagency Teams may not be helpful. The Interagency Team must listen to parents and other treatment providers before reaching any decision, which must be reached by consensus.

The Act provides that where an Interagency Team cannot reach a decision by consensus or where parents or legal guardians disagree with a decision, those decisions must be reviewed by regional directors of the respective agencies for resolution. Those regional directors must convene within 10 business days of the referral and arrive at a decision within 3 business days thereafter.

The Act also provides a right of appeal with the state’s Division of Administrative Law Appeals and that nothing in the Act limits the rights of parents or children under state and federal special education laws and regulations.

If you need additional assistance accessing these multi-agency teams, please contact: Samuel Leadholm at (617) 275-2982 or sleadholm@hla-inc.org, Jennifer Honig, Staff Attorney at Mental Health Legal Advisors Committee (“MHLAC”) at (617) 338-2345 x. 25 or jhonig@mhlac.org, or MHLAC’s intake line on M.W.F between 8:30-1 p.m. at (617) 338 2345 x. 20.

A Meeting in Worcester

You Are Cordially Invited

to Attend

The Department of Children and Families

REGIONAL FORUM

With Commissioner Angelo McClain

Date: Tuesday, November 3, 2009

Time: 2:30pm to 4:30pm for DCF Providers

Location: Regional Conference Room

Central Regional Office

121 Providence Street, Suite 300

Worcester, MA 01604

Come hear about:

*The Integrated Casework Practice Model and What it Means for You

*A Current Status Report on the Department’s Budget

RSVP by October 28, 2009

by contacting:

Lani Geselius at 508-929-2132 or

at Lani.Geselius@state.ma.us

So much going on: Update from the CBHI

Got this in the mail: Sounds like progress.

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MassHealth Rolls Out Two More Community-Based Services: In-Home Behavioral Services and Therapeutic Mentoring

Two new community-based behavioral health services for MassHealth-enrolled children and youth under age 21 began on October 1, 2009. In-Home Behavioral Services provides support to children and youth with challenging behaviors. Therapeutic Mentoring Services provides a therapeutic mentor to work one-on-one with a child. The mentor supports and coaches the child or youth learn social skills, such as better ways to communicate with other children and adults, how to deal with different opinions and how to get along with others.

How to Access These Services:

To access In-Home Behavioral Services or Therapeutic Mentoring, a child or youth must be receiving services from a “clinical hub”, either: outpatient therapy, In-Home Therapy, or Intensive Care Coordination (ICC). The child’s treatment plan, developed by one of these “clinical hub” providers, must include a goal which requires one of the new services to address. Families should talk to their child’s behavioral health provider about these services, or they can call the customer service department of their MassHealth Health Plan. (These numbers are listed at the end of this notice.) Lists of providers of the new services can be found on any of the MassHealth Health Plan’s websites.

In-Home Therapy Will Become Available Nov. 1, 2009

In-Home Therapy (IHT) provides intensive therapy for a child and family to treat the child’s behavioral health needs and help the family support the child in the home. Contact information for In-Home Therapy providers may be found on any of the MassHealth Health Plan’s websites. Families may contact IHT providers directly, or they may call the customer service department of their MassHealth Health Plan for assistance.

CSAs Serving Over 1,600 Children and Youth

The MassHealth Managed Care Entities (MCEs) have reported over 1,691children and youth are currently being served by the 32 Community Service Agencies (CSAs) located across the state. The CSAs began delivering services to MassHealth-enrolled children and youth under age 21 on June 30, 2009. They provide two of the five new MassHealth behavioral health services, Intensive Care Coordination (ICC) and Family Support and Training (Family Partners), to children and youth with serious emotional disturbance (SED). Referrals to the CSAs have remained steady at approximately 200 per week.

Mobile Crisis Intervention Teams Delivering Needed Services

Emergency Service Providers (ESPs) began delivering round-the-clock Mobile Crisis Intervention services on June 30, 2009. Since that time, Mobile Crisis Intervention Teams have recorded over 2,040 mobile crisis interventions or “encounters” with MassHealth-enrolled children and youth under age 21. The MassHealth Managed Care Entities (MCE) and Mobile Crisis Intervention providers are presently working within their communities to educate families, caregivers and others about the availability of crisis services in the home and community. Many people are still accustomed to the previous practice of crisis service delivery through the hospital emergency room.

MCEs Continue to Support Provider Implementation

The MassHealth Managed Care Entities (MCEs) continue to work closely with Intensive Care Coordination (ICC) and Mobile Crisis Intervention providers to implement these two new services. Upcoming MCE plans call for a regional meeting structure that will initially consist of ICC and Mobile Crisis providers and eventually include other service providers to support regional practice. The Massachusetts Behavioral Health Partnership (MBHP) also continues to provide technical assistance to Mobile Crisis Intervention providers through a contract with a leading national expert on this service. Last month, the MCEs hosted a conference for In-Home Behavioral Services, Therapeutic Mentoring and In-Home Therapy providers. The day-long conference included presentations by MCE staff on program specifications and medical necessity criteria as well as presentations by nationally known clinical leaders with expertise in each new service.

Mental Health Alphabet Soup

Busy down here, but I wanted to share this:

ABC soup for Children’s Mental Health- www.ppal.net

CAFAS Child & Adolescent Functional Assessment

CANS Child and Adolescent Needs and Strengths

CASPP Child and Adolescent Services Planning Principles

CBAT Community Based Acute Treatment

CFFC Coordinated Family-Focused Care

CHBI Children’s Behavioral Health Initiative

CHINS Children in Need of Services

CMS Centers for Medicare & Medicaid Services

CPT Care Planning Team

CSA Community Service Agency

CSP Community Support Program

DCF Department of Children and Families

DMH Department of Mental Health

DDS Department of Disability Services

DOE Department of Education

DYS Department of Youth Services

DSM IV Diagnostic and Statistical Manual, Version IV

EMH Emergency Mental Health

EOHHS Executive Office of Health & Human Services

EPSDT Early, Periodic Screening, Diagnosis and Treatment

ESP Emergency Services Program / Provider

FST Family Stabilization Team

FS & T Family Support and Training

IAP Individual Action Plan

ICC Intensive Care Coordination

ICP Individual Care Plan

IDEA Individuals with Disabilities Education Act

IEP Individualized Education Program

IVR Interactive Voice Registration

IT Information Technology

IHBT In Home Behavior Therapy

LEA Local Educational Agency

LOC Level of Care

MBHP Massachusetts Behavioral Health Partnership

MCPAP Massachusetts Child Psychiatry Access Project

MCE Managed Care Entity

MCI Mobile Crisis Intervention

MCT Mobile Crisis Team

MCO Managed Care Organization

M-CHAT Modified Checklist for Autism in Toddlers

MHSPY Mental Health Services Program for Youth

MYR Motivating Youth Recovery

PCC Primary Care Clinician

PCP Primary Care Physician / Provider

PHP Partial Hospital Program

PEDS Parents’ Evaluation of Developmental Status

PSC Pediatric Symptom Checklist

RESC Regional Emergency Service Center

SAMHSA Substance Abuse & Mental Health Services Administration

SED Serious Emotional Disturbance

SOC System of Care

TM Therapeutic Mentoring

TTS Therapeutic Training and Support

UCC Urgent Care Center

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Federation of Children with Special Needs- FCSN

NAMI- National Alliance of the Mentally Ill

PAL- Parent/ Professional Advocacy League