COUNTY RURAL OFFICES OF SOCIAL SERVICES MENTAL HEALTH AND DIABILITIES MANAGEMENT PLAN

Transcription

1 COUNTY RURAL OFFICES OF SOCIAL SERVICES MENTAL HEALTH AND DIABILITIES MANAGEMENT PLAN ANNUAL SERVICE AND BUDGET PLAN FISCAL YEAR 2015 JULY 1, 2014-JUNE 30, 2015 SERVING THE COUNTIES OF: CLARKE, DECATUR, LUCAS, MONROE, RINGGOLD, AND WAYNE Duffy Kester-, CROSS Governing Board of Directors

2 TABLE OF CONTENTS INTRODUCTION- ACCESS POINTS- TARGETED CASE MANAGEMENT- CRISIS PLANNING- SCOPE OF SERVICES and BUDGET- FINANCIAL FORECASTING- PROVIDER REIMBURSEMENT- CONTRACTED PROVIDER LISTING

3 Introduction County Rural Offices of Social Services was formed under Iowa Code Chapter 28E to create a Mental Health and Disability Service Region in compliance with Iowa Code In compliance with IAC the CROSS Management Plan includes three parts: Annual Service and Budget Plan, Annual Report and Policies and Procedures Manual. The Annual Service and Budget Plan includes the services to be provided and the cost of those services, local access points, Targeted Case Management agencies, a plan for ensuring effective crisis prevention and a description of the scope of services, projection of need and cost to meet the need, and provider reimbursement provisions. The Annual Service and Budget Plan has been approved by the CROSS governing board and is subject to approval by the Director of Human Services. CROSS management plans are available in each local CROSS office and on the Region and DHS Websites.

4 Access Points An access point is a part of the service system or community that shall be trained to complete the MH/DD funding applications for persons with a disability and forward them to the local CROSS Office. Access Points Clarke County Courthouse, CROSS Coordinator Office Crossroads Mental Health Clarke County Hospital Clarke County Public Health Decatur/Ringgold County Case Management Decatur County Community Services Leon Lamoni Decatur County Hospital Decatur County Public Health Decatur/Ringgold County Case Management Lucas County Community Services, CROSS Coordinator Office Southeast Iowa Case Management Lucas County Health Center Monroe County Community Services, Cross Coordinator Office Southeast Iowa Case Management Ringgold County Public Health Decatur/Ringgold County Case Management Wayne County Community Services Southeast Iowa Case Management Decatur /Ringgold County Case Management Address Clarke County Courthouse 100 S. Main, Osceola, IA N Main, Osceola, IA S Fillmore St. Osceola, IA W. Jefferson, Osceola, IA NE Idaho St, Leon, Iowa NE Idaho St., Leon, Iowa NE 14th St., Leon, Iowa E Ackerley, Lamoni, Iowa NW Church, Leon, Iowa NE Idaho St., Leon, Iowa NE Idaho St, Leon, Iowa South Grand Chariton, IA South Clinton, Albia, IA N. 7th, Corydon, IA South B Street, Albia, Iowa Washington Ave West, Albia, Iowa South Clinton, Albia, IA South Fillmore, Mount Ayr, Iowa NE Idaho St, Leon, Iowa North Lafayette, Corydon, IA South Clinton, Albia, IA West State Street, Corydon, IA NE Idaho Street, Leon, IA Phone Number Targeted Case Management CROSS shall offer a choice and access to cost effective, evidenced based, conflict free Targeted Case Management as described in IAC {l)g. The CROSS Technical Assistance Committee reviewed interested agencies, made recommendations to the Governing Board, who designated Targeted Case Management agencies to offer services to individuals enrolled in the Medicaid program. Designated Case Management agencies serving the CROSS are accredited by the Department of Human Services. Targeted Case Managers meet the qualifications as defined in IAC 441. The designated Targeted Case Management and Service Coordination Services meet the following expectations:

5 Performance and outcome measures relating to the safety, work performance and community residency of the individuals receivingthe service Standards including but not limited to social history, assessment, service planning, incident reporting, crisis planning, coordination, and monitoring for individuals receiving the services. Methodologies for complying with the requirements of sub rule g which may include the use of electronic recording keeping and remote or internet based training. CROSS has identified and designated the following providers for case management in the CROSS region: Decatur County Community Services - Case Management Southeast Iowa Case Management Crisis Planning Emergency Services Current basic crisis response provisions including 24 hour access to crisis response and evaluation are provided through Community Mental Health Centers and providers listed below. Area Clarke County Decatur County Lucas County Monroe County Ringgold County Wayne County Page County Story County Henry County Provider Cross Roads Mental Health Clarke County Hospital Clarinda Mental Health Institute Decatur County Hospital Lucas County Health Center Lucas County Hospital Monroe County Community Hospital Ringgold County Community Hospital Wayne County Hospital Clarinda Mental Health Institute Mary Greely Medical Center Mount Pleasant Mental Health Institute Mental Health Institutes / Hospitals Address 820 N. Main St. #1, Osceola, Iowa S. Fillmore St., Osceola, Iowa N. 16th St., Clarinda, Iowa NE 14th St, Leon, Iowa NW Church, Leon, Iowa N. 7th St., Chariton, Iowa N. 7th St., Chariton, Iowa NE 14th1 St, Leon, Iowa tfl St., Albia, Iowa Cleveland St., Mount Ayr, Iowa NE 14th St, Leon, Iowa S. East St., Corydon, Iowa N. 16lh St. #1, Clarinda, Iowa Duff Ave., Ames, IA E Washington St., Mount Pleasant, IA Phone (641) (641) (712) (641) (641) (641) (641) (641) (641) (641) (641) (641) (712) (515) (319) ***CROSS will honor other region(s) memorandums of understanding or contracts with mental health hospitals for emergency placement.

6 Scope of Services and Budget for FY 15 CROSS is in the development stage of standardization and regionalization. The FY 15 budget was developed at the local level with input and collaboration with stakeholders to assess need Additional funds were budgeted for development and decentralization of core and core plus services. As the funder of non-medicaid services, CROSS is the funding entity of last resort. CROSS recognizes the importance of individualized planning for services and supports to empower all individuals to reach their fullest potential. CROSS shall be responsible for funding only those services and supports that are authorized in accordance with the process described in the MH/DS Plan, within the constraints of budgeted dollars. CROSS shall be the funder of last resort and regional funds shall not replace other funding that is available. An individual who is eligible for other privately or publicly funded services and support must apply for and accept such funding and support and comply with requirements to remain eligible for such funding and support. Service Description Amount Other Possible Funding Assessment and evaluation The clinical review by a mental health professional of the current functioning of the individual using the service in regard to the individual's situation, needs, strengths, abilities, desires and goals to determine the appropriate level of care. $9,750 Basic Needs Case management (Targeted Case Management and Service Coordination) Includes meals on wheels, payment for room and board homes, personal needs allowances. Service provided by a case manager who assists individuals in gaining access to needed medical, social, educational, and other services through assessment, development of a care plan, referral, monitoring and follow-up using a strengths-based service approach that helps individuals achieve specific desired outcomes leading to a healthy self-reliance and interdependence with their community. $500 General Assistance, faith based social programs $47,609 Medicaid Chore Service for outside maintenance of home such as: window and door maintenance including hanging screens, replacing windowpanes and washing windows; minor repairs to walls, floors, stairs, railings and handles; heavy cleaning which includes attics or basements to remove fire hazards, moving heavy furniture, extensive wall washing, floor care or painting and trash removal; yard work such as mowing lawns, raking leaves and shoveling walks. $5,200 Volunteer programs in the community, SCICAP programs, Medicaid

7 Commitment Related (Evaluations, Sheriff Transport, Legal Representation, Mental Health Advocates Crisis evaluation Crisis Response Twenty-four hour Day habitation Court ordered services related to mental health commitments The process used with an individual to collect information related to the individual's history and needs, strengths, and abilities in order to determine appropriate services or referral during an acute crisis episode. Telephone crisis service-program that operates a crisis hotline either directly or through a contract. The service shall be available 24 hours a day and seven days a week including, but not limited to, relief of distress in pre-crisis situations, reduction of the risk of escalation, arrangements for emergency on-site responses when necessary, and referral of callers to appropriate services. Services that assist or support the individual in developing or maintaining life skills and community integration. Services shall enable or enhance the individual's functioning, physical and emotional health and development, language and communication development, cognitive functioning, socialization and community integration, functional skill development, behavior management, responsibility and selfdirection, daily living activities, self-advocacy skills, or mobility. $73,474 $24,650 $10,500 $61,300 Medicaid Family peer support Services provided by a family support peer specialist that assists the family of an individual to live successfully in the family or community including, but not limited to, education and information, individual advocacy, family support groups, and crisis response. $15,700 Medicaid Health homes A service model that facilitates access to an interdisciplinary array of medical care, behavioral health care, and community-based social services and supports for both children and adults with chronic conditions. Services may include comprehensive care management; care coordination and health promotion; comprehensive transitional care from inpatient to other settings, including appropriate follow-up; individual and family support, which includes authorized representatives; referral to community and social support services, if relevant; and the use of health information technology to link services, as feasible and appropriate. $24,209 Medicaid

8 Home and vehicle modification Home health aide services a service that provides physical modifications to the home or vehicle that directly address the medical health or remedial needs of the individual that are necessary to provide for the health, welfare, and safety of the member and to increase or maintain independence. Unskilled medical services which provide direct personal care. This service may include assistance with activities of daily living, such as helping the recipient to bathe, get in and out of bed, care for hair and teeth, exercise, and take medications specifically ordered by the physician. $33,930 Medicaid $9,850 Medicaid, PHN grants, Homemaker grants from AAA. Information and Referral Activities designed to provide facts about resources that are available and help to access those resources. $3,474 Job development Services that assist individuals in preparing for, securing and maintaining gainful, competitive employment. Employment shall be integrated into normalized work settings, shall provide pay of at least minimum wage, and shall be based on the individual's skills, preferences, abilities, and talents. Services assist individuals seeking employment to develop or reestablish skills, attitudes, personal characteristics, interpersonal skills, work behaviors, and functional capacities to achieve positive employment outcomes. $18,000 Medicaid Medication prescribing Mental health inpatient treatment commitment Mental health outpatient therapy Services with the individual present provided by an appropriately licensed professional as authorized by Iowa law including, but not limited to, determining how the medication is affecting the individual; determining any drug interactions or adverse drug effects on the individual; determining the proper dosage level; and prescribing medication for the individual for the period of time before the individual is seen again. Acute inpatient mental health services are 24-hour settings that provide services to individuals With Acute psychiatric conditions. Primary goal is to provide a comprehensive evaluation, rapidly stabilize acute symptoms; address health and safety needs and develop a comprehensive discharge plan to appropriate level of care. Services shall consist of evaluation and treatment services provided on an ambulatory basis for the target population including psychiatric evaluation, medication management and individual, family, and group therapy. $55,650 $789,466 $115,050 Medicaid Insurance Medicaid and Insurance Medicaid and Insurance 8

9 Peer support services Personal emergency response system A program provided by a peer support specialist including but not limited to education and information, individual advocacy, family support groups, crisis response, and respite to assist individuals in achieving stability in the community. An electronic device connected to a 24-hour staffed system which allows the individual to access assistance in the event of an emergency. $13,700 Medicaid $8,820 Medicaid Prescription Medicine Prevocational services Residential Care Facility Respite Services Prescription psychiatric medications for persons having a mental health diagnosis $3,050 Medicaid, Insurance, Drug company patient assistance programs, 340b pharmacies, and community assistance program. Services that focus on developing generalized skills that prepares an individual for employment. Prevocational training topics include but are not limited to attendance, safety skills, following directions, and staying on task. $47,268 Medicaid Licensed/Certified living arrangements approved by DIAorDHS. $418,490 Medicaid A temporary period of relief and support for individuals and their families provided in a variety of settings. The intent is to provide a safe environment with staff assistance for individuals who lack an adequate support system to address current issues related to a disability. Respite may be provided for a defined period of time; respite is either planned or provided in response to a crisis. $50,500 Medicaid Service Coordination Supported Community Living Services Supported Employment Activities designed to help individuals and families identify service needs and coordinate service delivery but which do not constitute case management as defined by the MH and ID Commission. Services provided in a non-institutional setting to adult persons with mental illness, mental retardation, or developmental disabilities to meet the persons' daily living needs. Helping individuals participate as much as possible in competitive work in integrated work settings that are consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals. Services are targeted for individuals with significant disabilities for whom competitive employment has not traditionally occurred; or for whom competitive employment has been interrupted or intermittent as a result of a significant disability including either individual or group supported employment, or both, consistent with evidence-based practice standards published by the Substance Abuse and Mental Health Services Administration. $66,712 $115,246 Medicaid $26,600 Medicaid

10 Transportation Transportation to day habilitation and vocational programs $47,655 Medicaid Work Activity/Sheltered Workshop Is for services provided by a facility carrying out a recognized program of rehabilitation, habilitation, or education for persons with disabilities. Designed to lead to competitive employment or provision of longterm, remunerative employment $159,076 Total Budget for Services Total Administration (Includes Direct Admin & Risk pool contribution) Direct Administration County Disbursement to MHDS Regional Risk Pool Funds Total Regional Budget $2,255,429 $389,895 $66,712 $55,389 $2,627,985 Financial Forecasting Historical service utilization is the starting point for all financial projections. However, recent changes in the system including transition to residency and Iowa Health and Wellness Plan have provided challenges to using historic data. Throughout the year CROSS staff, the regional advisory board and local stakeholders will identify unmet needs and areas for service development, and accounting for legislative action which will be incorporated into subsequent budgets. Provider Reimbursement Provisions Each service provider shall provide monthly billing invoices within 60 days of service provision, and other information requested of the provider for utilization review. The monthly billings shall include the following information: Name and unique identifier of each individual served during the reporting period. Dates of service. Number of units of service delivered to each individual served. When requested, attendance records. Unit rate and total cost of the units provided to each individual. Copayments or other charges billed to other sources shown as deductions on the billing. Actual amount to be charged to the Region for each individual for the period. CROSS staff shall review the billings and additional utilization information in comparison with service funding authorizations in place. Non-emergency services delivered without service funding authorization shall be deducted from the billing. All eligible bills shall be paid within 60 days of receipt of required documentation unless unforeseen circumstances exist. 10

11 No billings received more than 60 days after the close of the fiscal year in which the service was provided shall be considered for payment by CROSS unless there is a statutory obligation. Fiscal year for CROSS is July 1 -June 30. It is the intent of CROSS that only CROSS staff shall authorize services for residents of the CROSS region. Due to that, it is the policy of CROSS that if another county, region, or the State determines residency in error or approves services for persons who do not have residency in their region, CROSS may not assume retroactive payment. When written notification is received by CROSS of the error, CROSS staff shall authorize services according to the policies and procedures set forth in this manual. CROSS has identified the following providers currently contracting with the region. Additional providers may be added throughout the year as services are developed to meet the continuum of service needs of individuals. The CROSS region is in phase 3 of the establishment of Integrated Health Homes. At this time no Integrated Health Homes have been authorized in our region but two organizations have applied. Outpatient Mental Health Services Cross Roads Lucas County Health Center 302 NE 14 St, Leon, Iowa N. Main St. #1, Osceola, Iowa N. 7th St., Chariton, Iowa Mental Health Institutes and Hospitals Clarinda Mental Health Institute Mary Greeley Medical Center Mount Pleasant Mental Health Institute 1800 N. 16th ST., Clarinda, Iowa Duff Av e., Ames Iowa E Washington St., Mount Pleasant, IA Home Community Based Services MOSAIC -ID only Southern Iowa Resources for Families - Hab, Bl, and ID populations Crest Services 405 East Me Lane St., Osceola, Iowa W 1st St., Leon, Iowa 50144, 103 S. Lafayette St., Corydon, Iowa Brookdale, Chariton, Iowa

12 Residential Care Facilities Brees Rest Home New Venture 210 Washington Ave. E., Albia, Iowa S. Washington, Corydon, Iowa Employment Services MOSAIC Southern Iowa Resources for Families 405 East Me Lane St., Osceola, Iowa W 1st St., Leon, Iowa S. Lafayette St., Corydon, Iowa Crest Services Ringgold County Supportive Services Ragtime 1221 Brookdale, Chariton, Iowa S. Henderson Dr., Mount Ayr, Iowa North 2nd Street, Albia, Iowa