Collaborative Protocols Between Cenpatico of Arizona and. Arizona Department of Economic Security/Rehabilitation Services Administration (RSA)

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1 Cenpatico, as the Regional Behavioral Health Authority (RBHA) for Geographic Services Areas Two, Three and Four, and Rehabilitation Services Administration (RSA) Districts Four, Five and Six, agree to coordinate care to improve vocational rehabilitation service delivery for individuals who are diagnosed with a serious mental illness. This collaboration embraces the best practices of rehabilitation service delivery, ensures a cooperative team approach to enhance the quality of service delivery and creates a seamless system of care for the mutual clients we serve. This cooperative relationship was established initially through an Intergovernmental Agreement between RSA and the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS). The roles and responsibilities of Cenpatico and RSA are outlined in this document. Through an ongoing partnership and enhanced collaboration between Cenpatico, RSA, community rehabilitation providers, employers, and members, it is believed that individuals with a serious mental illness will realize their capability for recovery and move toward productive, independent lives within their communities. General Roles and Responsibilities of Cenpatico Employment and Rehabilitation Specialist and RSA-VR Counselors: Cenpatico Responsibilities RSA Responsibilities Educate provider agencies regarding vocational rehabilitation services. Providers are educated as needed via Monthly Provider Calls. Other educational opportunities may also occur via on-site training, Quarterly Vocational Task Force Meetings and Monthly Provider CEO meetings, etc. Ensure Comprehensive Service Providers are appropriately staffed as necessary, based on community need. Ensure providers identify and appropriately refer members who may benefit from vocational rehabilitation services. Employment Coordinator/Provider Clinical Staff is expected to involve the VR Counselor in the member s Individualized Service Plan (ISP) when the member has expressed a desire to work. Ensure that each member has an ISP that is centered on their employment and rehabilitation needs. Vocational choices, which may include any type of meaningful activity (whether directly targeted at paid employment acquisition or not) and plans to support those choices should be included in the ISP. The VR Counselor will act as an employment consultant to the clinical teams at the provider sites. Collaborative Protocols between Cenpatico & RSA Page 1 of 11 RSA orientations will be conducted at behavioral health provider sites at a minimum of one time per month, or as needed. Work with the member and clinical team to assist in developing career and/or employment goals that are a part of an active treatment planning process. The Individualized Plan for Employment (IPE) is developed with the input of the team consisting of the Adult Recovery Team, but not limited to :( member, family member, friends, Peer Support RSA Counselor, and Employment Coordinator/Clinical Team Representative from the provider agency). Coordinate with Cenpatico, and appropriate Tribal entities/agencies to ensure Native American members receive appropriate and beneficial VR services based on individual needs and services. RSA District Program Manager collaborates with the Cenpatico Rehabilitation and Employment Specialist to ensure that members and providers are aware of services available under RSA (Supported

2 Collaborative Protocols Between Cenpatico of Arizona and Coordinate with RSA, and appropriate Tribal entities/agencies to ensure Native American members receive appropriate and beneficial VR services based on individual needs and eligible services. Ensure providers facilitate, track, and follow-up on referrals to RSA for vocational rehabilitation services. The Rehabilitation and Employment Specialist will work with Cenpatico Provider staff and Employment Coordinators to educate and assist providers with operations and requirements relative to facilitating supported employment (SE) and extended supported employment services (ESE). Track ESE services on a database. Works in conjunction with Cenpatico training staff to develop and enhance training efforts for providers, Peer Support and Cenpatico staff, regarding RSA services, as well as ESE and SE services. Ensures that provider staff, as well as internal Cenpatico staff, receive training on the Cenpatico and RSA Collaborative Protocols and that the link to the protocols are available through the Cenpatico website. Ensures that all training remains focused on Cenpatico s vision of voice, choice, and member driven services. Collaborates with Cenpatico staff, RSA, Provider Employment Coordinators and provider staff to increase community awareness of the value of work and its relationship to recovery. Team trainings may occur on a quarterly and annual basis, or more often if necessary. Collaborates with identified Employment Coordinators/Clinical members to ensure monthly consultations with the VR Counselor regarding progress of program participants ; updates shall be documented in the Collaborative Protocols between Cenpatico & RSA Page 2 of 11 Employment, Extended Supported Employment, Counseling, etc.). Works with the Cenpatico Rehabilitation and Employment Specialist and Provider Employment Coordinators to increase community awareness of the value of work and its relationship to recovery. Works with the Cenpatico Rehabilitation and Employment Specialist to ensure that system issues are communicated in a manner that facilitates efficient problem-solving action to take place at the appropriate levels. The RSA staff can assist with the following services and/or activities after an individual is determined to be eligible for services: Vocational counseling and guidance Career exploration, vocational assessments, job planning Work exploration and work adjustment activities Referral services for available community services or supports Specific job training, development, and preparation Supported employment Post-employment services Transportation assistance (as appropriate) Assistive technology Interpreter services College or vocational school assistance with a related goal Supported education Ancillary services (e.g. occupational licenses, tools, equipment, and supplies) as necessary to reach vocational goals ** Some of the above services may be available through other agencies and/or resources and would therefore need to be obtained or exhausted through those sources (e.g. adaptive aids, such as wheelchairs, through Medicare or an AHCCCS Health Plan). RSA refers to these services as comparable benefits.

3 medical record. Audits provider medical records to ensure that persons diagnosed with a serious mental illness, who are potentially eligible and expressed their desire to work in their Individualized Service Plan (ISP), are referred to the VR program. If verification is needed to determine SMI status, Cenpatico s Customer Service phone number can be called at: for verification. The Rehabilitation and Employment Specialist will perform the following functions and activities: Enhance and increase available Rehabilitation and Vocational services with an emphasis on the delivery of pre-job training and development (H2027)and ongoing support (H2025) Ensure Demographic Employment Status Values are accurate Identification of system issues Assist in removing unnecessary RBHA-associated barriers during the eligibility process with RSA Contact providers to resolve problems Identify and resolve network and/or service gaps Increase understanding and awareness, within the member and behavioral health provider communities, of the value of work as a significant aspect of recovery of individuals with a serious mental illness. Ongoing education of providers Streamline systems and procedures Completion and distribution of ESE forms Attending IGA and RSA meetings and trainings as they occur Sharing information with providers related to RSA meetings and trainings Communication and Relationship between Rehabilitation and Employment Specialist/Provider Agency/ RSA/VR Staff Cenpatico Responsibilities RSA Responsibilities Meets quarterly with the Provider Employment Coordinators and RSA staff (by district) regarding system issues and improvements, service RSA staff (by district) will meet quarterly with the Cenpatico Rehabilitation and Employment Specialist regarding system issues and Collaborative Protocols between Cenpatico & RSA Page 3 of 11

4 delivery, network needs, joint training needs and results of relevant data analysis on member employment activities. The Rehabilitation and Employment Specialist will respond to and disseminate ESE forms, as needed. Receives member communication/activity forms from RSA and will disseminate to providers to place in members medical record. Is the point of contact regarding the name of the Clinical Director, the provider agency delivering the services and the initial verification of SMI status. improvements, service delivery, joint training needs, and results of relevant data analysis on member employment activities. Forward ESE forms to Cenpatico Rehabilitation and Employment Specialist for a signature. Upon request form the provider agency, VR Counselor are responsible for providing recommendations for open eligible and active VR clients to be incorporated into the Individual Service Plan (ISP) and coordination of care. Participation can be face-to- face or via the telephone. Follow up with providers regarding the member s successful engagement in services (e.g. work adjustment training, supported employment, job development, vocational or educational training). VR Counselor will meet with Provider Employment Coordinators/ Clinical staff on a monthly basis to discuss current caseload and progress for each shared member. Collaborative Protocols between Cenpatico & RSA Page 4 of 11

5 Cenpatico/Provider Documentation Documentation from Provider Employment Coordinator will include, but is not limited to: RBHA/RSA Vocational Rehabilitation Referral Any assessment information Pertinent Information (sent to VR Counselor) *Pertinent information includes: member issues that may impact their VR program, (i.e. hospitalization, incarcerations, relapse, re-locations, etc.) Note: Any pertinent information shared at a Clinical Staffing or a face-to-face meeting, the Provider Employment Coordinator must document the information in the medical record. RSA Documentation Documentation from the VR Counselor will include, but is not limited to: Eligibility Letter with Order of Selection priority category Individualized Plan for Employment (IPE) Closure information (Closure letter and Closure Form) - Pertinent Information (sent to the Employment Coordinator/Clinical Team) *Pertinent information includes: any recent change which may impact participation in the VR program. (i.e. obtained employment, loss of employment, loss of contact, graduation, etc.). These changes can be discussed at a clinical meeting but must also be submitted in written documentation for the medical record. Co-location of services and a one-stop service delivery are vital to the success of the program and the success of the individuals served. A VR Counselor must be assigned to each Cenpatico Intake and Care Coordination Agency (intake agency). Functional workspace includes a private area for the VR Counselor to meet with members, access to a phone and access to a computer. Providers will provide an appropriate work space at their clinics to accommodate both the VR Counselor and member. The workspace will be on-site and will be fully functional as described above. The VR Counselor will be assigned to each RBHA intake agency/clinical program site. The VR Counselor must visit the clinical program site a minimum of one day per month. The VR Counselor may provide an orientation, conduct intakes, discuss services available and consult with the provider Employment Coordinator and Clinical Team. A Rehabilitation Technician can conduct the orientations and provide other information and services on behalf of the VRC. Referral for VR Services Cenpatico Responsibilities / Provider Agency: Provider Employment Coordinator orients members regarding vocational rehabilitation services. Group Vocational Rehabilitation (VR) Orientations will be held at the Provider site a minimum of one time per month and at least one RSA Responsibilities Upon receipt of the referral packet, the VR Counselor has 7 business days to make initial contact to schedule an intake appointment. At the intake appointment, the VR application will be completed and signed. Collaborative Protocols between Cenpatico & RSA Page 5 of 11

6 Provider staff must be present. Additional VR Orientations are available at the local RSA/VR office. If the member cannot attend the group Orientation, or a group setting is not appropriate for the member, an individual 1:1 Orientation will be scheduled. After attending the VR Orientation, if the member chooses to apply for VR services, the member will then be assigned to a VR Counselor. The VR Counselor will then request a referral packet. The Provider staff/ Employment Coordinator will insure that the referral packet is delivered to the VR Counselor within 7 business days. The referral packet should include: Current RBHA/RSA Vocational Rehabilitation Referral Form Documentation of SMI determination and diagnosis with physician s signature (i.e. clinical summary) Most recent Psychological/Psychiatric Evaluation Current Individual Service Plan (ISP will reflect employment goal or pre-vocational interest) Comprehensive Assessments-Part E of ISP At Risk Crisis Plan (ARCP) Current Medication Sheet Recent progress notes/adult Recovery Team note (ART note should reflect services related to vocational services/employment services) The VR Counselor will use the Referral Packet and other necessary information to determine eligibility. VR eligibility should be determined within 30 days of a signed VR application and the member will receive a letter confirming the eligibility decision. The member and the Employment Coordinator at the provider agency will be notified of the eligibility decision by a letter, with a copy forwarded to the clinical team. Meetings are then scheduled to work on development of vocational goal(s). Develop an IPE to include services necessary to reach the vocational goal. Seek input from the Employment Coordinator and/or clinical team when developing the IPE. RSA/VR staff will complete the VR Coordination of Extended Supported Employment form (Part I) and obtain a signature from Cenpatico Rehabilitation and Employment Specialist to ensure funding for Extended Supported Employment (ESE) prior to implementing an Individualized Plan for Employment (IPE). Conduct a periodic review of each member s progress. The VR Counselor will consult with the provider s Employment Coordinator/Clinical staff to discuss the progress of program participants. Any updates should be documented in writing accordingly. After the member gains employment, SE services (Job coaching) are provided by and funded by VR. Collaborative Protocols between Cenpatico & RSA Page 6 of 11 All members shall be offered ESE services throughout the rehabilitation process by both RSA/VR and Provider staff. Once a member has been working in a job, is considered to be stable on the job, needs and chooses

7 ongoing support to maintain the employment, a Status 22 meeting is scheduled by the VR Counselor. The Status 22 meeting needs to occur to transfer the funding source from RSA/VR to the RBHA, after which ESE services start. At a minimum, the member, VR Counselor, Job Coach, and a Provider Vocational staff must be present, but the member may also invite anyone else they desire to be present. At the Status 22 meeting, Part II of the VR Coordination of Extended Supported Employment form is to be completed by the VR Counselor and signed by all parties. If the member chooses not to accept the ongoing support to maintain the employment, no Status 22 meeting is necessary. Provide post-employment services up until one year after successful closure. Information Sharing Verbal or non-electronic information may be exchanged between Cenpatico and DES/RSA without a release of information due to the nature of the relationship between Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) and Arizona Department of Economic Security/Rehabilitation Services Administration (ADES/RSA). A signed release of information/consent is not needed due to the Business Associate Agreement between ADHS/DBHS and ADES/RSA. Information exchanges should occur freely in regards to Referral packets, discussion of potential members, and those already active in the VR program. For purposes of the IGA and in compliance with 45-CFR, Parts ADES/RSA shall be a HIPPA Business Associate for the organized healthcare arrangement comprising the Arizona Department of Health Services (ADHS) Division of Behavioral Health (DBHS) and the Tribal/Regional Behavioral Health authorities (T/RBHA) for purposes of sharing mutual client information as authorized by the Agreement. ADES/RSA, as the Business Associate of the T/RBHAs, will not need a signed authorization for release of information from the client before obtaining a referral packet from the T/RBHA. ADES/RSA will conform to all requirements inherent in that designation. Protected health information to be disclosed will be the minimum necessary as needed for the purposes of the IGA. ADES and ADHS shall comply with the provisions of Arizona Administrative Code R Covered entities may disclose protected health information to persons that meet the rule s definition of business associate. or hire such persons to obtain or create protected health information for them, only if covered entities obtain specified satisfactory assurances from the business associates that it will appropriately handle the information; the regulation specifies the elements of such satisfactory assurances; covered entities have responsibilities when such specified satisfactory Collaborative Protocols between Cenpatico & RSA Page 7 of 11

8 assurances are violated by the business associates A covered entity may disclose protected health information to a business associate, as necessary to permit the business associate to perform functions and activities for or on behalf of the covered entity, or to provide the service specified in the business associate definition to or for the covered entity: (45-CFR, Section e) 2 Sharing client information in direct administration of VR program: VR counselor may release client information of which we are either primary or secondary source (without separate written authorization) to other individuals or agencies in the direct administration of a client s rehabilitation program as long as only necessary information is shared and that in the counselor s judgment, recipient can and will handle information in confidential manner. Consent for this release is given by the client when he/she sings an application for services. (Arizona Administrative Code R ) Issue Resolution and Appeals Should issues arise for a member, relative to the functioning of the Adult Recovery Team, the member may contact Cenpatico s Customer Service Department to file a complaint. If issue is related specifically to services within RSA, the member should be referred to their RSA Counselor. If a complaint cannot be resolved by the Customer Service Department, Cenpatico s Member Advisor and/or Rehabilitation and Employment Specialist may become involved in the issue resolution. The member has the right to file a grievance or an appeal and may receive assistance, if necessary. The Cenpatico Rehabilitation and Employment Specialist is available to assist RSA staff with cross-system or provider issues that arise. Should issues not be resolved at the level of the provider or the RBHA, then the issue may be forwarded to ADES/RSA and ADHS/DBHS Statewide Coordinators. When a potentially unfavorable decision is made, RSA will provide documents and information relative to the complaint/appeal process. Letters/documents relevant to the complaint/appeal process include the Request for Review of Counselor Determination Form, Information Regarding Requests for Review of Counselor Determinations, and Client Assistance Program. The member may choose whichever process works best for them as outlined in these documents. The goal is to resolve the complaint locally, and at the lowest possible level. RSA s Ombudsman may assist the member as warranted or requested in the filing of the grievance or appeal. RSA staff will be available to assist the Cenpatico Interagency Liaison with cross-systems issues or provider issues that arise. Should issues not be resolved at the level of the provider or RBHA, the issue may be forwarded to the ADES/RSA and ADHS/DBHS Statewide Coordinators. Members may contact the Center for Disability Law at any stage of the process. Collaborative Protocols between Cenpatico & RSA Page 8 of 11

9 Cenpatico/RSA Vocational Triad H2027 Psychoeducational Services (Pre-Job Training and Development): Services which prepare a person to engage in meaningful work-related activities may include: career/educational counseling, job shadowing, assistance in the use of educational resources, training in resume preparation, job interview skills, study skills, work activities, professional decorum and dress, time management, and assistance in finding employment Cenpatico provides these services Coordination of funding should be discussed and determined at the team meeting involving RSA and the individual s Employment Coordinator, Recovery Coach with the behavioral health provider agency. Consultation will provided by Cenpatico Rehabilitation/Employment Specialist, as needed. RSA Vocational Rehabilitation Services: Work internship exploration, education and training (may include vocational, post secondary, GED, etc.), counseling and guidance, assessments, evaluations, restoration services, rehabilitation technology, and ancillary supplies. As necessary to fulfill vocational goals, On-the-Job Training, referral assistance for support services, work adjustment, supportive employment, job development and placement assistance, and post-employment services are offered. Both RSA and RBHA can provide Support Services: Psychoeducational Service (Pre-Job Training and Development) and Ongoing Support to Maintain Employment (Job Coaching and Employment Support). H2025 Ongoing Support to Maintain Employment: Support services that enable a person to complete job training or maintain employment. May include monitoring and supervision, assistance in performing job tasks, work-adjustment, training, and supportive counseling. RSA provides these services consistent with the person s individual needs and until job stability is achieved. If a member has identified a continued need for support, the funding of this support will change to Cenpatico for ongoing supports. Coordination of funding should be discussed and determined at a team meeting involving RSA and the member s Employment Coordinator/Clinical Liaison or Recovery Coach with the behavioral health provider agency. Consultation will be provided by Cenpatico Rehabilitation/Employment Specialist, as needed. Collaborative Protocols between Cenpatico & RSA Page 9 of 11

10 Contact Information: Cenpatico (Yuma/La Paz)--Geographic Service Area 2 Cenpatico of Arizona 1501 W. Fountainhead Parkway Suite 360 Tempe, AZ Phone: Fax: Anthony Carrillo, Rehabilitation and Employment Specialist Office: ext Cell: (480) RSA (Yuma/La Paz) District IV Sharon Mikrut, RSA Region II Program Manager (Yuma) 400 W. Congress, Suite 420 Tucson, AZ Phone: , x217 Mike Scione, RSA Region I Program Manager (La Paz) 3221 N 16 th Street, Suite 200 Phoenix, AZ Phone: Andrea Benkendorf, Statewide Behavioral Health Coordinator Rehabilitation Services Administration 1789 W. Jefferson, 2NW Phoenix, AZ Cenpatico (Cochise, Graham, Greenlee, Santa Cruz)-Geographic Service Area 3 Cenpatico of Arizona 1501 W. Fountainhead Parkway Suite 360 Tempe, AZ Phone: Fax: RSA (Cochise, Graham, Greenlee, Santa Cruz) District VI Sharon Mikrut, RSA Region II Program Manager 400 W. Congress, Suite 420 Tucson, AZ Phone: , x217 Anthony Carrillo, Rehabilitation and Employment Specialist Office: ext Andrea Benkendorf, Statewide Behavioral Health Coordinator Rehabilitation Services Administration Collaborative Protocols between Cenpatico & RSA Page 10 of 11

11 Cell: (480) W. Jefferson, 2NW Phoenix, AZ Cenpatico (Pinal/Gila)--Geographic Service Area 4 Cenpatico of Arizona 1501 W. Fountainhead Parkway Suite360; Tempe, AZ Phone: Fax: Anthony Carrillo, Rehabilitation and Employment Specialist Office: ext Cell: (480) RSA (Pinal/Gila) District V Sharon Mikrut, RSA Region II Program Manager (Casa Grande and Coolidge) 400 W. Congress, Suite 420 Tucson, AZ Phone: , ext.217 Mike Scione, RSA Region I Program Manager (Apache Junction, Globe, Payson) 3221 N 16 th Street, Suite 200 Phoenix, AZ Phone: Andrea Benkendorf, Statewide Behavioral Health Coordinator Rehabilitation Services Administration 1789 W. Jefferson, 2NW Phoenix, AZ Collaborative Protocols between Cenpatico & RSA Page 11 of 11