CHELAN-DOUGLAS RSN/PHP POLICY AND PROCEDURE MANUAL Title: INPATIENT PSYCHIATRIC SERVICES

Transcription

1 CHELAN-DOUGLAS RSN/PHP POLICY AND PROCEDURE MANUAL Title: INPATIENT PSYCHIATRIC SERVICES Subject: MANAGEMENT OF CHILDREN S LONG-TERM INPATIENT PROGRAM (CLIP) Chapter: 5.10 Page: 1 of 5 Date Effective: July 1, 2002 Date Revised: May 31, 2006 Authorizing Signature: AUTHORITY: SCOPE: PURPOSE: Guiding Principle(s): Consumer Focused, Accessible WAC , Definitions WAC , Access to Services This policy applies to Chelan-Douglas Regional Support Network/Prepaid Health Plan (CDRSN/PHP) and its contractors (agencies/providers), and subcontractors (referred to as contractors or agencies or providers throughout this policy). This policy directs CDRSN/PHP and its contractors to monitor and coordinate services to service recipients who are currently hospitalized for psychiatric reasons at a Children s Long-term Inpatient Program facility. DEFINITIONS: A. Child. A service recipient under the age of 22. POLICY: The CDRSN/PIHP provides resources management services to all children in CLIP facilities. These services comply with the written agreement between the CDRSN and the CLIP administration. These agreements are binding and direct the treatment process for children receiving treatment services at CLIP facilities. Chelan-Douglas Regional Support Network/Prepaid Health Plan designates the Provider Network Clinical Team as the referral mechanisms for Chelan and Douglas County residents seeking voluntary CLIP placements. Additionally, the Provider Network Clinical Team will serve as Chelan and Douglas County s agent to determine whether appropriate less restrictive services are available for adolescents hospitalized involuntarily. VOLUNTARY APPLICATION PROCEDURES 1. Child identified as needing long-term inpatient services in a CLIP program. The assigned CDRSN/PHP provider agency ensures assignment and active participation of a case manager to each consumer and family. 1

2 The Child and Family Team develops the Individualized and Tailored Plan of Care and assures the participation of the consumer, family members, case manager, therapist, medical personnel, and individuals active in assisting in services for the consumer. The CDRSN/PHP provider agency ensures all designated parties receive information necessary for community care and improvement to services for the child, participate in timely development and implementation, of services, appropriate discharge planning and effective reintegration mechanisms. The Child and Family Team reaches consensus as to the necessity of the possible CLIP referral and assessments, evaluations, and referrals indicate the appropriateness of the CLIP referral. 2. Referral is made to the Provider Network Clinical Team and Chelan-Douglas Regional Support Network/Prepaid Health Plan (CDRSN/PHP). Contact the CDRSN Clinical Director and request a date and time to present the CLIP referral to the Provider Network Clinical Team for consultation and determination that the requested CLIP placement is appropriate. If approved, the Provider Network Clinical Team prepares a written recommendation for referral to a CLIP program. Case Manager to contact CDRSN/PHP Clinical Directors at the CDRSN/PHP and advise them of the placement request, obtain the application packet, and arrange a professional staffing or family team meeting for the CLIP candidate. 3. If not approved for CLIP referral, a written response will be provided to the referral source specifying the reasons for denial and recommendations for alternative services. 4. If approved by the Provider Network Clinical Team and the CDRSN/PHP, the CDRSN/PHP Clinical Director contacts the CLIP Committee Coordinator to open the CLIP referral process in accord with CLIP Policies and Procedures. 5. The clinical supervisor/hospital liaison for the assigned CDRSN/PHP provider agency coordinates completion of the CLIP application packet and presents all requested information to Clinical Directors at the CDRSN/PHP. 6. The CDRSN/PHP provider gathers any additional information as recommended by the CDRSN/PHP Clinical Directors and/or the CLIP Committee Coordinator. 7. The designated CDRSN/PHP Clinical Director reviews, signs, and forwards the application packet to the CLIP Committee. 2

3 8. The CDRSN/PHP ensures that all required CLIP application materials are submitted to the CLIP Committee prior to CLIP Administration consideration of the application. 9. The CLIP Certification Team approves or denies medical necessity for admission based on CLIP Administration admission criteria. 10. If the Certification team denies admission, a written response will be provided by the CLIP Administration specifying reasons for denial and recommendations for alternative services. 11. The CDRSN/PHP Clinical Director serves as contact person to the CLIP Administration to coordinate all voluntary admissions. 12. Once approved, the individual s name is placed on the waiting list. The individual is assigned to the most appropriate CLIP program by the CLIP Administration in coordination with the child s parents, Child and Family Team, the case manager, and CDRSN/PHP Clinical Director. INVOLUNTARY APPLICATION PROCEDURES 1. For adolescents detained involuntarily in an acute psychiatric setting, the Provider Network Clinical Team will coordinate with the Evaluation and Treatment (E&T) facility and evaluate the potential for less restrictive services. If the adolescent is placed on a 180 Day Restrictive order, the CDRSN/PHP Clinical Director will ensure that a written formulation/recommendation and necessary treatment documents are submitted to the CLIP Administration. 2. The psychiatric hospital provides information, evaluations, diagnosis, case planning, interventions, and assessments as requested by the CLIP committee. 3. The adolescent s name is placed on the waiting list based upon the date of their 180 Day order. 4. The CLIP Placement Team, in coordination with the parents, the Child and Family Team, the CDRSN/PHP Clinical Director, and the E&T will assign the adolescent to the most appropriate CLIP facility. PLAN OF CARE AND DISCHARGE PLAN 1. At any point after a child has been assigned to a CLIP program, the designated facility case manager can begin to collaborate with the community case manager(s) and Child and Family Team regarding the individual s plan of care and the specifics of admission and discharge. 2. Develop, maintain, and document support services in place during the waiting period prior to placement. 3

4 3. Upon admission of a child to a CLIP program, the designated community case manager(s) and Child and Family Team and the facility case manager will formulate a discharge plan involving necessary community services and supports to include transitional services by the CLIP program promoting rapid and successful reintegration of the child back into the community, as agreed upon by all parties. 4. Develop and document family and professional contacts who will maintain contact and support services while the child resides in the CLIP facility. 5. Develop initial discharge plan and coordinate wrap-around services that will be developed prior to discharge and continue during aftercare placement. 6. Prior to discharge, the responsibility of each party for providing ongoing services shall be clearly identified. It is intended that all discharges from a CLIP program will be planned. In the event of unexpected discharge, the facility case manager will immediately notify the designated community case manager(s) and Child and Family Team and collaborate to formulate a revised discharge plan. LENGTH OF STAY MANAGEMENT 1. Once certified as in need of admission to a CLIP program, the individual, his/her family or legal guardian, and the community and program teams negotiate the expected length of stay. It is the ultimate responsibility of the medical director of each CLIP facility to authorize continued inpatient stay every 30 days. 2. Formal review of length of stay by the CLIP Administration occurs in accord with the CLIP Policies and Procedures (Appendix A). 3. If formal re-certification by the CLIP Administration is required, the CDRSN/PHP will ensure that required documentation and a new formulation/recommendation justifying continued stay is provided. NOTES It is very important that referents follow these procedures and the CDRSN/PHP receives complete applications. Incomplete applications will result in delays in the process. If questions arise, please call the CDRSN/PHP for information and clarification. SEE ALSO: Chapter 1.5.1, Mental Health Provider - Roles and Responsibilities 4

5 Chapter 1.7, Staff Qualifications and Mental Health Professional Waiver Request Chapter 1.8, Individually Tailored, Culturally Competent Services Chapter 1.9, Continuity of and Coordination of Care Chapter 2.2.1, Mental Health Assessment and Intake Evaluation Chapter 2.2.5, Special Populations Assessment and Ongoing Consultation Glossary of Terms and Acronyms 5