Maricopa County. Family Member Guide. Magellan Member Services Magellan Health Services of Arizona, Inc.

Transcription

1 Maricopa County Family Member Guide Magellan Member Services Magellan Health Services of Arizona, Inc. 17

2 Table of Contents Family Member Guide Where and How to Access Behavioral Health Services Emergency or Crisis Services Description of Covered Behavioral Health Services Available Behavioral Health Services Services Provided by Indian Health Services or Tribal facilities About Provider Network Organizations Children s PNOs Adult PNOs Family members role in assessment, treatment, and support for behavioral health recipients with an emphasis on recovery, resiliency, and illness self-management Information on Treatment of Behavioral Health Conditions Adults Children and youth Principles of Recovery, Resilience, and Cultural Competency as well as Arizona System Principles Designated Representatives Limitations on Involvement of Family Members of Adult Service Recipients Important Phone Numbers and Hours of Operation How to Identify and Contact a Behavioral Health Recipient s Clinical Liaison and or Case Manager

3 Family Member Guide This guide is being made available to family members, guardians, and friends of people who are in need of or receive behavioral health services. Behavioral health services help people think, feel, and act in healthy ways. There are services for mental health problems and services for substance abuse. 2

4 Where and How to Access Behavioral Health Services For life-threatening situations, always call 911. For non-life threatening behavioral health situations, call: The provider, therapist, clinical liaison or case manager who serves your family member or friend; The Behavioral Health Crisis Line toll-free at , locally at or our crisis line for the hearingimpaired at They will review your family member s situation and help you get the best possible solution for the specific behavioral health need, or Magellan may refer you to a Maricopa County Service Provider. Transportation for a behavioral health emergency may be available by contacting the Behavioral Health Crisis Line toll-free at , locally at or our crisis line number for the hearing-impaired at Your relative or friend may need behavioral health services while away from home and out of Magellan s service area. This is called out-of-area care. Out-of-area care only includes emergency behavioral health services unless Magellan approves additional services. If your friend or relative wants to get non-emergency behavioral health services out of Magellan s service area, please call Magellan Member Services at or our member services phone line for the hearing-impaired at If your family member needs out of area care: Go to a hospital or crisis center and ask for help; Ask the hospital or crisis center to call Magellan Member Services at or our TTY number at ; The hospital or crisis center will contact Magellan for approval to continue behavioral health services.

5 Emergency or Crisis Services: Emergency services do not require pre-approval. Service recipients can choose any hospital or other setting for emergency care. However, there are certain emergency settings within the Magellan network that may be easier for you, your family member or your friend to use. These include: Urgent Care Central Psychiatric Care Center 903 N. 2nd Street Phoenix, AZ META Psychiatric Recovery Center (West) North 99th Avenue, Suite 402 Peoria, AZ , then press 2 St. Luke s Behavioral Health Center 1800 E. Van Buren St. Phoenix., AZ

6 Description of Covered Behavioral Health Services: Behavioral health services help people think, feel and act in healthy ways. There are services for mental health problems and there are services for substance abuse. Your friend or family member can get services based on three things: His or her need; His or her insurance; His or her provider s approval. All services are not available to all members. If you would like to see the guidelines that are used to determine admission, continued stay, and discharge, contact Magellan Member Services at or our TTY line at Adult service recipients, (along with their designated representatives if they have one), decide with their clinical team what services they need. Family members or guardians of children and youth also actively participate on the child and family team and are full participants in clinical decision making to determine what services are needed. The provider or clinical team may ask Magellan for approval of a service for your family member or friend, but the approval may be denied. If a request for services is denied, you can file an appeal. For more information on filing an appeal, you call Magellan Member Services at Your friend or family member may not agree with his or her provider about the type or quantity of services that are needed. If you feel that someone you care about needs a service, and their provider does not agree, contact Magellan Member Services at or our Member Services line for the hearing-impaired at The table (below/on the next page) lists the available behavioral health services and any limits they may have. Magellan must pay only for the available behavioral health services listed.

7 Available Behavioral Health Services Arizona Department of Health Services, Division of Behavioral Health Magellan Health Services of Arizona, Inc. Services TREATMENT SERVICES Behavioral Health Counseling and Therapy Behavioral Health Screening, Mental Health Assessment and Specialized Testing Other Professional Individual Group Family Behavioral Health Screening Mental Health Assessment Specialized Testing Traditional Healing Auricular Acupuncture REHABILITATION SERVICES Individual Skills Training and Development Group Extended Cognitive Rehabilitation Behavioral Health Prevention/Promotion Education Psycho Educational Services Psycho Educational Services and Ongoing Support to maintain employment Ongoing Support to maintain employment MEDICAL SERVICES Medication Services** Lab, Radiology and Medical Imaging Medical Management Electro-Convulsive Therapy SUPPORT SERVICES Case Management Personal Care Home Care Training (Family)

8 Title XIX/XXI Children And Adults Seriously Mentally Ill Adults (Regardless of Title XIX Eligibility) Non-title XIX/XXI Children and Adults, Non-seriously Mentally Ill Adults Available Available Provided per contract Not Available with TXIX/XXI funding* Not Available with TXIX/XXI funding* Available Available Provided based on available funding Provided based on available funding

9 Services SUPPORT SERVICES continued Self-help/Peer Services Therapeutic Foster Care Unskilled Respite Care*** Supported Housing Sign Language or Oral Interpretive Services Flex Fund Services Transportation CRISIS INTERVENTION SERVICES Crisis Intervention Mobile Crisis Intervention Telephone Crisis Services Stabilization INPATIENT SERVICES Hospital Sub-acute Facility RESIDENTIAL SERVICES Residential Treatment Center Behavioral Health Residential Facilities Emergency Non-emergency Level I/ IMD**** Level II Level III Room and Board BEHAVIORAL HEALTH DAY PROGRAMS Supervised Day Therapeutic Day Medical Day Limitations: * Services not available with TXIX/XXI funding, but may be provided if state funding is available ** Medication services are available to TXIX/XXI recipients and recipients who are receiving services as a person with Serious Mental Illness.

10 Title XIX/XXI Children And Adults Seriously Mentally Ill Adults (Regardless of Title XIX Eligibility) Non-title XIX/XXI Children and Adults, Non-seriously Mentally Ill Adults Not Available with TXIX/XXI funding* Provided free of charge Not Available with TXIX/XXI funding* Not Available with TXIX/XXI funding* Provided free of charge Not Available with TXIX/XXI funding* Provided based on available funding Provided based on available funding Provided based on available funding Not Available with TXIX/XXI funding* Not Available with TXIX/XXI funding* Provided based on available funding *** Unskilled Respite Care No more than 30 days or 720 hours of unskilled respite care per contract year (July 1st June 30th) per person **** Institutions for Mental Diseases (IMD) For Title XIX members age 21-64, only 30 days per admission and 60 days per contract year (July 1st June 30th)

11 Services Provided by Indian Health Services or Tribal Facilities The Arizona Department of Health Services (ADHS) does not pay for behavioral health services covered through an Indian Health Service (IHS) or a 638 tribal facility for Native American Title XIX or Title XXI members. The Arizona Health Care Cost Containment System (AHCCCS) is responsible for these payments. A 638 tribal facility means a facility owned and operated by a Native American tribe authorized to provide services according to Public Law ADHS is responsible for payment: For behavioral health services not covered through an IHS or 638 tribal facility; For behavioral health recipients referred off reservation from an IHS or 638 tribal facility; For emergency services rendered at a non-ihs or non-638 tribal facility to Native American behavioral health recipients. About Provider Network Organizations The Provider Network Organizations offer the full array of covered behavioral health services throughout Maricopa County. Case management services for persons with a serious mental illness and children with complex needs will be provided by the Provider Network Organizations. The Provider Network Organizations are the first to respond to enrolled persons experiencing a behavioral health crisis. Children s PNOs Beginning September 1, 2007, all children and youth service recipients will be assigned to a PNO. Service recipients in children s PNOs will receive services through their PNO starting in September. 10 Children s PNOs: Southwest Network, Inc. (SWN) Quality Care Network (QCN) The People of Color Network (PCN)

12 Adult PNOs: There are two adults Provider Network organizations. Magellan will hold contracts with adult PNOs starting in September, but the adult PNOs will not begin managing services for adult service recipients until January Family members role in assessment, treatment, and support for behavioral health recipients with an emphasis on recovery, resiliency, and illness self-management The lived experiences of children and youth, adult recipients and their families are unparalleled. People who have undergone these experiences best know the challenges and tensions they have encountered when trying to access services and supports through their interactions with various systems. They also often know what could help their friend or family member to be successful at home, in school, at work and to flourish in their communities. As a result of their lived experiences, they can use the knowledge and skills they gain to better participate in planning their own services and supports. These same skills and information are also vital for them to be able to help their peers find community resources, navigate disjointed or hard-to-access services, discover new ways to be involved in making decisions, and join one another in transforming the way behavioral health care is delivered. Effective parent, family, and service recipient involvement is essential to ensuring that all aspects of RBHA service design, delivery and evaluation are shaped to reflect the life experiences of youth and their families and adult service recipients and families. We look forward to supporting the effective involvement of parents, service recipients and their friends and families. They are a unique resource for the system and can provide reality-based, culturally relevant information from a perspective that no one else has! 11

13 Information on treatment of behavioral health conditions Adults Mental illnesses and substance use conditions can disrupt a person s thinking, feeling, mood, ability to relate to others, and daily functioning. Mental illnesses and substance use conditions, if left untreated, can result in a diminished capacity for coping with the ordinary demands of life. Mental illnesses and substance use conditions affect people of all ages, race, religions, and incomes. However, there are many ways that people with mental illnesses and/or substance use conditions can achieve health, wellness, and lives filled with meaning and purpose. In addition to medications, outpatient therapy, and peer support groups, other community services can be components of a person s personal plan for achieving wellness. The availability of transportation, diet, exercise, sleep, friends, family, and meaningful paid or volunteer activities also contribute to overall health and wellness. Children and youth Children and adolescents can suffer from emotional and mental disorders that can cause them to have difficulties in their day-to-day lives at home, in school, and with their peers. If left untreated, these disorders can lead to youth suicide, school failure, and involvement with the juvenile justice and criminal justice systems. Parents and guardians play an important role in both identifying symptoms of childhood mental and emotional disorders and in providing support for their children. It is important that parents and guardians are actively involved and engaged in the treatment process of their children. Parents and guardians should help shape decisions related to what will be best for their specific family situation in order to achieve the best outcomes for their child and family. Principles of recovery, resilience, and cultural competency as well as Arizona System Principles Resiliency, recovery, and cultural competency are the hallmarks of Magellan s programs and services. Resiliency: All people have qualities that enable them to rebound from adversity, trauma, tragedy, or other stresses and to go on with life with a sense of mastery, competency, and hope. Recovery: All people living with behavioral health conditions have the capacity to learn, grow, and change, and can achieve a life filled with meaning and purpose. 12

14 Cultural competence: We provide care and services that recognize the diverse backgrounds of the individuals and families we serve. Our strategies acknowledge and respect the behavior, ideas, attitudes, values, beliefs, motivations, customs, language, rituals, ceremonies, and practices of an individual or group of people. We believe that every individual and family has the ability to learn and grow. We support a philosophy of wellness that focuses on personal strengths, building hope and offering choices. Our focus on resiliency, recovery, and cultural competency means that we help individuals and families achieve: A sense of belonging A safe place to live Days filled with purpose Skills to achieve wellness A strong voice in our own lives Hope and confidence in ourselves and our future The following expectations shape the ways that programs and staff should involve service recipients and their families in their care and treatment: Demonstrate appreciation for the individuals and families we serve. Respect culture and language and communicate effectively. Discover and support the strengths, skills, and attributes of others. Think holistically about all areas of people s lives their physical health, mental health, addictions, culture, ethnicity, education, language, work, social relationships, housing status, spirituality, etc. Focus on the recipients self-determined readiness. Offer meaningful choices. Optimize peer and family supports as well as natural supports. Promote self-confidence in others. Celebrate and share stories of success, especially those that foster hope and empowerment. Measure, monitor, and improve. Create opportunities for service recipients and their families to play major roles in planning, delivering, and evaluating services. Model these principles in our actions, language, and decisions. Arizona System Principles Magellan s approach to care and services for RBHA service recipients is also consistent with and supports the six Arizona System Principles for Delivery of Behavioral Health Services: Easy access to care Behavioral health recipient and family member involvement Collaboration with the greater community Effective innovation Expectation for improvement Cultural competency 13

15 Designated Representatives If your adult family member or friend has been determined to have a serious mental illness, he or she has the right to have a designated representative to assist with the protection of his or her rights. It is important for people with behavioral health conditions to enjoy full protection of their rights, regardless of their age or their living situation. In stressful times, it is often peers and families who initially take on an advocacy role in both formal and informal ways. Advocating for equity, fairness and justice for people you care about can become overwhelming and may lead to frustration and burn out. Whether participating in the development of an individualized plan for education, ensuring appropriate treatment in a residential or criminal justice setting, or engaging in a grievance process, you need current and valid information. In addition, it is important to know where to reach out for additional help. What is a designated representative? A designated representative may be a parent, a guardian, a friend, a peer advocate, a relative, a human rights advocate, a member of a Human Rights Committee, an advocate from the State Protection and Advocacy system or any other person who may help protect rights and voice service needs. When can a designated representative help me? Individuals with serious mental illness have the right to have a designated representative to help protect rights and voice service needs during any meetings about the individual s Service Plan, Inpatient Treatment, or Discharge Plan. The designated representative must also receive written notice of the time, date and location of Service Plan, Inpatient Treatment Plan, and Discharge Plan meetings. And, the designated representative must be invited to the Individual Treatment and Discharge Plan meetings. Individuals with a serious mental illness have the right to have a designated representative assist in filing an appeal of the treatment decisions identified in their Service Plan, Inpatient Treatment and Discharge Plan. The designated representative may also attend the informal conferences or administrative hearings in order to protect rights and voice service needs. A designated representative can also assist in filing a grievance. A designated representative may also go to the meeting with the investigator, the informal conference, or an administrative hearing to protect rights and voice service needs. 14

16 If you have questions about designated representatives, call Magellan Member Services at or our TTY line at , or the ADHS/ DBHS Office of Human Rights at or Limitations on involvement of family members of adult service recipients Occasionally, adult service recipients may not want to share information with their family members. For example, they may not want their treatment team to share their personal health information with their family members. If the service recipient has indicated to the treatment team not to share information with you, then the treatment team must honor that request. However, you can always share your observations and insights about your family member with his or her treatment team. In Arizona, the age of consent for behavioral health treatment is 18 years old. The age of consent of substance use treatment is also 18 years old. 15

17 Important phone numbers and hours of operation Organization Phone Number Hours of Operation Emergency hours a day, 7 days a week Magellan Member Services Behavioral Health Crisis Line Toll free: TTY Toll free: Local: TTY: CHILDREN S PROVIDER NETWORK ORGANIZATIONS The Southwest Network Quality Care Network Toll free: Local: am 8 pm 24 hours a day, 7 days a week 8 am 7 pm Mondays through Fridays; Weekends by appointment 8 am 8 pm Mondays through Fridays Weekends by appointment People of Color am 6 pm (confirm) Network ADULT PROVIDER NETWORK ORGANIZATIONS The Southwest Network CHOICES Network of Arizona, Inc Information will be forthcoming in when the Southwest Network begins to deliver services Information will be forthcoming in when the Southwest Network begins to deliver services How to identify and contact a behavioral health recipient s clinical liaison and or case manager You can identify and contact a behavioral health recipients clinical liaison or case manger by calling the service recipient s Provider Network Organization above. 16