Illinois Mental Health Collaborative For Access And Choice Presents

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Illinois Mental Health CollaborativeFor Access
And ChoicePresents
Introduction to Provider Monitoring

• March 25, 2008

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Agenda

• Introductions
• Background
• Provider Monitoring Process
• Post Payment Review
• Clinical Review
• ACT Review
• CST Review

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DMH Presenters

• Christopher T. Power, Ph.D.
• Jackie Manker, LCSW
• Tom Miller, MHSA

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Collaborative Presenters

• Mike Mulvany, Director of Provider Relations
• Dee Durant, Director, Clinical Operations
• Sandy Potter, VP, Clinical Operations

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DMH Overview

• Overarching Themes for 4Q FY08
• This year is an introduction to how monitoring
  will be conducted in the future.
• A coordinated team approach with DHS/DMH, BALC,
  and Collaborative staff.
• No duplication of reviews
• No extrapolation this year so no penalty
• Compliance with both Rule 132 and the contract
• Evolving process so we learn and adjust as we go

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The Goals of the Collaborative

• Under the direction of DHS/DMH the Collaborative
  will perform provider monitoring activities
  starting in 4Q, FY08.
• as a coordinated team approach with DHS/DMH
  contract managers and BALC.
• this is an evolving process.

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Provider Monitoring

• Rule
• Clinical Record Review
• Post Payment Review
• Contract
• Coordination of benefits
• Non-Medicaid services
• Moving mental health system towards
  recovery-oriented services
• ACT/CST Fidelity reviews
• Crisis Plans
• Consumer participation

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Post Payment Review

• Process to ensure that the service billed is the
  service that was provided by matching claims with
  the documentation in the clinical record.
• The sample for review will be based on claims
  submitted for services provided during FY08.
• The review will be on the same sample for either
  ACT/CST Fidelity or clinical record reviews.
• The review will be only for those providers that
  have not had a post payment review by BALC in the
  past 6 months.

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Overview of Fidelity Monitoring

• One of the goals of the Collaborative is to
  ensure appropriate level of care
• Record review- not contract review
• ACT Fidelity will be based on the Dartmouth
  Assertive Community Treatment Scale (DACTS),
  recommended by SAMHSA
• (available on line at http//samhsa.hhs.gov/)

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Overview of Fidelity Monitoring (cont)

• CST fidelity will be based on the DHS/DMH mental
  health service definitions
• There will be on-going Team leader conference
  calls held by DHS/DMH and the Collaborative to
  support the ACT and CST Teams
• Fidelity monitoring is Team based
• (not agency based)

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CST Fidelity Monitoring

• The CST Fidelity tool
• developed from the DHS/DMH mental health service
  definitions
• contains program-specific items required by the
  rule
• measures the degree of implementation of CST
  services

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ACT Fidelity Monitoring

• The ACT Fidelity tool
• contains 28 program-specific items
• designed to measure the degree of implementation
  of ACT programs

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Next Steps

• Review Tools
• will be posted on the Collaborative website
• Scheduling Site Visits
• advance notification of reviews
• Monitoring Activities
• 4th quarter- FY08
• verbal results shared with providers
• written results within 30 days of completion of
  the review
• Follow-up with providers

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Questions and Answers
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Presentation

• Todays presentation will be available online
  within 2 weeks at
• http//www.IllinoisMentalHealthCollaborative.co
  m/providers/Training/Training_Workshops_Archives.h
  tm
• Be sure to share this information with your staff!

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For More Information
Todays presentation will be available online
at http//www.illinoismentalhealthcollaborative.c
om You can follow these steps Step 1 Go to
www.illinoismentalhealthcollaborative.com Step
2 Click on Providers Step 3 Click on
Education Center Step 4 Click on
Trainings/Workshops Step 5 Click on Archive
Forums
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Thank you!
Illinois Mental Health Collaborative for Access
and Choice