Rule 132 Medicaid Community Mental Health Service Program

1
Rule 132 Medicaid Community Mental Health
Service Program

• Application to the Individual Care Grant Program

Seth Harkins, Ed.D.Director, ICG
ProgramDepartment of Human ServicesDivision of
Mental Health Lee Ann Reinert, LCSW Clinical
Policy Manager Department of Human
Services Division of Mental Health
2
Agenda

• Understand the purpose and vision of Rule 132
• Understand the requirements of Rule 132
• Understand the Individual Care Grant (ICG)
  services covered by Rule 132
• Questions

3
Illinois Rule 132

• As the state mental health authority, the
  Department of Human Services, Division of Mental
  Health (DHS/DMH) uses Rule 132 to govern optional
  mental health Medicaid benefits in Illinois.
• http//www.ilga.gov/commission/jcar/admincode/059/
  05900132sections.html

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Underlying Vision of Recovery and Resilience

• Recovery refers to the process in which persons
  are able to live, work, learn, and participate
  fully in their communities.
• For some individuals, recovery is the ability to
  live a fulfilling and productive life despite a
  disability.
• For others, recovery implies the reduction or
  complete remission of symptoms.
• Science has shown that having hope plays an
  integral role in an individuals recovery.

5
Underlying Vision of Recovery and Resilience
(cont)

• Resilience means the personal and community
  qualities that enable us to rebound from
  adversity, trauma, tragedy, threats, or other
  stresses and to go on with life with a sense of
  mastery, competence, and hope.

6
Underlying Vision of Recovery and Resilience
(cont)

• We now understand from research that resilience
  is fostered by a positive childhood and includes
  positive individual traits, such as optimism,
  good problem-solving skills, and treatments.
• Closely-knit communities and neighborhoods are
  also resilient, providing supports for their
  members.

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Rule 132 Requirements

• Certification Process
• In order to bill for Rule 132, providers must be
  certified by the DHS Bureau of Accreditation,
  Licensure and Certification
• Covered in previous trainings
• Call Cathy Cumpston at 217-557-9282 for
  certification questions
• Recertification

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Rule 132 Requirements

• Role Definitions and Supervision
• Licensed Practitioner of the Healing Arts (LPHA)
• Qualified Mental Health Professional (QMHP)
• Mental Health Professional (MHP)
• Rehabilitative Services Associate (RSA)
• Clinical Record
• Utilization Review
• Post Payment Review

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ICG services billable under Rule 132

• Group A Evaluation and Planning
• Group B Mental Health Services
• Group C Non-Medicaid Services
• State of Illinois
• Community Mental Health Services
• Service Definition and Reimbursement Guide
• http//www.hfs.illinois.gov/assets/070107_cmph_gui
  de.pdf

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Group A Services

• Evaluation and Planning

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Mental Health Assessment

• A formal process of gathering information
• Results in treatment recommendations
• Diagnosis of mental illness not required prior to
  beginning process
• Completed within 30 days of start of treatment

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Mental Health Assessment (Cont)

• MHP may participate
• Requires at least one face to face contact with
  QMHP and signature
• Requires review and signature by LPHA
• Required elements listed within the Rule
• Updated annually by QMHP who has at least one
  face to face contact

13
Treatment plan development, review and
modification

• Services Crosswalk 50M Care Coordination
• For treatment provider

14
Treatment plan development, review and
modification

• Process resulting in a written Individual
  Treatment Plan
• Developed with active participation by individual
  being served and parent/guardian
• Based on MHA and any additional evaluations
• Prescribes treatment recommended

15
Treatment plan development, review, and
modification

• Completed within 45 days of completion of MHA
• MHP may participate, QMHP responsible for process
  and must sign plan
• LPHA must review
• Date of LPHAs signature is considered effective
  date of the ITP

16
Treatment plan development, review, and
modification

• Required elements are listed in the Rule
• Must include definitive 5-axis diagnosis. Record
  must document plan for any diagnostic questions
  remaining at the time of ITP development.
• Must be reviewed no less than every 6 months

17
Treatment plan development, review, and
modification

• Shall include
• Continuity of care planning with parent/guardian,
  
• Estimated transition/discharge date
• Goals for continuing care
• Signatures
• Under 12 parent or guardian
• Over 12, under 18 Individual served and
  parent/guardian
• Over 18/emancipated minor individual served
• Over 18, adjudicated legally incapable
  individual served and legal guardian

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Psychological evaluation

• Must be medically necessary
• Must be conducted within 90 days of the ITP
• Must utilize nationally standardized
  psychological assessment instruments
• Must result in written report including
  formulation of problems, tentative diagnosis,
  recommendations for treatment/services

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Group B Services

• Mental Health Services

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Mental Health Services

• Following MHA (or Admission Note in certain
  circumstances)
• Consistent with ITP (or Admission Note in certain
  circumstances)
• Face to face, video conference, telephone contact

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Mental Health Services (cont)

• Provided to
• Individuals
• Families of individuals
• Groups of individual consumers
• For the primary benefit and well-being of the
  individual
• Related to an assessed need and goal on the ITP

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Mental Health Services (cont)

• Services may be provided on-site or off-site, as
  indicated by the specific service

23
Crisis Intervention Services

• Activities to stabilize an individual in
  psychiatric crisis
• Goal of immediate symptom reduction,
  stabilization, and restoration to a previous
  level of role functioning
• May be provided by MHP with immediate access to
  QMHP

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Crisis Intervention Services

• Services Crosswalk 87M Therapeutic
  Stabilization
• One of an array of Rule 132 services
• Service must be provided and documented in
  accordance with definition and rule requirements

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Psychotropic Medication Services

• Psychotropic Medication Administration
• Psychotropic Medication Monitoring
• Psychotropic Medication Training

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Psychotropic Medication Services

• Psychotropic medication administration
• Time spent preparing the individual and the
  medication for administration
• Administering psychotropic medication
• Observing the client for possible adverse
  reactions
• Returning medication to proper storage
• Minimum staff LPN under RN supervision

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Psychotropic Medication Services

• Psychotropic medication monitoring
• Monitoring and evaluating target symptom response
• Monitoring for adverse effects, including tardive
  dyskinesia screening
• Monitoring for new target symptoms or medication
• Staff must be designated in writing by a
  physician or advanced practice nurse

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Psychotropic Medication Services

• Psychotropic medication training
• Training the individual or the individuals
  family/guardian to
• Administer the individuals medication
• Monitor levels and dosage
• Watch for side effects
• Staff must be designated in writing by a
  physician or advanced practice nurse

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Therapy/Counseling

• May be provided to
• Individual
• Group of 2 or more individuals
• A family
• Minimum Staff MHP

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Therapy/Counseling (cont)

• Examples
• Cognitive behavioral therapy
• Functional family therapy
• Motivational enhancement therapy
• Trauma counseling
• Anger management
• Sexual offender treatment

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Community Support

• Community Support Individual (CSI)
• Community Support Group (CSG)
• Community Support Residential (CSR)
• Minimum staff RSA

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Community Support

• Location of service
• CSI and CSG at least 60 must be provided in
  natural settings
• CSR must be billed as on-site
• For CSG, group size must not exceed 15
  individuals

33
Community Support

• Services and supports necessary to assist
  individuals in achieving rehabilitative,
  resiliency and recovery goals
• These services facilitate
• Illness self-management
• Skill building
• Identification and use of natural supports
• Use of community resources

34
Community Support Individual/Group

• Services Crosswalk 87M Therapeutic
  Stabilization
• One of an array of Rule 132 services
• Service must be provided and documented in
  accordance with definition and rule requirements

35
Examples of Community Support

• Coordination and assistance with identification
  of individual strengths, resources, preferences
  and choices
• Assistance with the identification of existing
  natural supports for development of a natural
  support team, and in building such a team
• Assistance with the identification of risk
  factors related to relapse and development of
  relapse prevention plans and strategies

36
Examples of Community Support

• Support and promotion of self-advocacy and
  participation in decision making, treatment and
  treatment planning
• Support and consultation with individual/support
  system directed primarily to the well-being and
  benefit of the individual

37
Examples of Community Support

• Skill building in order to assist in development
  of functional, interpersonal, family, coping, and
  community living skills that are negatively
  impacted by the individuals mental illness

38
Community Support Is NOT

• Supervised Meals
• Book-end Billing
• General Milieu Time

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Case Management Services

• Case management vs. Community support
• Case management does for the client
• Community support teaches the client how to do
  for self

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Case Management Services

• Mental Health Case Management
• Client Centered Consultation
• Transition Linkage and Aftercare

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Case Management Mental Health

• Assessment, planning, coordination and advocacy
• For individuals who
• Need multiple services
• Require assistance in gaining access and using
  services
• Identification and Investigation of available
  resources

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Case Management Mental Health (cont)

• Explaining options to the individual
• Linking the individual with appropriate resources
• Minimum staff RSA

43
Case Management Mental Health

• Services Crosswalk 51M
• Application assistance for youth currently
  receiving DMH funded services with a Recipient
  Identification Number (RIN)

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Examples of Case Management Mental Health

• Helping individual access appropriate mental
  health services, including the ICG program
• Applying for public entitlements
• Locating housing
• Obtaining medical and dental care
• Obtaining other social, educational, vocational
  or recreational services

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Examples of Case Management Mental Health

• Assessing the need for service
• Identifying and investigating available resources
• Explaining options
• Assisting in application process

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Client Centered Consultation

• An individual client-focused professional
  communication
• Between provider staff
• With staff of other agencies
• With other professionals or systems who are
  involved with providing services to a client
• Must be provided in conjunction with one or more
  Group B mental health services
• Minimum Staff RSA

47
Client Centered Consultation

• Services Crosswalk 50M Care Coordination
• For ICG/SASS worker during youths residential
  stay (not at transition times)

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Examples of Client Centered Consultation

• Face to face or telephone contacts (including
  scheduled meetings or conferences) between
  provider staff, staff of other agencies, and
  child-caring systems concerning the individuals
  status
• Contacts with educational, legal or medical
  system
• Staffing with school personnel or other
  professionals involved in treatment

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Transition Linkage and Aftercare

• Services are provided to assist in an effective
  transition in living arrangement consistent with
  the individuals welfare and development
• Minimum staff MHP

50
Transition Linkage and Aftercare

• Services Crosswalk 50M Care Coordination
• For ICG/SASS worker, during transitional phases
  of residential placement

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Examples of Transition Linkage and Aftercare

• Services provided to individuals being discharged
  from inpatient psychiatric care, transitioning to
  adult services, moving into or out of one
  placement to another placement or parents home
• Time spent planning with staff of current living
  arrangement or the receiving living arrangement
• Time spent locating client-specific placement
  resources, such as meetings and phone calls

52
Psychosocial Rehabilitation

• Facility-based rehabilitative skill-building
  services
• Individuals 18 or older
• Available at least 25 hours/week at least 4
  days/week
• Adjunct service to community support

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Psychosocial Rehabilitation (cont.)

• Program director must be at least QMHP
• Delivered by at least an RSA
• Staff to client ratio shall not exceed 1 to 15
• Document each session of service
• Only billable for ICG-Community, age 18 and older

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Group C

• Non-Medicaid Services

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Group C Non-Medicaid

• Oral interpretation and sign language
• Vocational Services age 14 or older only
• Vocational Engagement
• Vocational Assessment
• Job finding supports
• Job retention supports
• Job leaving/termination supports

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Oral Interpretation and Sign Language

• Service necessary to ensure provision of mental
  health services to individuals whose primary
  language is not English, or who have hearing
  impairment
• Need must be indicated on MHA
• Must be performed in conjunction with another
  medically necessary, billable service

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Vocational Engagement

• Activities for a specific client to engage that
  client in making a decision to actively seek
  competitive employment or formal
  credit/certificate bearing education
• Goal for employment or preparation for employment
  must be on ITP
• Minimum staff RSA

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Vocational Engagement Caveats

• Does not include provider-based pre-vocational
  programs or educational programs that do not
  result in credentials recognized by an employer
• Activities related to employment that may be
  viewed in terms of the clients broader
  rehabilitative or social functioning skills are
  not job specific should be expressed in those
  terms and billed as Medicaid-covered services

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Vocational Assessment

• Developing a vocational profile to guide
  individual choices in seeking and maintaining
  competitive employment
• Minimum staff RSA

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Vocational Assessment

• Vocational profile typically includes
• Work history
• Interests
• Skills
• Strengths
• Education
• Impact of symptoms on ability to use strengths
• Job preferences

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Vocational Assessment

• Clients vocational goals should be integrated in
  the treatment plan
• Does not include pre-vocational work experiences
  or simulated/situational work experiences at the
  providers site

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Job Finding/Retention Supports

• Activities for a specific individual, directed
  toward helping to find and procure a job/keep the
  job
• Provided under the following conditions
• Placement based on consumer job preferences
• Competitive employment in integrated work
  settings
• Ongoing supports as needed
• Integration of supported employment services with
  other mental health services

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Job Finding/Retention Supports

• At least 40 delivered in natural settings
• This does not include general job development
• Minimum staff RSA

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Job Finding/Retention Supports

• Interventions must be specific to work and the
  job
• Therapeutic supports to help individuals manage
  symptoms as they work toward achieving recovery
  goals should be distinguished from this service

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Job Leaving/Termination Supports

• Activities for a specific individual, who is
  employed, directed toward helping them leave a
  job in good standing.
• May also be provided to help client see unplanned
  job loss as transitional, and a learning
  experience that will help with the next job.

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Job Leaving/Termination Supports

• Provided to ensure that job loss is not seen as a
  reason to discontinue participation in supported
  employment
• Minimum staff RSA

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Other ICG Billable Services

• Overview of Material Covered in Previous Training

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Other ICG billable services

• 51M Application Assistance
• S9986 / W051M Pseudo RIN Application Assistance
• For youth who are new to DMH system and do not
  have RINs
• 72M Child Support Services
• S9986 / W072M ICG Child Support Services
• Will require authorization over 1575 per youth

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Other ICG billable services

• 97M Behavior Management
• S9986 / W097M ICG Behavior Management
• Will require authorization over 3500 per youth
• 17M Group Home
• S9986 / W017M ICG Services Group Home (Consumer
  Present)
• S9986 / W017B ICG Services Group Home (Bed
  Hold)

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Other ICG billable services

• 19M Residential
• S9986 / W019M ICG Services Residential
  (Consumer Present)
• S9986 / W019B ICG Services Residential (Bed
  Hold)
• S9986 / W020M or W021M Residential special unit
  1 or 2 (Consumer Present)
• S9986 / W020B or W021B Residential special unit
  1 or 2 (Bed Hold)

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Questions

• Seth Harkins, Ed.D.Director, ICG
  ProgramDepartment of Human ServicesDivision of
  Mental Health
• Lee Ann Reinert, LCSW
• Clinical Policy Manager
• Department of Human Services
• Division of Mental Health
• Cathy Cumpston, Chief
• Bureau of Accreditation, Licensure and
  Certification
• Department of Human Services