DMC ODS Case Management Monterey County Behavioral Health
DMC- ODS Case Management Monterey County Behavioral Health Substance Use Disorder Services Quality Improvement
Training Goals and Objectives Goals Define activities related to Case Management services Planned vs. Unplanned Compare with other possible services Best Practice Documentation Objectives Define DHCS definition of Case Management and how this applies to program services Identify documentation requirements
Case Management Services are available in all levels of care Case management is a separate services code available at all levels of care Case management can be provided by a Licensed Practitioner of the Healing Arts (LPHA) or an SUD Counselor Components of Case Management activities: Monitoring treatment progress Client advocacy and linkage to services Monitoring transitional needs to a high or lower level of SUD care Monitoring service delivery to ensure access to services and service delivery system
Unplanned vs. Planned Services Unplanned Services happen during the assessment phase: from date of admission to the finalization of the signed treatment plan Withdrawal Management 3. 2 - 72 hours Residential Treatment 3. 1 and 3. 5 - 30 days Outpatient Treatment 1 and 2. 1 - 30 days Narcotic Treatment Program 1 - 28 days Planned Treatment Services identified on Treatment Plan
“ Case management is defined in the Standard Terms and Conditions (STCs) as a service to assist beneficiaries in accessing needed medical, educational, social, prevocational, rehabilitative, or other community services. - DHCS Case Management Under the Drug Medical Organized Delivery System Frequently Asked Questions ”
Common Service Code Descriptions that are Confused with Case Management Service Code: Assessment/ Intake The process of determining that a consumer meets medical necessity criteria and being admitted into substance use disorder treatment via the ASAM assessment Evaluation or analysis of substance use disorders Diagnosing of substance use disorders Assessment of treatment needs to provide medically necessary services Treatment Planning The process of preparing an individualized treatment plan based upon information obtained in the intake and ASAM assessment EXCEPTION- NTP: Initial treatment planning is billed under individual counseling and any updates to the treatment plan are billed as case management Individual Counseling Sessions are designed to support direct communication and dialogue between the staff and consumer. Sessions will focus on psychosocial issues related to substance use and goals outlined in the consumer’s individualized treatment plan. Typically linked to an evidenced based practice.
Case Management is Linkage to Services Communication, Coordination, and Referral Assisting the consumer to access needed services through a variety of interventions including: Direct communication with the client and/or individuals within the community in order to facilitate access Coordination between services and/or appointments (medical appointments public assistance agencies, housing needs, etc. ) Facilitating appropriate referrals These services typically include interventions on behalf of the consumer with other community resources as needed- Social Security office, schools, social services, health departments, PCP office, housing, etc.
Case Management is Monitoring Access Activity needed to ensure that the consumer is accessing identified needed services, and is navigating the service delivery system effectively (keeping appointments, securing needed public assistance and housing). Monitoring Progress Evaluating whether the identified community resources are meeting the consumer’s needs, and whether the consumer is progressing toward targeted goals. Monitoring progress centers on making sure the consumer is continuing to access resources in an effective and appropriate manner. For example: once initial medical appointments and evaluations have been completed, is the consumer following recommended interventions and treatments and progressing toward improved health? If housing has been secured, is the consumer able to maintain or in danger of losing again?
Case Management is Placement Needs Placement Services Placement coordination services necessary to address the identified substance use disorder condition, including assessing the adequacy and appropriateness of the consumer’s living arrangements. Example: a client moving from a residential setting to a sober living environment. Services would typically include locating and coordinating the resources necessary to facilitate a successful and appropriate placement in the least restrictive setting and consulting, as required, with the care provider. Activities may also include identification and assistance during times of crisis and need for more intensive placement.
Case Management is not… Providing transportation only Clerical activities such as scheduling appointments On days when consumer is in a acute psychiatric hospital or jail Exceptions: day of admission, or for the purpose of coordinating placement of the consumer upon discharge When case management is being provided by, and reimbursed to, another agency by Medi- Cal (creation of duplicate payments). For direct delivery of services (rehabilitation, medical, educational, social, or other services, etc. ) Leaving voicemails or sending emails Other activities on DHCS Reasons for Recoupment list
Examples of Case Management Service Activities Contacting Primary Care Provider (PCP) office or Central Coast Alliance for Health (CCAH) office to secure a PCP appointment for a consumer to attend to needed physical exam or other identified health concern Link to or coordinate care with Mental Health Clinician or Psychiatrist Monterey County Behavioral health Beacon Health Strategies Coordinate medical appointment needs Coordinate with legal/probation services on treatment status update Outreach SLEs for information on available housing Assessing current level of care and anticipated discharge transfer to another level of care Coordination of access to MAT services Assisting in coordinating discharge from hospital/jail to appropriate level of care
Case Management Progress Note Details Start and End time of service session Duration= Real time Location: Face- to- face Telephone Telehealth Anywhere in the community (include how confidentiality was maintained) Only if with client, identify an evidenced based practice in the progress note D-I-R-P or F-I-R-P format Note must link case management services in client’s treatment plan
Case Management Progress Note Example: Medical D-I-R-P Case Management Note Data: Reason for service and how it relates to the treatment plan, i. e. consumer does not have an established PCP SUD counselor provided case management services to assist Tracy with establishing a relationship with newly assigned Primary Care Provider (PCP), Seaside Family Health. Tracy has not received a physical in the last 12 months. Intervention: Provide linkage of consumer to medical care(and assisting with minimizing barriers to the medical service) SUD Counselor obtained a ROI for PCP and provided linkage assistance to ensure Tracy arrived at her appointment on time and completed new- patient paperwork to accurately report current physical symptoms of fatigue and stomach cramps. Response: Outcome of service(s) Tracy asked SUD counselor to communicate self- reported needs to medical staff. SUD counselor reminded Tracy to ask for an appointment summary report that also included any follow-up recommendations by PCP in order to support her ongoing health. Plan: Follow- up plan and recommendation(s) SUD Counselor will follow up with Tracy on receipt of PCP’s evaluation and assist with additional medical linkages as indicated on report to support Tracy’s recovery from substance use.
Case Management Progress Note Example: Housing D-I-R-P Case Management Note Data: Reason for the service and how it relates to client’s treatment plan, i. e. client does not have access to stable housing SUD Counselor provided case management services to assist Tracy in connecting with housing resources. Tracy currently lives with substance using friends and struggles with maintaining her sobriety. Intervention: Provide linkage of client to housing resources SUD Counselor provided linkage assistance to ensure Tracy contacted the housing authority to begin the Section 8 application process. Tracy called the housing department with the number provided. With Tracy’s permission, SUD counselor assisted with communicating Tracy’s need and request for an application (ROI on file). Response: Outcome of service(s) Housing Department staff collected Tracy’s needed information and indicated an application will be sent to the provided address within 7 days. Plan: Follow- up plan and recommendation(s) SUD counselor to follow up with Tracy on receipt of section 8 application after 7 days and assist with additional housing linkage needs as indicated by Tracy.
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