Illinois Mental Health Collaborative For Access And Choice
Illinois Mental Health Collaborative For Access And Choice Presents Introduction to Provider Monitoring March 25, 2008 1
Agenda l l l 2 Introductions Background Provider Monitoring Process – Post Payment Review – Clinical Review – ACT Review – CST Review March 25, 2008
DMH Presenters • Christopher T. Power, Ph. D. • Jackie Manker, LCSW • Tom Miller, MHSA 3 March 25, 2008
Collaborative Presenters • Mike Mulvany, Director of Provider Relations • Dee Durant, Director, Clinical Operations • Sandy Potter, VP, Clinical Operations 4 March 25, 2008
DMH Overview l 5 Overarching Themes for 4 Q FY 08 – 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 March 25, 2008
The Goals of the Collaborative l Under the direction of DHS/DMH the Collaborative will perform provider monitoring activities starting in 4 Q, FY 08. – – 6 as a coordinated team approach with DHS/DMH contract managers and BALC. this is an evolving process. March 25, 2008
Provider Monitoring l Rule – – l Contract – – l Coordination of benefits Non-Medicaid services Moving mental health system towards recoveryoriented services – – – 7 Clinical Record Review Post Payment Review ACT/CST Fidelity reviews Crisis Plans Consumer participation March 25, 2008
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Post Payment Review l l 9 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 FY 08. The review will be on the 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. March 25, 2008
Overview of Fidelity Monitoring l l l 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/) 10 March 25, 2008
Overview of Fidelity Monitoring (cont) l l l 11 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) March 25, 2008
CST Fidelity Monitoring l The CST Fidelity tool: – – – 12 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 March 25, 2008
ACT Fidelity Monitoring l The ACT Fidelity tool – – 13 contains 28 program-specific items designed to measure the degree of implementation of ACT programs March 25, 2008
Next Steps l Review Tools – l Scheduling Site Visits – l – – 14 advance notification of reviews Monitoring Activities – l will be posted on the Collaborative website 4 th quarter- FY 08 verbal results shared with providers written results within 30 days of completion of the review Follow-up with providers March 25, 2008
Questions and Answers 15 March 25, 2008
Presentation Today’s presentation will be available online within 2 weeks at: http: //www. Illinois. Mental. Health. Collaborative. com/providers/Training/Traini ng_Workshops_Archives. htm Be sure to share this information with your staff! 16 March 25, 2008
For More Information Today’s presentation will be available online at: http: //www. illinoismentalhealthcollaborative. com 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” 17 March 25, 2008
Thank you! Illinois Mental Health Collaborative for Access and Choice 18
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