Working Draft: For Review and Comment
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MENTAL HEALTH AND ADDICTIVE DISEASES SERVICE
PROVIDER
CATEGORIZATION MODEL
MAY 28, 2003
The purpose of this concept paper is to describe a model for categorizing
mental health and addictive diseases providers so that interested parties
will have the opportunity to review, comment and make recommendations to
the Division prior to a decision regarding feasibility.
The Division is proposing two major categories of providers for Medicaid,
state and federal fund sources: Core Service Providers and Specialty
Service Providers. The model promotes the recovery of individuals by
creating an array of specialty services that have proven successful in
assisting individuals achieve a successful recovery, and by establishing a
provider called the Core Services Provider which serves as the consumer's
primary contact for all services and assures service coordination and
linkage among all service providers.
Core Services Providers
The first major category of providers would be providers who offer a
nucleus of services for a specific age or disability group (Adult Mental
Health Services, Adult Addictive Diseases Services and Children and
Adolescent Services) . This set of services would include community
support and a set of services that are often used by consumers and their
families. The required services vary slightly based on the population
served and will be explained later in this paper.
Core service providers will have the responsibility for the coordination
of all services needed by the consumer (provided by the core provider,
specialty providers and outside providers/supports), and will be seen as
the "glue" in ensuring services are coordinated. The model uses a concept
known as the "clinical home" in which a core provider staff person will
serve as the consumer's primary contact for all services and will assure
coordination and referral to specialty providers, when needed. In
addition, the core service providers will be responsible for ensuring a
comprehensive service plan is developed for each consumer that addresses
the unique needs of each consumer and promotes recovery.
For consumers who have complex needs and multiple providers, Community
Support Services (individual and team) can be used to ensure coordination
of care and service planning. For consumers whose needs are less complex,
the core service provider may use a designated staff member as the contact
to ensure service planning and coordination. The level of involvement of
the core service provider will be determined by consumer need and choice.
Specific functions that are performed by a core service agency include:
· Serving as the consumer's primary contact for all services. The
designated staff will assure coordination and referral to specialty
providers. To the extent possible, consumers will have choice in selecting
this staff person;
· Assisting the consumer through the development of a service plan that
promotes recovery;
· Coordinating the services identified in the service plan;
· Reviewing the service plan periodically with the consumer;
· Establishing referral agreements with agencies who will provide
specialty services needed by the consumer but not provided by the core
agency;
· Ensuring 24/7crisis capacity is available within the core provider and
referral agreements to the crisis stabilization program are in place for
referral as appropriate;
· Providing services in a manner that assures access to services within
the designated service area and,
· Providing the mandatory services listed below.
A core service provider may provide any specialty services for which they
are determined by the Division to be qualified.
Types of Core Services Providers
Core service providers are required to provide a core set of services to
individuals enrolled with their agency. A Consumer would not be required
to receive all core services through the core provider, if he/she has the
ability and desire to receive some services from another provider. In
order to assure that core providers have special expertise for the age
groups or disability areas, the Division will designate three types of
core providers: Adult Mental Health, Adult Addictive Diseases and Child
and Adolescent. If determined to be qualified, a single provider can
provide more than one set of core services.
1. Adult Mental Health Core Provider
· Provider must also provide drug/alcohol core services for persons
enrolled with co-occurring psychiatric and addictive disorders.
· Provider must be able to provide initial assessment for psychiatric
and addictive disorders.
· Provider must provide services for persons with co-occurring disorders
in an integrated manner.
· Provider must develop service plan that promotes recovery based on the
assessment.
· Provider must provide consumer and family education as an integrated
part of treatment modalities.
· Provider must directly provide all of the services identified below.
Subcontracting is not allowed. For the purposes of designation as a core
provider, the purchase of physician and other professionals' time in the
provision of services via a contract will not constitute a sub-contract.
· An Adult Mental Health Core Provider must provide the following
mandatory services:
· Diagnostic Assessment (including co-occurring disorders)
· Outreach
· Crisis Intervention (in and out of clinic)
· Community Support Individual
· Community Support Team
· Medication Administration
· Physician Assessment and Care
· Nursing Assessment and Care
· Medications
· Therapeutic Outpatient Services (Individual, Group and Family
Counseling).
2. Adult Addictive Diseases Core Provider
· Provider must have an affiliation agreement with an Adult Mental
Health Core Provider.
· If an Adult Addictive Diseases Core Provider identifies a consumer as
having a severe mental illness, that consumer will be considered for
transfer under the affiliation agreement to an Adult Mental Health Core
Provider. (Core Addictive Diseases Providers may provide co-occurring
psychiatric and addictive disorders with Division approval, but are not
required to do so).
· Provider must be able to provide an initial assessment for either
psychiatric or addictive disorders.
· Provider must develop service plan that promotes recovery based on the
assessment.
· Provider must provide consumer and family education as an integrated
part of treatment modalities.
· Provider must directly provide all of the services identified below.
Subcontracting is not allowed. For the purposes of designation as a core
provider, the purchase of physician and other professionals' time in the
provision of services via a contract will not constitute a sub-contract.
· An Adult Addictive Diseases Core Provider must provide the following
mandatory services:
· Diagnostic Assessment
· Outreach
· Crisis Intervention (in and out of clinic)
· Community Support Individual
· Community Support Team
· Medication Administration
· Physician Assessment and Care
· Nursing Assessment and Care
· Medications
· Therapeutic Outpatient Services (Individual, Group and Family
Counseling)
3. Child and Adolescent Core Provider
· Provider must provide services for both mental health and addictive
disorders.
· Must provide services for children and adolescents with co-occurring
disorders in an integrated manner.
· Provider must develop service plan that promotes recovery based on the
assessment.
· Provider must provide consumer and family education as an integrated
part of treatment modalities.
· Provider must coordinate the mental health, addictive diseases
services with needed services and supports from other systems, such as
Department of Family and Children's Services, school systems, Department
of Juvenile Justice and other involved community agencies.
· Provider must directly provide all of the services identified below.
Subcontracting is not allowed. For the purposes of designation as a core
provider, the purchase of physician and other professionals' time in the
provision of services via a contract will not constitute a sub-contract.
· A Child and Adolescent Core Provider must provide the following
mandatory services:
· Diagnostic Assessment
· Outreach
· Crisis Intervention (in and out of clinic)
· Community Support Individual
· Community Support Team
· Medication Administration
· Physician Assessment and Care
· Nursing Assessment and Care
· Medications
· Therapeutic Outpatient Services (Individual, Group and Family
Counseling)
Specialty Service Providers
Specialty services are those services that support recovery and have
proven successful in helping individuals and families achieve success.
These services may be provided by either core providers or providers who
only provide one or a group of specialty services. Services must be
provided in a manner that assures access to services within the designated
service area to include ease of location and service hours.
Specialty Services
Adult Mental Health Specialty Services
1. Intensive Day Treatment (Partial Hospitalization)
2. Psychosocial Rehabilitation and Supported Employment
3. Supported Employment
4. Assertive Community Treatment (Must have agreement in place with Core
Provider for "step-down" to community support)
5. Peer Support
6. Residential Supports
7. Provider may also provide time limited community support for the
purpose of transitioning consumer to other, less intensive community
services.
Adult Addictive Diseases Specialty Services
1. Ambulatory Detox and Therapeutic Outpatient Services (Individual,
Family and Group) or Substance Abuse Day Treatment
2. Residential Detox and Ambulatory Detox and Therapeutic Outpatient
Counseling or Substance Abuse Day Treatment.
3. Substance Abuse Day Treatment
4. Residential Supports
5. Residential Detox
Child and Adolescent Specialty Services
1. C&A Day Support and Day Treatment
2. Intensive Family Intervention
3. C&A Respite Care
4. Substance Abuse Adolescent Day Treatment
5. Substance Abuse C&A Residential
6. Residential Supports
7. Community-based Inpatient Services
Intensive Crisis Response Specialty Services
1. Each region must assure that in each service area there is a crisis
stabilization program with the capacity to serve as the initial access
point for adults in crisis through 24 by 7 crisis intervention services
and emergency room screening. Time limited community support services
will be available for individuals new to the service delivery system or
who are high users of crisis services to assure linkage with a core
provider.
2. Providers of intensive crisis services must provide pre-admission
screening for all state hospital admissions and provide information and
referral services for those individuals not deemed appropriate for
services.
3. Mobile crisis teams may be developed as part of an intensive crises
response service, but are not required.
Operational Parameters
· Each region must have one Core Service Provider for Adult Mental
Health, Adult Addictive Diseases and Child and Adolescent for each
service area that is funded under contract with the region.
· Regions must have a provider for all services, core and specialty. The
full array of service must be available service area wide.
· The consumer's Core Provider will contractually and operationally be
required to coordinate all services the consumer receives.
· Core providers will be required to assure access to the core services
within its designated service area.
· Each consumer in service must have a core provider. Consumers may have
as many different specialty providers as they choose for services that
are outlined in the service plan.
· Regional Offices are expected to develop its core and specialty
providers into a network of providers to assure a comprehensive array of
services offered in a coordinated fashion. Monthly provider meetings are
expected in each region to assure a coordinated system of providers and
to address common issues and problems.
Benefits of Model
· Promotes the recovery model through the development of a system to
ensure consumers are linked to needed services and the development of an
array of specialty services.
· Allows provider flexibility in the creation of an area of expertise.
· Allows more providers to be members of the provider pool, offer choice
to constituents and create flexible service arrays.
· Allows agencies to focus on a disability area promoting more
opportunity for best practice implementation (experts in one field
versus a "jack-of-all-trades" service delivery design).
· Promotes the delivery of community-based ambulatory detoxification
which has minimal utilization at this juncture.
· Allows Community Service Boards more flexibility in selecting services
they wish to provide.
· Allows Community Service Boards more options about services they
provide and available financial reimbursement.
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This concept paper is being used as the basis of discussion for a
community forum on June 18, 2003. The Division will also accept written
comments through June 30, 2003. Please send written comments to Margaret
Bradford at 2 Peachtree Street, NW, Suite 22.496, Atlanta, Georgia 30303. |
