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Toward a Peer-Driven System FY2013 Plan

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The Magellan Health clinical team for the Maricopa County RBHA designed and implemented a breakthrough plan for investing $27 million in Arizona state funds for peer and family roles.

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Toward a Peer-Driven System FY2013 Plan

  1. 1. Page 1 Magellan Health Services ADHS/DBHS Plan Submission Dr. Richard Clarke, CEO Shawn Thiele, Deputy CEO David Covington, VP Adult & Youth Services Toward a Peer-Driven System of Care FY2013 Non-TXIX SMI Funding Plan
  2. 2. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 2 CONTENTS I. Plan Overview 3 Introduction 3 Plan Highlights 4 II. Budget & Service Expectations 5 NTXIX Funding Distribution for FY2013 Table 7 NTXIX Funding Allocation Rationale 8 Peer Driven System of Care 8 Recovery Empowerment Continuum 10 NTXIX Service Descriptions 11 III. Implementation Plan 20 Communicaton Plan 21 DBHS Parameters and Plans 21 IV. Monitoring and Oversight 25
  3. 3. Page 3 Magellan Health Services I. PLAN OVERVIEW On June 14, 2012, ADHS/DBHS provided Magellan with a letter outlining the allocation of non-TXIX SMI funding for FY2013; creating an exciting opportunity to advance our system transformation efforts towards a peer-driven system of care focused on outcomes. Magellan Health Services and our community of service delivery partners have evolved this implementation and oversight plan based on analysis of system needs in conjunction with review of expectations articulated in Dr. Laura Nelson’s letter. We also considered the experience of the past two years, in which non-TXIX individuals with a serious mental illness have received a very limited benefit within our system of care. We have learned the following: 1. Based upon a clinical analysis of risk factors, utilization, crisis presentations, community tenure, independent living and many other elements, we have observed that many individuals fared well and are realizing better outcomes than they did two years ago; 2. However, we have also observed a group of 5% to 17% of NTXIX SMI individuals who have struggled without the intensive level supports they received in the past (Assertive Community Treatment, etc.); 3. Multiple community forums and stakeholder feedback sessions facilitated by ADHS/DBHS and Magellan Health Services have called for a shift to a peer-driven “system of care” (advancing beyond peer-driven services); 4. We must have the ability to appropriately encounter for services; and 5. DBHS guidance and court orders shift focus from case manager assignments to case management as a service with clinical review. We have carefully analyzed and reflected upon these learnings and considered how to provide appropriate supports while avoiding caretaking approaches that might undermine recovery and independence. In addition, over the last several months we have engaged the provider community in a planning process to prioritize funding and develop consensus about the strategy (with a group including the Peer-Run Organizations, the Adult PNOs, key GMH/SA agencies and others). We believe the leadership and guidance from DBHS and this Magellan/community proposal dramatically extends a recovery approach and moves us toward a “peer-driven system of care” that will achieve far better outcomes for individuals where they live, work and play. The following table outlines our broad funding category targets for the $54.4 million FY2013 NT SMI allocation: Magellan's NTXIX SMI Funding Allocation (excludes $1.7 million for supported housing) Crisis Services Medications NTXIX Services Total $9.8 Million $18.2 Million $26.5 Million $54.5 Million 1. The budget includes $1.7 million of State funds for supported housing and an additional $2.5 million of federal funds is leveraged for a total of $4.2 million in supported housing (which represents 14% of the total NTXIX SMI housing and services budget);
  4. 4. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 4 2. Crisis services allocation was set by DBHS at $9.8 million based on last year’s budget; 3. The medication management budget increase of approximately $1 million is based on the impact of an expanded formulary, projected increase in number of utilizers on brand medications, trending increase in lab expenditures and the new prior authorization process; and 4. The funding allocation of these first two items left a remainder of $26.5 million for NTXIX SMI community-based support services. PLAN HIGHLIGHTS We see DBHS’s investment in the NTXIX SMI population as an opportunity to re-emphasize our shared commitment to community integration, independence and self-sufficiency, individualized goals and outcomes, responsive services, natural supports and recovery. This plan: 1. Offers an enhanced service benefit to individuals in the non-title XIX SMI population; 2. Significantly expands the volume of peer & family member-delivered services with $13.5 million of new funding (51% of the total allocation); • 94 FTEs in new peer and family support jobs at the SMI clinics; • 39% expansion of service funding to peer-run organizations; designed to create new jobs and shift to more community-based/in-home supports such as ILS and personal care services that augment existing facility-based programs; and • RFP opportunities for SMI family support provider and respite provider. 3. Augments resources at the human service campus for individuals experiencing homelessness; 4. Offers funding flexibility to move designated service dollars within the targeted service delivery areas based on the needs of the population; 5. Empowers individuals to move through the system toward ownership and equity of their lives (see Recovery Empowerment Continuum, page 7); and 6. Establishes a constellation of services to support an individual’s unique recovery journey. The unique funding allocation and service delivery design features of this plan create an opportunity for peers to deliver a broader range of services to more people in more settings than ever.
  5. 5. Page 5 Magellan Health Services II. BUDGET AND SERVICE EXPECTATIONS $26.5 million of the $54.5 million DBHS-allocated NTXIX funds is targeted towards the delivery of services other than crisis, supported housing and medication. Please note that in addition to the $1.7 million of State funds designated to supported housing, Magellan has leveraged an additional $2.5 million in HUD Federal Funds / McKinney Vento Funds for supported housing to total of $4.2 million in this fiscal year for NTXIX SMI individuals. Our model of service delivery has been crafted to align with the needs of the target population and the articulated DBHS service-delivery objectives contained within Dr. Laura Nelson’s letter. The NTXIX SMI Service Funding Distribution for FY2013 table of page 7 outlines Magellan’s targeted funding allocation for each identified service area, service provider categories and the number of individuals served by those providers. FUNDING ALLOCATION FRAMEWORK Projecting the service utilization pattern for the current NTXIX SMI population is challenging since these individuals have not been able to access many of the targeted services over the past two years. Within the NTXIX Service Funding Distribution for FY2013 table of page 8, one will find that a majority of the funding is allocated to establishing resources (such as peer support) in lieu of a more limited service category (such as ILS). Those funded resources will then deliver a multitude of service types within the funded roles. DBHS’s vision to support flexible funding allocations that may adjust between specific service categories through the fiscal year aligns with Magellan’s view of a model that most efficiently meets the needs of this population. Potential movement will be based an ongoing need analysis throughout the fiscal year and proactive dialog with DBHS around the NTXIX SMI population’s monthly service utilization patterns. While $2.75 million (10.4% of service dollars) is dedicated to the delivery of independent living skills (ILS) training and personal care, the allocation of (1) $1.93 million for peer support within the PNOs, (2) $3 million for peer-run organizations, (3) $1.38 million for peer- delivered health promotion, and (4) $400,000 of peer-delivered permanent supportive housing support all contribute additional peer resources that may provide support for ILS and personal care issues based on need; resulting in a range of $2.75 million (10.4%) to $9.5 million (36%) for ILS and personal care for the NTXIX SMI population. Please note that living skills training represents 24% of peer-run organization encounters during the past year. That would lead to a projection that $730,000 of their allocated $3 million would go towards the delivery of living skills training. Please see the table of the following page for a listing of potential peer-delivered service codes. ILS & Personal Care Svc Peer Run (Dedicated ILS Funds) Peer- Delivered Health Promotion Peer Run (From $3M in Funds) Peer Support at PNO Provider Community
  6. 6. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 6 Services Available Under a Peer Support Staff Member Code Description Code. Description. H0038 Self-Help/Peer Services (individual) H2027 Psychoed. Services (Pre-Job Training & Dev.) H0038 HQ Self-Help/Peer Services (Group) S5110 Home Care Training, Family (Family Support) H0043 Supported Housing S5150 Unskilled Respite Care (15 min) H2014 Skills Training and Development - Individual S5151 Unskilled Respite Care (per diem) H2014 HQ Skills Training and Development - Group T1016 HN Case Management, Office H2016 Comprehensive Community Support Services (Peer Support) T1016 HN Case Management, Out of Office H2017 Psychosocial Rehabilitation Services (Living Skills Training) T1019 Personal Care (15 min) H2025 Ongoing Support to Maintain Employment (15 min) T1020 Personal Care (per diem) H2012 Supervised Behavioral Health Day Treatment H2015 Comprehensive Community Sup. Day Prg. H2026 Ongoing Support to Maintain Employment (per diem) S0215/AO120 Transportation Codes (Restrictions Apply) SUPPORTED HOUSING Magellan is committed to the delivery of supported housing through practices that align with the SAMHSA evidence-based practice of Permanent Supportive Housing. The $1.7 million referenced in this plan will be augmented by the leveraging of $2.5 million in HUD Federal Funds / McKinney Vento Funds for a total of $4.2 million dedicated to supported housing. This funding will be used to (1) provide housing to 107 NTXIX SMI individuals and their families and (2) provide housing support to the 292 NTXIX SMI individuals currently housed through ABC. For many people who have been homeless or marginally housed and living with a serious mental illness, affordable housing combined with supportive services has proved to be the link to stability and an enhanced quality of life. As its name implies, permanent supportive housing is the following: 1. Permanent: Tenants may live in their homes as long as they meet the basic obligations of tenancy (such as paying rent); 2. Supportive: Tenants have access to the support services that they need and want to retain housing; and 3. Housing: Tenants have a private and secure place to make their home; just like other members of the community with the same rights and responsibilities (SAMHSA). Please refer to Magellan’s SFY2013 Housing Spending Plan and Summary, which was submitted for DBHS review on June 29, 2012, for a more detailed view of the supported housing plan. The remainder of this plan focuses on the supportive services ($26.5 million) which augment the bricks and mortar as well as administrative elements necessary to acquire and keep affordable housing. All of these services contribute to the supportive element of the permanent supportive housing model. Magellan believe that the combination of funding allocations defined within the following NTXIX SMI Service Funding Distribution for FY2013 table (next page) and the fiscal flexibility of the plan contribute to delivery of services in a manner consistent with the evidence-based practice. It could be said that the entirety of this FY2013 NTXIX SMI budget supports permanent supportive housing as defined above by SAMHSA.
  7. 7. Page 7 Magellan Health Services NTXIX SMI Service Funding Distribution for FY2013 Service Type Category Ratio # Served Resources Allocated Cost % of Cost Assertive Comm. Treatment Com. Svc-PNO 12:1 400 1 New Team + 300 Vacancies $1,437,500 5.4% Supportive Case Management CM - PNO 30:1 1,200 40 CMs and 5 CCs $2,415,000 9.1% Connective Care Coordinators Fac. Svs-PNO 100:1 4,300 43 NTXIX Tx Coordinators $2,760,000 10.4% Peer Support Specialists Peer - PNO 100:1 5,900 43 Peer Support Specialists $1,928,000 7.3% Peer Run Organizations Peer Run n/a 5,900* 39% of TXIX SMI Funding $3,000,000 11.3% Health Promotion Peer - PNO 200:1 5900 30 Peer Wellness Coaches $1,380,000 5.2% Crisis Navigator Com. Svc - Pro n/a 5,900* Program Expansion $200,000 0.8% Family Mentors Family - PNO 200:1 5900 30 Family Mentors $1,380,000 5.2% Family Support RFP (Peer Run) n/a 5,900* RFP for Family Support $1,200,000 4.5% Supported Employment Emp & Peer n/a 5,900* $500K Sup. Emp. & $2M Peer Emp Svcs $2,500,000 9.4% Life Skills Training Com. Svc -Peer Run n/a 5,900* ILS In-home support services $1,500,000 5.7% Personal Assistance Com. Svc - Pro n/a 5,900* Providers with min. $400K peer-delivered $1,250,000 4.7% Respite Com- Svc - RFP n/a 5,900* $1,000,000 3.8% Human Service Campus Com. Svc –Pro & PR n/a 5,900* $250k Coord & $100k Peer $350,000 1.3% Transportation Com. Svc - Pro n/a 5,900* $2,000,000 7.6% Supported Housing (Services) HOPE Network n/a 107 Peer Supp., ILS & Pers Care for ABC $400,000 1.5% Administration RBHA n/a 5,900* 6.64% $1,759,000 6.6% Total *Based on June 2012 enrollment $26,459,500 $30,626,500 with housing Supp Housing (in housing plan) ABC n/a 399 In Housing Plan: $1.7M AZ & Fed Leverage of $2.5M $4,200,000 13.7% if part of this plan
  8. 8. Page 8 Magellan Health Services NTXIX SMI FUNDING ALLOCATION RATIONALE NTXIX SMI funding guiding principles: 1. Evolve a peer-driven system of care; 2. Offer assertive community treatment (ACT) and supportive case management to those determined at-risk for safety and successfully managing themselves in the community due to treatment non- adherence, severity of symptoms or inability to independently coordinate their own care or transition between systems; 3. Fund to establish resources (FTEs and programs) that offer the flexibility to deliver an array of services based on the needs of the population throughout the fiscal year instead of silos of service need; and 4. Promote community-based support services that enhance an individual’s quality of life in their community of choice; where they live work and play. PEER-DRIVEN SYSTEM OF CARE The allocation of NTXIX funding is being used to evolve a peer-driven system of care. $13.5 million (51% of new service funds) in expanded peer and family roles and services will dramatically shift the focus towards community integration, independence, individualized goals, responsive services, natural supports and recovery. To date, almost all peer-delivered services are offered through peer-run organizations; resulting in a siloed resource that has limited peer engagement in the care of most individuals with a serious mental illness. During the past year, approximately 8.4% (1,210) of the 14,330 individuals in the TXIX SMI population have three or more encounters from a peer-run organization while 91.6% (13,120) were not engaged in services through the peer-run organizations. The same adoption rate for the NTXIX SMI population would result in fewer than 500 individuals engaged in peer-delivered services and 5,400 without that valuable engagement and support. Conversely, 100% of individuals with a serious mental illness receive services from an adult PNO that is minimally staffed with only one dedicated peer support specialist at each clinic (clinics that each serve more people than any peer-run organization). • In FY2012, Peer-run organizations served less than 9% of the TXIX SMI population • Three of the five peer runs encounter 60% of funding or less versus system average of 90% • A siloed approach has resulted in limited engagement by peers for most individuals with SMI • Peer runs must expand from facility- based services providers with group community recreation activities to providers who deliver independent living skills (ILS) training, job coaching, and personal care services in the community (including in-home)
  9. 9. Page 9 Magellan Health Services Magellan believes that peer-run organizations and peer support specialists with the PNO possess a tremendous potential to expand from facility-based services providers with group community recreation activities to providers who deliver independent living skills (ILS) training, job coaching, and personal care services in the community. This proposal is designed to advance peers as an integral part of the service delivery system within the clinical home of the population; touching 100% of individuals. Magellan’s Recovery Empowerment Continuum outlines a vision of a peer-driven system of care. This NTXIX SMI Implementation and Oversight Plan is designed to advance central Arizona’s behavioral health system of care along that continuum; applying a data driven service-delivery design that focuses on realizing meaningful outcomes for those engaged within the system of care. Elements of the plan that support positive movement along the Recovery Empowerment Continuum include the following funding allocations for peer and family-delivered services: 1. 51% of NTXIX SMI service funds have been allocated to peer and family-delivered services; 2. $5.8 million has been allocated to fund peer and family-run organizations: a. Extension of all peer-run organization services to the NTXIX SMI population ($3 million); b. An RFP for a family support service provider in the SMI system ($1.2 million); c. Independent living skills (ILS) services ($1.5 million); and d. Peer Outreach at the Human Service Campus ($100k). 3. $4.7 million to fund PNO peer and family-delivered services: a. 43 FTEs in Peer Support Specialists; b. 30 FTEs in Peer Wellness Coaches; c. 1 FTE in ACT Peer Specialist; and d. 30 FTEs in Family Mentors. 4. $3 million to existing network providers: a. Peer job coaching ($2 million); b. Hope Network / MARC peer-support for permanent supportive housing ($400,000); c. Peer-delivered personal care ($400,000); and d. Crisis Navigator program expansion ($200,000). Peer & Family Support Funding Allocations Provider Type Funding Allocation % of Peer Funding Peer or Family Run $5,800,000 43% PNO $4,688,000 35% Provider $3,000,000 22% Total $13,488,000 100% This proposal increases the overall size of the peer-run organizations by over 400% since FY2008: • FY2008 - $3.5 million (included TXIX and NTXIX) • FY2012 - $8.7 million • FY2013 - $15.0 million (up $6.3 million as a function of this proposal)
  10. 10. Page 10 Magellan Health Services
  11. 11. Page 11 Magellan Health Services PEER WORKFORCE DEVELOPMENT Over the past 18 months, 360 peer support specialists have been trained and certified by existing peer- run training programs throughout Maricopa County. The agencies providing this training have demonstrated both the capacity and commitment to continue development of a peer workforce; fostering the existence of a well trained and sustainable workforce to draw from within this evolving system of care. Additionally, ADHS/DBHS is in the process of developing a statewide peer training certification. In partnership with the Magellan Recovery and Resiliency department, the Learning and Performance department will review all current peer certification training programs to ensure that they align with the evolving peer certification standards of ADHS/DBHS; specifically the incorporation of Concepts of Hope and Recovery, Advocacy and Systems Perspective, Psychiatric Rehabilitation Skills, and Professional Responsibilities of the Peer Support Employee and Self Care in the Workplace. To augment and enhance approved peer certification training, peer support specialists will also participate in new employee orientation (NEO) through the Magellan Learning and Performance department. Magellan has evolved a blended NEO format that combines classroom, online and field learning into a comprehensive development program. This orientation is designed to meet all topics set forth by PM 9.1 requirements and effectively incorporates coaching/mentoring of new employees through the use of the Field Education Competency Checklist (FECC). Magellan is able to track and report training compliance via our learning management system, Achieve. NTXIX SERVICE DESCRIPTIONS AND TARGETS NTXIX SMI Service Intensity Allocation ($6.6 Million or 25% of Services Funded) The proposed allocation of NTXIX service-delivery dollars represents a movement away from a primary reliance on case management to one that establishes a greater role for peer and family services in the community. These services provide vital supports as individuals move toward independence and are less reliant on caregivers. Clinical need for assertive community treatment, supportive case management or connective care coordination services will be evaluated through an individualized assessment process completed by the BHMP for each Non-Title XIX SMI individual. Magellan will provide Level of Care Guide (LCG) algorithm data sets to support individualized need assessment and prioritization of the case management assignment process. 20% of funds are allocated to case management staffing (supportive case management and connective care coordination) and 5% are dedicated to ACT (community-based service delivery).
  12. 12. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 12 DATA DRIVEN SERVICE INTENSITY ANALYSIS The analysis is being used to guide the evaluation of optimal level of service intensity based on 15 unique risk characteristics of every individual enrolled in SMI services. The risk data set includes the following 10 service utilization elements: 1. Current level service intensity, 2. Days in level of service intensity, 3. Level I admissions past year, 4. Level I days past year, 5. Level I admits prior year, 6. Level I days prior year, 7. Psych ER past year, 8. UPC contacts prior year, 9. Incarcerations prior year, 10. Number of medications prescribed. Each service utilization element is valued and weighted to estimate the individual’s current clinical need. The potential compounding impact of multiple hospitalizations, psychiatric ER visits or incarcerations as well as the affiliated inpatient days have the potential to greatly influence the calculated reflection of clinical need. Service utilization data is partnered with the following five valued and weighted individual functioning measures to offer a more comprehensive analysis of clinical need by the Level of Care Guide: 1. Global assessment of functioning (GAF), 2. Employment and rehabilitation activities, 3. Primary residence, 4. Frequency of substance use, and 5. Medical conditions. The chart at right reflects the results of the risk analysis for both the TXIX and NT SMI populations. Higher scores reflect more acuity and lower functioning, as evidenced by hospitalizations, etc. Scores below 30 reflect higher levels of independence and community tenure. This analysis of risk factors is being utilized as an important starting point in the conversation to prioritize individuals and inform the discussion of service intensity. The risk analysis is being utilized as an important starting point in the conversation to prioritize individuals and inform the medical and clinical discussion. It does not dictate the service intensity but is a guide to prioritize and inform screening. NTXIX SMI Service Intensity Analysis
  13. 13. Page 13 Magellan Health Services The evaluation process used to identify level of service intensity assignment applies the case management affiliation guidance established by DBHS as well as existing assertive community treatment (ACT) criteria to advance individualized recommendations for members of the NTXIX SMI population. This process is articulated in the Implementation Plan section of this document; targeting service intensity allocation as depicted in the graphic below. The determination of service intensity need / clinical appropriateness will be documented as follows: • Document on the initial comprehensive assessment upon completion of the assessment; • Document on the annual update to the assessment upon completion of the annual update; and • Document in the psychiatric progress note at any time between comprehensive assessments when it is determined that (a) the person qualifies for assignment to an identified case manager or (b) the person no longer qualifies for assignment to an identified case manager. ASSERTIVE COMMUNITY TREATMENT (ACT) Assertive community treatment (ACT) is not case management but rather an array of services provided by community-based, mobile mental health treatment teams to seriously mentally ill persons in vivo, seven days a week and 24 hours a day. Team composition consists of a clinical coordinator, psychiatrist, nurse, team specialists (rehabilitation, employment, housing, independent living, substance abuse, peer, and transportation), and behavioral health technicians. 400 NTXIX SMI individuals (7% of the population) are targeted to receive ACT services. This plan maximizes the use of current team vacancies to efficiently offer access to ACT services within an individual’s community of choice and the opportunity to receive services from any of the four adult provider network organizations (PNOs). 310 vacancies currently exist within the system’s 14 ACT teams and capacity to serve another 108 individuals can be realized by establishing an additional ACT team at a cost of $1.4 million. Magellan and our system partners believe this plan best aligns with recipient choice and fiscally responsible management of our system of care. As you will see in the chart below, demand
  14. 14. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 14 for ACT services has steadily declined over the past 18 months; suggesting these current team vacancies are a viable resource for re-allocation to the NTXIX SMI population. SUPPORTIVE CASE MANAGEMENT Case management is a supportive service provided to enhance treatment goals and effectiveness. Supportive case management is delivered and coordinated by multi-disciplinary staff based in mental health centers in various locations throughout Maricopa County. It is a recovery-focused and outcome oriented model of community psychiatric treatment. Interventions are designed to foster learning and growing in a supportive community atmosphere, focusing on consumer strengths as the springboard for all service planning and delivery. 1,200 NTXIX SMI individuals (20%) are targeted to receive supportive case management services. Clinical need for supportive case management assignment will be evaluated using the process articulated earlier in this plan. Magellan will track and confirm the aforementioned clinical and medical evaluations take place for each individual. We anticipate that supportive services will be available to NTXIX individuals at any SMI clinic they choose based on team availability (capacity) at a cost of $2.4 million. 462 435 377 317 291 286 155 106 166 188 221 243 272 288 310 68% 83% 80% 85% 91% 87% 89% 92% 91% 91% 92% 95% 91% 96% 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 65% 70% 75% 80% 85% 90% 95% 100% Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Current ACT Fidelity and Capacity (Includes Non-Title XIX Benefit Reduction July 2010) Census Available Capacity Fidelity Audit In July of 2010, 520 NTXIX SMI individuals lost their ACT services due to a reduction in benefit. A list of these individuals will be provided to the PNOs with an expectation that they be prioritized for assessment into ACT or supportive services based on their current clinical needs. Existing ACT criteria will be used to support the evaluation process and referrals to ACT teams will occur within the established practices of internal PNO referral and emergent level I ACT referrals.
  15. 15. Page 15 Magellan Health Services CONNECTIVE CARE COORDINATORS A majority of NTXIX SMI individuals will be assigned to connective care coordination services (29% targeted to receive ACT and supportive case management) with a connective care coordinator (40 FTEs total) at a staffing ratio of 100:1. These connective care coordinators, who may be either behavioral health technicians or behavioral health professionals, will be paired with a peer support specialist in the delivery of services (functionally lowering the individual to staff member ratio to 50:1) at a cost of $2.8 million. Unlike higher levels of service intensity (supportive and ACT) in which a case manager is assigned, coordinators will not have minimum contact expectations nor will they be developing service plans with their assigned individuals. The connective care coordinator (CCC) will serve like an air traffic controller who refers individuals to service providers based on their service plan. Primary referrals for support or engagement will go to the paired peer mentor who will reach out the CCC when he/she is unable to deliver those services themselves or unable to engage community resources to meet the person’s needs. Since many have demonstrated a high-degree of self-sufficiency as they progressed down their unique path to recovery, assignment to traditional supportive case management is not clinically appropriate and may in fact hinder recovery. Therefore, peers will not necessarily deliver services to all 100 assigned individuals but will be connected by the CCC when a need has been identified. Magellan will monitor the services delivered by these care coordinators through internal reporting (please see Provider Monitoring and Oversight – Utilization) to ensure they do not default into defacto case managers. The Peer Mentors and Connective Care Coordinators will work as a team. We are narrowing the scope of responsibilities of the Care Coordinator and broadening the role of the Peer Mentor. They will work together to engage and collaborate with the NTXIX SMI based upon specific level of need at any point in time. The table below outlines the anticipated array of services and the way this teaming will work: As is true of all NTXIX SMI individuals, this population will be able to access expanded NTXIX services; including $2 million in transportation funds to support participation in covered service activity. CCoommppaarriissoonn ooff PPeeeerr aanndd CCoonnnneeccttiivvee CCaarree CCoooorrddiinnaattoorr RRoolleess PPeeeerr MMeennttoorr 4433 PPeeeerr MMeennttoorrss ((11::110000)) CCoonnnneeccttiivvee CCaarree CCoooorrddiinnaattoorr 4433 CCoonnnneeccttiivvee CCaarree CCoooorrddiinnaattoorrss ((11::110000)) Lead Roles Joint Development of ISRP Medical Management Coordination Outreach and Engagement Triage Emergent, Urgent, and Routine Needs Collaboration and Peer Support Community Referrals Discharge Follow-up Point of Contact for Discharge Planning ILS and Personal Care Services Coordination of Care Advocacy Connect to support and rehab services Family Engagement Increase Self-Management & Independence
  16. 16. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 16 PEER SUPPORT SPECIALISTS Peer Worker refers to an individual who is, or has been, a recipient of behavioral services and who currently provides behavioral health services to individuals enrolled in the public behavioral health system. The peer worker may be either an employee or volunteer/unpaid. Services that may be provided by a peer worker vary depending on the peer worker’s education and experience. For example, a peer worker who is also behavioral health professional can provide all of the treatment and support services that the agency is able to provide under the agency’s OBHL license or the agency’s ADHS/DBHS Community Services Agencies Title XIX certification. Peer Workers may have job titles such as Peer Support Specialists, Recovery Guides, Recovery Specialists, etc. This budget funds the infusion of 74 FTEs of peer support within the adult PNOs at a cost of $3.3 million and another $5.8 million to peer and family-run organizations; supporting the evolution of a peer-driven system of care. 4,600 NTXIX SMI individuals in connective care coordination (any not assigned ACT or supportive case management) will be assigned a peer support specialist at a ratio of 100:1 and all NTXIX SMI individuals will be able to access peer wellness coaches staffed at a ratio of 200:1. Magellan anticipates that these individuals will provide ILS training and personal care services in support of our supported housing model. PEER RUN ORGANIZATIONS A peer-run service is an independent organization that is owned, administratively controlled, and operated by mental health consumers. It may offer a range of services, but it emphasizes self-help and recovery. Consumer-operated services are an evidence-based practice (EBP) that have consistently demonstrated effectiveness in helping people with mental illness achieve their desired goals. Peer-run organizations are allocated $5.8 million to: 1. Extension of all peer-run organization services to the NTXIX SMI population ($3 million); 2. An RFP for a family support service provider in the SMI system ($1.2 million); 3. Independent living skills (ILS) services ($1.5 million); and 4. Peer Outreach at the Human Service Campus ($100k). PEER SUPPORTED SERVICE PLANNING An individualized service plan will be developed in collaboration with the service recipient per Provider Manual section 3.9 when the NTXIX individual is engaged in ACT or supportive case management services. The service planning process will be documented in Clinical Advisor (the electronic health medical record). For those individuals in Connective care coordination, the existing process and requirements for documenting the service plan by the behavioral health medical Professional (BHMP) can be used. However, individuals shall have the option of accessing peer support services to assist them in developing a peer-driven, self-developed service
  17. 17. Page 17 Magellan Health Services plan to be shared with the BHMP. Peer supports working within the PNO sites and staff employed by peer-run organizations will be engaged to support the service planning process. Magellan has already solicited PNO and peer-run involvement in workgroups to evolve a format that can be shared throughout the behavioral health community. HEALTH PROMOTION Health promotion services are education and training activities provided to an individual or a group of persons and/or their families related to the enrolled person's treatment plan. Education and training sessions are usually presented using a standardized curriculum with the purpose of increasing an individual’s behavioral knowledge of a health-related topic such as the nature of an illness, relapse and symptom management, medication management, stress management, safe sex practices, HIV education, parenting skills education and healthy lifestyles (e.g., diet, exercise). Magellan is allocating $1.38 million to hire 30 peer wellness coaches within the PNOs to support delivery of health promotion services. For example, these peer wellness coaches with their focus on healthy living and lifestyles may help coordinate with prenatal classes and/or prenatal nutrition for single or pregnant mothers. CRISIS NAVIGATOR The Crisis Transition Navigator (CTN) program is a 24/7 short-term community-based service program delivered by trained and highly skilled peers. The CTN does not provide treatment services to the individual, but rather serves as a “bridge” by coordinating and monitoring RHBA and Community based resources and arranges for delivery of these necessary services and supports. The goal of the CTN is to provide willing recipients with; natural supports, pre-crisis planning, wellness plans and access to post- crisis services designed to successfully navigate them through their current crisis episode and reduce the likelihood of experiencing future crisis events. Magellan is allocating $200,000 to extend crisis navigator service capacity. FAMILY MENTORS Family mentors help to create and facilitate a variety of family group activities that support and strengthen a family’s journey of recovery. Family mentors model Magellan’s Core Principals of Recovery & Resiliency to raise awareness and educate staff to reduce stigma in a family member’s journey of recovery. Family mentors will offer support to families through activities that align with the SAMHSA evidence-based Family Psychoeducation model. In preparation of the transition from Child and Adolescent services to the Adult Services for people with serious mental illness, family mentors may attend the individual’s Child & Family Team (CFT) meetings; assisting the family in identifying its family culture and concerns identified as they transition into the adult system of care. Family mentors offer referrals to agencies whose primary focus is family support when the recipient has a child engaged in services and offer support to enroll a child when assistance is requested. Additionally, family mentors will develop a knowledge base and contacts in community resources to assist families and provide
  18. 18. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 18 consultation to members of the clinical team. $1.38 million of funding is allocated to the hiring of 30 additional family mentors within the adult PNO clinics. FAMILY SUPPORT Home care training family services (family support) involves face-to-face interaction with family member(s) directed toward restoration, enhancement, or maintenance of the family functioning to increase the family’s ability to effectively interact and care for the person in the home and community. May involve support activities such as assisting the family to adjust to the person’s disability, developing skills to effectively interact and/or manage the person, understanding the causes and treatment of behavioral health issues, understanding and effectively utilizing the system, or planning long term care for the person and the family. Magellan has allocated $1.38 million to the adult PNOs to hire 30 additional family mentors and plans on issuing a competitive RFLOI for an additional $1.2 million to a peer or family-run organization to deliver family support services. The RFLOI will be utilized to engage a multitude of family-support organizations; including those who may not be current service providers within Magellan’s system of care. SUPPORTED EMPLOYMENT Magellan will be implementing a supportive employment model consistent with SAMHSA’s Supported Employment evidence-based practice. Supported Employment (SE) is an approach to vocational rehabilitation for people with serious mental illnesses that emphasizes helping them obtain competitive work in the community and providing the supports necessary to ensure their success in the workplace. SE programs help consumers find jobs that pay competitive wages in integrated settings (i.e., with other people who don’t necessarily have disabilities) in the community. These services are defined within the Covered Services Guide as services and ongoing support to maintain employment services are designed to assist a person or group to choose, acquire, and maintain a job or other community activity. Magellan has allocated $500,000 to supported employment providers and an additional $2 million for peer- delivered employment services. LIFE SKILLS TRAINING Life skills training services include teaching independent living skills (ILS), social and communication skills to persons and/or their families. These skills are taught to individuals so they can maximize their ability to live and participate in the community and to function independently. Examples are the areas of self- care, household management, socializing, friendships, budgeting, and development of social networks, recreation, and avoidance of exploitation and the use of community resources. Magellan has allocated $1.5 million to ILS in-home support services delivered through peer-run organizations. In addition to the $1.5 million, this plan was drafted with a belief that funding for peer support services would also translate into the delivery of life skills training services from both peer-run and the adult PNO peer employees.
  19. 19. Page 19 Magellan Health Services PERSONAL ASSISTANCE These services involve the provision of support activities to assist a person in carrying out daily living tasks and other activities essential for living in a community. These services may include assistance with homemaking (cleaning, food preparation in accordance with requirements in A.A.C. R9-20-407, essential errands), personal care (bathing, dressing, oral hygiene) and general supervision and appropriate intervention (assistance with self-administration of medications, in accordance with requirements in A.A.C. R9-20-408, and monitoring of individual’s condition and functioning level). Magellan has allocated $1.25 million to support delivery of personal assistance; including 1:1 and supported housing provider supports. In addition to the $1.25 million, this plan was drafted with a belief that funding for peer support services would also translate into the delivery of personal assistance services from both peer- run and the adult PNO peer employees. RESPITE "Respite" means short term behavioral health services or general supervision that provides rest or relief to a family member or other individual caring for the behavioral health recipient or for the recipient. Respite services are designed to provide an interval of rest and/or relief to the family and/or primary care givers or the recipient receiving services and may include a range of activities to meet the social, emotional and physical needs of the behavioral health recipient during the respite period. These services may be provided on a short-term basis (i.e., few hours during the day) or for longer periods of time involving overnight stays. Respite services will be available on an in-home and out-of-home basis to caregivers, recipients and co- habitants which will provide rest and/or relief as well as a wide range of activities to meet the social, emotional and physical needs of the recipient(s). These services will be provided on a non-routine basis and will be available for periods of a few hours to overnight depending on the needs and circumstances. Respite services can be planned or unplanned. If unplanned respite is needed, the appropriate agency personnel will assess the situation and, with the caregiver, recommend the appropriate setting for respite. Magellan has allocated $1 million for the delivery of respite services. HUMAN SERVICE CAMPUS (PEER AND COORDINATION) Provide peer support and outreach services to enrolled SMI recipients that have found themselves homeless or without adequate services. The Human Services Campus provides a comprehensive service array such as shelter (CASS), case management for mental health and substance abuse, food services, medical & dental assistance, housing assistance, government benefits, IDs, legal assistance and employment services. The additional peer support services will assist recipients navigate the HSC services, offering groups, classes and one on one peer support.
  20. 20. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 20 Magellan currently has Crisis Transition Navigators and an SMI Evaluator co-located at the Lodestar Day Resource Center (LDRC) and shelter on the Human Services Campus. Magellan will expand the existing coordination services by adding behavioral health professionals that can help coordinate care for enrolled individuals, conduct additional SMI evaluations and provide crisis intervention services on-site when needed. $250,000 has been allocated for the delivery of coordination activities and an additional $100,000 to augment peer support services on the human service campus. TRANSPORTATION Magellan is allocating $2 million for the delivery of transportation services to support access to covered behavioral health services. Access to non-emergency transportation may be a necessary support service for non-Title XIX/XXI SMI members to access the multitude of covered services defined in this plan. Non-emergency transportation for non-Title XIX/XXI SMI members may be covered as a support service with the following limitations: • Transportation is covered only to and from providers of covered behavioral health services; • Transportation is covered only when no other means of transportation are available to the member to access covered behavioral health services; and • Only the most cost effective mode of transportation that meets the individual clinical needs of the member will be covered. The determination of the appropriate mode of transportation must be based upon the functional limitations of the member, and not as a matter of convenience for the member. SUPPORTIVE HOUSING FOCUS – HOPE NETWORK The goal of the Hope Network is to provide the wraparound support to participants, who have a housing voucher through Arizona Behavioral Health Corporation, in maintaining housing self-sufficiency over the course of the program (one year) through interventions focused on evidence-based treatment, wellness and recovery. All practices were selected to harmonize with the overall project goals of housing stability and self-sufficiency, and share the common theme of highly individualized and flexible approaches that assist persons who are considered chronically homeless, in obtaining and maintaining their housing. All models embrace a stage of change using a recovery approach to working with individuals who are homeless and may have co-occurring disorders. The heart of the program is the Hope team, a specialized services delivery team blending Behavioral Health Professionals, Benefit Specialists and Recovery Coaches who have experience in homelessness and mental health/substance abuse services. This team works to improve access, coordination and engagement in services in partnership with the Clinical Team and whomever the person chooses. Hope Network helps to provide stable housing and services for 100 adults each year though the provision of peer support, ILS, and personal care services. Magellan is allocating $400,000 for delivery supports to the 107 NTXIX SMI individuals who will be housed through ABC.
  21. 21. Page 21 Magellan Health Services III. IMPLEMENTATION PLAN SCREENING AND ASSIGNMENT PHASE By September 30th 2012, each non-TXIX eligible adult with a serious mental illness will be screened to determine their optimal service intensity affiliation. The adult PNOs will use specific criteria (see attached NTXIX Service Intensity Assignment Screening) and available resources (such as the Service Intensity Risk Analysis) to determine member assignment to assertive community treatment (ACT), supportive case management or connective care coordination. The screening process will include: 1. A face-to-face evaluation by the BHMP who will use the Case Management Needs Checklist and ACT Criteria Checklist to assess the person’s degree of clinical need. Again, each BHMP will be given the individual’s service intensity data analysis results, suggesting where the conversation might naturally start (Assertive Community Treatment, etc.); 2. BHMP recommendation for level of service intensity assignment (ACT, Supportive or Connective) will be documented on the NTXIX Service Intensity Assignment Screening. BHMP will sign and date the document; 3. Distribution of the NTXIX Service Intensity document to communicate information regarding each of the service delivery models. A copy of the NTXIX Services Letter will also be provided; 4. A NTXIX Service Intensity Assignment Screening that captures the dated signature of the service recipient to indicate whether the person agrees or disagrees with the recommended level of case management assignment; and 5. Review and delivery of the Notice of Decision (PM form 5.5.1) which will include a statement regarding the individual’s right to appeal the BHMP recommendation. The aforementioned screening will be documented in the Clinical Advisor medical record and confirmed by Magellan Health Services of Arizona staff. NTXIX individuals with a serious mental illness who receive a recommendation for ACT services and agree to that level of service, will be referred to an ACT team for a formal evaluation. Persons who receive a recommendation for supportive case management and agree to that level of service intensity will be assigned a case manager. Individuals who receive a recommendation of connective care coordination and agree to that level of service intensity will begin receiving connective care coordination services. All NTXIX SMI individuals will be provided with information on available services. Please refer to attached documents designed for use in the assessment process. o Attachment A: NTXIX Service Intensity Assignment Screening o Attachment B: NTXIX Service Intensity Document o Attachment C: NTXIX Services Letter o Notice of Decision (PM form 5.5.1) o
  22. 22. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 22 COMMUNICATIONS PLAN Please see attached communication plan and affiliated documents. o Attachment B: NTXIX Service Intensity Document o Attachment C: NTXIX Services Letter o Attachment D: NTXIX Benefits Increase Communication Plan DBHS PARAMETERS ADHS/DBHS has identified a core set of expectations associated with the allocation of NTXIX SMI funds. The tables in this section highlight Magellan’s plan to specifically address these DBHS expectations. NTXIX SMI Implementation and Oversight Plan – Assertive Community Treatment (ACT) Task # DBHS Parameter Plan Target Date 1.a.i. Specify ACT Criteria Individuals will be evaluated for ACT services based on the existing ACT Admission Criteria which is consistent with the evidence-based practice established by SAMHSA. Completed 1.a.ii. Prioritize individuals who lost ACT (7/2010) Magellan will provide a list of the 520 NTXIX individuals who were transitioned off of ACT services to each PNO. 7/6/12 PNOs to complete ACT screening for these individuals during their next appointment. 8/31/12 1.a.iii. Future Screening for ACT Individuals will be evaluated for ACT services based on the existing ACT Admission Criteria which is consistent with the evidence-based practice established by SAMHSA. Begin 7/9/12 and Ongoing Magellan will distribute LCG data sets and algorithm scores to PNOs on a quarterly basis to support evaluation of clinical need. 7/6/12 1.a.iv. Current ACT Capacity There are currently 14 ACT teams with a capacity to serve 1,512 individuals. The current ACT census of 1,202 leaves 310 vacancies within the system and we propose the addition of a 15th ACT team to expand capacity to 418. Please refer to the table below for ACT capacity by clinic. Contract 7/22/12 and Referrals 10/22/12 1.a.v. ISP Development Each individual will have a completed ISP in Clinical Advisor within 90 days of affiliation to an ACT team. Available and Ongoing ACT Capacity and Demand Analysis Facility ACT Census ACT Vacancies NTXIX Census Proj. NTXIX ACT (7%) PNO-Ch-Arcadia Center 84 24 466 32 PNO -Ch-Midtown 0 0 205 14 PNO -Ch-South Central 0 0 179 12 PNO -Ch-Tempe Enclave Site 91 17 384 26 PNO -Ch-Townley 73 35 431 29 PNO -Ch-West McDowell 88 20 187 13 PNO -PCN-Capitol Center 65 43 0 0 PNO -PCN-Centro Esperanza 0 0 271 18 PNO -PCN-Comunidad 268 56 412 28
  23. 23. Page 23 Magellan Health Services PNO -PIR-East Valley Campus 0 0 500 34 PNO -PIR-Metro Center 107 1 381 26 PNO -PIR-West Valley 75 33 479 33 PNO -PIR-Wickenburg 0 0 17 1 PNO -SWN-Bethany Village 83 25 294 20 PNO -SWN-Garden Lakes 0 0 266 18 PNO -SWN-Hampton 88 20 263 18 PNO -SWN-Highland 0 0 195 13 PNO -SWN-Osborn 92 16 203 14 PNO -SWN-Saguaro 0 0 516 35 PNO -SWN-San Tan 88 20 270 18 Additional ACT Team TBD 0 108 unknown 25-35 Total 1,202 418 5,919 402 IDENTIFICATION OF 15TH ACT TEAM Magellan will apply the same detailed system analysis used prior to the NTXIX benefit reduction in July of 2010 to identify the location of the new ACT team. This analysis will evaluate potential locations based on an algorithm that weighs: 1. The projected geographic demand for ACT services based on: a. Location of NTXIX population (7% projected to move into ACT services); b. Location of the 520 NTXIX individuals who were previously on ACT in June 2010; c. Location of NTXIX individuals with the highest LCG scores; and d. Current distribution of ACT services to meet the projected demand. 2. PNO ACT Outcomes Dashboard results; 3. Distribution of ACT teams by PNO to offer choice in provider; and 4. Facility capacity. NTXIX SMI Implementation and Oversight Plan - Supportive Case Management Task # DBHS Parameter Plan Target Date 1.b.i. Distribute Criteria for Case Management Assignment Distribute ADHS/DBHS criteria, affiliated screening tool and LCG data set to the PNOs. 7/6/12 1.b.ii. Screen for Case Management Services PNOs to complete case management screening using the approved screening tool for all NTXIX SMI individuals during the individual’s next appointment. 9/30/12 1.b.iii. Track CM Assignments Magellan will produce monthly reports of CM assignments for NTXIX individuals by PNO and clinic. Reporting will be used to identify outlier clinics/clinicians. 10/10/12 and Ongoing 1.b.iv. Notice of Decision and Right to Appeal Notice of Decision and Right to Appeal will be provided to those who do not agree with the level of service intensity recommendation made by the BHMP. Review for notice will be 9/30/12 Initial Notice and Ongoing
  24. 24. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 24 incorporated into the QI review process. 1.b.v. ISP Development Each individual will have a completed ISP in Clinical Advisor within 90 days of affiliation with a supportive case manager. Available and Ongoing NTXIX SMI Implementation and Oversight Plan - Case Management Services Task # DBHS Parameter Plan Target Date 1.c.i. Case Management Service Availability NTXIX SMI individuals who are not assigned to an ACT team or supportive case manager will be affiliated with a connective treatment coordinator and a peer support specialist to access case management services as needed. Initial screening by 9/20/12 1.c.ii. Track and Monitor Case Management Service Utilization Magellan will produce monthly reports of case management service utilization for NTXIX individuals by PNO and clinic. Reporting will be used to identify outlier clinics/clinicians and individual's clinical needs for case management assignment. 10/10/12 and Ongoing NTXIX SMI Implementation & Oversight Plan - Peer Support Services & Service Plan Process Task # DBHS Parameter Plan Target Date 1.d.i. Support Self-Sufficiency 73% of NTXIX SMI individuals will not be assigned to an ACT team or a supportive case manager. Our commitment to the concept that many individuals can successfully be their best case manager is demonstrated within our primary allocation of funds to peer and family delivered services (51% of service $) in community settings. Completed and Ongoing 1.d.ii. Peer-Driven Self- Developed Service Plan Magellan will partner with peer-run organizations, service recipients and their family members to evolve a standardized service plan format that will be available through all peer support providers within our system of care. 8/6/12 1.d.iii. Service Plan Review by the BHMP The affiliated connective care coordinator or peer support specialist will coordinate scheduling of the service plan review with the BHMP. Once agreed upon, the BHMP will sign the individualized service and recovery plan (ISRP) and adopt to guide service delivery. Ongoing 1.d.iv. Peer-Run Organizations and Peer Support in Service Planning Funding has been allocated for the hiring of 43 peer support specialists at the PNO clinics and full access to peer-run services. These staff members will be oriented to the standardized service plan format and expectations that support be offered. Orientation by 9/1/12 1.d.v. Service Plan Implementation The BHMP will review and approve the developed service plan. To support individuals who are functioning as "their own best case manager," Magellan will evolve and implement a communication plan that provides tangible resources on NTXIX individual treatment rights and resources for self-advocacy. The affiliated peer support specialist and connective care coordinator (both assigned at a ratio of 100:1) will augment advocacy efforts while maintaining primary responsibility for coordination and tracking of service provider referrals. 9/1/12 and Ongoing 1.d.vi. Training and Mentoring to Peer Support Staff Around New Service Plan Magellan will partner with peer-run organizations and the adult PNOs to evolve a training module for the new service plan and the new service planning process. Peer support providers will need to complete the training. 8/22/12
  25. 25. Page 25 Magellan Health Services 1.d.vii. Natural Supports and Crisis Planning into the Planning Process The peer training module will include an emphasis on natural supports and a section on crisis planning. 8/22/12 NTXIX SMI Implementation and Oversight Plan - Community-Based Support Services Task # DBHS Parameter Plan Target Date 2.a. Community-Based Support Services Allocated funding to each of the identified community-based support services (please see NTXIX SMI Service Funding Distribution for FY2013 Table in section II of this plan). Completed 2.b. Distribution of Support Services Allocation of support services was based on past utilization data and analysis of clinical needs through the application of the Level of Care Guide (LCG) algorithm. Completed Monitoring Utilization and Adjusting Allocations Service utilization will be monitored through monthly review of claims to evaluate system funding needs. Identified opportunities to better align service funding to system need will be proactively discussed with DBHS. 8/15/12 and ongoing 2.c. Support Service Funding Allocation Funding allocation and service targets are illustrated in the NTXIX SMI Service Funding Distribution for FY2013 Table in section II of this plan. Completed 2.d. Inpatient Discharge Planning The affiliated ACT and Supportive case manager will engage in discharge planning and follow up activities as outlined in Provider Manual section 3.8.7-C when aware of an admission. Connective care coordinators will also engage in discharge planning in collaboration with peer support to facilitate appropriate transition into the community. Magellan’s UM team will engage a formal communication campaign with inpatient providers to share information around the enhanced availability of services to NTXIX SMI individuals and encourage greater collaboration around discharge planning. Design Completed NTXIX SMI Implementation and Oversight Plan - Medication Management Task # DBHS Parameter Plan Target Date 3.a. Prior Auth. for Abilify Implement the established prior authorization process and DBHS- approved formulary for the NTXIX SMI population. Completed PROVIDER MONITORING AND OVERSIGHT Magellan will provide monitoring and oversight through weekly meetings with executive leadership, medical leadership and operational leadership of the PNOs, executive leadership of the Peer Run Organizations and other key provider leaders included in this funding allocation plan. This process and these meetings will be much more intense in the beginning dropping to monthly and quarterly as appropriate. We will utilize a similar basic process to the one that was successful in the FY2010 NTXIX SMI funding reduction project. Our teams will review individual tracking sheets and evaluate the assignment of services as compared with the Service Intensity Risk Analysis data.
  26. 26. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 26 QUALITY IMPROVEMENT PROVIDER MONITORING FOR ACT AND SUPPORTIVE CASE MANAGEMENT Performance measures such as a current assessment and a completed individual service plans will be tracked through the application of the Treatment Record Review (TRR) Tool. The TRR tool is applied to providers annually or more frequently based on supplemental monitoring and evaluation data that indicates the need for closer oversight. For all NTXIX adults who are receiving ACT or supportive case management, Magellan will apply the TRR annually utilizing a random, statistically reliable sample (90% confidence level/+/-10% variation) system wide. If needed, we will conduct focused audits and site visits to ensure any deficiencies are being addressed and corrected. Magellan will begin monitoring within 30 days of start of service. Magellan will also develop a simple checklist that will include elements in the TRR and conduct brief focused audits that will initially be conducted bi-weekly and target monthly and quarterly reviews based on evaluated performance. The complete TRR will be used annually. MONITORING FOR INDIVIDUALS IN CONNECTIVE For individuals receiving connective care coordination who elect to develop a self directed service plan with the collaboration of peer support staff, Magellan will review their records annually utilizing a random, statistically reliable sample (90% confidence level/+/-10% variation) at a system wide level. We will specifically review these records for evidence that all services recommended in the treatment plan have been implemented. If needed, we will conduct focused audits and site visits to ensure any deficiencies are being addressed and corrected. Magellan will begin monitoring within 30 days of start of service. Magellan will also develop a simple audit tool that will include elements in the self-directed service plan and conduct brief focused audits; initially on a bi-weekly basis and eventually targeted for monthly and quarterly reviews based on evaluated performance. PREPARING INTERNALLY TO ADDRESS GRIEVANCES, APPEALS AND COMPLAINTS Magellan will provide comprehensive training for the grievance, appeals and complaints team as well as customer service on benefit packet changes for NTXIX adults. Magellan will also provide training to BHMPs at the PNOs regarding their role in assessing service intensity needs and issuing a Notice of Decision. The Learning and Performance Department will be leading efforts to create an on-line learning course that will be assigned to each of the PNO BHMPs in their Achieve development plan by 7/6/2012. Completion of this training will be monitored by Magellan with an expectation that this 10 minute course be completed by BHMPs prior to completing the Service Intensity Assessment with NTXIX SMI individuals. In addition to the training, Magellan will track the number of grievances, appeals and complaints filed from NTXIX individuals with a serious mental illness related to service intensity assessments and work with the providers to address these issues.
  27. 27. Page 27 Magellan Health Services UTILIZATION AND FINANCIAL MONITORING Service utilization will be monitored through monthly review of productivity and expense tracking to evaluate system funding needs. Identified opportunities to better align service funding to system need will be proactively discussed with DBHS to discuss plans for funding re-alignment. Magellan will incorporate language into provider contracting that establishes an expectation that providers deliver the data necessary to support the evaluation activities described in this plan. CONTRACTING The following Request for Letters of Intent (RFLOI) implementation plan will be applied to support identification of a Family Support and Respite provider to meet the service-delivery targets defined in this plan. FY2013 contract amendments will be delivered to align with the remaining service-delivery targets within three weeks of receiving ADHS/DBHS plan approval. NOTE: Timelines are based on a July 6, 2012 approval of this plan by ADHS/DBHS Family Support: RFLOI Implementation Plan Step # Task Target Date 1 RFLOI distributed to Provider Network 7/17/12 2 Q&A due from providers 7/23/12 3 Q&A response dispersed 7/25/12 4 Proposals due 8/1/12 5 Initial meeting for proposal review 8/2/12 6 Proposal scoring complete 8/8/12 7 Decision approved by Executive Team 8/13/12 8 Provider notification of award and non-award 8/17/12 9 Strategic planning meeting with provider (initial and ongoing) 8/22/12 10 Scope of Work revised and contract amendment sent 8/29/12 11 Contract amendment signed 9/6/12 12 Program Start Date 10/8/12 Respite: RFLOI Implementation Plan Step # Task Target Date 1 RFLOI distributed to Provider Network 7/17/12 2 Q&A due from providers 7/23/12 3 Q&A response dispersed 7/25/12 4 Proposals due 8/1/12 5 Initial meeting for proposal review 8/2/12 6 Proposal scoring complete 8/8/12 7 Decision approved by Executive Team 8/13/12 8 Provider notification of award and non-award 8/17/12 9 Strategic planning meeting with provider (initial and ongoing) 8/22/12 10 Scope of Work revised and contract amendment sent 8/29/12
  28. 28. Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 28 11 Contract amendment signed 9/6/12 12 Program Start Date 10/8/12 Please refer to attached documents for use in the RFLOI process along with contract amendments for service expansion with existing contracted providers: o Attachment E – Family Support RFLOI o Attachment F - Family Support RFLOI Scoring Sheet o Attachment G – Respite RFLOI o Attachment H - Respite RFLOI Scoring Sheet

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