Behavioral Health and Developmental Disabilities ... with PIHP departments on the needs of the...
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Behavioral Health and Developmental Disabilities Administration MACMHB Fall Conference 10/27/14 1
Transcript of Behavioral Health and Developmental Disabilities ... with PIHP departments on the needs of the...
Behavioral Health and Developmental Disabilities Administration
MACMHB Fall Conference
10/27/14
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Introductions Lisa Grost, Autism Section Manager, MDCH
Nicole Dwyer, ASD Program Specialist, Detroit Wayne Mental Health Authority
Christine Lennon, Children and Family Services Supervisor, North Country Community Mental Health
Morgan VanDenBerg, Autism Behavioral Specialist, MDCH
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Overview
Updates on Autism and ABA in Michigan
Autism Coordination from the PIHP perspective
Regional success and challenges from the CMH perspective
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Medicaid/MIChild Autism Benefit The Michigan Medicaid and MIChild Autism Benefit
went into effect on April 1, 2013. Applied Behavior Analysis(ABA) is the approved
Autism Benefit service. Children enrolled in the Autism Benefit are also
eligible for any medically necessary services provide by the Managed Specialty Supports & Services Plan under the authority of Section 1915(b) of the Social Security Act (the “b-Waiver” “b-3s” or “b-3 services”)
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Autism Program Updates Children 18 months to 6 years old
1,493 children covered by Medicaid/MIChild received diagnostic services
950+ children are enrolled in the Autism ABA Benefit
5,898 children received other medically necessary Medicaid services
Monthly Autism Webinars the 3rd Wednesday of every month at 2 PM
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504 563
612 643 700
755 832
903 936
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100
200
300
400
500
600
700
800
900
1000
2014 Autism ABA Benefit Beneficiaries
Autism Site Reviews Submitted year one report April 1, 2013 – July 31, 2014 to
CMS
Completed all 10 PIHP Autism Site Reviews as of September 30, 2014
Have not finished the analysis of all the data from each Region for year 2’s CMS report
Encourage you all to join our monthly webinars if you can and review your site review reports for specifics and recommendations for your region
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Michigan Year One CMS Report PIHP system changed dramatically from 18 to 10 entities
during this first year of services.
State appropriation of $2.6M in contracts to improve the autism services in 2014
100% compliance with the providers possessing professional credentialing of LLP, LP, BCBA, and CMHP
Children not getting the amount, scope, duration, and frequency of ABA as identified in the plan of service Winter weather conditions, family attendance, and lack of
providers identified as the contributing factors to this performance measure not being met
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ABA Service Capacity
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Has capacity to provide ABA to additional children
Does not have capacity to provide ABA to additional children
May 2014 February 2014 November 2013 Initial 2013
Michigan ABA Successes Families are reporting amazing improvements and the
outcomes are changing their daily life 168% increase in BCBAs working in public and private
sector with children with ASD from April 2012 (38) to March 2014 (102)
67 BCBAs and 56 other qualified professionals working with Medicaid/MIChild children with ASD in Michigan (May 2014)
Behavior Analyst Certification Board reports 248 BCBA’s in Michigan
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Michigan ABA Successes $2.6M in autism contracts in 2014
$9M in autism contracts in 2015
Michigan now has 7 universities offering ABA degree programs up from 2 in 2012 (8th in the works)
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Michigan ABA Challenges ABA Providers
ABA providers are indicating they have room for more children; MDCH staff have provided leads and we are learning regions are not following up on increasing capacity.
This elevates our non-compliance with ABA.
Meeting level of ABA service recommended and authorized as medically necessary
PIHP Restructure (from 18 to 10)
PIHP/CMH autism coordinators
Training of behavioral support staff
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63
112
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130
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198
75
90
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PIHP Autism Benefit Children Enrolled
Region 1
Region 2
Region 3
Region4
Region 5
Region 6
Region 7
Region 8
Region 9
Region 10
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61 55
38
73
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47 51 52
42
40
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24
7
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15 20
6 17
0
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Michigan PIHP ABA Services
% Received ABA
% Received ABA asoutlined in IPOS
Per
cen
t o
f ch
ild
ren
en
roll
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he
Au
tism
Ben
efit
Autism Training Survey Top training needs identified include:
Parent and Family Training
Parent and Family Engagement
Autism safety training for staff
Family and peer mediated interventions
Reimbursement: payments, cost settlement, etc.
Annual Waiver Conference, 11/18-19, East Lansing https://www.macmhb.org/
8 Sessions for Autism and ABA
Anthony Ianni, Autism Alliance of Michigan, 11/18/14
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Centers for Medicare and Medicaid Services (CMS) Bulletin
July 7, 2014 CMS Bulletin Bulletin reviewed approaches available under Medicaid
for providing services to individuals with Autism Spectrum Disorder (ASD)
It also reviewed state obligations under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, where states must cover all medically necessary services for children, including services to address ASD.
MDCH is pursuing an expansion of behavioral intervention services for children with ASD beyond age 6 and we will update stakeholders about the policy and effective dates when they become more apparent
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Resources Website
www.michigan.gov/autism
Created the Autism Benefit Map is an interactive map that can be used to get information about the Medicaid and MIChild Autism Benefit Coordinator in a specific region.
Provider FAQ
iSPA Policy
Links to codes and encounter reporting
Other resource documents for Autism ABA Benefit
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Community Mental Health:
Autism Services Nicole Dwyer, Autism Benefit Specialist, Detroit Wayne Mental Health Authority
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Medicaid/MIChild Autism Benefit Objectives
Implementation Discussion:
Learn the Detroit-Wayne County service delivery
structure
Strengths & challenges of a large system of care
Understand where we are and where we move
forward
The PIHP Autism Coordinator’s Role
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Implementation Discussion
DWMHA
Wayne County Overview:
Largest County in Michigan
1,775,273 residents
115,000 under the age of 5
1,400 under the age of 5 with potential ASD diagnosis
24% of residents live below poverty level
12% of households do not speak English as primary
language
13% of people have an identified disability
20 *U.S. Census Bureau
Implementation Discussion
DWMHA
Autism Benefit Overview: 435 Positive M-CHAT/SCQs have been identified
324 children have been found eligible for the benefit
Service Structure:
DWMHA contracts with 7 ABA Provider Agencies to provide all-
inclusive ABA Benefit Services
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Implementation Discussion
DWMHA Strengths:
Motivated workforce
Robust provider network
Vision for future growth and improvement
Universities, large hospital systems, and subject matter experts
Challenges:
Growing Pains
Staff Retention
Service Coordination
Socially Significant Concerns for Population Served
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Inappropriate behaviors (tantrums, SIB, meltdowns, physical aggression, elopement)
Lack of independence in ADLS
Sleeping and feeding issues
Lack of or poor communication
Lack of natural supports
Lack of or limited transportation
Generations of mental illness, trauma and/or poor coping skills
CPS involvement
Lack of stable housing, finances, family structure
Distrust in the systems they are involved in
Lack of education and knowledge of services
Implementation Discussion
Socially Significant Concerns for Medicaid Population
The Role of a PIHP Autism Waiver
Coordinator Provide Administrative Oversight of the Benefit:
Ensure that standards and policies are developed and implemented
that are consistent with Federal and State guidelines
Develop and provide oversight to service infrastructure
Monitor performance indicators & utilization management
Provide technical assistance to provider network
Monitor the WSA and internal electronic record management
Collaborate with PIHP departments on the needs of the program
Identify processes and tools for efficiency
Provide status updates to administration
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The Role of a PIHP Autism Waiver
Coordinator
Provide Community Awareness:
Develop and maintain external relationships with stakeholders,
including schools, health plans, parent groups, public health,
DHS, etc.
Provide presentations to the system and community on the ASD
Waiver Benefit and educate system on accessing care
Train the system on Autism Spectrum Disorder, screening tools,
and processes
Conduct stakeholder workgroups & meetings
Identify training needs for the system and community
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The Role of a PIHP Autism Waiver
Coordinator
Clinical and Utilization Management Operations
Ensure that services provided and documentation comply with
ASD State Plan standards and quality
Develop protocols for an monitor Utilization Management
Monitor overall clinical care and quality with the ABA Service
providers to assure that all systems are meeting individual and
clinic performance goals
Act as the PIHP point-person for the ASD Benefit
Work with the MDCH Autism Team to provide clarification and
address any questions related to the ASD Benefit
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Autism Spectrum Services North Country Community Mental Health
Christine Lennon MA, LLPC, CMHP
North Country Community Mental Health
O Serving 6 counties in Northern Michigan:
O Cheboygan
O Emmet
O Charlevoix
O Gaylord
O Antrim
O Kalkaska
Current Numbers for the Autism Benefit
O AS of 10/23/14:
O 41 Referrals since April 1, 2013 O 12 children receiving direct ABA services.
O 2 children currently ready for BCBA services.
O 9 children waiting for parents to schedule testing.
O 5 children aged out of the program.
O 8 children did not meet criteria for ASD.
O 2 children switched from Medicaid to private insurance.
O 3 children’s families did not return calls to pursue services.
Translation Each child for the ABA/Autism Benefit receives:
O Intake assessment
O Pre-plan
O Plan of Service
O Testing for the Autism Benefit:
O Autism Diagnostic Observation Scale 2
O Autism Diagnostic Interview-Revised
O Vineland Adaptive Daily Living Scales
O Mullen Scales of Early Learning
O Wechsler Preschool and Primary Scale of Intelligence-III (WPPSI-III) or Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV)
O Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP)
O 5-20 hours of intensive, one-to-one ABA therapy per week at their home or in an office setting, 2-5 hours per day, 5 days per week
Challenges 1. Developing a process and plan for roll out
O Forecasting: costs for programming
O Forecasting: numbers of children to receive services
O Forecasting: numbers of clinical service providers needed
2. Creating an infrastructure
O Developing new documents, new processes, new pathways for services
O Meetings/Presentations/Proposals: MDCH/finance/contracts/testing/supervision/PIHP/billing/contracted BCBA’s and tutors/case managers/IT/Directors/Board
O Translating the ISPA into NCCMH language
3. Work Force Development
O Limited number of staff dedicated to autism benefit services
O Hiring Freeze
O Limited number of BCBA providers
O Limited number of ABA tutors
O Beginning BCBA course sequence was like learning a NEW LANGUAGE
Challenges 1. Code issues:
O Lack of codes, 2 direct services at once
O Changing codes
2. How many hats can you wear at once?
O Serving as clinician, administrator, supervisor, student, tester
O Reading 4 million progress notes and HICF
3. Serving rural areas = TIME
O Limited workforce
O Getting to homes that are far apart
O Travel costs for families
O Winter: Closed schools/roads/weather
advisories
NORTH COUNTRY COMMUNITY MENTAL HEALTH
ACCESS CENTER PCP MCHAT
Intake Assessment/Pre-Plan
with Family
Self Referral, Early On,ISD
Positive
TESTING ADIR/ADOS
(cognitive/adaptive)
Negative
Positive
POS with Support’s Coordinator
Approved Denied Denial
(Offer other services as
appropriate)
Refer for VB-MAPP
Evaluation
Support’s Coordinator
Updates POS for ABA
Service Provided
3, 6 and 12 month POSR
Submit to MDCH for approval
Submit to UM Committee for approval
Approved
Denial (Offer other services as
appropriate)
Denial (Offer other services as
appropriate)
Strengths
O Resiliency
O Passion for working with children
O Tenacity
What I Have Learned
O To create a common language for all of the
many people involved
O People in finance don’t care what a
motivating operation is
O Just because I have read through the
process 4000 times, doesn’t mean other
people have
O I have a lot more to learn!
The Work
Owen
Owen
July 2014 October 2014
Hope
O “I spent yesterday with my daughter and my grandson Owen. Owen is Autistic. In May Owen had limited space in the house, as most of it was gaited for his safety. He was non verbal, limited eye contact, and we were at a loss on how to help him acquire these safety skills. He was not allowed outside as he would run without direction or purpose. He is now able to play outside and will walk to the park holding fingers. He has never said Momma or Daddy or I love you but yesterday he said “uhn” and “twa”, for one and two and we celebrated. A glimmer of hope into a situation of this type is huge. Christine has been a full ray of sunshine for my daughter and grandson. I am beyond grateful for the Autism program at CMH and thought you should know.”
Questions?
Thank You! Additional Information:
www.michigan.gov/autism
Nicole Dwyer, Detroit Wayne Mental Health Authority
Lisa Grost, MDCH
Christine Lennon, North Country CMH
Morgan VanDenBerg, MDCH
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