1

D19 CHILDREN’S CLINICAL AND PREVENTION

SERVICES OPERATIONS MANUAL

A “Systems of Care” Approach to Enriching the Lives of Our

D19 CSB Youth and Families

Mission: To help strengthen the continuum of D19 CSB community-based services via the provision of a comprehensive array of clinical and prevention services designed to meet the special needs of children and adolescents with behavioral health, substance use and developmental disorders.

TABLE OF CONTENTS

I. CCPS Human Rights Statement……………………………….p. 2 II. CCPS Confidentiality Rights Statement……………………....p. 3 III. CCPS Records Management……………………………………p. 3 IV. CCPS Compliance Plan……………………………………….....p. 3 V. CCPS Prevention Services……………………………………..pp. 4-7 VI. CCPS Mental Health Case Management……………………...pp.8-22 VII. CCPS Developmental Disabilities Case Management………..pp. 23-41 VIII. Child Mental Health Initiative Funding………………………pp. 42-43

2

I. CCPS Human Rights Statement

It is the policy of District 19 Community Services Board (hereinafter referred to as “D19”) to protect the rights of consumers served in programs operated by the Board. in accordance with the Rules and Regulations to Assure the Rights of Consumers Receiving Services from Providers of Behavioral Health and Developmental Services and §37.2-400 of the Code of Virginia. Each consumer who receives CCPS services will be assured:

1. Protection to exercise his legal, civil, and human rights related to the receipt of those services;

2. Respect for basic human dignity; and 3. Services that are provided consistent with sound therapeutic practice.

CCPS will not deny any person his legal rights, privileges or benefits solely because he has been voluntarily or involuntarily admitted, certified for admission or committed to services. These legal rights include the right to:

1. Acquire, retain, and dispose of property; 2. Sign legal documents; 3. Buy or sell; 4. Enter into contracts; 5. Register and vote; 6. Get married, separated, divorced, or have a marriage annulled; 7. Hold a professional, occupational, or vehicle operator's license; 8. Make a will and execute an advance directive; and 9. Have access to lawyers and the courts.

CCPS staff will therefore comply with the current D19 Human Rights Plan (see current D19 CSB Human Rights Plan) approved by the Planning District 19 CSB Board of Directors, and in accordance with guidelines established by the Virginia Department of Behavioral Health and Developmental Services (DBHDS) and the Virginia Department of Medical Services (DMAS). Children’s Clinical and Prevention Services (CCPS) are offered in all nine (9) Planning District 19 localities: Colonial Heights; Dinwiddie; Emporia/Greensville; Hopewell; Petersburg; Prince George; Surry; and Sussex. For contact information on locations and/or directions to all D19 area clinics, please visit our website at www.d19csb.com.

3

II. CCPS Confidentiality Rights Statement

It is the policy of D19 CSB that CCPS staff will comply with the HIPAA Privacy Rule. Violations should be reported according to the protocols established in the D19 CSB Compliance Plan (please see current D19 HIPAA/Confidentiality policies and procedures). All consumer-specific service information, whether verbal or written, paper or electronic, photographs, videotapes or audiotapes, shall be kept confidential. This prohibition of disclosure specifically includes unauthorized disclosure of information to media, law enforcement or commercial organizations such as creditors, unless there is valid authorization or the disclosure is required by law. III. CCPS Records Management

It is the policy of the District 19 CSB that all CCPS administrative and medical record management shall be conducted in compliance with state and federal laws and regulations, as well as D19 CSB policies and procedures. It is therefore expected that all CCPS staff providing clinical services will establish and maintain medical records in accordance with D19, state licensure and Medicaid (DMAS) regulations (please see current D19 CSB, Dept. of Behavioral Health and Developmental Services and VA Dept. of Medical Services policies and procedures for records management – RM 001-RM 011). The purposes of the CCPS medical record are to demonstrate accountability, to enhance communication, to provide clinical data for research/education, to demonstrate quality and continuity of care, to defend liability issues, to meet licensure, reimbursement and accreditation requirements, and to facilitate UR and quality of care evaluations. IV. CCPS COMPLIANCE PLAN CCPS staff will adhere to all D19, state licensure and DMAS regulations set forth by the respective entities while conducting CCPS functions as agents of D19 Community Services Board. See existing D19 P/P’s for guidelines clinical, administrative, quality improvement (QI 001-QI 009), health and safety management (HSM 001-HSM 019).

4

V. CCPS PREVENTION SERVICES

Prevention Services at District 19 Community Services Board recognizes that small behavioral changes can make a world of difference in the lives of individuals and families in our communities. CCPS prevention specialists are available to offer consultation and technical assistance to community groups, agencies and organizational representatives to assist with coalition building, community development, risk needs and resource assessment. These specialists also:

Conduct educational life skills trainings for small groups of youth and parents Coordinate specialized community programs such public speaking and health

fairs Collaborate and assist with the development and implementation of

community and school prevention activities and Offer FREE, one-time consultation sessions to parents experiencing

temporary child rearing issues Prevention Programming Principles

Focus on reducing known risk factors. Know which risk factors the program will address and how the program activities will reduce the risk factors

Enhance protective factors while reducing risk. If a prevention program

reduces risk in a way that strengthens protective factors, a child is doubly protected

Address risk factors at the appropriate developmental stage and as early as

possible

Target programs to those exposed to multiple risk factors

Deliver programs to reach the diverse racial and cultural groups in a community

Work together with other people and organizations to address multiple

Address the risk factors most prevalent in a particular community

5

State Performance Contract – CSAP Strategies Information Dissemination Information resource center; resource directories, media campaigns, public service announcements, brochures, speakers bureaus, information lines Prevention Education Classroom and small group sessions; parenting and family management classes; peer leader/helper programs; education support groups for children of substance abusers and others at risk for substance use. Alternatives Drug free dances and parties, youth/adult leadership activities; after school programs; community recreation and drop-in centers Problem Identification & Referrals Student assistance programs, employee assistance programs, intervention programs associated with disciplinary offenses, juvenile court complaints, or DUI convictions. Community Based Processes School/ Community Team Training; systematic community planning; multi-agency coordination and collaboration Environmental Approaches Establishing and reviewing school ATOD policies; modifying alcohol and tobacco advertising practices; training for merchants and vendors to prevent underage access to alcohol Levels of Program Evaluation

Impact: Describes long term global effects of the initiative (measure goals) Incidence and prevalence data

Risk and protective factor data

Outcome: Described immediate or direct effects of program strategies (Measures objectives) Behavior

Attitudes Skills Knowledge

6

Process: Describes strategies implemented to achieve established goals and

objectives (measures strategies and program implementation) Implementation strategies Numbers served by program Participant satisfaction with survey

SAMHSA Strategic Prevention Framework for Planning, Implementation and Evaluation

CCPS PREVENTION PRIORITIES TOBACCO– MERCHANT EDUCATION AND STORE ASSESSMENTS PER SYNAR MANDATE (COUNTER TOOLS) ALCOHOL– AWARENESS CAMPAIGNS (I.E., TALK. THEY HEAR YOU) ON THE DANGERS OF ALCOHOL USE IN YOUTH, BING DRINKING IN YOUNG ADULTS, ETC. MARIJUANA – SOCIAL MARKETING AND AWARENESS CAMPAIGNS (I.E., PARENTS GIVE HUGS, NOT DRUGS SOCIAL MEDIA, BUS ADS) OPIOID, RX DRUGS AND HEROIN – SOCIAL MARKETING AND AWARENESS CAMPAIGNS AND ACTIVITIES ON THE DANGERS OF OPIOID, RX DRUG AND HEROIN USE IN YOUNG ADULTS (LOCK BOX AND DRUG DISPOSAL KIT DISTRIBUTION, SOCIAL MEDIA, MOVIE THEATER AND BILLBOARD ADS AND PSA’S) MENTAL HEALTH PROMOTION/SUICIDE PREVENTION – REGIONAL PARTNERSHIPS TO PROVIDE TRAINING, EDUCATION AND SUPPORTIVE SERVICES TO ALL PD19 COMMUNITIES TO ADDRESS BEHAVIORAL HEALTH WELLNESS AND SUICIDE PREVENTION NEEDS.

Additional Programs

7

Parent Education: A practical parenting program based on the principles of family systems, life span development and long term change. Curricula address complex and challenging areas of need such as: understanding your role as a parent; developing trust within the family; communicating within the family; building self-esteem within the family; understanding parenting and power; accepting and growing through natural transitions in the life cycle; and accepting and growing through unexpected transitions in the life cycle. Mental Health First Aid: An in-person training that teaches individuals how to help people developing a mental illness or in a crisis. Mental Health First Aid teaches you: signs of addictions and mental illnesses; 5-step action plan to assess a situation and help; impact of mental and substance use disorders; and local resources and where to turn for help.

VI. CCPS MENTAL HEALTH CASE MANAGEMENT

8

SERVICES

CCPS Mental Health case management services assist children, adolescents and their families with accessing needed medical, psychiatric, social, educational, and vocational services and other supports essential to meeting the basic needs of a consumer for successful recovery. Eligibility for case management services does not mandate treatment within District 19. The provision of case management services is contingent upon funding and staff availability within each locality. The services are provided by staff who meets the DMAS educational, licensure and/or certification criteria for Qualified Mental Health Case Manager (QMHCM) and Qualified Mental Health Professional – Children (QMHP-C or A). Individuals eligible for mental health case management must meet criteria for Serious Emotional Disturbance (SED), or At Risk of Emotional Disturbance (At Risk) as specified by the Department of Medical Assistance Services (DMAS) and VA Department of Behavioral Health and Developmental Services (DBHD). Definitions Please see DBHDS DMAS guidelines for additional definitions "Adolescent or Child" means the individual receiving the services described in this manual. For the purpose of the use of these terms, adolescent means an individual 12-20 years of age; a child means an individual from birth up to 12 years of age. “Assessment” means the face-to-face interaction in which the provider obtains information from the individual, and parent, guardian, or other family member or members, as appropriate, about the individual’s mental health status. It includes documented history of the severity, intensity, and duration of mental health problems and behavioral and emotional issues. "At Risk of Hospitalization” means one or more of the following: (i) within the two weeks before the Comprehensive Needs Assessment, the individual shall be screened by an LMHP, LMHP-R, LMHP-S or LMHP-RP for escalating behaviors that have put either the individual or others at immediate risk of physical injury such that crisis intervention, crisis stabilization, hospitalization or other high intensity interventions are or have been warranted; (ii) the parent/guardian is unable to manage the individual's mental, behavioral, or emotional problems in the home and is actively, within the past two to four weeks, seeking an out-of home placement; (iii) a representative of either a juvenile justice agency, a department of social services (either the state agency or local agency), a community services board/behavioral health authority, the Department of Education, or an LMHP, as defined in 12VAC35-105-20, or LMHP-R, LMHP-S, or LMHP-RP and who is neither an employee of nor consultant to the intensive in-home (IIH) services or therapeutic day treatment (TDT) provider, has recommended an out-of-home placement absent an immediate change of

9

behaviors and when unsuccessful mental health services are evident; (iv) the individual has a history of unsuccessful services (either crisis intervention, crisis stabilization, outpatient psychotherapy, outpatient substance abuse services, or mental health skill building) within the past 30 calendar days; (v) the treatment team or family assessment planning team (FAPT) recommends IIH services or TDT for an individual currently who, within the past thirty calendar days, is either: (a) transitioning out of residential treatment services, either psychiatric residential treatment facility (PRTF) or therapeutic group home TGH), (b) transitioning out of acute psychiatric hospitalization, or (c) transitioning between foster homes, mental health case management, crisis intervention, crisis stabilization, outpatient psychotherapy, or outpatient substance abuse services. "Care Coordination" means locating and coordinating services across multiple providers to include collaborating and sharing of information among health care providers, who are involved with the individual’s health care, to improve the restorative care and align service plans. Behavioral Health and Developmental Services. "Comprehensive Needs Assessment" means the face-to-face interaction, in which the provider obtains information from the individual, and parent or other family member or members, as appropriate, about the individual’s mental health status. It includes documented history of the severity, intensity, and duration of mental health care problems and issues and shall contain all of the following elements: (i) the presenting issue/reason for referral, (ii) mental health history/hospitalizations, (iii) previous interventions by providers and timeframes and response to treatment, (iv) medical profile, (v) developmental history including history of abuse, if appropriate, (vi) educational/vocational status, (vii) current living situation and family history and relationships, (viii) legal status, (ix) drug and alcohol profile, (x) resources and strengths, (xi) mental status exam and profile, (xii) diagnosis, (xiii) professional summary and clinical formulation, (xiv) recommended care and treatment goals, and (xv) The dated signature of the LMHP, LMHP-supervisee, LMHP-resident, or LMHPRP. “Counseling,” means the application of principles, standards, and methods of the counseling profession in (i) conducting assessments and diagnoses for the purpose of establishing treatment goals and objectives and (ii) planning, implementing, and evaluating treatment plans using treatment interventions to facilitate human development and to identify and remediate mental, emotional, or behavioral disorders and associated distresses that interfere with mental health. Counseling must be provided by a LMHP, LMHP-S, LMHP-R or

10

LMHP-RP acting within their scope of practice. “Early and Periodic Screening, Diagnostic and Treatment (EPSDT)” EPSDT is Medicaid’s comprehensive and preventive child health program for individuals under the age of 21. Federal law (42 CFR § 441.50 et seq) requires a broad range of outreach, coordination, and health services under EPSDT distinct from general state Medicaid program requirements. EPSDT is geared to the early assessment of children’s health care needs through periodic screenings. The goal of EPSDT is to assure that health problems are diagnosed and treated as early as possible, before the problem becomes complex and treatment more costly. Examination and treatment services are provided at no cost to the member. Any treatment service which is not otherwise covered under the State’s Plan for Medical Assistance can be covered for a child through EPSDT as long as the service is allowable under the Social Security Act Section 1905(a) and the service is determined by the Department of Medical Assistance Services (DMAS) or its agent as medically necessary. "Individual" means the Medicaid-eligible person receiving these services and for the purpose of this section includes children from birth up to 12 years of age or adolescents ages 12 through 20 years. Individuals may also be referred to as a “member”. "Individual Service Plan" or "ISP" means a comprehensive and regularly updated treatment plan specific to the individual's unique treatment needs as identified in the Comprehensive Needs Assessment. The ISP contains, but is not limited to, the individual’s treatment or training needs, his goals and measurable objectives to meet the identified needs, services to be provided with the recommended frequency to accomplish the measurable goals and objectives, the estimated timetable for achieving the goals and objectives, and an individualized discharge plan that describes transition to other appropriate services. The individual shall be included in the development of the ISP and the ISP shall be signed by the individual. If the individual is a minor child, the ISP shall also be signed by the individual's parent/legal guardian as appropriate. Documentation shall be provided if the individual, who is a minor child or an adult who lacks legal capacity, is unable or unwilling to sign the ISP. "Licensed Mental Health Professional" or "LMHP" means the same as defined in 12VAC35-105-20. "LMHP-Resident" or "LMHP-R" means the same as "resident" as defined in (i) 18VAC115-20-10 for licensed professional counselors; (ii) 18VAC115-50-10 for licensed marriage and family therapists; or (iii) 18VAC115-60-10 for licensed substance abuse treatment practitioners. An LMHP-resident shall be in continuous compliance with the regulatory requirements of the applicable counseling profession for supervised practice and shall not perform the functions of the LMHP-R or be considered a "resident" until the

11

supervision for specific clinical duties at a specific site has been preapproved in writing by the Virginia Board of Counseling. For purposes of Medicaid reimbursement to their supervisors for services provided by such residents, they shall use the title "Resident" in connection with the applicable profession after their signatures to indicate such status. "LMHP-Resident in Psychology" or "LMHP-RP" means the same as an individual in a residency, as that term is defined in 18VAC125-20-10, program for clinical psychologists. An LMHP-resident in psychology shall be in continuous compliance with the regulatory requirements for supervised experience as found in 18VAC125-20-65 and shall not perform the functions of the LMHP-RP or be considered a "resident" until the supervision for specific clinical duties at a specific site has been preapproved in writing by the Virginia Board of Psychology. For purposes of Medicaid reimbursement by supervisors for services provided by such residents, they shall use the title "Resident in Psychology" after their signatures to indicate such status. "LMHP-Supervisee in Social Work," "LMHP-supervisee," or "LMHP-S" means the same as "supervisee" as defined in 18VAC140-20-10 for licensed clinical social workers. An LMHP-supervisee in social work shall be in continuous compliance with the regulatory requirements for supervised practice as found in 18VAC140-20-50 and shall not perform the functions of the LMHP-S or be considered a "supervisee" until the supervision for specific clinical duties at a specific site is preapproved in writing by the Virginia Board of Social Work. For purposes of Medicaid reimbursement to their supervisors for services provided by supervisees, these persons shall use the title "Supervisee in Social Work" after their signatures to indicate such status. "Marketing Materials" means any material created to promote services through any media including, but not limited to, written materials, television, radio, websites, and social media. "Progress Notes" means individual-specific documentation that contains the unique differences particular to the individual's circumstances, treatment, and progress that is also signed and contemporaneously dated by the provider's professional staff who have prepared the notes. Individualized and member-specific progress notes are part of the minimum documentation requirements and shall convey the individual's status, staff interventions, and, as appropriate, the individual's progress, or lack of progress, toward goals and objectives in

12

the ISP. The progress notes shall also include, at a minimum, the name of the service rendered, the date of the service rendered, the signature and credentials of the person who rendered the service, the setting in which the service was rendered, and the amount of time or units/hours spent in the delivery of service. The content of each progress note shall corroborate the time/units billed. Progress notes shall be documented for each service that is billed. "Provider" means an individual or organizational entity that is appropriately licensed as required by the Department of Behavioral Health and Developmental Services and/or the Department of Health Professions and credentialed with the BHSA and/or MCO as a Medicaid provider of community mental health and rehabilitation services. “Psychoeducation” means (i) a specific form of education aimed at helping individuals who have mental illness and their family members or caregivers to access clear and concise information about mental illness and (ii) a way of accessing and learning strategies to deal with mental illness and its effects in order to design effective treatment plans and strategies. Qualified Mental Health Case Manager” means the same as defined in 12VAC30-50-420 and 12VAC30-50-430 and as described in Chapter II of this manual. "Qualified Mental Health Professional-Child" or "QMHP-C” means the same as defined in 12VAC35-105-20 and consistent with the requirements of 18VAC115-80-10. A QMHPC may only provide services to individuals under the age of 22 in accordance to 18VAC115- 80-10. "Qualified Mental Health Professional-Eligible" or "QMHP-E" means the same as the term is defined in 12VAC35-105-20 and consistent with the requirements of 12VAC35-105- 590 including a “QMHP-Trainee” as defined by the Department of Health Professions (DHP). "Qualified Paraprofessional in Mental Health" or "QPPMH" means the same as the term is defined in 12VAC35-105-20 and consistent with the requirements of 12VAC35-105- 1370. "Qualified Mental Health Professional-Adult" or "QMHP-A" means the same as defined in 12VAC35-105-20 and consistent with the requirements Eligible Targeted Case Management Population Definitions 1. Serious Mental Illness Adults, 18 years of age or older, who have severe and persistent mental or

13

emotional disorders that seriously impair their functioning in such primary aspects of daily living as personal relations, self-care skills, living arrangements, or employment. Individuals who are seriously mentally ill and who have also been diagnosed as having a substance abuse disorder or developmental disability are included. The population is defined along three dimensions: diagnosis, level of disability, and duration of illness. All three dimensions must be met to meet the criteria for serious mental illness. a. Diagnosis There must be a major mental disorder diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM). These disorders are: schizophrenia, major affective disorders, paranoia, organic or other psychotic disorders, personality disorders, or other disorders that may lead to chronic disability. A diagnosis of adjustment disorder or a V Code diagnosis cannot be used to satisfy these criteria. b. Level of Disability There must be evidence of severe and recurrent disability resulting from mental illness. The disability must result in functional limitations in major life activities. Individuals should meet at least two of the following criteria on a continuing or intermittent basis: 1) Is unemployed; is employed in a sheltered setting or supportive work situation; has markedly limited or reduced employment skills; or has a poor employment history. 2) Requires public financial assistance to remain in the community and may be unable to procure such assistance without help. 3) Has difficulty establishing or maintaining a personal social support system. 4) Requires assistance in basic living skills such as personal hygiene, food preparation, or money management. 5) Exhibits inappropriate behavior that often results in intervention by the mental health or judicial system. c. Duration of Illness The individual is expected to require services of an extended duration, or the individual’s treatment history meets at least one of the following criteria: 1) The individual has undergone psychiatric treatment more intensive than outpatient care more than once in his or her lifetime (e.g., crisis response services, alternative home care, partial hospitalization, and inpatient hospitalization). 2) The individual has experienced an episode of continuous, supportive residential care, other than hospitalization, for a period long enough to have significantly disrupted the normal living situation. 2. Serious Emotional Disturbance Serious emotional disturbance in children ages birth through 17 is defined as a serious mental health problem that can be diagnosed under the DSM, or the child must exhibit all of the following: a. Problems in personality development and social functioning that have been exhibited over at least one year’s time; and

14

b. Problems that are significantly disabling based upon the social functioning of most children that age; and c. Problems that have become more disabling over time; and d. Service needs that require significant intervention by more than one agency. Children diagnosed with Serious Emotional Disturbance and a co-occurring substance abuse or developmental disability diagnosis are also eligible for Case Management for Serious Emotional Disturbance. 3. At Risk of Serious Emotional Disturbance Children aged birth through seven are considered at risk of developing serious emotional disturbances if they meet at least one of the following criteria: a. The child exhibits behavior or maturity that is significantly different from most children of that age and which is not primarily the result of developmental disabilities; or b. Parents, or persons responsible for the child’s care, have predisposing factors themselves that could result in the child developing serious emotional or behavioral problems (e.g., inadequate parenting skills, substance abuse, mental illness, or other emotional difficulties, etc.); or c. The child has experienced physical or psychological stressors that have put him or her at risk for serious emotional or behavioral problems (e.g., living in poverty, parental neglect, physical or emotional abuse, etc.). Service Eligibility Criteria The Medicaid eligible individual shall meet the DBHDS criteria of serious mental illness, serious emotional disturbance in children and adolescents, or youth at risk of serious emotional disturbance. • There must be documentation of the presence of serious mental illness for an adult individual or of serious emotional disturbance or a risk of serious emotional disturbance for a child or adolescent. • The individual must require case management as documented on the ISP, which is developed by a qualified mental health case manager and based on an appropriate assessment and supporting documentation. • To receive case management services, the individual must be an “active client,” which means that the individual has an ISP in effect which requires regular direct or client-related contacts and communication or activity with the client, family, service providers, significant others, and others, including a minimum of one face-to-face contact every 90 calendar days. Persons eligible to receive case management services must have documented evidence in the clinical record to support such services. Documentation may include but is not limited to the following:

A. A psychiatrist’s diagnosis; B. Copies of hospital discharge summaries;

15

C. Reports, referrals, or information from other agencies involved with the client/family;

D. *A social or medical history; E. An employment history.

*Persons eligible to receive case management require initial and annual health and physical exams. The case manager is responsible for coordinating as well as securing copies of physical exams. All eligible MHCM consumers require primary screenings by the CSB. Referrals Persons eligible for case management services through District 19 should be residents of one of the nine jurisdictions of the agency. Medicaid consumers are protected by their Freedom of Choice rights and are not restricted to receive case management services within their respective localities. Prospective consumers may refer themselves or be referred by collateral resources, hospitals, schools, treatment facilities, family members or legal guardians. For all case management referrals, the aforementioned information must be provided in order to further assess for services. Referrals from hospitals and treatment facilities should include copies of discharge summaries, medical exams, medication lists and progress notes. Referrals within District 19 (if transfers are not appropriate) should be coordinated through the CCPS Manager/designee. The disposition of the referral should be documented with one of the following outcomes: A scheduled face-to-face appointment including date and time; Admittance to a waiting list; or a referral to an outside provider, if appropriate. Response-time to referrals should be within seven (7) business days. Screening For Services

Once a consumer has been referred for services, an initial screening can take place face-to-face or over the phone (if applicable, a 30-minute face-to-face screening can be offered for further assessment to determine eligibility). If it is determined that an individual is eligible for case management, staff must complete the screening/referral process and inform the applicant(s) of any necessary paperwork/documentation (proof of income, proof of address, insurance, etc.) to determine their financial responsibility. A signed D19 Financial Contract is then obtained prior to admission. Admission To Services

16

The initial comprehensive assessment appointment can be secured via our D19 Same Day Access Services (see agency and DMAS P/P’s qualified provider information and agency SDA program policies and procedures for office locations/hours, referral process, etc.). Mental health case management may be included as a recommended service on a Comprehensive Needs Assessment completed by a LMHP, LMHP-R, LMHP-RP or LMHPS. A qualified mental health case manager who is also a LMHP, LMHP-S, LMHP-R or LMHP-RP may conduct a Comprehensive Needs Assessment to include CMHRS services in addition to mental health case management. Individuals receiving mental health case management may continue having their assessments and reassessments completed by a qualified mental health case manager who is not a LMHP, LMHP-S, LMHP-R or LMHPRP. *Mental health case management assessments completed by a qualified mental health case manager who is not a LMHP, LMHP-R, LMHP-RP or LMHP-S shall be used only for mental health case management. If completed by a qualified case management who is not a LMHP, LMHP-R, LMHP-RP or LMHP-S, the assessment is conducted as part of the first month of case management service. The CCPS case manager is responsible for completing the admission process and developing the final CM ISP within thirty (30) days of the date of the initial admission assessment appointment. The admission process includes the completion of all applicable admission forms.

Once the admission process is completed, the CCPS case manager must register for targeted case management services per service population criteria for Medicaid reimbursement via applicable Medicaid MCO electronic submissions (please see DMAS/Medallion 4.O instructions). It is the case manager’s responsibility to complete Program Enrollment, secure MCO registration and ensure data entry no later than twenty-four (24) hours from date of completion for billing purposes. The primary service provider must notify or document the attempts to notify the primary care provider or pediatrician of the individual’s receipt of Community MH Rehabilitative Services, specifically mental health case management. Federal regulation 42CFR441.18 prohibits providers from using case management services to restrict access to other services. An individual cannot be compelled to receive case management if he or she is receiving another service, nor can an individual be required to receive another service if they are receiving case management. For example, a provider cannot require that an individual receive case management if the individual also receives medication management services. Case Management Functions

17

1. All consumers receiving case management services within District 19 must have a completed an initial ISP within twenty-four hours of admission/program enrollment and a comprehensive Person-Centered Individualized Service Plan (ISP) within 30 days of the initiation of service. The ISP must include the following:

- Consumer’s name and case identification number; - Consumer’s treatment and training needs; - Goals and measurable objectives to meet the consumer’s identified needs; - Services to be provided with recommended frequency to accomplish the measurable goals/objectives; - The person who is responsible for the service intervention.

2. All assessments and ISPs shall be updated as necessary as the needs of the individual

change and/or if the individual meets a different service population definition due to change age, diagnosis, level disability, duration of illness, etc.

3. All ISPs must be updated every 365 days.

4. The case manager will conduct a person-centered planning meeting and develop a new

ISP with the consumer at the annual update. The consumer and/or legal guardian must sign the updated service plan as verification that the case manager has discussed changes in the plan with her/him.

5. At the annual update, the case manager shall include information provided from essential

service providers and significant individuals who are involved in the overall treatment of the consumer. This information can be obtained by phone, face-to-face meetings, or fax.

6. The case manager and consumer shall review the ISP every 3 months and complete the

*Quarterly Progress Review (QPR). The QPR is an evaluation of the consumer’s progress towards the identified treatment goals. The first review is due by the last day of the 3rd month from the effective date of the ISP. A grace period of the last day of the following month will be given to complete the review. Subsequent reviews, however are due based on the original due date of the previous review(s); not on the date(s) the previous review(s) had been completed within the grace period.

7. Case managers should meet face-to-face with consumers once a month; however, a face-

to-face meeting must occur at least once every ninety (90) days. The purpose of the face-to-face meeting is for the case manager to observe the consumer’s condition, to verify linked services, to determine if there are any unmet needs at that time, and to determine if the current treatment plan should be continued or revised. Community outreach, home and program site visits are also encouraged to better assess consumer’s current living situation, as well as better determine appropriateness of community resources and ancillary services.

8. Monthly consumer-related contacts, communication or activities with family, other D19 and community service providers or significant others (as authorized) are allowed as long as the 90– day face-to-face contact requirement is met. There must be at least two

18

consumer-related case management activities conducted (which can include phone calls with consumers) for billing to occur; a single telephone call is not sufficient. Required case management activities include monitoring service delivery, linking and service coordination, education and counseling, enhancing community integration, direct assistance in developing/obtaining needed community resources.

9. All case management services shall be documented in the consumer’s medical records file and agency electronic health records data base system. Progress notes are to convey the consumer’s status, staff interventions, and the consumer’s progress towards the goals and objectives stated in the consumer’s ISP. At a minimum, a progress note should outline the following:

Name of service rendered; Date of service;

Signature and credentials of person rendering the service; Amount of time or units required to deliver the service; Detailed notes outlining the precise nature of the service(s) rendered (e.g., assessing needs, linking, collateral contacts, counseling). Operating Procedures for CCPS Staff Assigned to Clinics

INITIAL CALLS/SERVICE INQUIRIES/PREADMISSION SCREENING DATA ENTRY (EHR): All initial calls received at the clinics for CCPS services should be handled according to D19 P/P’s/clinic protocol regarding administrative support staff’s roles/responsibilities for gathering demographic information and preliminary data elements, etc. All applicable referral information, (including EHR ID number assignments) should be forwarded to CCPS Case Mgr. Supervisor for follow up and assignment (in the event CCPS MH case management staff is not available at time of call/service inquiries). CCPS staff will continue to schedule CM appointments and notify clinic administrative support staff, accordingly. FINANCIAL INFORMATION: All initial, annual, updated financials and extended payment contracts will be completed by clinic administrative support staff; CCPS staff in the clinics should only conduct financial assessments in emergency situations. It is therefore advised that all admission and annual financial assessments (and updates, as applicable) be conducted in the clinics to ensure timely/accurate completion of financial assessments. Notifications of any critical financial matters will also be forwarded to CCPS administrative support staff, who is responsible for routine insurance verifications, insurance pre-authorizations, extension requests, resolving insurance denials, etc. All extended payment contracts will be forwarded to be signed by the CCPS Mgr. The CCPS administrative support will be responsible for gathering data regarding billable services to ensure that all insurance claims are accurately made within established billing time frame(s). This includes running CM reports for all localities to track monthly CM

19

contacts. All adjustment requests regarding financial/reimbursement data elements need to therefore be forwarded to the CCPS administrative support staff ASAP if errors are discovered after billing deadlines. RECORDS MANAGEMENT: Clinic administrative support staff will assist CCPS staff with records management in accordance with existing RM 001 (Medical Record Creation, Content Order, Thinning and Closing) RM 002 (Medical Records - Active and Closed Record Storage and Transport) and RM 004 (Medical Records - Closed Record Retention and Disposition) guidelines (please see applicable P/P’s). CCPS Case Mgr. Supervisor is CCPS Mgr.’s designee/primary contact person for all records management issues regarding area clinics. CCPS administrative support staff is also available for questions, concerns or requests for assistance with records management protocol regarding CCPS medical records of all minors (persons under age 18) and/or of all persons under a disability (defined as declared incompetent by a court). CLINIC COVERAGE: It is expected that all CCPS staff assigned to clinics maintain a routine work schedule to ensure appropriate clinic coverage. CCPS staff will post monthly work schedules/calendars, and will document leave in master appointment books in a timely manner to alert Adult Clinical Services Managers and staff of planned absences. Any requests for planned leave should be submitted in advance to prevent coverage problems; it is therefore advised that CCPS staff continue to communicate leave matters with Adult Services Clinic Managers. Decisions/final approval of requests for leave, changes in work schedules, etc., that may result in potential clinic coverage problems will be determined by CCPS Manager after consultation with Adult Services Clinic Managers. In the event of unplanned leave, CCPS staff assigned to clinics must contact the clinic admin support staff and/or leave a voice mail message regarding their absence after contacting CCPS Manager/designee, per agency guidelines. Disability Assessments (SSA) CCPS staff cannot withhold clinical information currently in an individual’s medical record if the D19 psychiatrist refuses to complete the DDS form (per D19 policy regarding 6 mos of tx compliance) within fifteen (15) days of the date of receipt of the DDS request for records. The only exception is if the individual has not yet been enrolled into a D19 program and there is only a screening form available. If this is the case, then the CM should document such on the official DDS request form and return to DDS via mail (no faxes are allowed unless in urgent/emergency situations). CCPS staff must not to send a letter to DDS indicating that D19 policy prohibits completion of the DDS form unless the individual has been compliant with treatment for at least 6 months. Once a DDS request for records is received (even regarding closed cases), CCPS staff must attempt to schedule the psychiatric appointment – either for an initial psychiatric evaluation, or for the purpose of completing the DDS form - within 15 days of receipt of the medical records request. If the case is an existing case, and a psychiatric appointment

20

cannot be secured within the 15 days, CCPS staff must send copies of all D19 psychiatric and medication evaluations conducted during requested treatment dates/time frame(s). If the person has never seen a D19 psychiatrist, CCPS staff should send only the D19 psychosocial assessment(s) conducted during the requested treatment dates/time frame(s). If the D19 psychiatrist conducts the psych eval and/or completes the DDS form after the 15-day deadline, then CCPS staff should forward those documents, accordingly. CCPS staff must always keep copies of what is sent to any agency, and complete the D19 Disclosure of PHI Cover Letter and enclose such in the envelope with a copy of DDS authorization to disclose information. CCPS staff must then follow protocol regarding accurate documentation of SSI application/copies service activity/applicable fees in EHR, timely requests forwarded to d19 administrative support staff to notify D19 Central Reimbursement to set up an account with DDS Fund Source. Medical Services Psychiatric Services remain available to those *eligible CCPS consumers (age 14 and older) who meet the DMAS criteria for SED and At Risk for SED. Psychiatric services will offer appointments via Telemedicine Services. *CCPS consumers and their parents/legal guardians have the option to receive medical services from any psychiatrist or the contracted psychiatric services provider at the physical location of psychiatrist’s office. There will be no more preferential scheduling; support staff will fill all available telemedicine slots chronologically; preferences will be given only to those who can verify their school or work schedules. Consumers recently *discharged from hospitals/residential treatment facilities must be scheduled for aftercare appointments with psychiatrist ASAP to ensure timely activation of D19 med orders upon discharge. *CCPS staff must complete the treatment history data in agency EHR, accordingly. Clinic/CCPS admin support staff will contact parents/guardians of CCPS consumers to remind them of their scheduled Telemedicine psychiatric appointments 48 hours before and on the date of the scheduled appointments. CCPS staff needs to continuously address medication management issues with consumers and families; and help educate them of the importance of keeping appointments with the Telemedicine psychiatrist(s) to prevent any delay in securing necessary medication orders/prescriptions. Case Transfers

The CCPS Manager must approve all CCPS transfer requests. *It is the responsibility of the transferring case manager/D19 service provider to ensure that all forms are updated and current

21

in the consumer’s chart prior to case transfer. If the consumer’s chart has not been updated, the receiving D19 Program Manager reserves the right to deny the transfer until the necessary information has been updated. Once the receiving manager has obtained notification of the transfer, she/he has three (3) working days to review the chart and approve the transfer. Before a case is accepted for transfer, the D19 case manager/service provider must complete a Transfer Summary to close case to its program prior to the actual case transfer. Once notice of transfer is received, the receiving case D19 manager/service provider must then open the case to its site/program. If a D19 case is transferred for CCPS case management services from a D19 outpatient service provider, an assessment for case management services and ISP must be completed w/in 30 days of date of transfer. * This includes the updated assessment to determine eligibility criteria for continued case management services if child ages out of SED and/or AT RISK populations. . The CCPS case manager is responsible for coordinating case management services for consumers who move outside the D19 catchment area. To ensure continuity of care guidelines are met, the case manager must therefore follow up with the VACSB case manager (or out-of catchment service provider) within the first thirty (30) days of date of transfer to ascertain status/progress. Such service activity should be noted in the consumer’s record. Case Closings To be eligible for closing, cases must meet at least one of the following criteria:

A. The consumer has moved from District 19’s catchment area; B. The consumer has decided to receive case management services

from another agency. In such cases the case manager is responsible for verifying the consumer’s new service provider;

C. The consumer is sentenced to be incarcerated for six months or longer;

D. The consumer has requested in writing that his/her record be closed to District 19. In such cases the case manager shall respond via letter to the consumer or legal guardian that the request for termination has been received. The letter should also include a statement of treatment and service recommendations in order to prevent relapse and or hospitalization; acknowledgement of the individual’s right to resume District 19 services in the future; and information about the availability of District 19’s Crisis Hotline/District 19 Emergency Services;

E. Consumers who are non-compliant with treatment goals and objectives can be closed upon the approval of psychiatrist and program manager following a formal staffing. In such cases an entry should be made in the progress notes regarding the decision to close the consumer’s chart;

F. The consumer’s whereabouts are unknown and efforts have been made by staff to contact the consumer for a period of at least

22

three (3) months consistently. All efforts to contact consumer must be documented.

G. The consumer has been permanently placed in a nursing care facility and this has been verified;

H. The consumer is deceased; I. The consumer has completed treatment goals/objectives; J. The consumer has not received active case management services for

a period of ninety (90) days. Whenever service is terminated with a Medicaid consumer, the consumer must receive written notification of the pending action within ten (10) days with the following exceptions:

A. Recipient has stated in writing that he/she no longer wishes to receive the services;

B. Recipient gives information that requires the termination of Medicaid benefits and he/she knows that this action is a result of giving the information;

C. Recipient has been admitted to an institution where he/she is ineligible for Virginia State Plan for Medical Assistance Services;

D. Recipient moves to another state and has been determined eligible for Medicaid in the new jurisdiction;

E. Recipient’s whereabouts are unknown. The agency will determine the whereabouts are unknown if mail sent to recipient is returned as undeliverable

Once it is determined that a case is eligible for closing, the following steps should be taken to disenroll a consumer: 1. Schedule a termination session (as appropriate) to review consumer’s treatment plan;

2. Indicate on ISP whether goals/objectives were achieved. Complete a QPR form if due; 3. Make an entry in the progress notes as to consumer’s disenrollment; 4. Complete D19 Program Disenrollment process (consumers are not to be discharged from CSB).

VII. CCPS DEVELOPMENTAL DISABILITIES CASE MANAGEMENT SERVICES

23

CCPS Developmental Disabilities case management services (DDCM) assist children, adolescents diagnosed with mental retardation, autism and other developmental disabilities and their families with accessing needed medical, psychiatric, social, educational, and vocational, residential and other supports essential for living in the community and in developing a desired lifestyle. Eligibility for ID case management services does not mandate treatment within District 19. The provision of case management services is contingent upon funding and staff availability within each locality. The services are provided by staff who meets the Department of Medical Assistance Services (DMAS) educational, licensure and/or certification criteria for Qualified Developmental Disabilities Provider (QDDP). Individuals eligible for DD case management must meet criteria for DD Waiver Services and/or targeted case management (ID) or Episodic case management (DD). To be eligible to receive DD case management services, individuals must have documented evidence to have an intellectual disability as defined by The American Association on Intellectual and Developmental Disabilities (AAIDD), per DMAS. Children under age six (6) who are at developmental risk and who are receiving DD Waiver services are eligible for and must also be receiving Targeted Case Management services during the months that ID Waiver services are received. Documentation to prove eligibility may include but is not limited to the following:

F. A psychological evaluation conducted by a licensed professional reflecting ID diagnosis before age 18, or a psychological evaluation and/or medical evaluation conducted by a licensed professional documenting a DD diagnosis before age 22 ;

G. Reports, referrals, or information from other agencies involved with the client/family;

H. *A social or medical history; I. An employment history.

*Persons eligible to receive case management who are under the age of 21 require initial and annual health and physical and dental exams. The case manager is responsible for coordinating, as well as securing copies of, physical and dental exams. Referrals Persons eligible for DD case management services through District 19 should be residents of one of the nine jurisdictions of the agency. Medicaid consumers are protected by their Freedom of Choice rights and are not restricted to receive case management services within their respective localities. Prospective consumers may refer themselves or be referred by collateral resources, hospitals, schools, treatment facilities, family members or legal guardians.

24

For all case management referrals, the necessary information must be provided in order to further assess for services. Referrals from hospitals and treatment facilities should include copies of discharge summaries, medical exams, medication lists and progress notes. Referrals within District 19 (if transfers are not appropriate) should be coordinated through the CCPS Manager/designee. The completed first page of screening form must accompany all such referrals. The disposition of the referral should be documented with one of the following outcomes: A scheduled face-to-face appointment including date and time; Admittance to a waiting list; or a referral to an outside provider, if appropriate. Response-time to referrals should be within seven (7) business days. The case manager must send a letter to the individual notifying him/her of the right to appeal if: found ineligible for case management or MR Waiver services; and/or if placed on the Statewide DD Waiver Waiting List. Screening For Services Per agency policy, for any initial request for DDCM services, an appointment can be secured via our D19 Same Day Access Services (see agency and DMAS P/P’s qualified provider information and agency SDA program policies and procedures for office locations/hours, referral process, etc.).

Once a consumer has been referred for services, an initial screening can take place face-to-face or over the phone followed by face-to-face screening for further assessment to determine eligibility. If it is determined that an individual is eligible for DD case management, staff must inform the applicant(s) of any necessary paperwork/documentation (proof of income, proof of address, insurance, etc.) to determine their financial responsibility. A signed D19 Financial Contract is then obtained prior to admission. Admission To Services The initial assessment appointment should be scheduled within five to seven business days of the screening appointment. Persons to be assessed for statewide DD Waiver Wait list only may not require a full admission, but will require a comprehensive assessment to determine eligibility for DD Waiver services, including completion of the Virginia Intellectual and Developmental Eligibility Screening (VIDES). Please see existing emergency DBHDS/DOJ Regulations. The CCPS case manager is responsible for completing the admission process within thirty (30) days of the date of the initial admission assessment appointment. The admission process includes the completion of all applicable admission and assessment forms. It is the case manager’s responsibility to complete Program Enrollment, ensure data entry no later than twenty-four (24) hours from date of completion for billing purposes. DD Waiver Case Management

25

CCPS staff must determine whether someone meets the following functional criteria for DD Waiver services before completing a request for an available waiver slot verified by DBHDS: Individuals six years of age or older must have a psychological evaluation completed by a licensed professional that indicates a diagnosis of DD. The psychological evaluation must reflect the individual’s current level of functioning and support the diagnosis of ID as defined by the American Association on Intellectual and Development Disabilities (AAIDD), formerly known as the American Association on Mental Retardation (please see DMAS guidelines for definition).

The psychological evaluation or accompanying documentation must address intellectual functioning, adaptive behavior and age of onset. Individuals less than age six must have a psychological or standardized developmental evaluation that reflects the child’s current level of functioning and that states that the child has a diagnosis of intellectual disability or is at developmental risk (please see DBHDS/DOJ emergency regulations and guidelines for definition. Individuals eligible for DD Waiver services must meet the ICF/MR level of care. This is established by meeting the indicated dependency level in two or more of the categories on the Virginia Independent Developmental (Disability) Eligibility Survey (VIDES), which must be completed by the case manager with input from the individual, the family/caregiver, and providers, as appropriate. Individuals can meet “Priority 1, Priority 2 or Priority 3” eligibility requirements. B. Criteria. In order to be assigned to one of the categories below, the individual shall meet one of these criteria, as appropriate:

1. Priority One shall be assigned to individuals determined to meet one the following criteria and require a waiver service within one year:

a. An immediate jeopardy exists to the health and safety of the individual due to the unpaid primary caregiver having a chronic or long-term physical or psychiatric condition or conditions that significantly limit the ability of the primary caregiver or caregivers to care for the individual; there are no other unpaid caregivers available to provide supports.

b. There is immediate risk to the health or safety of the individual, primary caregiver, or other person living in the home due to either of the following conditions:

(1) The individual's behavior or behaviors, presenting a risk to himself or others, cannot be effectively managed by the primary caregiver or unpaid provider even with support coordinator/case manager-arranged generic or specialized supports; or

(2) There are physical care needs or medical needs that cannot be managed by the primary caregiver even with support coordinator/case manager-arranged generic or specialized supports;

c. The individual lives in an institutional setting and has a viable discharge plan; OR

26

d. The individual is a young adult who is no longer eligible for IDEA services and is transitioning to independent living. After individuals attain 27 years of age, this criterion shall no longer apply.

2. Priority Two shall be assigned to individuals who meet one of the following criteria and a waiver service will be needed in one to five years:

a. The health and safety of the individual is likely to be in future jeopardy due to

i. The unpaid primary caregiver or caregivers having a declining chronic or long-term physical or psychiatric condition or conditions that significantly limit his ability to care for the individual;

ii. There are no other unpaid caregivers available to provide supports; and

iii. The individual's skills are declining as a result of lack of supports;

b. The individual is at risk of losing employment supports;

c. The individual is at risk of losing current housing due to a lack of adequate supports and services; or

d. The individual has needs or desired outcomes that with adequate supports will result in a significantly improved quality of life.

3. Priority Three shall be assigned to individuals who meet one of the following criteria and will need a waiver slot in five years or longer as long as the current supports and services remain

a. The individual is receiving a service through another funding source that meets current needs;

b. The individual is not currently receiving a service but is likely to need a service in five or more years; or

c. The individual has needs or desired outcomes that with adequate supports will result in a significantly improved quality of life.

C. Individuals and family/caregivers shall have the right to appeal the application of the prioritization criteria (in the event that such application results in a reduction of access to services), emergency criteria, or reserve criteria to their circumstances pursuant to 12 VAC 30-110. All notifications of appeal shall be submitted to DMAS.

D. Slot allocation. Individuals who are in Priority 1 category who are determined to be most in need of supports at the time a slot is available are reviewed by the independent waiver slot assignment committee for the area in which the slot is available. The individual who has the highest need as designated by the committee will be recommended for the available waiver slot. The DMAS designee shall make the final determination for slot allocation.

27

E. Emergency access. Eligibility criteria for emergency access to either the FIS (12 VAC 30-120-700 et seq.), CL (12 VAC 30-120-1000 et seq.), or BI (12 VAC 30-120-1500 et seq.) waiver.

1. Subject to available funding and a finding of eligibility under 12VAC30-120-580, individuals shall meet at least one of the emergency criteria of this subdivision to be eligible for immediate access to waiver services without consideration to the length of time they have been waiting to access services. The criteria shall be one of the following:

a. Child Protective Services has substantiated abuse/neglect against the primary caregiver and has removed the individual from the home; or for adults where 1) Adult Protective Services has found that the individual needs and accepts protective services, or 2) abuse/neglect has not been founded, but corroborating information from other sources (agencies) indicate that there is an inherent risk present and there are no other caregivers available to provide support services to the individual.

b. Death of primary caregiver or lack of alternative caregiver coupled with the individual's inability to care for him/herself and danger to self or others without supports.

2. Requests for emergency slots shall be forwarded by the CSB/BHA to DBHDS.

a. Emergency slots may be assigned by DBHDS to individuals until the total number of available emergency slots statewide reaches ten percent of the emergency slots funded for a given fiscal year, or a minimum of three slots. At that point, the next non-emergency waiver slot that becomes available at the CSB in receipt of an emergency slot shall be reassigned to the emergency slot pool in order to ensure emergency slots remain to be assigned to future emergencies within the Commonwealth's fiscal year.

b. Emergency slots shall also be set aside for those individuals not previously identified but newly known as needing supports resulting from an emergent situation.

F. Reserve slots.

1. Reserve slots may be used for transitioning an individual who, due to documented changes in his support needs, requires a move from the DD waiver in which he is presently enrolled into another of the DD waivers to access necessary services.

a. An individual who needs to transition between the DD waivers shall not be placed on the DD waiting list.

b. A documented change in an individual's assessed needs, which requires a service or services that is or are not available in the DD waiver in which the individual is presently enrolled, shall exist for an individual to be considered for a reserve slot.

c. CSBs shall document and notify DBHDS in writing when an individual meets the criteria in subsection b within three business days of knowledge of need. The assignment of reserve slots shall be managed by DBHDS which will maintain a chronological list of individuals in need of a reserve slot in the event that the reserve slot supply is exhausted.

2. The waiver slot belonging to the individual who vacates one of the DD waivers to utilize the reserve slot to enroll in another DD waiver shall be assigned to an individual

28

on that CSB's/BHA's part of the statewide waiting list by DBHDS, after review and recommendations from the local Waiver Slot Assignment Committee.

G. If the individual determines at any time that he no longer wishes to be on the waiver waiting list, he may contact his support coordinator/case manager to request removal from the waiting list. The support coordinator/case manager shall notify DBHDS so that the individual's name can be removed from the waiting list.

Persons placed on DD Waiver wait lists that do not require/request ongoing case management services must be enrolled into the D19 DD “Follow-Along” program/case status. CCPS DDCM staff must make contacts with such cases for quarterly updates and annual VIDES assessments for continued eligibility for DD Waiver services/level of care status and ascertain whether there are any targeted case management needs. Results need to be documented in medical record; also on Waiver Wait List forms for quarterly submission to DBHDS.

For those individuals that receive ID case management services:

(1) The CSB that serves the individual will be the provider of support coordination/case management.

(2) The CSB shall provide a choice of support coordinator/case managers within the CSB.

(3) If the individual or family decides that no choice is desired in that CSB, the CSB shall afford a choice of another CSB with whom the responsible CSB has a memorandum of agreement.

(4) At any time, an individual may make a request to change their support coordinator/case manager.

b. For those individuals that receive DD case management services:

(1) The CSB that serves the individual will be the provider of support coordination/case management.

(2) The CSB shall provide a choice of support coordinator/case managers within the CSB.

(3) If the individual or family decides that no choice is desired in that CSB, the CSB shall afford a choice of another CSB with whom the responsible CSB has a memorandum of agreement.

(4) If the individual or family decides not to choose the responsible CSB or the CSB with whom there is a memorandum of agreement, then they will be given a choice of a private provider with whom the responsible CSB has a contract for support coordination/case management.

(5) At any time, an individual may make a request to change their support coordinator/case manager.

29

3. Individuals who are eligible for the BI, CL, and FIS waivers shall have free choice of the providers of other medical care under the plan.

4. When the required support coordination/case management services are contracted out to a private entity, the CSB/BHA shall remain the responsible provider and only the CSB/BHA may bill DMAS for Medicaid reimbursement.

G. Payments for support coordination/case management services under the Individual Support Plan shall not duplicate payments made to public agencies or private entities under other program authorities for this same or similar purpose.

H. The support coordinator/case manager shall maintain the following documentation, in either hard copy or electronic format, for a period of not less than six years from each individual's last date of service or in the case of a minor child, six years after the minor child's 18th birthday:

1. All assessments and re-assessments completed for the individual, all ISPs for the individual, and every service providers' Plan for Supports completed for the individual;

2. All supporting documentation related to any change in the ISP;

3. All related communication (including dates) with the individual; family/caregiver, consultants, providers, DBHDS, DMAS, DSS, DARS or other related parties;

4. An ongoing log that documents all contacts (including dates) made by the support coordinator/case manager related to the individual and family/caregiver; and

5. A copy of the current DMAS-225 form.

I. Individual choice of provider entities. The individual shall have the option of selecting the provider of his choice from among those providers meeting the individual's needs. The support coordinator/case manager shall inform the individual, and family member/caregiver as appropriate, of all available enrolled waiver service providers in the community in which he desires services, and he shall have the option of selecting the provider of his choice from the list of enrolled service providers.

J. Support coordinator/case manager's responsibility for the Medicaid Long Term Care Communication Form (DMAS-225). It is shall be the responsibility of the support coordinator/case manager to notify DMAS, DBHDS, and DSS, in writing within five business days, when any of the following circumstances occur:

1. Home and community-based waiver services are implemented.

2. An individual dies.

3. An individual is discharged or terminated from waiver services.

4. Any other circumstances (including hospitalization) that cause home and community-based waiver services to cease or be interrupted for more than 30 calendar days.

5. A selection by the individual or his family/caregiver, as appropriate, of a different support coordination/case management provider.

30

. Operational Guidelines: . "For individuals receiving case management [support coordination] services pursuant to this Agreement, the individual’s case manager [support coordinator] shall meet with the individual face-to-face (FF) on a regular basis and shall conduct regular visits to the individual’s residence, as dictated by the individual’s needs." “Regular basis” means face-to-face visits every 90 days (with a 10 day grace period) consistent with the requirements of the ID and DD Targeted Case Management (TCM) regulations. More frequent face-to-face visits are required if the individual meets the criteria. (See existing emergency regulations/DOJ Settlement Agreement guidelines) 2. At these face-to-face meetings, the case manager [support coordinator] shall: observe the individual and the individual’s environment to assess for previously unidentified risks, injuries, needs, or other changes in status; assess the status of previously identified risks, injuries, needs, or other change in status; assess whether the individual’s support plan is being implemented appropriately and remains appropriate for the individual; and ascertain whether supports and services are being implemented consistent with the individual’s strengths and preferences and in the most integrated setting appropriate to the individual’s needs. If any of these observations or assessments identifies an unidentified or inadequately addressed risk, injury, need, or change in status; a deficiency in the individual’s support plan or its implementation; or a discrepancy between the implementation of supports and services and the individual’s strengths and preferences, then the support coordinator/case manager shall report and document the issue, convene the individual’s service planning team to address it, and document its resolution. To “report and document the issue” and meet the other requirements of this section, case managers [support coordinators] should take the following actions in the situations listed: a. If any face-to-face contact results in the identification of a previously unidentified or inadequately addressed risk, injury, need, or change in status 1) Document in the record the specific unidentified or inadequately addressed risk, injury, need, or change in status, including the report to and the response of the designated provider(s). 2) Convene and mobilize Person-Centered Planning (PCP) team members needed to address the issue. 3) Report suspected abuse, neglect, or exploitation to Adult Protective Services or Child Protective Services and the DBHDS Office of Human Rights. 4) Report to the DBHDS Office of Licensing. 5) Document resolution of the issue in the record. b. If a deficiency in the individual’s support plan or its implementation is identified 1) Document in the record the specific deficiency, including the report to and the response of the designated provider(s). 2) Convene and mobilize PCP team members needed to address the issue.

31

3) Report to the DBHDS Office of Licensing, the individual’s PCP team members needed to address the issue and, in the case of an ID or DS Waiver individual, the Community Resource Consultant (CRC). 4) In the case of an individual on the DD Waiver, the DD Case Manager will complete steps 1 and 2 above, and then report the findings of deficiency to the DD Waiver unit at DMAS. 5) Document the resolution of the issue in the record. c. If a discrepancy between the implementation of supports and services and the individual’s strengths and preferences is identified 1) Document in the record the specific discrepancy, including the report to and the response of the designated provider(s). 2) Convene and mobilize the individual’s PCP team members needed to address the issue. 3) If the individual’s PCP team cannot achieve resolution, ID or DS support coordinator/case manager shall contact the CRC first and the DBHDS Office of Licensing second. DD Case Managers will contact the DD Waiver Unit at DMAS. 4) Document the resolution of the issue in the record. d. A “change in status” includes a change in residential, day support, pre-vocational, or supported employment provider. When a change in status occurs, the support coordinator/case manager should closely monitor the transition to the new provider to ensure there are not unnecessary gaps in services or delays and that services are provided in accordance with the individual's support plan. 3. The individual’s case manager [support coordinator] shall meet with the individual face-to-face at least every 30 days, and at least one such visit every two months must be in the individual’s place of residence, for any individuals who: a. Receive services from providers having conditional or provisional licenses. 1) Support coordinators/case managers shall fulfill the above face-to-face obligation for the entire time a provider is on a conditional (i.e., new) license or provisional license. This level of face-to-face contact will continue for at least three months after a provider has been removed from provisional status. 2) This requirement for more frequent case management visits applies to any individual in the target population who receives services from any DBHDS licensed provider, including a residential, day support, or prevocational provider, that has been issued a conditional or provisional license. 3) The DBHDS Office of Licensing (OL) will post information on the DBHDS website, updated on the 10th of each month, about each provider that is operating under a conditional or provisional license. b. Have more intensive behavioral or medical needs as defined by the Supports Intensity Scale ® (“SIS®”) category representing the highest level of risk to individuals. 1) If any response to the Virginia SIS® Supplemental Risk Assessment regarding an individual is “yes,” the support coordinator/case manager shall meet with the individual

32

face-to-face at least every thirty (30) days, with at least one visit every two months in the individual's residence, while those responses remain “yes.” Exception: A "yes" response to SIS Supplemental Risk Assessment Item #5 (fall risk) does not automatically constitute a more intensive behavioral or medical need requiring more frequent case management visits. Only if the individual has experienced an injury as a result of a fall in the past 90 days will a “yes” to item #5 necessitate the more frequent case management visits. In this circumstance, the support coordinator/case manager shall meet with the individual face-to-face at least every thirty (30) days, with one such visit every two months in the individual's residence, until the individual is stabilized. 2) If any item in sections 3a or 3b of the SIS Supplemental Risk Assessment are scored “2” (i.e., extensive support needed), the individual shall receive the more frequent face-to-face support coordinator/case manager visits while those responses remain scored “2.” The exceptions are a score of “2” on a) 3a #14 (lifting and/or transferring) unless an adverse event has occurred in the context of lifting or transferring in the past 90 days, in which case this level of contact will continue until the individual is stabilized, or b) 3a #15 (therapy services). c. Have an interruption of service greater than 30 days. 1) This means an interruption of any of the following waiver services: a) Congregate residential (including sponsored residential) b) In-home residential c) Personal Assistance (agency-directed or consumer-directed) d) Supported Employment e) Prevocational f) Day Support g) Ongoing therapeutic services. 2) The support coordinator/case manager shall meet with the individual face-to-face at least every thirty (30) days, with at least one such visit every two months in the individual's residence, until either services have resumed or the individual has lost his slot. 3) An extended vacation, when the individual and his or her family are out of town, does not constitute an interruption of service. Extended vacations must be clearly documented in the individual's record. d. Encounter the crisis system for a serious crisis or, for multiple less serious crises, within a three-month period. 1) Crisis includes both behavioral/psychiatric and medical events.

33

2) “Serious crisis” means admission to a Crisis Stabilization Unit (CSU), START, hospital (other than for routine or elective procedures) , hospital followed by admission to a Long Term Rehab facility, or an out of home placement due to CPS involvement or incarceration. 3) “Multiple less serious crises” means assessment for admission to a CSU, START, hospital (other than for routine or elective procedures), hospital followed by admission to a Long Term Rehab facility, or an out of home placement due to CPS involvement or incarceration three or more times in a twelve (12) month period. 4) The support coordinator/case manager shall meet face-to-face with the individual at least every thirty (30) days, with at least one such visit every two months in the individual's residence, for six months after discharge or until stabilized, if not stabilized within six months. e. Have transitioned from a Training Center (TC) within the previous 12 months. The support coordinator/case manager shall meet face-to-face with the individual at least every thirty (30) days, with at least one such visit every two months in the individual's residence, for twelve (12) months post TC discharge. f. *Reside in congregate settings licensed for five or more individuals. 1) The support coordinator/case manager shall meet face-to-face with the individual at least every thirty (30) days, with at least one such visit every two months in the individual's residence, for the entire time an individual is in a congregate setting licensed for five or more individuals. *RST Referrals must be made – see current RST referrals guidelines 2) OL will post on the DBHDS website, on the 10th of each month, a current list of congregate settings licensed for five or more individuals. 3) OL will be drafting a memo stating that if a provider is licensed for five or more individuals, but voluntarily agrees to serve fewer for the duration of the MFP year, the provider can submit a letter stating this intent to the Licensing Specialist, who will then reduce their licensed number of beds for that period of time. ***See updated DBHDS/DOJ revisions/decision tree guidelines for additional determinants for ECM eligibility criteria**** If the support coordinator/case manager cannot complete the required face-to-face contact, he/she must document the reason(s) and all attempts. After two, consecutive 30-day periods of no contact, the CSB support coordinator/case manager will contact his/her regional CRC, who will determine if further steps are needed (such as contacting the Licensing Specialist, etc.). This includes extended vacations individuals/families might take. The CSB support coordinator/case manager must also comply with the established Waiver “Request to Retain Slot” process as appropriate. After two consecutive 30-day periods of no face-to-face contact, the DD case manager will follow current guidance and contact the DD Waiver Unit at DMAS as appropriate.

34

CCPS Case Management Functions

1. All consumers receiving case management services within District 19 must have a completed Person-Centered Individual Support Plan (PCP) within 30 days of the initiation of service. The PCP must include the following:

- Consumer’s name and case identification number; - Parts I-V, to include support coordinator/case manager’s ISP; - Consumer’s treatment and training needs; - Goals and measurable objectives to meet the consumer’s identified needs; - Services to be provided with recommended frequency to accomplish the measurable goals/objectives; - The person who is responsible for the service intervention.

2. All assessments and PCPs shall be updated as necessary as the needs of the individual

change and/or if the individual meets a different service population definition due to change age, diagnosis, level disability, duration of illness, etc.

3. All PCPs must be updated every 365 days.

4. The case manager will conduct a person-centered planning meeting and develop a new

*PCP with the consumer at the annual update. The consumer and/or legal guardian must sign the updated support plan as verification that the case manager has discussed changes in the plan with her/him. *Effective October 1, 2019 – all PCP/ISP’s must be entered into WaMS.

5. At the annual update, the case manager shall include information provided from essential

service providers and significant individuals who are involved in the overall treatment of the consumer. This information can be obtained by phone, face-to-face meetings, or secured electronic submissions.

6. The case manager and consumer shall review the PCP every 3 months and complete the

*Quarterly Progress Review (QPR) Form. The QPR is an evaluation of the consumer’s progress towards the identified treatment goals. The first review is due by the last day of the 3rd month from the effective date of the PCP. A grace period of the last day of the following month will be given to complete the review. Subsequent reviews, however are due based on the original due date of the previous review(s); not on the date(s) the previous review(s) had been completed within the grace period.

*The D19 Consumer Satisfaction Survey also needs to be completed if consumer’s Legal Guardian agrees.

7. Case managers should meet face-to-face with consumers once a month; however, a face-to-face meeting must occur at least once every ninety (90) days (see previous Enhanced CM guidelines). The purpose of the face-to-face meeting is for the case manager to observe the consumer’s condition, to verify linked services, to determine if there are any unmet needs at that time, and to determine if the current treatment plan should be continued or revised. Community outreach, home and program site visits are also

35

encouraged to better assess consumer’s current living situation, as well as better determine appropriateness of community resources and ancillary services.

8. All case management services shall be documented in the consumer’s medical records file. Progress notes are to convey the consumer’s status, staff interventions, and the consumer’s progress towards the goals and objectives stated in the consumer’s ISP. At a minimum, a progress note should outline the following:

Name of service rendered; Date of service;

Signature and credentials of person rendering the service; Amount of time or units required to deliver the service; Detailed notes outlining the precise nature of the service(s) rendered (e.g., assessing needs, linking, collateral contacts, counseling) Operating Procedures for CCPS Staff Assigned to Clinics

INITIAL CALLS/SERVICE INQUIRIES/PREADMISSION SCREENING DATA ENTRY (EHR): All initial calls received at the clinics for CCPS services should be handled according to D19 P/P’s/clinic protocol regarding administrative support staff’s roles/responsibilities for gathering demographic information and preliminary data elements, etc. All applicable referral information, (including EHR ID number assignments) should be forwarded to Sr. DD Case Manager for follow up and assignment (in the event CCPS MH case management staff is not available at time of call/service inquiries). CCPS staff will continue to schedule CM appointments and notify clinic administrative support staff, accordingly. FINANCIAL INFORMATION: All initial, annual, updated financials and extended payment contracts will be completed by clinic administrative support staff; CCPS staff in the clinics should only conduct financial assessments in emergency situations. It is therefore advised that all admission and annual financial assessments (and updates, as applicable) be conducted in the clinics to ensure timely/accurate completion of financial assessments. Notifications of any critical financial matters will also be forwarded to CCPS administrative support staff, who is responsible for routine insurance verifications, insurance pre-authorizations, extension requests, resolving insurance denials, etc. All extended payment contracts will be forwarded to be signed by the CCPS Mgr. The CCPS administrative support will be responsible for gathering data regarding billable services to ensure that all insurance claims are accurately made within established billing time frame(s). This includes running CM reports for all localities to track monthly CM contacts. All adjustment requests regarding financial/reimbursement data elements need to therefore be forwarded to the CCPS administrative support staff ASAP if errors are discovered after billing deadlines.

36

RECORDS MANAGEMENT: Clinic administrative support staff will assist CCPS staff with records management in accordance with existing RM 001 (Medical Record Creation, Content Order, Thinning and Closing) RM 002 (Medical Records - Active and Closed Record Storage and Transport) and RM 004 (Medical Records - Closed Record Retention and Disposition) guidelines (please see applicable P/P’s). CCPS Senior DDCM is CCPS Mgr.’s designee/primary contact person for all records management issues regarding area clinics. CCPS administrative support staff is also available for questions, concerns or requests for assistance with records management protocol regarding CCPS medical records of all minors (persons under age 18) and/or of all persons under a disability (defined as declared incompetent by a court). CLINIC COVERAGE: It is expected that all CCPS staff assigned to clinics maintain a routine work schedule to ensure appropriate clinic coverage. CCPS staff will post monthly work schedules/calendars, and will document leave in master appointment books in a timely manner to alert Adult Clinical Services Managers and staff of planned absences. Any requests for planned leave should be submitted in advance to prevent coverage problems; it is therefore advised that CCPS staff continue to communicate leave matters with Adult Services Clinic Managers. Decisions/final approval of requests for leave, changes in work schedules, etc., that may result in potential clinic coverage problems will be determined by CCPS Manager after consultation with Adult Services Clinic Managers. In the event of unplanned leave, CCPS staff assigned to clinics must contact the clinic admin support staff and/or leave a voice mail message regarding their absence after contacting CCPS Manager/designee, per agency guidelines. Disability Assessments CCPS staff cannot withhold clinical information currently in an individual’s medical record if the D19 psychiatrist refuses to complete the DDS form (per D19 policy regarding 6 mos of tx compliance) within fifteen (15) days of the date of receipt of the DDS request for records. The only exception is if the individual has not yet been enrolled into a D19 program and there is only a screening form available. If this is the case, then the CM should document such on the official DDS request form and return to DDS via mail (no faxes are allowed unless in urgent/emergency situations). CCPS staff must not to send a letter to DDS indicating that D19 policy prohibits completion of the DDS form unless the individual has been compliant with treatment for at least 6 months. Once a DDS request for records is received (even regarding closed cases), CCPS staff must attempt to schedule the psychiatric appointment – either for an initial psychiatric evaluation, or for the purpose of completing the DDS form - within 15 days of receipt of the medical records request. If the case is an existing case, and a psychiatric appointment cannot be secured within the 15 days, CCPS staff must send copies of all D19 psychiatric and medication evaluations conducted during requested treatment dates/time frame(s). If the person has never seen a D19 psychiatrist, CCPS staff should send only the D19 psychosocial assessment(s) conducted during the requested treatment dates/time

37

frame(s). If the D19 psychiatrist conducts the psych eval and/or completes the DDS form after the 15 day deadline, then CCPS staff should forward those documents, accordingly. CCPS staff must always keep copies of what is sent to any agency, and complete the D19 Disclosure of PHI Cover Letter and enclose such in the envelope with a copy of DDS authorization to disclose information. CCPS staff must then follow protocol regarding accurate documentation of SSI application/copies service activity/applicable fees in EHR, timely requests forwarded to d19 administrative support staff to notify D19 Central Reimbursement to set up an account with DDS Fund Source. Medical Services Psychiatric Services remain available to those *eligible CCPS consumers (age 14 or older) who meet the DMAS criteria for those with documented diagnoses of developmental and/or intellectual disabilities with behavioral health issues requiring psychotropic medications. *The psychiatrist(s) currently contracted to provide Child Medical Services will offer appointments via Telemedicine Services. *CCPS consumers and their parents/legal guardians have the option to receive medical services from any psychiatrist or the contracted psychiatric services provider at the physical location of psychiatrist’s office. *CCPS staff must enter the treatment history data in EHR, accordingly. Case Transfers The following procedures will be followed by all Virginia Community Services Boards (CSBs) and Behavioral Health Authorities (BHAs) to address Support Coordination/Case Management (SC/CM) and service delivery responsibilities when individuals with a developmental disability (DD) move from one CSB/BHA jurisdiction to another, or when a request is made for SC/CM responsibilities to be transferred to another jurisdiction. These procedures apply to any individual who changes residency or requests a transfer of SC/CM responsibilities regardless of funding source including Medicaid Waiver, Community Intermediate Care Facility1, Targeted Case Management (TCM) and those persons without specialized funding sources, and is compatible with the process outlined in the Mental Retardation/Intellectual Disability Community Services Manual, Chapter IV. CSB/BHAs have the responsibility to participate in intense communication regarding individuals moving into a new CSB/BHA area who have complex behavioral, psychiatric, and/or medical needs (e.g. involvement with REACH, psychiatric facilities, rehabilitation facilities, emergency placements) to ensure the quality of care.

1. Preliminary Notification of Relocation

A. When an individual plans to or relocates outside his/her CSB/BHA jurisdiction, either temporarily or permanently, the CSB/BHA of origin will

38

secure an authorization to release protected health information and notify the receiving CSB/BHA.

B. The CSB/BHA of origin shall identify and discuss with the receiving

CSB/BHA any intensive support needs concerning this individual’s placement such as a crisis plan, behavioral concerns, REACH Services, recent discharge information from training center or psychiatric hospitalization, medication management, medical, waiver wait list status and/or need for other services.

2. Written Notification of Relocation

A. An initial transfer letter will be sent by the CSB/BHA of origin to the receiving CSB/BHA.

B. For an individual whose SC/CM is being transferred, the receiving CSB/BHA’s DD

Director will send a letter of acceptance to the CSB/BHA of origin.

C. For an individual whose SC/CM is not being transferred, on-going psychiatric services and medication management may need to be retained by the jurisdiction of origin.

3. Timeline for Transfer of SC/CM

Within 45 days of receipt of the transfer information, any concerns shall be negotiated and resolved.

Unless a particular individual’s situation meets the definition of “exception” as delineated in the exceptions listed below, the transfer of SC/CM responsibility will take place within 90 days of the relocation notification date.

In cases of Medicaid billing, each CSB/BHA needs to be cognizant of regulations and communicate the billing end date for the CSB/BHA of origin and start date for the receiving CSB/BHA.

4. Exceptions SC/CM will be retained by the CSB/BHA of origin in the following situations: A. When an individual is relocating on a temporary basis and the CSB/BHA

of origin agrees to provide SC/CM and has the ability to manage emergency situations.

39

B. When an individual is a minor and receives services in one jurisdiction but his/her family retains legal residency in the CSB/BHA of origin’s jurisdiction, and/or when individuals are receiving services through the Comprehensive Services Act.

C. When an individual is a minor and in the custody of the Department of Social Services (DSS), and is in foster care placement outside of the responsible DSS and CSB/BHA of origin’s jurisdiction.

D. Should there be special circumstances in which it is beneficial for the CSB/BHA of origin to retain SC/CM for longer than 90 days, an agreement will be negotiated between CSB/BHA DD Directors regarding length of time and exchange of information. Examples may include psychiatric or medical crisis, or termination of service placements is requested through the authorization process stability of placement, etc.

The CCPS Manager must approve all CCPS transfer requests. *It is the responsibility of the transferring case manager/D19 service provider to ensure that all forms are updated and current in the consumer’s chart prior to case transfer. If the consumer’s chart has not been updated, the receiving D19 Program Manager reserves the right to deny the transfer until the necessary information has been updated. Once the receiving manager has obtained the consumer’s chart, she/he has three (3) working days to review the chart and approve the transfer. Before a case is accepted for transfer, the D19 case manager/service provider must close case to its program prior to the actual case transfer. Once notice of transfer is received, the receiving case D19 manager/service provider must then open the case to its site/program. If a D19 case is transferred for CCPS case management services from a D19 outpatient service provider, an assessment for case management services and ISP must be completed w/in 30 days of date of transfer. The CCPS case manager is responsible for coordinating case management services for consumers who move outside the D19 catchment area. To ensure continuity of care guidelines are met, the case manager must therefore follow up with the VACSB case manager (or out-of catchment service provider) within the first thirty (30) days of date of transfer to ascertain status/progress. Such service activity should be noted in the consumer’s record. Case Closings To be eligible for closing, cases must meet at least one of the following criteria:

1. The consumer has moved from District 19’s catchment area; 2. The consumer has decided to receive case management services from another agency. In

such cases the case manager is responsible for verifying the consumer’s new service provider;

3. The consumer is sentenced to be incarcerated for six months or longer;

40

4. The consumer has requested in writing that his/her record be closed to District 19. In such cases the case manager shall respond via letter to the consumer or legal guardian that the request for termination has been received. The letter should also include a statement of treatment and service recommendations in order to prevent relapse and or hospitalization; acknowledgement of the individual’s right to resume District 19 services in the future; and information about the availability of District 19’s Crisis Hotline/District 19 Emergency Services;

5. Consumers who are non-compliant with treatment goals and objectives can be closed upon the approval of psychiatrist and program manager following a formal staffing. In such cases an entry should be made in the progress notes regarding the decision to close the consumer’s chart;

6. The consumer’s whereabouts are unknown and efforts have been made by staff to contact the consumer for a period of at least three (3) months consistently. All efforts to contact consumer must be documented;

7. The consumer has been permanently placed in a nursing care facility and this has been verified;

8. The consumer is deceased; 9. The consumer has completed treatment goals/objectives; 10. The consumer has not received active case management services for a period of ninety

(90) days. Whenever service is terminated with a Medicaid consumer, the consumer must receive written notification of the pending action within ten (10) days with the following exceptions:

A. Recipient has stated in writing that he/she no longer wishes to receive the services;

B. Recipient gives information that requires the termination of Medicaid benefits and he/she knows that this action is a result of giving the information;

C. Recipient has been admitted to an institution where he/she is ineligible for Virginia State Plan for Medical Assistance Services;

D. Recipient moves to another state and has been determined eligible for Medicaid in the new jurisdiction;

E. Recipient’s whereabouts are unknown. The agency will determine the whereabouts are unknown if mail sent to recipient is returned as undeliverable.

Once it is determined that a case is eligible for closing, the following steps should be taken to disenroll a consumer: 1. Schedule a termination session (as appropriate) to review consumer’s treatment plan;

2. Indicate on ISP whether goals/objectives were achieved. Complete a QPR form if due;

41

3. Make an entry in the progress notes as to consumer’s disenrollment; 4. Complete D19 Disenrollment process (consumers are not to be discharged from CSB).

IX. CCPS MENTAL HEALTH INITIATIVE FUNDS

42

CCPS will utilize Mental Health Initiative (MHI) funding in accordance with the following DBHDS guidelines for CSA non-mandated services: MHI funds must be used exclusively to serve new, currently un-served children and adolescents or provide additional services to underserved children and adolescents with serious emotional disturbances and related disorders that are not mandated to receive services under the CSA. Children and adolescents must be under 18 years of age at the time services are initiated. MHI-funded services must be based on the individual needs of the child or adolescent and must be included in an individualized services plan. Services must be child-centered, family focused, and community-based. The participation of families is integral in the planning of these services. Target Population for Mental Health Initiative Funds The target population to be exclusively served with MHI funds is children and adolescents with serious emotional disturbance and related disorders who are not mandated for services under the CSA. Serious emotional disturbance in children is defined in DBHDS state board policy as follows: A defined serious mental health problem that can be diagnosed under DSM-IV and/or all of the following: Problems in personality development and social functioning that have been exhibited over at least one year's time; and Problems which are significantly disabling based upon the social functioning of most youngsters their age; and Problems that have become more disabling over time; and Service needs that require significant intervention by more than one agency. Appropriate Services to be Supported by Mental Health Initiative Funds Services that are most appropriate for use of these funds include: emergency, local inpatient, outpatient, intensive in-home, therapeutic day treatment, alternative day support (including specialized after school and summer camp, behavior aide, or other wrap-around services), and highly intensive, intensive, supervised family support services (including therapeutic foster care or residential respite care). Services should be provided in the least restrictive and most appropriate settings, including homes, schools, pre-schools, community centers, group homes, and juvenile detention centers. Prevention and early intervention services are not appropriate uses of these funds. MHI funds may not be used for residential care services or for CSA-mandated populations Referral Procedures for Mental Health Initiative Funds

43

The FAPT/Lead Agency representative presents a case for staffing. FAPT reviews criteria to determine whether case is eligible for MHI funds. If case meets eligibility criteria/child is considered a viable candidate for MHI funds, a referral to the D19 MHI Case Manager is made. The following documentation must be completed and forwarded to the D19 MHI Case Manager when a referral is made: 1) IFSP; 2) CANS (optional); 3) D19 authorization to disclose confidential information

forms (2) for CSA vendor and FAPT/CPMT. The D19 MHI Case Manager completes the required D19 Mental Health Initiative ISP Summary Form. The forms are forwarded for authorization/processing. An authorized CPMT representative must sign the Mental Health Initiative ISP Summary Form to indicate approval for use of Mental Health Initiative Funds. Accountability and Reporting Requirements for Mental Health Initiative Funds D19 will maintain an open/enrolled case and case record on all children receiving MHI-funded services. *The D19 MHI Case Manager should ensure that all funds are obligated by June 30th of each year, with all funds being expended by September 30th of each year. The D19 MHI Case Manager will monitor MHI services and expenditures by contacting the child, parent(s) and vendors at least twice a month. The MHI Case Manager will review all MHI invoices to ensure accuracy; and to make certain that all invoices must be accompanied by monthly summaries. CSA-certified vendors will enter into MHI contracts with D19 to provide services to cases approved for MHI funds prior to service delivery. * All available funding sources must be accessed to provide services for these children and adolescents prior to utilizing the MHI funding. These sources include, but are not limited to, CSA non-mandated funding, Medicaid, Children’s Medical Security Insurance Plan, Family Access to Medical Insurance Security, private insurance, and other federal, state, or local funds. Other federal or state funds include: Promoting Safe & Stable Families funds, mental health federal block grant funds, Virginia Juvenile Community Crime Control Act funds, and other state mental health general funds used by CSBs for child and adolescent services. ***SEE D19 MHI SERVICES PROTOCOL DEVELOPED FOR PD19 CSA LOCALITIES***