RTC Waiver Provider Forum

March 2009

Purpose of the Provider Forum

• Gain an overall understanding of the RTC Waiver

• Learn who can access waiver supports• Discover what services and supports

will be available under the waiver• Understand how to enroll as an RTC

Waiver Provider and the requirements of being an RTC Waiver Provider

Overview: Maryland’s RTC Waiver

• The purpose of the waiver is to provide up home and community-based services up to Maryland children and youth ages 6-21 who require an RTC-level of care and meet financial criteria

• The RTC Waiver uses a team-based approach called Wraparound to provide mental health and medical services to youth with serious mental health needs.

• The team – including the youth, family members, care coordinators, and service providers – develops a individualized plans of care that support the child and his/her family.

Overview: Maryland’s RTC Waiver

• The Waiver is a demonstration Waiver ending in 2012.

• Maryland is one of nine states with this Waiver.

• The state share of the costs for the Waiver will come primarily from the Children’s Cabinet Interagency Fund.

• A child and family can receive services up to two years. Because of the specialized services, the RTC waiver has a limited number of openings, or slots, each year.

Value Structure & Service Delivery Model for the Waiver

• Value Structure for the waiver:– Systems of Care Principles;– Family-driven;– Youth-guided;– Culturally and linguistically competent;– Community-based; and– Flexible and individualized.

• Service delivery model:– Care coordination embedded in CME with a practice

model of High Fidelity Wraparound—Every participant will have a care coordinator and a Child and Family Team;

– Family Support Partners; and– Youth Support Partners.

Operating Structure for the Waiver• The Mental Hygiene Administration (MHA)

within the Department of Health and Mental Hygiene (DHMH) will be the operating agency for the Waiver.

• The Medicaid Division of Waiver Programs is responsible for oversight of the Waiver.

• Daily project management and evaluation for the Waiver is conducted by the Maryland Child and Adolescent Innovations Institute and Mental Health Institute at the University of Maryland, Baltimore.

Care Management Entities (CME) providing Care Coordination using High Fidelity

Wraparound• CMEs will serve as the entry point to the waiver,

assisting youth and their families with the enrollment process, including the assessments and documentation needed for the medical eligibility and financial eligibility for the waiver.

• The CMEs will also provide care coordination, including facilitation of the Child and Family Teams, and will support the provider enrollment process.

• The Wraparound model is used to implement the care coordination process provided by the CME, with fidelity to the Wraparound principles and its practice model evaluated by a neutral party. (See http://www.rtc.pdx.edu/nwi/ to learn more)

Who will the RTC Waiver serve?

• Children and youth in the waiver must meet technical, medical, and medical assistance (financial) eligibility to enter the waiver.

– Technical Eligibility: Includes living in Baltimore City, Montgomery County, St. Mary’s County, or Wicomico County; Being 6-20 years old at the time of enrollment; and Choosing to Enroll in the RTC Waiver

– Medical Eligibility:• Under 18 years of age, but no younger then 6 years of age with

serious emotional disturbance (SED) or a youth aged 18 through 21 years with serious mental illness (SMI);

• Certified as requiring RTC level of care (Certificate of Need indicating Medical Necessity for RTC); and

• Able to be treated safely in the community under a plan of care (POC).

– Financial Eligibility:• Community Medicaid or MCHP Eligible or• Meet requirements for Family of One

Waiver Slot Allocation & Prioritization of Eligibility

• Slot Allocation:– 50% of waiver slots are reserved for youth who are Community

Medicaid/MCHP Eligible– 50% of waiver slots are reserved for youth who are not in the custody of

the State– The slot reservations are not mutually exclusive

• Prioritization of Enrollment:– At the beginning of the waiver, priority eligibility will go to eligible

individuals who are currently being served in Wraparound projects in the designated service areas.

– Thereafter, eligible individuals shall be enrolled in the waiver program on a first-come, first-served basis in accordance with the slot allocation until the cap on waiver participation is reached.

• Once the annual cap on waiver participation or slot allocation is reached, a waiting list will be established for the categories of eligibility for individuals interested in applying for waiver services.

• For the first year there are 70 slots available. There are 80 slots available for the second year (to include any youth who remain in the Waiver from year 1).

RTC Waiver Services

• Medical and mental health services are accessed through HealthChoice and the public mental health system.

• All waiver participants will have access to all services that are a part of the regular public mental health system and will be enrolled in HealthChoice, Maryland Medicaid's managed care program.

• All RTC Waiver services are fee-for-service.

RTC Waiver Services• There are 7 RTC Waiver services that are new Medicaid

services available for Medicaid reimbursement only to waiver participants. – Caregiver peer-to-peer support (Family Support Partners)– Youth peer-to-peer support (Youth Support Partners)– Family and youth training– Crisis and Stabilization Service– In-home respite– Out-of-home respite– Experiential and Expressive Behavioral Services

• Art• Dance/Movement• Drama/Psychodrama• Equine• Horticultural• Music

RTC Waiver Service Providers

• All providers who want to provide any waiver service must enroll as a Medicaid waiver service provider.

• If a provider is already a Medicaid provider but wants to provide a waiver service, the provider will have to enroll as a Medicaid waiver service provider.

• If a provider is already a Medicaid provider and wants to serve waiver participants but does not want to provide a new waiver service, the provider does not need to obtain a new provider number.

RTC Waiver Services: Caregiver Peer-to-Peer Support• Provided to the caregiver of a Waiver participant by

a family support partner. • Purpose is to support the caregiver through

information, advocacy, coordination, and other supports by an individual who is a legacy family member.

• Eligible providers:– Employed by a Family Support Organization– At least 21– Receives supervision from someone at least 21 with at

least 3 years of experience– Current or prior experience as a caregiver of a child with

SED or young adult with SMI– Have received specific training & certification

RTC Waiver Services: Youth Peer-to-Peer Support

• Provided to the Waiver participant by a youth support partner.

• Purpose is to support the youth through information, advocacy, coordination, and other supports by an individual who is a peer.

• Eligible providers:– Employed by a Family Support Organization– 18-26 years old– Receives supervision from someone at least 21 with at

least 3 years of experience– Has experience with State or local services and systems

as a consumer who had emotional, behavioral, or mental health challenges.

– Have received specific training & certification

RTC Waiver Services: Family and Youth Training

• Based on an approved curriculum.• Designed to promote skill development to support

individual and particular needs of the caregiver or youth.

• Can be provided in individual or group sessions.• Provided by a legacy family member or youth.• Eligible Providers:

– Employed by an approved waiver service provider agency, including, but not limited to, a family support organization; be an approved individual waiver service provider

– Individual providing the training must have experience as a co-trainer and have received training and certification as approved by MHA

– Trainer(s) must meet Caregiver and Youth Peer-to-Peer requirements.

RTC Waiver Services:Crisis & Stabilization Services

• Purpose is to de-escalate crises, stabilize children and youth in their homes and communities, and prevent hospitalization or harm to self or others.

• Eligible providers:– Are an agency with a current formal written

agreement with a local core service agency to serve as a crisis response system

– Have capacity to provide or arrange for 24/7 services– Employ clinical supervisors who meet specific criteria– Employ behavior care aides who meet specific

criteria

RTC Waiver Services: Expressive & Experiential

Behavioral Services• Purpose is to involve creative arts as a form

of expression and are used as an adjunct to traditional therapy.

• Provide techniques for participant self-expression and personal growth.

• Include: Art, Dance/Movement, Equine-Assisted, Horticultural, Music, and Drama/Psychodrama Behavioral Services

• Eligible providers:– Have a bachelor or master’s degree from an

accredited college or university– Are currently registered in the applicable

association

RTC Waiver Services: Respite Services—In-Home & Out-of-

Home• Temporary care services in the participant’s home or in the

community• Purpose is to support the participant to remain in the home

by providing enhanced support to the caregiver or temporarily relieving the caregiver from the responsibility of caring for the participant

• Eligible providers:– Must meet the requirements to provide respite care under

COMAR 10.21.27 and be approved to provide respite care under those regulations

– Have respite care specialists that meet specific criteria– Ensure that the in-home respite services are provided in the

home or a community setting (not overnight)– Ensure that out-of-home respite services are providing in a

community-based alternative living arrangement outside the home and, if applicable, in accordance with COMAR 14.31.05-.07

RTC Waiver Service Provider Enrollment

1. Interested individuals will complete a provider application packet and send it to the CME. If the provider is interested in serving more than one jurisdiction, the provider only needs to submit the packet to one CME. Background checks and child abuse and neglect clearances must be initiated, in accordance with the relevant policies. (See below)

2. The CME will: Check whether there are missing items; Follow up, if necessary; and Forward completed application to the Administrative Services

Organization (ASO).

Enrollment Process (continued)

3. The ASO will determine the technical elements are met, with the exception of background checks and clearances.

4. The ASO and MHA will: Meet and review the packet; Make a determination; and Send packet to Medicaid for processing.

Enrollment Process (continued)

5. Medicaid Division of Waiver Services and Provider Enrollment will: Process application to assign MA

provider number; Send approval or denial notices to

applicant; and Issue notice to CME, ASO, and MHA of

enrollment.

Miscellaneous:

• The entire process is expected to take up to 40 business days—for application packets that are completed accurately.

• Once the provider enrollment letter has been sent from DHMH, the ASO will contact the provider to assist them with enrollment in the authorization and billing systems.

Review of Materials in Provider Enrollment Packet

• Left-side of Packet: Informational Materials

• Right-side of Packet: Forms for Completion, if applicable

• All forms are available by going to http://www.medschool.umaryland.edu/innovations/RTC_providers.asp

• Other information, including the RTC Waiver Regulations and Medical Care Program Regulations, are available at http://www.medschool.umaryland.edu/innovations/RTC_waiver.asp

Informational Materials• RTC Waiver Brochure• Prospective Provider Letter• RTC Waiver Services Overview• RTC Waiver Service Provider Rates• Instructions for completion of the Medical Care Program Provider

Application• Contact Information• Evidence of Compliance Chart• Child Care Criminal History Background Check & Child Abuse & Neglect

Clearance General Information• Consent for Release of Information/Background Clearance Request• RTC Waiver Regulations• Medical Care Program Regulations (COMAR 10.09.36)• General Resources• Medical Necessity Criteria for Waiver Services• Training Requirements for Caregiver Peer-to-Peer Support, Youth Peer-to-

Peer Support, and Family & Youth Training Providers

Forms for Completion• Provider Application Packet Checklist• Provider Application Face Sheet• Medical Care Program Provider Application & Provider

Agreement• General Conditions for Provider Participation• Certificate of Eligibility to be designated a Family Support

Organization• Attestations:

– Caregiver Peer-to-Peer Support Providers– Family and Youth Training Providers– Youth Peer-to-Peer Support Providers– Crisis & Stabilization Service Providers– Expressive & Experiential Behavioral Services– In-Home & Out-of-Home Respite Providers

Once an RTC Waiver Provider is enrolled:

• Trainings will be available on how to receive authorizations for services and how to bill for services.

• Additional information will be provided on the Reportable Events Policy.

• The RTC Waiver Service Provider will:– Be a critical part of the Waiver participant’s child and

family team and, therefore, be expected to participate in the individualized care planning process;

– Have to submit monthly reports to DHMH or its designee on any updates to the background checks and new hires; and,

– Be expected to comply with all requirements of the RTC Waiver Program, including those referenced in the General Conditions for Provider Participation document.

Questions?Feel free to contact us!

Care Management Entity contact information is available in the Provider Enrollment Packet, along with contact

information for Jeronica Baldwin at DHMH, Division of Waiver Services

Deborah Harburger, RTC Waiver Project Manager, can also be contacted by e-mailing dharburg@psych.umaryland.edu

Thanks for your interest in becoming an RTC Waiver Service Provider!

Completed packets can be sent at any time from today forward to the Care Management Entity in your jurisdiction.

We look forward to working with you!