CCC Provider Training Overview - Virginia Association of ......Mar 10, 2014 · CCC Provider...

CCC Provider Training Summary

Virginia Premier Health Plan • 03/10/2014

Virginia Commonwealth University Health System Health Plan Division

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Table Of Contents• Overview 4

• Disability Literacy: Mental Health Awareness 5

– Course Summary 6

• Introduction 7

• Identifying Patients 8

• Working with Patients 9

• Crisis Intervention 11

• Services and Resources 13

• Long Term Support and Services (LTSS) 14

• Additional Services and Resources 16

• Assessing Needs 17

• Integration 18

• Disability Literacy: Access, Accommodations and The ADA 19

– Course Summary

• Providing Healthcare 20

• The ADA & Olmstead 21

• Prejudices & Myths 22

• Providing Healthcare 23

• Providing Care/Literacy 24

• Providing Care/ Language 25

• Providing Care/ Chronic Conditions 26


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Table Of Contents• Access 27

• Barriers 29

• Accommodation 30

• Conclusion 31

• Health Literacy: Caring For Our Members & Patients 32

– Course Summary

• Wellness Principles 33

• Person Centered Planning 36

• Independent Living 38

• Model of Care 40

– Course Summary 41

• Cultural & Disability Sensitivity 43

• Fraud & Abuse 47

• Appendix 51

• Appendix Introduction 52

• Attestation (1 of 1 ; 1 of 2) 53


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Overview

This module includes course summaries for the Commonwealth Coordinated

Care Provider Training. You will be able to attest to training if you have taken

similar training within the past year with another Health Plan. The option to

attest is available for 3 out of the 4 courses provided. If you have not taken

similar training review the course summaries for the below sections.

• Disability Literacy: Mental Health Awareness

• Disability Literacy: Access, Accommodations and the ADA

• Health Literacy: Caring For Our Members and Patients

• Model of Care*

*This course is exclusive to VA Premier Health Plan, Inc. Attestation is not provided, course summary

must be reviewed.

Disability Literacy: Mental Health

Awareness


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Disability Literacy: Mental Health Awareness

Course Summary

The National Alliance on Mental Illness defines a mental health impairment as:

A medical condition that disrupts a person's thinking, feeling, mood, ability to relate to

others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental

illnesses are medical conditions that often result in a diminished capacity for coping

with the ordinary demands of life.

Data indicates that individuals with intellectual development disabilities (IDD) or mental

health issues are more likely to live at home, are often part of the dually eligible

program, much more likely to use emergency services and are often the last and least

served.

“These crises are not the inevitable consequences of mental disability, rather, they

represent the combined impact of additional factors, such as lack of access to

essential services and supports, poverty, unstable housing, coexisting substance use,

other health problems, discrimination, and victimization.”

Paolo del Vecchio, M.S.W., Associate Director for Consumer Affairs at SAMHSA’s Center for Mental Health Services


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Course Summary: Introduction

The Institute of Medicine recommends that providers of medical services

establish “effective linkages” within their own organizations and between

the providers of mental health and substance abuse.

The lack of coordination among primary care doctors, hospital emergency

rooms, behavioral health practitioners, and other providers leaves patients

(often with many other social challenges such as homelessness) confused,

frustrated, and, too often with inadequate care.

Primary care physicians and mental health providers alike are often

unaware of who is prescribing what to whom.


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Course Summary: Identifying Patients

VPHP Medical Management staff will identify the most vulnerable patients upon

enrollment and on an ongoing monthly basis.

Identifying specific information regarding the patient is also important. The DMAS

medical transition data reports are used to identify patients with:

Selected diagnoses

Prior authorizations for services that are presently being received by individuals

who are new to the plan

Patients designated as part of the vulnerable subpopulations

Patients receiving services at a Community Services Board or who are assigned a

Targeted Case Manager

Members of the vulnerable subpopulation are those who struggle with behavioral

and/or multiple chronic conditions.


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Course Summary: Working with Patients

Virginia Premier staff, providers and agencies must work together to

provide the key services listed here.

Service planning and coordination

Cross systems/ Interdisciplinary training

Outpatient mental health

Residential housing/day/vocational opportunities

Respite

Inpatient hospitalization

Behavioral support planning

Family support and education/outreach


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Course Summary: Working with Patients

The Interdisciplinary Care Team (ICT) is a member centered group that

discusses the care plan, health status and current/possible interventions for

the patient. The ICT is always comprised of:

The Patient

The Care Manager

The Primary Care Physician

Based on the needs of the patient, additional ICT members may be added:

Family members and/or caregiver or legal representation

Medical and Pharmacy Directors

Specialists

Disease Manager

Social and Medical Outreach Workers

Health Educator


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Course Summary: Crisis Intervention

When working with the mental and behavioral health population it becomes criticalthat members of the ICT have an understanding of Crisis Intervention and Prevention.

Crisis prevention should come through early identification of individuals at highrisk. The immediate involvement of the ICT in the development of a crisis response plan is critical.

Reaching out to community agencies that specialize in crisis prevention tactics and education should almost always be part of the intervention plan. In addition, providing assistance and education to family members/caregiver or guardian in crisis situations is essential as they may be feeling a higher level of crisis/stress than the patient.

Should a patient present with signs of a crisis or potential crisis:

Call the Community Service Board (CSB).

CSB will send someone to complete a crisis assessment on the patient.

If the crisis staff representative feels the patient is a danger to him/her self or someone else, they can obtain a temporary detention order (TDO).


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Course Summary: Crisis Intervention

When working with patients with mental health issues, particularly those who

have experienced a crisis, understanding the concept of recovery is key.

For many people, the concept of recovery is about staying in control of their life

despite experiencing a mental health problem. Professionals in the mental health

sector often refer to the ‘recovery model’ to describe this way of thinking.

Putting recovery into action means focusing care on supporting recovery and

building the resilience of people with mental health problems, not just on treating or

managing their symptoms.

There is no single definition of the concept of recovery for people with mental health

problems, but the guiding principle is hope – the belief that it is possible for someone

to regain a meaningful life, despite serious mental illness. Recovery is often referred

to as a process, outlook, vision, conceptual framework or guiding principle.


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Course Summary: Services and Resources

This session provided information regarding agencies, services and

resources available to the mental and behavioral health population.

This summary provides a look at just a few.

Respite care (agency and consumer-directed) is a service provided to

unpaid caregivers of patients who use Waiver services. Respite is

provided on an episodic or routine basis because of the absence of or

need for relief of those unpaid individuals who normally provide the

care.

Therapeutic consultation is provided in fields such as psychology,

social work, behavioral analysis, speech therapy, occupational therapy,

therapeutic recreation, physical therapy disciplines or behavior

consultation to assist patients with disabilities, parents and family

members, and providers to implement goals and services.


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Course Summary: LTSS

LTSS includes:

Adult Day Health Care (ADHC) Services

Personal Care Services: by Agency and Consumer-Directed

Personal Emergency Response System (PERS)

With or without medication monitoring

Respite Care Services – Agency and Consumer-Directed

Transition Services and Transition Coordination

Assisted Living or Nursing Home


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Course Summary: LTSS

Long-Term Support and Services (LTSS): A variety of services that assist

individuals with health or personal needs of daily living over a period of

time. Examples include assistance with bathing, dressing and other basic

activities of daily life and self-care, as well as support for everyday tasks

such as laundry, shopping, and transportation. LTSS are provided over an

extended period, predominantly in homes and communities, but also in

facility-based settings such as nursing facilities.

Long-term services and supports can be provided at home, in the

community, or in various types of facilities, including NFs and assisted living

facilities.


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Course Summary: Services and Resources

Additional services and resources include:

Behavioral Therapy Services

Community Mental Health Rehabilitative

Services (CMHRS) (such as Intensive In Home, Therapeutic Day Treatment, and

Mental Health Supports for adults)

Targeted Case Management

Treatment Foster Care Case Management

Residential Treatment (Levels A, B & C)

Substance Abuse Services

Inpatient and Outpatient Psychiatric and Substance Abuse Treatment Services (such

as medication management, and individual, family, and group therapies) for non-

MCO enrolled individuals


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Course Summary: Assessing Needs

Each member of the health plan will have a primary care provider, a care

manager, and an interdisciplinary care team who will serve to identify new

issues that the member may be experiencing and communicate these to

other members of the team.

VPHP will also ensure that members are re-assessed on a periodic basis to

identify new issues that have arisen. VPHP will utilize its predictive

modeling tool in order to identify individuals who have recently experienced

a change in condition to predict which members are at-risk for an adverse

medical event and require intervention.


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Course Summary: Integration

Behavioral health must be fully integrated in the delivery or physical health

and LTSS services to be effective. A full integration in addressing the

behavioral health needs of the patient benefits the individual and the

system in general promoting efficiencies and alleviating administrative

burdens.

An integrated Medicare/Medicaid system will also benefit healthcare

providers who, like dually eligible members, face the challenges and

confusion of navigating an otherwise fragmented system. Promoting

efficiencies and alleviating administrative burdens for providers is critical to

maintaining adequate networks and access to care.

Disability Literacy: Access,

Accommodations and The ADA


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1. I attest that I have taken the ADA course or a similar version(within the

past 12 months). It covered 'The Americans with Disability Act' and its

prohibitions against discrimination of individuals with disabilities. In addition it

explored

Rights of the disabled to receive care in the most integrated setting, and

when public accommodations are necessary,

The impact that personal prejudices and barriers have on communication,

understanding and health care outcomes,

Ways to promote independent living for disabled individuals

I agree

I disagree

2. Where have you taken the ADA course or similar version of the course?

Anthem

Humana

Disability Literacy: Access, Accommodations

and The ADA

Course Summary: Providing Health Care


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and The ADA

Course Summary: The ADA & Olmstead

In Olmstead vs. L.C., the Supreme Court ruled that disabled people have “the right to receive care in the most integrated setting appropriate and that their unnecessary institutionalization was discriminatory and violated the ADA.” This ruling created several home and community based services (HCBS) programs and started a transition movement.

Transition involves the transfer of individuals from skilled nursing facilities (SNF) to a HCBS location and requires the SNF and the local contact agency (LCA) to investigate and resolve resident complaints about:

movement into the community,

supporting residents in their decision-making to leave a SNF,

providing residents information and education about their rights and options, and

identifying appropriate candidates and making the necessary referrals to LCAs.


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and The ADA

Course Summary: Prejudices & Myths

When addressing the provision of effective health care for patients with disabilities,

the place to begin is by taking a look at personal prejudices – discovering and

mitigating filters, myths and assumptions. Prejudices and myths create barriers in

understanding, communication, and improved health care. Challenge your first

impressions when first meeting a disabled patient.

MYTHS: People with disabilities live very different lives than people without

disabilities. A person’s disability defines who they are as an individual. People with

disabilities are sick and in constant pain.

Prejudices and assumptions may also be made when a person presents with a

disability that is misunderstood. For example, people with speech impediments are

often thought to cognitive disability or mental illness.


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and The ADA

Course Summary: Providing Health Care

The reason this chapter is so important is because patients with disabilities or limited English proficiency often perceive that their physicians do not listen to them, explain treatment options, treat them with respect, spend enough time with them, and/or involve them in the treatment decisions.

Part of the disconnect stems from a lack of understanding on how to communicate with individuals with certain disabilities and what auxiliary aids are available to improve communication.

The law requires that a public accommodation must provide auxiliary aids and services when they are necessary to ensure effective communication with individuals with hearing, vision, or speech impairments.

"Auxiliary aids" include such services or devices as qualified interpreters, assistive listening headsets, television captioning and decoders, telecommunications devices for deaf persons (TDD's), videotext displays, readers, taped texts, Braille materials, and large print materials.


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and The ADA

Course Summary: Providing Care/Literacy

The following populations are at high risk for limited literacy and/or competency skills. Many patients in these

groups have well-developed skills; however, others struggle with health literacy. It is critical to their health

care that their physicians uncover and address their needs.

Elderly

Low-income

English as a second language

Deaf or hard of hearing

People with learning disabilities

Individuals who did not graduate from high school

Recent immigrants

Individuals with unique health challenges

Tools that can help determine literacy levels include but are not limited to:

ABLE: Adult Basic Learning Examination

LAD: Literacy Assessment for Diabetes

NLS: Nutritional Literacy Scale

REALM: Rapid Assessment of Adult Literacy in Medicine

TOFHLA: Test of Functional Health Literacy in Adults


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and The ADA

Course Summary: Providing Care/Language

Medicaid regulations require that the primary language spoken by each individual be

identified at the time of enrollment and that each managed care member be provided

with the names of contracted providers that speak languages other than English in the

patient’s service area. Additionally, Medicaid regulations require states to make

oral interpretation services available and require that each MCO make these services

available free of charge to each patient and potential patient.

In all cases, MCOs are required to consider the needs of patients who may require

alternative methods of communication, such as patients with visual impairments, and

provide communication services necessary to accommodate these patients. MCOs must

provide communication materials in all of the prevalent languages within the MCO’s

service areas. Plans that cover service areas with a significant non-English-speaking

population are required to provide written patient materials in the language of these

populations.

The Rehabilitation Act Title 508 states that individuals with disabilities must have

access to and use of information and data that is available to patients of the public who

are not disabled.


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and The ADA

Course Summary: Providing Care/Chronic Conditions

One critical piece of information regarding providing health care to

patients with disabilities is understanding the risk among the

disabled population to suffer from chronic conditions. As a provider, it

is important to understand that the risk of suffering from multiple

chronic conditions is much higher among patients with disabilities.

Elderly or Disabled with the Consumer Direction waiver

Intellectual/developmental disabilities

Cognitive or memory problems

Physical or sensory disabilities

Residing in nursing facilities

Serious and persistent mental illnesses

End stage renal disease

Complex or multiple chronic conditions

Anticipated long-term service and support needs in the future


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and The ADA

Course Summary: Access

In order to function effectively and safely in jobs, education, and everyday

life, people with disabilities have to have physical and social access to the

same spaces, employment, goods, services, entertainment, and community

participation that everyone else does. When that’s the case, their

disabilities don’t limit their ability to fully participate in life.

This session provided information regarding access to communication,

information, programs and services and suggested means of providing

access through technology:

Readers

Internet

TTY and TDD equipment


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and The ADA

Course Summary: Access

The ADA requires businesses and other public facilities to allow service

animals to accompany people with disabilities on their premises, and

forbids excluding people with service animals or isolating them from other

customers. Making this type of accommodation for individuals builds

confidence, increase self-sufficiency and integration into the community.

Once members with special health care needs are identified, Medicaid

regulations require that MCOs conduct an assessment of each special

needs member to identify conditions that require regular treatment and

monitoring, and provide these members with programs, processes, and

accommodations that enable patients to have access to health care

providers who specialize in that condition.


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and The ADA

Course Summary: Barriers

In this session, a multitude of barriers were discussed including:

Attitude

Lack of Services

Ineffective Communication

Language

Emotional issues and lack of confidence

Also discussed were barriers and regulations surrounding physical access. Under the ADA, it is

expected that the government body, the owner or tenant of the space, the service provider, the

employer, etc. make a “reasonable accommodation” to enable access for people with

disabilities. A reasonable accommodation is an adjustment to whatever barrier prevents access

that doesn’t impose an undue hardship on the individual, business, organization, or institution

providing the accommodation, or on its other users or participants.

Ways in which to make these accommodations were explored in this chapter.


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and The ADA

Course Summary: Accommodations

Another aspect of accommodations

is providing a disabled individual with

options for independent living.

Consumer direction ranges from the

individual independently making all

decisions and managing services

directly, to an individual using a

representative to manage needed

services.

Individuals have the primary authority

to make choices that work best for

them, regardless of the nature or

extent of their disability or the source

of payment for services.

Existing models vary; however, all

models of consumer direction reflect

three central beliefs:

1. People with disabilities have a

unique understanding of their

personal care needs.

2. Many patients are competent to

oversee the delivery of personal

care and services.

3. Service recipients – rather than

service providers – have a right to

control the personal care services

that significantly affect their day-to-

day existence.


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and The ADA

Course Summary: Conclusion

Challenge your perceptions, prejudices and commonly held myths

Familiarize yourself with the populations most often impacted by the stigma

of “disabled”

Use tools and techniques to identify literacy – not assumptions and

preconceived generalities

Fine tune your key communication skills

Audit your office and your staff against the barriers introduced in this

session and remove as many as possible

Talk to patients about their perceptions of communication and treatment in

order to continually improve your approach

Health Literacy: Caring For Our

Members & Patients


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Health Literacy: Caring For Our Members &

Patients

Course Summary: Wellness Principles

Wellness principles revolve around a holistic philosophy and active lifestyle

that helps members achieve their maximum health potential. Therefore the

principle of wellness is focusing on the mind and body. Wellness principles

focus on a medical approach that doesn’t wait for someone to show signs

of illness before taking action.

Virginia Premier’s medical management staff partners with members to

achieve a positive impact on their wellness through educational

opportunities, screenings, and programs that are geared toward helping

members improve and then maintain their health. Initiatives include but are

not limited to:

Annual influenza and pneumococcal vaccines

Preventative services for the management of chronic conditions

One-on-one counseling


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Patients


Primary Care Physicians and Specialists (as needed) will be a part of eachmember’s Interdisciplinary Care Team. The care manager, member andphysician will work together to develop an individualized wellness plan foreach enrollee. However, in order for members to achieve the best possibleoutcomes, they need to understand their responsibility in taking charge ofand participating in their own personal wellness.

Virginia Premier’s goals center around continuous improvement in eacharea of member wellness, with the ultimate goal of helping members reachtheir maximum health potential. Improvements include but are not limitedto:

Improving access to essential services and affordable care

Improving coordination of care through an identified point of contact

Improving seamless transitions of care across healthcare settings

Improving access to preventative health services and assuring

appropriate utilization of services


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Patients


Person-centered planning is a process directed by the family or the

individual and is intended to identify the strengths, capacities, preferences,

needs and desired outcomes of the individual.

The goal is to have the needs directed by the member or by the family. if

appropriate. Goal setting is primarily the responsibility of the member.

Participants in the person-centered planning process can utilize a mix of

paid and non-paid services and supports that will assist them achieve

personally-defined outcomes.

Virginia Premier care managers will work with members and their

Interdisciplinary Care Team to create, review and update a Plan of Care.


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Patients

Course Summary: Person-Centered Planning

Person-centered planning is a process directed by the family or the

individual and is intended to identify the strengths, capacities, preferences,

needs and desired outcomes of the individual.

The goal is to have the needs directed by the member or by the family. if

appropriate. Goal setting is primarily the responsibility of the member.

Participants in the person-centered planning process can utilize a mix of

paid and non-paid services and supports that will assist them achieve

personally-defined outcomes.

Virginia Premier care managers will work with members and their

Interdisciplinary Care Team to create, review and update a Plan of Care.


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Patients

Course Summary: Person-Centered Planning

The care manager will include input from the ICT to create the plan and

serve as a single point of contact for the member.

The Plan of Care should be based on health outcomes important to the

member, and all plans are to be both comprehensive and holistic.

An important aspect of person-centered planning is the concept of a

community presence in the member’s life. Other important concepts

include self-direction and a focus on the member’s talents and gifts.

Person-centered planning is not a one-time event. It is an ongoing activity

requiring caregivers to listen, learn and lend support to the member while

he/she is on this journey.


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Patients

Course Summary: Independent Living

Independent living is the belief that each person with a disability is unique, has

the same civil rights as people without disabilities, and should have equal

access to social and economic services.

Care should be person-centered and support self-direction. Therefore, the

philosophy centers around working with individuals with disabilities so that they

may maintain or take back charge of their own lives and make their own

choices.

The independent living philosophy believes that individuals with disabilities

know their needs best and have the right to determine how they integrate into

the community.


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Patients

Course Summary: Independent Living

Centers for Independent Living (CILs) are non-residential, non-profit

facilities that help support this philosophy through a variety of services.

CILs provide services for individuals with varying degrees of disability

including those with significant disabilities and/or challenges.

Services provided include but are not necessarily limited to:

Independent living skills

Peer to Peer mentoring

Financial, Accessibility, and Waiver services

Self-determination

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