Employment and Community First CHOICES (ECF CHOICES)...•Group 7 services are designed for members...

Employment and Community First CHOICES (ECF CHOICES)

Amerigroup Community Care

TNPEC-2667-19 March 2019

• Group 7

• Group 8

• Employment services

• Billable behavioral health (BH) services

• Competency-based staff training

• Integrated Support Coordination Team (ISCT)

• Outcomes reporting

• QA surveys

• Critical incident reporting

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Agenda

Group 7

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• Group 7 services are designed for members with I/DD who are:

o Up to age 21 and living with family. The family must commit to active participation.

o At imminent, significant risk of placement outside the home due to a behavioral or psychiatric condition.

• Intensive Behavioral Family-Centered Treatment, Stabilization and Supports (IBFCTSS) entail:

o In-home, family-centered treatment with Supportive Home Care (SHC).

o Family-centered assessment.

o Behavior Support Plan (or other behavior management).

o Individual and family therapy.

o Linkage to psychiatry.

o Cross-systems crisis planning and response (available 24 hours a day, 7 days a week).

o Collaboration with ISCT.

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Group 7

• Community integration support services

• Community transportation

• Independent living skills training

• Assistive technology, adaptive equipment and supplies

• Minor home modifications

• Community support development, organization and navigation

• Family caregiver education and training

• Family-to-family support

• Decision making supports counseling and assistance

• Health insurance counseling and forms assistance


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Other services available to Group 7 members

Agencies providing services to members in Group 7 are required to have the following licenses:

• Personal Supports Service Agency (PSSA) license

o From Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) or Department of Intellectual and Developmental Disabilities (DIDD)

• Outpatient Mental Health license from TDMHSAS for each office location where records are kept

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Group 7: Agency licensure requirements

Note: The work experience must entail working with people who have an I/DD and co-occurring behavioral health conditions.

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• Direct support professional (DSP) will be the behavior support specialist (BSS). The BSS is required to have one of the following combinations of education and experience.

o Bachelor’s degree in related field and one year of experience

o Associate’s degree in related field and three years experience

o Five years of experience

o Additional competency-based training

Group 7: Staffing requirements

• A master’s-level, licensed mental health professional may be employed or contracted. Qualifications and responsibilities are outlined below.

o Licensed professional counselor with mental health service provider designation (LPC-MHSP), licensed clinical social worker (LCSW), master’s of science in nursing (MSN) with BH background, or master’s-level behavior analyst (BA)

o Completion of family-centered assessment, behavior management plan

o Provides individual and family therapy

o Provides clinical guidance and oversight of BSSs, including through crisis response

• Psychiatrist may be employed, contracted or operating under a business agreement.

o Provides timely access to care, including to prevent or intervene in a crisis (as needed).

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Group 7: Staffing requirements (cont.)

• During months 1-3:

o Family-centered assessment and planning

o Training of all paid and unpaid caregivers (ongoing as needed)

o Twice weekly face-to-face individual and family treatment by master’s-level, licensed behavioral health (BH) professional

o Crisis response by BSS with support from master’s-level, licensed BH professional and linkage to psychiatry as needed

o Follow-up review and update crisis plan as appropriate by master’s-level licensed BH professional

• Deliverables:

o Comprehensive family-centered BH assessment

o Cross-system crisis plan (with updates, as appropriate)

o Completion of training for all paid and unpaid caregivers on crisis plan

o Data and reporting

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Expectations for Group 7

• During months 4-6:

o Ongoing assessment and planning as needed

o Weekly face-to-face individual and family treatment by master’s-level, licensed BH professional

o Crisis response by BSS with support from master’s-level, licensed BH professional and linkage to psychiatry as needed


• Deliverable:

o Data and reporting

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Expectations for Group 7 (cont.)

• Months 7-9:

oOngoing assessment and planning as needed

o Twice-monthly face-to-face individual and family treatment by master’s-level, licensed BH professional

oCrisis response by BSS with support from master’s-level, licensed BH professional and linkage to psychiatry as needed


• Deliverable:

oData and reporting

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• Months 10-12 (and beyond, as appropriate):

oOngoing assessment and planning as needed

oAt least monthly face-to-face individual and family treatment by master’s-level, licensed BH professional

oCrisis response by BSS with support from master’s-level, licensed BH professional and linkage to psychiatry as needed


• Deliverable:

oData and reporting

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• IBFCTSS H2020 HI/HN (therapeutic behavioral services, per diem)

o HI — Integrated mental health and I/DD program

o HN — bachelor’s-degree level

• IBFCTSS monthly base rate only

o Months 1-3 (90 days) — $2000

o Months 4-6 (90 days) — $800

o Months 7-9 (90 days) — $400

o Months 10-12 (90 days) — $250

• Total = $9950 per member, per year*

* This total is for one year, but there is no guarantee that a member is in the service for one year.

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Rates in Group 7

In addition to the monthly base rate, there will be an add-on for Intensive Behavioral Supportive Home Care (IBSHC) services provided as a component of IBFCTSS benefits. IBSHC services will be provided by a qualified BSS. This add-on amount will be added to the monthly base rate to determine the per member, per year reimbursement rate. Ranges of IBSHC add-on rates are as follows:

• Up to 4 hours per day — $108/day

• > 4-8 hrs/day — $216/day

• > 8-12 hrs/day — $324/day

• > 12-16 hrs/day — $432/day

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Rates in Group 7

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IBFCTSS base plus add-on rate

Months 1-3Up to 4 hours/day> 4-8 hours/day> 8-12 hours/day> 12-16 hours/day

Per member/per month$5,240$8,480$11,720$14,960

CodesH2020.HI HN UA U1H2020.HI HN UA U2H2020.HI HN UA U3H2020.HI HN UA U4



CodesH2020.HI HN UB U1H2020.HI HN UB U2H2020.HI HN UB U3H2020.HI HN UB U4



CodesH2020.HI HN UC U1H2020.HI HN UC U2H2020.HI HN UC U3H2020.HI HN UC U4



CodesH2020.HI HN UD U1H2020.HI HN UD U2H2020.HI HN UD U3H2020.HI HN UD U4

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Billing for Group 7

The per diem rate will be billed each day the person is authorized for services, regardless of whether a service is provided on that day. The exception is for extended periods when the member is outside the home and the benefit is in suspended status.

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Billing for Group 7 (cont.)

• Outcome-based transition planning and implementation incentives are payable in phases (2 months and 6 months following transition) to promote stabilization and tenure.

• If the member transitions to Group 4, 5 or 6 by end of month 6 — $3,000 total ($1,500 per phased payment)

o Phase 1 T2038.HI*.U4 UA — payable at 2 months post transition

o Phase 2 T2038.HI*.U4 UB — payable at 6 months post transition

• If the member transitions to Group 4, 5 or 6 by end of month 9 — $2,000 total ($1,000 per phased payment)



• If the member transitions to Group 4, 5 or 6 by end of month 12 — $1,000 total ($500 per phased payment)



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Outcomes-based incentives for Group 7

Group 8

19Note: Sample, Calibri size 11.

Group 8 services are designed for members with I/DD who are:

• 21 or older and not living with family or 18-21 and aging out of state custody.

• Are transitioning out of a high intensity level of care, incarceration or a family setting and have a psychiatric or behavioral condition that places themselves or others at significant risk of harm, necessitating 24/7 supervision and monitoring.

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Group 8

• Combines 24 hours per day, 7 days per week HCBS with intensive behavioral health services. Services include:

o Behavior assessment

o Behavior Support Plan (applied behavioral analysis [ABA])

o Linkage to psychiatry

o Cross-systems crisis planning and response (available 24/7)

o Collaboration with Integrated Support Coordination Teams (ISCTs)

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Intensive behavioral treatment, stabilization and supports

• Assistive technology, adaptive equipment and supplies

• Minor home modifications

• Decision making supports counseling and assistance

• Individual education and training

• Peer-to-peer person-centered planning, self-direction, employment and community support and navigation

• Specialized consultation and training

• Adult dental services


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Other services available in Group 8

• Direct support professional (DSP) will be the behavior support specialist (BSS). The BSS is required to have one of the following combinations of education and experience.

o Bachelor’s degree in related field and one year of experience

o Associate’s degree in related field and three years experience

o Five years of experience

o Additional competency-based training

• Master’s-level, licensed mental health professional (may be employed or contracted)

• Licensed board-certified behavioral analyst (BCBA), can be same person as above

• Psychiatrist may be employed, contracted or operating under a business agreement

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Group 8: Staffing requirements

Please note: The experience must entail working with people who have an I/DD and co-occurring behavioral health conditions.

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Group 8 rates

Rates for IBCTSS

• Up to $545/day for no more than 90 days

• Up to $470/day for no more than an additional 90 days

• Up to $395/day for day 181 and following

• Annualized maximum for IBCTSS (Year 1): $164,425

• Annualized maximum for IBCTSS (Year 2 and ongoing): $144,175

• If the member transitions to Group 5 or 6 by end of month 6 — $5,000 total ($2,500 per phased payment)

o Phase 1 T2038.HI*.U1UA — payable at 2 months post transition

o Phase 2 T2038.HI*.U1UB — payable at 6 months post transition

• If the member transitions to Group 5 or 6 by end of month 9 — $3,000 total ($1,500 per phased payment)



• If the member transitions to Group 5 or 6 by end of month 12 — $1,500 total ($750 per phased payment)



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Outcomes-based incentives for Group 8

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Employment services in groups 7 and 8

• All ECF CHOICES employment services are available to members in Groups 7 and 8

• Staff qualifications are the same

• There are no exceptions for these groups around employment outcomes, expectations or documentation (although more time might be needed and extensions may be granted)

• When implementing employment services to individuals with severe co-occurring psychiatric or behavioral needs:

o Teamwork and communication with the SC, family, mental health professional and BSS is critical to successful employment outcomes.

o Employment staff should take extra time to prepare before working with these individuals, including review of Person-Centered Support Plan (PCSP), Behavior Support Plan (BSP) and safety plans.

o Discovery will be crucial to find out all the specific supports and conditions the person will need to be successful and ensure a solid job match.

o Self-employment might be a good option.

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Employment services in groups 7 and 8 (cont.)

• BH services for which the Group 7 member is authorized and are funded by the Division of TennCare can be billed separately by providers. Such services include:

o Psychosocial rehabilitation

o Intensive outpatient program

• On a case by case basis with MCO approval, certain BH services may be billable by a provider other than the Group 7 provider. These services must not duplicate the BH services required in Group 7. Such services include:

o ABA, including services from registered behavioral technician (RBT)

o Individual, family and group therapy

• Crisis prevention, intervention, and stabilization are not billable units because they are incorporated in the Group 7 rates.

• Members in Group 7 cannot be enrolled in system of support (SOS), except during transition periods into and out of Group 7.

• Mobile crisis can be accessed as applicable if the need for inpatient care arises.

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Billabe BH services for Group 7

• BH services for which the Group 8 member is authorized and are funded by the Division of TennCare can be billed separately by providers. Such services include:

o ABA, including services from registered behavioral technician (RBT)

o Psychiatric appointments

o Individual, family and group therapy

o Psychosocial Rehab

o Intensive outpatient program

• Crisis prevention, intervention, and stabilization are not billable units because they are incorporated in the Group 7 rates.

• Members in Group 7 cannot be enrolled in SOS, except during transition periods into and out of Group 7.

• Mobile crisis can be accessed as applicable when the need for inpatient care arises.

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Billable BH services for Group 8

Break

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Competency-based training for staff

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• All BSSs must complete the required training for DSPs in Groups 4, 5, and 6 within regular timelines.

• Before working with members in Groups 7 and 8, they must complete training in specific topics and elements.

o Providers may use pre-approved training modules.

o Providers may develop or procure similar training, after approval by the Behavior Health Training Review Committee (BHTRC).

• Competency-based training involves documentation of the trainee’s knowledge through written assessment and/or direct observation by a qualified trainer.

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Competency-based training requirements

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Pre-approved required training

Topic Required elements Pre-approved sources Cost Agency-specific

Positive Behavior Supports (PBS)

Standards of PBSPrinciples of Positive Behavior Supports for DSPs: Part 3 (Relias, 1 credit hour)

$19.95Must be approved by BHTRC

Basic Principles of Applied Behavior Analysis

Principles of Positive Behavior Supports for DSPs: Part 4 (Relias, 1 credit hour)

$19.95

Must be approved by BHTRCor

Functional Behavior Assessment and Positive Behavior Support (Mental Health Wellness-I/DD, estimated time 50 minutes)

Free

Crisis Prevention, Intervention, and Stabilization

Managing Challenging Behavior, Focused Learning (Relias, 1 credit hour)

$19.95

Must be approved by BHTRCandCrisis Response for Individuals with Developmental Disabilities (Relias, 0.75 credit hours)

$30

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Pre-approved required training (cont.)


Co-Occurring Mental Health Conditions with I/DD

Physical and Environmental Factors Contributing to Behavior and Behavior Health ConditionsMental/Behavior Health Conditions

Co-Occurring Disorders: Intellectual Disability and Developmental Disabilities and Mental Illness module (MHW-I/DD, estimated time 50 min)

Free

Must be approved by BHTRCand

Overview of Other Medical Diagnoses Associated with IDD (MHW-I/DD, estimated time 50 min)

Free

Trauma-Informed Care

I/DD and Trauma: Road to Recovery (Relias, 1.50 credit hours)

$19.95

Must be approved by BHTRCorTrauma-Informed Care module (MHW-I/DD) (estimated time 50 min)

Free

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Integrated Behavior Health Services & Supports

Description of all available behavior health services covered by TennCare

MCO document with description of behavior health services

Requires written attestation of review for each trainee

Free N/A

Roles & Responsibilities of an Integrated Team

MCO-developed training

Requires written attestation of review for each trainee

Free

Agencies may elect to add to the MCO-developed training to clarify roles/responsibilities specific to their program.


1. Documenting and reporting psychiatric symptoms and target behaviors

2. Preparing and sharing information (across shifts, for scheduled appointments, during crisis responses and urgent/emergency care)

3. Integrating behavioral health in person-centered support planning

N/A N/A

Agency-specific, must cover: Tracking mood, behavior,

sleep, appetite and energy level

Information-sharing across shifts

How to share information in initial and ongoing person-centered support planning

Preparing information to share at health care appointments

What to share (written and verbal reports) during urgent/emergency events

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Agency-Approved Crisis Management Procedures

The training must include: Physical management

procedures that can assist in management of severe aggression, property destruction and self-injury

Prevention techniques Nonphysical intervention

techniques

Approved crisis management training programs: Professional Crisis

Management (PCM) Crisis Prevention Institute

(CPI) Quality Behavior Supports

(QBS) The Mandt System Therapeutic Crisis

Intervention (TCI)

DSPs must maintain active certification in the approved program to continue working with members in groups 7 and 8.

Cost depends on program purchased.

An agency may develop its own physical management techniques, but they must be reviewed and approved by the BHTRC prior to implementation.

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Member-Specific Training on Plans

Agency-specific, must include all support and treatment plans for the individual. Person-specific signs/

symptoms of psychiatric diagnoses and related treatment plans

Person-specific signs/symptoms of medical diagnoses and related treatment plans

Person-Centered Support Plan

Behavior Support Plan (or equivalent behavior plan) —qualified trainer is licensed BCBA or RBT

Crisis Plan

N/A N/A

Direct observation of adequate implementation of approaches and interventions must be documented in addition to competency-based written assessment.

Amerigroup will provide a recommended checklist for member-specific training. Agencies may use their own checklists, as long as they cover all of the required elements.

• Prior to working with a person in Group 7 or 8, the BSS must be trained and assessed for competency on all of the person's medical and psychiatric and behavioral diagnoses, health care plans, behavioral health treatment plans, and cross-system crisis plan.

• Amerigroup has provided a checklists for providers to document training in the following areas:

o Medical diagnoses

o Psychiatric diagnoses

o BSP (BAs can substitute their own training forms, as long as they cover all the required elements)

o Elements of PCSP and Cross-System Crisis Plan should be included under Medical, Psychiatric or BSP tabs, as applicable.

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Competency checklist

• Amerigroup welcomes providers to develop or procure training that covers the required training elements.

• The BHTRC reviews provider-proposed trainings to determine if they may supplant the equivalent pre-approved modules.

• If approved by the BHTRC, the provider-developed information can be used to train BSSs.

• The BHTRC includes behavior support directors for long-term services and supports from several managed care organizations in Tennessee.

• The BHTRC meets on an as-needed basis when training programs are submitted for review.

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BHTRC

• Submit the completed Behavior Health Training Review Committee Form

• The BHTRC will respond to acknowledge they have received your submission within three business days. They will return a decision within 14 business days. The BHTRC will base its decision on comparing the proposed training to the elements and information covered in the pre-approved training requirements.

• Submissions will be either:

o Approved

o Approved with suggested edits

o Not approved with recommended edits and resubmission for review

o Not approved

• Trainings must be approved or approved with suggested edits prior to implementation as training to count toward the required foundational BSS training for Groups 7 and 8.

• Modules that are approved or approved with suggested edits for a provider will be shared with the Provider Relations departments at the MCOs with whom that provider contracts for ECF CHOICES.

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To have a proposed training reviewed by the BHTRC

ISCT

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• This is an MCO-based team that includes at least the behavior supports director and the member’s support coordinator. Other team members can be included depending on the MCO structure and the member needs.

• The team collaborates with providers in developing comprehensive initial and ongoing assessments, development and implementation of the PCSP, monitoring progress and outcomes, and transition planning.

• The ISCT ensures adequacy, continuity and coordination of physical health, behavioral health, and long-term services and supports.

• The type of meeting (face-to-face, etc.) depends on needs of the member, the family, and the provider

o More frequent meetings take place during transitions into and out of Group 7 and 8 (e.g., weekly).

o At least monthly face-to-face during the ongoing service.

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ISCT

• Decrease in number of crisis events that require:

o Telephone intervention

o In-person intervention and stabilization

oOut-of-home placement

• Reduced use of behavior respite

• Reduced ED use for BH crises

• Reduced CSU utilization

• Reduced psychiatric inpatient utilization

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Outcomes for Groups 7 and 8

• Reduced use of psychotropic medications (except as medically necessary to treat diagnosed conditions)

• Diversion of involvement in justice system

• Effective management of personal health and wellness (appointments made and kept, preventive care completed)

• Increased community tenure and stability in living arrangements

• Increased participation in integrated competitive employment

• Decrease in missed school days

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Outcomes for Groups 7 and 8 (cont.)

• The Member Outcome Survey reports the following outcomes for members:

o Improved quality of life

o Improved satisfaction with services and supports

o Increase in personal recovery capital

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Member-reported outcomes for Groups 7 and 8

• Family Caregiver Outcome Survey reports the following outcomes from the perspective of the family:

o Increase in perceived ability of family caregivers to support person

o Increase in perceived ability of family caregivers to prevent & stabilize crisis events

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Family-reported outcomes (Group 7 only)

• Safe transition to and stabilization in the community

• Successful transition to appropriate level of community-based services and supports in a stable community-based living arrangement

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Community transitions

• DIDD will perform quality assurance (QA) reviews for Groups 7 and 8

o Separate tools for these groups (currently being developed)

o Year 1 — consultative

o Year 2 and after — annual

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Quality assurance reviews

• DIDD will manage Tier 1 investigations, just as in Groups 4, 5 and 6

• Currently, MCOs, the Division of TennCare, and DIDD are working on changes needed for Group 7 and 8

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Critical incident reporting

Q&A panel

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Employment and Community First CHOICES (ECF CHOICES)...•Group 7 services are designed for members...

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