UNVEILING ACCESS TO CHILDREN’S

SYSTEM SERVICESAn Answer to Some of Your Questions…

“AT THE TOP OF THE PYRAMID” Intensive

Intervention: When it is time to seek help for problem behaviors that are outside the expertise/role of program staff and ECMH

KEY POINTS IN ACCESSING MH SERVICES If there is a primary insurance (ex: BCBS) the

family should call them to locate in network providers: this typically applies to MHIP, MH-PHP, MH/SA OP, psychological, and psychiatric services.

BHRS (and FBMHS, RTF, CRR, etc) is not covered by primary insurers (with the exception of Act 62 when applicable). The family would need to apply for MA.

MA is always the “payor of last resort” when a primary insurance is established.

WHO ARE THE BH-MCOS IN PA? CBHNP (Community Behavioral Health

Network of PA) www.cbhnp.org

CCBHO (Community Care Behavioral Health) www.ccbh.com

VBH (Value Behavioral Health) www.vbh-pa.com

CBH (Community Behavioral Health) www.dbhmrs.org/community-behavioral-health

Magellan www.magellanofpa.com

MAP OF PA COUNTIES WITH BH-MCOS IDENTIFIED

ONE GOAL, MANY DOORS AND POINTS OF ACCESS

ACCESS POINTS ARE NOT LIMITED TO:

Get MH service

s

Through MHMR

Through CYS

Through self

referral

Through a human service provider

Through Juvenile Justice

Through Educatio

n

OBTAINING MEDICAL ASSISTANCE Apply online at: www.compass.state.pa.us Obtain paper form of application at the local county

assistance office. Obtain printable copy of application at

http://www.dpw.state.pa.us/ucmprd/groups/public/documents/form/s_001562.pdf

Family will be notified within 30 days after they receive the COMPLETED application whether or not the family member is eligible. Sometimes this can impact access to BHRS due to the

MA regulation that psychological evaluations for this level of care expire after 60 days and can no longer be accepted for MNC review. Families will need a re-evaluation with a psychologist for new

recommendations to submit to the BH-MCO

THE APPLICATION PROCESS FOR CATEGORY PH 95 (LOOPHOLE) o There is a common misconception that all children with

a disability or all children with an IEP (Individual Education Plan) or all children with a particular diagnosis qualify for Medical Assistance. This is not the case because the “rules” are not that simple.

o This loophole allows for documentation of the “disability standard” for non-SSI disabled child provision.o “Childhood Listings of Impairments” for mental health

disorders can be found at http://www.socialsecurity.gov/disability/professionals/bluebook/112.00-MentalDisorders-Childhood.htmo There are additional descriptions of impairments other than MH

issues on this site as well.o You can access more detailed information on the

loophole at the PA Health Law Project website, http://www.phlp.org, under the “Recent Publications” section.

CASSP (CHILD AND ADOLESCENT SERVICE SYSTEM PROGRAM) PA adheres to the CASSP Principles

Child-centered, family-focused, community-based, multi-system, culturally competent, least restrictive/least intrusive

www.parecovery.org/principles_cassp.shtml (for introduction to CASSP and a current list of Coordinators)

At the county level, integrated children’s services planning is required by DPW.

CASSP Coordinators serve as the contact person for children with multi-system needs. Children with serious emotional and behavioral needs

often require services from more than one child-serving system

School services, child welfare, juvenile justice, healthcare system, family system

CHILDREN’S SERVICES CONTINUUM

• Restricti ve and Intrusi ve

RTFCRR-HHMHIPPHPFBMHS

• Le as t res tric tive for BHR S wo uld be to be gin with a s in gle c li nic i an NO T a c li nic i an/ TSS co mbi nat ion ( in m os t ca ses )

BHRS*MT/BSC/TSS*ASP*STAP

• Least Restricti ve/Least Intrusi ve

IOPOPTCM

SERVICES AT YOUR LOCAL MH/MR

Mental Health Case Management Services Goals of this service:

To connect individuals with the appropriate services To improve level of functioning To provide continuity of care To identify necessary resources

Available for Adults and Children Three Levels of Case Management (*)

Administrative Blended Case Management Intensive Case Management

Intellectual Disabilities (MR/ASD) Services (*) Crisis Intervention Services (*)

ACCESSING SERVICES AT YOUR MHMR Contact the county MHMR to discuss what their

services are and how families can access them. www.mhmrpa.org or your local county webpage

Typical Intake session could include the following: Answering questions that determine eligibility for

services Filling out several forms Determine Liability (who pays for the service) through

review of Insurance and Financial information After the Intake:

Evaluation (through a community agency) Disposition (development of individualized service plan

based on recommendations made)

BEHAVIORAL HEALTH REHABILITATION SERVICES (AKA BHRS) The most commonly recommended services for small

children are: Mobile Therapy (MT): The role of the mobile therapist is

to provide intensive therapeutic services to the child and family, and must be individualized for the child and family and based upon the Member’s needs. The services include all forms of psychotherapy and include conducting behavioral therapies such as, creating behavior modification plans.

Behavior Specialist Consultant (BSC): The role of a behavior specialist consultant is to design and direct the implementation of a behavior modification intervention plan, which is individualized to each child or adolescent and to family needs. Consultations are specific to the individual needs of the Member and should result in the BSC giving direction to the team to reduce the symptoms of the client

BEHAVIORAL HEALTH REHABILITATION SERVICES (AKA BHRS), CONTINUED Therapeutic Staff Support (TSS):

The role of a TSS is one on one intervention to a child or adolescent at home, school, and community when the behavior without this intervention would require a more restrictive treatment or educational setting.

Specific therapeutic staff support services include: crisis intervention techniques, behavior modification interventions, implementing reinforcements, emotional support, time structuring activities, time out strategies, and passive restraints when necessary, and additional psychosocial rehabilitative activities as prescribed in the treatment plan or behavior plan designed by the qualified clinician.

In general, The TSS must use specific interventions or methods as listed on the treatment plan to stabilize the child, teach, and transfer the skills to the family, natural environment, and other team members.

Overall, the task of the TSS is to support the family’s and team member’s efforts to stabilize the child or adolescent and promote age appropriate behavior by giving the natural supports the skills to support child needs.

TYPICAL PROCESS IN OBTAINING BHRS Psychological or Psychiatric evaluator makes

recommendations. Evaluation is sent to family’s preferred provider

(see individual BH-MCO’s website for a list of these).

Initial ISPT (interagency services planning team) meeting is scheduled and held by an identified BHRS provider.

Packet items are submitted for review by a care manager according to Health Choices Appendix T Medical Necessity Criteria. Denial of services can only be completed by a

Psychiatrist or a Psychologist-NOT the Care Manager at the BH-MCO.

ACCESSING PROVIDER INFORMATION IN THE REGION YOU ARE WORKING IN Suggestions:

Contact the Provider Relations Representative for identified Primary Insurance or BH-MCO for a current list of in network providers for the identified service.

Seek provider list on the Primary Insurance or BH-MCO’s website

Contact the MHMR office, they typically have this information available for families. They should also have a summary of all community

resources available in their county Contact a local BHRS provider, they will have this

list because families have to fill out the preferred provider form to submit with a packet.

QUESTIONS?