IACCT Provider Training - magellanofvirginia.com• The IACCT LMHP receives the inquiry form from the IACCT ICM. The LMHP notifies the ICM of the intention to provide the education

IACCT Provider Training

Danette Brady, Clinical Director

Tricia Van Rossum, Mgr. Clinical Care Services

Magellan of Virginia December 9 and 12, 2016

Training Objectives

• Identify and describe important roles in the Independent Assessment, Certification and Coordination Team (IACCT) process

• Review of IACCT Processes

• IACCT One-Pager

• Physician Engagement

• IACCT Assessment Process

• IACCT Reassessment process

• Special Considerations process

• Review Inquiry form, Referral form, and IACCT SRA


IACCT Members and Roles

• Magellan will serve as a single point of entry for youth at risk of admission to residential treatment. For all Medicaid funded residential admissions, referrals must be made to Magellan, and the admission will be coordinated by the Independent Assessment, Certification and Coordination Team (IACCT).

• This team will consist of various professionals who will collaborate to provide assessments or assist in gathering medical and behavioral health treatment records that will be used to fully assess the youth and family needs in order to formulate a preliminary plan of care.

Independent Assessment, Certification & Coordination Team (IACCT)


IACCT Team Members


Youth & Family

LMHP

Physician

Magellan Intensive Care

Manager (ICM)

Magellan Family Support

Coordinator (FSC)

Other Participants

Youth and Family

Youth and family or legal guardian serve as full partners in making

decisions about their treatment needs.

This includes the IACCT working with the family in:

• Identifying strengths and needs

• Participating in face to face assessments

• Setting goals

• Choosing culturally and linguistically competent supports, services and providers

• Partnering in decision making processes related to service options

• Identifying natural supports and viable family options

IACCT Member Roles and Responsibilities


Licensed Mental Health Professional (LMHP)

• Meets face to face with the family to conduct the assessment

• Provides a comprehensive psychosocial assessment, which shall include a thorough review of an individual’s current mental health status.

‒ Child and Adolescent Needs and Strengths Assessment (CANS)

‒ Adverse Childhood Experiences (ACEs): C - ACES

‒ If necessary: utilize other clinical tools or assessments/screenings

• Identify strengths and needs, and risk level and describe the severity of symptoms.

• Make recommendations to include level of care, treatment modalities, and cultural and family nuances

IACCT Team Member Roles and Responsibilities


Physician

• It is intended that the physician member of the IACCT will be a youth’s existing primary care physician, or psychiatrist if applicable, since it is expected that these physicians will be familiar with the youth.

•Psychiatrists (MD or DO) must be credentialed with Magellan for reimbursement if the member has FFS, otherwise they will bill the activity through the MCO as a covered physician service

• IACCT may utilize a specific centralized physician familiar with the service system, e.g., a psychiatrist at the local CSB. This can be determined by the IACCT in order to meet the needs of each individual youth and family

• It is best practice that the physician signing the Certificate of Need will have personal knowledge of the youth’s physical and mental health condition. This means that the physician would have had a face-to-face evaluation with the youth in order to assess the youth’s clinical needs prior to signing the Certificate of Need. Magellan and the DMAS MCO’s will help coordinate physician involvement in the IACCT process

•*If necessary, the physician can utilize telemedicine as an option*



Magellan - Intensive Care Manager (ICM)

• Receive referrals for youth at risk of residential placement and coordinate the Independent Assessment with the contracted IACCT

• Within 5 days of the referral, review the results from the assessments and recommendations of the IACCT and apply the established medical necessity criteria to determine Medicaid funding authorization

• Assign the family support coordinator

• Assist the family in developing facility referrals if residential is recommended or collaborate with the rest of the IACCT to develop a community based plan of care if residential is not recommended.

• Collaborate with family support coordinators to monitor family engagement, strengths, and needs throughout the course of treatment



Magellan – Family Support Coordinator (FSC)

• Perform outreach to the family or guardian to coordinate any face-to-face assessments, encourage and facilitate family engagement in any treatment option decisions

• Provide education for informed decision making regarding treatment, and offer any other support or assistance to the family throughout the course of treatment

• Promoting family engagement throughout the course of treatment whether the plan of care is residential treatment or community based services

• In cases where the plan of care is community based, the FSC will remain engaged with the family to support the community based plan of care and help identify supports

• After discharge from residential, the FSC will continue to remain in contact at least monthly to provide ongoing support to the youth and family



Other Participants: These members will vary based on each individual’s specific needs and involvement in services.

• Case Manager

• Probation Officer

• Teacher

• FAPT

• DSS Worker

• Private Providers



IACCT ReferralProcess

Your Guide to the IACCT

Physician Engagement Process

IACCT Assessment Process

IACCT Assessment Process

• The IACCT LMHP receives the inquiry form from the IACCT ICM. The LMHP notifies the ICM of the intention to provide the education session and obtain verbal consent from the guardian within one business day. If the LMHP completes the education session, he/she completes the referral form and sends it to Magellan.

• If the ICM completes the education session then the ICM completes the referral form and sends it to the LMHP.

• The timelines starts the business day following the receipt of the referral.

• The LMHP schedules a face-to-face assessment to take place within 2 business days of receiving the emailed referral.

• The LMHP will alert the ICM of the appointment date and time.

• During the face to face assessment, the LMHP will conduct the initial IACCT assessments and schedule the IACCT recommendation meeting within 3 days of the face-face assessment.


IACCT Assessment Process Continued

• Submit the IACCT SRA to Magellan within 1 business day of the face to face assessments.

• IACCT recommendation meeting will occur if all the required participants are present. If all the required participants are not present an extension is offered and the LMHP reschedules the meeting to occur within 3 days.

• During the recommendation meeting the LMHP and ICM will discuss the assessments and determine the appropriate level of care needed.

• If FAPT/CSA is the referral source or if residential services were recommended, follow the FAPT/CSA process.

• The ICM will develop a referral list for community based services or residential based services and provide this information to the family.

• If Residential services are recommended the guardian will select a residential facility. The guardian will also notify the LMHP and sign a release for the LMHP to share the assessments with the residential facility.


IACCT Assessment Process Continued

• If Residential services are recommended

• The physician will sign the CON

• The LMHP will submit the CON to the ICM by secure email within one business day

• The guardian will select a residential facility

• The guardian will also notify the LMHP and sign a release for the LMHP to share the assessments with the residential facility

• The LMHP will share copies of the psychosocial assessment, CANS, ACES, and CON with the residential facility


Request for 3 Day Extensions

• If the youth and parent/guardian are unable to attend the face to face appointment within two business days, the IACCT LMHP needs to notify the IACCT ICM of this missed appointment and request a 3 business day extension.• The LMHP will reschedule the assessment to take place within 3 business days

and notify the ICM of the new appointment date and time.

• After the youth and family have missed two appointments the referral would be closed and a letter would be ailed to the youth and family.

• If there are challenges engaging a physician in completing a review of a known client or Face to Face meeting with a unknown client and making CON recommendations, the LMHP needs to notify the ICM of such challenges and request a 3 business day extension. • Up to two 3 day extensions can be offered for obstacles to physician

engagement.


Special Considerations

• Children Services Act (CSA) VS. Non-CSA referrals

• Inpatient Acute Care Facility refers the child

• Retro Referral Process

• Emergency Foster Care Placement

• Commercial Insurance


CSA VS. Non-CSA

• If CSA makes the referral

• IACCT invites FAPT to recommendation meeting. The LMHP should gather information from the locality in regards to the youth’s involvement in FAPT and previous services tried.

• If Residential services were recommended Magellan would authorize Residential treatment based on MNC and FAPT would maintain it’s authority regarding educational expenses and services not covered by Medicaid.

• If Residential services do not meet medical necessity criteria IACCT shall communicate the decision and service recommendations to FAPT.

• The ICM could assist in coordinating community based services covered by Medicaid.


CSA VS. Non-CSA Continued

• If the referral source is not CSA• Guardian would need to sign a consent form to allow the locality to be notified.

• When possible, the IACCT would invite FAPT to the recommendation meeting to explore viable options in the youth’s locality.

• If Residential services were recommended, Magellan ICM would make a FAPT referral for consideration of educational funding.

‒ FAPT makes a decision about CSA eligibility. If the youth is determined to be CSA eligible then FAPT maintain it’s authority regarding educational expenses and services not covered by Medicaid.

‒ If FAPT decides the person is not CSA eligible, then Medicaid would cover the residential treatment portion and options for educational expenses would be explored with the youth and family.

• If Residential services do not meet medical necessity criteria, the IACCT would communicate to FAPT that residential services were not recommended.

• Magellan could assist in coordinating community based services covered by Medicaid.


Inpatient Referral Process

• Upon youth’s admission to the inpatient facility, the facility will assess for viable options and develop an initial discharge plan.

• Once residential services are recommended as an option for the discharge plan, the inpatient facility will submit an IACCT Residential Inquiry form to Magellan within one business day. Alternatively, this form can be completed telephonically with Magellan during a concurrent review.

• Magellan will then follow the process of completing the IACCT referral form.

• Magellan will contact youth’s locality and local IACCT.

• The IACCT LMHP will coordinate with the LMHP from the inpatient facility to gather diagnostic and clinical assessments already completed.


Inpatient Referral Process Continued

The IACCT LMHP will complete the Independent Assessments by:

• Utilizing inpatient clinical documentation

•Conducting face to face meeting with family/guardian to gather additional information to complete assessments OR Utilize telemedicine to complete face to face interview with youth who is in acute facility

• The IACCT LMHP partners with the inpatient facility to complete the CON with the facility physician and to make sure all viable options, including community based options, have been explored (physician cannot be referring to affiliated residential program, if this is conflict, Magellan would assist in engaging MCO physician)

• Magellan would assist in identifying residential facilities that meet needs of family and youth

• Magellan would assist in coordinating residential admission, including working with locality regarding funding for education


Retro Eligibility Cases

There are two main categories for retro eligibility cases:

1. Youth in foster care who are placed in residential according to the Emergency Placement by DSS in which they become Medicaid eligible.

2. Youth who are already in residential treatment under an alternative funding or commercial insurance and become Medicaid eligible while in placement.


Retro Eligibility Process

• In cases where a youth is already in residential and becomes Medicaid eligible, or was placed at the time of eligibility as an emergency placement, the assigned foster care worker will submit a residential inquiry form to Magellan immediately and no later than 5 business days of eligibility.

• In cases where the child is a Medicaid member, the assigned foster care worker will submit a residential inquiry form to Magellan within 5 business days of member’s admission to the residential facility.

• Best practice would include the foster care worker also concurrently referring the child to FAPT.


Retro Eligibility Process Continued

• The youth would then be referred to the IACCT responsible for the member’s plan of care to assess needs and review for medical necessity back to the date of eligibility.

• In cases where the residential facility or group home is far away from the child’s medical home, the IACCT LMHP may:

• Use telemedicine to complete assessment

• Coordinate with the facility’s clinician to obtain clinical information and psychosocial assessment

• Coordinate with the IAACT where the facility is located to complete any needed assessments


IACCT Reassessment Process

Reassessment Process

• In cases where the youth is receiving residential treatment, the IACCT LMHP will conduct a reassessment at 90 days or earlier

• Thirty days prior to the due date of the reassessment, the ICM will email a reassessment referral form to the LMHP indicating the reassessment due date

• The LMHP will coordinate with the residential facility in order to complete the requirements of the reassessment

• The reassessment can be completed face to face, by telemedicine, or telephonically


Reassessment Process Continued

• The LMHP will submit the reassessment SRA to Magellan within 1 business day

• The re-assessment process includes

• A psychosocial addendum if deemed clinically necessary by the IACCT LMHP

• An updated CANS submitted by a person certified to complete the CANS

• A review of the CANS individualized outcome report

• Recommendations for any updates or changes needed to the current residential IPOC/CIPOC


IACCT Forms

Online Inquiry Form for Residential Services


Online Referral Form for Residential Services


Proposed Communication following submission of Referral Form

After submitting the online referral form, the IACCT LMHP will receive the following information from Magellan via secure email:

Date and time Magellan ICM emailed referral to IACCT secure email: ____Date ___________ Time (ET)

Date and time Magellan ICM phoned IACCT contact: ____________ Date ___________ Time (ET)

IACCT 2 business day face to face assessment due date: ________________________________

IACCT 5 business day timeline due date: ________________________________

Locality referred to: ___________________________________________________

Name of IACCT point of contact referred to: ________________________________________

Name and Contact information for Intensive Care Manager and Family Support Coordinator Assigned:

ICM Name: ________________________________ICM Phone number: ______________________

FSC Name: ________________________________FSC Phone number: _______________________


Online SRA Form for Residential Services


Registration Request Process

• Submit IACCT Assessment SRA to Magellan within 1 Business Day

• Complete the SRA

• Attach the psychosocial assessment, ACES, and CANS

• CPT codes

• 90889 HK for initial IACCT assessment

• 90889 TS for IACCT reassessment


Additional upcoming information, training, and resources

Upcoming Trainings

The following trainings will be recorded and posted to www.magellanofvirginia.com under “For Providers”

• Special considerations for Pre-referral process

• Reassessment Process

• Physician Engagement for Psychiatrists and Physicians

• IACCT CANS Training


http://www.magellanofvirginia.com/

Additional Information and Resources

Magellan of Virginia - Psychiatric Residential Treatment Facility changeshttp://magellanofvirginia.com/for-providers-va.aspx

DMAS Behavioral Health, Addiction and Recovery Treatment Serviceshttp://dmasva.dmas.virginia.gov/Content_pgs/obh-home.aspx

Building Bridges Initiative http://www.buildingbridges4youth.org/resources

http://magellanofvirginia.com/for-providers-va.aspx

http://dmasva.dmas.virginia.gov/Content_pgs/obh-home.aspx

http://www.buildingbridges4youth.org/resources

Conclusion and Q&A

Legal disclaimers

Confidentiality Statement for Educational Presentations


By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment.

Confidentiality Statement for Providers


The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

Thank You

Documents

IACCT Provider Training - magellanofvirginia.com• The IACCT LMHP receives the inquiry form from the IACCT ICM. The LMHP notifies the ICM of the intention to provide the education