Rule Revision Workgroup Meeting Minutes - 1/7/2014

Participants: Ray Connor & Judy Griffeth, co-chairs, Dennis Beedle, Lisa Betz, Alan Dietrich, Rosemary Bussa, Hannah Chapman, Cathy Cumpston, Sondra Frazier, Jamie Germain, Kathy Henke, Judy Hutchinson, Kimberly Jenkins, Susan Krause, Dr. Renee Mehlinger, Jean Meister, Dr. Cynthia Mester, Margo Roethlisberger, Dee Ann Ryan, Meryl Sosa, Rita Thorpe, John Schornagel, Mr. Rice

Meeting began with introductions and roll call. Last meeting's minutes were reviewed and approved for posting on the DMH website.

Discussion:

In the previous meeting, some questions were raised regarding the application of SSI benefits to the cost of RTC. ICG rule section 135.30 (b) requires that "all SSA benefits be applied to the cost of care, to the extent provided by law." Alan Dietrich requested the input of Kevin Rice from SSA, who agreed to join today's meeting via teleconference. The group asked a number of questions including the following:

  1. What is the "law" that is referenced in 135.30 b?
  2. Who monitors the application of these monies toward program costs? (It was reported that not all agencies pursue these monies.) Does the oversight responsibility rest with SSA or the ICG program?
  3. Are SSA funds applicable to cover program costs from the day of admission or only after 90 days (as with Medicaid eligibility)? What is the time limit for family income exclusion for ICG placed youth?
  4. Can SSA monies be used to cover ancillary costs of placement including youth clothing, transportation and maintenance of home/living expenses or must it be applied directly to per diem charges?
  5. Are all youth SSI eligible by virtue of being ICG eligible?
  6. Are survivors benefits and/or SSA payments that result from disability of a parent equally applicable to the cost of care (even when the amount exceeds the SSI payment amount)?

Kevin Rice agreed to research the questions and provide responses to the co-chairs. Our thanks goes to Mr. Rice for his contribution and to Alan Dietrich for arranging his assistance.

Cathy Cumpston reported that SSI payments are treated as third party liability payments. There continue to be questions about whether adoption subsidies follow the youth, as SSA payments do. Jamie Germain will follow-up with a contact who may be able to provide a list of what adoption subsidies cover. Kimberly Jenkins will share these financial issues with the Legislation & Finance workgroup.

Next the group reviewed the draft edits to the SED definition. In the diagnostic criteria section, members discussed credentials requirements of the individual determining the diagnosis. While all agreed that a licensed clinical professional should determine the diagnosis, participants discussed that youth who may need intensive services provided through the ICG program should be assessed by an individual with expertise in child/adolescent mental health field. Participants expressed concern about the lack of availability of child and adolescent psychiatrists in central and downstate Illinois, particularly on an outpatient basis. Most youth who apply for ICG have been psychiatrically hospitalized and would have been assessed by C & A psychiatrist at that time. Tele-psychiatry is also an option. Participants questioned the need for diagnoses in both a psychiatric and psychological evaluation. The projective testing in a psychological evaluation is particularly valuable in consideration of eligibility for ICG. School psychological evaluations typically do not include the scope of testing data needed to assist with ICG eligibility determination. Payment issues for psychological testing remain a significant concern. While Medicaid pays for psychological testing, it is at a much lower rate than the testers typically bill; therefore, few providers offer this service for Medicaid eligible youth. Families with private insurance often do not have benefits for this service and are cost-prohibitive for most families.

The following recommendations in this section were made: 1) Add language to reflect that the eligible diagnosis has been determined by a child and adolescent psychiatrist (or minimally by a general psychiatrist w/consultation of a child and adolescent psychiatrist). 2) Seek clarification on available funds for psychological evaluations. 3) Kimberly Jenkins will forward this payment related issue to Legislation and Finance committee.

Proposed changes were approved in the functional impairment section. Meryl Sosa noted a typo in this section that had been noted in a previous meeting but overlooked in the draft edits. The correct statement should be "The functional impairment must be: 1) the result of the mental health problems for which the child is or will be receiving care".

Participants discussed the Treatment History section of the SED definition and struggled to reach consensus on the language in this section. The critical issue centered on how to ensure that available and appropriate interventions/services have been exhausted prior to seeking ICG services. Discussion points included information derived from family utilization of the SASS program, the role of the ICG program, the need to look at the whole system of services, and the consent decree provision that families cannot be directed to services that do not exist. How does one best define a "demonstrated lack of progress?" Is it evidenced by ongoing safety concerns? How does the lack of available services affect this? It is evidenced through criteria defined in the functional impairment section? What if frequency of unsafe behaviors has reduced but is still ongoing? The discussion was tabled due to lack of agreement. Members can forward recommended language to co-chairs for input into the next draft. SED definition will be reviewed at the next meeting.

Next on the agenda was Section 135.95 Service Appeals. Jean Meister suggested we first look at Section 135.81 Individual Services Plan Development, to review the decision making process. 135.81 (b) was a proposed addition for the development of a child and family team (CFT). John Schornagel remarked that this term (CFT) has different meanings & different requirements across systems & proposed that we select a different name, such as Comprehensive Planning Team. Dr. Beedle noted there should be no reference to the Collaborative in the Rule; instead, reference should be made to "DHS or its agent or its designee." Jean Meister raised the question of who has primary decision making authority for services, and recommended that that be the parent. Members added that the team should include multidisciplinary representation, including staff from the ICG program. In response to a question about ICG coordinators facilitating the plan, Lisa Betz reported that there are only 54 SASS agencies which cover LAN areas, whereas there are 139 agencies that provide Rule 132 services. Margo Roethlisberger noted that due to billing restrictions, only one member of her team could participate in the each meeting and there is no reimbursement for facilitation for non-medicaid eligible families.

Dr. Beedle requested clarification on frequency of disputes regarding service plan development. Co-chairs responded that particularly in the last 12-18 months service denials have be issued for both level of care decisions and individual service requests (summer camp, for example). Step down letters for youth in residential care were issued without agreement about clinical appropriateness to do so. Requests to step up to residential care were denied. The current rule does not include a service appeal process for these decisions. Language for services appeals has been drafted in the rule, section 135.95, which will be discussed in an upcoming meeting. Participants are encouraged to review those drafts and provide feedback to the co-chairs. Ongoing discussion is needed first though, in Section 135.81 Individual Services Plan Development. Participants are asked to review this section in advance of the next meeting and be prepared to discuss recommendations.

The meeting concluded with a reminder that the original workgroup deadline (January 15) is quickly approaching. Co-chairs will submit a request to Dr. Ferguson & Dr. Mehlinger for extension through the end of January and seek advice about options to integrate feedback from other workgroups into this workgroup's recommendations.

Next meeting: Monday, January 13, 2014, from 9-11a.m in the Chicago Reed Annex.

Notes submitted by: Judy Griffeth, LCSW, Allendale Association