ELIGIBILITY

EMERGENCY DEPARTMENT

  • Q: Hospital liability won't just disappear if Madden doctor disagrees with disposition. How will that be addressed?

    A: Liability continues to exist for ED personnel in all cases. Transfer to a DHS/DMH hospital is based on medical necessity, not for the purpose of assumption of liability if there is no reasonable need for hospitalization. If it is felt that DMH and its agents have erred, the ED continues to have the option of admitting the patient to its own unit or transferring the patient to a psychiatric unit that accepts other patients from that ED.

  • Q: Is there a system for us to obtain paperwork after signed (Transport form) by the hospital staff?

    A: Hospital or EDA evaluator can make copies at the time of signature for their records. IPT will not have duplicates.

  • Q: Who handles involuntary presentation?

    A: EDA services are available to eligible persons regardless of their presentation status at the emergency department.

ELIGIBILITY AND DISPOSITION ASSESSMENT (EDA)

  • Q: What is the expected response time for EDAs? Does this include telephone time?

    A:  The one hour response time for the evaluator to be on-site at the ED includes phone time and is 60 minutes.

  • Q: What is the expected response time from Madden Intake on an appeal?

    A:  Sixty minutes from the time Madden receives the call.

  • Q: Does the LOCUS have a place for signatures and the individual's name?

    A:  On the DHS/DMH provider information website, there is a link to the FY12 Provider Manual, which contains the LOCUS information. Included is a link to a LOCUS scoring sheet that has space for consumer name and staff signatures. We plan to have the LOCUS links posted on the R1SCCS page. For now, here is the link: Level of Care Utilization System (LOCUS).

  • Q: What are the limitations for DD and MR individuals?

    A: To be eligible, an individual must have a preliminary diagnosis of mental illness or mental illness and substance use disorder. There is no specified disallowance for the individual to also have an intellectual diagnosis.

  • Q: If we refer to Madden, do we need an authorization number from the collaborative?

    A: If an EDA is completed, you should call Collaborative for the Level of Care (LOC) authorization. If the consumer is to be referred to Madden, the authorization # for that person will be required for voluntary transport and subsequent ACS service. ACS services are to be provided for a 12 month period after enrollment.

  • Q: Question: Are EDA screeners to do screenings on the medical floors?

    A: NO, EDAs are only responsible to requests from Emergency Departments. The hospital LPHA staff is responsible for contacting Madden as under previous protocol to initiate a transfer request to Madden, including all intake packet information. Madden, at it sole discretion, may authorize care into R1SCCS for ONLY those consumers with R1SCSS home residence.

  • Q: If the consumer has been sitting at the hospital and is on Madden's wait list, are we to go back and try to find a chips bed?

    A: Authorization for Madden is authorization for inpatient level of care. Should a CHIPS bed become available and that hospital accepts the referral, that disposition can be completed. DMH has not enforced "homelessness" as a CHIP exclusion criteria as of yet.

  • Q: Is the "appeal" (please define) process to Madden between ER doctor and EDA, or collaborative, and EDA and ER doctor?

    A: The appeal process exists for the EDA to request reconsideration if in disagreement with the Collaborative CCM's decision, and the process, which includes the EDA, the CCM and the Madden physician, is fully defined in the R1SCCS Policy and Procedure Manual on the website.

  • Q: Do we (EDA) override the ER doctor? (the state is contracting with EDA, so does the EDA disposition override the ER doctor recommendation?

    A: EDAs have no control over the final action the ED physician wishes to pursue. The ED physician can request an appeal to Madden as outlined in the R1SCCS Policy and Procedure Manual. The decision made by the CCM, however, is binding related to DMH authorizing and paying for only those services as authorized. Transfer to Madden or any other SOH will NOT occur until that SOH approves of the requests. If the ED physician wishes to pursue hospital level or other level of care that is their prerogative. DMH will not authorize nor pay for that action.

  • Q: Under what circumstances would an EDA screener screen someone who's unfunded and from out-of-state but staying with a relative in the R1SCCS catchment area?

    A: EDAs should not likely be involved with this case. If the EDA was completed, the consumer would NOT qualify for ANY level of care in R1SCCS; if hospital care is needed the only resources would be SOH. After the EDA process is completed the EDA (person) is not obligated to assist the hospital in this action since the consumer does not qualify as eligible for R1SCCS care.

  • Q: Would we do an EDA screening on someone from out-of-state who may have had Medicaid from the State they came from.

    A: NO

  • Q: EDA agencies need a clear step-by-step outline of what to do when the ER disagrees with the Collaborative's decision or with the EDA screener's recommendations?

    A: The appeal process is outline in the R1SCCS Policy and Procedure Manual.

  • Q: Is the 24-hr post-EDA screening linkage contact reported under EDA services since the consumer is not yet enrolled?

    A: ACS services should be reported as an ACS service.

  • Q: When the EDA screener is utilizing the LOCUS, is this reported as part of the EDA screening (under Rule 132 service of crisis intervention) or is the LOCUS reported separately using the Rule 132 service code for Case Management-LOCUS?

    A: You should report the LOCUS event in addition to the time you spend providing crisis intervention.

SERVICES AUTHORIZATION

  • Q: How will John Doe authorizations work?

    A: Until further notice, if hospitalization is required the individual should be referred to Madden.

  • Q: Collaborative has stated that they only handle voluntarily admissions.

    A: Untrue, the Collaborative assigns and authorizes a LOC based on medical necessity for all EDA.


COMMUNITY HOSPITAL INPATIENT PSYCHIATRIC SERVICES (CHIPS)

  • Q: Please clarify "bed days" vs # of beds for CHIPS hospitals.

    A: DMH is purchasing access to psychiatric beds, not a specific number of beds.

  • Q: Will individuals be referred to CHIPS hospitals if they require oxygen?

    A: No.

  • Q: If someone is at a CHIPS hospital and needs to go to DMH hospital, will they need another EDA evaluation?

    A: No - will be handled thru the concurrent review process with a hospital to hospital review.

MENTAL HEALTH CRISIS RESIDENTIAL

  • Q: How will medications be funded for people in crisis residential?

    A: Medications are part of the provider's grant payments.

DASA RESIDENTIAL CRISIS STABILIZATION

  • Q: How will medications for DASA providers be covered?

    A: Medications are part of their grant payment.

  • Q: DASA providers now don't have to do physical exams when someone arrives from an ED. Is there an expectation that they will for this system?

    A: There is no intention for DASA providers to complete a physical exam. DASA providers are expected to treat the individuals as they treat any other person to whom they provide care with regard to their physical needs.

ACUTE COMMUNITY SERVICES

  • Q: Can an individual be involved in two different ACS if they are providing different services?

    A: NO, only one ACS agency is assigned and they are responsible for that LOC. They can independently (sub) contract for other OP LOCs as needed for the consumer.

  • Q: Can the USARF be considered as the beginning Mental Health Assessment (MHA) for a new ACS consumer, with updated information added at time of the first post-D/C face-to-face contact (along with an Individual Treatment Plan, Safety Plan, and a Transition Plan completed) or must the ACS provider initiate a completely new MHA?

    A: USARF is not a Mental Health Assessment. Prior to delivery of Rule 132 services, a complete MHA report must be signed and dated by the LPHA. The MHA report must be completed within 30 days of the first face-to-face with the consumer. The USARF will contain some but not all of the information necessary to complete an MHA. An agency may use the USARF as a reference, or include it as a part of the MHA in their documents, so long as they follow the guidance in the Rule 132 Q&As related to MHA documentation.

  • Q: Psychiatric Evaluations: Can psychiatric evaluations provided an ACS client be reported under ACS? This service is usually reported/billed under Program 350 (Psychiatric Leadership).

    A: YES, can be provided to ACS. Psychiatric evaluations should be provided to ACS clients when medically necessary, and those services should be reported under ACS. Any service reported under one capacity grant for the purpose of expense reconciliation cannot also be reported under another capacity grant.

  • Q: If an ACS consumer needs a substance abuse evaluation, can this be provided through the ACS program, if the staff person has a CADC and is able to utilize and perform an ASAM assessment?

    A: YES, can be provided under ACS.

  • Q: Once a consumer is discharged from a R1SCCS crisis care service (DMH, CHIPs, Crisis Residential, etc) to an ACS provider, is the ACS provider expected to perform a new LOCUS to determine the appropriate level of care services needed?

    A: NO, a new LOCUS is not required. However, LOCUS can be performed if it appears medically necessary.

  • Q: If the consumer is authorized for ACS, does that authorization qualify them also for CHIPS or Crisis Residential?

    A: NO. However, being authorized for CHIPS does authorize ACS or Crisis Residential.

  • Q: Are we correct in assuming that Rule 132 services such as Mental Health Assessment; Case Management-Mental Health; Case Management-Client Centered Consultation; Psychotropic Medication Monitoring; Psychotropic Medication Administration; Psychotropic Medication Training; as well as, sign-language interpreter; paying for prescribed psychotropic medications; psychological testing, etc, can be reported(shadowed billed) under ACS?

    A: YES, can be provided and reported under ACS. 

  • Q: Did DMH modify the USARF for R1SCCS to include a space to record the LOCUS level of care number?

    A: No modification was done. (9/25/12)


MADDEN MENTAL HEALTH CENTER SERVICES

  • Q: Are the Madden admissions voluntarily or involuntary.

    A: Madden admissions can be either voluntary or involuntary.


TRANSPORTATION

  • Q: Can we use taxicabs for 'high risk' folks who need admission to CHIPS, as well as for people going to less intense levels of care?

    A: DMH has arranged for a transportation provider which it will fund to transport individuals from the ED to the appropriate level of care. DMH will be monitoring the performance of the vendor and if response time is an issue, it will be resolved contractually with the vendor.

  • Q: What if is there is no social security number? They ( hospital ER staff ) do not know it, are not able to give it or don't have one.

    A: Not a problem for IPT (transportation provider); they require the authorization #. This should be a rare occurrence, as most people know their numbers and they can be cross checked through Medi-system. Increased frequency of such from any particular facility would be cause for further investigation.

  • Q: If the Illinois Patient Transportation denies transfer of a client, what is the next step?

    A: IPT has the right to refuse transfer due to lack of stabilization, medical issue, no authorization code, etc. All refusals are reviewed by DMH with IPT and follow-up to the ER in question. If IPT refuses transport, the IPT supervisor will usually be called for resolution at the time of refusal.


GENERAL ISSUES

  • Q: Can all the moving parts of the system be on the receiving end, periodically, of a list of contact numbers and website links for all of the other moving parts of the system?

    A: Yes.

  • Q: Will treatment providers be expected to have a standard protocol with respect to belongings?

    A: Treatment providers will be expected to follow their current protocols.