A. Adult Care and Referral Entry Service (ACARES)
Similar to the Crisis and Referral Entry Service (CARES) design used for the Child and Adolescent System, the Department will purchase capacity for such a service for adults and create a single point of entry to the Region 1 South Crisis Care System for the person presenting with psychiatric emergencies at local EDs. ACARES would not be a provider of any other direct clinical services, and during Phase I, would be accessed only by the EDs in the Region 1 South area.
Due to limited resources it is important for responders to this RFI to note that DHS's initial priority is to ensure sufficient alternative services for Region 1 South residents that would have previously been served by Tinley Park Mental Health Center; that is, the equivalent of the 1,900 individuals served annually at TPMHC. Thus, during Phase I the focus will be to intercept individuals in crisis at the EDs. ACARES approval of access to the new Region 1 South Crisis System will be based on the following criteria:
- The person is a resident of the Region 1 South area, or is a person who is homeless from the Region 1 South area
- The referring ED has certified that the person is presenting based on a psychiatric crisis
- The outcome of the clinical assessment indicates that one of the Region 1 South Crisis System alternatives could be used to avoid SOH admission
- The person agrees to the alternative crisis care
- An appropriate alternate crisis care is available (e.g., bed at the III.7, bed at a CHIPS hospital, etc.)
During Phase I, EDs would contact ACARES when:
- A person having neither private nor public insurance coverage presents to their EDs and needs assessment for or access to the psychiatric acute care options described in this document;
- There is no capacity at the ED to provide the assessment required for entry into the Region 1 South Crisis Care System; or
- A qualified assessment has been performed and the ED is seeking referral entry service into the Region 1 South Crisis Care System.
ACARES will be responsible for answering all incoming calls to an established 24/7/365 hot. NOTE: After the Region 1 South Crisis Care System established, the Department may negotiate a plan for opening the ACARES line for community referrals. Such refinements or "sequential intercepts," will be guided by the ongoing ACCT Committee Structure and DHS monitoring of the flow of people into and through the new Crisis Care System.
The ACARES Line Workers will provide the following services to the Region 1 South EDs:
- Collect information to evaluate whether the ED patient meets eligibility criteria for the ACARES response (see 1-3 above);
- Determine if the assessment done by the referring ED is sufficient to determine eligibility for one or more of the Region 1 South Crisis Care System services;
- Where the assessment is determined to be insufficient for entry into the Region 1 South Crisis Care System, dispatch a qualified crisis assessment worker to perform the assessment;
- Based on the assessment results, authorize the person for the most appropriate available Region 1 South Crisis Care service;
- Where more than one Region 1 South Crisis Care service will be authorized for a person (i.e., CHIPS followed by Rule 132 services), the ACARES Line will assume responsibility for authorizing the transition between services;
- Arrange for transportation of the person to (or between) the authorized Region 1 South Crisis Care System provider site(s); and,
- Authorize payment for the cost of transportation and any Region 1 South Crisis Care service. This authorization will be provided upon certification that the provider of the service has been denied coverage under all other private and public health insurance programs, including the Medicaid program of the Illinois Department of Healthcare and Family Services. Denial of Medicaid must follow an adequate Medicaid application. The definition of an adequate Medicaid application will be developed by DMH.
Transportation is an essential ingredient of a crisis system that ties all the service components together. The ability to safely transport individuals in need of crisis services in a timely and cost effective manner is critical to operations. The requirements for providers who are authorized to transport persons in crisis vary between communities and may be determined by the legal status (voluntary versus involuntary) of the individual in need of treatment.
For situations when staff cannot coordinate transport between Region 1 South Crisis Care sites using local law enforcement or emergency medical vehicles, or when public or private commercial means of transport, such as a taxi voucher program, are not feasible, IDHS/DMH proposes to issue a separate RFI for transportation services independent of the other clinical services described here, with the transportation service authorized by the ACARES entity.
NOTE: For Will, Grundy and Kankakee Counties, it is anticipated that supplementary transport services will be bid out under an Invitation for Bid or a Sole Source Contract. These services will be for the transport of consumers voluntarily seeking non-inpatient community services such as Crisis Residential, access to a Living Room model program or Level 3.5 DASA services. Transfers of patients from emergency rooms to psychiatric units on an involuntary basis is already provided by Illinois Patient Transport
Within Cook County, DMH proposes that within Region 1 South, three (3) newly funded transportation services will be developed. First would be car transport of involuntary patients being moved from emergency departments to hospitals with psychiatric units, second as necessary, funding to be provided for involuntary patients whose risk level and or clinical criteria requires the use of an ambulance. Lastly, in circumstances where no other transport means is available, car transport for consumers seeking non-inpatient services such as Crisis Residential, access to a Living Room model program or Level III.5 DASA services.
IDHS/DMH will arrange transportation alternatives that are:
- Consistently available
- Performed by individuals with the appropriate skill levels for managing the individual being transported
C. Emergency and Transition Medication
Accessing psychotropic medications is critical for averting unnecessary inpatient admissions or ED presentations and also for maintaining stability for some individuals post discharge. Stipends or grants to local CMHCs for accessing emergency medications and access to the DHS state-operated mail order pharmacy services (locally housed in Will County and with likely savings for non-emergency medications in the 25-30% range) for post discharge medications will both be available. ACARES will likely play a role in the certification of the need for emergency/transition medications for persons entering the Region 1 South Crisis Care System.
DMH plans to support the needs for discharge and emergency medication needs through a combination of mini-grants to providers under this RFI to support emergent prescriptive needs and a larger monetary accessibility to the IDHS Pharmacy (OCAPS). Providers would be able to access pharmaceuticals through a mail order prescription process from the locally situated IDHS Pharmacy hub in Joliet. Bidders should project the anticipated total cost necessary based on projected volumes.
We plan to provide generic medications in all of the categories. We will consider brand name behavioral health meds only on a case by case basis with prior authorization by both DMH and OCAPS. The categories to be covered are as follows:
- Antihypertensive medications (generics only)
- Hyperglycemic medications (generic only)
- Analgesics (generic only)
- Dyslipidemias (generic only)
- Antipsychotics (generic first)
- Antidepressants (generic first)
- Mood Stabilizers (generic first)