Collaborative Protocol between Cenpatico Integrated Care ... · DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 3 Introduction Cenpatico Integrated Care (herein referred

2017

Collaborative Protocol between

Cenpatico Integrated Care and

Division of Developmental Disabilities

Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)

and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the

exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.

DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 1

Contents

Introduction ........................................................................................................................................................ 3

Referral for Behavioral Health Services .............................................................................................................. 3

Crisis and Emergent Referrals ............................................................................................................................. 3

Cenpatico Responsibilities .............................................................................................................................. 4

DDD Responsibilities ....................................................................................................................................... 4

Routine and Non-Emergent Referrals ................................................................................................................. 5



Adult Recovery Team & Child and Family Team Process .................................................................................... 6



Joint Responsibilities ...................................................................................................................................... 6

Crisis and Safety Planning ................................................................................................................................... 7


Coordination with Qualified Behavioral Health Professional (QBHP) ................................................................. 8

Cenpatico Responsibilities: ............................................................................................................................. 8

DDD Responsibilities: ...................................................................................................................................... 8

Discharge Planning Process ................................................................................................................................. 9


Community Collaborative Care Teams ................................................................................................................ 9

Coordination of Care & Member-Issue Resolution Process ................................................................................ 9

Cenpatico Responsibilities ............................................................................................................................ 10

DDD Responsibilities ..................................................................................................................................... 10

System Barrier Resolution Process ................................................................................................................... 11

Joint Responsibilities .................................................................................................................................... 11

Cenpatico Responsibilities ............................................................................................................................ 11

DDD Responsibilities ..................................................................................................................................... 12





Information Sharing and Member Privacy ........................................................................................................ 12

Joint Responsibilities .................................................................................................................................... 12

Signature Page .................................................................................................................................................. 13





Introduction

Cenpatico Integrated Care (herein referred to as Cenpatico) and the Division of Developmental Disabilities

(DDD) share a common goal to provide the highest quality services to individuals and families within our

shared areas. These areas include Pima, Pinal, Cochise, Graham, Greenlee, Santa Cruz, La Paz and Yuma

Counties. As a function of this common goal, we collectively aspire to provide services that are member driven,

flexible, easily accessible, innovative, and based on empirically supported best practice models.

Cenpatico and the Eastern, Southern and Northern Districts of the Division of Developmental Disabilities (DDD)

agree to coordinate activities associated with service delivery. Within this process, it is our vision to look at

every individual as a whole, without regard to their DD or behavioral health/General Mental Health (GMH) or

Sever Mental Illness (SMI) status or diagnosis. With this vision as the foundation of our partnership, we

believe that both DDD and Cenpatico will realize a bond and commitment to our mutual populations to

provide the most comprehensive and well-coordinated care possible.

To that end, Cenpatico and DDD acknowledge the value of sharing, utilizing, and following the assumptions

and guidelines formed within the Arizona Principles. We hereby recognize the extreme importance of the

Child and Family Team (CFT), as well as the Adult Recovery Team (ART) process. We agree that these services

are most effective when they:

Begin with the child, the adult, and his or her family (whatever that family composition may be)

Are collaborative in nature

Reflect the family’s voice

Respect their preferences, interests, needs, culture, language, and belief system

Provide opportunities for families to identify their roles within the structure of the behavioral health and DDD systems

Provide opportunities and techniques for members and their families to move through the recovery process to the maximum extent possible

Acknowledge child and family strengths

Referral for Behavioral Health Services

The referral process serves as the principal pathway by which persons are able to gain prompt access to

publicly supported services. Dependent upon an individual’s presenting concerns, either a crisis or routine

referral to behavioral health services may be needed.

Crisis and Emergent Referrals

Cenpatico IC seeks to ensure Members receive crisis services on a timely basis and, when appropriate, in their homes and communities. Crisis mobile teams are available to help Members obtain the appropriate crisis services. Cenpatico IC discourages providers from sending Members to emergency rooms for non-medical reasons.





To meet the needs of individuals in communities throughout Arizona, Cenpatico IC provides crisis intervention services through a contracted Crisis Call Center. Crisis services can be secured 24 hours per day, 7 days per week by calling the Crisis Call Center at 1-866-495-6735.

Cenpatico Responsibilities

Services provided to stabilize a crisis situation can be telephonic or face-to-face, dependent upon

member need. The response may include any needed covered behavioral health service including, but

not limited to:

o Assessment for need of higher level of care

o Danger to self/others

o Potential transport to inpatient facility

Behavioral health services provided within a timeframe indicated by clinical need, but no later than 2

hours from identification of need or as quickly as possible when a response within 2 hours is

geographically impractical. All Crisis Mobile Teams (CMTs) must respond within 2 hours.

Contracted agencies will provide immediate crisis response on all individuals needing such services.

Upon receipt of call by Nursewise, staff will triage call according to criteria. If the identified concern

cannot be resolved over the phone, a CMT will be dispatched to location of the member according to

time frames above.

If higher level of care is determined to be medically necessary, the CFT or ART shall be responsible for

convening a meeting once admission has occurred, so a discharge plan can be developed.

Discharge planning process must begin within 24 hours of admission to an inpatient facility. Please

Reference the Discharge Planning Process section of this document.

DDD Responsibilities

If the DDD Support Coordinator is making a referral for a member experiencing a behavioral health

crisis, he/she should request the “supervisor on call” for a more immediate response.

DDD Support Coordinator is encouraged to attend any behavioral health intake appointments, if the

family consents.

If an intake is necessary, DDD will assist in obtaining collateral information which may be helpful in

addressing each individual’s unique needs. While not required, information that may be helpful in

ensuring a member’s needs are identified during an intake may include, but is not limited to:

o Psychiatric assessments

o Psychological assessments

o Psycho-social and/or educational assessments

o IEPs (documentation from the school; with signed consent from the responsible person)

o ISPs (Individual Support Plan)

o Medical evaluations (if available)

o Specialty reports: neurological; eating disorder, physical, or speech therapy etc.





o Behavior plans/data (if available)

Routine and Non-Emergent Referrals


If an AHCCCS-eligible individual receiving services through DES/DDD is referred for or requests an intake for

routine services, the Cenpatico Intake and Care Coordination Agency (ICC Agency) will attempt to ascertain the

location of the local DES/DDD office where that member is receiving services, and notify the Support

Coordinator of the intake and enrollment.

Appointment for initial assessment should be within 7 calendar days of referral or request for

behavioral health services.

The first behavioral health service following the initial assessment appointment within timeframes

indicated by clinical need, but no later than 23 calendar days of the initial assessment.

Services must include any necessary covered behavioral health service that will meet the member’s

behavioral health need regardless of their GMH or SMI status.

Services provided by ICC Agencies and Specialty Provider Agencies shall be aimed at rehabilitation and

acquisition of a skill or behavior. Long-term habilitation services, aimed at maintaining a skill or

behavior related to their DDD diagnosis, are the responsibility of DDD.

All services shall be provided based on the needs of the individual in the most clinically appointed time

frame.


If eligible members are not enrolled with a Cenpatico ICC Agency, the DDD Support Coordinator will

encourage, support and guide parent or legal guardian or member through the behavioral health

enrollment process. DDD will assist in obtaining an intake appointment upon individual’s request.

The DDD Support Coordinator is encouraged to attend the behavioral health intake appointment if the

member and family so chooses.

DDD will assist in obtaining collateral information which may be helpful in identifying and addressing

each individual’s unique needs during an intake. While not required, information that may be helpful

in ensuring a member’s needs are identified during intake may include, but is not limited to:

o Psychiatric assessments

o Psychological assessments

o Psycho-social and/or educational assessments

o IEPs (documentation from the school; with signed consent from the responsible person)

o ISPs (Individual Support Plan)

o Medical evaluations (if available)

o Specialty reports: neurological; eating disorder, physical, or speech therapy etc.





o Behavior plans/data (if available)

DDD Support Coordinator can assist member or family or legal guardian in obtaining transportation to

behavioral health intake appointment.

Adult Recovery Team & Child and Family Team Process

Coordination of care within the Cenpatico provider network occurs most commonly through a member-driven

treatment team approach.

At a minimum, the ART/CFT must include the member, behavioral health representative, DDD Support

Coordinator and should extend to any individuals important to the member’s life who are identified by the

team.


In person participation in ART/CFT meetings is preferred, however Cenpatico providers will ensure

telephonic participation is possible for any team members unable to attend in person.

Provide a copy of the approved Individualized Service Plan and medication sheet, if applicable, along

with any assessments to the DDD Support Coordinator within seven (7) working days of completion of

the ART/CFT.

Individualized Service Plan/ISP reviews shall occur according to the needs and requirements of the

member during each ART/CFT meeting.

If requested, the member’s ICC Agency shall provide a copy of all Title 36 court orders for behavioral

health services to the appropriate district DDD Support Coordinator.


Provide copy of the DDD ISP within fifteen (15) working days, including any professional assessments

to the designated ICC Agency.

DDD Support Coordinator communicates with the ART/CFT facilitator to assist in the identification of

team members for the ART/CFT and assists by providing phone numbers and contact information.

The DDD Support Coordinator will monitor the effectiveness of behavioral health services provided to

any dually-enrolled member.

Joint Responsibilities

The development of the Individualized Service Plan (ISP) as well as the DDD 90 day review, are

completed by utilizing best practice guidelines and completed by collaboration, when possible.

All team members must be notified of changes in BH Recovery Coach or DDD Support Coordinator.

Notification of change in the ART/CFT Team or DDD Support Coordination should be given to the

appropriate agency within five (5) working days.





It is a shared responsibility to respect everyone’s time. Therefore providing as much notice as

possible, prior to the scheduling of any meeting and tentative agenda items, is a paramount part of the

process.

The ART/CFT Team which includes the DDD Support Coordinator shall have shared responsibility for

the supervision over ART/CFT Team activities as well as services/supports.

If guardianship is identified as a potential need or issue, the team will meet to discuss the surrogate

decision making process. Lack of guardianship or questions regarding guardianship shall not be a

barrier to the delivery of behavioral health services.

Communication needs to occur between both agencies, when there is a transition between RBHA’s

(inter-RBHA transfers), RBHA providers (intra-RBHA transfers), change in residency, and when there is

a transition from the children’s to the adult’s behavioral health system. The details of these transition

processes must be discussed in detail during the ART/CFT meetings in order to assure adequate

coordination of care.

Note: A “Professional Staffing” and an ART/CFT meeting are different. ART/CFT meetings must include the

member and a behavioral health representative. If these two parties are not both in attendance at a

meeting, the meeting is considered a professional staffing.

Note: At any time that respite services should be identified as a need on either side, it is critical to be

aware that the total number of respite hours is capped at 600 hours, regardless of whether those hours

are provided by the Division or Cenpatico.

Crisis and Safety Planning


In order to address and plan for barriers to implementing the Individualized Service Plan, the ART/CFT will

meet to develop a Crisis Plan and if needed, a Safety Plan. Every Individualized Service Plan will have a crisis

plan. However, safety plans are constructed when high-risk conditions are present. When a safety plan is

required, there will be significant overlap with the crisis plan.

A crisis plan will be documented and completed through the ART/CFT meeting.

o Crisis planning follows a four-step model that includes: Prediction, Functional Assessment,

Prevention, and Crisis Planning.

o Crisis plans will be specific and will include names and phone numbers, as well as

contingencies. Crisis plans should include a process, agreed upon timeframes and minimum

member’s to engage in emergency ART/CFT (i.e. in the event of placement disruption, the

team agrees particular members will come together within 24 hours to address the crisis).

o A copy of the plan will be immediately given to the team members and updated through the

team process as needed.





o Crisis planning may involve the community resources to aide with community preparedness.

However, disclosure to members of an ART/CFT who are not providers of health, mental

health or social services requires the authorization of the person or the person’s legal guardian

or parent.

o The DDD Support Coordinator will participate in the development and on-going maintenance

of the crisis and safety plan through participation at ART/CFT and on-going coordination of

care with the designated behavioral health providers.

A Safety Plan will be documented and completed through the ART/CFT meeting when high risk

conditions develop that put the member, family or community in immediate risk.

o Conditions that call for a Safety Plan can include, but are not limited to, sexual acting out,

suicidal ideation, elopement from placements and possible harm to member, family or

community.

o Safety plans will be specific and will include names, phone numbers and person specific actions

to make sure safety plan can be carried out effectively.

o A copy of the plan will be immediately given to the team members and updated through the

team process as needed.

Note: Teams are discouraged from using law enforcement or emergency room as interventions for reasons

that are non-medical or non-safety related.

Coordination with Qualified Behavioral Health Professional (QBHP)

DDD requires that a Behavioral Health Medical Practitioner (also known as a Qualified Behavioral Health

Professional (QBHP)) conduct a Consult and Review of Behavioral Health Service form (DDD-1463A) on all

dually-enrolled members every 90 days to review medications, behavior and functioning.

Cenpatico Responsibilities:

When DDD Support Coordinator submits Consult and Review of Behavioral Health Service form (DDD-

1436A) to ICC Agency Behavioral Health Medical Practitioner (BHMP), the ICC Agency will return

completed Consult and Review of Behavioral Health Service form (DDD-1436A) to Support Coordinator

within 10calendar days.

If Support Coordinator contacts the QBHP to complete Consult and Review of Behavioral Health

Service form (DDD-1436A) up to three times with no response, Cenpatico may request a corrective

plan of action.

DDD Responsibilities:

The DDD Support Coordinator will ensure a quarterly (90 day) consult is sent to ICC agency for the

member with the Qualified Behavioral Health Professional (QBHP). When the quarterly consult is

completed, the Support Coordinator will ensure information is documented in the member’s





record. Any concerns as a result of this consult, should prompt an ART/CFT meeting. Concerns should

be discussed during the next ART/CFT meeting. A copy of results will be provided at the next ART/CFT

meeting.

o It is preferable that this information be provided in the context of the team meeting or

medication review.

o If a consultation cannot take place in person or by phone, the Support Coordinator will submit

the Consult and Review of Behavioral Health Service form (DDD-1436A) to the Qualified

Behavioral Health Professional for completion. The Support Coordinator will review the

consultation with the team.

Discharge Planning Process


Should inpatient stay become necessary, discharge planning must begin immediately upon admission

between all involved agencies.

If the DDD Support Coordinator is not available on an emergent basis, then an alternate person,

Division staff, must be chosen to attend.

If clinical team determines the need for member is to require out of home placement, steps should be

taken by ICC agency to submit appropriate paperwork to Cenpatico.

If the most recent residence is questionable in any way, DDD Support Coordinator and/or Dedicated

Recovery Coach must communicate this information to the CFT/ART.

Community Collaborative Care Teams

Cenpatico has established the Consultation and Clinical Intervention (CCI) program (currently available in Pima

County only) in compliance with AHCCCS Policy Manual Chapter 570 – Community Collaborative Teams for

Select DDD Members. The purpose of this program is to communicate, collaborate, and coordinate services

and supports as well as address the complex behavioral, medical, and developmental needs of dually enrolled

Title XIX BH and ALTCS/DDD members with co-occurring behavioral health physical conditions. More

information specific to Cenpatico’s program can be located in the Cenpatico Provider Manual and

Attachments.

Coordination of Care & Member-Issue Resolution Process

All parties should strive to reach consensus/resolution at the ART/CFT level, and all resolutions should be

focused on ensure adequate and appropriate member care.






If additional assistance with coordination of care is necessary to ensure member care, Cenpatico’s

Coordination of Care team can be of assistance. This team can be contacted by emailing

[email protected].

If additional team facilitation and/or issue resolution assistance is required to ensure member needs

are met, Cenpatico’s Clinical Team can be of assistance. This team can be contacted by emailing

[email protected] and requesting an ART Coach or CFT Coach (dependent upon

member’s age.)

Cenpatico Customer Service staff are available to accept and submit customer complaints with regard

to issues with service provision, member rights or coordination of care. The unit operates between

the hours of 8:00 am to 5:00 pm, Monday through Friday and can be reached at 1-866-495-6738.

Educate system partners about the rights and the process for filing complaints in a manner that is

understandable.

Cenpatico resolves to file and close the loop on all provided complaints. An oral or written notice will

be provided within 14 calendar days of the complaint.

Maintain confidentiality and privacy of complaint matters and records at all times.

If consensus/resolution cannot be achieved, the Cenpatico provider and/or Cenpatico staff will advise

the members of the team of the right to file a grievance or appeal, and provide assistance in filing

such, as necessary and appropriate.


If additional assistance with coordination of care is necessary to ensure member care, DDD may

contact Cenpatico’s Coordination of Care team for support. This team can be contacted by emailing

[email protected].

If additional team facilitation and/or issue resolution assistance is required to ensure member needs

are met, DDD may contact Cenpatico’s Clinical Team to intervene and be of support. This team can be

contacted by emailing [email protected] and requesting an ART Coach or CFT

Coach (dependent upon member’s age.)

Complaints pertaining to member specific situations can be reported to Cenpatico by utilizing their toll

free telephone number: 1-866-495-6738. To submit a written complaint, mail the complaint to:

Cenpatico Behavioral Health of Arizona

333 E. Wetmore Rd, Ste. 600

Tucson, AZ 85705

mailto:[email protected]








System Barrier Resolution Process


Cenpatico and DDD staff will meet at a minimum of bi-monthly to address system issues through Collaborative

Meetings.

Meetings must address at a minimum:

Joint training needs

What’s working and what’s not working

Distribution of Community Resource Information

Integration of family/member involvement

Attendance and/or presentations from area ICC Agency

Discussion about regulatory changes that affect both agencies

New or updated Practice Improvement Protocols, Clinical Guidance Documents and Technical

Assistance Documents

These Collaborative Meetings are intended to address systems barriers that have not been addressed at a

lower level. Attempts should be made to resolve issues at the lowest level in order to continue local

collaboration efforts. Cenpatico and DDD will also schedule ad hoc meetings as often as necessary to address

issues related to specific members.


Cenpatico will participate in at least one meeting bi-monthly with DES/DDD and any other

community/agency partners, or stakeholders. At minimum representation from the Cenpatico clinical

team, a medical management administrator (i.e. Medical Director or designee) and Stakeholder Liaison

to DES/DDD and any other designated staff will attend these meetings. The focus of these meetings

will be system issues.

Cenpatico’s Stakeholder Liaison to DES/DDD will ensure system issues and barriers are discussed at

each Collaborative meeting. If not resolved, barrier items will remain active until the issue is resolved

to a satisfactory level.

Cenpatico’s Stakeholder Liaison will invite any identified members who may be of assistance in

reviewing or resolving the identified issues and/or barrier.

Cenpatico encourages ICC Agency management to hold regular collaborative meetings with DDD.






DDD will participate in at least one meeting bi-monthly with Cenpatico and any other

community/agency partners, or stakeholders. A minimum of program managers or district level staff,

and any other designated staff will attend these meetings.

The focus of these meetings will be system issues.

DDD management-level staff will forward issues to Cenpatico’s DES/DDD Stakeholder Liaison prior to

each Collaborative meeting.

DDD Support Coordinators are encouraged to forward issues to their immediate supervisor, who will

then forward to management level staff for discussion during a meeting.

DES/DDD will invite any identified members who may be of assistance in reviewing or resolving the

identified barrier.

Information Sharing and Member Privacy


Cenpatico and DDD agree to send all emails involving personal health information via

encryption/secure manner. Staff with either agency will indicate “[secure]” at the beginning of the

subject line. It is critical to note that in order for an email to be truly encrypted this exact verbiage

must be indicated in the subject line.

Currently, Cenpatico and DDD possess the same security programs.

Attachments can be no larger than four megabytes.

Faxes must be sent only to secured fax machines as required by HIPAA.

All other HIPAA compliance requirements must be followed.





Signature Page

Collaborative Protocol between Cenpatico Integrated Care and

Department of Developmental Disabilities

Effective Date: 01/01/2017

Last Revision Date: 11/7/2016

Cased on AHCCCS Contract Number: YH17-0001

End Date (if applicable): To be reviewed in one year

_Signature on File_______________________________ ___________________________

Cenpatico Interim CEO: Dr. Michael D. McKinney Date

_Signature on File_______________________________ ___________________________

DDD Behavioral Health Manager: Tyrone Peterson Date