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How To Access I/DD Services In NC

JENNA FLYNN, MSW, LCSWA & SHARONDA JONES, MSW, LCSW

NASW-NC CLINICAL INSTITUTE – WILMINGTON, NC

INTRODUCTIONS

JENNA FLYNN, MSW, LCSWA

• 16 years MHSUD

• 11 years IDD

• MCOs for 6 years

SHARONDA JONES, MSW, LCSW

• 9 years MHSUD

• Emerging IDD knowledge

• MCO for 2 years

AGENDA

• Importance of Issue

• Introduction to I/DD diagnoses

• I/DD Eligibility Review Process through NC LME/MCO’s

• I/DD Services

• NC Innovations and TBI Waivers

• Coordinating I/DD and MHSUD Services for Individuals with Co-Occurring Diagnoses

• Resources

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WHY IS THIS IMPORTANT?

CHILDREN WITH COMPLEX NEEDS

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INTELLECTUAL/DEVELOPMENTAL DISABILITIES

• Often abbreviated I/DD or IDD

• “Severe, long-term disability that can affect cognitive ability, physical functioning, or both.

These disabilities appear before age 22 and are likely to be life-long.”

• Umbrella term

• DSM5 Changes

• No IQ threshold

• Heavier focus on Adaptive Functioning as indicator of severity

I/DD DIAGNOSES

• Intellectual

• Mild

• Moderate

• Severe

• Profound

• Neurodevelopmental

• Autism Spectrum

• ADHD (not currently a qualifying

diagnosis)

I/DD DIAGNOSES

• Physical

• Spina Bifida

• Cerebral Palsy

• Vision and Hearing Impairment

• Chromosomal

• Down Syndrome

• Fragile X

• Angelman’s Syndrome

• Many deletion syndromes

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I/DD DIAGNOSES

• Injury related

• Traumatic/Acquired Brain Injury*

• Fetal Alcohol Spectrum

• May also see

• Developmental Delay (prior to 8 yo)

• Co-occurring I/DD diagnoses

SUSPECTED OR CONFIRMED?

• Member not making tx gains

• Reported hx of delay, IEP/specialized

education

• Reported hx of injury, drug exposure

• If suspected, refer out for confirmation

via IQ test, medical screening, or

specialized diagnostic assessment

• Be clear to the evaluator what you are

suspecting

• Confirmed via psychological evaluation,

neuropsychological evaluation,

medical documents for medical

diagnosis

• Be wary of hospital d/c summaries,

psychiatric evaluations, CCAs when

considering I/DD diagnoses

INSURANCE CONSIDERATIONS

• Private Insurance

• Be sure to check coverage for I/DD specific supports (ABA, Evaluations, Respite)

• May still access IDD support through LME/MCOs (IPRS income threshold)

• Includes TRICARE

• Medicaid

• “B3”

• Includes EPSDT Criteria (covered in video)

• IPRS

• “State-funded” services as well as coverage for uninsured

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TERMINOLOGY

• IDD

• Member

• AKA client, patient, individual

• LOC

• Dual Diagnosis

• CCA

• Psych Eval

• Registry of Unmet Needs

• AKA RUN, Registry, Innovations Waitlist

POLL THE AUDIENCE

• Any current cases you are carrying that have co-occurring MH/IDD?

CASE EXAMPLE - CLARK

• 2017 Psych Eval:

• FSIQ GIA <40, BASC and Vineland “Low” and 48 = Moderate to Severe ID using DSM5 style

• ADHD Combined

• 2016 Eval:

• FSIQ 43-58, Vineland Adaptive Composite 61 = Mild to Moderate ID using DSM4 style

• CARS-2 indicates Mild to no ASD symptoms

• Delusional Disorder, Persecutory Type (Provisional), Intermittent Explosive Disorder, Other

Persistent Mood (Affective) Disorder, Social (Pragmatic) Communication Disorder

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CASE EXAMPLE

• Life history (risk and protective factors)

• What our team is discovering:

• Actual presentation appears to be higher than his level of true functioning, therefore his

abilities can easily be overestimated

• ACTT provider not oriented to IDD needs, particularly as they present for this member

NC MANAGED CARE ORGANIZATIONS

https://www.ncdhhs.gov/providers/lme-mco-directory

VAYA HEALTH

• Counties: Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay,

Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk,

Rutherford, Swain, Transylvania, Watauga, Wilkes, Yancey

• Contact person: Access = 828-225-2785

• Kathy Dills is contact for RUN assessment

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VAYA HEALTH

• Process

• Verify Insurance

• For Innovations Waitlist/RUN:

• If Medicaid, referral to Community Connections if it is available in resident’s county for RUN

assessment

• If Private or uninsured, RUN assessment is completed by Kathy Dills (Vaya staff).

• For IDD Services Only:

• Member is connected directly with an IDD provider agency without any review by Vaya

• Provider to determine what services are needed and will seek authorization

CARDINAL INNOVATIONS

• Counties: Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin,

Granville, Halifax, Mecklenburg, Orange, Rockingham, Person, Rowan, Stanly, Stokes,

Union, Vance and Warren

• Contact person: Registry Department 704-939-7980 /

registry@cardinalinnovations.org

• Coordinator assigned is specific to County and Last Name

• Can call general number or use Live Chat option on website to have questions answered

• Email and voicemail monitored daily with coordinators assigned by territory

CARDINAL INNOVATIONS

• Process:

• Documentation submitted: IQ testing plus Adaptives with 3 domains (Social, Practical,

Conceptual)

• Vineland or ABAS preferred

• IQ and Adaptives must be two or more standard deviations below mean (scores ~70 or

below)

• Documentation reviewed internally by Registry Department

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CARDINAL INNOVATIONS

• Process:

• If Not Eligible: member will receive letter stating specifically why

• If Eligible:

• RSNA will be done over the phone and referrals sent to non-Innovations providers

• SIS assessment completed for placement on RUN

PARTNERS BEHAVIORAL HEALTH

• Counties covered: Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry, Yadkin

• Contact person: Access Care Department 704-884-2501

• There are many IDD staff assigned in their various counties that callers will be connected to

PARTNERS BEHAVIORAL HEALTH

• Process:

• When you call, you will get automated response. press “1” for “Schedule An Appointment.”

• Connect with IDD staff. If they aren’t available, you will receive a call back.

• IDD Staff will assist with connecting to evaluations (if needed) and gathering info to support

IDD Eligibility. They are your point of contact.

• Requires qualifying diagnosis and adaptive scores under 70

• If Eligible, placed on RUN and referred for IDD services through provider agencies.

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ALLIANCE BEHAVIORAL HEALTHCARE

• Counties covered: Cumberland, Durham, Johnston, Wake

• Contact person: Access and Information Line 1-800-510-9132

• Ask for IDD Access Department

• Team of 6 with IDD Supervisor

ALLIANCE BEHAVIORAL HEALTHCARE

• Process:

• Connect with IDD Access Coordinator (6 total)

• Complete short telephone screening (Life Domains)

• Submit Psych Eval and Adaptive Testing, IEP

• Testing thresholds of 2 SDs below mean (~70)

• IDD Eligibility Committee meets weekly to review cases

• If IDD Eligible, referrals can be sent to providers for services and can be placed on RUN

• If Not IDD Eligible, may pursue additional testing

SANDHILLS CENTER

• Counties covered: Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph,

Richmond

• Contact person: Call Center 1-800-256-2452.

• Calls are answered by Licensed Clinicians

• Can ask for a referral for any discipline, including Eligibility for non-Innovations

• Non-Innovations Care Coordination available will assist with referrals, will meet with family and

complete intake. EVERYONE gets this initially

• You may need to leave a message and receive a return call

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SANDHILLS CENTER

• Process:

• Verify Insurance

• Clinicians will screen the member if they aren’t currently connected to services

• Submit documents (Psychological Evaluation or Medical Evaluation)

• Will go based off of what psychologist diagnosed, no testing thresholds

• Documentation is reviewed by IDD Referral Committee weekly and makes decision of

eligibility

• If Eligible, referrals are sent and member is placed on RUN by non-Innovations CC

• If Not Eligible, a letter will be sent for your records

TRILLIUM HEALTH RESOURCES

• Counties covered: Brunswick, Carteret, Nash, New Hanover, Onslow, Pender, Beaufort,

Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin,

Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, Washington

• Contact person: Access to Care Line: 1-877-685-2415

• Will reach recording first and will need to choose an option

TRILLIUM HEALTH RESOURCES

• Process:

• Individuals must have a Psych Eval completed and submitted to Trillium

• Will be linked to a provider as long as document confirms IDD

• No threshold for scores

• Will place on Innovations Waitlist

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EASTPOINTE

• Counties covered: Bladen, Columbus, Duplin, Edgecombe, Greene, Lenoir, Robeson,

Sampson, Scotland, Wayne, Wilson

• Contact person: Call Center 1-800-913-6109

• Will initially reach recording

• Call Center indicates Provider Network is who handles IDD Eligibility

• Tracie Falmer is current contact person

EASTPOINTE

• Process:

• Network Operations – Tracie Falmer IDD Team Lead in Rocky Mount

• May have to leave a message and receive a call back

• Wasn’t able to reconnect with her

WHY DIFFERENCES?

• LME-MCOs are “individual contractors” with DMA

• https://dma.ncdhhs.gov/lme-mco-contracts-dma

• Link to actual contracts with each MCO

• Requirements are broad

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I/DD SERVICES

• Developmental Therapy

• Developmental Therapy-Professional

• Personal Assistance

• B3 In-Home Skill Building

• B3 and IPRS Respite

• Long-Term Vocational Supports

• ABA Therapy*

• B3 De-Institutionalization (DI)

• B3 Supported Employment

• Adult Day Vocational Program

NC INNOVATIONS WAIVER

• Home and Community-Based Medicaid program

• Waives some typical Medicaid requirements

• Waitlist Time is county specific

• Habilitative, Skill-Building, Personal Care Supports

• Each Innovations enrollee receives long-term IDD Care Coordination who will engage in

planning and support family and treatment team with orientation to waiver, linkage

and engagement with providers, monitoring of service provision, and any changes to

Individual Support Plan (ISP) needed

NC INNOVATIONS WAIVER

• Community Living and Support (CLS)

• Residential Supports

• Supported Living

• Day Supports (Individual and Group)

• Supported Employment

• Assistive Technology/Home and Vehicle

Modifications

• Community Transition

• Community Navigator

• Community Networking

• Crisis Services

• Respite

• Individual Goods and Services

• Natural Supports Education

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CAP-C AND CAP-DA

• Coordinated by DHHS, not LME-MCOs

• CAP-C: https://dma.ncdhhs.gov/providers/programs-services/long-term-care/community-

alternatives-program-for-children

• CAP-DA: https://dma.ncdhhs.gov/providers/programs-services/long-term-

care/community-alternatives-program-for-disabled-adults

• For potential referrals, please visit web links above.

TBI WAIVER

• Set to pilot in Alliance catchment effective 8/2018

• Must meet SNF or Specialty Rehab Hospital LOC

• Must have experienced TBI age 22 or older

• Supports similar to those available through Innovations Waiver

• Questions? Call Alliance or email TBIInfo@alliancebhc.org

COORDINATING CARE FOR DUALLY DIAGNOSED

• Service exclusions?

• NONE. Difference in scope/intent

• EPSDT benefits

• Coordination of Care

• Case Example of Tommy

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COORDINATING CARE FOR DUALLY DIAGNOSED

• Be a Teacher

• Be Curious

• National Association for Dual Diagnoses (NADD)

• Be Uncomfortable

• Be an Advocate

• Connect with Resources

NC START

• Systemic, Therapeutic Assessment,

Resources, and Treatment

• Statewide community crisis prevention

and intervention program for ages 6 and

above with IDD and co-occurring

complex behavioral and/or mental health

needs

• Can provide consultation to providers,

families, MCOs, etc.

NC START

• NC START West Asheville Kannapolis/Concord:

• 888-974-2937, Referrals: 888-974-2937

• NC START Central Durham:

• 919-908-0952, Referrals: 919-908-0952

• NC START East New Bern Wilmington:

• 888-962-3782, Referrals: 252-571-9039

• For MOST areas, referrals to Child START program go through the MCO

• Ages 6-20

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DISABILITY RIGHTS OF NC

• Toll-Free: 877-235-4210

Phone: 919-856-2195

TTY: 888-268-5535

Fax: (919) 856-2244

• Email: info@disabilityrightsnc.org

• (Please provide your full name and a

phone number so we can follow up with

you. Thank you!)

CHILDREN WITH COMPLEX NEEDS

• Children with Complex Needs are ages 5 and under 21, with a developmental and/or

intellectual disability and a mental health disorder diagnosis who are Medicaid eligible and

at risk of not being able to return to or maintain placement in a community setting.

• Statewide Administrator for Children with Complex Needs, at

Rachel.Johnson@dhhs.nc.gov or 919-733-7011.

• EVERY MCO has been charged with identifying a cohort of youth

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WANT A COPY OF THE POWERPOINT?

• Please use the notecards on your table to write your email address

• We will email you the final copy once the conference is over

• Please feel free to contact us after the conference:

• Jenna Flynn: jflynn@alliancebhc.org

• Sharonda Jones: sjones@alliancebhc.org