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Psychosocial Rehabilitation NEW YORK CHILDREN’S STATE PLAN AMENDMENT (SPA) SERVICE-BY-SERVICE OVERVIEW SERIES

July 28, 2016

Presented by: ‣ Maria Morris-Groves, NYS Office of Alcoholism and

Substance Abuse Services ‣ Allison Behan, Child Welfare and Community Services,

NYS Office of Children and Family Services

3

Housekeeping & Logistics ‣ WebEx Chat Functionality for Q&A

‣ Slides are posted at MCTAC.org and a recording will be

available soon (usually less than one week)

‣ Questions not addressed today will be reviewed and incorporated into future training and resources

‣ Reminder: Information and timelines are current as of the date of the presentation. Content presented is summary and discussion of the draft SPA manual currently available on-line. Please refer to the manual for further detail, definitions, references, and other useful information.

Goals for Today ‣Review key information from SPA Manual

‣Add context and clarity whenever possible

‣Generate and answer questions

‣Help inform service providers’ decision-making

process about obtaining SPA designation ◦ The designation process will be finalized and announced soon. A

presentation and opportunity for designation-specific questions will also be offered.

Agenda ‣Children’s System Transformation & SPA

Refresher and Update

‣Psychosocial Rehabilitation Walkthrough

‣Upcoming training and available resources

‣Q&A

Overview and Refresher of Children’s SPA

What’s Ahead for New York State’s Children’s System ‣ Children’s Health Homes: Statewide 10/1/16 ‣ New State Plan Services: Statewide 1/1/2017 ‣ Behavioral Health & SPA Services Transition to Managed

Care (including children in the care of Voluntary Foster Care Agencies) ◦NYC/LI/Westchester: 7/1/2017 and Rest-of-State: 1/1/2018

‣ Children's Home and Community Based Services Transition to Managed Care ◦NYC/LI/Westchester: 7/1/2017 and Rest-of-State: 1/1/2018

Children’s Medicaid State Plan Amendment - Update • Draft SPA Provider Manual was released on March 9, 2016 • Six New Services (require CMS approval):

• Crisis Intervention • Other Licensed Practitioner • Community Psychiatric Supports and Treatment (CPST) • Psychosocial Rehabilitation (PSR) • Family Peer Support Services • Youth Peer Support Services

• SPA Designation/Application – in final revision stage

• Rates to be released Fall 2016

Children’s Redesign Goals The main goals of the additional services in New York’s State Medicaid Plan are to: ‣ Identify needs early on in a child’s life; ‣ Maintain the child at home with support and services; ‣ Maintain the child in the community; ‣ Prevent the need for long-term and/or more expensive

services; and ‣ Increase the delivery of services following trauma-informed

care principles.

SPA Provider Manual Organization • Definition of Service Components • Allowable Service Modality • Allowable Setting • Admissions/Continued Stay/Discharge Criteria (i.e.,

medical necessity) • Limitations/Exclusions • Agency/Supervisor/Practitioner Qualifications • Training Requirements and Recommendations • Recommended Staffing Ratio/Caseload Size Manual available at MCTAC.org under Resources

Key Points Proposed Medicaid State Plan Services will: ‣ Be available to all Medicaid eligible children under the age of 21

who meet medical necessity criteria (currently being refined). ‣ Be delivered in a culturally competent manner and be trauma-

informed.

‣ Allow interventions to be delivered in natural community-based settings where children and their families live and bolster lower intensity services to prevent the need for more restrictive settings and higher intensity services.

‣ Fall under the Early Periodic Screening, Diagnosis and Treatment benefits (known commonly as EPSDT).

Key Points (continued) ‣ The new benefits are standalone services, not programs, for

SPA designated providers.

‣ Services provided to children and youth must include communication and coordination with the family, caregiver and/or legal guardian. Coordination with other child-serving systems should occur to achieve the treatment goals.

‣ When children’s SPA services launch, they will initially be billed under Medicaid fee-for-service until transitioned to Medicaid Managed Care.

‣ Once designated for SPA services, providers can begin their contract negotiations with Managed Care Plans (January 2017).

Medical Necessity ‣ Medical necessity includes any treatment that: • Corrects or ameliorates chronic conditions found through

an EPSDT screening OR • Addresses the prevention, diagnosis, and treatment of

health impairments; the ability to achieve age-appropriate growth and development; and the ability to attain, maintain, or regain functional capacity.

‣ Each state plan service will have criteria for: • Admission • Continued Stay • Discharge

Psychosocial Rehabilitation

Psychosocial Rehabilitation (PSR)

‣ Interventions to compensate for or

eliminate functional deficits and interpersonal and/or environmental barriers associated with a child/youth’s behavioral health needs.

‣ For children and their families

‣ Intent: to restore, rehabilitate, and support a child/youth’s functional level as much as possible and as necessary for the integration of the child/youth as an active and productive member of their community and family with minimal ongoing professional interventions.

Defining Family ‣ Family is a unit of people residing together, with significant

attachment to the individual ‣ Includes both adults and children, with adults taking on

parenthood/caregiving for the children, even if the individual is living outside of the home

‣ Family is inclusive of the wide diversity of primary caregiving units and may include the following relationships:

• Birth • Foster • Adoptive • Self-created unit

Service Components ‣ Activities must be task oriented and intended to achieve the

identified goals or objectives as set forth in the treatment plan. ‣ Service options:

• Personal and Community Competence • Social and Interpersonal Skills • Daily Living Skills • Personal Autonomy and Health Skills • Social Skills • Community Integration

Personal and Community Competence ‣ Using rehabilitation interventions and individualized

collaborative, hands-on training to build developmentally appropriate skills

‣ Intent is to: • Promote personal independence, autonomy, and mutual

supports • Develop and strengthen the individual’s independent

community living skills • Support community integration in the domains of

employment, housing, education, in both personal and community life

Social and Interpersonal Skills

‣ To restore, rehabilitate and support: • Increasing community tenure and avoid more restrictive placements • Enhancing personal relationships • Establishing support networks • Increasing community awareness • Developing coping strategies and effective functioning in the individual’s

social environment, including home, work, and school locations • Learning to manage stress, unexpected daily events and disruptions, and

symptoms with confidence • Developing interpersonal skills when interacting with peers and

maintaining friendships or a supportive social network while engaged in a recovery plan

• Training on social etiquette • Developing self-regulation skills, including anger management

Daily Living Skills ‣ To restore, rehabilitate, and support:

• Improving self-management of the negative effects of psychiatric, emotional, physical health, developmental, or substance use symptoms that interfere with a person’s daily living

• Support the individual with the development and implementation of daily living skills and daily routines necessary to remain in the home, school, work, and community

• Wellness skills such as • Meal planning • Healthy shopping and meal preparation • Nutrition awareness • Exercise options

Personal Autonomy & Health Skills

Person Autonomy Skills: • Learning self-care • Developing skills specific to

managing medications and self-care consistent with directions of prescribers

• Developing methods of communication with prescribers about medication side effects or issues

• Gaining the ability to make independent choices and take a proactive role in treatment, including talking with treatment provider about questions or concerns

Health Skills: • Developing constructive and

comfortable interactions with health care professionals

• Relapse prevention planning strategies

• Managing symptoms and medications

• Re-establishing good health routines and practices

Personal Autonomy & Health Skills Examples

‣ Develop daily living skills specific to managing medications and learning self care consistent with the directions of prescribers ◦ Setting an alarm to remind a child when it is time to take a

medication ◦ Developing reminders a calendar when it is time to refill a

prescription

‣ Developing methods of communication with prescribers about medication side effects or medication issues ◦ Help the youth prepare for an upcoming appointment by

encouraging them to write down questions or concerns to discuss with the prescribing physician

Social Skills ‣ Implementing learned skills so the child can remain in a

natural community location and achieve developmentally appropriate functioning.

• Re-establishing Social Skills include:

• Developing conversation skills and a positive sense of self to result in more positive peer interactions

• Coaching on interpersonal skills and communication • Transportation navigation • Developing and pursuing leisure and recreational interests • Using community resources • Managing money • Trigger avoidance – help individual with effectively responding to or avoiding

identified precursors or triggers that result in functional impairments

Community Integration

‣ To restore, rehabilitate, and support the identification and pursuit of personal interests that support community integration:

• Identify resources where interests can be enhanced and shared with others in the community

• Identify and connect to natural supports and resources, including family, community networks, and faith-based communities

• Such as: creative arts, reading, exercise, faith-based pursuits, cultural exploration

SPA Manual example -- Susie ‣ Susie is a 17 year old who is struggling with obesity due to

depression. ‣ She attends outpatient therapy and developed a treatment plan

with her licensed practitioner. ‣ One of the goals developed was to work on acquiring healthy

wellness skills. ‣ The PSR provider has collateral contact with the licensed

practitioner and is focusing on assisting Susie with meeting this goal in the community.

‣ The PSR provider re-establishes Susie’s nutritional awareness and formulate a menu plan.

‣ Once a week, the PSR provider takes Susie to the local grocery store and supports her choice of healthier food options when shopping.

SPA Manual example -- David ‣ David, a 10 year old, is interested in playing soccer but has

difficulties in socializing with other children due his anxiety. ‣ The child’s clinician recommends PSR and develops the treatment

plan with the intended goal of the child acquiring healthy social skills with others during soccer practice.

‣ The PSR provider assists the child in restoring self-regulation techniques to prevent inappropriate outbursts during the child’s soccer practice.

Allowable modalities ‣ All interventions must be face-to-face

‣ Can include collateral contacts as long as the contact is directly related to the recipient’s goals and treatment plan

‣ Options: • Individual • Groups

• Should not exceed 6 – 8 members (consideration of smaller groups if participants are younger than 8 years of age)

• Members should share common characteristics, such as related experiences, developmental age, chronological age, challenges, or treatment goals

Settings and caseload size ‣ Settings: PSR can occur in a variety of settings including

community locations where the child/youth lives, works, attends school, engages in services (e.g. provider office sites), and/or socializes.

‣ Caseload size: based on the needs of the child/youth and

families with an emphasis on successful outcomes, individual satisfaction, and meeting the needs identified in the individual treatment plan.

Provider agency qualifications ‣ Any child serving agency or agency with children’s behavioral

health and health experience that is licensed, approved, certified, or designated by DOH, OASAS, OCFS, or OMH to provide comparable and appropriate services referenced in definition.

‣ Must comply with additional requirements including: ‣ Adhere to Medicaid requirements ‣ Ensure staff receive training on Mandated Reporting, ‣ Practitioners maintain licensure necessary to provide services ‣ Maintain needed insurance ‣ Follow safety precautions needed to protect child population ‣ Adhere to cultural competency guidelines ‣ Be knowledgeable about trauma-informed care

Individual staff qualifications ‣ Must be at least 18 years old

‣ Have a high school diploma, high school equivalency preferred, or a State Education Commencement Credential (e.g. SACC or CDOS)

‣ Minimum of three years’ experience in children’s mental health, addiction and/or foster care.

Note: ‣ The practice of PSR by unlicensed individuals does not include those

activities that are restricted under Title VIII.

Supervisor qualifications ‣ PSR provider must receive regularly scheduled

supervision from: • Licensed clinical social worker (LCSW) • Licensed mental health counselor (LMHC) • Licensed creative arts therapist (LCAT) • Licensed marriage and

family therapist (LMFT) • Licensed psychoanalyst • Licensed psychologist

‣ Supervisors must also be aware of and sensitive to trauma informed care, cultural needs and how to best meet those needs, and be capable of training staff regarding these issues.

• Physician’s assistant • Psychiatrist • Physician • Registered Professional

Nurse • Nurse Practitioner

Training requirements and recommendations ‣ Required: Training on Psychosocial Rehabilitation,

including: • Engagement and follow-through • Group facilitation • Identification and delivery of functional skill building

interventions – personal, health (including medication advocacy and coaching), autonomy, and community competence

‣ Recommended: • Domestic violence • Motivational interviewing • Personal safety in the community

Admissions & Continued Stay

‣ The child/youth has a diagnosable behavioral health condition as classified in the DSM V, including v-codes.

‣ The service is recommended by any of the following licensed practitioners of the healing arts operating within the scope of their practice under State license:

✓Licensed Master Social Worker (LMSW) ✓Licensed Clinical Social Worker (LCSW) ✓Licensed Mental Health Counselor ✓Licensed Creative Arts Therapist ✓Licensed Marriage and Family Therapist ✓Licensed Psychoanalyst ✓Licensed Psychologist ✓Physician’s Assistant ✓Psychiatrist ✓Physician ✓Registered Professional Nurse, or ✓Nurse Practitioner

Admissions & Continued Stay

‣ The service is included in the child/youth’s Treatment Plan. ‣ A licensed Community Psychiatric Supports and Treatment

(CPST) practitioner or Other Licensed Practitioner (OLP) must develop the treatment plan, with the PSR worker implementing the interventions.

‣ This service is directed at implementing the interventions already outlined in the treatment plan including developing skills or achieving specific outcome(s).

‣ The frequency and intensity of the service aligns with the unique needs of the child.

Treatment Plan & Notes The treatment plan must specify the amount, duration, and scope of services, and should be: ‣ Developed or revised in a person-centered manner with

participation of the child/youth, family and providers;

‣ Re-evaluated to determine whether services have contributed to meeting the stated goals;

‣ Revised with different strategy, goals, and services if there is no measureable reduction of disability or restoration of functional level

Discharge criteria ‣ Child/youth has successfully reached individually-

established treatment plan goals for discharge

‣ The child/youth and family has been involved in the discharge process

To be Finalized and Announced ‣ Provider designation criteria and process

‣ PSR billing methodology and coding structure ‣ PSR Medical Necessity criteria ‣ Any additional PSR limitations ‣ SPA service documentation requirements

‣ Utilization Management process

Once finalized, these will be incorporated into the SPA Provider Manual and shared widely.

Training and Resources

SPA Training Series Schedule ‣ Thursday, 6/30 -- Other Licensed Practitioners ‣ Thursday, 7/7 -- Psychosocial Rehabilitation Services ‣ Thursday, 7/14-- Family Peer Support Services & Youth

Peer Support and Training ‣ Thursday, 7/21 -- Community Psychiatric Supports and

Treatment ‣ Thursday, 7/28 -- Crisis Intervention State-led training on the Child and Adolescent Needs and Strengths (CANS-NY): ‣ Albany on June 22nd and 23rd ‣ NYC on July 12th and 13th and again on August 29th and 30th ‣ Rochester on August 18th and 19th

SPA Training Plan • June/July – High-level service-by-service overview, designation process,

billing rules when available

• September – Rates/billing codes, staffing requirements, caseloads, eligibility/medical necessity, deficit funding, EHR help (in-person)

• October – Referral process, documentation, continuing education, co-enrollment rules, exclusions, health home interaction, reporting requirements (web-based)

• November/December – Detailed training for each service (full-day statewide in-person and web-based supplements)

• January 1, 2017 – SPA goes live! Ongoing support and training responsive to areas of provider need supporting implementation

Resources and Information Please specify if kids system/managed care specific in subject line: NYS OMH Managed Care Mailbox OMH-Managed-Care@omh.ny.gov NYS OASAS Mailbox: PICM@oasas.ny.gov NYSDOH Health Homes for

Children’s Health Home: HHSC@health.ny.gov NYS OCFS Mailbox: OCFS-Managed-Care@ocfs.ny.gov

Children’s Managed Care Design: http://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health_reform.htm

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