FY 2014 FFS Enrollment Scoring Criteria

I. Attachment I :“Agency-Specific Information – Evidence-based Practices” (20 points maximum)

DMHAS encourages agencies to utilize evidence-based practices that are well- supported by research evidence with outcomes that are reliable, valid, and provide transparency to assure that techniques and procedures will provide the best possible interventions or treatment. Please provide a list of evidence-based practices that your agency has implemented with consumers. Describe how the agency has implemented these practices and their impact consumer outcomes (500 words maximum).

Criteria Max Score per item Score

A list of evidence based practices employed by or 10 planned for implementation by the agency is provided. Points are to be awarded only if the EBPs can be verified on the SAMHSA reference sheet or at http://www.nrepp.samhsa.gov/Search.aspx Response includes a description of how the 5 agency implements or plans to implement the EBPs. Points are to be awarded if implementation or plan to employ the practices at the agency is described; points are not to be awarded if only definitions of the EBPs are provided. Response includes a description of the impact that 5 the EBPs have had or are expected to have on consumer outcomes at the agency. Points are to be awarded for data, cited examples, trend analysis, survey results or other evidence that the agency measures consumer outcomes. Points can be awarded for a response that describes expected outcomes/impact as a result of a planned EBP implementation by the agency.

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II. Attachment II :– Policy and Procedure Regarding Availability of Public Funding and Alternatives” (10 points maximum) Acceptance into the DMHAS FFS networks does not ensure funds are available for all consumers that meet income eligibility and clinical eligibility for services. In addition, the DMHAS non-criminal justice initiatives (Driving Under the Influence (DUII), Medically Assisted Treatment (MATI) and South Jersey (SJI) have managed new consumer enrollment to insure that resources are available for existing consumers to complete care. Please provide a copy of the agency’s policy and procedure to advise consumers of available public funding options and alternatives when public funds are not available

Criteria Max Score per item Score Policy includes the following elements regarding public funding requirements Points are awarded if policy includes procedure for 3 Income Eligibility screening Points are awarded if policy includes procedure for 3 Program Eligibility screening Points are awarded if policy address payment 4 options if consumer is not eligible for public funding or if public funding is not available

III. Attachment III:Policy and Procedure Regarding Consumers Taking Physician-Prescribed Medications (20 points maximum) All DMHAS FFS network agencies are required to support any and all consumers who take legitimately prescribed medications including medications for the treatment of opioid dependence, which are referred to or present for admission at the agency. Please provide a copy of the agency’s policy and procedure regarding support for consumers who are taking physician-prescribed medications. If the policy includes referral to another agency for these services, the policy must include specific details regarding the referral process. Criteria Max Score per item Score Policy clearly describes how agency supports 6 consumers who are taking physician prescribed medication Policy clearly describes how agency supports 6 consumers who are taking physician prescribed medication including medication for opioid dependence Policy clearly describes integration of medication 8 assisted care within and/or if consumer is referred to another agency

IV. Attachment IV: Sample Treatment Plan”

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(25 points maximum)

Please provide a sample treatment plan that includes identified problems, related goals, specific objectives to meet the identified goals, and concrete and measurable actions on the part of the counselor and the consumer to achieve the objectives. The sample treatment plan should be de-identified but must include a section for consumer signature.

Criteria Max Score per item Score Sample Treatment Plan includes the following elements: Points are to be awarded if examples of the elements below are present in the sample treatment plan provided. Identified problems 5 Goals related to the identified problems 5 Specific objectives to meet the identified goals 5 Concrete, measureable actions or interventions to 5 achieve the objectives Identifies person responsible for implementation of 4 actions/interventions (i.e. consumer, clinician) Section for client signature 1

V. Attachment V : Utilization Rate Performance Criterion” (25 points maximum) The agency’s utilization rate is a performance criterion that reflects treatment engagement and retention rates, which are correlated with improved consumer treatment outcomes. Please provide a narrative (500 words or less) that describes your agency’s process to monitor its utilization rates and efforts to improve consumer engagement and retention in treatment.

Criteria Max Score per item Score Narrative includes the following elements regarding Utilization Rate Performance Criterion Points are awarded if agency describes process 5 they follow/intent to follow, to monitor consumer utilization of authorizations. (i.e. authorization request, cancel authorization and claim submission activity) Points are awarded if narrative includes 10 description of process for intake/billing staff and clinical staff to monitor consumer engagement and retention Points are awarded if narrative includes 10 description of the agency’s process to improve engagement and retention of consumers in treatment

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