Spring 2017 Provider Meeting Notes

SPRING 2017 PROVIDER MEETING NOTES

Bangor, May 16, 2017 Augusta, May 17, 2017 Portland, May 18, 2017

 Welcome & Introductions

 We’re happy to welcome residential providers to this meeting and we look forward to hearing more about your services during provider updates  Department Updates

 Our new Acting OCFS Office Director is Kirsten Capeless

 We are currently in negotiations with Massachusetts General Hospital for a Medical Director. CBHS would be using their program known as “MGH Visiting”. Hoping for August 1st start date. We will not only have a Medical Director but also access to the latest research available through their hospital. Additionally, CBHS is partnering with Doctor Christopher Pezzulo and OMS regarding ADHD protocol for therapy before medication.  Jennifer Dondero is our new Clinical and Community Resource Team Leader. Changes have been made with our five Care Specialists who have historically worked with residential providers. Roles have been shifted to provide more support to families/children and our child welfare colleagues. Nurse Consultants (Ellie Larrabee & Lynn Witten) – These positions will provide medical consultation within Children’s Behavioral Health and Child Welfare. Part of the initial focus will be helping to ensure that the medical and behavioral health needs of youth coming into state custody are being met. The nurses will also support initiatives around medical issues, like lowering the use of psychotropic medications for children in state custody.

Reportable Events Coordinator (Lana Pelletier) - This position will screen all reportable events for Children’s Behavioral Health. This also includes monitoring patterns and trends, as well as following up on specific reportable events. The position supports providers in data quality and organizing agency feedback regarding Reportable Events.

Residential Coordinator – (Jodi Charon) - We are developing this position to help support timely and appropriate admissions and discharges for youth in residential treatment. She will provide support around referrals, admission process and will track beds. Additional details will be shared as they become available. Program Support Coordinator (Jamie Bartlett) - This position will assist in coordinating training and support for Children’s Behavioral Health Service

1 Programs. It will provide program support and assistance as new initiatives are developed and implemented.

Question: Will the changes be able to better assist with home and community based providers knowing more about PNMI capacity (# of beds for what ages/diagnoses)? Yes.

Additionally, Judy DeMerchant, Family Information Specialist, will now oversee the Grievance Process.

 Regulations Governing Behavior Plan Development and Implementation for Children with Intellectual Disabilities or Autism Spectrum Disorder in Maine (Behavior Regulations):  We encourage you to review these regulations, which are specific to the ID/DD population, and submit comments. Regulations apply to all services offered by the department. They can be viewed via the links below: http://www.maine.gov/dhhs/ocfs/policy.shtml or http://www.maine.gov/dhhs/ocfs/documents/10-16FinalBehavRegs.pdf The comment period has been extended to June 5th. Please address all comments to the agency contact person identified in the Notice of Agency Rule-making Proposal [email protected] . Notification will also be published in statewide newspapers and on the CBHS website: http://www.maine.gov/dhhs/ocfs/policy.shtml  Department Policies Updates

 Rates: The Burns and Associates rate study remains in Legislative Review. The current draft is a revision of the original draft rates. The new draft rates reflect some changes and are available for viewing on the Burns and Associates website. We encourage you to review. http://www.burnshealthpolicy.com/MaineBH/  30 Day Service “overlap” clarification: When a child is in a PNMI, a provider can start TCM and HCT up to 30 days prior to discharge, if a medical necessity exists and with Kepro’s approval. Similarly, if a medical necessity exists and with Kepro’s approval, TCM and HCT can stay involved while the child transitions into a PNMI. Additionally, HCT can follow the child to treatment foster care. The process is different for hospitals due to their funding. Comment from provider: There is some disagreement/confusion amongst PNMI, Case Management providers, Kepro, and OMS as to whose job it is/who is responsible for what with discharge planning. Residential providers often times do not have the information they need about services that are available in the youth’s community and how to make the referral.

2 Question: Who can ITRT reach out to if there is no targeted case manager? Regional Resource Coordinator (RC). Question: Does the overlap include BHHO and outpatient providers? OMS is currently reviewing this issue. We will update you as information becomes available. Question: A residential provider asked if it’s possible for TCM to remain on the case during transition to and discharge from PNMI. In some cases, KEPRO will extend care based on clinical need. Questions about billing must be directed to Josh Birdwell at [email protected]

 CANS Update: Currently, we have five different versions of CANS. We’ve developed one single, comprehensive CANS tool to be used in TCM and BHH. No additional training is needed if provider is already trained in the current CANS tool. When your annual certification is due, the new training will be available. No rule change necessary as OMS and OCFS will develop a clarifying memorandum that will allow us to use the new CANS tool. OCFS plans to initiate the new CANS on July 1, 2017.

 CBHS Planning Process: We’ve been working with a small stakeholder group and OCFS staff for over a year. The CBHS Planning Process is a modified version of the PCP (Person Centered Planning) process used in the adult world. We believe the CBHS Planning Process identifies all of the best elements of the PCP and we have added additional items pertinent to the population we serve. A manual will be developed and provided to all TCM/BHH agencies. The new process is planned for Section 13, TCM, and BHH’s. The next step is to finalize the draft with the stakeholder workgroup, then announce a roll out date. Details will be provided as they are developed. Question: Will this require a separate service plan document? No.

 BHH Meetings: Held every two months. If you would like to participate, please email [email protected] to be added to the invite list.

Question from DRM: Are BHH minutes published? Minutes of the BHH meetings are distributed to those stakeholders involved in the meetings and to anyone upon request. The BHH meetings are open to all. If you would like to be on the distribution list, please email [email protected]. Question/Comment: A provider was told that only children with autism can receive authorization for Specialized rate 28. Kepro stated they are working with OMS to determine if, as an evidenced-based practice, ABA is the sole evidence-based service available to children with autism. Kelly Parnell of Kepro advised that all referrals for non-ASD or ID/DD cases

3 requesting specialized services are being referred to the Kepro physician for further review. The determination is based on functional scores and the child’s presentation. Question: Are families being notified when they are denied? Kepro said yes.  Referral Management List: Re: HCT and 28. Lists are posted every Monday. The list includes towns so providers can get an overview of where service is needed. Lists can be found by going to CBHS website >Provider> Reports. Providers can also contact Resource Coordinators for website address. At this time we are unable to provide age and gender to the list per DHHS general counsel. There is a risk for client identification – especially in our small towns.

Question: Can Kepro provide age range? Providers can call Kepro to get the age and gender of a specific child.

TCM/BHH or referent should be sending the whole referral packet to the matched HCT provider. KEPRO doesn’t do that. If TCM case is closed KEPRO will provide the referral information to the HCT agency picking up the child. Several providers shared that they often encounter cases where no TCM is assigned. Agencies are being asked to get a new release from the family before information is released. Also, it often takes 2-3 weeks to get the client information packet. Agencies noted they are losing critical staff because it can take weeks to get the information packet. One provider noted information provided by KEPRO is helpful and often enough to get started with opening a new case. When TCM Providers have to close, they are trying to educate families about how best to advocate for their child. Question: Can CBHS provide a “Cheat sheet” or flow chart to assist families? OCFS continues to work with providers to refine the Referral Management process. At this time, a detailed workflow to be widely distributed would be unwise given the ongoing adjustments to the process. At such time that a RM process is complete and working well for all, a workflow will be considered.

Some providers noted that not having immediate access to referral packets can cause major staffing problems. BHP’s who are hired to staff a case can’t begin work until the packet is received. One provider has adopted a policy of returning the case to the RM list if the referral packet isn’t received within one week.

Question/Comment: Can TCM’s get the name of the agency that has been matched with their client. Why can’t KEPRO send the packet directly to the agency versus having to go thru the TCM? Seriously slows down the process.

Director Barrows encouraged providers to keep sharing their concerns. CBHS is committed to getting the RM process working smoothly for all providers.

4 IMPORTANT: We have noticed that some clients waiting for a preferred provider live in a region/area that isn’t served by the provider. If you see a client waiting for your agency in a town you do not serve, notify Kepro immediately. They will inform the referent.  Clients on RM list waiting for HCT could possibly be served by one of the Evidence-Based Practices (EBP), MST or FFT. When there is a long wait for HCT in your area, we encourage TCMs and BHHs to review their referrals and determine if a child qualifies for EBP services.

 Providing HCT without a BHP is not allowed in practice. If an agency loses a BHP for a few weeks and the family wishes to continue while the agency searches for another BHP, they may continue for a short time. However, operating for an extended period time without a BHP is not permitted and may open up the agency to an audit risk. Question: Is clinician only HCT under consideration by OCFS & OMS? No. Question: What happened to the HCT workgroup? This workgroup has developed a draft of a new HCT rule; however, promulgating this new rule may take some time given the many priorities of MaineCare. No estimate is possible at this time. Comment from provider: “Clinician Only” HCT may be better service due to clinician being able to also implement the “BHP” aspect of the service. Question: Can HCT be provided in private day-care setting? Contact Josh Birdwell at OMS. Question: What about rural providers who can’t hire qualified BHP’s? Contact your RC for guidance if you are experiencing trouble staffing a BHP. Question: Has the credentialing of the BHP in HCT has been changed yet, i.e., reduction in requirements? The rule has been drafted. We are looking to reduce requirement from BA/BS to Associates (2 year) degree. We must wait until OMS can promulgate the rule.  Section 28 Providers: Previous proposal was to increase the requirements of BHP’s to associates degrees so BHP’s could provide multiple services. This proposal was removed due to provider feedback. Two rates being proposed for 28 BHP’s: HS diploma vs. Bachelors level. Agency would be able to bill at a higher level for a BHP with a Bachelor’s degree.

Question: Would there be a workgroup to vet any new/revisions to BHP training based on passing of any new requirements? No. Current curriculum has just been updated.

5 Question: Will there eventually be a requirement for specialized rate providers to hire Registered Behavior Technicians (RBT’s)? We are not aware of this being considered for any service. New BHP curriculum will be on-line except for the last live-certification day. There will be no charge for the online training or the final live-certification day.

 Transition Presentation by OADS (Office of Aging and Disability Services)

 Early planning is important for youth transitioning to adulthood and it’s never too soon to begin the discussions with the student and his/her team. Referrals to OADS for transition services should be sent to the intake coordinator at your regional Office of Aging and Disability Services (OADS) when the student reaches 17 ½ years of age.

 To make a referral to OADS, contact intake coordinator for the region. Just entering information in EIS does not constitute a referral.

 Referrals can be faxed or emailed to intake and OADS will schedule a time to meet with family. OADS will gather paperwork and send the file to the supervisor for an Eligibility Decision.

 For Intellectual Disabilities (ID’s), OADS needs evidence of diagnosis during the developmental stage of their life – that is, up to age 19.

 If child ever had IEP, they should have an evaluation.

 Vinelands must be done by a licensed psychologist. IQ and adaptive measures must also be done. Referring them for updated neuro-testing (must be done by a Psychological provider versus an LCSW/LCPC.) Some school psychologists do the testing, but do not always complete adaptive testing. Eligibility criteria are detailed in the Transition manual.

 If family lacks the financial resources for an evaluation for their youth, please contact OADS resource coordinator or intake coordinator. They can make in-house referrals to obtain necessary assessments.

 Families with or without MaineCare can go thru the intake process

 Families should not wait until after youth graduates from high school to apply for OADS eligibility determination. The longer one waits, the more difficult it is to obtain school records.

 Rule 14-197: ID/DD diagnostic requirements are separate from diagnosis of Autism. For Autism, adaptive scores from the Vineland should be no more than three years old.

 A residential provider noted there is legitimate concern for kids approaching transition age who are living in residential placements and have no Targeted Case Manager. Residential staff may need more training and information regarding Transition process.

 If someone is offered a Section 29 slot, services must be accepted within 60 days and be in services within six months. If timing is not good when determined eligible, can re-apply.

6  Many youth who are referred to OADS are living with grandparents, who are not always the guardian. OADS must have permission from legal guardian for services.

 Adult members (18-21) must choose between Section 28 (children’s) and Section 29. Cannot have both.

 Recent changes to Section 29 include work related supports

 Currently, there are 1500 people waiting for Section 21

 Once determined eligible for Case Management, client is eligible for life

 There is no requirement to accept case management services when eligibility is established

 State will provide Case Management if child does not have MaineCare

 When a youth turns 16, Family Information Specialist (Judy DeMerchant) is notified from EIS and calls TCM’s to alert them the youth is approaching the age of eligibility. Judy also speaks with the families to inform about procedures and policies. TCM’s should be having conversations with families about what happens after adulthood.

 Jeanne Tondreau’s office sent out a mailing to schools six months ago to alert them about transition process for older youth

 OADS Intake Coordinators from Region 1 can visit schools or agencies with a power point demonstration about Transition process

 Question: Provider has applied to provide Section 29 services with staff but has been told there is up to 30 day wait for approval to provide services. Is there a way to expedite the approval? This would need to be addressed by MaineCare.

 Providers would like a list of testing/evaluation providers

 If children are referred for testing thru their PCP’s they often get in sooner

 We are hearing families are reluctant to discuss the process. TCM’s must discuss transition with family members

 Families with or without MaineCare can still go thru the intake process

Transition to Adulthood manual: http://www.maine.gov/dhhs/ocfs/cbhs/transition-adulthood/shtml. OADS Website: http://www.maine.gov/dhhs/oads/index.html

OADS CONTACTS

District 1 York 1.207.822.2225 District 2 Cumberland 1.207.822.2225 District 3 Androscoggin, Oxford and Franklin 1.207.753.9100 District 4 Lincoln, Knox, Waldo, Sagadahoc 1.207.596.4302 District 5 Kennebec, Somerset 1.207.287.2205 District 6 Piscataquis/Penobscot 1.207.561.4380 District 7 Washington, Hancock 1.207.561.4380 District 8 Aroostook 1.207.493.4037

7  Update from Jessica Wood, Youth and Family Program Specialist

We completed the RFP process for homeless youth grants and are in contract negotiation.

On May 19, we co-hosted a homeless youth forum and over 100 people attended. We are dedicated to solving youth homelessness in Maine.

1st Episode Psychosis Training: being held next week at UMA. Our hope is that providers statewide will want to learn more about the service.

 EIS Updates

The new EIS program, known as Phoenix is in development and estimated to be available within the next six months. System is very user friendly. SAMHS will roll out first. OCFS next and then OADS. Users will be able to change their own passwords. Contact [email protected] with any questions.  KEPRO Updates: Kelly Parnell shared that the new Atrezzo portal is coming in July. Training dates have been announced and will begin in June. Contact Kelly Parnell if you do not have access to training information. June 28th is the last access date for providers on Care Connection. New system will go live on July 5th at 8 am. CSR’s will need to be submitted prior to when the system will be unavailable.  Provider Updates

 Penquis is preparing a presentation on supported decision making, guardianship information, etc. Contact Penquis directly at 973-3500 for more information.

 Wings in Bangor is sponsoring a Special Education training that will focus is on teaming with area agencies, eligibility, IEP process, etc. It is open to all providers. Will be held August 8th from 9 am to Noon. Contact Jessica Cambridge at 941-2988.

 KBH in Augusta is offering MST and BSP. Contact Melissa Winchester at 314-5664.

 Community Care has grant funds for Adult Community Integration. Funds designated for those ineligible for MaineCare. Diagnosis not necessary. Service is available within a 30 mile radius of Bangor and Skowhegan.

 Child Welfare Conference is scheduled in Bangor for June 22. Registrations are now being accepted. Contacted Jessica Cambridge at [email protected] or register via the website.

8  Maine Immigrant and Refugee Services in Lewiston is starting a Section 28 program. They have information about a free summer youth soccer program in Lewiston. Contact them at 753-2700.

 Granite Bay Care is in the process of starting a Section 97 Residential program and is looking to connect with people and share ideas

 Social Significance (Tim Folley) in Waldoboro (York County) accepts private insurance and has grants to provide ABA services for children without MaineCare. They provide Specialized 28 services and can be reached at 247-7781.

 DRM is offering regional training on Rights of Recipients on Fridays throughout August.

 Resource Coordinator Updates

 Several notifications regarding Children’s Behavioral Health, including Provider meeting invitations, are coming through the govdelivery list serve, which can be accessed via http://www.maine.gov/dhhs/ocfs/ Be certain to check off Children’s Behavioral Health.  Individual Planning Funds (IPF) are still available. Contacts are Judy DeMerchant or Cheryl Hathaway.  If an agency is considering adding a new service or office location, please notify your regional Resource Coordinator for approval procedure. Agencies that are closing locations or dropping services must provide 60 days’ notice to their regional Resource Coordinator.  Service Needs . Hancock, Washington, Aroostook, and Piscataquis need HCT services. . Cheryl said OMS might be able to work with rural providers to accommodate families when no BHP’s are available. Discussed this as a possible pilot program. . Section 28: Hancock has a high need for specialized or non-specialized. Bangor has the highest need for Specialized at this time. . In Cumberland and York county, needs for services are high in Standish, Scarborough, Yarmouth, Naples, Cape Neddick and Limington . HCT needs are high in both Oxford and Androscoggin county – in particular Lewiston and Livermore Falls. . Thomaston and Rockland area needs basic 28 services. . Specialized services are needed throughout Knox County. Discovering Kids is a new provider in the area. . Assistance Plus needs BHP’s in mid-coast area