Community Mental Health for Central Michigan

COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN

SERVICES ADMINISTRATION – CHAPTER 2

DIRECT SERVICES – SECTION 300

ACCESS TO SERVICES – SUBJECT 005

Page 12 of 12

I.  PURPOSE: To establish policies and procedures to ensure that all persons have prompt, easy access to a system that will assist them in determining which, if any, of the supports and services of Community Mental Health For Central Michigan (CMHCM) are appropriate and available for them or for anyone of concern to them.

II.  APPLICATION: All mental health services programs of Community Mental Health for Central Michigan (CMHCM) as well as those under contract with CMHCM for the provision of mental health services and supports.

III.  REFERENCES:

A.  Michigan Mental Health Code Public Act 258 of 1974, as amended

B. PIHP and CMHSP contracts between Michigan Department of Community

Health (MDCH) and Community Mental Health for Central Michigan (CMHCM)

C Medical Services Administration Manual: Community Mental Health Services Programs, Chapter III

D.  The Joint Commission Comprehensive Accreditation Manual for Behavioral Health Care

E.  MDCH Access System Standards – Effective October 1, 2008

F.  MDCH Specialty Pre-Paid Health Plan 2002 Application for Participation (AFP)

G.  MDCH Administrative Rules

H.  The Diagnostic and Statistical Manual of Mental Disorders (DSM)

I.  Public Health Code PA 368 of 1978

J.  Michigan Medicaid Provider Manual

IV.  DEFINITIONS:

A. ASSESSMENT / A process for determining who is eligible for which service (or combination of service components), at which level of intensity, and for how long. An assessment is used to collect information in a manner that will enable the provider to establish (or rule out) the presence of a qualifying mental illness/substance use disorder or a developmental disability. It is also used to determine consumer’s strengths, areas of need, and general history including prior treatment. The assessment process also assists in engaging the consumer/family in the development of a treatment relationship. Assessment outcomes are based on clinical judgment, diagnosis, and standardized assessment scales. Service determinations are guided by the agency assessment grid. The assessment serves as the basis for the treatment plan.
B. CO-OCCURRING / A disorder in which an individual has both an alcohol or other drug addiction and mental health diagnosis.
C. DEGREE OF DISABILITY / Substantial disability/ serious functional impairment in at least one or more primary aspects of daily living such that self-sufficiency is markedly reduced. This includes:
w  Personal hygiene and self-care,
w  Self-direction, activities of daily living,
w  Learning and recreation, or
w  Social transactions and interpersonal relationships.
In older persons (55 or older), loss of functional capacity might also include:
w  Loss of mobility,
w  Sensory impairment,
w  Physical stamina to perform activities of daily living or ability to communicate immediate needs as the result of medical conditions requiring professional supervision, or
w  Conditions resulting from long-term institutionalization.
GAF Scores: Usually GAF scores of 50 or below are required to be considered SMI.
D. DEVELOPMENTAL
DISABILITY / Either of the following:
1.  If applied to an individual older than five years, a severe, chronic condition that meets all of the following requirements:
a.  Is attributed to a mental or physical impairment or a combination of mental and physical impairments. (Mental impairment is related to a cognitive or neurological disability. This is most often evidenced in the form of mental retardation, autism, or traumatic brain injury. It may also be related to other conditions that adversely affect the individual’s cognitive abilities. Physical impairment is related to an individuals physical functioning and the ability to move one’s own body.)
b.  Is manifested before the individual is 22 years old.
c.  Is likely to continue indefinitely.
d.  Results in substantial functional limitations in three or more of the following areas of major life activities:
·  Self-care
·  Receptive and expressive language
·  Learning
·  Mobility
·  Self-direction
·  Capacity for independent living
·  Economic self-sufficiency
(CMHCM defines a substantial functional limitation for an adult as a condition in which an individual does not have the ability to function in such a way as to remain safe, healthy, and accessing the community as necessary. In the case of children between the ages of 5 and 18, these limitations apply to the child as well as the parents in terms of reasonable provisions of parental support. These limitations must be specifically related to the mental or physical impairments being described. The ability to use adaptive equipment or technology to accommodate for functional limitations is taken into account when considering whether functional limitations exist. As a person acquires the skill to utilize available accommodations the person’s functional limitations may decrease.)
e.  Reflects the individual’s needs for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are of lifelong or extended duration and are individually planned and coordinated.
2.  If applied to a minor from birth to age five, a substantial developmental delay or a specific congenital or acquired condition with a high probability of resulting in developmental disability as defined for an individual older than five years above.
E. EMERGENCY
SITUATION / A situation in which an individual is experiencing a serious mental illness or a developmental disability, or a child is experiencing a serious emotional disturbance, and one of the following apply:
1.  The individual can reasonably be expected within the near future to physically injure himself, herself, or another individual, either intentionally or unintentionally.
2. The individual is unable to provide himself or herself food, clothing, or shelter, or attend to basic physical activities such as eating, toileting, bathing, grooming, dressing, or ambulating, and this inability may lead in the near future to harm to the individual or to another individual.
3. The individual’s judgment is so impaired that he or she is unable to understand the need for treatment and, in the opinion of the mental health professional, his or her continued behavior as a result of the mental illness, developmental disability, or emotional disturbance can reasonably be expected in the near future to result in physical harm to the individual or to another individual.
F. PRIORITY POPULATION / The following should be considered in determining priority populations:
A. Mental Illness: All mental illness diagnoses (except V codes or substance abuse alone or developmental disability alone), may be eligible for services, with Seriously Mentally Ill (SMI)/Seriously Emotionally Disturbed (SED) defined by:
w  Diagnosis and degree of disability, or
w  Diagnosis and duration of illness, or
w  Diagnosis and prior service utilization criteria

B.  Developmental Disability: See definition in this section.

C.  Pregnant Women: When abusing substances.

D.  Injecting Drug Users.

G. PROVIDER / One that provides mental health services and/or supports under contract with CMHCM.
H. SERIOUS EMOTIONAL
DISTURBANCE (SED) / A diagnosable mental, behavioral, or emotional disorder
affecting a minor that exists or has existed during the past year for a period of time sufficient to meet diagnostic criteria specified in the most recent diagnostic and statistical manual of mental disorders published by the American Psychiatric Association and approved by the MDCH and that has resulted in functional impairment that substantially interferes with or limits the minor’s role or functioning in family, school, or community activities. The following disorders are included only if they occur in conjunction with another diagnosable serious emotional disturbance:
1.  A co-occurring substance use disorder.
2.  A developmental disability.
3.  A “V” code in the diagnostic and statistical manual of mental disorders.
I. SERIOUS MENTAL ILLNESS (SMI) / A diagnosable mental, behavioral, or emotional disorder affecting an adult or if an adult presents with a preexisting condition sufficient to meet diagnostic criteria specified in the most recent diagnostic manual of mental disorders published by the American Psychiatric Association and approved by the MDCH and that has resulted in functional impairment that substantially interferes with or limits one or more major life activities or if the clinical picture is clearly not related to a primary medical condition.
The following disorders are included only if they occur in conjunction with another diagnosable serious mental illness:
1.  A substance use (co-occurring) disorder.
2.  A developmental disability.
3.  A “V” code in the diagnostic and statistical manual of mental disorders.
4.  Dementia, Alzheimer’s and Huntington’s.
J . URGENT SITUATION / A situation in which an individual is determined to be at risk of experiencing an emergency situation in the near future if he or she does not receive care, treatment, or support services.
K. WAITING LIST / A listing of individuals that are not eligible for Medicaid, ABW or MIChild, and/or who request services from CMHCM but cannot be immediately served.

V.  POLICY:

A.  The Access system shall serve as the front door to the agency.

B.  The Access system shall include key functions that: welcome; screen; determine eligibility for services; collect appropriate information; refer to appropriate services; inform individuals of available services and appeal rights; and conduct outreach to designated populations.

C.  The Access system shall establish standards of access, timelines, and care to meet contractual requirements, external standards, and quality care.

D.  The Access system shall be accessible, affordable, and available to all residents of the state.

E.  The Access system shall have capacity to address urgent and emergent situations.

F.  Access staff shall meet established and utilized competency standards.

G.  Wait list procedures shall be established and utilized.

H.  Appeal procedures shall be established and utilized.

VI.  PROCEDURE

A.  PHILOSOPHY – Community Mental Health for Central Michigan’s (CMHCM) Access system functions not only as the front doors for obtaining services, but provides an opportunity for residents with perceived problems resulting from trauma, crisis, or problems with functioning to be heard, understood, and provided with options. The Access system is available and accessible to all individuals on a telephone and/or walk-in basis. Rather than screening individuals “in” or “out” of services, it is expected that the Access system first provide the person “air time,” and express the message: “How may I help you?” This means that individuals who seek assistance are provided with guidance and support in describing their experiences and identifying their needs in their own terms, then assistance with linking them to available resources. CMHCM will conduct active outreach efforts throughout the communities to assure that those in need of mental health services are aware of service entry options and encouraged to make contact. In order to be welcoming to all who present for services, the Access system will respond to all local resident groups within the service area, including being culturally competent, and able to address the needs of persons with co-occurring mental illness and substance use disorders. Furthermore, the practices of the Access system and conduct of staff reflect the philosophies of support and care, including person-centered, self-determined, recovery-oriented, trauma-informed, and least restrictive environments.

B.  WHO IS SERVED?

1.  CMHCM's Access system services shall be available to all residents of the State of Michigan, regardless of where the person lives, or where he/she contacts the system. Staff shall be welcoming, accepting, and helping with all applicants for service.

2.  Priority population needs will be consistently met with high standards of care as evidenced by utilizing best practices while meeting/exceeding various state-required benchmarks such as intake and first service timeliness. CMHCM will serve non-priority population as capacity allows; assuring that priority population service needs are met. CMHCM management will review capacity to serve non-priority population on a regular basis. Waiting lists, for the non-Medicaid population, will be maintained and monitored.

3.  No person shall be discriminated against in seeking services and supports because of race, religion, color, national origin, ancestry, citizenship, age, sex, marital status, parental status, Vietnam-era veteran, disabled veteran, handicap, membership in any labor organization, political affiliation, height, weight, or sexual orientation.

4.  Access to agency services will be in keeping with medical necessity and entry/exit criteria (see Administrative Manual Policy 2-400-001, Utilization Management).

5.  Access system staff shall first determine whether the presenting mental health need is an urgent situation, an emergency situation, or routine situation and, if so, will address emergent and urgent situations first. To assure understanding of the problem from the point of view of the person who is seeking help, methods for determining urgent or emergent situations must incorporate "caller or consumer-defined" crisis situations. Access staff must be able to demonstrate empathy as a key customer service method. CMHCM shall ensure timely access for the following supports and services:

a.  Persons in emergent or urgent clinical situations.

b.  Persons requiring face-to-face services.

c.  Persons with mental illness and/or developmental disabilities requesting non-emergency services.

d.  All persons determined by the assessment to require ongoing service.

6.  A minor 14 years of age or older may request and receive mental health services and a mental health professional may provide mental health services, on an outpatient basis, excluding pregnancy termination referral services and the use of psychotropic drugs, without the consent or knowledge of the minor’s parent, guardian, or person in loco parentis. Except as otherwise listed below, the minor’s parent, guardian or person in loco parentis shall not be informed of services without the consent of the minor unless the minor is notified of the mental health professional’s intent to inform the minor’s parent, guardian, or person in loco parentis.

a.  Services provided to a minor under this section shall, to the extent possible, promote the minor’s relationship with the parent, guardian, or person in loco parentis, and shall not undermine the values that the parent, guardian, or person in loco parentis has sought to instill in the minor.

b.  Services to a minor under this section shall be limited to not more than 12 sessions or four months per request for service. After the 12th session or fourth month of service, the mental health professional shall terminate the service or, with the consent of the minor, notify the parent, guardian, or person in loco parentis to obtain consent to provide further outpatient services.

c.  The minor’s parent, guardian or person in loco parentis is not liable for the cost of the services that are received by a minor under this section.