CBHS Provider Meeting

CBHS Provider Meeting, Region 1

June 6, 2011

Present:

Mike Parker, DHHS-CBHS
Elizabeth Sjulander, SacoRiver Health
Sylvie Demers, CSI Inc.
Dan Chaimowitz, Affinity
Carolyn Cheney, Pine TreeSociety
Kristine Belanger, Milestones Family Services
Renae Foster, Casa Inc.
Jim Pease, Casa Inc.
Holly Freeman, Wings
Melissa Maurais, Casa Inc.
John Regan, CAFÉ
Michelle Armstrong, DHHS-CBHS
Brett Webster, Bridges of Maine
Hannah Welch, Bridges of Maine
Peter Reynolds, Port Resources
Chesari Tempesta, Youth MOVE Maine
Rachel Posner, DHHS-CBHS
Bob Barton, DHHS-CBHS
Rebecca Ryan, Living Innovations
Deborah Clarke, Woodfords Family Services
Ellen Martzial, Woodfords Family Services
Marcia Hard, Merrymeeting Behavioral Health Assoc.
Sarah Mehlhorn, Waban Projects
Gary Grover, Back to Basics
Debbie Winship, Affinity
Amy Mihill, MVRA
Carrie Baker, Merrymeeting Behavioral Health Assoc.
Donna Mrowka, Learning Works
Karri White, Bridge to Success
Corinne Whitling Walker, Providence
Jana Colby, DHHS-CBHS
Susan Hromadka, MAS Home Care
Kim Proulx, MAS Home Care
Ken Hopple, Back to Basics
Lisa Salger, DHHS-CBHS
Ellen Tims, DHHS-CBHS
Doug DuBois, Port Resources
Amy Cohan, Spurwink
Sally Hunt, DHHS-CBHS
Tracy Haller, Casa
Katherine Bate, Community Care

Waiver update

Mike Parker provided an update about the children’s waiver. This is a waiver for children with cognitive disabilities & PDD/Autism. The ages are 5-17. As of last Thursday, the Department is still in the process of getting the proposed MaineCare policy language finalized, and approved by the Attorney General’s office. The next step is that the proposed rule will go out for public comment.

What is the difference between the waiver and RCS (Section 28)?

The waiver can provide a greater span of services. For example., under RCS you can’t provide supervision; the service needs to be training. However, under the waiver, it is permissible to provide supervision. There is also a residential provision in the new children’s waiver.

Number of slots?

There will be 40 slots the first year, and an additional 20 in year two and year three. There are a limited number of slots, and the waiver will serve children with the most intense needs.

What will happen to children on the waiver when they turn 18? Will they automatically go into the adult waiver? This transition continues to be under discussion.

It is important to work with adult services on that well prior to the child’s 18th birthday.

If you think you have a potential client who might fit the program, give Mike a call.

Youth MOVE

Chesari Tempesta is the Regional Resource Specialist for Youth MOVE Maine. Youth MOVE works with young people 14-25 who have been impacted by any of the systems. It’s about youth empowerment and youth voice. (Chesari distributed handouts describing Youth MOVE, including times of group meetings.) She has been working to get a youth group up and running in the Portland area. Youth MOVE has been active in the Lewiston area for about 5 years. Youth MOVE has just hired staff to cover other parts of the state. Youth MOVE provides trainings for youth on public speaking skills, advocacy training, and how to impact on policy decisions. Youth MOVE also helps youth connect with each other for peer support. There are trainings monthly on topics the youth are interested in. At present, there is a monthly group at the PrebleTeenCenter. The Portland youth group is very interested in raising awareness about youth homelessness and helping their peers get connected to resources. This group will be working on creating a resource map to help youth in the Portland area find and navigate resources for housing, employment, education, and more.

Please feel free to call Chesari. If you’re working with a young person who might be interested in Youth MOVE, please call.

Is there a group in YorkCounty?

Right now, there’s just in Portland. If YorkCounty youth can come to Portland, they’re welcome. There’s a $20 stipend for youth attending groups, so this can help with transportation.

Youth MOVE also offers training and technical assistance to providers on topics such as getting youth on boards, and helping them be part of agency decision-making. Chesari looks forward to partnering with provider organizations. New marketing materials will be available end of June. Youth are involved in CQI efforts at the state level, involved in policy development. Youth are participating in a CQI effort to help survey youth in residential treatment.

Chesari can be reached at , and (207)754-3946.

Flex & Therapeutic Recreation Funds

Michelle Armstrong described a slight change that will start on July 1 in how therapeutic recreation is handled. Applications will be coming to Michelle Armstrong at CBHS, rather than toWoodfords. Information and application materials will be on the CBHS website. (Respite applications will still go to Woodfords.)

Flexible funds will have a new name, Individual Planning Funds. This is designed to reflect that these funding requests are part of the child’s individualized plan.

What if the child does not have a case manager (and therefore no ISP)?

Parents can certainly apply directly. Particularly if no ISP is available, it’s helpful if the parent includes information to explain the behavioral health need that is supported by this application.

Please remember to look for alternative sources of funding before applying for Individual Planning Funds. And we will also be asking about parent contribution.

Michelle Descoteaux talked about the purpose of Individual Planning Funds. CBHS does have funds to help support families and children related to treatment needs. Individual Planning Fund requests really should be tied to behavioral health needs. Michelle has received a range of requests—evaluations, safety equipment, psychological evaluations, adaptive equipment, etc. But she has also received requests for enrichment or for non-behavioral health items—a passport, driver’s education, legal fees, etc. If you have any questions about a particular request, please call and ask. These funds can’t go to education costs—for example, we can’t cover tutoring for school, or equipment for school.

Will the therapeutic recreation application be on the website?

Yes. And we’re coordinating with Woodfords and with Region 2 around this change.

Is the limit for the recreation funds still on?

Yes, the level of funding isn’t changing. Information about therapeutic recreation is available on the CBHS website. If you have any questions, contact Michelle Armstrong.

EPSDT (Early Periodic Screening, Diagnosis, and Treatment Services)

Luc Nya from OMS gave a PowerPoint presentation about EPSDT, and responded to questions (below):

If a child is denied TCM by APS for “medical necessity,” would EPSDT be an option? For example: the child has many medical needs, a heart condition, seizures, etc., and has been denied ongoing case management by APS. The child needsmedical case management, someone to coordinate the medical appointments & issues.

Yes, this might be appropriate to ask EPSDT about. It’s important how you frame the request.

In general, it is important how you frame a request when trying to access EPSDT. An example is durable medical equipment. Someone might write to EPSDT saying that the child needs a wheelchair on the playground to be safe there. This sounds more like a recreational issue, even though there’s a medical reason for the child to be in the wheelchair. Someone else could submit this request saying that, for the child to function well in society, to go to school, to go to community activities, he needs this wheelchair. In the latter, if you couch it more in medical terms, it may pass “medical necessity.” A request that looks more like recreation would not be approved.

In this example, does the agency that might provide the medical case management make the application?

No. The application needs to come from a physician, OT, speech pathologist, LCSW or other appropriately licensed professional who is currently a direct provider/diagnostician for the child. Other people can help fill out the application, however.

Luc has been getting a lot of calls from case managers looking for funding for various things, such as a wheelchair. Sometimes people think that hehas flexible funds, like CBHS does. He doesn’t have a budget. He receives applications and then a determination is made whether or not it meets medical necessity. If it meets medical necessity criteria, MaineCare will cover it.

Is there a list of durable medical equipment dealers that MaineCare uses, and do they have to be approved?

Luc is working on a list that can be available as a resource for people.

There are different applications for durable medical equipment and for EPSDT.

The EPSDT applications are available at

In order to sign onto this MaineCare site, you’ll need to have your agency’s NPI number. (If you don’t know what this is, see someone in your finance department.)

Wait Lists

(see my notes)

Rachel Posner talked about wait lists for services that aren’t covered by Central Enrollment. For RCS-Section 28, referrals go through CBHS. For all other services, providers accept referrals directly. When a child requests a Medicaid service, & is eligible for that service, the child must be served within 180 days. This is a contract requirement, and a MaineCare requirement, based in Federal Medicaid law. If an agency can’t serve the child in a timely way, the agency is obligated to help the family in accessing the service from another agency. We know that agencies work hard to help families access services, and that typically agencies are very flexible in helping families with referrals to other agencies if they can’t serve the child quickly. The priority, in Medicaid law, is for the child to get the service (e.g. HCT, TCM) in a timely way, not for the child to wait for a particular agency. And clinically, it doesn’t make sense for the child to wait, if the service is available from another agency. CBHS will be closely monitoring waitlists to make sure that agencies meet the contract requirements.

Regarding other contract requirements, there was a question about the AC-OK: does a separate plan need to be done for each service if the agency provides multiple services? No, there’s one overall co-occurring plan for each agency, which should be part of the agency’s overall plan.

Transition to Adult Services

Bob Barton talked about transitioning young adults to services from the Office of Adults with Cognitive & Physical Disabilities (OACPD). They have very limited resources at the present time. The two adult waivers have very few slots. We’re finding young people who are graduating from high school (at age 20) without services. Please let us know well in advance so we can work with adult services ahead of time, to plan for these situations.

We need to be working on transition once the child turns 16. There is a form that goes to Mike Parker with transition information. Funds are very limited at adult services, but this is even harder if they don’t know who is coming their way. Referrals to adult services should start when the youth is 17, whether the family chooses to remain with children’s TCM for a while or not. Youth have to go through eligibility again, with OACPD, even though the youth has been eligible for services through CBHS. Families sometimes want to stay with children’s services, which is their option; but we have found instances where a children’s case manager didn’t know some of the adult resources, and so the youth didn’t have access to all the resources they might have gotten. In a few instances we have been able to put together a package of resources with some RCS-Section 28 services and some funds from adult services.

There was a conference call with OACPD this week on transition issues, which was very helpful. There’s another call this coming Thursday (6/9). There’s also a very helpful update on the OACPD website.

Mike Parker described the MIS 2-page form. This is very helpful for us, and for intake adult services. Fill out at 16, and mail or e-mail (password protected). It’s helpful if you send to Mike Parker, please also send a copy to Millie Savage who does intake at OACPD.

Navigating the CBHS Website

Mike is part of a committee that meets monthly to update the CBHS website. We’re constantly trying to upgrade so it’s more user-friendly. Mike did a demonstration of how to start with and find the DHHS website; and from there, how to find the CBHS site. Mike showed the group how to access the provider list, and emphasized the importance of agencies keeping that information up-to-date. In the next couple of months, there will be a form for providers to use to submit changes for the provider list.

Are there parents on the website committee? Parents find the website hard to navigate. Yes, there are 2 parents on the website committee. We are also very interested in feedback about the website.

In terms of feedback, a BHP trainer said that during a training, the group tried to access the CBHS website, and wasn’t successful. It’s hard to get to the CBHS website without having it bookmarked.

Clarice Dunn reminded the group that for RCS-Section 28, all the forms are on the website. It’s helpful for providers to check the forms on the website periodically to make sure you’re using the most recent forms. Mike also showed how to access RCS/28 forms.

Is the updated Change of Status form 2 or 3 pages?

It’s now 1 page. There are some forms from March 2011.

Our provider meeting notes should be on the website also.

Also note that on the right side of the CBHS website are related sites (CDS, DOC, Education, etc.).
We still want to improve the website, and welcome your feedback.

Design suggestion: icon-based system. There are a lot of words on the website. The more we can go to an icon-based style, the easier it will be for people to navigate. Symbols may be easier than words.