Information Item C

Information Item C

I.Adult Services

A.Service Target

B.Uniform Assessment Completion Rate

C.Minimum Hours

D.Assertive Community Treatment Average Hours

E.Supported Employment Target

F.Supported Housing Target

G.Disease Management Outcomes

II.Child and Adolescent Services

A.Service Target

B.Uniform Assessment Completion Rate

C.Ohio Scales Completion Rate

D.Minimum Hours

E.Family Partner Target

F.Family Partner Minimum Hours

G.Disease Management Outcomes

III.Performance Measures Assessed Within CARE

A.New Generation Medication

B.Legislative Budget Board: Community Support Plan

C.Readmissions

D.Follow-Up Within 7 Days

IV.Crisis Response System Outcomes

A.Crisis Episodes Resulting in Psychiatric Hospitalizations

B.Community Linkage

C.Crisis Follow-Up

V.Rider 65 (81st Legislature) Performance Measures

A.Transitional Services

B.Adult Intensive Ongoing Services

C.Child and Adolescent Intensive Ongoing Services

VI.Waitlist Management Requirements

A.Uniform Assessment

B.Medical Necessity Determination or Service Refusal

C.Referral for Other Medically Necessary Medicaid Services

D.Medicaid Recipient Waitlist Removal

VII.Uniform Assessment Instructions

A.Adult Uniform Assessment

B.Child and Adolescent Uniform Assessment

VIII.Glossary of Terms

I. Adult Services

A. Service Target

1. Explanation: The statewide performance level for the adult service targets is 100%.

2. Calculation: Adult service targets are calculated based on a proportional distribution of the Legislative Budget Board’s service targets according to all appropriated Mental Health (MH) funds. The average number of adults in a Full Service Package (FSP) per month divided by the target specific to the contractor measured semiannually.

a. Numerator: The total number of Client Months where a client was in a FSP.

b. Denominator: The target assigned to the contractor times six months.

3. Exclusion(s)/Exception(s): Contractor will not be subject to recoupment for not meeting the service target for adults up to, but not exceeding, a 10% reduction of the total service target based on maintaining the minimum hours threshold described in Section I.C. Minimum Hours below.

4. Sanctions and Remedies: Will be based on Contractor’s current six month adult MH allocation.

5. Data Source: Client Assignment and Registration (CARE) system. Mental Retardation and Behavioral Health Outpatient Warehouse (MBOW) report found in the CA Contract Performance Measures folder.

B. Uniform Assessment Completion Rate

1. Explanation: The statewide performance level for Uniform Assessment (UA) Completion Rate is 90%.

2. Calculation: The proportion of adults served or authorized for services during the six month period who have a completed and current UA.

a. Numerator: Total number of adults with a completed UA.

b. Denominator: Unduplicated number of adults with a completed UA or a service encounter.

3. Exclusion(s)/Exception(s):

a. The following are not included in the calculation of this measure:

i. Delivery of a Screening Service or Assessment Service encounter without a completed UA.

ii. 100% of service hours by Third Party Payer as noted by field #12, FIRST_BILLED_PAYER_CD on all encounter records for the month.

iii. Delivery of a crisis false alarm service encounter.

iv. Delivery of crisis intervention services to a collateral contact only (i.e., RECIPIENT_CD = 2 or 5).

4. Sanctions and Remedies: Will be based on the contractor’s current six month adult MH allocation.

5. Data Source: CARE system. MBOW report found in the CA Contract Performance Measures folder.

C. Minimum Hours

1. Explanation: The statewide performance level for Minimum Hours is 80%. The focus of this measure is on people authorized who received no or minimal service(s) in a month. The minimum requirement per service package (SP) is as follows:

a. SP 1 - 0.5 hours minimum per adult who is Under Served with a Deviation Reason Code = Consumer Choice per month.

b. SP 2 - 1.5 hours minimum per adult per month.

c. SP 3 - 3 hours minimum per adult per month.

d. SP 4 - 3.5 hours minimum per adult per month.

2. Calculation: The proportion of adults authorized to a FSP who receive at least the minimum number of service hours across SPs.

a. Numerator: The number of Client Months where the client received at least the minimum amount of MH Hourly Services corresponding to the authorized FSP.

b. Denominator: All adults authorized in a FSP.

c. Example: Across six months, if a client met minimum hour criteria in 4 months and was authorized for all 6 months, the net calculation would be 4/6 (4 Client Months meeting minimum / 6 Client Months authorized) or 66.7%.

3. Exclusion(s)/Exception(s): Contractor will not be subject to recoupment for failure to meet this performance measure if Contractor meets the requirements described in Section I.GE.10. Outcomes Required to Qualify for Waiver of Recoupment for Minimum and Average Hours Targets. The following are not included in the calculation of this measure:

a. Clients with an LOC-R = 2, 3, or 4, and an LOC-A = 1 who are Under Served with a Deviation Reason Code other than Consumer Choice;

b. Clients with a LOC-R = 1 and an LOC-A = 1; and

c. Partially Authorized Months.

4. Sanctions and Remedies: Will be based on the contractor’s current six month adult MH allocation.

5. Data Source: CARE system and MBOW. MBOW report found in the CA Contract Performance Measures folder.

D. Assertive Community Treatment Average Hours

1. Explanation: The statewide performance level for Assertive Community Treatment (ACT) Average Hours is 100%. The ACT team must provide an average of 10 hours of service per client based on service encounters for adults authorized in SP 4.

2. Calculation: The average amount of service provided per month to adults authorized for SP 4 services.

a. Numerator: The sum of SP 4 MH Hourly Services.

b. Denominator: The number of SP 4 Client Months.

3. Exclusion(s)/Exception(s): Contractor will not be subject to recoupment for failure to meet this performance measure if Contractor meets the requirements described in Section I.GE.10. Outcomes Required to Qualify for Waiver of Recoupment for Minimum and Average Hours Targets. The following are not included in the calculation of this measure:

a. Partially Authorized Months.

4. Sanctions and Remedies: Will be based on the contractor’s current six month adult MH allocation.

5. Data Source: CARE system and MBOW. MBOW report found in the CA Contract Performance Measures folder.

E. Supported Employment Target[CMD1]

1. Explanation: The statewide performance level for supported employment services is 3%.

2. Calculation:

a. Numerator – The number of adults recommended and authorized for a FSP, who receive a supported employment service encounter.

b. Denominator – The number of adults recommended and authorized for a FSP.

3. Exclusion(s)/Exception(s): N/A

4. Sanctions and Remedies: Will be based Performance Contract General Provision Article 19, specifically Section 19.02.

5. Data Source: CARE system and MBOW. MBOW report found in the CA Contract Performance Measures folder.

F. Supported Housing Target[CMD2]

1. Explanation: The statewide performance level for supported housing services is 3%.

2. Calculation:

a. Numerator – The number of adults recommended and authorized for a FSP, who receive a supported housing service encounter.

b. Denominator – The number of adults recommended and authorized for a FSP.

3. Exclusion(s)/Exception(s): N/A

4. Sanctions and Remedies: Will be based Performance Contract General Provision Article 19, specifically Section 19.02.

5. Data Source: CARE system and MBOW. MBOW report found in the CA Contract Performance Measures folder.

G. Disease Management Outcomes

1. Functioning

a. Target: 38[CMD3]% of all adults served during the fiscal year have acceptable or improving functioning.

b. Calculation:

i. Acceptable Functioning

(a) Numerator – The number of adults recommended and authorized for a FSP, whose latest functional impairment has a rating of 1 and where their latest functional impairment rating is equal to their first functional impairment rating (as measured by Dimension 4 of the Adult-TRAG). In addition, the first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP, who have at least two functional impairment ratings (as measured by Dimension 4 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

ii. Improving Functioning

(a) Numerator – The number of adults recommended and authorized for a FSP, whose latest functional impairment rating is less than their first functional impairment rating (as measured by Dimension 4 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP, who have at least two functional impairment ratings (as measured by Dimension 4 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

iii. No Change Functioning

(a) Numerator – The number of adults recommended and authorized for a FSP, whose latest functional impairment rating is 2 or more, whose latest functional impairment rating is equal to their first functional impairment rating (as measured by Dimension 4 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP, who have at least two functional impairment ratings (as measured by Dimension 4 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

iv. Worsening Functioning

(a) Numerator – The number of adults recommended and authorized for a FSP, whose latest functional impairment rating is greater than their first functional impairment rating (as measured by Dimension 4 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP, who have at least two functional impairment ratings (as measured by Dimension 4 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

2. Criminal Justice Involvement

a. Target: 44[CMD4]% of all adults served during the fiscal year have improving criminal justice involvement.

b. Calculation:

i. Improving Criminal Justice Involvement

(a) Numerator – The number of adults recommended and authorized for a FSP, with a rating of 2 or more on Dimension 8 (Criminal Justice Involvement) of their first Adult-TRAG but whose latest rating on the Adult-TRAG is less, where first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP, who have a rating of 2 or more on Dimension 8 (Criminal Justice Involvement) of their first Adult-TRAG, where first UA and last UA date range is greater than 90 days during the fiscal year.

ii. No Change Criminal Justice Involvement

(a) Numerator – The number of adults recommended and authorized for a FSP, with a rating of 2 or more on Dimension 8 (Criminal Justice Involvement) of their first Adult-TRAG and whose latest rating on the Adult-TRAG is the same, where first UA and last UA date range is greater than 90 days during the fiscal year.

iii. Worsening Criminal Justice Involvement

(a) Numerator – The number of adults recommended and authorized for a FSP, with a rating of 2 or more on Dimension 8 (Criminal Justice Involvement) of their first Adult-TRAG and whose latest rating on the Adult-TRAG is greater, where first UA and last UA date range is greater than 90 days during the fiscal year.

3. Employment[CMD5]

a. Target: 14.7% of all adults served during the fiscal year have an Adult Uniform Assessment Community Data Section 4. B. Paid Employment Type score of 1 = Independent/Competitive/Supported/Self Employment.

b. Calculation:

i. Numerator – The number of adults recommended and authorized for a FSP with an Adult Uniform Assessment Community Data Section 4. B. Paid Employment Type score of 1.

ii. Denominator – All adults recommended and authorized for a FSP.

4. Housing

a. Target: 72[CMD6]% of all adults served during the fiscal year have acceptable or improving housing.

b. Calculation:

i. Acceptable Housing

(a) Numerator – The number of adults recommended and authorized for a FSP, whose latest housing instability rating is 1 and where their latest housing instability rating is equal to their first housing instability rating (as measured by Dimension 6 of the Adult-TRAG). In addition, the first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP who have at least two housing instability ratings (as measured by Dimension 6 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

ii. Improving Housing

(a) Numerator – The number of adults recommended and authorized for a FSP, whose latest housing instability rating is less than their first housing instability rating (as measured by Dimension 6 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

iii. No Change Housing

(a) Numerator – The number of adults recommended and authorized for a FSP, whose latest housing instability rating is 2 or more, whose latest housing instability rating is equal to their first housing instability rating (as measured by Dimension 6 of the Adult-TRAG), and where first UA and last UA date range is greater than 90 days during the fiscal year.

iv. Worsening Housing

(a) Numerator – The number of adults recommended and authorized for a FSP, whose latest housing instability rating is greater than their first housing instability rating (as measured by Dimension 6 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

5. Co-Occurring Substance Use

a. Target: 87[CMD7]% of all adults served during the fiscal year have acceptable or improving co-occurring substance use.

b. Calculation:

i. Acceptable Co-Occurring Substance Use

(a) Numerator – The number of adults recommended and authorized for a FSP, whose first co-occurring substance use rating is equal to 2 and where their latest co-occurring substance use rating is equal to their first co-occurring substance use rating (as measured by Dimension 7 of the Adult-TRAG). In addition, the first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP whose first co-occurring substance use rating is equal to 2 and who have at least two co-occurring substance use ratings (as measured by Dimension 7 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

ii. Improving Co-Occurring Substance Use

(a) Numerator – The number of adults recommended and authorized for a FSP, whose first co-occurring substance use rating is 2 or more and whose latest co-occurring substance use rating is less than their first co-occurring substance use rating (as measured by Dimension 7 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP whose first co-occurring substance use rating is 2 or more and who have at least two co-occurring substance use ratings (as measured by Dimension 7 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

iii. No Change Co-Occurring Substance Use

(a) Numerator – The number of adults recommended and authorized for a FSP, whose first co-occurring substance use rating is greater than 2, whose latest co-occurring substance use rating is equal to their first co-occurring substance use rating (as measured by Dimension 7 of the Adult-TRAG), and where first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP whose first co-occurring substance use rating is greater than 2 and who have at least two co-occurring substance use ratings (as measured by Dimension 7 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

iv. Worsening Co-Occurring Substance Use

(a) Numerator – The number of adults recommended and authorized for a FSP, whose first co-occurring substance use rating is greater than 1 and whose latest co-occurring substance use rating is greater than their first co-occurring substance use rating (as measured by Dimension 7 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

(b) Denominator – All adults recommended and authorized for a FSP whose first co-occurring substance use rating is greater than 1 and who have at least two co-occurring substance use ratings (as measured by Dimension 7 of the Adult-TRAG), where first UA and last UA date range is greater than 90 days during the fiscal year.

6. Crisis Avoidance

a. Target: Percent of all adults with time in crisis will not exceed 2.3% for those authorized for a level of care during the fiscal year.

b. Calculation:

i. Numerator – The number of Crisis Client Months among those recommended and authorized for a FSP with time in crisis greater than 0, who are not in the month of admission.

ii. Denominator – The number of Client Months for those recommended and authorized for a FSP, who are not in the month of admission.

7. Time Between Assessment and First Service Encounter