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Medicaid Mental Health

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Julie de Losada

on 4 August 2015

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Transcript of Medicaid Mental Health

Medicaid Mental Health
Accessing services for Children & Youth
How do kids with medicaid get the services they need?
Financial
Advisory Board
August 2015

Prepared by Julie de Losada, MS/LMHC
North Sound Mental Health Administration
julie_de_losada@nsmha.org
Clinical
RSN
Key Phone Numbers
The ins and outs of the Medicaid children's mental health system in Washington and the North Sound.`
Pathways
STEP 1
Financial Eligibility
STEP 2
Medical Necessity
Four Paths to Access
RSN Services
The individual has a mental illness as determined by a Mental Health Professional (MHP) in a face-to-face intake/assessment. The diagnosis must be included in the list of Covered Diagnoses;
An individual must meet all of the following
The diagnosis must be included in the list of Covered Diagnoses;
The individual’s impairment(s) and corresponding need(s) must be the result of a mental illness. The individual must meet the Functional Criteria for Serious Mental Illness (SMI) or Seriously Emotionally Disturbed (SED);
The intervention is deemed to be reasonably necessary to improve, stabilize or prevent deterioration of functioning resulting from the presence of a mental illness.
The individual is expected to benefit from the intervention; and,
the individual’s unmet need(s) cannot be more appropriately met by any other formal or informal system or support.
Mental health services are available through...
Regional Support Networks
DSHS contracts with RSNs. RSNs contract with a network of providers.
Apple Health Plans
HCA contracts with MCOs. MCOs contract with a variety of providers for mental AND physical health care for individuals whose condition does not meet the RSN Access to Care Standards.
Core Provider Agreements
Licensed professionals who accepts payment on a fee-for-service basis for providing services to individuals not enrolled with a MCO and whose condition does not meet the RSN Access to Care Standards.
Bridgeways
*Catholic Community Services
*Center for Human Services
*Compass Health
Interfaith
Lake Whatcom Center
Sunrise Services
*SeaMar
aka Managed Care Organizations
Amerigroup
Community Health Plan of Washington
Coordinated Care
Molina
United Health Care
Tribal Health Centers
Some tribes have health care centers that can provide behavioral health services.
Outpatient Contracting &Oversight
Inpatient Authorization
Crisis Services Contracting & Oversight
Care Coordination
But How do i Access Services?!?!
Start with the Access Line
(888) 693-7200
M-F 8:30 -5:00
Operated by Volunteers of America
Crisis Hotline
(800) 584-3578
or 911
Crisis Telephone Line
•Crisis Outreach
•Involuntary Treatment Investigations
•Crisis Respite Services where appropriate
•Assistance in hospitalization if medically necessary

Available Services
Assessment
Individual
Family
Group
Intensive
IOP
PACT
WISE
Residential
All Medically Necessary Services
Services
Behavioral Health Organizations
Crisis
Inpatient
CLIP
ITA
Voluntary
"10.77"
County based Services and supports
Mental health + substance use disorder services = bho
Full transcript