MCTAC / CTAC Medicaid Managed Care (MMC) Readiness Assessment Tool Addendum for Child-Serving Organizations

Full text

(1)

Addendum for Child-Serving Organizations

v. 12.17.14

1 I. Present Managed Care Involvement

Percentage of current reimbursement for services coming from managed care

 Less than 10%  26 to 50%  More than 75%

 10 to 25%  51% to 75%  I do not know/Not applicable

Insurance coverage for your current service enrollees

___% Medicaid Only

___% Medicaid and Medicare ___% Medicare Only

___% Medicare and commercial insurance ___% Commercial insurance

___% No Coverage

Please identify which types of programs your agency operates (check all that apply)  OMH (Office of Mental Health)

 OASAS (Office of Alcoholism and

Substance Abuse Services)

 Both OMH and OASAS

 OCFS (Office of Children and Family Services)

 Other (please specify): ___________

 I do not know/ Not applicable

This assessment was completed by:

This readiness assessment is being filled out for an agency that provides services in which COUNTY OR COUNTIES?

Please specify: _______________________________________________________________________ ____________________________________________________________________________________

II. Early Identification and Screening

(2)

Addendum for Child-Serving Organizations

III. Treatment Models and Evidence-Based Practices

Please list the specific treatment models used in your program currently (e.g., CBT, TF-CBT, FFT, MST, etc.). If none, please indicate by writing “NONE” in the space provided below.

IV. Outcome Measures and Tracking

(3)

Addendum for Child-Serving Organizations

v. 12.17.14

3 V. Agency Assessment of Service Array

Please indicate whether you provide each of the services listed within your organization:

Service

STATE PLAN SERVICES If yes, what services do you provide and who provides this service? (list services, number of staff, and their credentials)

If no, do you collaborate with others (e.g., outside agencies) to provide these services?

Crisis Intervention Services - provided to a child

and his/her family/caregiver who is experiencing a psychiatric or substance use crisis, are designed to interrupt and/or ameliorate a crisis experience including an assessment, immediate crisis

resolution and de-escalation, and development of a safety plan. Example services: Crisis Response, Immediate Crisis Response

 YES  NO

Community Psychiatric Treatment and Support Services - goal-directed supports and

solution-focused interventions intended to achieve identified goals or objectives as set forth in the child’s plan of care. Example services: Intensive In-Home Services; Crisis Avoidance,

Management, and Training; Evidence Based Practices; School-Based Interventions

(4)

Addendum for Child-Serving Organizations

If yes, what services do you provide and who provides this service? (list services, number of staff, and their credentials)

If no, do you collaborate with others (e.g., outside agencies) to provide these services?

Psychosocial Rehabilitation Services - work with

children and their families to implement interventions outlined on a treatment plan to compensate for or eliminate functional deficits and interpersonal and/or environmental barriers

associated with a child/youth’s behavioral health needs

 YES  NO

Family Peer Support Services - array of formal

and informal services and supports provided to

familiescaring for/raising a child who is

experiencing social, emotional, developmental, substance use and/or behavioral challenges provided by a peer with lived experience

 YES  NO

Youth Peer Advocacy and Training Services –

services that provide the training and support necessary to ensure engagement and active

participation of the youth in the treatment planning process and with the ongoing implementation and reinforcement of skills learned throughout the treatment process by a youth peer with lived experience

(5)

Addendum for Child-Serving Organizations

v. 12.17.14

5

HOME AND COMMUNITY BASED SERVICES (HCBS)

If yes, what services do you provide and who provides this service? (list services, number of staff, and their credentials)

If no, do you collaborate with others (e.g., outside agencies) to provide these services? Care Coordination - activities that will support

engaging children and families in care and

promoting continuity of care; assessment of needs; creating an individualized, child and

family/caregiver centered plan of care;

coordinating and arranging for the provision of services; building the family or caregiver’s natural supports; and monitoring and evaluating a child and family or caregiver’s needs

 YES  NO

Habilitative Skill Building - provided to the child

and the child’s family/caregiver to support the development and maintenance of skills sets, utilizing an individualized, strength based approach in assisting the child in recognizing his/her functional assets/strengths and those that need developing.

 YES  NO

Family Caregiver Supports and Services -

enhance the child’s ability to function as part of a family/caregiver unit and enhance the

family/caregiver’s ability to care for the child in the home and/or community

(6)

Addendum for Child-Serving Organizations

If yes, what services do you provide and who provides this service? (list services, number of staff, and their credentials)

If no, do you collaborate with others (e.g., outside agencies) to provide these services? Crisis Respite - short-term care and intervention

strategy for children and their families as a result of a child’s mental health/substance use crisis event, medical crisis or trauma that creates an imminent risk for an escalation of symptoms without supports and/or a loss of functioning

 YES  NO

Planned Respite - short-term relief for

family/caregivers that are needed to enhance the family/caregiver’s ability to support the child’s functional, mental health/substance use disorder and/or health care issues

 YES  NO

Prevocational Services -individually designed to

prepare a youth to engage in paid work, volunteer

work or career exploration  YES  NO

Supported Employment - individually designed

to assist youth with severe functional challenges to

engage in paid work or volunteer work.  YES  NO

Community Advocacy and Support - improves

the child’s ability to gain from the community and educational experience and enables the child’s environment to respond appropriately to the child’s disability and/or health care issues

(7)

Addendum for Child-Serving Organizations

v. 12.17.14

7

If yes, what services do you provide and who provides this service? (list services, number of staff, and their credentials)

If no, do you collaborate with others (e.g., outside agencies) to provide these services? Non-Medical Transportation - offered, in

addition to any medical transportation furnished under the 42 CFR 440.17(a) in the State Plan. Non-medical Transportation services are necessary, as specified by the service plan, to enable participants to gain access to authorized services that enable them to integrate more fully into the community and ensure the health, welfare, and safety of the child/youth

 YES  NO

Day Habilitation Services - assists children with

developmental disabilities with the self-help, socialization, and adaptive skills necessary for successful functioning in the home and community when other types of skill-building services are not appropriate

 YES  NO

Adaptive and Assistive Equipment - provides

technological aids and devices that can be added to the home, vehicle, or other eligible residence of the enrolled child to enable him/her to accomplish daily living tasks that are necessary to support the health, welfare, and safety of the child

(8)

Addendum for Child-Serving Organizations

If yes, what services do you provide and who provides this service? (list services, number of staff, and their credentials)

If no, do you collaborate with others (e.g., outside agencies) to provide these services? Accessibility Modifications - provides internal

and external physical adaptations to the home or other eligible residences of the enrolled child that are necessary to support the health, welfare, and safety of the child

 YES  NO

Palliative Care - set of services offered to help

families deal with end-of-life related issues due to child’s illness. Types of services included: Family Palliative Care Education (Training); Bereavement Therapy; Pain and Symptom

Management; Expressive Therapy (Art, Music and Play); and Massage Therapy

 YES  NO

Completed by: _______________________________________________________________ Date: _______________________________

Title: ______________________________________________________________________ Agency: ______________________________

Figure

Updating...

References

Updating...

Related subjects :