Agencies | Governor
Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services
chapter
Amount, Duration, and Scope of Medical and Remedial Care and Services [12 VAC 30 ‑ 50]
Action 2011 Mental Health Services Program Changes for Appropriate Utilization & Provider Qualifications
Stage Final
Comment Period Ends 1/29/2015
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1/29/15  4:14 pm
Commenter: Deborah Sikes, LPC, LSATP Clinical Director, NCG

Proposed changes to IIH Case Management/Care Coordination
 

 

Proposed Definition:

"Care coordination" means collaboration and sharing of information among health care providers, who are involved with an individual's health care, to improve the care.”

Comment:

Allowing case management for children, adolescents and families receiving IIH to be provided by the CSB case manager (if there is one) and limiting the scope of what the IIH provider offers to “care coordination” (as defined above) has the potential to result in disjointed case management that misses the scope of collaboration required for successful outcomes.  For the following reasons, the definition of care coordination needs to be expanded to include all treating/associated professionals invested in the child/adolescent and the IIH provider needs to remain primary in facilitating care management:

  1. Not all children and adolescents eligible for IIH will have a CSB case manager, resulting in some receiving case management and some being denied case management while they receive IIH Services.
  2. Many CSBs continue to manage waiting lists out of necessity to fulfill the need of those requesting services, including case management.
  3. IIH providers will be able to discuss case management needs and provide case management weekly as deemed appropriate for the child/adolescent, rather than only during scheduled appointment times.
  4. IIH providers are in the home working with families multiple times weekly and are in a position to report on current needs/progress and coordinate with associated treatment team members (health care and non-health care providers) as needed to assist families in meeting treatment goals.
  5. Children and adolescents receiving IIH are typically involved with a variety of agencies including those required to meet eligibility, including DSS, Court Services Units and schools.  
  6. The continuity of care has the potential to suffer if case management is not coordinated regularly and with the goal of having all players on the same page.  This proposed model will only complicate things for the family who may end up confused at times about who to go to for what purpose.

The reconsideration of the scope of “Care Coordination” for IIH providers is vital to preserving the spirit of collaboration and the continuity of care needed for sucessful treatment planning and service outcomes for those participating in the program.

CommentID: 37860