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Medicaid Toolkit 2011


Providing Medicaid Eligible Community Support Services:  Skill Building Interventions for Children

Providing and documenting Medicaid eligible Community Support services was the most requested topic in the CCAI poll of provider needs last year.  This workshop is a very interactive day devoted to the development of attendees' understanding of how to plan for and implement skill building interventions into Medicaid services.  Participants will learn how to develop client and treatment goals, write objectives, match objectives to skill needed, and use curriculum for skill building sessions.  Attendees will also develop role-plays and "homework" assignments for specific steps in a skill building cirriculum.  Role plays and homework are essential elements of any effective skill building process.  Attendees will learn how to manage an agenda for a skill building intervention into Medicaid services - both group and individual models.  Skills that will be considered include social skills, coping skills, disease management skills, skills needed for independent living and others that focus on child and/or family members.  As the residential step-down initiative swings into high gear, give your staff the tools they need to capture these Community Support services.

Target:  Direct workers and Supervisors
Duration:  1 day session held at 2 locations, Chicago area and Downstate
Speaker:  Mary Thornton
Dates:  Chicago area - April 28, 2011 and Downstate - April 29, 2011


Clinical Supervision:  Using a Group Learning Model to Enhance Medicaid Compliance

Clinical supervision is critical for assuring the integration of quality care and compliance in a Medicaid environment.  However, supervisors typically have received little or no training in how to actually be a supervisor within this type of production-focused and medically necessary environment.  As a result, evidence-based clinical supervision occurs retrospectively, meaning that it is addressed only after a problem has been identified.

This presentation will be interactive and will focus on effective group supervision of paraprofessionals and professionals within the Medicaid environment, particularly the residential environment.  This particular group of direct service staff manage the milieu and provide a variety of interventions that must satisfy licensing, accreditation and Medicaid standards of care.  The Model of Supervision being presented will include the four core functions of supervision, Administration, Practice, Support and Professional Development, with an emphasis on the latter three in a group supervision model.  These models are being used more frequently, especially with staff that do not require individual supervision for  licensure, because it is both cost effective and an effective learning model for these employees.  Supervisors need to be able to think on their feet, help staff move from discussion to action plans, model medical necessity thinking and show how lessons learned with one case can be generalized to others to increase the capacity of the whole staff group to provide effective and high quality care.  All of these functions will be considered within three phases of group supervision:  beginning (informed consent), middle and ending, with a special emphasis on the informed consent between supervisor and supervisee.

Target:  Clincial Directors, Direct Care Supervisors, Compliance and QA/QI staff
Duration:  1 day session
Speaker:  Scott Migdole from Mary Thornton & Associates
Date:  May 24, 2011


Treatment Planning:  A Best Practice Clinical Model for Children and Families
(2 Days of Interactive Training Followed by 3 Webinars)

Treatment planning for children is an essential component to effective, evidence-based care.  However, while treatment plans are fundamentally important, clinicians throughout the country struggle to develop ones that are effective, practical and meet the requirements as set forth by Medicaid.  CCAI will offer a hands-on model to help staff throughout your agency.  To this end, many treatment plans tend to be administrative products with little or no relevance in  day-to-day practice.  The results in the actual treatment and subsequent documentation of the session being entirely divorced from the treatment plan leading to major compliance concerns with Medicaid and other payers.

These workshops are focused on utilizing the Transtheoretical Model of Change (TTM) as a principle model for child-centered treatment planning.  Through it, participants will learn how to develop goals and objectives consistent with a child's stage of change and then link these to individualized interventions designed to promote resiliency and health.  This allows for a practical, dynamic document, as opposed to one which is static and unchanging.  Of particular importance is that the model focuses on helping clinicians to identify a stage of change for the family in relation to a child's objectives and goals, helping to assure compliance with the identified patient requirements of Medicaid.

The model with resonate with attendees as it focuses on treatment planning and compliance at the practice level, as opposed to presentations that list requirements and then request that staff merely "check the boxes".  In support of the model, the presenter will also provide attendees with (a.) a common inter and intra agency language, (b.) quality assurance systems where practice and compliance are intertwined and the progress of a youth can be marked over time, and (c.) utilization management systems which can be translated into day-to-day supervisory practice.  The presetation is interactive and will encourage feedback and discussion from participants.

Three webinars will follow the training days to increase the learning and provide extended assistance in treatment planning.

The webinars will help participants implement and sustain the treatment planning model and will include both didactic and experiential learning approaches.  This will provide an effective and efficient method for reviewing cases and developing treatment plans.  As case conferencing, if done well, requires a fairly rigid process to allow for adequate time to introduce the case, subsequent discussion and analysis, the webinars will be highly structured and require participants to prepare cases in advance of the calls.

The CCAI cas conferencing will be facilitated by Scott Migdole of Mary Thornton & Associates.  Prior to the initial conference, CCAI will solicit volunteers who would be interested in presenting and discussing one of their complex cases.  Information will be provided to participants prior to the first call outling (1.) how to present a case and the organization of its content and (2.) information about how the teleconference will be managed including time keeping and the necessity of the call being  practical and outcome-based.

The overarching goals of these webinars are to:  implement the stages of change treatment planning model; assist clinical leaders in increasing their skills in developing and manageing case conferences within their own organizations; integrate Medicaid mental health services into the plan with the ability to articulate these services into the treatment program; provide presenters with assistance in developing treatment or action plans for cases that are difficult or stuck; and increasing the knowledge level of all involved in managing and planning for these complex cases.

Target:  Clinical Directors and Supervisors
Trainer and COP Leader:  Scott Migdole
Training Dates:  July 12, 2011 and July 26, 2011
Follow-up Webinar Dates:  August 4, 2011, August 11, 2011 and September 15, 2011


A Community of Practice for Medicaid Compliance

Compliance can be a very lonely job as well as frustrating and sometimes even scary.  There is a huge amount of information that must be absorbed, new regulations to contend with, and any number of issues that all must be tackled NOW!  CCAI will offer an opportunity for QA and QI staff responsible for compliance to get together on a regular basis in order to learn, share information, discuss methodology, and dissect regulations.  This Community of Pratice (COP) allows for a shared sense of purpose and focus for compliance staff.  The COP will be developed through a series of four (4) webinars facilitated by Mary Thornton.  Prior to the initial webinar, CCAI will survey participants to determine their most pressing concerns or the areas they believe present the highest risk.  This list will be used to determine the topic for the first webinar and the list will be added to as more or different issues arise.  Issues that could possibly be considered include: evaluating the effectiveness of your compliance program; identifying and quantifying risk; the Federal Office of the Inspector General (OIG's); work plan for 2011; etc.  The COP is intended to be interactive, so attendees will be asked to partner with one another to present topics or to describe their current practices.  The COP is a proven way for providers to increase their compliance capability.

Target:  QA and QI staff or anyone with Compliance Responsibility
Duration:  4 webinar sessions lasting 2 hours each 10 a.m.-12 a.m.
COP Leader:  Mary Thornton
Dates:  May 27, 2011, June 27, 2011, July 29, 2011 and September 16, 2011, October 21, 2011


Medicating the Seriously Emotionally Disturbed (SED) Child

Children and medications are a hot topic for Medicaid because of the concern around accurate diagnosing and the impacts of medication side effects on the children that are taking these drugs.  Concerns frequently mentioned are early onset diabetes, weight gain and cardiac issues.  Protecting your agency is important as the Federal Office of the Inspector General (OIG) has listed Off-Label Prescribing of Medications for kids as an area to investigate.  Off-Label Prescribing happens when a medication has been approved for one use but is being used for another.  Many children are being prescribed psychiatric medications that have not been approved for use with children.  Even foster care agencies need to be aware of the scope of medication prescribed to clients in their care.  In Alaska, a law group is suing individual psychiatrists for prescribing anti-psychotics for kids claiming that they are being disabled for life as a result.  In Illinois, a whistleblower suit was recently unsealed by the Department of Justice involving a false claims action against a psychiatrist and her organization for prescribing psychiatric medicaton to a child. 

This webinar will be conducted by a child psychiatrist who is going to discuss how to develop and evaluate medical policy around polypharmacy (the prescribing of more than one anti-psychotic int he same class of drugs or the prescribing of mulitple medications for the same diagnosis), Off-Label Prescribing, the use of medication algorithms (these are set procedures for physicians to use in prescribing certain medications, e.g. lab testing, EKGs, weights and vital signs, and dosing decisions), etc.  The webinar should be attended by Medical Directors, nursing, QA and compliance staff because of the interest at both federal and state levels on the topic of kids and psychiatric medications.  Protect your agency before you become the target of a review.

Target:  Medical Director, Nurses, QA/QI and Compliance Staff
Duration:  1 webinar session lasting 2 hours
COP Leader:  Todd Christiansen, M.D.
Date:  May 12

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