Arizona Department of Health Services

Division of Behavioral Health Services

PROVIDER MANUAL

Magellan Health Services of Arizona Edition

Section 3.17Transition of Persons

3.17.1Introduction

3.17.2References

3.17.3Scope

3.17.4Did you know…?

3.17.5Definitions

3.17.6Objectives

3.17.7Procedures

3.17.7-A.Transition from child to adult services

3.17.7-B.Transition due to a change of the Behavioral Health Provider or the behavioral health category assignment

3.17.7-C.Transition to ALTCS Program Contractors

3.17.7-DInter-T/RBHA Transfer

3.17.7-E.Transitions of persons receiving court ordered services

3.17.7-F.Transitions of persons being discharged from inpatient settings

3.17.7-G.Transitions of persons receiving behavioral health services from Indian Health Services (IHS)

3.17.1Introduction

Persons receiving behavioral health services in the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) system may experience transitions during the course of their care and treatment. Examples of transitions of care include changing service providers, establishing eligibility under Arizona Long Term Care Services (ALTCS), transitioning into adulthood, and moving out of the T/RBHA’s geographic service area. During transitions of care, behavioral health providers must ensure that services are not interrupted and that the person continues to receive needed behavioral health services. Coordination and continuity of care during transitions are essential in maintaining a person’s stability and avoiding relapse or decompensation in functioning.

The intent of this section is to:

▪Identify the situations that require a transition of care;

▪Describe expectations for providers when initiating or accepting a transition of care for an enrolled person; and

▪Identify resources to assist behavioral health providers in supporting a person who is experiencing a transition of care.

3.17.2References

The following citations can serve as additional resources for this content area:

A.R.S. § 36, Chapter 5

9 A.A.C. 21, Article 5

AHCCCS/ADHS Contract

ADHS/RBHA Contract

ADHS/TRBHA IGAs

Section 3.2, Appointment Standards and Timeliness of Services

Section 3.3, Intake and Referral Process

Section 3.4, Co-payments

Section 3.8, Outreach, Engagement, Re-Engagement and Closure

Section 3.10, SMIEligibility Determination

Section 3.11, General and Informed Consent to Treatment

Section 3.12, Advance Directives

Section 3.13, Covered Behavioral Health Services

Section 3.18, Pre-petition Screening, Court Ordered Evaluation and Treatment

Section 3.21, Service Prioritization for Non-Title XIX/XXI Funding

Section 3.22 Out-of-State Placements for Children and Young Adults

Section 3.23, Cultural Competence

Section 4.1, Disclosure of Behavioral Health Information

Section 4.4, Coordination of Care with Other Governmental Entities

Section 5.1, Notice Requirements and Appeal Process for Title XIX and Title XXI Eligible Persons

Section 5.2Member Complaints

Section 5.3, Grievance and Request for Investigation for Persons Determined to Have a Serious Mental Illness (SMI)

Section 5.4, Special Assistance for SMI Members

Section 5.5, Notice and Appeal Requirements (SMI and Non-SMI/Non-Title XIX/XXI)

Section 5.6, Provider Claims Disputes

Section 6.1, Submitting Tribal Fee-for-Service Claims to AHCCCS

Section 6.2, Submitting Claims and Encounters to the RBHA

Section 7.5, Enrollment, Disenrollment and other Data Submission

Section 9.1, Training Requirements

Section 10,

Collaborative Protocol Between Magellan Health Services and Arizona Department of Corrections (ADC)

Collaborative Protocol Between Magellan Health Services and Arizona Department of Juvenile Corrections (ADJC)

Collaborative Protocol Between Magellan Health Services and Child Protective Services (CPS)

Collaborative Protocol Between Magellan Health Services and District l of the Division of Developmental Disabilities (DDD) for Adult Consumers

Collaborative Protocol Between Magellan Health Services and District I of the Division of Disabilities (DDD) Coordination of Child and Family Team Process

Collaborative Protocol Between Magellan Health Services and Maricopa County Juvenile Probation Department (MCJPD)

ADHS/DBHS Practice Protocol,Transition to Adulthood

ADHS/Gila River Health Care Corporation Intergovernmental Agreement

ADHS/Pascua Yaqui Behavioral Health Program Intergovernmental Agreement

Transitioning to Adult Services Practice Improvement Protocol

ADHS/DBHS Policy Clarification Memorandum: Inter-RBHA Coordination of Service

Psychotropic Medication Use in Children and Adolescents Practice Protocol

Practice Improvement Protocol 8, The Adult Clinical Team

Practice Improvement Protocol 9, The Child and Family Team

The Arizona Vision and Twelve Principles

ADHS/DBHS Policy Clarification Memorandum: General and Informed Consent to Treatment for Persons under the Age of 18

ADHS/DBHS Practice Protocol, Providing Services to Children in Detention

The Unique Behavioral Health Service Needs of Children, Youth, and Families Involved with CPS Practice Protocol

Information Sharing with Family Members of Adult Behavioral Health Recipients Technical Assistance Document

3.17.3Scope

To whom does this apply?

All persons, regardless of funding source or behavioral health category, currently enrolled with a T/RBHA and experiencing a transition of care.

3.17.4Did you know…?

Some persons may experience a transition of payers, but not actually change providers. This could happen for example, when a Title XIX behavioral health recipient moves from an Arizona Health Care Cost Containment System (AHCCCS) acute care Health Plan to the ALTCS program. Many ALTCS Program Contractors for the elderly and physically disabled (ALTCS/EPD) contract with the same behavioral health providers as the T/RBHAs. This kind of transition, where fiscal responsibility changes but not the provider, may be transparent to the person receiving servicesbut could result in administrative changes for the provider (e.g., submitting claims or bills to the ALTCS Program Contractor versus submitting an encounter as a T/RBHA provider).

The ALTCS program is considered a “carve-in model,” a service delivery model that assigns coverage of medical and behavioral health services through a single entity (i.e., Program Contractor). An exception to this “carve-in model” is the delivery of covered behavioral health services for persons eligible for ALTCS through the Division of Developmental Disabilities (DDD). ALTCS/DDD eligible persons receive covered behavioral health services through the T/RBHAs and their subcontracted behavioral health providers.

Accurate diagnosis of a co-occurring serious mental illness can be difficult when the person has been diagnosed with a developmental disability, which includes Autism and Cognitive Disability. Psychiatric symptoms are often inaccurately attributed to a person’s developmental disability rather than a serious mental illness. All diagnoses that can be made of persons of normal intelligence can also be made in a person with a developmental disability. The Diagnostic Manual: Intellectual Disabilities (DM: ID), published in 2008, may be a useful resource in the diagnosis of mental illness in a person with a developmental disability

3.17.5Definitions

Behavioral Health Category Assignment

One of five possible designations (i.e., child non-SED, child with SED, adult diagnosed as SMI,adult non-SMI with general mental health need and adult non-SMI with substance

abuse) that is assigned to each person enrolled in the ADHS/DBHS behavioral health

system.

Designated T/RBHA

The T/RBHA responsible for the geographic service area where an eligible person has

established his/her residence.

Home T/RBHA

The T/RBHA with which the person is currently enrolled.

Independent Living Setting

A setting in which a person lives without supervision or in-home services provided by a

T/RBHA or subcontracted provider agency.

Institution for Mental Disease (IMD)

A hospital, nursing facility, or other institution of more than 16 beds that is primarily

engaged in providing diagnosis, treatment, or care of persons with mental diseases,

including medical attention, nursing care, and related services. An institution is an IMD

if its overall character is that of a facility established and maintained primarily for the

care and treatment of individuals with mental diseases.

Out-of-area service

The provision of a behavioral health service to a person in a geographic area other than

that of the person’s home T/RBHA. Out-of-area service provision includes services

provided to a person who is discharged from an inpatient or residential setting to a

different T/RBHA’s area, but who does not live in an independent living setting.

Residence

The place where a person lives on a permanent basis.

Serious Mental Illness (SMI)

A condition of persons who are eighteen years of age or older and who, as a result of amental disorder as defined in A.R.S. 36-501, exhibit emotional or behavioral functioningwhich is so impaired as to interfere substantially with their capacity to remain in thecommunity without supportive treatment or services of a long -term or indefinite duration.

In these persons, mental disability is severe and persistent, resulting in a long-termlimitation of their functional capacities for primary activities of daily living such asinterpersonal relationships, homemaking, self-care, employment and recreation.

Transfer

The closure of a person’s record by the home T/RBHA and simultaneous enrollment ofthe person by a different T/RBHA.

Transition from Youth to Adulthood

Adult Recovery Team

Child and Family Team

Guardian

Natural Support/Family

Peer/Recovery Support

Person-Centered Planning

Special Assistance

3.17.6Objectives

To ensure the coordination and continuity of care for all behavioral health recipients experiencing a transition in service providers.

Transition from Youth to Adulthood Objectives ensure:

  • The identification of all eligible adolescents and young adults, between the ages of 16 and 24, enrolled in Magellan Health Services of Arizona, the Regional Behavioral Health Authority (RBHA) of Maricopa County; and

That Service Providers support a smooth transition for all Title XIX/XXI children who are turning 18 years of age and transitioning to the adult SMI or GMH/SA behavioral health systems through the development and implementation of initiatives that improve the quality and effectiveness of programs and services for transition-age youth and young adults in order to strengthen the outcomes for them across the transition domains of employment/career, education, living situation, personal effectiveness/wellbeing, and community-life functioning.

3.17.7Procedures

3.17.7-A.Transition from Youth to Adulthood

Overview

A critical focus of the ADHS/DBHS service delivery system is the effective and efficient delivery of behavioral health services to transition-aged youth, who are considered a special population who have unique developmental needs, in order to prepare them to move into adulthood.

Whether their mental health challenges began in childhood or presented during their later adolescent years, transition age youth require developmental skills which improve their capacity to complete their education, obtain employment, and achieve independence.

Therefore, it is the responsibility of Service Providers to ensure youth and young adults are provided the opportunity to experience a positive transition into the adult world. This process should support independence, interdependence and recovery, and help ensure that youth and young adults are given the support, skills and connections needed to experience future success. Further, it is essential that youth and young adults have the skills to identify their support needs and advocate for themselves. A thorough plan for the transition into adulthood is critical for ensuring that youth become stable and productive adults.

To ensure that transition-aged youth are provided necessary behavioral health services, Magellan Health Services has established a comprehensive transition process with explicit guidelines, requirements and procedures to implement programs and services that smoothly transition youth and young adults from the children’s behavioral health system of care into the adult SMI or GMH/SA behavioral health systems of care.

Services Strategies

Youth Transition to Adulthood strategies will encompass the Transition to Independence Process (TIP) system, developed by Hewitt B. “Rusty” Clark, Ph.D., Department of Child and Family Studies,Louis de la Parte Florida Mental Health Institute,University of South Florida, Tampa, Florida as a Best Practice model to serving the needs of youth/young adults. The TIP system is operationalized through seven guidelines and their associated elements that drive the practice level activities and provide a framework for the program and community system to support these functions.

TIP promotes activities that are all done with respect for the youth and family’s values, culture and perspective; and its service/treatment planning uses the following guidelines:

  • Engage young people through relationship development, person-centered planning, and a focuson their futures.
  • Use a strength-based approach with young people, their families, and other informal and formal key players;
  • Build relationships and respect young persons’ relationships with family members and other informal and formal key players;
  • Facilitate personal-futures planning and goal setting;
  • Include prevention planning for high-risk situations, as necessary;
  • Engage young people in positive activities of interest; and
  • Respect cultural and familial values and young persons’ perspectives.
  • Tailor services and supports to be accessible, coordinated, developmentally-appropriate, and build on strengths to enable the young people to pursue their goals across all transitiondomains.
  • Facilitate young persons’ goal achievement across all transition domains;

1)Employment and Career

2)Educational Opportunities

3)Living Situation

4)Community Life Functioning

  • Tailor services and supports to be developmentally-appropriate and build on the strengths, and address the needs, of the young people, their families, and other informal key players; and
  • Ensure that services and supports are accessible and coordinated.
  • Acknowledge and develop personal choice and social responsibility with young people.
  • Encourage problem-solving methods, decision making, and evaluation of impact on self and others; and
  • Balance one’s work with young people between two axioms;

Maximize the likelihood of the success of young people; and

Allow young people to contact natural consequences through life experience.

  • Ensure a safety-net of support by involving a young person’s parents, family members and other informal and formal keyplayers.
  • Involve parents, family members, and other informal and formal key players;
  • Parents, family members, or other informal key players may need assistance in understanding this transition period or may need services/supports for themselves;
  • Assist in mediating differences in the perspectives of young people, parents, and other informal and formal key players;
  • Facilitate an unconditional commitment to the young person among his/her key players; and
  • Create an atmosphere of hopefulness, fun, and a future focus.
  • Enhance young persons’ competencies to assist them in achieving greater self-sufficiency and confidence.
  • Utilize assessment methods, e.g., functional in-situation assessment;
  • Teach meaningful skills relevant to the young people across transition domains;
  • Use teaching strategies in community settings; and
  • Develop skills related to self-management, problem-solving, self-advocacy, and self-evaluation of the impact of one’s choices and actions on self and others.
  • Maintain an outcome focus in the TIP system at the young person, program, and community levels.
  • Focus on a young person’s goals and the tracking of his/her progress;
  • Evaluate the responsiveness and effectiveness of the TIP system; and
  • Use process measures for continuous TIP system improvement.
  • Involve young people, parents, and other community partners in the TIP system at the practice, program, and communitylevels.
  • Maximize the involvement of young people, family members, informal and formal key players, and other community representatives;
  • Tap the talents of peers and mentors;
  • Hire young adults as peer mentors and peer counselors;
  • Assist young people in creating peer support groups; and
  • Partner with young people, parents, and others in the TIP system governance and stewardship.

Service Providers shall at a minimum become “TIP informed” to better tailor services and supports that are accessible, coordinated, developmentally appropriate and strength-based to enable youth and young adults to pursue their goals across all transition domains.

Medical/Physical Healthcare

Service Providers will follow the applicable guidelines below to assist the youth/young adult to plan for:

  • A transfer from a pediatrician to an adult health care provider, if pertinent;
  • Obtaining medical coverage, including how to select a health plan and a physician; as well as preparing an AHCCCS application by the youth’s 17th birthday, as indicated in ADHS/DBHS Transition to Adulthood Practice Protocol.; and
  • The transition by providing information on Advanced Directives, as indicated in Magellan Provider Manual 3.12.
  • Recommended immunization for the 18-21 year old age group that would include tuberculosis (TB) and meningococcal vaccines.

Safety/Crisis Plans

Service Providers will follow applicable guidelines for ensuring that Safety and Crisis plans are in place, as described in the Child and Family Team Practice Protocol.Children’s Providers will also coordinate with the adult service provider case manager and/or adult recovery team to ensure the transitioning youth/young adult is aware of the crisis services available in the adult system.

Financial

Service Providers will promote team discussions with the youth/young adult and family/caregiver about any needs for assistance with financial matters such as a payee service. Guidelines will reflect the importance of reviewing and updating any federaland/or state financial forms to reflect the change in status of the youth/young adult to ensure there will be no disruption in the receiving of financial assistance; informing the youth/young adult and family/caregiver on changes related to Social Security benefits and the programs especially designed for young adults and their families, including Social Security Work Incentives planning.

Vocational/Employment/Education

The Child and Family Team will identify vocational and educational needs as early as possible in the transition process. Magellan will ensure that a representative from the adult system will be involved in these meetings to ensure both areas are addressed before, during and after the transition to adulthood.Magellan strongly encourages all Child and Family Team members, including case managers wherever possible, to continue participation in the lives of recipients until age 21 in order to facilitate a smooth transition to adulthood and to provide the best chance for successful outcomes. The youth and legal guardian may also request to retain his/her current Child and Family Team until the youth turns 21.