Timberlands Regional Support

Network

What Timberlands RSN is and doesAnnual Report

Priorities by Contract and Client Services and for 2013 by Functional

Area

Regional Support Networks (RSN), as Prepaid Inpatient Health Plans (PIHP):

Provide mental health services through contracted licensed providers agencies (Community Mental Health Agency, CMHA)

For children and adults who are eligible Medicaid-covered enrollees.

Specifically adults who are acutely mentally ill, chronically mentally ill, or seriously disturbed and children who are acutely mentally ill, severely emotionally disturbed, or seriously disturbed.

Per Washington Revised Code of Washington (RCW): The regional support network shall have the flexibility, within the funds appropriated by the legislature for this purpose, to design the mix of services that will be most effective within their service area of meeting the needs of people with mental disorders and avoiding placement of such individuals at the state mental hospital. Regional support networks are encouraged to maximize the use of evidence-based practices and alternative resources with the goal of substantially reducing and potentially eliminating the use of institutions for mental diseases.

Mental health services are also provided, as funds allow, to non-Medicaid clients. Any person regardless of funding source is eligible for Crisis Services.

What is an RSN?

Timberlands Regional Support Network (TRSN) is: A quasi governmental entity, Created through an Interlocal Agreement, Into a legal partnership, between Lewis, Pacific and Wahkiakum

Counties. Timberlands RSN stretches from the Pacific Ocean to east of Mt. Rainier in the Cascade mountain range encompassing 3,947 square miles and a community population of approximately 101,000 people.

Who is TRSN?

TIMBERLANDS RSN GOVERNING BOARD

Three members, one member representing each County Authority.

Ron Averill, Lewis CountyCommissioner Steve Rogers, Pacific County

Commissioner Mike Backman, Wahkiakum CountyCommissioner Lee Gross, Lewis County Alternate

Commissioner Frank Wolfe, Pacific County AlternateFred Johnson, Wahkiakum County Alternate

ADVISORY BOARD

Two representatives from each County.

Suzanne Holmes, Wahkiakum CountySusan Dingethal, Wahkiakum County

Steve Clark, Lewis CountyDoug Levitt, Pacific County

Maiko Minami, Pacific CountyJoannie Bjorge, Law Enforcement, Wahkiakum

BRIAN CAMERONAdministrator

SANDY EVERMANExecutive Coordinator

TRINIDAD MEDINAIS Administrator

TRISHA YOUNGQuality Manager

BehavioralHealthcare Options

Contract

OMBUDS SERVICESContract

Timberlands Regional Support Network2013

QUALITY REVIEW TEAM, LLC

Rolly Armstrong, Wahkiakum CountyTracy McDougall, Pacific County

Kat Erskine, Pacific CountyLaRonna Lorber, Lewis County

Contract

GLENN LIPPMAN, M.D.Medical Director

Contract

PROTOCALL INC.Contract

CASCADE MENTAL HEALTH CARELewis County Agency

WILLAPA BEHAVIORAL HEALTHPacific County Agency

WAHKIAKUM MENTAL HEALTH SERVICESWahkiakum County Agency

LEWISCOUNTYCLIENTS

PACIFICCOUNTYCLIENTS

WAHKIAKUMCOUNTYCLIENTS

TRSN provides funding for, and oversight

of, direct mental health services delivered by its contracted providers.

TRSN staff themselves do not provide any direct mental health services to clients.

TRSN contracts with Cascade Mental Health Care, Willapa Behavioral Health and Wahkiakum Mental Health Services to provide direct mental health services for each of Timberlands RSN Counties, Lewis, Pacific and Wahkiakum.

What does an RSN do?

Timberlands Regional Support Network is committed to ensuring:

That all eligible citizens of the communities we represent include all age groups experiencing mental illness: Can better manage their illness; Achieve their personal goals; And live, work and participate in their

communities.

Mission Statement

Who do we contract with?

Timberlands RSN contracts with Washington’s Department of Social and Health and Services(DSHS) and monitored by the Department of Behavioral Health and Recovery (DBHR) Contracts include: PIHP Contract(Medicaid) and STATE Contract (Non-Medicaid), Federal Block

Grant and other misc contracts.

TRSN contracts with Provider Agencies in each of the counties represented. These contracts are an extension of the services responsibilities, policies and procedures, program specification, qualifications, credentialing and requirements of TRSN’s contract with DSHS.

Timberlands RSN also contracts with: Medical Director Ombudsman (Grievance System) Quality Review Team, LLC (Services Quality) Behavioral Healthcare Options Inc. (Authorizing Client Services) ProtoCall Services Inc. (After hours Crisis Services) Wahkiakum County Treasury and a local Accountant

Contracts

PRIORITIES IN MEETING AND MONITORING CONTRACTS DSHS/DBHR Contract with TRSN:

Federal External Quality Review Organization (EQRO) annual evaluation (June 2013)

Washington State DSHS/DBHR contract monitoring and contract deliverables through out the year.

Legislative sponsored targeted reviews of services and fiscal responsibility Federal sponsored targeted audits and reviews Fraud and Abuse and On going changes and requirements as a result of Healthcare Reform

TRSN contract with Provider Agency includes Annual contract monitoring of Administration, Clinical and Quality

Management, Fiscal, Fraud and Abuse and Information Systems. Contract Deliverables monitoring Quality Assurance Activities Quality Assessment

Chart reviews Clinical Utilization

Data Reports – Contract Performance, Standard, Specification, and Outcome Measurements Quality Indicators

Contract Requirements

Contract Monitoring

TRSN Contracted Services Outpatient Treatment Services Assessment to determine eligibility, including the medical necessity,

for additional services. Individual, Family and Group Counseling, Case Management Psychiatric evaluation and medication management. Children’s “Wrap Around” type services Peer Support Services Intensive Services including in the home where appropriate Crisis Services – Available 24/7 to anyone Crisis triage and stabilization services Crisis and Inpatient Diversion support including and Step-down bed

resources Evaluation and Treatment Facilities Community Hospital Psychiatric Inpatient Care Involuntary Detention Services and Court Hearings Community Based Services Residential Services, Transitional Housing, Step Down bed support Prison and Jail Treatment and Transition services Peer Recovery Centers Ombudsmen Services

TRSN SPECIAL PROJECTS that create Enhanced Services for RSN Eligible Clients

High-Utilizer Clients - Clients whose services represent a large percent of resources expended

Non-Medicaid Client increased Case Load - Clients who do not meet Medicaid eligibility criteria and are prioritized by acuity level or agency defined need

Peer Support - Alumni Clients that can be trained and hired back to work with Clients

Pain Management and Crisis Plan Protocol and Development  Agency Clinicians working with High Risk and/or Clients with evidence of needed pain management and integrated care coordination. And Training

Child Wraparound Intensive care Coordination  

Jail Services Upgrades

Open Border Program – Allows clients living on County borders service location choice

Coordination of Care with Health Plans

Information Services Resources / Personnel upgrade to meet Health Care Reform and Electronic Health Records (EHR) and Telehealth requirements

Homeless Support, Referral and Placement Added ARNP, High Intensive Resources Added staff resources for secondary service sites School Programs and Groups for Kids Trainings including Mental Health First Aid and Law Enforcement Crisis Intervention

Training

How do we Track, Monitor and Report TRSN client services are meeting standards and client’s are satisfied?

Quality Management Plan, Utilization Management Plan and Quality and Performance Monitoring On site Client Chart reviews and Service Utilization Reviews Monthly and Quarterly Data Reports reviewed at Clinical

Director and Quality Management Committee meetings. Quality and Performance Indicators Incident Reports Ombuds Services Report (Grievance) Quality Review Team (QRT) Surveys Mental Health Statistics Improvement Project Survey (MHSIP)

Client Services Monitoring

Timberlands RSN’s would like to announce and introduce the new client run business

Quality Review Team, LLC

The QRT provides service monitoring through the TRSN region and the team consists of

Rolly Armstrong, Wahkiakum County, Manager Tracy McDougall, Pacific County LaRonna Lorber, Lewis County

Kat Erskine, Pacific County

TRSN 2012 Annual Report

TRSN PRIORITES

CONTRACT REQUIREMENTS

CLIENT SERVICES and OUTCOMES

Responsible for the overall operations and administration of Timberlands RSN. Responsible for

development of plans, policies, procedures, standards, budget and fiscal operations, personnel and information system functions for TRSN, as approved by the TRSN Governing Board. Some of these responsibilities are carried out in conjunction with other TRSN staff.

The Administrator develops provider contracts, oversees funding, monitors providers for contract compliance, quality, capacity and manages the appropriate allocation of resources in accord with contract expectations and Governing Board direction

Assures appropriate service and responsible for ongoing review of service system; Makes adjustments to assure high quality, accessible and cost effective service delivery system.

Builds productive relationships and works closely with provider network and business associates; responsible for annual and ongoing contract monitoring. Develops and monitors agreements and MOU’s with other systems, as required or needed

Represents TRSN at the State Level (DSHS, Division of Behavioral Health and Recovery, Association of County Human Services, etc.), and with citizen groups, allied service providers, advocates, service recipients, etc.

TRSN Administrator

TRSN Administrator Priorities

Contract Client Service

Special Projects – Continue to do service gap analysis and implement enhanced services to meet the unmet needs of TRSN clients, while prioritizing funding resources

Open Borders Contracting for added Crisis Stabilization Beds Finding or creating alternative housing resources for

hard to house clients Hospital Relationship Building Quality Review Team and Ombuds Services

Collaboration Customer Service across the network Incident trending and service upgrades Authorizing System Upgrades Tribal relationship building Telehealth implementation Jail and Crisis System Upgrades Medicaid Expansion –

Planning, Organizing and Positioning TRSN structure to meet needs of increased client population

HealthCare Reform – Integrated and Coordinated Care – Planning for Health Homes, Dual Eligible services and increasing Healthcare requirements.- Sharing Information

Developing Relationships with Community Organizations and Alliances and Health Plans and their facilities

Contract Management-Contract Deliverables BUDGET Planning RSN Merging and new Legislative Requirements Internal business systems upgrades Regional Partnering to leverage resources on

common goals and objectives Planning for decreased Western State Hospital

(WSH) Bed Allocation Planning for Lack of Inpatient Beds and finding

alternative resources Planning and Coordinating for Federal, State and

Fiscal Audits and Reviews. Impact on Hospital Association on RSNs QRT and Ombuds, Accountant Contract Coordination Federal Block Grant Planning and Coordination Judicial Cost Planning TRSN Utilization and Reporting System Upgrades New Grievance System requirements New Medical Loss Ratio requirements New Performance Based Contracts Working on new Report Card System New DSHS emphasis on Evidence Based and

Outcome Planning for New Mental Health WAC requirement New Emphasis on Integrating Crisis Services HR Planning and Follow up

TRSN Administrator2013 Priorities

Medicaid Expansion – Planning, Organizing and Positioning TRSN structure to meet needs of increased client population.

HealthCare Reform – Integrated and Coordinated Care – Planning for Health Homes, Dual Eligible services and increasing Healthcare requirements.- Sharing Information.

New DSHS required Performance based Contracts with emphasis on Evidence Base Practice, Outcome Measurements and Medical Loss Ratio Requirements.

Special Projects – Continue to do service gap analysis and implement enhanced services to meet the unmet needs TRSN clients, while prioritizing resources.

Regional Partnering to leverage resources toward common goals and objectives. Continue to develop relationships with Community Organizations, Alliances and Health Plans and their facilities.

Planning for the continued lack of Inpatient beds and finding alternative resources.

Planning for new legislative bills impact on TRSN business Budgeting, fiscal planning, monitoring and adjusting to priorities.

Quality Manager / Clinical Director

The Quality Manager (QM) is responsible for planning, designing, implementing, coordinating, analyzing and evaluating Quality Management activities. QM activities include, but are not limited to: monitoring performance

indicators, implementing performance improvement projects, performance improvement measures and continuous quality improvement initiatives.

The Quality Manager leads development of plans and needed actions in response to annual contract monitoring, certification reviews, EQRO or other DSHS monitoring reviews as well as instituting and ensuring follow-up as appropriate.

The Quality Manager facilitates the Quality Management Committee (QMC).

The Clinical Director reviews client charts to ensure appropriate service delivery and efficient utilization management.

The Clinical Director facilitates Clinical Directors meetings.

Coordinate quality management activities (Medical Director, Behavioral Healthcare Options Inc., Quality Management Committee, Quality Review Teac, Ombuds), facilitate Clinical Director’s meetings and Quality Management Committee.

Quality Management Review Client Satisfaction Treatment outcome measures Quality Initiatives Performance Improvement Projects Recovery and Resilience Focus

Coordination of Care Primary Care / Health Homes Jail Services Health Plan Coordination Community Referrals Allied Providers Home and Community Services

Continuum of Care Crisis Inpatient Outpatient Discharge

Client Services Complete required reports, participate in

External Quality Review Organization review and Contract Monitoring

Quality Management / Clinical Oversight Clinical Policy and Procedure Training and consultation as needed Review and analysis of data Evidence Based Practice Practice Guidelines

Care Management / Utilization Management Care Coordination Case Management Resource Management Children’s Care Coordinator Risk Management

Performance Monitoring Clinical Chart Audits Utilization Reviews Contract Monitoring Grievance and Appeal Incidents review

Contract

Quality Manager/Clinical Director

Quality Manager / Clinical Director

2013 Priorities

Medicaid Expansion Resource Management Evaluation LOCUS (Adult Level of Care Utilization System) / CALOCUS (Child

& Adolescent Level of Care Utilization System)

Healthcare Reform Coordination Health Homes

Health Plans

Hospital Discharge Protocol

Children’s Services Children focused Performance Improvement Project (PIP)

The IS Administrator is responsible for the reporting

of client data to the State.

The IS Administrator is responsible for assuring that data and reports needed to carry out activities and monitor compliance are available.

The IS Administrator also monitors the quality and completeness of TRSN’s data system (data integrity).

 The Compliance Officer manages issues related to

Fraud and Abuse and HIPAA compliance.

IS Administrator/Compliance Officer

IS Administrator/Compliance Officer

Contract Quality of Data

Manage Medicaid Management Information System (AVATAR)

State Encounter Data Reporting Encounter Data Validation Washington State Consortium

(Avatar) State Meeting Representation Policy and Procedures IS Implementations Training &

Support

Compliance HIPAA Fraud and Abuse Breach Notifications Data Security Contract Monitoring Policy and Procedures

Client Services Quality of Data

Agency IS Support Facilitate Information System

Quality Committee Quality Indicator Reports

Development Customized Report Development Quality Management Committee Electronic Health Record

Implementation, Training and Support

Compliance Compliance Reports Client Privacy and Data Security Reporting Fraud and Abuse Verification of Services

IS Administrator / Compliance Officer

2013 Priorities Health Care Reform

Electronic Health Record Meaningful Use

Health Information Exchange ProtoCall Services Inc.

Data Quality Agency Training / Support Data Timeliness Standards

Compliance Fraud and Abuse Program Monitoring Reports HIPAA

The Executive Coordinator provides office management and

coordination to the Administrator, Governing & Advisory Boards.

The Executive Coordinator is responsible for assuring that materials needed to carry out activities and monitor compliance are available and accurate.

The Executive Coordinator completes delegated tasks such as: Jail Roster Cross Reference – checks daily Inpatient Hospital and Health Plan Notifications – daily

admits and discharges to each agency Excluded Parties List System – Fraud and Abuse - monthly Provider Licenses & Certifications

Executive Coordinator

Executive Coordinator Priorities

Contract

Provider Licenses and Certification

Excluded Parties List System Provider Staff Rosters and

Changes Governing Board and Advisory

Board members coordinator Advisory Board Recruitment Open Public Meeting Act contact

Client Service

Client Service Calls Client Services Logs

Coordination / Follow up regarding information requests

TRSN webpage manager Jail Rosters Cross Reference Cross Systems Reports Inpatient Hospital Notification

2013 Priorities

Update Contract Deliverables Coordinate Audits, Reviews,

Mtgs Inform TRSN Network Structure

on Contract related information

Update Website to meet Health Reform

Add Community resource referral sources

Assist in Care Integration notification

Clients and Communities Communication and Coordination

Provider Priorities

The concern whenever contrasting these two areas is that the hope should always be that the work under the contract supports the work with the client. Unfortunately that is not always the case. Both are very

important to consider and it’s important to try to reconcile the two as best as possible.

Contract Access (First contact—standards do not include

client choice. Trying to find balance between client choice and contract. Client’s do not always understand the importance of accepting appointments right away vs. next week)

Hospitalization follow up Hospital Recidivism Evidence Based Practice implementation Special Population consults (quality vs.

timeliness is something the contract does not take into consideration. Hope new WAC will allow for better results)

Jail Services—making services meaningful (real engagement vs. meeting contract language with completing certain number of assessments, etc.)

Upgrade LOC guidelines (these are not particularly meaningful because the standards seem arbitrary and do not take into account fluctuating care needs for clients. Seems to be a structure designed to justify itself)

Paperwork (Developing way to meet requirements without becoming overly burdensome)

Client Services

Access (first contact and follow up)—clients that do not show up for intakes, clients that do not show up for follow up, better manner of using crisis services (non-crisis services option)

Exiting services—developing better plans to transition out of care

Decreased dependency—Focusing clients on getting better as a solution not as another problem

Crisis services-being client and community friendly (as much as possible)

Hospitalization—making hospital stays and transitions meaningful experiences.

Focusing Care Management toward clients developing skills to meet basic needs (workload necessitates expediency vs. quality)

Preventative services—Education of community and clients

Improved coordination efforts• Primary Care Providers (PCPs) physical

health• Community Partners• Family

QUALITY in everything we do

Timberlands RSN 2012 Success Stories

As we come to the end of our Annual Report presentation we hope this has demonstrated how important each and everyone at the table is to making up the TRSN TEAM as we continue to deliver quality mental health services

in Lewis, Pacific and Wahkiakum Counties.

We like to focus on the following quotation...

Clients recover,

Clinicians facilitate recovery.

Systems and communities support recovery.

We would now like to present 2012 success stories!