Nebraska Medicaid Program

Current Initiatives

Children's Mental Health and Substance Abuse Statewide Infrastructure Grant (SIG)

Glossary of Terms

Medicaid Definitions

Family Centered Care Definitions

Infrastructure

Infrastructure refers to structural components that are necessary to build a delivery system for children’s mental health and substance abuse services at the state, local and community level. Components of the system are financing mechanisms, policies and regulations, training and technical assistance, information and communication technology, processes for needs assessment and strategic planning, and research and evaluation.

Integrated Care Coordination Units (ICCUs)

These units are located in five of the six Behavioral Health Regions in the State and are joint collaborations between each region and the Department of Health and Human Services. The ICCUs are designed to integrate care for children in the child welfare/juvenile justice system and is intended to effectively manage the care of children and families with multiple and complex needs at the local level. The youth served through this project are high-need wards of the state who are in Agency-Based Foster Care (therapeutic foster care) and higher levels of care. Funding is through a case rate based on 95% of the historic cost of serving these youth. This project utilizes an integrated care coordination collaborative that includes Protection and Safety Workers (child welfare and juvenile justice system) and Professional Partners (mental health and substance abuse service system) who work in conjunction with family support organizations in each Region to provide advocacy for families served in the program).

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Medicaid Definitions

Transportation

Transportation Services are those services that ensure that members without transportation get to medically necessary mental health and substance abuse appointments.

Customer Assistance Program (CAP) Managed Care Only Service

The Customer Assistance Program provides short term, solution-focused therapy aimed at assisting those who have personal problems that interfere with their daily living and well being. CAP is an early intervention approach to dealing with those problems before they become unmanageable. CAP is intended to provide assistance to individuals who do not have a DSM IV diagnosis or who will not need ongoing assistance. CAP services require registration, but not pre-certification.

Outpatient Mental Health and Substance Abuse Services

Outpatient Mental Health and Substance Abuse services are behavioral health services rendered in an office/clinic environment, a member’s home or other locations appropriate to the provision of service for psychotherapy or medication management. Services focus on the restoration, enhancement and/or maintenance of a member’s level of functioning and the alleviation of symptoms, which interfere with functioning in at least one major life area (e.g. familial, social, educational, employment). The goals, frequency and length of treatment will vary according to the needs of the individual or family being served and the response to treatment. Outpatient services may be provided in an individual, family or group format.

Intensive Outpatient (Managed Care Only Service)

Intensive outpatient is a level of care between day treatment and traditional outpatient. Service may be delivered in a group format within a facility or as an individualized format within a member’s own home. This level of care is intended to prevent admissions to higher levels of care or to serve as aftercare for members who are transitioning from higher levels. Intensive outpatient can be 6 -12 hours of individual, family and group therapy per week.

Community Treatment Aide (CTA)

Community Treatment Aide services are supportive, directive and teaching services provided in the home, school or other community location to assist the member in improving their capacity for living in the least restrictive environment. These services are typically delivered by a para-professional. They are to be prescribed and supervised by the supervising practitioner and included as part of the master treatment plan.

Day Treatment

Day treatment provides a coordinated set of individualized therapeutic services to persons who may be able to function in a normal school, work, and/or home environment, but are in need of therapeutic supports. Day Treatment is a community-based level of care. It is a comprehensive, multidisciplinary approach to treatment for members who do not require or meet the guidelines for higher levels of care, but require more intensive and comprehensive services that can be provided at the outpatient level.

Partial Hospitalization ( Managed Care Only Service)

Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. The program provides diagnostic and treatment services on a level of intensity similar to an inpatient program, but on less that a 24-hour basis. These services include therapeutic milieu, nursing, psychiatric evaluation, medication management, group, individual and family therapy. The environment at this level of treatment is highly structured and there should be a staff-to-patient ration sufficient to ensure necessary therapeutic services, professional monitoring, control and protection. Partial hospital treatment may be appropriate when a member does not require the more restrictive and intensive environment of a 24-hour inpatient or residential setting, but does need up to eight hours of clinical services each day. Partial hospitalization can be used both as a transitional level of care (i.e., step-down from inpatient or residential treatment) as well as a stand-alone level of care to stabilize a deteriorating condition and avert hospitalization or residential treatment. This level of care is not appropriate for youth living in subacute levels of care (RTC, ETGH, TGH or TFC).

Treatment Foster Care

Treatment Foster Care is a level of care provided to children and adolescents who require a higher level of care than is found in traditional foster care. The member is placed in the safe, secure and nurturing environment of a private home with licensed foster parents who have received specialized training in the care of children and adolescents with emotional or substance abuse disorders. Treatment foster parents provide care for one child and perform behavioral interventions and life skills training in addition to assuring that the child receives needed mental health and substance abuse services, medical care and education. This level of care is transitional, and typically considered for children and adolescents who have been recently discharged, or who are being diverted from higher levels of care. Family therapy is included in the per diem to prepare for reunification or alternative placement.

Treatment Group Home

Treatment Group Homes provides 24-hour mental health and/or substance abuse services in a licensed, non-secure facility. They are designed for children and/or adolescents with significant functional impairment, but some capability to engage in community-based activities. Treatment group homes offer a less restrictive treatment environment that residential treatment, but are more restrictive that treatment foster care. Typically, treatment services include 24 hours per week of individual, group and family counseling, vocational training, recreational therapy and skill building. Members may also be involved in community-based activities such as school, work or recreation.

Enhanced Treatment Group Home (Managed Care Only Service)

Enhanced Treatment Group Homes proved 24-hour mental health and/or substance abuse services in a licensed non-secure facility. Enhanced Treatment Group Homes are designed for youth who are eligible for Medicaid Manage Care Mental Health/Substance Abuse Services. Youth have significant functional impairments but some capacity to engage in community-based activities. Youth typically have impairments due to emotional disorders and primary or co-morbid clinically significant impairments from one of the disruptive behavior disorders of childhood and adolescence. Enhanced Treatment Group Homes offer a less restrictive treatment environment then residential treatment and provides an enhanced array of treatment interventions and treatment modalities. Typically, treatment services include 21 hours per week of individual group and family counseling, intensive cognitive behavioral interventions, vocational training, recreational therapy and skill building. Members need to be involved in community-based activities such as school, training or work experience and recreation.

Residential Treatment

This level of care provides 24 hour behavioral treatment in a licensed, highly structured residential program for child/adolescents who do not require an inpatient setting and will benefit from a short-term, structured residential setting. This supervised short-term treatment model serves as an alternative to inpatient hospitalization. In this facility-based program, children/adolescents receive services in a safe, structure setting, with continuous 24-hour observation and supervision. The program addresses the identified problem through 42 hours per week of crisis stabilization, initial and continuing bio-psychosocial assessment, care management, medication management, therapy and mobilization of family support and community resources in the context of a comprehensive multidisciplinary treatment plan.

23-Hour Crisis Observation, Evaluation, Holding and Stabilization

This level of care provides up to 23 hours of care in a secure and protected environment. The program is medically staffed, psychiatrically supervised and includes continuous nursing services. The primary objective of this level of care is for prompt evaluation and/or stabilization of individuals presenting with acute symptoms or distress. Before or at admission, a comprehensive assessment is conducted and a treatment plan developed. The treatment plan should place emphasis on crisis intervention services necessary to stabilize and restore the individual to a level of functioning that does not require hospitalization. Duration of services at this level of care may not exceed 23 hours and 59 minutes, by which time stabilization and/or a determination of the appropriate level of care will be made, and facilitation of appropriate treatment and support linkages will be coordinated by the treatment team.

Acute Inpatient

Acute inpatient treatment represents the most intensive level of care. Multidisciplinary assessments and multi-modal interventions are provided in a 24-hour secure and protected setting which is a medically staffed and psychiatrically supervised treatment environment. Twenty-four hour skilled nursing care, daily medical care, and a structured treatment milieu are required. The goal of acute inpatient is to stabilize acute psychiatric and substance abuse conditions.

Best Practice

Clinical intervention that has been consistently shown in research studies to assist consumers in achieving their desired goals of health and wellness.

Promising Practice

Many of these are in the early stages of research and may be individualized practices selected by the family.

Professional Partner Program

Utilizes the wraparound approach to coordinate services and supports to children and their families and to ensure they have voice, ownership, and access.

System of Care

A comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and their families.

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Family Centered Care Definitions

Compassionate

Every effort to communicate with consumers, colleagues and families embodies compassion and is distinguished by good manners. The hopes of the individual and family are cherished, nurtured and held dear.

Individualized

People are unique; their problems are as well. Simple logic dictates that the best solution to their problems are those that are uniquely tailored to them.

Family/Person Driven

Families are the experts on what they need. This process produces a new level of individual and family input and eventually, investment in plans intended to alleviate distress and respond to troubling circumstances.

Strengths Based

A thorough discovery of individual and family strengths, cultures, preferences, and values is where this process starts. Meetings begin with a description of the strengths, culture and values of the individual/family.

Strategies intended to meet unmet needs focus on how individual and family strengths can best help get each identified task completed. Strengths, cultures, preferences and values drive the selection and design of the strategies.

Culturally Competent

We set out to learn each individual’s and family’s unique culture. These are among the cornerstone strengths and assets on which the plan is based

Team Developed and Supported

The people who are involved with the family – both formally and informally – come together in a Family Team. This team, which changes as it’s developed, forms a circle of support around the person in need.

Outcome Focused

Accountability is encouraged because planned outcomes are defined in advance and monitored throughout the process. Outcome statements identify specifically what is to be produced by the plan.

Needs Driven

Unmet needs, when met, become the bridges between the desired outcomes and the current reality. Needs statements are specific and positively framed. Needs are not service-oriented responses intended to assist the individual/family to meet their desired outcomes.

Flexible

The integrity of the individual and family is the concern, not the integrity of the program. We don’t try to shove square pegs into round holes. Unique supports and resources are developed to best fit a particular person or family and meet their needs.

Unconditional

Plans are supposed to work, to produce desired outcomes. If the plan does not work, change the plan. Do Not Give Up

Normalized

Plans are created that feel so familiar and comfortable to their intended beneficiaries that they claim them as their own. People have access to the activities that typify daily life for children and adults of the same age, stage and culture.

Community Based

We should help people remain in their neighborhoods and communities and still get their unmet needs met.

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