Crisis Calls
How you handle a call from a member in crisis?
•Keep member on the line
•Assess for Crisis Triggers (MH/SUD/DV)
•Solicit a buddy if needing to call 911
•Send to BHCM for next day follow up call
How are new hires onboarded and trained?
•Fidelis has a formal onboarding training series that all staff take
•New staff shadow and mentor with tenured staff during their first 30-90 days of hire
•New staff receive audits during their first 90 days to assure compliance right away
What is GoMo?
Members who are engaged in CM and score as Low risk, we offer Care Management via Text Platform, in addition to Telephonic communication (if member agrees).
GoMo communications: Speak to documentation for GoMo
What range of BH/SUD services does Fidelis offer to Medicaid Members?
•Covered benefits include routine outpatient MH and SUD Services.
•Emergency services such as IPMH and Detox
•SUD Services such as Residential, Rehab, OP Rehab, IOP, and OTP
•Mental Health Services such as ACT, PROS, CDT
•ECT, TMS, Home Care
•HARP Members are eligible for CORE/HCBS
•Children with eligibility can receive Child HCBS
What are your roles and responsibilities?
HARP – speak to your cohort’s roles/responsibilities
Mainstream – speak to your role and how you receive referrals, assist members, etc.
Childrens’ – speak to your role and what you do to assist children/RP’s
What are 3 Crisis Triggers you listen for?
•Recently experiencing an event that may lead to an unstable and dangerous situation affecting an individual or group. Some examples include, but are not limited to:
•Current/recent suicidal thoughts
•Having an intent to cause harm to themselves or others
•Having a medical emergency - an injury or illness that would result in serious bodily harm, loss of limb
•Loss of bodily functions, or loss of life
•Having urgent need of mental health or substance abuse care
•Being an untreated victim of sexual assault
•Reported or suspected abuse or maltreatment to children under 21 years of age.
•Substance Use/Abuse:
•using drugs regularly — daily/ several times a day
•having intense urges for the drug that block out any other thoughts
•Over time, needing more of the drug to get the same effect
•Taking larger amounts of the drug over a longer period of time than you intended
•Making certain that you maintain a supply of the drug
Spending money on the drug, even though you can't afford it
How are staff trained to handle Crisis Calls?
•We have a formal Crisis Call training series for our staff
•There is an annual Crisis Call refresher training
What is the different between Passive and Active Care Management?
HARP: be able to speak to UTR/LTC cases. If we are saying these members are passively CM based on triggers: What are the triggers?
Differentiate Passive v. Active
What is the different between Passive and Active Care Management?
HARP: be able to speak to UTR/LTC cases. If we are saying these members are passively CM based on triggers: What are the triggers?
Differentiate Passive v. Active
When there is a dual diagnosis, someone with a BH diagnosis with also a need for Medical, for example- Hospice, who is on point, and were are those hand offs?
Speak to Co-Management
Speak to Multi-Disciplinary approach including PH, PH, MD, SDOH
Target Populations where both disciplines work together on Co-Managing member's whole health
Gaps in Care Reports to proactively identify need.
After a Crisis Call, what kind of follow up should a Member expect?
After a Crisis Call, what kind of follow up should a Member expect?
A Behavioral Health Case Manager will call the member the next day
Do dedicated Children’s staff take any special training?
•Yes all of our Children’s staff have children’s experience and take the NYS Children’s trainings offered through MCTAC
Walk us through how you coordinate care for a HARP member with the PCP, Health Home, and other providers involved in the member's care?
All HARP members have outreach attempts to PCP, HHCM, and any relevant BH providers within their first month of enrollment, annually, and when clinically relevant.
What is your process to refer a member to BH Case Management?
•We have an internal process to make a referral to a BH Case Manager
•HARP Members are all assigned a HARP Care Manager, and we can share information with the HARP CM to help coordinate care
•Clinical rounds: we can review members for collaborative case management/consultative purposes
What happens when someone changes from Low Risk to Med/High: Do you revoke GoMo?
•We would not revoke the tool but outreach telephonically more often
What if you need to call 911 – explain the process.
-Keep member on the line
-Solicit a buddy to call Emergency Services
-Stay on the line with the member until EMS arrives
How are teams trained to use the LOCADTR?
•All of our staff were trained on the LOCADTR in a box training.
What are the Range of Behavioral Health Services that your plan offers to members?
Covered Benefits
Case Management
Care Coordination
Speak to all scopes/Teams - Children, HARP, Mainstream
How does UM collaborate with Case Management?
•We make referrals for members who would benefit from Care Management and share information with the BH CM
•We work together with Care Managers when needed to review/approve services that have been requested for members.
How does your organization (Fidelis) interact with the Health Homes?
•We make referrals to Health Homes for eligible members
•Our Care Managers coordinate with a member’s Health Home CM regularly
Are there any special considerations for members in crisis due to domestic violence?
Yes, we will meet the members where they are at. We will not surprise a member with Emergency Services
We will confirm the member is safe and not call emergency services without their consent
How are new hires onboarded and trained?
•Fidelis has a formal onboarding training series that all staff take
•New staff shadow and mentor with tenured staff during their first 30-90 days of hire
•New staff receive audits during their first 90 days to assure compliance right away
Walk through scenario of a HARP member getting connected to Adult BH HCBS - what role does the care management team play in getting a referral initiated and ensuring services are accessible?
HARP CM’s attempt to educate members regarding HCBS/CORE benefits during their initial month of enrollment, annually, and when clinically indicated. HARP CM’s complete LOSD request for HCBS and can refer members directly to CORE providers. Member’s interested in HCBS without a HHCM can be referred to a RCA.
Is PROS covered for Medicaid Members? How can you tell? Show screen for points!
•Yes; PROS is covered with no authorization requirements
•Screen-share: F6
How do you assist members in need of getting connected to PCPs?
•Find a Doc + Hands on approach to connecting and coordinating with member and PCP