CurrentADAPolicy N/A

Children's in-home and community-based mental health services under West Virginia DOJ settlement

Defines obligations of West Virginia DHHR to provide in-home and community-based mental health services to children with serious mental health conditions, to reduce unnecessary placement in Residential Mental Health Treatment Facilities, and to implement quality assurance, statewide access, and crisis response. Affects DHHR, partnering state agencies, providers, and children under 21 in West Virginia.

Policy Summary

PayerADA

PolicyChildren's in-home and community-based mental health services under West Virginia DOJ settlement

Policy CodePolicy N/A

Change TypeNo material change noted

Effective DateEffective Date: date upon which both Parties have executed this agreement

Next Review Date

Key ActionDHHR shall provide screening, intake, and assessments and develop Individualized Service Plans for children needing in-home and community-based services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

21max age

120implementation plan draft (days)

25%target reduction in placements

Dec 31, 2024terminate if compliant by

7 days

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imminent threat cure period

60 daysother breach cure period

Coverage Criteria for Children’s In-Home and Community-Based Services

Initial coverage criteria (community-based services)

Covered when ALL of the following are met for children under 21 in the target population:

Target population inclusion: Child is under age 21 AND has a Serious Emotional or Behavioral Disorder or Disturbance resulting in functional impairment and (i) is placed in a Residential Mental Health Treatment Facility or (ii) reasonably may be expected to be placed in a Residential Mental Health Treatment Facility; AND meets DHHR eligibility for mental health services.

Paragraph 23

Family/individual consent: Community-based services are appropriate and the child's family or guardian (or the individual if age 18 or over) does not oppose community-based services.

Paragraph 24

Service availability: DHHR ensures timely statewide access to in-home and community-based services sufficient to meet the individual's needs, including Wraparound Facilitation, Behavioral Support Services, Children's Mobile Crisis Response, Therapeutic Foster Family Care, and Assertive Community Treatment.

Paragraphs 24, 33-40

Crisis response: Children's Mobile Crisis Response is available statewide to all children with a toll-free hotline and mobile teams; regional Crisis Response Teams must be able to respond face-to-face within an average time of one hour as specified in the implementation plan.1 hour average response time per region

Paragraphs 29-30

A child or guardian retains the right to refuse offered services. Nothing in this agreement overrides a child’s or guardian’s decision to decline community-based services.

DHHR must assess each child remaining in a Residential Mental Health Treatment Facility to determine whether the residential setting is the most integrated appropriate option. The Parties anticipate phased regional implementation with statewide reforms and timelines; the implementation plan targets initial statewide implementation by October 1, 2020 and includes goals to reduce unnecessary residential placements. Assessments and related planning are part of the implementation activities to be completed under the agreement.

Provider Responsibilities and Operational Requirements

Documentation Required

Screening and intake requirements

DHHR shall ensure that all children who are eligible to receive mental and physical health care and services through DHHR are screened to determine if they should be referred for further mental health evaluation or services. DHHR shall adopt a standardized set of mental health screening tools for use in identifying who may be in the target population. A mental health screen shall be completed for any child not already known to be receiving mental health services when: the child enters DHHR Youth Services, the child welfare system, or the juvenile justice system; or the child or family (or foster or kinship care family, where appropriate) requests mental health services or that a screen be conducted. DHHR shall conduct outreach and training on the use of the screening tools to physicians who serve children who are Medicaid-eligible. Fifty-two percent of Medicaid-eligible children who are not in the Youth Services, child welfare, or juvenile systems shall be screened with the mental health screening tool annually.

Standardized mental health screening at entry points: Youth Services, child welfare, juvenile justice, or upon request
Outreach and training to physicians serving Medicaid-eligible children
Annual screening target: 52% of Medicaid-eligible children not in the specified systems

Documentation Required

Residential vs Community-Based Level of Care Criteria

Specified Treatment Modalities

Wraparound Facilitation / ACT / Therapeutic Foster Family Care

Wraparound Facilitation fidelity: Child and Family Teams shall operate with high fidelity to the National Wraparound Initiative's model; the Child and Adolescent Needs and Strengths (CANS) tool (or similar approved tool) shall be used to develop Individualized Service Plans, and the Wraparound Facilitator shall lead the Child and Family Team and coordinate plan development and implementation.

Paragraphs 34-35; CANS use described in paragraph 35

Visit Limits and Service Availability

Visit limits and service availability

Visit limits policyNo explicit visit limits specified; DHHR shall ensure each service is available and accessible statewide in the necessary amount, location, and duration.

Availability requirementDHHR shall ensure children receive, as needed, all in-home and community-based services described in the agreement.

Statewide accessEach service must be available and accessible statewide to children in the target population.

Information to familiesDHHR shall provide families and children with accurate, timely, and accessible information about available services in their communities.

Key Definitions

Assertive Community Treatment (ACT) definition

DefinitionAssertive Community Treatment (ACT) is a treatment model in which a multidisciplinary team assumes accountability for a small, defined caseload and provides the majority of direct services to those individuals in the individual's community environment.

Fidelity requirementACT operates with high fidelity to an assessment tool, such as the Dartmouth Assertive Community Treatment Scale (DACTS).

Service settingMajority of direct services are provided in the individual's community environment.

Residential Mental Health Treatment Facility definition

DefinitionResidential Mental Health Treatment Facility is a structured 24-hour group care treatment and diagnostic setting for children with serious emotional or behavioral disorders or disturbances.

Background and Purpose

This agreement addresses provision and quality assurance of in‑home and community‑based mental health services for children with serious emotional or behavioral disorders that substantially impair functioning. The purpose is to expand services such as Wraparound Facilitation, crisis response teams, Therapeutic Foster Family Care, and Assertive Community Treatment to enable children to receive care in the most integrated setting appropriate, reduce unnecessary use of Residential Mental Health Treatment Facilities, and establish quality monitoring, data collection, and remedial actions based on periodic reviews.

Policy Summary

PayerADA

PolicyChildren's in-home and community-based mental health services under West Virginia DOJ settlement

Policy CodePolicy N/A

Change TypeNo material change noted

Effective DateEffective Date: date upon which both Parties have executed this agreement

Next Review Date

Key ActionDHHR shall provide screening, intake, and assessments and develop Individualized Service Plans for children needing in-home and community-based services.

SourceLink

On This Page

Screening, assessment, and ISP documentation

For a child whose screening indicates a need for further evaluation or services, for whom placement in a Residential Mental Health Treatment Facility is recommended or has been made, or who has received mental health crisis intervention, DHHR shall timely provide an intake and assessment process which includes a face-to-face meeting with a community provider, the child, and family (or foster or kinship parent, where applicable), to identify the child's need for in-home and community-based services. DHHR shall ensure statewide access to Wraparound Facilitation for each child identified as needing in-home and community-based services. DHHR will use the Child and Adolescent Needs and Strengths (CANS) tool (or similar tool approved by both parties) to assist the Child and Family Team in the development of Individualized Service Plans (ISPs). A qualified individual shall conduct an assessment of the child's needs with the CANS. The Wraparound Facilitator shall lead the development of the ISP. For children who are in Residential Mental Health Treatment Facilities, the ISP shall include discharge planning. For any child who has a Multidisciplinary Treatment Team (MDT), DHHR shall provide the child's screening, assessments, and ISPs to the MDT.

Intake and assessment must include face-to-face meeting with provider, child, and family
Use CANS (or approved similar tool) for assessment and ISP development
ISPs must include discharge planning for children in Residential Mental Health Treatment Facilities
Provide screening, assessments, and ISPs to any existing MDT

Denial Risk

Retaliation investigations

DHHR agrees that it shall not retaliate against any person because that person has filed or may file a complaint, provided assistance or information, or participated in any other manner in the United States' investigation. DHHR agrees that it shall timely and thoroughly investigate any allegations of retaliation in violation of this agreement and take any necessary corrective actions identified through such investigations.

Prohibition on retaliation for participants in complaints or investigations
Obligation to promptly and thoroughly investigate retaliation allegations
Requirement to take necessary corrective actions when retaliation is found

Prior Authorization

Breach cure timelines and failure to cure

The United States shall provide West Virginia with written notice of any asserted breach, and shall engage in good faith discussions to resolve the dispute before seeking judicial enforcement. For conditions or practices that pose an immediate and serious threat to the life, health, or safety of individuals covered by this agreement, DHHR shall have seven (7) days from the date of the United States giving notice to cure the asserted breach. For all other conditions or practices, West Virginia shall have up to 60 days from the date of the notice to cure the asserted breach. Failure to cure within these timelines may lead to enforcement actions as set forth in the agreement.

7-day cure period for breaches posing immediate and serious threat to life, health, or safety
Up to 60-day cure period for other breaches
United States will provide written notice and attempt good faith discussions prior to seeking judicial enforcement

Included provider types

Includes Group Residential Care, Psychiatric Facilities (Long Term), and Psychiatric Hospital (Short Term) as listed on DHHR's Legislative Foster Care Placement Report.

Note on changesParties acknowledge names/functions of these provider types may change with implementation of the Family First Prevention Services Act and agree to meet and confer as necessary.

Serious Emotional or Behavioral Disorder or Disturbance definition

DefinitionSerious Emotional or Behavioral Disorder or Disturbance is the presence of a diagnosable mental, behavioral, or emotional disorder that results in functional impairment which substantially interferes with or limits the child's role or functioning in family, school, or community activities.

Synonym'Serious Mental Health Condition' is defined as a serious emotional or behavioral disorder or disturbance.

Functional impactDefinition emphasizes substantial interference with the child's roles in family, school, or community settings.