CCC Provider Training Summary
Virginia Premier Health Plan • 03/10/2014
Table Of Contents
•
•
Overview
Disability Literacy: Mental Health Awareness
–
•
Course Summary
•
Introduction
•
Identifying Patients
•
Working with Patients
•
Crisis Intervention
•
Services and Resources
•
Long Term Support and Services (LTSS)
•
Additional Services and Resources
•
Assessing Needs
•
Integration
Disability Literacy: Access, Accommodations and The ADA
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4
5
6
7
8
9
11
13
14
16
17
18
19
Course Summary
•
•
•
•
•
•
•
Providing Healthcare
The ADA & Olmstead
Prejudices & Myths
Providing Healthcare
Providing Care/Literacy
Providing Care/ Language
Providing Care/ Chronic Conditions
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21
22
23
24
25
26
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Table Of Contents
•
•
Barriers
•
Accommodation
•
Conclusion
•
Wellness Principles
•
Person Centered Planning
•
Independent Living
Course Summary
•
Cultural & Disability Sensitivity
•
Fraud & Abuse
Appendix
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27
29
30
31
32
Course Summary
Model of Care
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•
Access
Health Literacy: Caring For Our Members & Patients
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•
•
Appendix Introduction
Attestation (1 of 1 ; 1 of 2)
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Overview
This module includes course summaries for the Commonwealth Coordinated
Care Provider Training. You will be able to attest to training if you have taken
similar training within the past year with another Health Plan. The option to
attest is available for 3 out of the 4 courses provided. If you have not taken
similar training review the course summaries for the below sections.
•
•
•
•
Disability Literacy: Mental Health Awareness
Disability Literacy: Access, Accommodations and the ADA
Health Literacy: Caring For Our Members and Patients
Model of Care*
*This course is exclusive to VA Premier Health Plan, Inc. Attestation is not provided, course summary
must be reviewed.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Mental Health
Awareness
Disability Literacy: Mental Health Awareness
Course Summary
The National Alliance on Mental Illness defines a mental health impairment as:

A medical condition that disrupts a person's thinking, feeling, mood, ability to relate to
others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental
illnesses are medical conditions that often result in a diminished capacity for coping
with the ordinary demands of life.

Data indicates that individuals with intellectual development disabilities (IDD) or mental
health issues are more likely to live at home, are often part of the dually eligible
program, much more likely to use emergency services and are often the last and least
served.

“These crises are not the inevitable consequences of mental disability, rather, they
represent the combined impact of additional factors, such as lack of access to
essential services and supports, poverty, unstable housing, coexisting substance use,
other health problems, discrimination, and victimization.”
Paolo del Vecchio, M.S.W., Associate Director for Consumer Affairs at SAMHSA’s Center for Mental Health Services
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Disability Literacy: Mental Health Awareness
Course Summary: Introduction

The Institute of Medicine recommends that providers of medical services
establish “effective linkages” within their own organizations and between
the providers of mental health and substance abuse.

The lack of coordination among primary care doctors, hospital emergency
rooms, behavioral health practitioners, and other providers leaves patients
(often with many other social challenges such as homelessness) confused,
frustrated, and, too often with inadequate care.

Primary care physicians and mental health providers alike are often
unaware of who is prescribing what to whom.
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Disability Literacy: Mental Health Awareness
Course Summary: Identifying Patients

VPHP Medical Management staff will identify the most vulnerable patients upon
enrollment and on an ongoing monthly basis.

Identifying specific information regarding the patient is also important. The DMAS
medical transition data reports are used to identify patients with:


Selected diagnoses

Prior authorizations for services that are presently being received by individuals
who are new to the plan

Patients designated as part of the vulnerable subpopulations

Patients receiving services at a Community Services Board or who are assigned a
Targeted Case Manager
Members of the vulnerable subpopulation are those who struggle with behavioral
and/or multiple chronic conditions.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Mental Health Awareness
Course Summary: Working with Patients
Virginia Premier staff, providers and agencies must work together to
provide the key services listed here.

Service planning and coordination

Cross systems/ Interdisciplinary training

Outpatient mental health

Residential housing/day/vocational opportunities

Respite

Inpatient hospitalization

Behavioral support planning

Family support and education/outreach
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Disability Literacy: Mental Health Awareness
Course Summary: Working with Patients

The Interdisciplinary Care Team (ICT) is a member centered group that
discusses the care plan, health status and current/possible interventions for
the patient. The ICT is always comprised of:



The Patient
The Care Manager
The Primary Care Physician
Based on the needs of the patient, additional ICT members may be added:






Family members and/or caregiver or legal representation
Medical and Pharmacy Directors
Specialists
Disease Manager
Social and Medical Outreach Workers
Health Educator
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Disability Literacy: Mental Health Awareness
Course Summary: Crisis Intervention
When working with the mental and behavioral health population it becomes critical
that members of the ICT have an understanding of Crisis Intervention and
Prevention.
Crisis prevention should come through early identification of individuals at high
risk. The immediate involvement of the ICT in the development of a crisis response
plan is critical.
Reaching out to community agencies that specialize in crisis prevention tactics and
education should almost always be part of the intervention plan. In addition,
providing assistance and education to family members/caregiver or guardian in
crisis situations is essential as they may be feeling a higher level of crisis/stress
than the patient.
Should a patient present with signs of a crisis or potential crisis:

Call the Community Service Board (CSB).

CSB will send someone to complete a crisis assessment on the patient.

If the crisis staff representative feels the patient is a danger to him/her self or someone
else, they can obtain a temporary detention order (TDO).
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Mental Health Awareness
Course Summary: Crisis Intervention
When working with patients with mental health issues, particularly those who
have experienced a crisis, understanding the concept of recovery is key.

For many people, the concept of recovery is about staying in control of their life
despite experiencing a mental health problem. Professionals in the mental health
sector often refer to the ‘recovery model’ to describe this way of thinking.

Putting recovery into action means focusing care on supporting recovery and
building the resilience of people with mental health problems, not just on treating or
managing their symptoms.

There is no single definition of the concept of recovery for people with mental health
problems, but the guiding principle is hope – the belief that it is possible for someone
to regain a meaningful life, despite serious mental illness. Recovery is often referred
to as a process, outlook, vision, conceptual framework or guiding principle.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Mental Health Awareness
Course Summary: Services and Resources
This session provided information regarding agencies, services and
resources available to the mental and behavioral health population.
This summary provides a look at just a few.
Respite care (agency and consumer-directed) is a service provided to
unpaid caregivers of patients who use Waiver services. Respite is
provided on an episodic or routine basis because of the absence of or
need for relief of those unpaid individuals who normally provide the
care.
Therapeutic consultation is provided in fields such as psychology,
social work, behavioral analysis, speech therapy, occupational therapy,
therapeutic recreation, physical therapy disciplines or behavior
consultation to assist patients with disabilities, parents and family
members, and providers to implement goals and services.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Mental Health Awareness
Course Summary: LTSS
LTSS includes:

Adult Day Health Care (ADHC) Services

Personal Care Services: by Agency and Consumer-Directed

Personal Emergency Response System (PERS)

With or without medication monitoring

Respite Care Services – Agency and Consumer-Directed

Transition Services and Transition Coordination

Assisted Living or Nursing Home
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Disability Literacy: Mental Health Awareness
Course Summary: LTSS

Long-Term Support and Services (LTSS): A variety of services that assist
individuals with health or personal needs of daily living over a period of
time. Examples include assistance with bathing, dressing and other basic
activities of daily life and self-care, as well as support for everyday tasks
such as laundry, shopping, and transportation. LTSS are provided over an
extended period, predominantly in homes and communities, but also in
facility-based settings such as nursing facilities.

Long-term services and supports can be provided at home, in the
community, or in various types of facilities, including NFs and assisted living
facilities.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Mental Health Awareness
Course Summary: Services and Resources
Additional services and resources include:

Behavioral Therapy Services

Community Mental Health Rehabilitative

Services (CMHRS) (such as Intensive In Home, Therapeutic Day Treatment, and
Mental Health Supports for adults)

Targeted Case Management

Treatment Foster Care Case Management

Residential Treatment (Levels A, B & C)

Substance Abuse Services

Inpatient and Outpatient Psychiatric and Substance Abuse Treatment Services (such
as medication management, and individual, family, and group therapies) for nonMCO enrolled individuals
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Mental Health Awareness
Course Summary: Assessing Needs

Each member of the health plan will have a primary care provider, a care
manager, and an interdisciplinary care team who will serve to identify new
issues that the member may be experiencing and communicate these to
other members of the team.

VPHP will also ensure that members are re-assessed on a periodic basis to
identify new issues that have arisen. VPHP will utilize its predictive
modeling tool in order to identify individuals who have recently experienced
a change in condition to predict which members are at-risk for an adverse
medical event and require intervention.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Mental Health Awareness
Course Summary: Integration

Behavioral health must be fully integrated in the delivery or physical health
and LTSS services to be effective. A full integration in addressing the
behavioral health needs of the patient benefits the individual and the
system in general promoting efficiencies and alleviating administrative
burdens.

An integrated Medicare/Medicaid system will also benefit healthcare
providers who, like dually eligible members, face the challenges and
confusion of navigating an otherwise fragmented system. Promoting
efficiencies and alleviating administrative burdens for providers is critical to
maintaining adequate networks and access to care.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Access,
Accommodations and The ADA
Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Providing Health Care
1. I attest that I have taken the ADA course or a similar version(within the
past 12 months). It covered 'The Americans with Disability Act' and its
prohibitions against discrimination of individuals with disabilities. In addition it
explored
 Rights of the disabled to receive care in the most integrated setting, and
when public accommodations are necessary,
 The impact that personal prejudices and barriers have on communication,
understanding and health care outcomes,
 Ways to promote independent living for disabled individuals

I agree

I disagree
2. Where have you taken the ADA course or similar version of the course?

Anthem

Humana
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: The ADA & Olmstead


In Olmstead vs. L.C., the Supreme Court ruled that disabled people have “the
right to receive care in the most integrated setting appropriate and that their
unnecessary institutionalization was discriminatory and violated the ADA.” This
ruling created several home and community based services (HCBS) programs
and started a transition movement.
Transition involves the transfer of individuals from skilled nursing facilities
(SNF) to a HCBS location and requires the SNF and the local contact agency
(LCA) to investigate and resolve resident complaints about:
 movement into the community,
 supporting residents in their decision-making to leave a SNF,
 providing residents information and education about their rights and options,
and
 identifying appropriate candidates and making the necessary referrals to
LCAs.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Prejudices & Myths

When addressing the provision of effective health care for patients with disabilities,
the place to begin is by taking a look at personal prejudices – discovering and
mitigating filters, myths and assumptions. Prejudices and myths create barriers in
understanding, communication, and improved health care. Challenge your first
impressions when first meeting a disabled patient.

MYTHS: People with disabilities live very different lives than people without
disabilities. A person’s disability defines who they are as an individual. People with
disabilities are sick and in constant pain.

Prejudices and assumptions may also be made when a person presents with a
disability that is misunderstood. For example, people with speech impediments are
often thought to cognitive disability or mental illness.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Providing Health Care



The reason this chapter is so important is because patients with disabilities or
limited English proficiency often perceive that their physicians do not listen to
them, explain treatment options, treat them with respect, spend enough time
with them, and/or involve them in the treatment decisions.
Part of the disconnect stems from a lack of understanding on how to
communicate with individuals with certain disabilities and what auxiliary aids are
available to improve communication.
The law requires that a public accommodation must provide auxiliary aids and
services when they are necessary to ensure effective communication with
individuals with hearing, vision, or speech impairments.
"Auxiliary aids" include such services or devices as qualified interpreters,
assistive listening headsets, television captioning and decoders,
telecommunications devices for deaf persons (TDD's), videotext displays,
readers, taped texts, Braille materials, and large print materials.
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Providing Care/Literacy

The following populations are at high risk for limited literacy and/or competency skills. Many patients in these
groups have well-developed skills; however, others struggle with health literacy. It is critical to their health
care that their physicians uncover and address their needs.

Elderly
Low-income
English as a second language
Deaf or hard of hearing
People with learning disabilities
Individuals who did not graduate from high school
Recent immigrants
Individuals with unique health challenges







Tools that can help determine literacy levels include but are not limited to:

ABLE: Adult Basic Learning Examination

LAD: Literacy Assessment for Diabetes

NLS: Nutritional Literacy Scale

REALM: Rapid Assessment of Adult Literacy in Medicine

TOFHLA: Test of Functional Health Literacy in Adults
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Providing Care/Language
Medicaid regulations require that the primary language spoken by each individual be
identified at the time of enrollment and that each managed care member be provided
with the names of contracted providers that speak languages other than English in the
patient’s service area. Additionally, Medicaid regulations require states to make
oral interpretation services available and require that each MCO make these services
available free of charge to each patient and potential patient.

In all cases, MCOs are required to consider the needs of patients who may require
alternative methods of communication, such as patients with visual impairments, and
provide communication services necessary to accommodate these patients. MCOs must
provide communication materials in all of the prevalent languages within the MCO’s
service areas. Plans that cover service areas with a significant non-English-speaking
population are required to provide written patient materials in the language of these
populations.

The Rehabilitation Act Title 508 states that individuals with disabilities must have
access to and use of information and data that is available to patients of the public who
are not disabled.

Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Providing Care/Chronic Conditions
One critical piece of information regarding providing health care to
patients with disabilities is understanding the risk among the
disabled population to suffer from chronic conditions. As a provider, it
is important to understand that the risk of suffering from multiple
chronic conditions is much higher among patients with disabilities.









Elderly or Disabled with the Consumer Direction waiver
Intellectual/developmental disabilities
Cognitive or memory problems
Physical or sensory disabilities
Residing in nursing facilities
Serious and persistent mental illnesses
End stage renal disease
Complex or multiple chronic conditions
Anticipated long-term service and support needs in the future
Virginia Commonwealth University Health System Health Plan Division
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Access

In order to function effectively and safely in jobs, education, and everyday
life, people with disabilities have to have physical and social access to the
same spaces, employment, goods, services, entertainment, and community
participation that everyone else does. When that’s the case, their
disabilities don’t limit their ability to fully participate in life.

This session provided information regarding access to communication,
information, programs and services and suggested means of providing
access through technology:

Readers

Internet

TTY and TDD equipment
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Access

The ADA requires businesses and other public facilities to allow service
animals to accompany people with disabilities on their premises, and
forbids excluding people with service animals or isolating them from other
customers. Making this type of accommodation for individuals builds
confidence, increase self-sufficiency and integration into the community.

Once members with special health care needs are identified, Medicaid
regulations require that MCOs conduct an assessment of each special
needs member to identify conditions that require regular treatment and
monitoring, and provide these members with programs, processes, and
accommodations that enable patients to have access to health care
providers who specialize in that condition.
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Barriers
In this session, a multitude of barriers were discussed including:

Attitude

Lack of Services

Ineffective Communication

Language

Emotional issues and lack of confidence
Also discussed were barriers and regulations surrounding physical access. Under the ADA, it is
expected that the government body, the owner or tenant of the space, the service provider, the
employer, etc. make a “reasonable accommodation” to enable access for people with
disabilities. A reasonable accommodation is an adjustment to whatever barrier prevents access
that doesn’t impose an undue hardship on the individual, business, organization, or institution
providing the accommodation, or on its other users or participants.
Ways in which to make these accommodations were explored in this chapter.
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Accommodations

Another aspect of accommodations
is providing a disabled individual with
options for independent living.


Consumer direction ranges from the
individual independently making all
decisions and managing services
directly, to an individual using a
representative to manage needed
services.
1.
People with disabilities have a
unique understanding of their
personal care needs.
2.
Many patients are competent to
oversee the delivery of personal
care and services.

Individuals have the primary authority
to make choices that work best for
them, regardless of the nature or
extent of their disability or the source
of payment for services.
Virginia Commonwealth University Health System Health Plan Division
3.
Existing models vary; however, all
models of consumer direction reflect
three central beliefs:
Service recipients – rather than
service providers – have a right to
control the personal care services
that significantly affect their day-today existence.
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Disability Literacy: Access, Accommodations
and The ADA
Course Summary: Conclusion

Challenge your perceptions, prejudices and commonly held myths

Familiarize yourself with the populations most often impacted by the stigma
of “disabled”

Use tools and techniques to identify literacy – not assumptions and
preconceived generalities

Fine tune your key communication skills

Audit your office and your staff against the barriers introduced in this
session and remove as many as possible

Talk to patients about their perceptions of communication and treatment in
order to continually improve your approach
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Health Literacy: Caring For Our
Members & Patients
Health Literacy: Caring For Our Members &
Patients
Course Summary: Wellness Principles


Wellness principles revolve around a holistic philosophy and active lifestyle
that helps members achieve their maximum health potential. Therefore the
principle of wellness is focusing on the mind and body. Wellness principles
focus on a medical approach that doesn’t wait for someone to show signs
of illness before taking action.
Virginia Premier’s medical management staff partners with members to
achieve a positive impact on their wellness through educational
opportunities, screenings, and programs that are geared toward helping
members improve and then maintain their health. Initiatives include but are
not limited to:
 Annual influenza and pneumococcal vaccines
 Preventative services for the management of chronic conditions
 One-on-one counseling
Virginia Commonwealth University Health System Health Plan Division
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Health Literacy: Caring For Our Members &
Patients
Course Summary: Wellness Principles


Primary Care Physicians and Specialists (as needed) will be a part of each
member’s Interdisciplinary Care Team. The care manager, member and
physician will work together to develop an individualized wellness plan for
each enrollee. However, in order for members to achieve the best possible
outcomes, they need to understand their responsibility in taking charge of
and participating in their own personal wellness.
Virginia Premier’s goals center around continuous improvement in each
area of member wellness, with the ultimate goal of helping members reach
their maximum health potential. Improvements include but are not limited
to:
 Improving access to essential services and affordable care
 Improving coordination of care through an identified point of contact
 Improving seamless transitions of care across healthcare settings
 Improving access to preventative health services and assuring
appropriate utilization of services
Virginia Commonwealth University Health System Health Plan Division
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Health Literacy: Caring For Our Members &
Patients
Course Summary: Wellness Principles

Person-centered planning is a process directed by the family or the
individual and is intended to identify the strengths, capacities, preferences,
needs and desired outcomes of the individual.

The goal is to have the needs directed by the member or by the family. if
appropriate. Goal setting is primarily the responsibility of the member.

Participants in the person-centered planning process can utilize a mix of
paid and non-paid services and supports that will assist them achieve
personally-defined outcomes.

Virginia Premier care managers will work with members and their
Interdisciplinary Care Team to create, review and update a Plan of Care.
Virginia Commonwealth University Health System Health Plan Division
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Health Literacy: Caring For Our Members &
Patients
Course Summary: Person-Centered Planning

Person-centered planning is a process directed by the family or the
individual and is intended to identify the strengths, capacities, preferences,
needs and desired outcomes of the individual.

The goal is to have the needs directed by the member or by the family. if
appropriate. Goal setting is primarily the responsibility of the member.

Participants in the person-centered planning process can utilize a mix of
paid and non-paid services and supports that will assist them achieve
personally-defined outcomes.

Virginia Premier care managers will work with members and their
Interdisciplinary Care Team to create, review and update a Plan of Care.
Virginia Commonwealth University Health System Health Plan Division
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Health Literacy: Caring For Our Members &
Patients
Course Summary: Person-Centered Planning

The care manager will include input from the ICT to create the plan and
serve as a single point of contact for the member.

The Plan of Care should be based on health outcomes important to the
member, and all plans are to be both comprehensive and holistic.

An important aspect of person-centered planning is the concept of a
community presence in the member’s life. Other important concepts
include self-direction and a focus on the member’s talents and gifts.

Person-centered planning is not a one-time event. It is an ongoing activity
requiring caregivers to listen, learn and lend support to the member while
he/she is on this journey.
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Health Literacy: Caring For Our Members &
Patients
Course Summary: Independent Living

Independent living is the belief that each person with a disability is unique, has
the same civil rights as people without disabilities, and should have equal
access to social and economic services.

Care should be person-centered and support self-direction. Therefore, the
philosophy centers around working with individuals with disabilities so that they
may maintain or take back charge of their own lives and make their own
choices.

The independent living philosophy believes that individuals with disabilities
know their needs best and have the right to determine how they integrate into
the community.
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Health Literacy: Caring For Our Members &
Patients
Course Summary: Independent Living

Centers for Independent Living (CILs) are non-residential, non-profit
facilities that help support this philosophy through a variety of services.

CILs provide services for individuals with varying degrees of disability
including those with significant disabilities and/or challenges.

Services provided include but are not necessarily limited to:
 Independent living skills
 Peer to Peer mentoring
 Financial, Accessibility, and Waiver services
 Self-determination
Virginia Commonwealth University Health System Health Plan Division
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