COMMON QUESTIONS ASKED REGARDING MENTAL HEALTH SERVICES IN KEOKUK COUNTY.

????????????????????????

· CPC” WHAT IS IT AND WHO IS IT?

In 1995 legislation went into effect requiring counties to put in place a central point of coordination process for their mental health services.  The central point of coordination process is the county’s way of assuring that persons with disabilities (who meet certain requirements) receive essential services and supports within the limits of the mental health budget.  The county has a central person to coordinate and oversee that these services and supports are provided in a manner which makes sense and is within the guidelines of the budget.  The person who does this job is often called the “CPC”.  Keokuk County employs Jesse Hornback as the CPC.

· HOW TO CONTACT THE CPC?

Jesse Hornback works in the Keokuk County Courthouse.  His office is next to the elevator on the 2^nd floor.  Jesse can be reached at 641-622-2383.  The office hours are 8:00 - 4:00, Monday through Friday.  It is best to cal land set up an appointment if you would like to talk or meet with Jesse.  Applicants are encouraged not to leave their jobs in order to meet with the CPC.  Efforts will be made to work with schedules so that appointments can be made.  Your questions and concerns are welcome and appreciated.

· WHO ARE CONSUMERS?

Consumers are persons who receive services.  Keokuk County funds consumers with the following disabilities: mental illness, chronic mental illness and mental retardation.  General definitions are listed below.  The Keokuk County Mental Health Management Plan includes definitions which are more specific and are used in making eligibility decisions.  Please direct specific questions regarding the Mental Health Plan to the CPC.

· WHAT DISABILITIES ARE FUNDED OR ACCEPTED?

1.)           MENTAL ILLNESS (MI) - Mental illness is a disability which involves

significant disturbances in thinking, emotion, and behavior.

2.)           CHRONIC MENTAL ILLNESS (CMI) - Chronic mental illness is a type of mental illness that occurs in a consumer who is 18 years or older.  Generally, consumers with chronic mental illness have undergone one or more psychiatric hospitalizations or have had at least one time in his/her life in which a residential level of care has been necessary.  Consumers with chronic mental illness also have concerns in several of the following areas:  keeping a job, difficulty with social behavior, or needing help with basic living skills.

3.) MENTAL RETARDATION (MR) - mental retardation is a disability which involves the subnormal ability to learn and substantially low IQ (IQ of approximately 70 or below).  Consumers with mental retardation also have difficulty in several of the following areas:  being personally independent, getting and keeping a job, the ability to relate socially with persons of their age and in their cultural group.  Mental retardation is caused during the developmental period and/or in the first years after birth.

· WHAT IS A PROVIDER AND WHO ARE PROVIDERS?

A provider is a person or agency that “provides” a service for consumer(s).Providers must be reviewed by Keokuk County to be sure their costs are reasonable, that they provide a quality service, and that they meet established professional standards.  If a provider meets these guidelines then they are included in the County’s group of providers, which is called the Keokuk County Provider Network.  Keokuk County uses a variety of providers so that the consumer’s service needs are met and so that services can be provided close to the consumer’s home and natural supports.  Some of the local providers include agencies such as First Resources, Southeast Iowa Case Management, New Directions, and WCDC.  For a complete listing, again direct questions to the CPC.

· WHAT ARE THE ELIGIBIITY REQUIREMENTS FOR FUNDING BY KEOKUK COUNTY?

Keokuk County funds services based on the consumer’s disability, essential need level, legal settlement, and funding availability.  The consumer must also meet poverty guidelines.  Listed below are definitions of these requirements.

1.)   DISABILITY

Disability refers to the consumer’s diagnosis of mental illness, chronic mental illness, or mental retardation.  The consumer’s disability needs to be confirmed in writing by a professional.  General definitions of disabilities are on page 1.  Disability eligibility decisions are made by a professional and based on more specific definitions that can be found in the Keokuk County Plan.

2.) ESSENTIAL NEED LEVEL

Essential need level refers to services being provided to help consumers to receive what is necessary to be safe as well as to function at his or her maximum independence level in the community.  Some consumers do have needs requiring institutional placements; these needs are also taken into consideration and funded as appropriate.

3.) LEGAL SETTLEMENT

Legal settlement refers to the county which is responsible for overseeing/providing services to the consumer.  In order to obtain legal settlement a consumer must as an adult live in a county for one year or more without receiving services.  If a consumer has a life long disability then the legal settlement is the same as that of his/her parents when the consumer turns 18 years of age. Other specific conditions that influence legal settlement are outlined in the Iowa Code.  The CPC determines Legal Settlement.  Emergency Services cannot be denied based on legal settlement.  Consumers living in Keokuk County may receive payment of their services from another county if that is where their legal settlement lies.

4.) FUNDING AVAILABILITY

Funding availability refers to not spending more money than is available in the Mental Health Budget.  The Mental Health Budget is required to include money for a variety of essential services so it is important that we look carefully at what

a consumer really needs when making funding decisions.  New consumers request funding assistance every year yet the budget only minimally increases.

· WHAT ARE KEOKUK COUNTY’S RESOURCE LIMITS?

Keokuk County Mental Health uses resource limits the same as SSI; those limits are as follows:

1.  Resources should not exceed $2,000 for a single person, $3,000 per married

     couple.

2.  consumers are allowed one vehicle and a homestead.

3.  Definition of resources and exclusions will follow federal SSI standards

· WHAT ARE THE FEDERAL POVERTY GUIDELINES?

The Keokuk County Mental Health funding eligibility criteria is 150% of the State Established Poverty Guidelines.  See the CPC for more information.

· WHAT TYPES OF SERVICES CAN BE FUNDED?

Keokuk County Mental Health funds a variety of essential services.  More types of services have been added each year to reflect changing needs and new programs that make sense and are cost effective. Some services are “mandated” or required.  “Entitlement” services are mandated.  Entitlement services vary among disability groups but include at times services such as case management.  Other mandated services are those services that are in the Keokuk County Mental Health budget and are provided as necessary based on funding availability.  Keokuk County makes an effort to respect that consumers with different disabilities have different needs.  A significant effort is made to fund needs based on priorities.  Keokuk County is considered the “payer of last resort”; this means that if there is another source available to fund services, it should be used first.  For instance, Vocational Rehabilitation funds should be used when available before Keokuk County funding is used.  It is also important to not duplicate a service, meaning if a service is available to a consumer through another source then Keokuk County should not pay for that service a second time.

Listed below are services potentially funded per disability by Keokuk County:

· MATRIX OF SERVICE ELIGIBILITY ANDUTILIZATION MANAGEMENT CRITERIA

       FOR SERVICE PAID BY KEOKUK COUNTY

SERVICE TYPE	THRESHOLD ELIGIBILITY STANDARD	FINANCIAL ELIGIBILITY STANDARD	SPECIAL CLINICAL CRITERIA	UTILIZATION REVIEW PROCESS
MH Advocate	MI, CMI	None per statute	Chapter 229 commitment status	N/A
Legal Represent.	MI, CMI, MR	Indigent per statute	Commitment	N/A
Evaluation	MI, CMI, MR	No Restriction	Emergency	N/A
Transport-Sheriff	MI, CMI, MR	No Restrictions	Commitment	N/A
Transport-non Sheriff	MR**	Income below 150% poverty	Need for special transp.	Review annually
Outpatient Treatment	MI, CMI, MR	Income below 150% poverty, no 3^rd party payer	Unable to main- tain in community w/o support	Review every six months
Support. Employ. Job Coaching Work Develop.	MI*,CMI, MR	Income below 150% poverty	Benefit from pre- vocation skill develop.	Review every three months
CSALA/SCL	MI*,CMI, MR	Income below 150% poverty	Able to live in comm. W/support.	Review every six months
RCF and RCF/MR	CMI, MR	Medicaid & SSI Eligible	Unable to live in comm. W/o supervision	Review every six months
RCF/PMI	CMI, MR	Medicaid & SSI Eligible	Unable to live in RCF-greater need	Review monthly as needed
Sheltered workshop	MR	Income below 150% poverty	Benefit from pre- vocational skill dev. Not ready for Comm. Emp.	Review every six months
ICF/MR	MR, DD	Medicaid eligible	Medicaid ICF/MR as applied by the Iowa Foundation	Review annually
HCBS-MR	MR**	Medicaid eligible	Need for Service Most cost effective	Review every six months
Sr. Program, Adult Day Care	MR**	Income below 150% poverty	Alternative to workshop	Review every six months
Case Management	CMI, MR,DD	Medicaid Eligible	Medicaid & need	Review annually
Day treatment, partial hospitalization	CMI, MI	Medicaid Eligible	Need for Service Most cost effective	Review every six month
Work Activity	MR**	Income below 50% poverty	Alternative to workshop	Review every six months
ARO	CMI	Medicaid Eligible	Need for Service Most cost effective	Review every six Months

Vocational limitations are as follows:  consumers employed in the community including enclavesfor 10 hours or more per week, will not be eligible for sheltered workshop or work activity services paid by the county.  Those consumers in workshop services, funded by the county, must have community employment as a goal.  Sheltered workshop services will be funded for a period of

eighteen (18) months per lifetime, to prepare the consumer for community employment.  If

community employment has not been obtained within 18 months, Keokuk County will discontinue workshop funding.  However, Pre-Vocational, work activity, adult day care or other day programming may be funded, however, there will be no community employment goals.  The decision to access alternative options after discontinuing funding of Shelter Workshop services shall be agreed upon by the team of the individual and as approved by the CPC Administrator. If a consumer obtains employment in the community but loses the job for any reason other than non-cooperation of the consumer, unexcused absences, or other just causes brought on by the consumer the consumer may return to the workshop for the remainder of the 18 month time frame, if the consumer has not used the entire 18 month workshop funding.  Keokuk County will fund only those days actually attended by the consumer, vacation, sick leave or holidays will not be paid under work activity and adult day care.  An attendance sheet or time sheet must accompany the bill each month verifying attendance.

*Non-Sheriff Transportation for employment purposes will be considered by need on a case by case basis and will only be available to those consumers with a MR diagnosis at this time as long as funding levels allow for such costs.  In the case of budget constraints, as this service is not mandated by either federal or state code, this service would be evaluated and either reduced, suspended, or eliminated.  At that time, the individual for which transportation would be provided, would either need to fund the service privately or find an alternative.   It may also be a possibility for the individual and the provider with whom they work to reach an agreement where transportation is provided by said provider.   It is noted that an exception can be approved by the CPC Administrator in extreme special circumstances.

*Job Coaching and/or Supported Employment will be funded after all other funding sources have been exhausted i.e.,Vocational Rehabilitation, etc.  This may continue on an on-going basis based on need and approval of the individual’s team and approval of the CPC Administrator.  Job development will be funded for a maximum of six months. Enclave employment will be funded a maximum of six (6) months for the purpose of obtaining job skills necessary for employment.

*Job coaching, supported employment, or Job development for MI individuals may be funded on a short-term basis up to $500.00 maximum per lifetime.  Vocational Rehabilitation or other funding sources must be accessed before any funding will be authorized as the county is a payer of last resort.

* MI individuals may be funded for CSALA/SCL on a short-term basis with a maximum of $500.00 per lifetime.

5.) HOW DO I APPLY FOR SERVICES?

If a new consumer would like to receive services, the first step is to fill out a CPC Application.  Applications are available at access points in the community.  These can include the CPC, Southeast Iowa Case Management, Mental Health Centers, Department of Human Services, Mental Health Institutes, Hospitals, and possible to court system.  The consumer may fill out the application, someone may come along to help, or the CPC can help.  Applications available at the listed agencies have staff that will assist in completing the application.  It is helpful if you let us know what services are needed.  Once the application is complete, legal settlement will be determined, verification of the disability will be done and financial eligibility will be determined.  A “Notice of Decision” will be sent within 7 days with the decision of eligibility and what services are approved for funding.  If the consumer is not eligible, the “Notice of Decision” will indicate the reason.

6.) WHAT HAPPENS DURINGROUTINE AUTHORIZATION OF SERVICES AND/OR MAKING SERVICE CHANGES?

All services, which are not emergency psychiatric hospitalizations, must have pre-authorization through Keokuk County funding agreements.  A funding agreement is a type of contract between Keokuk County, the provider and the consumer that explains how much service the county will pay for and at what cost.  Funding agreements are usually for a six month period.   

Most changes in service are requested when there is a “staffing” or a meeting with those persons who work closely with the consumer.  It is important especially for case managers to let the CPC know if consumer needs a change in services.

7.) ARE SERVICES OFTEN REDUCED AND IS THERE A WAITING LIST?

Generally services are not reduced if they continue to be needed.  A reduction in services could occur if the demand for services exceeded the budget allocation.

There are times when a consumer’s services are changed or reduced because the consumer’s level of need changes.  For instance, if a consumer has reached their maximum potential in a sheltered workshop, then the workshop hours may be decreased and supported employment hours may be added.  This change would help the consumer to gradually move into a more independent job and is considered a sign of progress both on the part of the consumer and the provider.

So far it has not been necessary for Keokuk  County Mental Health to use a waiting list.  It is important that we work together to be sure that consumers request and receive only those services that are essential.

8.) HOW DO I HANDLE SERVICE CHANGES THAT I DON’T AGREE WITH?

If a decision is made by Keokuk County to stop the consumer’s services or

change services and you do not agree with this decision, then as a consumer, parent of a consumer if under 18, or as a guardian, you have the right to appeal that decision.  The appeal process gives the opportunity to have the Keokuk County Board of Supervisors take another look at the situation and potentially make a different decision.  If in disagreement with the Keokuk County Board of Supervisors, there is a three member Appeals Board appointed by Keokuk County, Jefferson County, and Van Buren County that will hear appeals beyond that of the Keokuk County Board of Supervisors.  This is the final step in the appeals process.  If the appeal process is chosen then there are specific steps to take and the CPC will go over these steps with you.  During an appeal you can present your situation yourself or have someone represent you at your own cost.  Although the appeal process is available, it is hoped that through open communication it will seldom be necessary.  If a decision is made by the CPC that you don’t understand or agree with, the first recommended step is to talk to the CPC to get a better understanding of the situation.

9.) WHAT IF A PSYCHIATRIC HOSPITALIZATION IS NECESSARY?

If a consumer is in serious danger of self-harm or harming someone else, then a psychiatric hospitalization may be necessary.  Being in serious danger of self-harm or harming someone else means that the consumer is likely to  physically injure himself/herself or another person, is likely to inflict serious emotional injury on a family member or someone else, or is unable to satisfy his/her need for nourishment, clothing, medical care, or shelter so that it is likely the consumer will suffer physical injury, debilitation or death.

Psychiatric hospitalizations can either be voluntary or based on a court commitment.  Listed below is the hospitalization process for consumers whose costs are payable in whole or in part by Keokuk County.

10.) WHAT HAPPENS DURING A VOLUNTARY PSYCHIATRIC HOSPITALIZATION?

If a consumer realizes that he or she is in danger of self-harm or harming someone else, then the consumer should call the closest community mental health center and make arrangements for a “prescreening for a hospitalization”.  This means that the consumer will talk to a professional at the mental health center and the professional will determine if being admitted to a hospital for psychiatric services is necessary or if other services or supports would meet the consumer’s needs.  If a hospitalization is necessary, then the mental health professional will help to coordinate paperwork with the hospital and Keokuk County Mental Health.  Keokuk County’s local mental health center is New Directions.   The hospitals authorized for use by Keokuk County Mental Health are the University of Iowa Hospitals and Clinics and the  Mental Health Institutions (particularly Mt. Pleasant or Independence).  Transportation to the hospital for a voluntary admission is not paid for by Keokuk County Mental Health.

11.) WHAT HAPPENS DURING A INVOLUNTARY PSYCHIATRIC HOSPITALIZATIONS/COURT COMMITMENT?

Any interested person can file an application to involuntarily commit a consumer if it is believed that the consumer is in serious danger of self-harm or harming someone else.  In order to begin this process, the interested person must go to the Clerk of Court’s office at the county courthouse in the county of the consumer’s residence or where the consumer is presently located.  To file an application, the interested person will also need a written statement by a licensed physician that supports the application or one or more sworn witness statements that support the application.  Information known on any insurance that can be used and where the consumer’s legal settlement lies is also helpful.  If the paperwork is filled out in Keokuk County then Jesse Hornback will be called to help complete the forms.  It is realized that filling out this paperwork can be difficult when a person has a close relationship with the consumer, so the CPC will make an effort to help with the process.

After the paperwork is complete, it is forwarded to an available  Judge.  The Judge will investigate the situation to determine the consumer’s needs.  A commitment hearing will be scheduled if the Judge feels this is necessary.  The Judge may determine that the consumer requires immediate hospitalization before the hearing occurs.  With assistance from Jesse Hornback, the Judge will coordinate the commitment process and involved persons will be kept informed.  Arrangements will be made as necessary for legal representation, transportation by a sheriff, and representation by a consumer advocate.  Most of the time, consumers are court committed to the University of Iowa Hospitals and Clinics or a state Mental Health Institute (particulary Mt. Pleasant MHI); occasionally commitments are also made to  another hospital such as Ottumwa Regional Health Center depending on insurance and financial circumstances.