PERSON-CENTERED | MEDICALLY NECESSARY
Just as building a strong house requires a variety of materials, building well-being requires community resources, social relationships, and opportunities to thrive. Well-being needs a sturdy foundation at the start to prevent issues and keep it standing through all kinds of weather.
Trillium coordinates services for adults and children to address mental health and substance use (MH/SU) challenges. To ensure people receive the services they need in a timely manner, we employ clinically-trained and licensed staff to manage and authorize those services.
Trillium requires priority admission to all women who are pregnant and injecting drugs, pregnant and using substances and other individuals who are injecting drugs.
Care Coordination and Care Management
Care coordination is a major function at Trillium. It is a proactive, person-centered, assessment-based approach to integrating medically-necessary behavioral health services, primary health care and natural and community social support services. We prioritize finding the right individualized care for the people we serve.
Our Care Management Department includes three regional teams with integrated staff serving members with mental health, substance use, and intellectual/developmental disabilities. Rather than separate groups focused on individual populations, the new arrangement allows for a cohesive structure to facilitate communication around a variety of issues and identify any barriers to a successful recovery.
Individuals who need intensive services are assigned to a Care Coordinator. This includes individuals recently hospitalized with MH/SU diagnoses and children at risk of or placed out-of-home. Most Care Coordination functions occur over the phone. Our team of Care Coordinators assists individuals and families in the following ways:
- Provide education regarding MH/SU, including recovery-oriented supports and natural or community supports;
- Ensure members receive a quality, comprehensive assessment that identifies symptoms and diagnosis, how those symptoms affect daily life, and the person’s strengths and treatment needs;
- Link to community and natural supports;
- Monitor the Person-Centered Plan or Treatment Plan;
- Request and monitor the Crisis Plan developed between the provider and the member;
- Assist in the discharge planning process for individuals hospitalized for behavioral health reasons to ensure success in their recovery;
- Link the member to needed psychological, behavioral, educational, and integrated health care services;
- Assist with coordination of all Medicaid benefits, including primary care engagement;
- Monitor the treatment provided ensuring the health and safety of the member, the person’s satisfaction with care and services, and that services are delivered as specified in the plan;
- Collaborate to address obstacles to successful recovery
Types of services our Care Coordinators assist individuals and families with include:
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Utilization Management (UM)
We have a team of Master’s level licensed clinicians, called UM Care Managers, who review Treatment Authorization Requests (TARs) for medical necessity. In most cases, this is done prior to the provider delivering a service to a member. During the review process our UM Care Managers follow guidelines set forth by state governing agencies and Trillium.
Resources our Care Managers use include:
- Medicaid Clinical Coverage Policies 8A-8P
- B3 Guide
- Enhanced Services Implementation Developmental Therapy (Update #5)
- Intensive Alternative Family Treatment
- American Psychiatric Association (DMS-5)
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