Mental Health & Substance Use

PERSON-CENTERED
      MEDICALLY NECESSARY

Trillium serves approximately 26,250 adults and children annually who seek services 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.

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Trillium requires priority admission to all women who are pregnant and injecting drugs, pregnant and using substances and other individuals who are injecting drugs.

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Care Coordination

Care Coordination is important to Trillium.  It focuses on finding the right services for each person. Care Coordinators use assessments to figure out all the behavioral health services that may be medically necessary, assist with linking to primary health care, and identifying natural and community support services  for a person. When calling our 24-Hour Access to Care Line, everyone gets some level of care coordination when speaking to one of our call center agents.

An assigned Care Coordinator works with people who need intensive services such as individuals recently hospitalized with MH/SU diagnoses and children at risk of out-of-home placement.. Through phone calls or in person meetings, Care Coordinators may help people and families in the following ways:

Basic benefit services include outpatient treatment: 

• Assessment and psychological testing
• Medication Management 
  • Service to help a person understand their medication and dosage to avoid hospital readmission.
• Individual, family and group therapy
• Behavioral health counseling

Per Clinical Coverage Policy 8-A, Enhanced benefit services include:

• Assertive Community Treatment Team (ACT) - A community-based treatment team of medical, behavioral health, and rehabilitation professionals that works to meet the needs of a person with severe and chronic mental illness. The ACT team is a single point of contact that can adjust services to meet the needs of the individual as they change over time to help meet their goals.
• Day Treatment - Treatment through structured, daily activities that helps young people and their families build on strengths and addresses identified needs. Settings take the place of traditional school or work locations.
• Diagnostic Assessment - A test which helps figure out the best fit for a person among a choice of programs, projects, or treatment plans. The evaluation covers the general health history, any symptoms, progress notes, medications taken, and more. 
• Intensive Alternative Family Treatment (IAFT) - Treatment plan for young people whose challenges require out of home care. Treatment also involves training for the family.
• Intensive In-Home Services (IIH) - Service that provides around-the-clock team support to help the needs of young people and adults in order to keep them living in their communities.
• Multi-Systemic Therapy (MST) - Treatment that works to decrease anti-social behavior in youth at risk of out of home placement or who have been in the juvenile detention system. MST involves the families, schools, probation officers, and community supports.
• Community Support Team (CST) - A team of community-based MH/SU rehabilitation services and supports for adults with MH/SU disorders who have significant treatment needs in achieving recovery goals. CST helps ensure individuals connect with community services and resources while building interpersonal skills.
• Peer Support Specialist Services - Person-centered supports which guide, provide input, and encourage people to take ownership of their recovery and function in their community. 
• Psychosocial Rehabilitation - Mental health services for those with psychiatric disabilities designed to lower problems in social settings related to psychosis. It helps the individual develop community living skills, personal care, social relationships, and educational activities.
• Partial Hospitalization - A short-term mental health service for children or adults which provides a broad range of approaches that may include: group or single person activities or therapy, recreational therapy, community living skills training, or medical services.
• Facility Based Crisis - Short-term services to help a person who has serious behavior symptoms and requires treatment in a 24-hour residential facility. Services help stabilize individuals in crisis to help prevent hospitalization. 
• Mobile Crisis Management (MCM) -  Allows people to access help through the telephone in serious mental health situations. MCM offers immediate response, stabilization, and prevention activities by sending clinicians to an individual’s home, office, or school setting.
• Outpatient Opioid Treatment (OOT)  - A service to help a person make lifestyle changes through appropriate medications such as Methadone, rehabilitation and medical services.
• Substance Abuse Intensive Outpatient Program (SAIOP) - Intensive treatment options at least three days a week for people and groups to help begin recovery through counseling and life skills support. 
• Substance Abuse Comprehensive Outpatient Program (SACOT) - Short-term treatment service for adults who require controlled environments to stay in recovery and allow individuals to continue living in their communities.
• SA Medically Monitored Community Residential Treatment - A non- hospital rehabilitation facility for adults, with twenty-four hour a day medical or nursing monitoring, where a planned program of professionally directed evaluation, care and treatment for the restoration of functioning for individuals with alcohol and other drug problems or addiction occurs.

Services are only authorized (approved) when medically necessary. Medical necessity is care that is appropriate for the prevention, diagnosis, or restorative treatment of a mental health illness, substance use disorder, or intellectual/developmental disability.

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Utilization Management (UM)

UM Care Managers review Treatment Authorization Requests (TARs) for medical necessity. In most cases, UM Care Managers review the TARs before a member receives services. UM Care Managers follow the rules of Trillium and the state when they review TARs. 

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)