Best and Worst Practices In Private Sector Managed Mental Healthcare

Best (& Worst) Practices In Private Sector Managed Mental Healthcare Part I: Level-Of-Care Criteria May 1999 Compliance
The panelists selected this issue as a major area for review as this problem has a tremendously negative impact on treatment outcomes, AND we discovered that it is used by some vendors as a cause to deny authorization of mental health services. While we commend those criteria sets that listed achieving maximum compliance as an objective, we believe it is a worst practice to use this issue simply as a way to cut costs or "dump" consumers onto the public sector. We also strongly oppose protocols whereby consumers lose desirable services when they decline services they find to be less desirable. In the training guidelines for criteria sets, we identified one best practice that attempts to solve this difficult problem: "In situations where the patient has a history of non-compliance with viable treatment plans, the Care Manager may work with the provider to structure a written treatment agreement for the patient to sign." However, there were many worst practices identified in this area, examples of which are provided below: [Criteria for discharge from acute inpatient care-this one criterion suffices] "The individual, family, guardian and/or custodian is non-compliant in treatment or in following program rules and regulations." We find this statement objectionable in several ways: This is sufficient as a stand-alone criterion, regardless of danger of harm to self or others; A consumer should not be penalized due to family/guardian and/or custodian compliance; and Non-compliance with rules and regulations is excessively harsh-particularly as such non-compliance may simply be symptomatic of a person's mental illness. Please see page 19 and 20 for pertinent examples related to substance abuse (abstinence as compliance, as well as required participation in 12-step programs).		Introduction Key findings "Report card" on information sharing Methodology Development process Comprehensiveness Corporate philosophy Access issues Compliance Child and family issues Substance abuse and co-occurring disorders Cultural competence Provider autonomy Coordination/ consultation among providers Denial notification and appeal processes More observations, recommendations and areas for further study Acknowledgments