1. health and fitness

MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
I. Present Managed Care Involvement
Percentage of current reimbursement for services coming from managed care
Less than 10%
10 to 25%
26 to 50%
51% to 75%
More than 75%
I do not know/Not applicable
Insurance coverage for your current service enrollees
___% Medicaid Only
___% Medicare and commercial insurance
___% Medicaid and Medicare
___% Commercial insurance
___% Medicare Only
___% No Coverage
Please identify which types of programs your agency operates (check all that apply)
OMH (Office of Mental Health)
OASAS (Office of Alcoholism and
Substance Abuse Services)
Both OMH and OASAS
OCFS
Other (please specify): ___________
I do not know/ Not applicable
This assessment was completed by:
This readiness assessment is being filled out for an agency that provides services in which
COUNTY OR COUNTIES?
Please specify: _______________________________________________________________________
____________________________________________________________________________________
II. Early Identification and Screening
Please list the screening and evaluation tools used in your program for children and families (e.g.,
the CBCL, GAIN, BDI, PHQ). If your program does not use any screening tools, please indicate by
writing “NONE” in the space provided below.
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
III. Treatment Models and Evidence-Based Practices
Please list the specific treatment models used in your program currently (e.g., CBT, TF-CBT, FFT,
MST, 7 Challenges, 12-Step Facilitation, etc.). If none, please indicate by writing “NONE” in the
space provided below.
IV.Outcome Measures and Tracking
How does your program track client progress and outcomes? Please list any measures you utilize to
track outcomes (standardized or non-standardized). If none, please indicate by writing “NONE” in
the space provided below.
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
V. Agency Assessment of Service Array
Please indicate whether you provide each of the services listed within your organization:
Service
STATE PLAN SERVICES
If yes, what services do you provide and who provides this
service? (list services, number of staff, and their credentials)
If no, do you collaborate
with others (e.g., outside
agencies) to provide these
services?
Crisis Intervention Services - provided to a child
and his/her family/caregiver who is experiencing a
psychiatric or substance use crisis, are designed to
interrupt and/or ameliorate a crisis experience
including an assessment, immediate crisis
resolution and de-escalation, and development of a
safety plan. Example services: Crisis Response,
Immediate Crisis Response
YES
NO
Community Psychiatric Treatment and
Support Services - goal-directed supports and
solution-focused interventions intended to achieve
identified goals or objectives as set forth in the
child’s plan of care. Example services: Intensive
In-Home Services; Crisis Avoidance,
Management, and Training; Evidence Based
Practices; School-Based Interventions
YES
NO
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
If yes, what services do you provide and who provides this
service? (list services, number of staff, and their credentials)
If no, do you collaborate
with others (e.g., outside
agencies) to provide these
services?
Psychosocial Rehabilitation Services - work with
children and their families to implement
interventions outlined on a treatment plan to
compensate for or eliminate functional deficits and
interpersonal and/or environmental barriers
associated with a child/youth’s behavioral health
needs
YES
NO
Family Peer Support Services - array of formal
and informal services and supports provided to
families caring for/raising a child who is
experiencing social, emotional, developmental,
substance use and/or behavioral challenges
provided by a peer with lived experience
YES
NO
Youth Peer Advocacy and Training Services –
services that provide the training and support
necessary to ensure engagement and active
participation of the youth in the treatment planning
process and with the ongoing implementation and
reinforcement of skills learned throughout the
treatment process by a youth peer with lived
experience
YES
NO
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
HOME AND COMMUNITY BASED
SERVICES (HCBS)
Care Coordination - activities that will support
engaging children and families in care and
promoting continuity of care; assessment of needs;
creating an individualized, child and
family/caregiver centered plan of care;
coordinating and arranging for the provision of
services; building the family or caregiver’s natural
supports; and monitoring and evaluating a child
and family or caregiver’s needs
Habilitative Skill Building - provided to the child
and the child’s family/caregiver to support the
development and maintenance of skills sets,
utilizing an individualized, strength based
approach in assisting the child in recognizing
his/her functional assets/strengths and those that
need developing.
Family Caregiver Supports and Services enhance the child’s ability to function as part of a
family/caregiver unit and enhance the
family/caregiver’s ability to care for the child in
the home and/or community
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If yes, what services do you provide and who provides
this service? (list services, number of staff, and their
credentials)
If no, do you collaborate with
others (e.g., outside agencies)
to provide these services?
YES
NO
YES
NO
YES
NO
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
If yes, what services do you provide and who provides
this service? (list services, number of staff, and their
credentials)
If no, do you collaborate with
others (e.g., outside agencies)
to provide these services?
Crisis Respite - short-term care and intervention
strategy for children and their families as a result
of a child’s mental health/substance use crisis
event, medical crisis or trauma that creates an
imminent risk for an escalation of symptoms
without supports and/or a loss of functioning
YES
NO
Planned Respite - short-term relief for
family/caregivers that are needed to enhance the
family/caregiver’s ability to support the child’s
functional, mental health/substance use disorder
and/or health care issues
YES
NO
Prevocational Services -individually designed to
prepare a youth to engage in paid work, volunteer
work or career exploration
YES
NO
Supported Employment - individually designed
to assist youth with severe functional challenges to
engage in paid work or volunteer work.
YES
NO
Community Advocacy and Support - improves
the child’s ability to gain from the community and
educational experience and enables the child’s
environment to respond appropriately to the
child’s disability and/or health care issues
YES
NO
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
If yes, what services do you provide and who provides
this service? (list services, number of staff, and their
credentials)
If no, do you collaborate with
others (e.g., outside agencies)
to provide these services?
Non-Medical Transportation - offered, in
addition to any medical transportation furnished
under the 42 CFR 440.17(a) in the State Plan.
Non-medical Transportation services are
necessary, as specified by the service plan, to
enable participants to gain access to authorized
services that enable them to integrate more fully
into the community and ensure the health, welfare,
and safety of the child/youth
YES
NO
Day Habilitation Services - assists children with
developmental disabilities with the self-help,
socialization, and adaptive skills necessary for
successful functioning in the home and community
when other types of skill-building services are not
appropriate
YES
NO
Adaptive and Assistive Equipment - provides
technological aids and devices that can be added to
the home, vehicle, or other eligible residence of
the enrolled child to enable him/her to accomplish
daily living tasks that are necessary to support the
health, welfare, and safety of the child
YES
NO
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
If yes, what services do you provide and who provides
this service? (list services, number of staff, and their
credentials)
Accessibility Modifications - provides internal
and external physical adaptations to the home or
other eligible residences of the enrolled child that
are necessary to support the health, welfare, and
safety of the child
Palliative Care - set of services offered to help
families deal with end-of-life related issues due to
child’s illness. Types of services included:
Family Palliative Care Education (Training);
Bereavement Therapy; Pain and Symptom
Management; Expressive Therapy (Art, Music and
Play); and Massage Therapy
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If no, do you collaborate with
others (e.g., outside agencies)
to provide these services?
YES
NO
YES
NO
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
VI.
Trauma Informed Care Principles
In our agency,
Strongly
Agree (1)
Agree
(2)
Neutral
(3)
Disagree
(4)
Strongly
Disagree
(5)
Not
applicable/ I
don't know
(6)
We have a system in place to orient families to the rules and expectations of the program. (1)
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We train and supervise staff on trauma informed principles and practices. (2)
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We have a system in place to ensure that our physical environment is safe and welcoming for
consumers. (3)
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We develop rules and regulations that are sensitive to the needs of caregivers and children
who have experienced trauma. (4)
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We have a system in place to ensure that the suggestions, needs, and perspective of families,
informs the decisions we make. (5)
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We have a clearly defined plan or protocol for management of crises with families that have
been clearly communicated to all staff. (6)
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Services focus on ‘what happened to you’ rather than ‘what's wrong with you’. (7)
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We (or collaborating agencies) are implementing at least one evidence-based trauma
treatment approach to help families heal from past traumatic experiences. (8)
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We routinely screen and assess for trauma in caregivers and children (9)
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We have a supervisory process to address the impact of our work on the staff’s emotional
and physical wellbeing. (10)
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MCTAC / CTAC
Medicaid Managed Care (MMC) Readiness Assessment Tool
Addendum for Child-Serving Organizations
Completed by: _______________________________________________________________ Date: _______________________________
Title: ______________________________________________________________________
Agency: ______________________________
E-mail: _____________________________________________________________________
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