Toward a Peer-Driven System FY2013 Plan

Magellan Health Services
ADHS/DBHS Plan Submission
Dr. Richard Clarke, CEO
Shawn Thiele, Deputy CEO
David Covington, VP Adult & Youth Services
Toward a Peer-Driven
System of Care
FY2013 Non-TXIX SMI Funding Plan

Magellan of Arizona NTXIX SMI Implementation and Oversight Plan Page 2
CONTENTS
I. Plan Overview 3
Introduction 3
Plan Highlights 4
II. Budget & Service Expectations 5
NTXIX Funding Distribution for FY2013 Table 7
NTXIX Funding Allocation Rationale 8
Peer Driven System of Care 8
Recovery Empowerment Continuum 10
NTXIX Service Descriptions 11
III. Implementation Plan 20
Communicaton Plan 21
DBHS Parameters and Plans 21
IV. Monitoring and Oversight 25

I. PLAN OVERVIEW
On June 14, 2012, ADHS/DBHS provided Magellan with a letter outlining the allocation of non-TXIX SMI
funding for FY2013; creating an exciting opportunity to advance our system transformation efforts
towards a peer-driven system of care focused on outcomes. Magellan Health Services and our
community of service delivery partners have evolved this implementation and oversight plan based on
analysis of system needs in conjunction with review of expectations articulated in Dr. Laura Nelson’s
letter. We also considered the experience of the past two years, in which non-TXIX individuals with a
serious mental illness have received a very limited benefit within our system of care. We have learned
the following:
1. Based upon a clinical analysis of risk factors, utilization, crisis presentations, community tenure,
independent living and many other elements, we have observed that many individuals fared
well and are realizing better outcomes than they did two years ago;
2. However, we have also observed a group of 5% to 17% of NTXIX SMI individuals who have
struggled without the intensive level supports they received in the past (Assertive Community
Treatment, etc.);
3. Multiple community forums and stakeholder feedback sessions facilitated by ADHS/DBHS and
Magellan Health Services have called for a shift to a peer-driven “system of care” (advancing
beyond peer-driven services);
4. We must have the ability to appropriately encounter for services; and
5. DBHS guidance and court orders shift focus from case manager assignments to case
management as a service with clinical review.
We have carefully analyzed and reflected upon these learnings and considered how to provide
appropriate supports while avoiding caretaking approaches that might undermine recovery and
independence. In addition, over the last several months we have engaged the provider community in a
planning process to prioritize funding and develop consensus about the strategy (with a group including
the Peer-Run Organizations, the Adult PNOs, key GMH/SA agencies and others). We believe the
leadership and guidance from DBHS and this Magellan/community proposal dramatically extends a
recovery approach and moves us toward a “peer-driven system of care” that will achieve far better
outcomes for individuals where they live, work and play. The following table outlines our broad funding
category targets for the $54.4 million FY2013 NT SMI allocation:
Magellan's NTXIX SMI Funding Allocation (excludes $1.7 million for supported housing)
Crisis Services Medications NTXIX Services Total
$9.8 Million $18.2 Million $26.5 Million $54.5 Million
1. The budget includes $1.7 million of State funds for supported housing and an additional $2.5
million of federal funds is leveraged for a total of $4.2 million in supported housing (which
represents 14% of the total NTXIX SMI housing and services budget);

2. Crisis services allocation was set by DBHS at $9.8 million based on last year’s budget;
3. The medication management budget increase of approximately $1 million is based on the
impact of an expanded formulary, projected increase in number of utilizers on brand
medications, trending increase in lab expenditures and the new prior authorization process; and
4. The funding allocation of these first two items left a remainder of $26.5 million for NTXIX SMI
community-based support services.
PLAN HIGHLIGHTS
We see DBHS’s investment in the NTXIX SMI population as an opportunity to re-emphasize our shared
commitment to community integration, independence and self-sufficiency, individualized goals and
outcomes, responsive services, natural supports and recovery. This plan:
1. Offers an enhanced service benefit to individuals in the non-title XIX SMI population;
2. Significantly expands the volume of peer & family member-delivered services with $13.5 million
of new funding (51% of the total allocation);
• 94 FTEs in new peer and family support jobs at the SMI clinics;
• 39% expansion of service funding to peer-run organizations; designed to create new
jobs and shift to more community-based/in-home supports such as ILS and personal
care services that augment existing facility-based programs; and
• RFP opportunities for SMI
family support provider
and respite provider.
3. Augments resources at the human
service campus for individuals
experiencing homelessness;
4. Offers funding flexibility to move
designated service dollars within
the targeted service delivery areas
based on the needs of the
population;
5. Empowers individuals to move
through the system toward ownership and equity of their lives (see Recovery Empowerment
Continuum, page 7); and
6. Establishes a constellation of services to support an individual’s unique recovery journey. The
unique funding allocation and service delivery design features of this plan create an opportunity
for peers to deliver a broader range of services to more people in more settings than ever.

II. BUDGET AND SERVICE EXPECTATIONS
$26.5 million of the $54.5 million DBHS-allocated NTXIX funds is targeted towards the delivery of
services other than crisis, supported housing and medication. Please note that in addition to the $1.7
million of State funds designated to supported housing, Magellan has leveraged an additional $2.5
million in HUD Federal Funds / McKinney Vento Funds for supported housing to total of $4.2 million in
this fiscal year for NTXIX SMI individuals. Our model of service delivery has been crafted to align with the
needs of the target population and the articulated DBHS service-delivery objectives contained within Dr.
Laura Nelson’s letter. The NTXIX SMI Service Funding Distribution for FY2013 table of page 7 outlines
Magellan’s targeted funding allocation for each identified service area, service provider categories and
the number of individuals served by those providers.
FUNDING ALLOCATION FRAMEWORK
Projecting the service utilization pattern for the current NTXIX SMI population is challenging since these
individuals have not been able to access many of the targeted services over the past two years. Within
the NTXIX Service Funding Distribution for FY2013 table of page 8, one will find that a majority of the
funding is allocated to establishing resources (such as peer support) in lieu of a more limited service
category (such as ILS). Those funded resources will then deliver a multitude of service types within the
funded roles. DBHS’s vision to support flexible funding allocations that may adjust between specific
service categories through the fiscal year aligns with Magellan’s view of a model that most efficiently
meets the needs of this population. Potential movement will be based an ongoing need analysis
throughout the fiscal year and proactive dialog with DBHS around the NTXIX SMI population’s monthly
service utilization patterns.
While $2.75 million (10.4% of service dollars)
is dedicated to the delivery of independent
living skills (ILS) training and personal care, the
allocation of (1) $1.93 million for peer support
within the PNOs, (2) $3 million for peer-run
organizations, (3) $1.38 million for peer-
delivered health promotion, and (4) $400,000
of peer-delivered permanent supportive
housing support all contribute additional peer
resources that may provide support for ILS
and personal care issues based on need;
resulting in a range of $2.75 million (10.4%) to
$9.5 million (36%) for ILS and personal care for the NTXIX SMI population. Please note that living skills
training represents 24% of peer-run organization encounters during the past year. That would lead to a
projection that $730,000 of their allocated $3 million would go towards the delivery of living skills
training. Please see the table of the following page for a listing of potential peer-delivered service codes.
ILS &
Personal
Care Svc
Peer Run
(Dedicated
ILS Funds)
Peer-
Delivered
Health
Promotion
Peer Run
(From $3M
in Funds)
Peer
Support at
PNO
Provider
Community

Services Available Under a Peer Support Staff Member
Code Description Code. Description.
H0038 Self-Help/Peer Services (individual) H2027 Psychoed. Services (Pre-Job Training & Dev.)
H0038 HQ Self-Help/Peer Services (Group) S5110 Home Care Training, Family (Family Support)
H0043 Supported Housing S5150 Unskilled Respite Care (15 min)
H2014 Skills Training and Development - Individual S5151 Unskilled Respite Care (per diem)
H2014 HQ Skills Training and Development - Group T1016 HN Case Management, Office
H2016 Comprehensive Community Support Services (Peer Support) T1016 HN Case Management, Out of Office
H2017 Psychosocial Rehabilitation Services (Living Skills Training) T1019 Personal Care (15 min)
H2025 Ongoing Support to Maintain Employment (15 min) T1020 Personal Care (per diem)
H2012 Supervised Behavioral Health Day Treatment H2015 Comprehensive Community Sup. Day Prg.
H2026 Ongoing Support to Maintain Employment (per diem) S0215/AO120 Transportation Codes (Restrictions Apply)
SUPPORTED HOUSING
Magellan is committed to the delivery of supported housing through practices that align with the
SAMHSA evidence-based practice of Permanent Supportive Housing. The $1.7 million referenced in this
plan will be augmented by the leveraging of $2.5 million in HUD Federal Funds / McKinney Vento Funds
for a total of $4.2 million dedicated to supported housing. This funding will be used to (1) provide
housing to 107 NTXIX SMI individuals and their families and (2) provide housing support to the 292
NTXIX SMI individuals currently housed through ABC. For many people who have been homeless or
marginally housed and living with a serious mental illness, affordable housing combined with supportive
services has proved to be the link to stability and an enhanced quality of life. As its name implies,
permanent supportive housing is the following:
1. Permanent: Tenants may live in their homes as long as they meet the basic obligations of
tenancy (such as paying rent);
2. Supportive: Tenants have access to the support services that they need and want to retain
housing; and
3. Housing: Tenants have a private and secure place to make their home; just like other members
of the community with the same rights and responsibilities (SAMHSA).
Please refer to Magellan’s SFY2013 Housing Spending Plan and Summary, which was submitted for DBHS
review on June 29, 2012, for a more detailed view of the supported housing plan. The remainder of this
plan focuses on the supportive services ($26.5 million) which augment the bricks and mortar as well as
administrative elements necessary to acquire and keep affordable housing. All of these services
contribute to the supportive element of the permanent supportive housing model. Magellan believe
that the combination of funding allocations defined within the following NTXIX SMI Service Funding
Distribution for FY2013 table (next page) and the fiscal flexibility of the plan contribute to delivery of
services in a manner consistent with the evidence-based practice. It could be said that the entirety of
this FY2013 NTXIX SMI budget supports permanent supportive housing as defined above by SAMHSA.

NTXIX SMI Service Funding Distribution for FY2013
Service Type Category Ratio # Served Resources Allocated Cost % of Cost
Assertive Comm. Treatment Com. Svc-PNO 12:1 400 1 New Team + 300 Vacancies $1,437,500 5.4%
Supportive Case Management CM - PNO 30:1 1,200 40 CMs and 5 CCs $2,415,000 9.1%
Connective Care Coordinators Fac. Svs-PNO 100:1 4,300 43 NTXIX Tx Coordinators $2,760,000 10.4%
Peer Support Specialists Peer - PNO 100:1 5,900 43 Peer Support Specialists $1,928,000 7.3%
Peer Run Organizations Peer Run n/a 5,900* 39% of TXIX SMI Funding $3,000,000 11.3%
Health Promotion Peer - PNO 200:1 5900 30 Peer Wellness Coaches $1,380,000 5.2%
Crisis Navigator Com. Svc - Pro n/a 5,900* Program Expansion $200,000 0.8%
Family Mentors Family - PNO 200:1 5900 30 Family Mentors $1,380,000 5.2%
Family Support RFP (Peer Run) n/a 5,900* RFP for Family Support $1,200,000 4.5%
Supported Employment Emp & Peer n/a 5,900* $500K Sup. Emp. & $2M Peer Emp Svcs $2,500,000 9.4%
Life Skills Training Com. Svc -Peer Run n/a 5,900* ILS In-home support services $1,500,000 5.7%
Personal Assistance Com. Svc - Pro n/a 5,900* Providers with min. $400K peer-delivered $1,250,000 4.7%
Respite Com- Svc - RFP n/a 5,900* $1,000,000 3.8%
Human Service Campus Com. Svc –Pro & PR n/a 5,900* $250k Coord & $100k Peer $350,000 1.3%
Transportation Com. Svc - Pro n/a 5,900* $2,000,000 7.6%
Supported Housing (Services) HOPE Network n/a 107 Peer Supp., ILS & Pers Care for ABC $400,000 1.5%
Administration RBHA n/a 5,900* 6.64% $1,759,000 6.6%
Total *Based on June 2012 enrollment $26,459,500
$30,626,500
with housing
Supp Housing (in housing plan) ABC n/a 399 In Housing Plan: $1.7M AZ & Fed Leverage of $2.5M $4,200,000 13.7%
if part of this plan

NTXIX SMI FUNDING ALLOCATION RATIONALE
NTXIX SMI funding guiding principles:
1. Evolve a peer-driven system of care;
2. Offer assertive community treatment (ACT) and supportive case management to those determined
at-risk for safety and successfully managing themselves in the community due to treatment non-
adherence, severity of symptoms or inability to independently coordinate their own care or
transition between systems;
3. Fund to establish resources (FTEs and programs) that offer the flexibility to deliver an array of
services based on the needs of the population throughout the fiscal year instead of silos of service
need; and
4. Promote community-based support services that enhance an individual’s quality of life in their
community of choice; where they live work and play.
PEER-DRIVEN SYSTEM OF CARE
The allocation of NTXIX funding is being used to evolve a
peer-driven system of care. $13.5 million (51% of new
service funds) in expanded peer and family roles and
services will dramatically shift the focus towards community
integration, independence, individualized goals, responsive
services, natural supports and recovery. To date, almost all
peer-delivered services are offered through peer-run
organizations; resulting in a siloed resource that has limited
peer engagement in the care of most individuals with a
serious mental illness. During the past year, approximately
8.4% (1,210) of the 14,330 individuals in the TXIX SMI
population have three or more encounters from a peer-run
organization while 91.6% (13,120) were not engaged in
services through the peer-run organizations. The same
adoption
rate for the NTXIX SMI population would result in
fewer than 500 individuals engaged in peer-delivered
services and 5,400 without that valuable
engagement and support. Conversely, 100% of
individuals with a serious mental illness receive
services from an adult PNO that is minimally staffed
with only one dedicated peer support specialist at
each clinic (clinics that each serve more people than
any peer-run organization).
• In FY2012, Peer-run organizations
served less than 9% of the TXIX SMI
population
• Three of the five peer runs encounter
60% of funding or less versus system
average of 90%
• A siloed approach has resulted in
limited engagement by peers for most
individuals with SMI
• Peer runs must expand from facility-
based services providers with group
community recreation activities to
providers who deliver independent
living skills (ILS) training, job coaching,
and personal care services in the
community (including in-home)

Magellan believes that peer-run organizations and peer support specialists with the PNO possess a
tremendous potential to expand from facility-based services providers with group community recreation
activities to providers who deliver independent living skills (ILS) training, job coaching, and personal care
services in the community. This proposal is designed to advance peers as an integral part of the service
delivery system within the clinical home of the population; touching 100% of individuals. Magellan’s
Recovery Empowerment Continuum outlines a vision of a peer-driven system of care. This NTXIX SMI
Implementation and Oversight Plan is designed to advance central Arizona’s behavioral health system of
care along that continuum; applying a data driven service-delivery design that focuses on realizing
meaningful outcomes for those engaged within the system of care. Elements of the plan that support
positive movement along the Recovery Empowerment Continuum include the following funding
allocations for peer and family-delivered services:
1. 51% of NTXIX SMI service funds have been allocated to peer and family-delivered services;
2. $5.8 million has been allocated to fund peer and family-run organizations:
a. Extension of all peer-run organization services to the NTXIX SMI population ($3 million);
b. An RFP for a family support service provider in the SMI system ($1.2 million);
c. Independent living skills (ILS) services ($1.5 million); and
d. Peer Outreach at the Human Service Campus ($100k).
3. $4.7 million to fund PNO peer and family-delivered services:
a. 43 FTEs in Peer Support Specialists;
b. 30 FTEs in Peer Wellness Coaches;
c. 1 FTE in ACT Peer Specialist; and
d. 30 FTEs in Family Mentors.
4. $3 million to existing network providers:
a. Peer job coaching ($2 million);
b. Hope Network / MARC peer-support for permanent supportive housing ($400,000);
c. Peer-delivered personal care ($400,000); and
d. Crisis Navigator program expansion ($200,000).
Peer & Family Support Funding Allocations
Provider Type Funding Allocation % of Peer Funding
Peer or Family Run $5,800,000 43%
PNO $4,688,000 35%
Provider $3,000,000 22%
Total $13,488,000 100%
This proposal increases the overall size of the peer-run organizations by over 400% since FY2008:
• FY2008 - $3.5 million (included TXIX and NTXIX)
• FY2012 - $8.7 million
• FY2013 - $15.0 million (up $6.3 million as a function of this proposal)

PEER WORKFORCE DEVELOPMENT
Over the past 18 months, 360 peer support specialists have been trained and certified by existing peer-
run training programs throughout Maricopa County. The agencies providing this training have
demonstrated both the capacity and commitment to continue development of a peer workforce;
fostering the existence of a well trained and sustainable workforce to draw from within this evolving
system of care. Additionally, ADHS/DBHS is in the process of developing a statewide peer training
certification.
In partnership with the Magellan Recovery and Resiliency department, the Learning and Performance
department will review all current peer certification training programs to ensure that they align with the
evolving peer certification standards of ADHS/DBHS; specifically the incorporation of Concepts of Hope
and Recovery, Advocacy and Systems Perspective, Psychiatric Rehabilitation Skills, and Professional
Responsibilities of the Peer Support Employee and Self Care in the Workplace.
To augment and enhance approved peer certification training, peer support specialists will also
participate in new employee orientation (NEO) through the Magellan Learning and Performance
department. Magellan has evolved a blended NEO format that combines classroom, online and field
learning into a comprehensive development program. This orientation is designed to meet all topics set
forth by PM 9.1 requirements and effectively incorporates coaching/mentoring of new employees
through the use of the Field Education Competency Checklist (FECC). Magellan is able to track and
report training compliance via our learning management system, Achieve.
NTXIX SERVICE DESCRIPTIONS AND TARGETS
NTXIX SMI Service Intensity Allocation ($6.6 Million or 25% of Services Funded)
The proposed allocation of NTXIX service-delivery
dollars represents a movement away from a primary
reliance on case management to one that establishes a
greater role for peer and family services in the
community. These services provide vital supports as
individuals move toward independence and are less
reliant on caregivers.
Clinical need for assertive community treatment,
supportive case management or connective care
coordination services will be evaluated through an
individualized assessment process completed by the BHMP for each Non-Title XIX SMI individual.
Magellan will provide Level of Care Guide (LCG) algorithm data sets to support individualized need
assessment and prioritization of the case management assignment process. 20% of funds are allocated
to case management staffing (supportive case management and connective care coordination) and 5%
are dedicated to ACT (community-based service delivery).

DATA DRIVEN SERVICE INTENSITY ANALYSIS
The analysis is being used to guide the evaluation of optimal level of service intensity based on 15
unique risk characteristics of every individual enrolled in SMI services. The risk data set includes the
following 10 service utilization elements:
1. Current level service intensity,
2. Days in level of service intensity,
3. Level I admissions past year,
4. Level I days past year,
5. Level I admits prior year,
6. Level I days prior year,
7. Psych ER past year,
8. UPC contacts prior year,
9. Incarcerations prior year,
10. Number of medications
prescribed.
Each service utilization element is valued and weighted to estimate the individual’s current clinical need.
The potential compounding impact of multiple hospitalizations, psychiatric ER visits or incarcerations as
well as the affiliated inpatient days have the potential to greatly influence the calculated reflection of
clinical need. Service utilization data is partnered with the following five valued and weighted individual
functioning measures to offer a more comprehensive analysis of clinical need by the Level of Care Guide:
1. Global assessment of functioning (GAF),
2. Employment and rehabilitation activities,
3. Primary residence,
4. Frequency of substance use,
and
5. Medical conditions.
The chart at right reflects the results
of the risk analysis for both the TXIX
and NT SMI populations. Higher
scores reflect more acuity and lower
functioning, as evidenced by
hospitalizations, etc. Scores below
30 reflect higher levels of
independence and community
tenure. This analysis of risk factors is
being utilized as an important
starting point in the conversation to
prioritize individuals and inform the
discussion of service intensity.
The risk analysis is being utilized as an important starting point in the conversation to
prioritize individuals and inform the medical and clinical discussion. It does not dictate the
service intensity but is a guide to prioritize and inform screening.
NTXIX SMI Service Intensity Analysis

The evaluation process used to identify level of service intensity assignment applies the case
management affiliation guidance established by DBHS as well as existing assertive community treatment
(ACT) criteria to advance individualized recommendations for members of the NTXIX SMI population.
This process is articulated in the Implementation Plan section of this document; targeting service
intensity allocation as depicted in the graphic below.
The determination of service intensity need / clinical appropriateness will be documented as follows:
• Document on the initial comprehensive assessment upon completion of the assessment;
• Document on the annual update to the assessment upon completion of the annual update; and
• Document in the psychiatric progress note at any time between comprehensive assessments
when it is determined that (a) the person qualifies for assignment to an identified case manager
or (b) the person no longer qualifies for assignment to an identified case manager.
ASSERTIVE COMMUNITY TREATMENT (ACT)
Assertive community treatment (ACT) is not case management but rather an array of services provided
by community-based, mobile mental health treatment teams to seriously mentally ill persons in vivo,
seven days a week and 24 hours a day. Team composition consists of a clinical coordinator, psychiatrist,
nurse, team specialists (rehabilitation, employment, housing, independent living, substance abuse, peer,
and transportation), and behavioral health technicians.
400 NTXIX SMI individuals (7% of the population) are targeted to receive ACT services. This plan
maximizes the use of current team vacancies to efficiently offer access to ACT services within an
individual’s community of choice and the opportunity to receive services from any of the four adult
provider network organizations (PNOs). 310 vacancies currently exist within the system’s 14 ACT teams
and capacity to serve another 108 individuals can be realized by establishing an additional ACT team at a
cost of $1.4 million. Magellan and our system partners believe this plan best aligns with recipient choice
and fiscally responsible management of our system of care. As you will see in the chart below, demand

for ACT services has steadily declined over the past 18 months; suggesting these current team vacancies
are a viable resource for re-allocation to the NTXIX SMI population.
SUPPORTIVE CASE MANAGEMENT
Case management is a supportive service provided to enhance treatment goals and effectiveness.
Supportive case management is delivered and coordinated by multi-disciplinary staff based in mental
health centers in various locations throughout Maricopa County. It is a recovery-focused and outcome
oriented model of community psychiatric treatment. Interventions are designed to foster learning and
growing in a supportive community atmosphere, focusing on consumer strengths as the springboard for
all service planning and delivery.
1,200 NTXIX SMI individuals (20%) are targeted to receive supportive case management services. Clinical
need for supportive case management assignment will be evaluated using the process articulated earlier
in this plan. Magellan will track and confirm the aforementioned clinical and medical evaluations take
place for each individual. We anticipate that supportive services will be available to NTXIX individuals at
any SMI clinic they choose based on team availability (capacity) at a cost of $2.4 million.
462 435 377 317
291 286
155 106 166 188 221 243 272 288 310
68%
83%
80%
85%
91%
87%
89%
92%
91% 91%
92%
95%
91%
96%
500
600
700
800
900
1,000
1,100
1,200
1,300
1,400
1,500
1,600
1,700
1,800
1,900
2,000
2,100
2,200
2,300
65%
70%
75%
80%
85%
90%
95%
100%
Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Current
ACT Fidelity and Capacity
(Includes Non-Title XIX Benefit Reduction July 2010)
Census Available Capacity Fidelity Audit
In July of 2010, 520 NTXIX SMI individuals lost their ACT services due to a reduction in benefit. A
list of these individuals will be provided to the PNOs with an expectation that they be prioritized
for assessment into ACT or supportive services based on their current clinical needs. Existing ACT
criteria will be used to support the evaluation process and referrals to ACT teams will occur within
the established practices of internal PNO referral and emergent level I ACT referrals.

CONNECTIVE CARE COORDINATORS
A majority of NTXIX SMI individuals will be assigned to connective care coordination services (29%
targeted to receive ACT and supportive case management) with a connective care coordinator (40 FTEs
total) at a staffing ratio of 100:1. These connective care coordinators, who may be either behavioral
health technicians or behavioral health professionals, will be paired with a peer support specialist in the
delivery of services (functionally lowering the individual to staff member ratio to 50:1) at a cost of $2.8
million. Unlike higher levels of service intensity (supportive and ACT) in which a case manager is
assigned, coordinators will not have minimum contact expectations nor will they be developing service
plans with their assigned individuals. The connective care coordinator (CCC) will serve like an air traffic
controller who refers individuals to service providers based on their service plan. Primary referrals for
support or engagement will go to the paired peer mentor who will reach out the CCC when he/she is
unable to deliver those services themselves or unable to engage community resources to meet the
person’s needs.
Since many have demonstrated a high-degree of self-sufficiency as they progressed down their unique
path to recovery, assignment to traditional supportive case management is not clinically appropriate
and may in fact hinder recovery. Therefore, peers will not necessarily deliver services to all 100 assigned
individuals but will be connected by the CCC when a need has been identified. Magellan will monitor the
services delivered by these care coordinators through internal reporting (please see Provider Monitoring
and Oversight – Utilization) to ensure they do not default into defacto case managers.
The Peer Mentors and Connective Care Coordinators will work as a team. We are narrowing the scope of
responsibilities of the Care Coordinator and broadening the role of the Peer Mentor. They will work
together to engage and collaborate with the NTXIX SMI based upon specific level of need at any point in
time. The table below outlines the anticipated array of services and the way this teaming will work:
As is true of all NTXIX SMI individuals, this population will be able to access expanded NTXIX services;
including $2 million in transportation funds to support participation in covered service activity.
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Lead Roles
Joint Development of ISRP Medical Management Coordination
Outreach and Engagement Triage Emergent, Urgent, and Routine Needs
Collaboration and Peer Support Community Referrals
Discharge Follow-up Point of Contact for Discharge Planning
ILS and Personal Care Services Coordination of Care
Advocacy Connect to support and rehab services
Family Engagement
Increase Self-Management & Independence

PEER SUPPORT SPECIALISTS
Peer Worker refers to an individual who is, or has been, a recipient of behavioral services and who
currently provides behavioral health services to individuals enrolled in the public behavioral health
system. The peer worker may be either an employee or volunteer/unpaid. Services that may be
provided by a peer worker vary depending on the peer worker’s education and experience. For example,
a peer worker who is also behavioral health professional can provide all of the treatment and support
services that the agency is able to provide under the agency’s OBHL license or the agency’s ADHS/DBHS
Community Services Agencies Title XIX certification. Peer Workers may have job titles such as Peer
Support Specialists, Recovery Guides, Recovery Specialists, etc.
This budget funds the infusion of 74 FTEs of peer support within the adult PNOs at a cost of $3.3 million
and another $5.8 million to peer and family-run organizations; supporting the evolution of a peer-driven
system of care. 4,600 NTXIX SMI individuals in connective care coordination (any not assigned ACT or
supportive case management) will be assigned a peer support specialist at a ratio of 100:1 and all NTXIX
SMI individuals will be able to access peer wellness coaches staffed at a ratio of 200:1. Magellan
anticipates that these individuals will provide ILS training and personal care services in support of our
supported housing model.
PEER RUN ORGANIZATIONS
A peer-run service is an independent organization that is owned, administratively controlled, and
operated by mental health consumers. It may offer a range of services, but it emphasizes self-help and
recovery. Consumer-operated services are an evidence-based practice (EBP) that have consistently
demonstrated effectiveness in helping people with mental illness achieve their desired goals. Peer-run
organizations are allocated $5.8 million to:
1. Extension of all peer-run organization services to the NTXIX SMI population ($3 million);
2. An RFP for a family support service provider in the SMI system ($1.2 million);
3. Independent living skills (ILS) services ($1.5 million); and
4. Peer Outreach at the Human Service Campus ($100k).
PEER SUPPORTED SERVICE PLANNING
An individualized service plan will be developed in
collaboration with the service recipient per Provider Manual
section 3.9 when the NTXIX individual is engaged in ACT or
supportive case management services. The service planning
process will be documented in Clinical Advisor (the
electronic health medical record). For those individuals in
Connective care coordination, the existing process and
requirements for documenting the service plan by the
behavioral health medical Professional (BHMP) can be used. However, individuals shall have the option
of accessing peer support services to assist them in developing a peer-driven, self-developed service

plan to be shared with the BHMP. Peer supports working within the PNO sites and staff employed by
peer-run organizations will be engaged to support the service planning process. Magellan has already
solicited PNO and peer-run involvement in workgroups to evolve a format that can be shared
throughout the behavioral health community.
HEALTH PROMOTION
Health promotion services are education and training activities provided to an individual or a group of
persons and/or their families related to the enrolled person's treatment plan. Education and training
sessions are usually presented using a standardized curriculum with the purpose of increasing an
individual’s behavioral knowledge of a health-related topic such as the nature of an illness, relapse and
symptom management, medication management, stress management, safe sex practices, HIV
education, parenting skills education and healthy lifestyles (e.g., diet, exercise). Magellan is allocating
$1.38 million to hire 30 peer wellness coaches within the PNOs to support delivery of health promotion
services. For example, these peer wellness coaches with their focus on healthy living and lifestyles may
help coordinate with prenatal classes and/or prenatal nutrition for single or pregnant mothers.
CRISIS NAVIGATOR
The Crisis Transition Navigator (CTN) program is a 24/7 short-term community-based service program
delivered by trained and highly skilled peers. The CTN does not provide treatment services to the
individual, but rather serves as a “bridge” by coordinating and monitoring RHBA and Community based
resources and arranges for delivery of these necessary services and supports. The goal of the CTN is to
provide willing recipients with; natural supports, pre-crisis planning, wellness plans and access to post-
crisis services designed to successfully navigate them through their current crisis episode and reduce the
likelihood of experiencing future crisis events. Magellan is allocating $200,000 to extend crisis navigator
service capacity.
FAMILY MENTORS
Family mentors help to create and facilitate a variety of family group activities that support and
strengthen a family’s journey of recovery. Family mentors model Magellan’s Core Principals of Recovery
& Resiliency to raise awareness and educate staff to reduce stigma in a family member’s journey of
recovery. Family mentors will offer support to families through activities that align with the SAMHSA
evidence-based Family Psychoeducation model. In preparation of the transition from Child and
Adolescent services to the Adult Services for people with serious mental illness, family mentors may
attend the individual’s Child & Family Team (CFT) meetings; assisting the family in identifying its family
culture and concerns identified as they transition into the adult system of care. Family mentors offer
referrals to agencies whose primary focus is family support when the recipient has a child engaged in
services and offer support to enroll a child when assistance is requested. Additionally, family mentors
will develop a knowledge base and contacts in community resources to assist families and provide

consultation to members of the clinical team. $1.38 million of funding is allocated to the hiring of 30
additional family mentors within the adult PNO clinics.
FAMILY SUPPORT
Home care training family services (family support) involves face-to-face interaction with family
member(s) directed toward restoration, enhancement, or maintenance of the family functioning to
increase the family’s ability to effectively interact and care for the person in the home and community.
May involve support activities such as assisting the family to adjust to the person’s disability, developing
skills to effectively interact and/or manage the person, understanding the causes and treatment of
behavioral health issues, understanding and effectively utilizing the system, or planning long term care
for the person and the family. Magellan has allocated $1.38 million to the adult PNOs to hire 30
additional family mentors and plans on issuing a competitive RFLOI for an additional $1.2 million to a
peer or family-run organization to deliver family support services. The RFLOI will be utilized to engage a
multitude of family-support organizations; including those who may not be current service providers
within Magellan’s system of care.
SUPPORTED EMPLOYMENT
Magellan will be implementing a supportive employment model consistent with SAMHSA’s Supported
Employment evidence-based practice. Supported Employment (SE) is an approach to vocational
rehabilitation for people with serious mental illnesses that emphasizes helping them obtain competitive
work in the community and providing the supports necessary to ensure their success in the workplace.
SE programs help consumers find jobs that pay competitive wages in integrated settings (i.e., with other
people who don’t necessarily have disabilities) in the community. These services are defined within the
Covered Services Guide as services and ongoing support to maintain employment services are designed
to assist a person or group to choose, acquire, and maintain a job or other community activity. Magellan
has allocated $500,000 to supported employment providers and an additional $2 million for peer-
delivered employment services.
LIFE SKILLS TRAINING
Life skills training services include teaching independent living skills (ILS), social and communication skills
to persons and/or their families. These skills are taught to individuals so they can maximize their ability
to live and participate in the community and to function independently. Examples are the areas of self-
care, household management, socializing, friendships, budgeting, and development of social networks,
recreation, and avoidance of exploitation and the use of community resources. Magellan has allocated
$1.5 million to ILS in-home support services delivered through peer-run organizations. In addition to the
$1.5 million, this plan was drafted with a belief that funding for peer support services would also
translate into the delivery of life skills training services from both peer-run and the adult PNO peer
employees.

PERSONAL ASSISTANCE
These services involve the provision of support activities to assist a person in carrying out daily living
tasks and other activities essential for living in a community. These services may include assistance with
homemaking (cleaning, food preparation in accordance with requirements in A.A.C. R9-20-407, essential
errands), personal care (bathing, dressing, oral hygiene) and general supervision and appropriate
intervention (assistance with self-administration of medications, in accordance with requirements in
A.A.C. R9-20-408, and monitoring of individual’s condition and functioning level). Magellan has allocated
$1.25 million to support delivery of personal assistance; including 1:1 and supported housing provider
supports. In addition to the $1.25 million, this plan was drafted with a belief that funding for peer
support services would also translate into the delivery of personal assistance services from both peer-
run and the adult PNO peer employees.
RESPITE
"Respite" means short term behavioral health services or general supervision that provides rest or relief
to a family member or other individual caring for the behavioral health recipient or for the recipient.
Respite services are designed to provide an interval of rest and/or relief to the family and/or primary
care givers or the recipient receiving services and may include a range of activities to meet the social,
emotional and physical needs of the behavioral health recipient during the respite period. These
services may be provided on a short-term basis (i.e., few hours during the day) or for longer periods of
time involving overnight stays.
Respite services will be available on an in-home and out-of-home basis to caregivers, recipients and co-
habitants which will provide rest and/or relief as well as a wide range of activities to meet the social,
emotional and physical needs of the recipient(s). These services will be provided on a non-routine basis
and will be available for periods of a few hours to overnight depending on the needs and circumstances.
Respite services can be planned or unplanned. If unplanned respite is needed, the appropriate agency
personnel will assess the situation and, with the caregiver, recommend the appropriate setting for
respite. Magellan has allocated $1 million for the delivery of respite services.
HUMAN SERVICE CAMPUS (PEER AND COORDINATION)
Provide peer support and outreach services to enrolled SMI recipients that have found themselves
homeless or without adequate services. The Human Services Campus provides a comprehensive service
array such as shelter (CASS), case management for mental health and substance abuse, food services,
medical & dental assistance, housing assistance, government benefits, IDs, legal assistance and
employment services. The additional peer support services will assist recipients navigate the HSC
services, offering groups, classes and one on one peer support.

Magellan currently has Crisis Transition Navigators and an SMI Evaluator co-located at the Lodestar Day
Resource Center (LDRC) and shelter on the Human Services Campus. Magellan will expand the existing
coordination services by adding behavioral health professionals that can help coordinate care for
enrolled individuals, conduct additional SMI evaluations and provide crisis intervention services on-site
when needed. $250,000 has been allocated for the delivery of coordination activities and an additional
$100,000 to augment peer support services on the human service campus.
TRANSPORTATION
Magellan is allocating $2 million for the delivery of transportation services to support access to covered
behavioral health services. Access to non-emergency transportation may be a necessary support service
for non-Title XIX/XXI SMI members to access the multitude of covered services defined in this plan.
Non-emergency transportation for non-Title XIX/XXI SMI members may be covered as a support service
with the following limitations:
• Transportation is covered only to and from providers of covered behavioral health services;
• Transportation is covered only when no other means of transportation are available to the
member to access covered behavioral health services; and
• Only the most cost effective mode of transportation that meets the individual clinical needs of
the member will be covered. The determination of the appropriate mode of transportation
must be based upon the functional limitations of the member, and not as a matter of
convenience for the member.
SUPPORTIVE HOUSING FOCUS – HOPE NETWORK
The goal of the Hope Network is to provide the wraparound support to participants, who have a housing
voucher through Arizona Behavioral Health Corporation, in maintaining housing self-sufficiency over the
course of the program (one year) through interventions focused on evidence-based treatment, wellness
and recovery. All practices were selected to harmonize with the overall project goals of housing stability
and self-sufficiency, and share the common theme of highly individualized and flexible approaches that
assist persons who are considered chronically homeless, in obtaining and maintaining their housing. All
models embrace a stage of change using a recovery approach to working with individuals who are
homeless and may have co-occurring disorders. The heart of the program is the Hope team, a
specialized services delivery team blending Behavioral Health Professionals, Benefit Specialists and
Recovery Coaches who have experience in homelessness and mental health/substance abuse services.
This team works to improve access, coordination and engagement in services in partnership with the
Clinical Team and whomever the person chooses. Hope Network helps to provide stable housing and
services for 100 adults each year though the provision of peer support, ILS, and personal care services.
Magellan is allocating $400,000 for delivery supports to the 107 NTXIX SMI individuals who will be
housed through ABC.

III. IMPLEMENTATION PLAN
SCREENING AND ASSIGNMENT PHASE
By September 30th
2012, each non-TXIX eligible adult with a serious mental illness will be screened to
determine their optimal service intensity affiliation. The adult PNOs will use specific criteria (see
attached NTXIX Service Intensity Assignment Screening) and available resources (such as the Service
Intensity Risk Analysis) to determine member assignment to assertive community treatment (ACT),
supportive case management or connective care coordination. The screening process will include:
1. A face-to-face evaluation by the BHMP who will use the Case Management Needs Checklist and
ACT Criteria Checklist to assess the person’s degree of clinical need. Again, each BHMP will be
given the individual’s service intensity data analysis results, suggesting where the conversation
might naturally start (Assertive Community Treatment, etc.);
2. BHMP recommendation for level of service intensity assignment (ACT, Supportive or
Connective) will be documented on the NTXIX Service Intensity Assignment Screening. BHMP will
sign and date the document;
3. Distribution of the NTXIX Service Intensity document to communicate information regarding
each of the service delivery models. A copy of the NTXIX Services Letter will also be provided;
4. A NTXIX Service Intensity Assignment Screening that captures the dated signature of the service
recipient to indicate whether the person agrees or disagrees with the recommended level of
case management assignment; and
5. Review and delivery of the Notice of Decision (PM form 5.5.1) which will include a statement
regarding the individual’s right to appeal the BHMP recommendation.
The aforementioned screening will be documented in the Clinical Advisor medical record and
confirmed by Magellan Health Services of Arizona staff.
NTXIX individuals with a serious mental illness who receive a recommendation for ACT services and
agree to that level of service, will be referred to an ACT team for a formal evaluation. Persons who
receive a recommendation for supportive case management and agree to that level of service intensity
will be assigned a case manager. Individuals who receive a recommendation of connective care
coordination and agree to that level of service intensity will begin receiving connective care coordination
services. All NTXIX SMI individuals will be provided with information on available services.
Please refer to attached documents designed for use in the assessment process.
o Attachment A: NTXIX Service Intensity Assignment Screening
o Attachment B: NTXIX Service Intensity Document
o Attachment C: NTXIX Services Letter
o Notice of Decision (PM form 5.5.1)
o

COMMUNICATIONS PLAN
Please see attached communication plan and affiliated documents.
o Attachment B: NTXIX Service Intensity Document
o Attachment C: NTXIX Services Letter
o Attachment D: NTXIX Benefits Increase Communication Plan
DBHS PARAMETERS
ADHS/DBHS has identified a core set of expectations associated with the allocation of NTXIX SMI funds.
The tables in this section highlight Magellan’s plan to specifically address these DBHS expectations.
NTXIX SMI Implementation and Oversight Plan – Assertive Community Treatment (ACT)
Task # DBHS Parameter Plan Target Date
1.a.i. Specify ACT Criteria
Individuals will be evaluated for ACT services based on the existing
ACT Admission Criteria which is consistent with the evidence-based
practice established by SAMHSA.
Completed
1.a.ii.
Prioritize individuals
who lost ACT (7/2010)
Magellan will provide a list of the 520 NTXIX individuals who were
transitioned off of ACT services to each PNO.
7/6/12
PNOs to complete ACT screening for these individuals during their
next appointment.
8/31/12
1.a.iii.
Future Screening for
ACT
Individuals will be evaluated for ACT services based on the existing
ACT Admission Criteria which is consistent with the evidence-based
practice established by SAMHSA.
Begin 7/9/12
and Ongoing
Magellan will distribute LCG data sets and algorithm scores to PNOs
on a quarterly basis to support evaluation of clinical need.
7/6/12
1.a.iv. Current ACT Capacity
There are currently 14 ACT teams with a capacity to serve 1,512
individuals. The current ACT census of 1,202 leaves 310 vacancies
within the system and we propose the addition of a 15th ACT team
to expand capacity to 418. Please refer to the table below for ACT
capacity by clinic.
Contract
7/22/12 and
Referrals
10/22/12
1.a.v. ISP Development
Each individual will have a completed ISP in Clinical Advisor within
90 days of affiliation to an ACT team.
Available and
Ongoing
ACT Capacity and Demand Analysis
Facility ACT Census ACT Vacancies NTXIX Census Proj. NTXIX ACT (7%)
PNO-Ch-Arcadia Center 84 24 466 32
PNO -Ch-Midtown 0 0 205 14
PNO -Ch-South Central 0 0 179 12
PNO -Ch-Tempe Enclave Site 91 17 384 26
PNO -Ch-Townley 73 35 431 29
PNO -Ch-West McDowell 88 20 187 13
PNO -PCN-Capitol Center 65 43 0 0
PNO -PCN-Centro Esperanza 0 0 271 18
PNO -PCN-Comunidad 268 56 412 28

PNO -PIR-East Valley Campus 0 0 500 34
PNO -PIR-Metro Center 107 1 381 26
PNO -PIR-West Valley 75 33 479 33
PNO -PIR-Wickenburg 0 0 17 1
PNO -SWN-Bethany Village 83 25 294 20
PNO -SWN-Garden Lakes 0 0 266 18
PNO -SWN-Hampton 88 20 263 18
PNO -SWN-Highland 0 0 195 13
PNO -SWN-Osborn 92 16 203 14
PNO -SWN-Saguaro 0 0 516 35
PNO -SWN-San Tan 88 20 270 18
Additional ACT Team TBD 0 108 unknown 25-35
Total 1,202 418 5,919 402
IDENTIFICATION OF 15TH ACT TEAM
Magellan will apply the same detailed system analysis used prior to the NTXIX benefit reduction in July
of 2010 to identify the location of the new ACT team. This analysis will evaluate potential locations
based on an algorithm that weighs:
1. The projected geographic demand for ACT services based on:
a. Location of NTXIX population (7% projected to move into ACT services);
b. Location of the 520 NTXIX individuals who were previously on ACT in June 2010;
c. Location of NTXIX individuals with the highest LCG scores; and
d. Current distribution of ACT services to meet the projected demand.
2. PNO ACT Outcomes Dashboard results;
3. Distribution of ACT teams by PNO to offer choice in provider; and
4. Facility capacity.
NTXIX SMI Implementation and Oversight Plan - Supportive Case Management
1.b.i.
Distribute Criteria for
Case Management
Assignment
Distribute ADHS/DBHS criteria, affiliated screening tool and LCG
data set to the PNOs.
7/6/12
1.b.ii.
Screen for Case
Management Services
PNOs to complete case management screening using the approved
screening tool for all NTXIX SMI individuals during the individual’s
next appointment.
9/30/12
1.b.iii. Track CM Assignments
Magellan will produce monthly reports of CM assignments for
NTXIX individuals by PNO and clinic. Reporting will be used to
identify outlier clinics/clinicians.
10/10/12 and
Ongoing
1.b.iv.
Notice of Decision and
Right to Appeal
Notice of Decision and Right to Appeal will be provided to those
who do not agree with the level of service intensity
recommendation made by the BHMP. Review for notice will be
9/30/12
Initial Notice
and Ongoing

incorporated into the QI review process.
1.b.v. ISP Development
Each individual will have a completed ISP in Clinical Advisor within
90 days of affiliation with a supportive case manager.
Available and
Ongoing
NTXIX SMI Implementation and Oversight Plan - Case Management Services
1.c.i.
Case Management
Service Availability
NTXIX SMI individuals who are not assigned to an ACT team or
supportive case manager will be affiliated with a connective
treatment coordinator and a peer support specialist to access case
management services as needed.
Initial
screening by
9/20/12
1.c.ii.
Track and Monitor Case
Management Service
Utilization
Magellan will produce monthly reports of case management service
utilization for NTXIX individuals by PNO and clinic. Reporting will be
used to identify outlier clinics/clinicians and individual's clinical
needs for case management assignment.
10/10/12 and
Ongoing
NTXIX SMI Implementation & Oversight Plan - Peer Support Services & Service Plan Process
1.d.i. Support Self-Sufficiency
73% of NTXIX SMI individuals will not be assigned to an ACT team or
a supportive case manager. Our commitment to the concept that
many individuals can successfully be their best case manager is
demonstrated within our primary allocation of funds to peer and
family delivered services (51% of service $) in community settings.
Completed
and Ongoing
1.d.ii.
Peer-Driven Self-
Developed Service Plan
Magellan will partner with peer-run organizations, service
recipients and their family members to evolve a standardized
service plan format that will be available through all peer support
providers within our system of care.
8/6/12
1.d.iii.
Service Plan Review by
the BHMP
The affiliated connective care coordinator or peer support specialist
will coordinate scheduling of the service plan review with the
BHMP. Once agreed upon, the BHMP will sign the individualized
service and recovery plan (ISRP) and adopt to guide service delivery.
Ongoing
1.d.iv.
Peer-Run Organizations
and Peer Support in
Service Planning
Funding has been allocated for the hiring of 43 peer support
specialists at the PNO clinics and full access to peer-run services.
These staff members will be oriented to the standardized service
plan format and expectations that support be offered.
Orientation
by 9/1/12
1.d.v.
Service Plan
Implementation
The BHMP will review and approve the developed service plan. To
support individuals who are functioning as "their own best case
manager," Magellan will evolve and implement a communication
plan that provides tangible resources on NTXIX individual treatment
rights and resources for self-advocacy. The affiliated peer support
specialist and connective care coordinator (both assigned at a ratio
of 100:1) will augment advocacy efforts while maintaining primary
responsibility for coordination and tracking of service provider
referrals.
9/1/12 and
Ongoing
1.d.vi.
Training and Mentoring
to Peer Support Staff
Around New Service
Plan
Magellan will partner with peer-run organizations and the adult
PNOs to evolve a training module for the new service plan and the
new service planning process. Peer support providers will need to
complete the training.
8/22/12

1.d.vii.
Natural Supports and
Crisis Planning into the
Planning Process
The peer training module will include an emphasis on natural
supports and a section on crisis planning.
8/22/12
NTXIX SMI Implementation and Oversight Plan - Community-Based Support Services
2.a.
Community-Based
Support Services
Allocated funding to each of the identified community-based
support services (please see NTXIX SMI Service Funding Distribution
for FY2013 Table in section II of this plan).
Completed
2.b.
Distribution of Support
Services
Allocation of support services was based on past utilization data
and analysis of clinical needs through the application of the Level of
Care Guide (LCG) algorithm.
Completed
Monitoring Utilization
and Adjusting
Allocations
Service utilization will be monitored through monthly review of
claims to evaluate system funding needs. Identified opportunities to
better align service funding to system need will be proactively
discussed with DBHS.
8/15/12 and
ongoing
2.c.
Support Service
Funding Allocation
Funding allocation and service targets are illustrated in the NTXIX
SMI Service Funding Distribution for FY2013 Table in section II of
this plan.
Completed
2.d.
Inpatient Discharge
Planning
The affiliated ACT and Supportive case manager will engage in
discharge planning and follow up activities as outlined in Provider
Manual section 3.8.7-C when aware of an admission. Connective
care coordinators will also engage in discharge planning in
collaboration with peer support to facilitate appropriate transition
into the community. Magellan’s UM team will engage a formal
communication campaign with inpatient providers to share
information around the enhanced availability of services to NTXIX
SMI individuals and encourage greater collaboration around
discharge planning.
Design
Completed
NTXIX SMI Implementation and Oversight Plan - Medication Management
3.a. Prior Auth. for Abilify
Implement the established prior authorization process and DBHS-
approved formulary for the NTXIX SMI population.
Completed
PROVIDER MONITORING AND OVERSIGHT
Magellan will provide monitoring and oversight through weekly meetings with executive leadership,
medical leadership and operational leadership of the PNOs, executive leadership of the Peer Run
Organizations and other key provider leaders included in this funding allocation plan. This process and
these meetings will be much more intense in the beginning dropping to monthly and quarterly as
appropriate. We will utilize a similar basic process to the one that was successful in the FY2010 NTXIX
SMI funding reduction project. Our teams will review individual tracking sheets and evaluate the
assignment of services as compared with the Service Intensity Risk Analysis data.

QUALITY IMPROVEMENT
PROVIDER MONITORING FOR ACT AND SUPPORTIVE CASE MANAGEMENT
Performance measures such as a current assessment and a completed individual service plans will be
tracked through the application of the Treatment Record Review (TRR) Tool. The TRR tool is applied to
providers annually or more frequently based on supplemental monitoring and evaluation data that
indicates the need for closer oversight. For all NTXIX adults who are receiving ACT or supportive case
management, Magellan will apply the TRR annually utilizing a random, statistically reliable sample (90%
confidence level/+/-10% variation) system wide. If needed, we will conduct focused audits and site visits
to ensure any deficiencies are being addressed and corrected. Magellan will begin monitoring within 30
days of start of service. Magellan will also develop a simple checklist that will include elements in the
TRR and conduct brief focused audits that will initially be conducted bi-weekly and target monthly and
quarterly reviews based on evaluated performance. The complete TRR will be used annually.
MONITORING FOR INDIVIDUALS IN CONNECTIVE
For individuals receiving connective care coordination who elect to develop a self directed service plan
with the collaboration of peer support staff, Magellan will review their records annually utilizing a
random, statistically reliable sample (90% confidence level/+/-10% variation) at a system wide level. We
will specifically review these records for evidence that all services recommended in the treatment plan
have been implemented. If needed, we will conduct focused audits and site visits to ensure any
deficiencies are being addressed and corrected. Magellan will begin monitoring within 30 days of start of
service. Magellan will also develop a simple audit tool that will include elements in the self-directed
service plan and conduct brief focused audits; initially on a bi-weekly basis and eventually targeted for
monthly and quarterly reviews based on evaluated performance.
PREPARING INTERNALLY TO ADDRESS GRIEVANCES, APPEALS AND COMPLAINTS
Magellan will provide comprehensive training for the grievance, appeals and complaints team as well as
customer service on benefit packet changes for NTXIX adults. Magellan will also provide training to
BHMPs at the PNOs regarding their role in assessing service intensity needs and issuing a Notice of
Decision. The Learning and Performance Department will be leading efforts to create an on-line learning
course that will be assigned to each of the PNO BHMPs in their Achieve development plan by 7/6/2012.
Completion of this training will be monitored by Magellan with an expectation that this 10 minute
course be completed by BHMPs prior to completing the Service Intensity Assessment with NTXIX SMI
individuals. In addition to the training, Magellan will track the number of grievances, appeals and
complaints filed from NTXIX individuals with a serious mental illness related to service intensity
assessments and work with the providers to address these issues.

UTILIZATION AND FINANCIAL MONITORING
Service utilization will be monitored through monthly review of productivity and expense tracking to
evaluate system funding needs. Identified opportunities to better align service funding to system need
will be proactively discussed with DBHS to discuss plans for funding re-alignment. Magellan will
incorporate language into provider contracting that establishes an expectation that providers deliver the
data necessary to support the evaluation activities described in this plan.
CONTRACTING
The following Request for Letters of Intent (RFLOI) implementation plan will be applied to support
identification of a Family Support and Respite provider to meet the service-delivery targets defined in
this plan. FY2013 contract amendments will be delivered to align with the remaining service-delivery
targets within three weeks of receiving ADHS/DBHS plan approval.
NOTE: Timelines are based on a July 6, 2012 approval of this plan by ADHS/DBHS
Family Support: RFLOI Implementation Plan
Step # Task Target Date
1 RFLOI distributed to Provider Network 7/17/12
2 Q&A due from providers 7/23/12
3 Q&A response dispersed 7/25/12
4 Proposals due 8/1/12
5 Initial meeting for proposal review 8/2/12
6 Proposal scoring complete 8/8/12
7 Decision approved by Executive Team 8/13/12
8 Provider notification of award and non-award 8/17/12
9 Strategic planning meeting with provider (initial and ongoing) 8/22/12
10 Scope of Work revised and contract amendment sent 8/29/12
11 Contract amendment signed 9/6/12
12 Program Start Date 10/8/12
Respite: RFLOI Implementation Plan
Step # Task Target Date
1 RFLOI distributed to Provider Network 7/17/12
2 Q&A due from providers 7/23/12
3 Q&A response dispersed 7/25/12
4 Proposals due 8/1/12
5 Initial meeting for proposal review 8/2/12
6 Proposal scoring complete 8/8/12
7 Decision approved by Executive Team 8/13/12
8 Provider notification of award and non-award 8/17/12
9 Strategic planning meeting with provider (initial and ongoing) 8/22/12
10 Scope of Work revised and contract amendment sent 8/29/12

11 Contract amendment signed 9/6/12
12 Program Start Date 10/8/12
Please refer to attached documents for use in the RFLOI process along with contract amendments for
service expansion with existing contracted providers:
o Attachment E – Family Support RFLOI
o Attachment F - Family Support RFLOI Scoring Sheet
o Attachment G – Respite RFLOI
o Attachment H - Respite RFLOI Scoring Sheet

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