Mark

Questions & Answers: DRM's Community Mental Health Advocates

Posted on November 08, 2021

by Mark C. Joyce, Esq.

DRM's Community Mental Health Advocates: Accessing Community Mental Health Services & the "Self-Referral" Process


Q: I learned that DRM recently hired three new community mental health advocates. Do these advocates help people navigate the process of obtaining assessments for Section 17 Community Integration Services (also known as Section 17 Case Management), Behavioral Health Home Services or Assertive Community Treatment Services?
A: Yes, these advocates can help people navigate this process of obtaining assessments for these mental health services.

Q: Why is that important?
A. It is important because many people rely on MaineCare to be able to pay for these services and they must meet certain eligibility criteria before the service can be provided to them under MaineCare rules.

Q: How is this eligibility determination made?
A: This determination, also known as an intake or assessment, is going to first be made by the mental health agency who the person initially contacts when seeking the service.

Q: Can a person who wants to receive any of these mental health services contact the agency directly and ask them to provide them with the service?
A: Yes.This is called a "self-referral."

Q: Does that mean that anyone who makes a self-referral will automatically get scheduled for an eligibility intake or assessment from that agency?
A: No. Each mental health agency has its own process for how they handle these self-referrals.

Q: If the agency conducts an eligibility assessment and finds that the person is eligible does that mean the person is deemed eligible for that service by MaineCare?
A. No. The decision as to eligibility rests with MaineCare. The mental health agency will, in almost all cases, submit its intake or assessment information to a company MaineCare contracts with to review these assessments. This company is called Kepro. Kepro then issues a determination as to whether or not the person is eligible for that service under MaineCare rules.

Q: If Kepro determines that the person is not eligible for that mental health service then is that the final decision?
A: No. The person has the right to an administrative appeal. If they appeal within calendar 10 days and their services have already started, then they will continue pending the final outcome of their appeal. If the person is successful in their appeal then the initial denial will be reversed

Q: Can a person self-refer to Kepro and ask them to make an eligibility determination for the mental health service they are seeking without first being assessed by a mental health agency?
A: No. There is no process for a person to self-refer for an assessment directly to Kepro.

Q: Then is it possible for a person who might otherwise be eligible for a mental health service under MaineCare to not obtain it?
A: Yes. If they are not able to successfully navigate the self-referral process they will not be able to get the needed initial assessment from the mental health agency.

Q: Why is this important?
A: Because with no eligibility determination made by the agency, Kepro will have nothing to review and therefore the person will have nothing to appeal.

Q: If that happens, can the DRM community advocates help the person?
A: Yes, that's one of the services these DRM community advocates provide, they help people navigate this process.

Q: How do they do this?
A: The advocates engage in extensive community outreach and ask people to contact them directly if they are having issues with this process. During these outreach events, they distribute informational handouts that contain the DRM's toll-free number and the advocates' extensions, so that people can call if they have questions. DRM's toll-free number is 800.452.1948.  To reach a community advocate, dial Ext. 119, Ext. 208 or Ext. 210. The handouts that are distributed include:

Two of the advocates are attorneys and can also review requests for possible appeal for people who Kepro determined were ineligible for the mental health service.

Q: What is the process for being put on a wait list?
A: Like the process for assessments, each mental health agency has their own process. However, under MaineCare rules, if the agency that the person contacts has determined that it does not have the capacity to conduct an intake or initial assessment then the person has the option to be placed on what is called a "hold for service" which is commonly referred to as a "wait list".

Q: Does this mean when the person's name comes up on the wait list they will then be provided with the service?
A: No. They will still need to be assessed for eligibility for the service at that time.

Q: What if the person can't wait. Do they still have to agree to be put on that agency's wait list?
A: No. If the person does not want to be put on that particular agency's wait list, then the agency is required under MaineCare rules to give the person alternatives to being placed on the wait list including, but not limited to, giving information on other service providers within a 25-mile radius servicing the area.

Q: How is this information provided to the person who does not want to be placed on that agency's wait list?
A: MaineCare rules provide that the agency shall provide the information to the person in writing.

Q: Can these DRM advocates help me with this process?
A: Yes, if a person contacts an agency and is told there are no openings and not given the option of being place on that agency's wait list or given information in writing about the alternatives if they don't want to be placed on that agency's wait list they can contact the DRM community mental health advocates.

Q: What happens if all the referrals the person is given also have wait lists?
A: Again, that person can contact the DRM community mental health advocates to discuss this situation.