OMA Advisory: Clients Who Return after a Break: “Boomerang” Clients

The Problem:

Agencies often have clients who are in treatment for a while, and then the leave. After a significant time away (six months to a year), they reappear and are put back into treatment.

This can be very problematic for Outcomes because providers need to close and then re-open episodes and outcomes. Furthermore, until January 2009 there is a problem with filing a “Discontinuation” KEC on a client who then comes back. Under the current system, if you “Discontinue” a client, it removes the Program associated with that client. The user then needs to file a Data Change/Deletion Request Form to get the program reactivated. This problem will be fixed by the next build (in Jan 2009) so that a simple KEC will be required to reactivate the outcomes on this client.

The Solution:

If you have a client you have been seeing for a time and they disappear, you will need to Disenroll/Discontinue them after a time. The MHSA guidelines state that you should Disenroll under these circumstances:

“After repeated attempts to contact client, client cannot be located. Client is missing, has not made contact with FSP agency. Agency may request disenrollment of a client after multiple documented outreach attempts for at least thirty (30) days but not more than ninety (90) days.”

The procedures for disenrolling a client with Countywide Programs are detailed in the MHSA FSP Guidelines (pp. 62-64) at this location:

http://dmh.lacounty.info/MHSA/documents/MHSA%20FSP%20GUIDELINES.pdf

Please remember that prior to filling out a KEC for discontinuation or to transfer to another provider number in FSP, you must first have signed authorization to disenroll or transfer from countywide administration. Your discontinuation status change date should be the DMH countywide signature date on the disenrollment form.

After that, you will need to file a KEC to Discontinue services. Please DO CHECK to make sure they have not simply moved to another provider. You can do this by looking to see if they have a new episode elsewhere in the DMH system by checking the client on the Integrated System.

If they have moved to another provider without letting you know, please contact that new provider in order to complete a KEC to transfer the client.

In many cases, the Disenrolled Client is gone…but then, what do you do if they return?

IF THE CLIENT HAS BEEN GONE FOR MORE THAN A YEAR SINCE DISENROLLMENT…

As with any other client, you will need to apply to Countywide again to have them re-authorized as FSP clients. You will then need to open a new episode, add a new Program, and create a new Baseline Assessment.

IF THE CLIENT HAS BEEN GONE FOR LESS THAN A YEAR SINCE DISENROLLMENT…

As with any other client, you will need to apply to Countywide again to have them re-authorized as FSP clients before you can provide and bill for new services under MHSA. Assuming the original episode is closed, you will need to open a new episode in the Integrated System.

THROUGH THE END OF JANUARY 2009… You will need to file a Data Change / Deletion Request Form instructing DMH to Re-open the Program. Until February of 2009, if a KEC to Discontinue has been filed on a client, it will terminate the client’s Program. We will be changing this in January so you can skip this step then.

Once the client has an open episode and the Program is active, you can file a KEC to indicate Reestablishment of FSP.