Access and Service Authorization Standard
Services shall be provided irrespective of immigration status, insurance coverage, and language. Access to services shall be individually- and family-oriented (including client-defined family) in the context of racial/ethnic cultural values. Access criteria for different levels of care shall include health/medical, behavior, and functioning in addition to diagnosis. Criteria shall be multidimensional in six domains: psychiatric, medical, spiritual, social functioning, behavior, and community support.
- Specific procedures shall be developed to ensure comparability of access and receipt of benefits across populations. Racial/ethnic Mental Health Specialists shall be involved in the development and ongoing implementation and evaluation of these procedures.
- Gate keeping, service authorization, and critical service junctures for consumers from the four groups shall be performed by or under the supervision of a culturally competent mental health professional.
- Restrictive placements for consumers from the four groups shall be made only with prior cultural consultation. Restrictive placements include inpatient, residential, and involuntary treatment.
- Access shall be decentralized and facilitated through multiple outreach and case-finding approaches. These approaches shall include strategic co-location within racial/ethnic community organizations, social service agencies, community action agencies, health centers, churches, mosques, schools, and neighborhood locales which are accessible through public transportation and in-home, in-community, and mobile care. They shall be publicized by culturally and linguistically appropriate information which allows client choices.
- Agencies shall have the flexibility of providing services to consumers from the four groups who may not reside in the agency's geographic service area, when this is in the best interest of the clients.
- Access to traditional healers and self-help services shall be covered by the benefits package.
- The use of telephone numbers (e.g.,. 1-800) for access shall not be exclusive of other points of entry for 24 hour crisis service and shall be accompanied by education of consumers from the four groups in the use of such access procedures.
- Legal documentation for immigrant groups shall not be a requirement for service and shall not serve as a barrier to service access. (Legal status shall not be confused with sponsored and unsponsored status.)
- Confidentiality requirements shall be adapted to incorporate the values of consumers, particularly including family decisions about services when appropriate, so as not to serve as a barrier to care.
- Equal availability of telephone and other communication means of access, for consumers and families from the four groups shall be assured. Staff who provide telephone access services shall be culturally and linguistically competent, and have access to racial/ethnic mental health professional staff for consultation.
- Programs serving consumers and families of the four groups shall provide culturally inviting environments (e.g., decor, ambiance) as measured by consumer satisfaction surveys.
- The Health Plan shall provide all consumers, families, and providers a culturally based and linguistically complete orientation and ongoing education about access to managed care.
- Ability to pay shall not be a barrier to accessing services in a managed health care environment.
Recommended Performance Indicators
- Procedures for access in place with specific provisions for consumers from the four groups.
- Time from point of first contact through service provision for all levels of care are tracked by age, gender, ethnicity (i.e., particular subgroup and mixed origins), primary language, and level of functioning.
- Rate and timeliness of response to telephone calls by consumers from the four groups.
- Tracking of authorization decisions including denials, rationale, and disposition by ethnicity.
Benchmark: Comparability across ethnic groups served.
- Tracking of access and utilization rates for populations of the four groups across all levels of care in comparison to the covered population.
Benchmark: Proportional to covered population.
- Consumer and family satisfaction with access and authorization services.
Benchmark: 90% satisfaction.