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Prior Approval Review
Guidance for Completing the PROS PAR Application

Part I – Project Approval

Section C – Project Description

Subsection 3, Additional Sites

Ensure that all multi-site designations are kept consistent. For instance, the site labeled ‘Multi-site 1’ on page 4 should be the same site named ‘Multi-site 1’ on page 5 and throughout the document.

Section D – Program Information

Subsection 3, Capacity and Persons Served

Ensure that the information provided reflects an understanding that ‘Capacity’ and ‘Persons Served’ are different concepts, as described in this section of the application.

Subsection 4, Part a, Average number of individual expected to receive services in each component

The number of individuals indicated in each component must agree with the number indicated on the fiscal calculator. If there is a difference, provide a brief explanation.

Section F – Staffing

Subsections 1 (Initial Operation – Staffing Chart) and 2 (Full Operation – Incremental Staffing Chart)

Staff titles and/or disciplines for clinical staff, as well as their professional status, must be clearly specified. Clinical staff is defined in 512.4(f).

For comprehensive Personalized Recovery Oriented Services (PROS) programs, at least 40% of clinical staff must be professional. (For limited license programs, 20%.) A list of disciplines considered to be professional staff can be found in 512.4(z).

For comprehensive PROS programs, at least one of the professional staff must be a Licensed Practitioner of the Healing Arts (defined in 512.4[p]) and be employed on a full-time basis. For limited license programs, at least one member of the professional staff must be employed full time.

Ensure that there is a minimum of .125 Full Time Equivalent (FTE) psychiatrist and .125 FTE registered nurse for every 40 participants enrolled in clinical services.

Ensure that contract staff (CS) salaries are not included in the total for staffing salaries on the charts in Section F(1) and F(2). Contract staff expenses should be included in Other Than Personal Services (OTPS).

Section G – Financial

General Points

Ensure that all terminology is clear when describing revenue and expenses. For instance, terms like “client wages” and “consultant costs” must be clearly defined because they often do not mean the same thing at different agencies.

Ensure that a Fiscal Implication Form is obtained from your Office of Mental Health (OMH) Field Office and that it is completed and returned to the Field Office in a timely manner. This form must be submitted and processed before an operating certificate can be issued for the PROS program.

Subsection 1 – Operating Budget

Staffing salaries must coincide with those indicated in the tables in Section F.

In the ‘Administrative Costs’ field, administrative and support staff salaries should be indicated on a separate sheet and attached to the PAR application.

The ‘Other Expenses’ field should indicate any expenses not otherwise covered in this section. Be sure to clearly indicate all details related to these expenses. Examples of such expenses include non-Medicaid transportation, facility repairs, building repair and maintenance, nursing supplies, lunch program.

Subsection 2 – Operating Revenue

Revenue figures must match those indicated on the fiscal calculator.

The projected Medicaid revenue related to various PROS components must be consistent with the information provided in Section D, Subsection 4a.

Medicare revenue must be clearly indicated.

State aid amounts must be correct and accurately detailed. The annualized funding in the first year of full operation is based on the high end of the range (monthly caseload + 15%) for persons served monthly at full operation. For example, if the monthly served number at full operation in Section D is 100, the funding would take the annualized amounts ($46,409 and $44,000) and multiply by 1.15.

Ensure that start-up funding is indicated for initial operation only, and is not included in the ongoing budget.

Section J - Attachments

Subsection 1 – Functional PROS Program Description

a – Overview: Demonstrate an understanding that PROS is a unique program with expectations that are different from Continuing Day Treatment (CDT), clubhouse and/or psychosocial club models. For instance, describe how the program will assist participants to understand that recovery from mental illness is an attainable outcome. Explain how participants will be included in every aspect of the program from service design to delivery of services to documentation to quality management. Indicate how service planning will take into account the goals and desires of all program participants.

b – Goals: Include an understanding and belief in the capacity for individuals to recover from mental health disabilities. This requires more than a statement of such. Consider providing experiences and/or examples that clearly show a belief in and commitment to the goal of recovery.

f – Services: With the exception of Ongoing Rehabilitation and Support (ORS), a variety of services may be provided in each PROS component. In this section, demonstrate the ability to provide a variety of services based on participants’ needs. If the program plans to offer services to a specialized population (i.e. Mentally Ill Chemical Abuser (MICA)), additional information should be provided that shows an understanding of the unique needs of that population as well as the competence of staff to provide such services.

In determining the needs of participants, it is essential to utilize effective assessment tools. Assessments are necessary to identify an individual’s strengths, barriers, abilities, natural supports & preferences, and to formulate a relevant service plan that has meaning for the participant. The proposed assessment tools should be included with the PAR application.

g – Program Schedule: Indicate that the program schedule is a flexible document which will change often in response to the needs of program participants. Include a draft program schedule with the PAR application to show an understanding of this concept. In addition, confirm your understanding of PROS service categories (512.5) by relating each service on the schedule to a corresponding category in the regulations. Further, demonstrate that there is a choice of services available to participants at all times during the program day. Evening and weekend hours should be incorporated into the schedule to show that there is maximum choice available to participants.

k – Recipient Participation: Clearly indicate, with examples, how program participants will contribute to their own recovery. This can include assisting in the development of the Individualized Recovery Plan (IRP), documentation of progress notes, updating and amending the program schedule, the opportunity to become recipient employees, etc.

Subsection 5 – Evidence-Based Practices

b, c – Indicate in detail your plans to provide ongoing training and supervision to staff regarding evidence-based practices. This may include attendance at OMH sponsored trainings but should also incorporate other assistance such as use of the SAMHSA (Substance Abuse and Mental Health Services Administration) web site tool kits and/or other trainings or workshops from reliable sources in the community. Explain how this education will be incorporated into the services to be offered.

Subsection 6 – Employment

b – Describe how staff will identify the employment needs of program participants. Provide detail regarding plans to guide participants toward an interest in integrated, competitive employment. Indicate the services to be offered in this regard. Plans may include, among other things, inviting people from the community to the program to speak about potential careers or employment-related opportunities.

c – Demonstrate an understanding that employment-related services can be provided in all components of PROS, not just in Ongoing Rehabilitation and Support (ORS). For instance, an individual who is thinking about work may need CRS services to help him or her determine what kind of work to pursue. When ready to find a job, he or she may need IR services to assist in the search. Once employed, he or she may want ORS services for support to maintain the job.

d – Give a clear and detailed description of how vocational net deficit funding will be used to augment employment-related services.

Subsection 9 – Cultural Competence

b – Describe how the cultural, ethnic and linguistic needs of each individual will be assessed in a comprehensive and person-centered manner. Understanding each individual’s sense of him- or herself in terms of culture, ethnicity and diversity is critical to providing culturally competent services as well as to good service planning in general.

Part II – Physical Plant

Section 4 – Space Utilization Plan

Ensure that the floor plan clearly indicates the purpose and dimensions of each room. Clearly describe how each area will be utilized. For instance, rather than indicating that a space is just an “office”, describe it as a “nurse’s office” or a “group room”. If necessary, it is acceptable to attach a separate sheet in order to accommodate these kinds of notes. In addition, indicate the nature and utilization of any program adjacent to the space that will be utilized by the PROS program.

Comments or questions about the information on this page can be directed to the Bureau of Inspection and Certification.