Child, Youth & Family Handbook Magellan Healthcare, Inc. Wyoming’s Care Management Entity

Contact us: Toll-free: 1-855-883-8740 Website: www.MagellanofWyoming.com Email: [email protected] Facebook: www.facebook.com/WYMagellan

Magellan Healthcare deeply appreciates the permission granted to adopt/adapt information from The Wraparound Process User’s Guide: A Handbook for Families for this document. The guide is a product of the National Wraparound Initiative. Citation: Miles, P., Bruns, E.J., Osher, T.W., Walker, J.S., and the National Wraparound Initiative Advisory Group (2006). The Wraparound Process User’s Guide: A Handbook for Families, Portland, OR. National Wraparound Initiative, Research and Training Center on Family Support and Children’s Mental Health, Portland State University.

Table of contents Welcome to Magellan. . . . . . . . . . . . . . . . . . . . 2 Contact us. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Getting help in other languages and formats . . 2 What to do in an emergency . . . . . . . . . . . . . . . . 3 Crisis support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Refer a child. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 What is High Fidelity Wraparound? . . . . . . . 4 High Fidelity Wraparound principles. . . . . . . . . 4 What your child and family can expect. . . . . 5 When you call. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Choice of provider . . . . . . . . . . . . . . . . . . . . . . . . 5 Forms to complete . . . . . . . . . . . . . . . . . . . . . . . . 5 What does HFWA look like?. . . . . . . . . . . . . . 6 How does HFWA work for my family?. . . . . . . . 6 How do I know if my child qualifies for HFWA?. . . . . . . . . . . . . . . . . . . . . . . . 6 What services will we be able to get?. . . . . . . . . 7 What do I do if I think my child needs physical or behavioral health services other than HFWA?. . . . . . . . . . . . . . . . . . . . . . . . . 7 What are flex funds?. . . . . . . . . . . . . . . . . . . . . . . 7 High Fidelity Wraparound phases. . . . . . . . . 8 Phase 1: Engagement and preparation. . . . . . . . 8 Phase 2: Initial planning. . . . . . . . . . . . . . . . . . . . 9 Phase 3: Plan implementation. . . . . . . . . . . . . . 10 Phase 4: Transition. . . . . . . . . . . . . . . . . . . . . . . 11 High Fidelity Wraparound checklist . . . . . . 12 What can I expect from my family care coordinator? . . . . . . . . . . . . . . . . . . . . . 13 What is expected of me?. . . . . . . . . . . . . . . . 14

Youth involvement. . . . . . . . . . . . . . . . . . . . . 15 MY LIFE program. . . . . . . . . . . . . . . . . . . . . . . . 15 MY LIFE Wyoming . . . . . . . . . . . . . . . . . . . . . . . 15 Eight Dimensions of Wellness. . . . . . . . . . . . . . 16 Measuring family satisfaction . . . . . . . . . . . 17 Confidentiality. . . . . . . . . . . . . . . . . . . . . . . . 17 Member rights and responsibilities. . . . . . . 18 Your rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Your responsibilities. . . . . . . . . . . . . . . . . . . . . . 19 Complaints & grievances . . . . . . . . . . . . . . . 20 What if I have a serious complaint?. . . . . . . . . 20 How do I let Magellan know if there is something wrong or I am not happy with the services being received? . . . . . . . . . . . . . . . 20 Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 What if I don’t agree with a complaint or grievance resolution?. . . . . . . . . . . . . . . . . . . 21 More important information . . . . . . . . . . . . 23 Eligibility and application process for the Children’s Mental Health Waiver. . . . . . . . . . . . 23 Get involved! Advisory councils. . . . . . . . . . . . 23 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) . . . . . . . . . . . . . . . . . . 23 Total Health Record (THR) . . . . . . . . . . . . . . . . 23 Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Provider resources . . . . . . . . . . . . . . . . . . . . . . . 24 Community resources . . . . . . . . . . . . . . . . . . . . 24 Helpful links. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Documentation overview . . . . . . . . . . . . . . . 27

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Welcome to Magellan Your child or youth may have a complex behavioral health condition that causes problems at home, at school or in the community. If so, please contact Magellan Healthcare. The information in this handbook will help you know more about what High Fidelity Wraparound (HFWA) offers. Welcome to Magellan Healthcare, Inc., Wyoming’s Care Management Entity (CME) for youth who have complex behavioral health conditions. (Behavioral health is also referred to as mental health.) Magellan understands that each child, youth and family member has unique strengths, needs, culture and life experiences. As the CME, we support providers in tailoring their services to meet those needs. We respect the culture and experiences of youth and their families.

Contact us

High Fidelity Wraparound (HFWA) is a communitybased program to help keep children and youth at home, in school and out of trouble. Our approach enables us to help children and youth lead successful lives. We help them develop and keep positive ties to their communities. We support their health and well-being. To achieve this, we work with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid). We also work with other state agencies. Together, we coordinate the care, services and supports that youth and their families need.

If you have problems with the services you’ve received, we can help you:

Partnering with families ensures the success of HFWA around the state of Wyoming. We want you to be involved beyond the care planning process of HFWA. We want you to have roles in improving quality, delivering training and guiding our work through your involvement in local committees and sharing your ideas with us. This handbook will tell you who is qualified to receive HFWA, what the program offers and how to access care.

If your child is in a life-threatening situation, call 911 right away. 2

If you need help, or you want to learn more about us, please contact us as shown below. When you contact us, we can help you: • Learn about HFWA and get the services you need. • Get a referral to a provider, such as a counselor or therapist. • Get answers to your questions.

• Solve the problems. • Make a complaint. • Get a review of a decision made about your complaint or problem. We look forward to serving you! Magellan in Wyoming Toll-free: 1-855-883-8740 TDD/TTY: 1-800-424-6259 Website: www.MagellanofWyoming.com Email: [email protected] Address: 205 Storey Blvd., Suite 120 Cheyenne, WY 82009

Getting help in other languages and formats If you would like to get written information in your preferred language, such as Spanish, or in a format such as Braille, please contact us at 1-855883-8740. Our TDD/TTY number is 1-800-4246259. Or, visit www.MagellanofWyoming.com. We will help you.

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What to do in an emergency

Crisis support

An emergency is a situation in which your child or youth is in a life-threatening situation and needs help right away. In an emergency, you must act quickly:

Remember to call 911 first if your child is in an emergency situation. If your child is in crisis—that is, if he or she is acting in a way that you believe might lead to an emergency situation, call Magellan toll-free at 1-855-883-8740. You can call to talk to a mental health professional at any time of day, every day of the week. Magellan will help you to identify your level of need and help to coordinate support. This could include activating your child and family team or connecting to local resources and/or hospital care if needed.

• Call 911 at once! You do not need to call Magellan first. Take your child or youth to the closest hospital. 911 will help him or her get transported to a hospital in an emergency. Your child can use any hospital for emergency care, even if he or she is in another city or state. • Tell the hospital that your child is a Magellan Healthcare member enrolled in the Wyoming Care Management Entity. Ask them to call Magellan Healthcare at 1-855-883-8740 to coordinate outreach with the High Fidelity Wraparound provider to have the child and family team informed of the crisis and to set up an emergency team meeting. • If your child is currently receiving behavioral health or primary care, contact his or her provider. The provider may be able to offer additional support and intervention. • Or, contact Magellan any time, day or night. Call 1-855-883-8740. We will help you find the right care for your child.

In addition, consultation with child doctors can be set up just about any time through state-supported resources to help avoid escalation to a crisis. The Partnership Access Line (PAL), which offers mental health consultation outreach for children, is open from 9 a.m. to 6 p.m. daily. Call 1-877-501-7257 or contact PAL online at http://wyomingpal.org. PAL gives any healthcare provider or family direct access to a child psychiatry consultation. Children also can be evaluated via telepsychiatry services supported by the state. The website for these services is http://telehealth.wyo.gov.

Refer a child Don’t need our services but know someone who does? There is no wrong door for referrals! The two quickest ways to get started are: • If you are currently working with a family, fill out the referral form that can be found on the Magellan of Wyoming website • Email [email protected] with the name and phone number for the family

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What is High Fidelity Wraparound? High Fidelity Wraparound is a planning process that follows a series of steps to help children and their families realize their hopes and dreams. The High Fidelity Wraparound process also helps make sure children and youth grow up in their homes and communities. HFWA is not a clinical treatment program. It is a care coordination and planning process that brings people together from different parts of the whole family’s life. HFWA includes families, trainers, coaches and process mentors. Together they seek positive, health outcomes for children with behavioral health needs. There is no standard treatment or process, each process and plan of care looks different based on what the youth and family needs.

High Fidelity Wraparound principles High Fidelity Wraparound relies on a set of ten principles (listed below) to serve youth and their families. The program may vary in different communities. However, HFWA is driven by the same principles no matter where you live or who is on your team. It is these principles that underlie a joint approach to helping youth and families. The principles are based on those in The Wraparound Process User’s Guide. Principle

Evidence of the principle in HFWA

1. Family voice and choice

Youth and families identify their team. The team provides options so that the plan reflects family values and preferences.

2. Team-based

The team is committed to youth and families through informal, formal and community support relationships.

3. Natural supports The plan supports individual and community relationships for youth and families. 4. Collaboration

Team members blend ideas to develop the plan. They share responsibility for setting up the plan and monitoring its results.

5. Communitybased

Services should be provided in the most responsive, open and easy-to-access settings possible.

6. Culturally competent

The plan respects and builds on the values, preferences, beliefs and culture of the child/youth and family.

7. Individualized

The team develops an approach to supports and services that closely fits each youth/family’s needs.

8. Strengths-based

The plan builds on the capabilities, knowledge and skills of the child and family. It also does this for their community and for other team members.

9. Unconditional

Despite hardships, the team persists in working toward the plan of care goals. They do this until the team agrees that a formal HFWA process is no longer required.

10. Outcomes-based

Through the plan of care, the team strives to reach clear goals that youth and families say are important. The team monitors progress toward goals and revises the plan if needed.

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What your child and family can expect When you call

Forms to complete

When you call Magellan, our customer service staff will help you learn about the services you and your family can get. Magellan has staff members who speak different languages. We also have translators to work with you. We have information in Spanish if you need it.

You and your family will initially be connected with an independent assessor who will help you to complete the application and required assessments for entry into the CME. This application will request basic information about you, your child and the reason for referral as well as consent forms for submitting and sharing this information.

We will provide the information you and your family need to learn about the program’s available services. We will help you understand our role and how the program will help youth and families. We will provide information to help you and your family stay connected to the services you need.

Choice of provider Providers and services available through Magellan will be explained to you. You will have the ability to make decisions regarding the services that will be provided to your child. You will also be able to select the provider(s) who will work with your child while he/she is a member of Magellan. You will have the right to change provider(s) at any time for any reason. Magellan providers have a right to end their services, but they must give a 30day written notice to you and your youth. You will also have the right to request an informal dispute resolution or a formal hearing if you were not given a choice of services or providers. Magellan will share a list of its providers with you, and we will answer your questions. You can find a list of providers available to you on our online provider search function. Visit www.MagellanofWyoming.com and select the “For youth & families” tab and click “Find a Provider”. Follow the “Provider Search (online)” link to use the online tool.

The independent assessor will help you complete: ££ CASII/ESCII assessment. These are the required assessments for entry into the program. ££ HFWA application. ££ Level of care form. The independent assessor will work with you and a qualified mental health professional to get this form completed. ££ Provider Choice form. You will select the provider you would like to work with. ££ Freedom of Choice form. This form simply states that you understand you have the ability to choose your own provider and services.

After you are approved and connected with your provider of choice, at your first meeting with a care coordinator you will be asked to read and sign several forms to begin services and future coordination.

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What does HFWA look like? How does HFWA work for my family? A family care coordinator, family support partner and youth support partner will help youth and family members. They will help the youth and family decide what they want for their future. They will help the youth/family understand and be prepared for the process. They will develop a child and family team. They will also support the team’s progress.

How do I know if my child qualifies for HFWA? A child or youth qualifies if: • He or she is between the age of 4 and 21. −− He or she is eligible for Medicaid (see Wyoming Medicaid at www.wesystem.wyo.gov, or call 1-800-2511269. Call center hours are Monday through Friday, 9 a.m. to 5 p.m. MST). • He or she has been involved in multiple systems. • He or she has received a specific behavioral/ mental health diagnosis. • He or she has social or emotional challenges that impact his/her life.

The team will include those people whom youth and families say are important in their lives. It will also include others who may be involved with them. The team will work together to develop a plan that builds upon the family’s strengths. This will help serve the child and family’s unique needs. The family care coordination will direct the teambased approach to help youth and families resolve complex situations with positive results.

• Upon completion of an assessment by a behavioral health provider, he or she scores as follows. −− Youth ages six (6) to twenty (20) must have a minimum Child and Adolescent Service Intensity Instrument (CASII) total score of twenty (20). −− Youth ages four (4) and five (5) must have an Early Childhood Service Intensity Instrument (ECSII) score of eighteen (18) to thirty (30). −− Or, the needed social and emotional assessment information is provided that illustrates level-of-service needs. Other factors that are considered for the child or youth include: • He or she is at risk of out-of-home placement.

Visit this link for a guide you can use as your “road map” for getting a better understanding of the Wraparound Process:

• He or she currently meets psychiatric residential treatment facility (PRTF) level of care or is placed in a PRTF.

www.nwi.pdx.edu/pdf/Wraparound_Family_ Guide09-2010.pdf

• He or she currently meets the “acute psychiatric stabilization hospital” level of care.

(National Wraparound Initiative) 6

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Or, he/she had an acute hospital stay for mental or behavioral health conditions in the last 365 days. Or, he/she is currently placed in an acute hospital stay for mental or behavioral health conditions. • He or she is on the Children’s Mental Health Waiver (1915(c)). • He or she is between the ages of 4 and 21, has Medicaid and is referred to the CME. He/she must meet defined eligibility requirements. This includes clinical eligibility and serious emotional disturbance (SED) criteria. Once qualified, your child and family will be ready for High Fidelity Wraparound.

What services will we be able to get? Service

1915 (b) Waiver

1915 (c) Waiver

Family care coordination*

X

X

Family support*

X

X

Youth support*

X

X

Respite

X

X

Flex funds

X

X

Youth and family training Telehealth

X X

What do I do if I think my child needs physical or behavioral health services other than HFWA? You and your child and family team will be building a comprehensive integrated plan of care (POC) that addresses all aspects of your life. If your prioritized needs require physical or behavioral health service interventions that are not covered within HFWA, this will still be outlined within the POC. Access and coordination of those services will be managed by your family care coordinator. For more information on available services and supports besides HFWA, please call 1-800-2511269 or go to Wyequalitycare.acs-inc.com.

What are flex funds? If your family is dealing with an urgent need and/or financial hardship, you may request flex funds. Flex funds are monies used for expenses in support of the youth and family’s plan of care. Flex funds should be requested as a last resort to provide a youth and family with emergency assistance. Please work with your child and family team to request flex funds if needed. Your family care coordinator will be able to walk you through the process of requesting flex funds. Flex funds are discretionary funds subject to availability.

X

*These functions are core components of the services offered with your enrollment in High Fidelity Wraparound. These services, including respite, flex funds and youth and family training, will be reviewed and tied to needs as identified by you and your team in accordance with benefit authorizations and limitations. Magellan Healthcare, Inc. Child, Youth & Family Handbook  Call us free at 1-855-883-8740. We are here to help.

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High Fidelity Wraparound phases Below is a summary of each phase of the High Fidelity Wraparound process. These sections will help you understand what to expect. This includes the actions you will take and what results your family can expect to see. Also included is information about related forms and documents. Don’t forget: you have a team to help you!

Phase 1: Engagement and preparation A family care coordinator and a family support partner (if you choose one) meets with your family. They will discuss the High Fidelity Wraparound process with you and listen to your family’s story. Actions the team takes

Results families should see

££ We describe our vision for the future.

££ Met with family care coordinator and explained our story.

££ We identify people who care about us as a family and those who have helped each family member. ££ With the family care coordinator, we decide who will attend a meeting to develop a plan of care. We decide where to have the meeting.

££ Addressed immediate needs and crises and put together an initial crisis plan. ££ Generated a strengths list. ££ Agreed on who will contact potential team members. ££ Got more information about this process.

££ We describe our vision for the future. Forms the team completes

Documents created

££ Form providing initial permission to provide services.

££ Strength, Needs, and Cultural Discovery (SNCD).

££ Release(s) allowing the family care coordinator to speak with the other team members.

££ Strength List/Inventory.

££ Survey about our family called the Family Empowerment Tool (FET).

££ The Child and Adolescent Needs and Strengths (CANS) inventory.

££ List of potential child and family team (CFT) members.

££ Survey for our child to complete called the California Healthy Kids Survey (CHKS)

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Phase 2: Initial planning You’ll attend your first child and family team (CFT) meeting with people who are providing services to your family. Also included will be people who are connected to you in a helpful role. Together with the team

Results familes should see

££ Develop a mission statement about what we will work on together.

££ Our strengths were listed and reviewed. Developed a team mission statement that reflects what we and other team members hope to get out of this process.

££ Look at our family’s needs in detail. ££ Identify different ways to meet those needs that match our strengths. All team members will do something in the plan.

££ Reviewed needs that reflect our concerns and worries. ££ Selected a limited number of needs to keep everyone from being overwhelmed. ££ Brainstormed a variety of strategies to meet family needs. ££ Chose strategies to meet those needs that matched our strengths. ££ The plan of care has been distributed to all team members.

Forms the team completes

Documents created

££ Permission(s) and release(s) if new service providers are called.

££ Plan of care that includes the team mission and most important needs. Also, the plan says who is responsible to follow through and when. ££ Written crisis plan that includes who will help if things go wrong. The plan will say who should be called and in what order. ££ Schedule of future team meetings.

Different team members will take on agreed-upon tasks. When the meeting is over, everyone will know what they have to do and how to contact other team members.

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Phase 3: Plan implementation Based on your planning meetings, your team will create a written plan of care. You have committed to action steps. The team members are committed to doing the work. Your team comes together regularly. When your team meets, you’ll do four things: • Review your accomplishments and see what’s going well.

• Adjust things that aren’t working. • Assign new tasks.

• Assess whether your plan has been working. Forms the team completes

Documents created

££ Updated release forms for team members, especially if new members are added.

££ Team minutes (meeting summary) that detail the accomplishments of the team.

££ A survey about our activities and satisfaction called the Wraparound Fidelity Index (WFIEZ), to be completed after 3 and 9 months of participation.

££ The minutes show changes to the plan and the schedule of meetings. ££ Regular progress reports that reflect progress made from the time of the original plan. ££ An updated Child and Adolescent Needs and Strengths (CANS) inventory to be completed every three months.

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Phase 4: Transition You’ll reach this final phase when you can confirm the following: • You have held practice crisis drills and are confident you know what to do if things go wrong. • You have a way to access services in the future. • You have a way to connect with other families who have been through the process.

• You have a list of phone numbers from team members, whom you can contact if needed. • Leaving HFWA has been discussed with the whole team. • You have written documents that describe your strengths and accomplishments. • Your family is running its own team meetings.

• Your concerns have been considered. You will eventually reach a point in the process when the team will not need to meet regularly. When all goals have been met, the team might have one final meeting to have a small celebration. As a family, you’ll get a record of everything that happened throughout the High Fidelity Wraparound process, as well as a list of what worked. The team makes a plan for the future, including where to call for help or if you need to meet again as a team. Forms the team completes

Documents created

££ Discharge summary.

££ Transition plan that describes how ongoing services will be accessed if necessary.

££ Survey about our family called the Family Empowerment Tool (FET). ££ Survey for our child to complete called the California Healthy Kids Survey (CHKS).

££ Crisis plans that include communication instructions for those who will be contacted in the event of an emergency. ££ Follow-up phone numbers for all team members who might be contacted after the transition. ££ A discharge Child and Adolescent Needs and Strengths (CANS) inventory. ££ Formal discharge plan that describes strengths of the family, the actions that were successful and those that were not.

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High Fidelity Wraparound checklist Use this checklist to keep track of how High Fidelity Wraparound is going! Phase 1: Engagement and team preparation

Phase 3: Plan implementation and refinement

££ Met with family care coordinator and family support partner and explained our story.

££ Activities promised are being provided. ££ Assessment of the plan is occurring.

££ Addressed immediate needs and crises and put together an initial crisis plan.

££ Team is meeting often enough to check on follow-through.

££ Generated a strengths list.

££ You’re being asked if actions are meeting your needs.

££ Generated a team member list. ££ Agreed on a first meeting. ££ Agreed on who will contact potential team members. ££ Got more information about this process. Phase 2: Initial planning ££ Participated in one or two child and family team meetings. ££ Strengths were listed and reviewed. ££ Developed a team mission statement that reflects what you and other team members hope to get out of this process. ££ Reviewed needs that reflect your concerns and worries. ££ Picked a few needs to keep you and the team from becoming overwhelmed. ££ Brainstormed a variety of strategies to meet those needs. ££ Chose strategies to meet those needs that matched your strengths.

££ Accomplishments are reviewed and recorded.

££ Adjustment of the plan is occurring based on your feedback. ££ Assignments are being made and recorded at each team meeting. ££ Copies of the minutes and the updated plan of care are sent to all team members. ££ Regular progress reports are written and sent out. ££ You’re practicing what to do if a crisis occurs with your family and the team. Phase 4: Transition ££ You have held practice crisis drills and are confident you know what to do if things go wrong. ££ You have a way to access services in the future. ££ You have a way to connect with other families who have been through the process. ££ Your concerns have been considered.

££ All team members are reflected as doing something in the plan.

££ You have a list of team member phone numbers and you can contact them if needed.

££ The plan of care has been distributed to all team members.

££ Leaving HFWA has been discussed with the whole team. ££ You have written documents that describe your strengths and accomplishments.

From the Wraparound Process User’s Guide, National Wraparound Initiative.

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What can I expect from my family care coordinator? Magellan Healthcare offers a statewide network of providers from which families can choose. Helping ensure each family has access to a provider is a key principle of HFWA; Magellan will provide you with provider locations, experience and information so that you can choose the best provider match for your family. Within 72 hours of notification of your enrollment, the family care coordinator will set up the first meeting with you to explain his or her role in the process. A chosen family support partner and youth support partner will also work individually with your family on specific skills to reach set goals. All meetings should be scheduled at a time and place that works best for you. The initial meetings will include completion of necessary paperwork (such as permission to treat and release of information forms). This will enroll your youth in the process. Then you will share both the positive things in your life and the current challenges. Your family care coordinator will work closely with you to complete various documents and tools during HFWA to track progress and success. The plan of care (POC) helps direct and guide the team as you move through the HFWA process. The team will identify and prioritize your needs. Actions in the plan will build on the strengths of your youth and family. The team will document progress. If some actions are not working, you can change the plan at any time. These changes MUST be discussed and can only be changed during your CFT meetings. The plan of care must be agreed upon and signed by all team members.

This is the timeline you can expect:

Your youth is accepted into the CME.

The family care coordinator is notified of enrollment within 24 hours.

Your assigned family care coordinator will contact your family within 72 hours to arrange the first meeting.

Your family care coordinator meets with your family to identify strengths and to identify team members.

30 Your first child and family team (CFT) meeting will be held within 30 days of notification.

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What is expected of me? Your team will need you to participate in the following ways. • Engage with your family care coordinator and family support partner within 72 hours of enrollment into the program. • Help develop a team and make decisions with that team. • Participate in child and family team meetings at least once a month—and more often if needed—as organized by your family care coordinator.

• Be willing to discuss difficult issues. • Develop crisis and safety plans within the first 14 days of enrollment. Use them when needed. If the plans are not working, raise your concerns at the next scheduled child and family team meeting. Or, contact your family care coordinator. • Understand that this is a process and it will take time.

• Help identify your family’s strengths and needs.

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Youth involvement Magellan strongly encourages youth to be involved in all aspects of their own care. Youth should be seen as experts in their own lives and recovery. They should be actively involved in their treatment, including selecting their own goals and deciding how those goals will be achieved. When young people are actively involved in their treatment decisions, they are more likely to follow through with treatment plan objectives and achieve positive outcomes. Magellan also encourages youth to share their ideas on how to improve services. Youth in recovery can develop leadership skills that help others recover as well. We hope that your youth will participate and enjoy the opportunities for personal growth available through the HFWA program.

MY LIFE program Your youth may benefit greatly from participating in an innovative program that Magellan sponsors in a number of regions of the country. MY LIFE (Magellan Youth Leaders Inspiring Future Empowerment) is a free program offered to any youth in the community between the ages of 13 and 23. The program actively engages youth through teaching, coaching and mentoring. The program helps youth to use their voices to inspire and create positive change for themselves and others in the community.

Regular meetings are the foundation of the MY LIFE model. They provide opportunities for youth to: • Create a community of support. • Plan monthly activities. • Practice social skills. • Learn from presenters and peers. • Develop leadership skills. MY LIFE also provides a much-needed voice in the community to combat negative views about behavioral health and foster care issues. MY LIFE benefits the individual youth involved by helping them build self-confidence, positive social supports and leadership skills. It also has been beneficial to systems that serve youth by bringing about changes to improve care for youth and young adults.

MY LIFE Wyoming Join your local MY LIFE group! MY LIFE Cheyenne meets the last Tuesday of every month. MY LIFE Laramie meets the last Wednesday of every month. Learn more by visiting the MY LIFE page at www.MagellanofWyoming.com For more about MY LIFE, visit www.Facebook.com/MYLIFEYouth.

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Eight Dimensions of Wellness It is important to provide support to help youth advance in all “Eight Dimensions of Wellness.” These dimensions have been outlined and promoted by the Substance Abuse and Mental Health Services Administration (SAMHSA). Focus on all of these dimensions is critical to helping young people lead happy and fulfilling lives. Therefore, we work with youth, families, providers and communities to provide opportunities for young people to advance in all of these dimensions of wellness. • Emotional—Being aware of feelings and being able to cope with stress, success and disappointment. • Environmental—Feeling safe where we live, work and play; and spending time in places that support happiness and a sense of well-being. • Financial—Feeling secure with our current and future money needs. • Intellectual—Using creative abilities and finding ways to expand knowledge and skills.

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• Occupational—Participation in meaningful work, school and/or volunteer activities. • Physical—Recognizing the need for physical activity, healthy foods and sleep. • Social—Developing a sense of belonging and a well-developed support system made up of friends, family and the community. • Spiritual—Expanding a sense of purpose, peace and meaning in life.

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Measuring family satisfaction Families and youth will also be asked to complete a special survey just for HFWA called the Wraparound Fidelity Index (or “WFI-EZ”). This survey asks about your experience and satisfaction with the High Fidelity Wraparound process. It is used to assess how well the core activities of HFWA are being applied. Everyone on the team is asked about his or her experiences. There is no right or wrong answer to any question. It is an anonymous survey. The results of the WFI-EZ help HFWA providers, the Wyoming CME and the state make improvements to HFWA. This survey is sent to the federal government.

Magellan and the State of Wyoming have high standards when it comes to working with families. When you participate in these surveys, it allows us to gauge the effectiveness of the program and make changes to help families.

Confidentiality All information about your child and family is confidential and will not be shared with others unless you okay it. You will sign consent forms at the beginning of the HFWA program, which will allow Magellan, your family care coordinator, family support partner, and your child and family team to compile and share the information needed to develop, implement and monitor your family’s plan of care.

Information about you and your family will always remain confidential. The only time this would not be the case would be in situations when: • Your child or youth threatens to harm him/ herself or others. • Someone believes that abuse or neglect might be occurring. Such reports should be made to the Department of Family Services office in the county where the child or youth lives.

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Member rights and responsibilities Your family has rights and responsibilities under the HFWA program. In particular, as a member of the program, your child or youth’s rights are very important. Family care coordinators must explain your child’s rights at the first visit.

Your rights As an enrollee in the program, your child or youth has the right to: • Be treated carefully, with respect, dignity and privacy. • Be treated fairly, whatever his/her: −− Race. −− Ethnic background. −− Religion. −− Disability. −− Gender. −− Source of −− Sexual payment. orientation. • Have your child’s treatment and other information kept private. The only time we may share treatment records is when required by law. (The previous section, Confidentiality, provides more details.) • Get care easily and when needed. • Learn about treatment in a way that: −− Respects your culture. −− You can understand. −− Fits your needs. • Take part in making your child’s plan of care. • Get information in a language your family can understand. Also, get things translated for free. • Get information in other ways if you ask for it. • Get information about Magellan and its: −− Providers. −− Role in the treatment −− Programs. process. −− Services.

• Ask providers and others on the child and family team about their work history and training. • Not be kept alone or forced to do something your child does do not want to do. This is based on a federal law. • Give your thoughts on the Rights and Responsibilities policy. • Ask for a certain type of provider. • Have your child’s team make care decisions based on your child’s needs. • Get healthcare services that obey Wyoming and federal laws about your rights. • Help make decisions about your child’s healthcare. This includes the right: −− To get a second medical opinion. −− To say no to treatment. This is your right unless the court says otherwise. • File a complaint or grievance about: −− Magellan. −− A provider. −− The care your child receives. • File an appeal about a Magellan action or decision. • Get a copy of your child’s records. You can ask that they be changed or corrected.

• Get information about clinical rules followed in your child’s care.

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• Use your rights. This will not affect the way Magellan and its providers treat you. • Talk with your child and family team about what strategies are right for your child.

• Ask for information in a way that you can get to it easily. This applies if you have a visual, hearing or physical disability. This will help you know about the benefits and services you can get.

Your responsibilities As the parent or guardian of a child or youth, you have the responsibility to: • Help get the support he or she needs from a provider. • Model respect for your child and team to anyone providing care. • Give providers and Magellan the information they need. This helps support quality care and getting the right services. • Ask questions about your child’s care. This helps you and the provider understand your child’s condition. It helps create goals and plans you agree on. • Follow your child’s plan of care. This plan is agreed upon by the whole team and it is the responsibility of everyone to make sure it is completed. If you encounter barriers, you can contact your family care coordinator. • Attend all team meetings. You should call the family care coordinator as soon as you know you need to reschedule a meeting. • Tell the child and family team if the plan of care does not seem to be working. • Share worries about the quality of your child’s care.

• Tell someone if you suspect abuse or fraud. (This is someone not being honest.) If you suspect abuse or fraud, call Magellan’s Corporate Compliance Hotline. You can reach this number 24 hours a day, seven days a week. −− This hotline is run by an outside company. −− You do not have to give your name when you call. −− You can also send an email. −− Magellan will look into all calls and emails. −− The calls and emails will stay private. Corporate Compliance hotline: 1-800-915-2108. Corporate Compliance email address: [email protected]. −− You can also report fraud, waste or abuse through Magellan’s Special Investigations Unit hotline. Special Investigations Unit hotline: 1-800-755-0850. Special Investigations Unit email: [email protected]. −− You may also report fraud, waste and abuse to the state or federal government.

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Complaints & grievances What if I have a serious complaint? You might not be happy with the service that you and your child are getting. Try to talk with the provider to solve the problem first. If that does not work, you may make a complaint or voice your concern. A complaint is also called a grievance. The way we handle your complaint is called our “grievance process.” You will hear the words “filing a grievance.” This is what we call the process when you make a complaint or voice your concern. Reasons for complaints or grievances can include: • You are unhappy with the quality of care or services. • You believe a provider did not respect your child’s rights. • You believe a provider has been rude. • A provider has abused or mistreated your child. • Your child has been put in a dangerous setting or situation. You can call us about a complaint or grievance. Or, you can tell us in writing. You can also contact us through our website.

How do I let Magellan know if there is something wrong or I am not happy with the services being received? Call to make a complaint Call Magellan at 1-855-883-8740. If you are deaf or have trouble hearing, please call our TDD/TTY number at 1-800-424-6259. We will be able to solve your problem on the telephone most of the time. You may also send your complaint in writing . Written complaint Please write to: Magellan Healthcare, Inc Attention—Grievances 205 Storey Blvd., Suite 120 Cheyenne, WY 82009 Online (website) complaint You also can file a complaint online. The address is www.MagellanHealth.com/member. 1. Click on the ‘question mark’ in the upper right-hand corner of the screen. 2. Click on the link labeled ‘Complaints’ (or ‘Compliments’) located in the list labeled ‘Feedback.’ 3. Click on the link labeled ‘Contact Us.’ 4. Type and send your message. Magellan has 30 days to review, make a decision and respond to you.

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Appeals A letter will be mailed to you. The letter will explain that Magellan received your concern. After the grievance has been resolved, you will receive a second letter. The second letter explains the steps Magellan took to address your concern.

What if I don’t agree with a complaint or grievance resolution? If you are not satisfied with this process, you have the right to ask for an appeal. Your request must be sent within 30 business days of receipt of the second letter from Magellan. What is an appeal? An appeal is a request for a hearing officer to review our decision if you think we made a mistake and you do not agree with it. How do I file an appeal? To file an appeal, you or your representative must send a written appeal request to the Wyoming Department of Health within 30 days from the date on the letter we sent to tell you our decision. You may write a letter or complete an Appeal Request Form. Or you may call 307-777-7531. You must send the Wyoming Department of Health a copy of the letter we sent to you. You must sign the appeal request and send it to the: Division of Healthcare Finance-Medicaid Wyoming Department of Health Attention: Lisa Brockman 6101 Yellowstone Rd. Suite 210 Cheyenne, WY 82009

If you want your appeal to be a fast appeal, you must write that on your appeal request and ask your provider to send a letter to tell the Wyoming Department of Health why you need a fast appeal. After the date the provider letter is received, the Wyoming Department of Health will give you an answer in three working days or fewer if you qualify for a fast appeal. If your appeal is not a fast appeal, the Wyoming Department of Health will give you an answer within 90 calendar days of when you filed your appeal. Can someone else file the appeal for me? Yes. A friend, relative, lawyer, doctor or other person can file the appeal for you, but first you must give that person written permission to act for you. What happens if I miss the deadline for filing my appeal? If you miss this deadline and have a good reason for missing it, the Wyoming Department of Health may give you more time to file your appeal. Examples of a good reason are, but are not limited to: • You had a serious illness or a death in the family. • You did not get the letter about the decision you wish to appeal. • You received the wrong information about the deadline for requesting an appeal. • Another unusual situation.

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Will my services continue during my appeal? Your services may continue if you request that the Wyoming Department of Health continue them. Certain rules apply. For example, if you lose your appeal you may have to pay for the services that you received while the appeal was in progress. How will I find out about the decision? The Wyoming Department of Health will send you a letter explaining the appeal decision. If you do not agree with the decision, you may appeal to your Circuit Court. The appeal decision will give you information on how to do so. Please contact the Wyoming Department of Health if you have questions about appeals. Call 307-777-7531.

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More important information Eligibility and application process for the Children’s Mental Health Waiver The Children’s Mental Health Waiver allows for HFWA eligibility for a child who does not qualify for Medicaid through his/her family. The Children’s Mental Health Waiver application is submitted to the state for clinical and financial eligibility determination. Financial eligibility is determined on the child’s income only.

Get involved! Advisory councils Magellan actively encourages youth and family input and participation on advisory councils. Advisory councils are designed to help us gather critical information on how we can continuously improve the services we offer to youth and families. Through regional advisory councils, we regularly share program information and details about local services. Please consider participating in the development of a top-notch system of care for Wyoming. Upcoming meeting information can be found on the advisory council webpage on www.MagellanofWyoming.com.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) EPSDT is Early and Periodic Screening, Diagnostic and Treatment. It is a benefit for providing eligible children with preventive healthcare services such as regular checkups and full physical and mental healthcare from birth up to age 21. These assessments (or “screenings”) must include check-ups in four areas: physical health, dental health, vision and hearing. A primary care physician (PCP) for the child/youth works with the family in accessing the services your child needs. Magellan will ensure that every child has a PCP, and that the PCP will perform and manage all EPSDT requirements. We will maintain ongoing communication to ensure tracking of EPSDT requirements and coordination of care.

Total Health Record (THR) What is THR? The Total Health Record (THR) is a Web-based health record tool. The record is based on information from a number of the child’s healthcare services. This record may include: • Patient data.

• Vital signs.

• EPSDT information.

• Past medical history.

• Progress notes and problems.

• Immunizations.

• Medications.

• Radiology reports.

• Lab data.

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Resources Provider resources

Independent assessors

Please visit our website, www.MagellanofWyoming.com, to find a High Fidelity Wraparound or respite provider. You can use the provider search function on the website to find a provider by location or name. You may also customize your search to meet the needs of your child and family.

The independent assessor is the person who completes the CASII and ESCII Assessments as part of the process to determine if a youth meets the clinical qualifications for HFWA. More information about the independent assessor may be found here: http://www.magellanofwyoming.com/ foryouthandfamilieswy/find-a-provider.aspx

Community resources

Magellan in Wyoming website

Please visit our website, www.MagellanofWyoming.com, for an up-to-date list of local community resources that can help you find assistance with job training, food banks and more.

www.MagellanofWyoming.com

Helpful links Use these guides for more information about psychotropic medications: • Making Healthy Choices: A Guide on Psychotropic Medications for Youth (National Resource Center for Youth Development), http://youth.gov/feature-article/making-healthychoices-guide-psychotropic-medications-youthfoster-care • Appropriate Use of Psychotropic Drugs in Children and Adolescents: A Clinical Monograph (Magellan Health, Inc.), www.magellanhealthcare.com/medicaid/oursolutions/childrens-services/appropriate-useof-psychotropic-medications-in-children.aspx • Choosing the Right Treatment: What Families Need to Know About EvidenceBased Practices (National Alliance on Mental Illness), www2.nami.org/namiland09/CAACebpguide.pdf

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Glossary Below are a list of terms you may hear your provider, Magellan or formal supports use. Care Management Entity (CME): Magellan Healthcare serves as the care management entity for HFWA in Wyoming. This means that Magellan oversees the enrollment of members into the program and oversees the delivery of services. CASII/ECSII – Child and Adolescent Service Intensity: This assessment is completed by an independent assessor and is required to be submitted with an application to the High Fidelity Wraparound program along with every 12 months afterward as long as the youth is enrolled. Family care coordinator (FCC): A person who is trained to coordinate the HFWA process for an individual family. This person may also be called a family care coordinator, navigator, wraparound specialist, resource facilitator or some other term. The person in the facilitator role may change over time, depending on what the family thinks is working best. For example, a parent, caregiver, or other team member may take over facilitating team meetings after a period of time. Family support partner (FSP): A person who has experienced High Fidelity Wraparound. This person is a formal member of the team. His or her role is to serve as a partner, peer mentor, coach, educator, advocate and resource for family members. Formal supports: Services and supports provided by professionals (or other individuals who are “paid to care”) under requirements for which there is oversight by state or federal agencies, national professional associations or the general public arena.

High Fidelity Wraparound principles: Ten statements that define the HFWA philosophy and guide the activities of the process. Independent Assessor: A person who is trained and authorized to complete the CASII or ESCII evaluation for your child. These assessments are required with the enrollment packet. Level of care: This is a form that is required with the enrollment packet to verify that the youth meets the clinical eligibility to be enrolled in HFWA. The form is completed by a licensed clinician. Life domains: Areas of daily activity critical to healthy growth and development of a child or successful functioning of a family. Life domains include areas such as safety, school/work, health, social/fun, a place to live, legal issues, culture, behaviors, emotions, transportation and finances. Member: The use of the term member in the HFWA setting is referring to the youth enrolled in the program. Mission statement: A statement crafted by the child & family team that provides a one- to two- sentence summary of what the team is working toward with the youth and family. Natural supports: Individuals or organizations in the family’s own community, kinship, social or spiritual networks. This could be friends, extended family members, ministers, neighbors, etc.

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Outcomes: Child, family or team goals stated in a way that can be observed and measured. Plan of care or wraparound plan (POC): A dynamic document that describes the family, the team and the work to be undertaken to meet the family’s needs and achieve the family’s longterm vision. Respite: A service that includes your child spending time with a certified respite provider and works on skills-building. It is available short-term and is episodic in nature. Strategies: Statements in a plan of care that describe specific activities that will be undertaken, including who will do them and within what timeframe. Strengths: Strengths are the assets, skills, capacities, actions, talents, potential and gifts in each family member, each team member, the family as a whole, and the community. In HFWA, strengths help family members and others to successfully navigate life situations. Thus, a goal for HFWA is to promote these strengths and to use them to accomplish the goals in the team’s plan of care.

Vision statement: A statement constructed by the youth and family (with help from his or her facilitator and possibly the wraparound team) that describes how he or she wishes things to be in the future, individually and as a family. Waiver: There are two Medicaid waivers that pay for HFWA services in the state of Wyoming. The waivers are the Children’s Mental Health waiver and the 1915 (b) waiver. Wraparound team or Child and Family team (CFT): A group of people—chosen with the family and connected to them through natural, community and formal support relationships—who develop and implement the family’s plan, address unmet needs and work toward the family’s vision. Youth support partner (YSP): A young adult between the ages of 18 and 26 who has personal experience with the system of care as a youth with behavioral health needs. This person can be a member of the child and family team if the youth requests it. Similar to the family support partner, the youth support partner’s role is to serve as a partner, peer mentor, coach, educator, advocate and resource for youth.

Telehealth: An available service that allows anyone with an Internet connection to work with certified providers around the state to receive their services.

From the Wraparound Process User’s Guide, National Wraparound Initiative. 26

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Documentation overview The grid below highlights the documentation that is required in HFWA, when it is needed and who is in charge of making sure it is completed. High Fidelity Wraparound Start CASII/ESCII LOC Diagnosis

Post CME Services End of service

6 months

POC

POC

FET

CANS

CHKS

CHKS

30 days

3 months

6 months

9 months

12 months

POC

POC

POC

POC

CANS

CANS

CANS

CANS

SNCD

WFI-EZ

FET CHKS

Continue pattern

WFI-EZ

FET CASII/ESCII LOC Diagnosis

CANS

Legend CANS—Child and Adolescent Needs/Strengths CHKS—Child and Adolescent Service Intensity CASII/ECSII—California Health Kids Survey FET—Family Empowerment Tool POC—Plan of Care SNCD—Strengths, Needs and Cultural Discovery WFI-EZ—Wraparound Fidelity Index–Short Form

Independent Assessor FCC Survey Team CME

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Magellan Healthcare, Inc., d/b/a Magellan in Wyoming (hereinafter Magellan) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Magellan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Magellan: Provides free aids and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages If you need these services, contact Mary Jane Schultz. If you believe that Magellan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the Quality Improvement and Outcomes Manager, 1-855-883-8740, 1-800-424-6259, Fax: 1-888-656-2597, WYQuality@ MagellanHealth.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Quality Improvement and Outcomes Manager is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs. gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-868-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-855-883-8740 (TTY: 1-800-424-6259). 如果您，或是您正在協助的對象，有關於[插入SBM項目的名稱 Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, 方面的問題，您有權利免費以您的母語得到幫助和訊息。洽詢一位翻譯員，請撥電話 [在此插入數字 1-855-883-8740 (TTY: 1-800-424-6259). Falls Sie oder jemand, dem Sie helfen, Fragen zum Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, haben, haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer 1-855-883-8740 (TTY: 1-800-424-6259) an. Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa 1-855-883-8740 (TTY: 1-800-424-6259). Si vous, ou quelqu’un que vous êtes en train d’aider, a des questions à propos de Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, vous avez le droit d’obtenir de l’aide et l’information dans votre langue à aucun coût. Pour parler à un interprète, appelez 1-855-883-8740 (TTY: 1-800-424-6259).

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Call us free at 1-855-883-8740. We are here to help.  Magellan Healthcare, Inc. Child, Youth & Family Handbook

만약 귀하 또는 귀하가 돕고 있는 어떤 사람이Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, 에 관해서 질문이 있다면 귀하는 그러한도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다. 그렇게 통역사와 얘기하기위해서는1-855-883-8740 (TTY: 1-800-424-6259) 로 전화하십시오. Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi 1-855-883-8740 (TTY: 1-800-424-6259). Se tu o qualcuno che stai aiutando avete domande su Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, hai il diritto di ottenere aiuto e informazioni nella tua lingua gratuitamente. Per parlare con un interprete, puoi chiamare 1-855-883-8740 (TTY: 1-800-424-6259). Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, о вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону 1-855-883-8740 (TTY: 1-800-424-6259). Jika Anda, atau seseorang yang Anda tolong, memiliki pertanyaan tentang Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, Anda berhak untuk mendapatkan pertolongan dan informasi dalam Bahasa Anda tanpa dikenakan biaya. Untuk berbicara dengan seorang penerjemah, hubungi 1-855-883-8740 (TTY: 1-800-424-6259). ご本人様、またはお客様の身の回りの方でも、Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, についてご質 問がございましたら、ご希望の言語でサポートを受けたり、情報を入手したりすることができます。料金はかかりませ ん。通訳とお話される場合、1-855-883-8740 (TTY: 1-800-424-6259) までお電話ください。 यदि तपाई ं आफ्न ा लादि आफ ै ं आवेि नको काम ि ि ,ै वा कस ैल ाई मद्द त ि ि ै ह नु हु नु छ् , Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, बारे प्र श्न हर ू छन् भने आफ्न ो मातृभ ाषामा दन:श लु क् सहायता वा जानकारी पाउने अदिकार छ । ि ोभाषे (इन्ट रप्र ेट र) सँ ि क रु ा िन ु पु रे 1-855-883-8740 (TTY: 1-800-424-6259) मा फोन िन ु हु ोस् । ‫امش رگا‬، ‫ دينکيم کمک وا ەب امش ەک یسک اي‬، ‫ دروم رد لاوس‬، ‫کمک ەک دي راد ار نيا قح ديشاب ەتشاد‬ Magellan Healthcare, Inc., d/b/a Magellan in Wyoming, 1-855-883-8740 (TTY: 1-800-424-6259) ‫نابز ەب تاعالطا و‬ ‫ دييامن تفايرد ناگيار روط ەب ار دوخ‬.‫دييامن لصاح سامت‬ જો તમે અથવા તમે કોઇને મદદ કરી રહ ્ ાાં તેમ ાંથી કોઇને [એસબીએમ ક ર ્ યક ્ રમન ાં ન મ મ કો] વિ શે પ ્ રશ ્ નો હોર ્ તો તમને મદદ અને મ હહતી મેળિ િ નો અવિ ક ર છે. તે ખર ્ ય વિ ન તમ રી ભ ષ મ ાં પ ્ ર પ ્ ત કરી શક ર ્ છે. દ ભ વષર ્ ો િ ત કરિ મ ટે,આ [અહી ં દ ખલ કરો નાંબર ] પર કોલ કરો. D77 kwe’4 atah n7l7n7g77 Magellan Healthcare, Inc. d/b/a Magellan in Wyoming, haada yit’4ego b7na’7d7[kidgo 47 doodago h1ida b7k1 anilyeed7g77 t’1adoo le’4 y7na’7d7[kidgo beehaz’1anii h0l= d77 t’11 hazaadk’ehj7 h1k1 a’doowo[go bee haz’3 doo b33h 7l7n7g00. Ata’ halne’7g77 koj8’ bich’8’ hod77lnih 1-855-883-8740 (TTY: 1-800-424-6259).

1-855-883-8740 www.MagellanofWyoming.com B-H1015rev1 (6/16)  ©2015 Magellan Health, Inc.