| (a) Assessment and documentation. At the first routine
face-to-face or telemedicine contact with an individual seeking routine
care services, as described in §412.314(d)(2) of this title (relating
to Access to Mental Health Community Services,) a QMHP-CS with appropriate
supervision and training must perform an assessment of the individual.
The assessment must be documented and must include:
(1) the individual's identifying information;
(2) completion of the appropriate uniform assessment(s)
and assessment guideline calculations;
(3) present status and relevant history, including
education, employment, housing, legal, military, developmental, and
current available social and support systems;
(4) co-occurring mental illness, emotional disturbance,
substance abuse, chemical dependency, or developmental disorder;
(5) relevant past and current medical and psychiatric
information, which may include trauma history;
(6) information from the individual and LAR (if applicable)
regarding the individual's strengths, needs, natural supports, describe
community participation, responsiveness to previous treatment, as
well as preferences for and objections to specific treatments;
(7) if the individual is an adult without an LAR, the
needs and desire of the individual for family member involvement in
treatment and mental health community services;
(8) the identification of the LAR's or family members'
need for education and support services related to the individual's
mental illness or emotional disturbance and the plan to facilitate
the LAR's or family members' receipt of the needed education and support
services;
(9) recommendations and conclusions regarding treatment
needs; and
(10) date, signature, and credentials of staff member
completing the assessment.
(b) Diagnostics. The diagnosis of a mental illness
must be:
(1) rendered by an LPHA, acting within the scope of
his/her license, who has interviewed the individual, either face-to-face
or via telemedicine;
(2) based on the DSM;
(3) documented in writing, including the date, signature,
and credentials of the person making the diagnosis; and
(4) supported by and included in the assessment.
(c) Provision of services. The LMHA, MCO, and provider
must require each provider to implement procedures to ensure that
individuals are provided mental health community services based on:
(1) the department's uniform assessment and utilization
management guidelines;
(2) medical necessity as determined by an LPHA; and
(3) health management needs as determined by a physician,
physician assistant, or registered nurse.
(d) Prerequisites to provision of services.
(1) Routine care services. For routine care services,
before providing mental health community services to an individual,
the provider must:
(A) obtain authorization from the department or its
designee for the type(s), amount, and duration of mental health community
services to be provided to the individual in accordance with the appropriate
uniform assessment and utilization management guidelines;
(B) obtain a determination of medical necessity from
an LPHA; and
(C) in collaboration with the individual and their
LAR (if applicable), develop a treatment plan for the individual that
includes a list of the type(s) of mental health community services
authorized in accordance with subparagraph (A) of this paragraph.
(2) Crisis services. For crisis services, as described
in §412.321 of this title (relating to Crisis Services), a provider
must deliver services in accordance with the utilization management
guidelines and authorization of services and timeframes described
in §412.318(c) of this title (relating to Utilization Management).
A diagnosis is not required when services are delivered in crisis
situations.
(e) Content and timeframe of treatment plan. Each provider
must develop a written treatment plan, in consultation with the individual
and their LAR (if applicable), within 10 business days after the date
of receipt of notification from the department or its designee that
the individual is eligible and has been authorized for routine care
services.
(1) At minimum, a staff member credentialed as a QMHP-CS
is responsible for completing and signing the treatment plan. The
treatment plan must reflect input from each of the disciplines of
treatment to be provided to the individual based upon the assessment.
The treatment plan must include:
(A) a description of the presenting problem;
(B) a description of the individual's strengths;
(C) a description of the individual's needs arising
from the mental illness or serious emotional disturbance;
(D) a description of the individual's co-occurring
substance use or physical health disorder, if any;
(E) a description of the recovery goals and objectives
based upon the assessment, and expected outcomes of the treatment
in accordance with paragraph (2) of this subsection;
(F) the expected date by which the recovery goals will
be achieved;
(G) a list of resources for recovery supports, (e.g.,
community volunteer opportunities, family or peer organizations, 12-step
programs, churches, colleges, or community education); and
(H) a list of the type(s) of services within each discipline
of treatment that will be provided to the individual (e.g., psychosocial
rehabilitation, medication services, substance abuse treatment, supported
employment), and for each type of service listed, provide:
(i) a description of the strategies to be implemented
by staff members in providing the service and achieving goals;
(ii) the frequency (e.g., weekly, twice a month, monthly),
number of units (e.g., 10 counseling sessions, two skills training
sessions), and duration of each service to be provided (e.g., .5 hour,
1.5 hours); and
(iii) the credentials of the staff member responsible
for providing the service.
(2) The goals and objectives with expected outcomes
required by paragraph (1)(E) of this subsection must:
(A) specifically address the individual's unique needs,
preferences, experiences, and cultural background;
(B) specifically address the individual's co-occurring
substance use or physical health disorder, if any;
(C) be expressed in terms of overt, observable actions
of the individual;
(D) be objective and measurable using quantifiable
criteria; and
(E) reflect the individual's self-direction, autonomy,
and desired outcomes.
(3) The individual and LAR (if applicable) must be
provided a copy of the treatment plan and each subsequent treatment
plan reviewed and revised.
(f) Review of treatment plan.
(1) Each provider must:
(A) review the individual's treatment plan prior to
requesting an authorization for the continuation of services;
(B) review the treatment plan in its entirety, as permitted
under confidentiality laws by considering input from the individual,
the individual's LAR (if applicable), and each of the disciplines
of treatment;
(C) determine if the plan is adequately addressing
the needs of the individual; and
(D) document progress on all goals and objectives and
any recommendation for continuing services, any change from current
services, and any discharge from services.
(2) In addition to the required review under paragraph
(1) of this subsection, a provider may review the treatment plan in
the following instances:
(A) if clinically indicated; and
(B) at the request of the individual or the LAR (if
applicable), or the primary caregiver of a child or adolescent.
(3) Any time the treatment plan is reviewed, the provider
must:
(A) meet with the individual either face to face or
via telemedicine to solicit and consider input from the individual
regarding a self-assessment of progress toward the recovery goals,
as described in subsection (e)(1)(E) of this section;
(B) solicit and consider the input from each of the
disciplines of treatment in assessing the individual's progress toward
the recovery goals and objectives with expected outcomes, described
in subsection (e)(1)(E) of this section;
(C) solicit and consider input from the LAR (if applicable)
or primary caregiver, if the individual is a child or adolescent regarding
the level of satisfaction with the services provided; and
Cont'd... |
