Action | 2011 Mental Health Services Program Changes for Appropriate Utilization & Provider Qualifications |
Stage | Proposed |
Comment Period | Ended on 4/12/2013 |
Definition:
“Service-specific provider assessment” means the “face-to-face interaction in which the provider obtains information from the child or adolescent, and parent or other family member or members, as appropriate, about health status. It includes documented history of the severity, intensity, and duration of health care problems and issues and shall contain all of the following elements: (i) the presenting issue/reason for referral, (ii) mental health history /hospitalizations, (iii) previous interventions by providers and timeframes and response to treatment, (iv)medical profile, (v) developmental history including history of abuse, if appropriate, (vi) educational/vocational status, (vii) current living situation and family history and relationships, (vii) legal status, (ix) drug and alcohol profile, (x) resources and strengths, (xi) mental status exam and profile, (xii) diagnosis, (Xiii) professional assessment summary and clinical formulation (xiv) recommended care and treatment goals, and (xv) the dated signature of the LMHP.
Definition:
“Certified prescreener” means an employee of either the local community services board/behavioral health service administrator or its designee who is skilled in the assessment and treatment of mental illness and who has completed a certification program approved by DBHDS.
12VAC30-50-226
“Clinical experience” means, for the purpose of rendering (i) mental health day treatment/partial hospitalization, (ii) intensive community, (iii) Psychosocial rehabilitation, (iv) mental health support, (v) crisis stabilization, and (vi) crisis intervention services, practical experience in providing direct services on a full-time basis to individuals with medically-documented diagnoses of mental illness or intellectual/developmental disability or the provision of direct geriatric services or full-time special education services. Experience shall include supervised internships, supervised practicums, or supervised field experience. Experience shall not include unsupervised internships, unsupervised practicums, and unsupervised field experience. This required clinical experience shall be calculated as set forth in 12VAC35-105-20
12VAC30-50-226
“Individual service plan” or “ISP” means a comprehensive and regularly updated treatment plan specific to the individual’s unique treatment needs as identified in the clinical assessment. The ISP contains his treatment or training needs, his goals and measurable objectives to meet the identified needs, services to be provided with the recommended frequency to accomplish the measurable goals and objectives, and an individualized discharge plan that describes transition to other appropriate services. The ISP shall be signed by the individual. If the individual is a minor child, the ISP shall be signed by the individual’s parent/legal guardian. Documentation shall be provided if the individual, who is a minor child is unable or unwilling to sign the ISP.
12VAC30-50-226
12VAC30-50-226
The service-specific providre assessment, as defined at 12VAC30-50-130, shall document eh individuals behavior and describe how the individual meets criteria for this service. The provision of this service to an individual shall be registered with either the DMAS or the BHSA to avoid duplication of services and to ensure informed care coordination. This registration shall transmit to DMAS or its contractor: (i)the individual’s name and Medicaid identification number; (ii) the specific service to be provided, the relevant procedure code, begin date of the service, and the amount of the service that will be provided; and(iii) the provider’s name and NPI ,a provider contact name and number, and e-mail address.
12VAC30-50-226
Crisis Stabilization services for nonhospitalized individuals shall provide direct mental health care to individuals experiencing an acute psychiatric crisis, which may jeopardize their current community living situation. Services may be authorized for up to a 15 –day period per crisis episode following a face-to-face service-specified provider assessment by a QMHP-A or QMHP-C that is reviewed and approved by an LMHP within 72 hours of the assessment. Only one unit of service shall be reimbursed for this assessment. The provision of this service to an individual shall be registered with either DMAS or the BHSA to avoid duplication of services and to ensure informed care coordination. This registration shall transmit to DMAS or its contractor: (i) the individual’s name and Medicaid identification number; (ii) the specific service to be provided, the relevant procedure code, begin date of the service, and the amount of the service that will be provided; and (iii) the provider’s name and NPI, a provider contact name and phone number, and an e-mail address.
Definition:
“Service-specific provider assessment” means the “face-to-face interaction in which the provider obtains information from the child or adolescent, and parent or other family member or members, as appropriate, about health status. It includes documented history of the severity, intensity, and duration of health care problems and issues and shall contain all of the following elements: (i) the presenting issue/reason for referral, (ii) mental health history /hospitalizations, (iii) previous interventions by providers and timeframes and response to treatment, (iv)medical profile, (v) developmental history including history of abuse, if appropriate, (vi) educational/vocational status, (vii) current living situation and family history and relationships, (vii) legal status, (ix) drug and alcohol profile, (x) resources and strengths, (xi) mental status exam and profile, (xii) diagnosis, (Xiii) professional assessment summary and clinical formulation (xiv) recommended care and treatment goals, and (xv) the dated signature of the LMHP.