23-Hour Observation – Psychiatric Eval - clarification

Requirement that a psychiatric evaluation must be completed. 

 Draft Regs’ adjustment is significant.  Previously: “A psychiatric evaluation by a psychiatrist, nurse practitioner or physician assistant must be available at admission into the service”.  

This has been removed and replaced.  This had acknowledged that not all circumstances that an individual was in crisis and met the medical necessity of the service would require the need for a psychiatric evaluation to resolve the immediate crisis or prior to identification of supports or transition to another level of care.  It appears from the following that the Draft Regs are stated to meet the requirements there must be a psychiatric eval which may not be consistent with needs.

 Required Activity (Page 41)

Assessment

• A psychiatric evaluation must be completed at admission by a psychiatrist or psychiatric nurse practitioner.
• The 23-Hour Crisis Stabilization provider may use a psychiatric evaluation completed within 24 hours prior to admission by a psychiatrist or psychiatric nurse practitioner to meet this requirement. Documentation that the 23-Hour Crisis Stabilization psychiatrist or psychiatric nurse practitioner has reviewed and updated (as clinically necessary) the evaluation at admission must be in the clinical record.

 On Page 44

The following components must be available to individuals in the treatment program and provided in accordance with the individual’s assessed needs: (Starting on Page 43)

• At a minimum, required components of 23- Hour Crisis Stabilization include: assessment (psychiatric, nursing and LMHP), crisis intervention and care coordination. Providers must have the capacity to provide any of the above components for up to 23 hours based on the individual’s needs.

 Clarification needed.