Current through Register Vol. 49, No. 9, September, 2024
200.000
COUNSELING AND CRISIS SERVICES GENERAL INFORMATION
201.000
Introduction
Medicaid (Medical Assistance) is designed to assist eligible
Medicaid clients in obtaining medical care within the guidelines specified in
Section I of this manual. Counseling Services are covered by Medicaid when
provided to eligible Medicaid clients by enrolled providers.
Counseling and Crisis Services may be provided to eligible
Medicaid clients at all provider certified/enrolled sites. Allowable places of
service are found in the service definitions located in Section 252 and Section
255 of this manual. Upon effective date of this manual, Acute Crisis Units
across all Medicaid manuals will be called Crisis Stabilization Units. Manuals
are in the process of being updated.
210.100
Coverage of Services
Counseling and Crisis Services are limited to enrolled
providers as indicated in 202.000 who offer core counseling services for the
treatment of behavioral disorders.
Counseling and Crisis Services providers must establish an
emergency response plan. Each provider must have 24-hour emergency response
capability to meet the emergency treatment needs of the Counseling Services
clients served by the provider. The provider must implement and maintain a
written policy reflecting the specific coverage plan to meet this requirement.
A machine recorded voice mail message to call 911 or report to the nearest
emergency room in and of itself is not sufficient to meet the
requirement.
All Counseling and Crisis Services providers must demonstrate
the capacity to provide effective, equitable, understandable, and respectful
quality care and services that are responsive to different cultural health
beliefs and practices, preferred languages, health literacy, and other
communication needs.
210.200
Staff Requirements
Each Counseling and Crisis Services provider must ensure that
they employ staff which are able and available to provide appropriate and
adequate services offered by the provider. Counseling and Crisis Services staff
members must provide services only within the scope of their individual
licensure. The following chart lists the terminology used in this provider
manual and explains the licensure, certification, and supervision that are
required for each performing provider type. Non-independently licensed
clinicians must serve as a rendering provider through a certified agency
provider.
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PROVIDER TYPE
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LICENSES
|
STATE CERTIFICATION
REQUIRED
|
SUPERVISION
|
|
Independently Licensed Clinicians -
Master's/Doctoral
|
Licensed Certified Social Worker (LCSW)
Licensed Marital and Family Therapist (LMFT)
Licensed Psychologist (LP)
Licensed Psychological Examiner - Independent
(LPEI)
Licensed Professional Counselor (LPC)
|
Yes, must be licensed through the relevant licensing
board to provide services
|
Not Required
|
|
Non-independently Licensed Clinicians -
Master's/Doctoral
|
Licensed Master Social Worker (LMSW)
Licensed Associate Marital and Family Therapist
(LAMFT)
Licensed Associate Counselor (LAC)
Licensed Psychological Examiner (LPE)
Provisionally Licensed Psychologist (PLP)
Provisionally Licensed Master Social Worker
(PLMSW)
|
Yes, must be licensed through the relevant licensing
board to provide services and be employed or contracted by a certified
Behavioral Health Agency, Community Support System Agency, or certified by the
Dept. of Education as a school-based mental health provider
|
Required
|
|
Licensed Alcoholism and Drug Abuse Counselor
Master's
|
Licensed Alcoholism and Drug Abuse Counselor (LADAC)
Master's Doctoral
|
Yes, must be licensed through the relevant licensing
board to provide services
|
|
|
Advanced Practice Nurse (APN)
|
Adult Psychiatric Mental Health Clinical Nurse
Specialist
Child Psychiatric Mental Health Clinical Nurse
Specialist
Adult Psychiatric Mental Health APN
Family Psychiatric Mental Health APN
|
Must be employed or contracted by a certified
Behavioral Health Agency, or Community Support System Agency
|
Collaborative Agreement with Physician Required
|
|
Physician
|
Doctor of Medicine (MD)
|
Must be employed or contracted by a certified
|
Not Required
|
|
Doctor of Osteopathic Medicine (DO)
|
Behavioral Health Agency, or Community Support System
Agency
|
|
The services of a medical records librarian are required. The
medical records librarian (or person performing the duties of the medical
records librarian) shall be responsible for ongoing quality controls, for
continuity of patient care, and patient traffic flow. The librarian shall
assure that records are maintained, completed and preserved; that required
indexes and registries are maintained, and that statistical reports are
prepared. This staff member will be personally responsible for ensuring that
information on enrolled patients is immediately retrievable, establishing a
central records index, and maintaining service records in such a manner as to
enable a constant monitoring of continuity of care.
When a Counseling and Crisis Services provider files a claim
with Arkansas Medicaid, the staff member who actually performed the service
must be identified on the claim as the rendering provider. This action is taken
in compliance with the federal Improper Payments Information Act of 2002
(IPIA), Public Law 107-300, and the resulting Payment Error Rate Measurement
(PERM) program initiated by the Centers for Medicare and Medicaid Services
(CMS).
211.400
Facility Requirements
The Counseling and Crisis Services provider shall be
responsible for providing physical facilities that are structurally sound and
meet all applicable federal, state and local regulations for adequacy of
construction, safety, sanitation and health. These standards apply to buildings
in which care, treatment or services are provided. In situations where
Counseling and Crisis Services are not provided in buildings, a safe and
appropriate setting must be provided.
211.500
Non-Refusal Requirement
The Counseling and Crisis Services provider may not refuse
services to a Medicaid-eligible client who meets the requirements for
Counseling Services as outlined in this manual. If a provider does not possess
the services or program to adequately treat the client's behavioral health
needs, the provider must communicate this with the Primary Care Physician (PCP)
or Patient-Centered Medical Home (PCMH) for clients receiving Counseling
Services so that appropriate provisions can be made.
212.000
Scope
The Counseling and Crisis Services Program provides treatment
and services that are provided by a certified Behavioral Health Services
provider to Medicaid-eligible clients who have a Behavioral Health diagnosis as
described in the American Psychiatric Association Diagnostic and Statistical
Manual (DSM-5 and subsequent revisions).
Eligibility for services depends on the needs of the client.
Counseling and Crisis Services can be provided to any client as long as the
services are medically necessary.
Counseling and Crisis Services are time-limited behavioral
health services provided by qualified licensed practitioners in an allowable
setting for the purpose of assessing and treating mental health and/or
substance abuse conditions. Counseling Services settings shall mean a
behavioral health clinic/office, healthcare center, physician office, child
advocacy center, home, shelter, group home, and/or school.
213.000
Counseling and Crisis Services
Program Entry
The intake assessment, either the Mental Health Diagnosis,
Substance Abuse Assessment, or Psychiatric Assessment, must be completed prior
to the provision of counseling or crisis services in the Counseling and Crisis
Services Program manual. This intake will assist providers in determining
services needed and desired outcomes for the client. The intake must be
completed by a behavioral health professional qualified by licensure and
experienced in the diagnosis and treatment of behavioral health
disorders.
Prior to continuing provision of counseling services, the
provider must document medical necessity of Counseling and Crisis Services. The
documentation of medical necessity is a written intake assessment that
evaluates the client's mental condition, and based on the client's diagnosis,
determines whether treatment in the Counseling Services Program is appropriate.
This documentation must be made part of the client's medical record.
View or print the procedure codes for
counseling services.
219.110
Daily Limit of Client
Services
For services that are not reimbursed on a per diem or per
encounter rate, Medicaid has established daily benefit limits for all services.
Clients will be limited to a maximum of eight (8) hours per twenty-four (24)
hour day of Counseling and Crisis Services. Clients will be eligible for an
extension of the daily maximum amount of services based on a medical necessity
review by the contracted utilization management entity (See Section 231.000 for
details regarding extension of benefits).
223.000
Exclusions
Services not covered under the Counseling and Crisis Services
Program include, but are not limited to:
A. Room and board residential costs
B. Educational services
C. Telephone contacts with patient
D. Transportation services, including time
spent transporting a client for services (reimbursement for other
Counseling Services is not allowed for the period of time the Medicaid client
is in transport)
E. Services
to individuals with developmental disabilities that are non-behavioral health
in nature
F. Services which are
found not to be medically necessary
G. Services provided to nursing home and
ICF/IDD residents other than those specified in the applicable populations
sections of the service definitions in this manual
224.000
Physician's Role
Counseling and Crisis Services providers are responsible for
communication with the client's primary care physician to ensure psychiatric
and medical conditions are monitored and addressed by appropriate physician
oversight and that medication evaluation and prescription services are
available to individuals requiring pharmacological management.
226.100
Documentation
All Counseling and Crisis Services providers must develop and
maintain sufficient written documentation to support each medical or remedial
therapy, service, activity, or session for which Medicaid reimbursement is
sought. This documentation, at a minimum, must:
A. Be individualized to the client and
specific to the services provided, duplicated notes are not allowed
B. Include the date and actual time the
services were provided
C. Contain
original signature, name, and credentials of the person who provided the
services
D. Document the setting in
which the services were provided. For all settings other than the provider's
enrolled sites, the name and physical address of the place of service must be
included
E. Document the
relationship of the services to the treatment regimen described in the
Treatment Plan
F. Contain updates
describing the patient's progress
G. Document involvement, for services that
require contact with anyone other than the client, evidence of conformance with
HIPAA regulations, including presence in documentation of Specific
Authorizations, if required
Documentation must be legible and concise. The name and title
of the person providing the service must reflect the appropriate professional
level in accordance with the staffing requirements found in Section
211.200.
All documentation must be available to representatives of DHS
or Office of Medicaid Inspector General at the time of an audit. All
documentation must be available at the provider's place of business. A provider
will have 30 (thirty) days to submit additional documentation in response to a
request from DHS or OMIG. Additional documentation will not be accepted after
this thirty (30) day period.
228.133
Review Process
The record will be reviewed using a review tool based upon the
promulgated Medicaid Counseling and Crisis Services manual. The review tool is
designed to facilitate review of regulatory compliance, incomplete
documentation, and medical necessity. All reviewers must have a professional
license in therapy (LP, LCSW, LMSW, LPE, LPE-I, LPC, LAC, LMFT, LAMFT, etc.).
The reviewer will screen the record to determine whether complete information
was submitted for review. If it is determined that all requested information
was submitted, then the reviewer will review the documentation in more detail
to determine whether it meets medical necessity criteria based upon the
reviewer's professional judgment.
If a reviewer cannot determine that the services were medically
necessary, then the record will be given to a psychiatrist for review. If the
psychiatrist denies some or all of the services, then a denial letter will be
sent to the provider and the client. Each denial letter contains a rationale
for the denial that is record-specific and each party is provided information
about requesting reconsideration review or a fair hearing.
The reviewer also will compare the paid claims data to the
progress notes submitted for review. When documentation submitted does not
support the billed services, the reviewer will deny the services that are not
supported by documentation. If the reviewer sees a deficiency during a
retrospective review, then the provider will be informed that it has the
opportunity to submit information that supports the paid claim. If the
information submitted does not support the paid claim, the reviewer will send a
denial letter to the provider and the client. Each denial letter contains a
rationale for the denial that is record-specific and each party is provided
information about requesting reconsideration review or a fair hearing.
Each retrospective review, and any adverse action resulting
from a retrospective review, shall comply with the Medicaid Fairness Act. DHS
will ensure that its contractor(s) is/are furnished a copy of the Act.
255.003
Crisis Stabilization
Unit
|
CPT®/HCPCS PROCEDURE CODE
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PROCEDURE CODE DESCRIPTION
|
|
View or print the procedure codes for counseling
services.
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Behavioral Health; short-term residential
|
|
SERVICE DESCRIPTION
|
MINIMUM DOCUMENTATION REQUIREMENTS
|
|
Crisis Stabilization Units provide brief crisis
treatment services to persons eighteen (18) years of age and over, who are
experiencing a psychiatric or substance abuse-related crisis, or both, and may
pose an escalated risk of harm to self or others
Crisis Stabilization Units provide hospital and jail
diversion in a safe environment with mental health and substance use disorder
services on-site or on call at all times, as well as on call psychiatry,
available twenty-for (24) hours a day.
Crisis Stabilization Units may provide the service of
Extended Observation Bed. This is an all-inclusive service and is paid on a per
diem basis (census count at midnight and client is in the bed) that includes
services such as evaluation, observation, clinical interventions, crisis
stabilization and social services interventions.
Crisis Stabilization Units may provide the service of
Short-Term Observation Bed. This is an all-inclusive service and is paid on a
per diem basis (census count at midnight and client is not in the bed) that
includes services such as evaluation, observation, clinical interventions,
crisis stabilization and social services interventions.
|
* Date of service
* Assessment information including mental health and
substance abuse psychosocial evaluation, initial discharge plan, strengths and
abilities to be considered for community re-entry
* Place of service
* Specific persons providing pertinent information and
relationship to client
* Diagnosis and synopsis of events leading up to acute
crisis admission
* Interpretive summary
* Brief mental status and observations
* Utilization of previously established psychiatric
advance directive or crisis plan as pertinent to current situation OR rationale
for crisis intervention activities utilized
* Client's response to the intervention that includes
current progress or regression and prognosis
* Clear resolution of the current crisis and/or plans
for further services
* Development of a clearly defined crisis plan or
revision to existing plan
* Thorough discharge plan including treatment and
community resources
|
|
Crisis Stabilization Units may provide the services of
Professional Assessment, Stabilization and referral. These services are paid on
a fee for service basis (census count at midnight and client is not in the bed)
that includes any service described in the Counseling and Crisis Manual. These
services would be billed when a CSU is not providing Extended Observation Bed
nor Short-Term Observation Bed which are paid on all-inclusive per diem
basis.
|
* Staff signature/credentials/date of
signature(s)
|
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NOTES
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EXAMPLE ACTIVITIES
|
|
|
|
APPLICABLE POPULATIONS
|
UNIT
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BENEFIT LIMITS
|
|
Adults
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Per Diem Fee for Service
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* Ninety-six (96) hours or less per admission;
Extension of Benefits required for additional days
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PROGRAM SERVICE CATEGORY
|
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Crisis Services
|
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ALLOWED MODE(S) OF DELIVERY
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TIER
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Face-to-face
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N/A
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ALLOWABLE PERFORMING PROVIDERS
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PLACE OF SERVICE
|
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Acute Crisis Units must be certified by the DHS as an
Acute Crisis Unit Provider.
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55 (Residential Substance Abuse Treatment Facility), 99
(Other)
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Crisis Stabilization Unit Certification
100.000 GENERAL PROVISIONS
101.000 Purpose
This chapter sets forth the Standards and Criteria used in the
certification of Crisis Stabilization Units by the Arkansas Department of Human
Services. The rules regarding the certification processes including, but not
necessarily limited to, applications, requirements for, levels of, and
administrative sanctions are found in this manual.
102.00 Definitions
The following words or terms, when used in this Chapter, shall
have the defined meaning, unless the context clearly indicates
otherwise:
"Abuse" means the causing or permitting of harm or
threatened harm to the health, safety, or welfare of a resident by a staff
responsible for the resident's health, safety, or welfare, including but not
limited to: non-accidental physical injury or mental anguish;
sexual abuse; sexual exploitation; use of mechanical restraints
without proper authority; the intentional use of excessive or unauthorized
force aimed at hurting or injuring the resident; or deprivation of food,
clothing, shelter, or healthcare by a staff responsible for providing these
services to a resident.
"Crisis Stabilization Unit" means a program of
emergency services for mental health and substance use disorder crisis
stabilization, including, but not limited to, observation, evaluation,
emergency treatment and referral, when necessary, for inpatient psychiatric or
substance use disorder treatment services. Crisis Stabilization Units must
adhere to the following:
1.) Have 16
beds or less
2.) Be independently
certified by the Department of Human Services
"Adverse license action" means any action by a
licensing authority that is related to client care, any act or omission
warranting exclusion under DHS Policy 1088, or that imposes any restriction on
the licensee's practice privileges. The action is deemed to exist when the
licensing entity imposes the adverse action except as provided in Ark. Code
Ann. §
25-15-211 (c).
"Certification" means a written designation,
issued by DHS, declaring that the provider has demonstrated compliance as
declared within and defined by this rule.
"Clinical privileging" means an organized method
for treatment facilities to authorize an individual permission to provide
specific care and treatment services to clients within well-defined limits,
based on the evaluation of the individual's license, education, training,
experience, competence, judgment, and other credentials.
"Client" means any person for whom a Crisis
Stabilization Unit furnishes, or has agreed or undertaken to furnish,
services.
"Co-occurring disorder" means any combination of
mental health and substance use disorder symptoms or diagnoses in a
client.
"Co-occurring disorder capability" means the
organized capacity within any type of program to routinely screen, identify,
assess, and provide properly matched interventions to individuals with
co-occurring disorders.
"Compliance" means conformance with:
1. Applicable state and federal laws, rules,
and regulations including, without limitation:
a. Titles XIX and XXI of the Social Security
Act and implementing regulations;
b. Other federal laws and regulations
governing the delivery of health care funded in whole or in part by federal
funds, for example, 42 U.S.C. §
1320c-5;
c. All state laws and rules applicable to
Medicaid generally and to Crisis Stabilization Unit services
specifically;
d. Title VI of the
Civil Rights Act of 1964 as amended, and implementing regulations;
e. The Americans With Disabilities Act, as
amended, and implementing regulations;
f. The Health Insurance Portability and
Accountability Act ("HIPAA"), as amended, and implanting
regulations.
"Crisis intervention" means an immediately
available service to meet the psychological, physiological and environmental
needs of individuals who are experiencing a mental health and/or substance
abuse crisis.
"Crisis stabilization" means emergency psychiatric
and substance abuse services for the resolution of crisis situations and may
include placement of an individual in a protective environment, basic
supportive care, and medical assessment and referral.
"Critical incident" means an occurrence or set of
events inconsistent with the routine operation of the facility, or the routine
care of a client. Critical incidents specifically include but are not
necessarily limited to the following: adverse drug events; self- destructive
behavior; deaths and injuries to clients, staff and visitors; medication
errors; clients that are absent without leave (AWOL); neglect or abuse of a
client; fire; unauthorized disclosure of information; damage to or theft of
property belonging to a clients or the facility; other unexpected occurrences;
or events potentially subject to litigation. A critical incident may involve
multiple individuals or results.
"Emergency examination" means the examination of a
person who appears to be a mentally ill person, an alcohol-dependent person, or
drug-dependent person and a person requiring treatment, and whose condition is
such that it appears that emergency detention may be warranted, by a licensed
mental health professional to determine if emergency detention of the person is
warranted. The examination must occur within twelve (12) hours of being taken
into protective custody.
"Initial Assessment" means examination of current
and recent behaviors and symptoms of an individual who appears to be mentally
ill or substance dependent.
"Intervention plan" means a description of
services to be provided in response to the presenting crisis situation that
incorporates the identified problem(s), strengths, abilities, needs and
preferences of the individual served.
"Licensed mental health professional" or
"LMHP" as defined.
"Linkage services" means the communication and
coordination with other service providers that assure timely appropriate
referrals between the Crisis Stabilization Unit and other providers.
"Mental health professional" or "MHP"
means a person who possesses an Arkansas license to provide clinical behavioral
health care. The license must be in good standing and not subject to any
adverse license action.
"Professionally recognized standard of care" means
that degree of skill and learning commonly applied under all the circumstances
in the community by the average prudent reputable member of the profession.
Conformity with Substance Abuse and Mental Health Services Administration
(SAMHSA) evidence-based practice models is evidence of compliance with
professionally recognized standards of care.
"Progress notes" mean a chronological description
of services provided to a client, the client's progress, or lack of, and
documentation of the client's response related to the intervention plan.
"Provider" means an entity that is certified by
DHS as a Crisis Stabilization Unit and enrolled by DMS as a Behavioral Health
Agency.
"Psychosocial evaluations" are in-person
interviews conducted by professionally trained personnel designed to elicit
historical and current information regarding the behavior and experiences of an
individual and are designed to provide sufficient information for problem
formulation and intervention.
"Qualified Behavioral Health Provider" means a
person who:
1. Does not possess an
Arkansas license to provide clinical behavioral health care;
2. Works under the direct supervision of a
mental health professional;
3. Has
successfully completed prescribed and documented courses of initial and annual
training sufficient to perform all tasks assigned by a mental health
professional;
4. Acknowledges in
writing that all qualified behavioral health provider services are controlled
by client care plans and provided under the direct supervision of a mental
health professional.
"Restraint" refers to manual, mechanical, and
chemical methods that are intended to restrict the movement or normal
functioning of a portion of the individual's body.
Mechanical Restraints shall not be utilized within a certified
Crisis Stabilization Unit.
"Sentinel event" is a type of critical incident
that is an unexpected occurrence involving the death or serious physical or
psychological injury to a client, or risk thereof. Serious injury specifically
includes loss of limb or function. The phrase "or risk thereof" includes a
variation in approved processes which could carry a significant chance of a
serious adverse outcome to a client. These events signal the need for immediate
investigation and response. Sentinel events include, but are not limited to:
suicide, homicide, criminal activity, assault and other forms or violence,
including domestic violence or sexual assault, and adverse drug events
resulting in serious injury or death.
"Triage" means a dynamic process of evaluating and
prioritizing the urgency of crisis intervention needed based on the nature and
severity of clients' presenting situations.
"Trauma Informed" means the recognition and
responsiveness to the presence of the effects of past and current traumatic
experiences in the lives of all clients.
104.000 Applicability
The standards and criteria for services as subsequently set
forth in this chapter are applicable to Crisis Stabilization Units as stated in
each section.
110.000 CRISIS
STABILIZATION UNITS
111.000
Required service options
Crisis Stabilization Units provide brief medically necessary
crisis treatment services to persons ages 18 and above who are experiencing a
psychiatry- and/or substance abuse-related crisis and may pose an escalated
risk of harm to self or others.
Crisis Stabilization Units provide brief crisis treatment
services to persons eighteen (18) years of age and over, who are experiencing a
psychiatric or substance abuse-related crisis, or both, and may pose an
escalated risk of harm to self or others.
Crisis Stabilization Units provide hospital and jail diversion
in a safe environment with mental health and substance use disorder services
on-site or on call at all times, as well as on call psychiatry, available
twenty-four (24) hours a day.
Crisis Stabilization Units may provide the services of Extended
Observation Bed. This is an all-inclusive service and is paid on a per diem
basis (census count at midnight and client is in the bed) that includes
services such as evaluation, observation, clinical interventions, crisis
stabilization and social services interventions.
Crisis Stabilization Units may provide the service of
Short-Term Observation Bed. This is an all-inclusive service and is paid on a
per diem basis (census count at midnight and client is not in the bed) that
includes services such as evaluation, observation, clinical interventions,
crisis stabilization and social services interventions.
Crisis Stabilization Units may provide the services of
Professional Assessment, Stabilization and referral. These services are paid on
a fee for service basis (census count at midnight and client is not in the bed)
that includes any service described in the Counseling and Crisis Manual. These
services would be billed when a CSU is not providing Extended Observation Bed
nor Short-Term Observation Bed which are paid on all-inclusive per diem
basis.
(a) Crisis Stabilization Unit
services shall be provided in the least restrictive setting possible. Services
should be provided within, or as close to the community in which they reside as
possible.
(b) A physician shall be
available at all times for the crisis unit, either on-duty or on call. If the
physician is on call, he or she shall respond by telephone or in person to the
licensed staff on duty at the crisis unit within 20 minutes.
(c) Crisis Stabilization Unit services shall
include, but not be limited to, the following service components and each shall
have written policy and procedures and each shall be co-occurring disorder
capable and trauma informed, with policies and procedures that support this
capability:
(1) Triage services;
(2) Co-occurring capable Psychiatric crisis
stabilization; and
(3) Co-occurring
capable Drug/alcohol crisis stabilization.
(d) The Crisis Stabilization Unit shall have
written policy and procedures addressing restraints, and these shall be in
compliance with Section 503.000.
113.00 Crisis stabilization, triage
(a) Crisis stabilization services shall
include triage services and emergency examination.
(b) Qualified staff providing triage services
shall be:
(1) A Mental Health Professional
(MHP) capable of providing crisis stabilization services within the scope of
their individual licensure; and
(2)
Knowledgeable about applicable laws, DHS rules, facility policy and procedures,
and referral sources.
(c)
Components of this service shall minimally include the capacity to provide:
(1) Immediate response, on-site and by
telephone;
(2) Screening for the
presence of co-occurring disorders;
(3) Integrated emergency mental health and/or
substance use disorder examination on site or via telemedicine; and
(4) Referral, linkage, or a combination of
the two services.
(d) The
Crisis Stabilization Unit shall have written policy and procedures minimally:
(1) Providing, triage crisis services;
and
(2) Defining methods and
required content for documentation of each triage crisis response service
provided.
(3) Ensuring that
individuals who present in crisis with co-occurring disorders are identified,
and that there are no barriers to access triage crisis response based on
arbitrary alcohol or drug levels, types of diagnosis or medications while
remaining in compliance with facility certification, licensure, and medical
standards. Nothing in this Section shall require a facility to treat a client
that is not medically stable.
114.00 Crisis stabilization, psychiatric,
substance use disorder and co-occurring services
(a) Crisis stabilization services shall
provide continuous twenty-four (24) hour evaluation, observation, crisis
stabilization, and social services intervention seven (7) days per week for
clients experiencing mental health or substance use disorder related crises; or
those who present with co-occurring disorders.
(b) Licensed nurses and other support staff
shall be adequate in number to provide care needed by clients twenty-four (24)
hours a day seven (7) days per week.
(c) Crisis stabilization services shall be
provided by a co-occurring disorder capable multidisciplinary team of medical,
nursing, social services, clinical, administrative, and other staff adequate to
meet the clinical needs of the individuals served.
(d) Staff members assigned to a medical
supervised detoxification component shall be knowledgeable about the physical
signs of withdrawal, the taking of vital signs and the implication of those
vital signs, and emergency procedures as well as demonstrating core
competencies in addressing the needs of individuals receiving detoxification
services who may have co-occurring mental health disorders and be on
psychotropic medication.
(e)
Services shall minimally include:
(1)
Medically-supervised substance use disorder and mental health screening,
observation and evaluation;
(2)
Initiation and medical supervision of rapid stabilization regimen as prescribed
by a physician, including medically monitored detoxification where
indicated;
(3) Medically-supervised
and co-occurring disorder capable detoxification, in compliance with procedures
outlined in the Arkansas DHS Regional Alcohol and Drug Detoxification
Manual.
(4) Intensive care and
intervention during acute periods of crisis stabilization;
(5) Motivational strategies to facilitate
further treatment participation for mental health and/or substance abuse needs;
and,
(6) Providing referral,
linkage or placement, as indicated by client needs.
115.00 Linkage Services to higher
or lower levels of care, or longer term placement
(a) Persons needing mental health services
shall be treated with the least restrictive clinically appropriate
methods.
(b) In cases where clients
are not able to stabilize in or are not appropriate for the Crisis
Stabilization Unit, linkage services shall be provided, including the following
steps:
(1) Qualified Crisis Stabilization Unit
staff shall perform the crisis intervention and referral process to the
appropriate treatment facility.
(2)
The referral process shall require referral to the least restrictive service to
meet the needs of the client. The referral shall be discussed with the client,
the client's legal guardian, or both the client and legal guardian as
applicable, and shall include a discussion of why a less restrictive community
resource was not utilized if applicable. This discussion shall be documented in
the client's record. If an adult client wishes to include family members in the
decision making process, appropriate releases should be obtained.
(3) Staff shall make referral to an
appropriate treatment facility to include demographic and clinical information
and documentation. Appropriate releases should be obtained as
indicated.
(c) The Crisis
Stabilization Unit shall have a written plan for addressing non-psychiatric
medical emergencies, including transfer to a general medical-surgical hospital
when necessary. All emergencies must be documented and reviewed by appropriate
staff.
(d) If the Crisis
Stabilization Unit is referring a client to an acute inpatient facility, the
client must meet the admission criteria.
116.00 Pharmacy services
(a) The Crisis Stabilization Unit shall
provide specific arrangements for pharmacy services to meet clients' needs.
Provision of services may be made through agreement with another program or
through a pharmacy in the community.
(b) Medical records must contain valid
prescriptions for medications administered while a client is in the care of a
Crisis Stabilization Unit.
(c) The
Crisis Stabilization Unit shall have the capacity to administer medications,
including injectables, twenty-four (24) hours per day.
120.000 CRISIS STABILIZATION UNIT MEDICAL
RECORDS REQUIREMENTS
121.000
Medical record keeping system
Each Crisis Stabilization Unit shall maintain an organized
medical record keeping system to collect and document information appropriate
to the treatment processes. This system shall be organized; easily retrievable,
usable medical records stored under confidential conditions and with planned
retention and disposition.
122.00 Basic requirements
(a) The Crisis Stabilization Unit's policies
and procedures shall:
(1) define the content
of the client's medical record in accordance with Section 300.000 through
Section 310.000 of this manual.
(2)
define storage, retention and destruction requirements for client medical
records;
(3) require client medical
records be confidentially maintained in locked equipment under secure
measures;
(4) require legible
entries in client medical records signed with first name or initial, last name,
and dated by the person making the entry;
(5) require the client's name be typed or
written on each sheet of paper or page in the client record;
(6) require a signed consent for treatment;
and
(7) require a signed consent
for follow-up before any contact after discharge is
made.
123.000
Record access for clinical staff
(a) The
Crisis Stabilization Unit shall assure client records are readily accessible to
the Crisis Stabilization Unit staff directly caring for the client. Such access
shall be limited to the minimum necessary to carry out the staff member's job
functions or the purpose for the use of the records.
124.00 Clinical record content, intake and
assessment
(a) The Crisis Stabilization Unit
shall assess each individual to determine appropriateness of admission. Initial
assessments are to be completed on all clients voluntary or involuntary at time
of entrance.
(b) Client intake
information shall contain, but not be limited to the following identification
data:
(1) Client name;
(2) Name and identifying information of the
legal guardian(s)
(3) Home
address;
(4) Telephone
number;
(5) Referral
source;
(6) Reason for
referral;
(7) Significant other to
be notified in case of emergency;
(8) Intake data core content;
(9) Presenting problem and
disposition;
(10) A record of
pertinent information regarding adverse reactions to drugs, drug allergies, or
sensitivities shall be obtained during intake and kept in a highly visible
location in or on the record; and
(11) Screening for co-occurring disorders,
trauma, medical and legal issues.
(c) Client assessment information for clients
admitted to Crisis Stabilization Units shall be completed within 12 hours of
client's entrance.
(1) Integrated mental
health and substance abuse psychosocial evaluation that minimally addresses:
(A) The client's strengths and abilities to
be considered during community re- entry;
(B) Economic, vocational, educational,
social, family and spiritual issues as indicated; and
(C) An initial discharge plan.
(2) Interpretive summary of
relevant assessment findings that results in the development of an intervention
plan addressing mental health, substance use disorder, and other related issues
contributing to the crisis;
(3) An
integrated intervention plan that minimally addresses the client's:
(A) Presenting crisis situation that
incorporates the identified problem(s);
(B) Strengths and abilities;
(C) Needs and preferences; and
(D) Goals and objectives.
125.00 Health,
mental health, substance abuse, and drug history
(a) A health and drug history shall be
completed for each client at the time of entrance in a Crisis Stabilization
Unit (as soon as practical). The medical history shall include obtainable
information regarding:
(1) Name of
medication;
(2) Strength and dosage
of current medication;
(3) Length
of time patient was on the medication if known;
(4) Benefit(s) of medication;
(5) Side effects;
(6) The prescribing medical professional if
known; and
(7) Relevant drug
history of family members.
(b) A mental health history, including
symptoms and safety screening, shall be completed for each client at the time
of entrance in a Crisis Stabilization Unit (as soon as practical).
(c) A substance abuse history, including
checklist for use, abuse, and dependence for common substances (including
nicotine and caffeine) and screening for withdrawal risk and IV use shall be
completed for each client at the time of entrance.
126.00 Progress notes
(a) The Crisis Stabilization Unit shall have
a policy and procedure mandating the chronological documentation of progress
notes for clients admitted to Crisis Stabilization Units.
(b) Progress notes shall minimally address
the following:
(1) Person(s) to whom services
were rendered;
(2) Activities and
services provided and as they relate to the goals and objectives of the
intervention plan, including ongoing reference to the intervention
plan;
(3) Documentation of the
progress or lack of progress in crisis resolution as defined in the
intervention plan;
(4)
Documentation of the intervention plan's implementation, including client
activities and services;
(5) The
client's current status;
(6)
Documentation of the client's response to intervention services, changes in
behavior and mood, and outcome of intervention services;
(7) Plans for continuing therapy or for
discharge, whichever is appropriate; and
(c) Progress notes shall be documented
according to the following time frames:
(1)
Intervention team shall document progress notes daily; and
(2) Nursing service shall document progress
notes on each shift.
127.00 Medication record
(a) The Crisis Stabilization Unit shall
maintain a medication record on all clients who receive medications or
prescriptions in order to provide a concise and accurate record of the
medications the client is receiving or has been prescribed for the
client.
(b) The client medical
record shall contain a medication record with information on all medications
ordered or prescribed by physician staff which shall include, but not be
limited to:
(1) The record of medication
administered, dispensed or prescribed shall include all of the following:
(A) Name of medication,
(B) Dosage,
(C) Frequency of administration or prescribed
change,
(D) Route of
administration, and
(E) Staff
member who administered or dispensed each dose, or prescribing physician;
and
(2) A record of
pertinent information regarding adverse reactions to drugs, drug allergies, or
sensitivities shall be updated when required by virtue of new information, and
kept in a highly visible location in or on the record.
129.00 Aftercare and discharge
summary
(a) The aftercare plan shall minimally
include:
(1) Presenting problem at
intake;
(2) Any co-occurring
disorders or issues, and recommended interventions for each;
(3) Physical status and ongoing physical
problems;
(4) Medications
prescribed at discharge;
(5)
Medication and lab summary, when applicable;
(6) Names of family and significant other
contacts;
(7) Any other
considerations pertinent to the client's successful functioning in the
community;
(8) The Client's, the
client's legal guardian, or as indicated both the client's and legal guardian's
comments on participation in his or her crisis resolution efforts;
and
(9) The credentials of the
staff members treating the client and their dated signatures.
130.00 Other records
content
(a) The client record shall contain
copies of all consultation reports concerning the client.
(b) When psychometric or psychological
testing is done, the client record shall contain a copy of a written report
describing the test results and implications and recommendations for
treatment.
(c) The client medical
record shall contain any additional information relating to the client, which
has been secured from sources outside the Crisis Stabilization Unit.
141.000 DHS Investigations
The Arkansas Department of Human Services in any investigation
or program monitoring regarding client rights shall have access to clients,
Crisis Stabilization Unit records and Crisis Stabilization Unit staff.
151.00 Organizational description
(a) The Crisis Stabilization Unit shall have
a written organizational description which is reviewed annually by both the
Crisis Stabilization Unit and DHS, which minimally includes:
(1) The overall target population,
specifically including those individuals with co-occurring disorders, for whom
services will be provided;
(2) The
overall mission statement;
(3) The
annual facility goals and objectives, including the goal of continued progress
for the facility in providing person centered, culturally competent, trauma
informed and co-occurring capable services;
(b) The Crisis Stabilization Unit's governing
body shall approve the mission statement and annual goals and objectives and
document their approval.
(c) The
Crisis Stabilization Unit shall make the organizational description, mission
statement and annual goals and objectives available to staff.
(d) The Crisis Stabilization Unit shall make
the organizational description, mission statement and annual goals and
objectives available to the general public upon request.
(e) Each Crisis Stabilization Unit shall have
a written plan for professional services which shall have in writing the
following:
(1) Services description and
philosophy;
(2) The identification
of the professional staff organization to provide these services;
(3) Written admission and exclusionary
criteria to identify the type of clients for whom the services are primarily
intended; and
(4) Written goals and
objectives.
(5) Delineation of
processes to assure accessible, integrated, and co-occurring capable services
and a plan for how each program component will address the needs of individuals
with co-occurring disorders.
(f) There shall be a written statement of the
procedures/plans for attaining the organization's goals and objectives. These
procedures/plans should define specific tasks, including actions regarding the
organization's co-occurring capability, set target dates and designate staff
responsible for carrying out the procedures or plans.
152.00 Information Analysis and Planning
(a) The Crisis Stabilization Unit shall have
a defined plan for conducting an organizational needs assessment that specifies
the methods and data to be collected, which shall include but not limited to
information from:
(1) Clients;
(2) Governing Authority;
(3) Staff;
(4) Stakeholders;
(5) Outcomes management processes;
and
(6) Quality record
review.
(b) The Crisis
Stabilization Unit shall have a defined system to collect data and information
on a quarterly basis to manage the organization.
(c) Information collected shall be analyzed
to improve client services and organizational performance.
(d) The Crisis Stabilization Unit shall
prepare an end of year management report, which shall include but not be
limited to:
(1) An analysis of the needs
assessment process; and
(2)
Performance improvement program findings.
(e) The management report shall be
communicated and made available to among others:
(1) The governing authority;
(2) Crisis Stabilization Unit staff;
and
(3) DHS if and when
requested.
156.00 Performance improvement program
(a) The Crisis Stabilization Unit shall have
an ongoing performance improvement program designed to objectively and
systematically monitor, evaluate, and improve the quality of client
care.
(b) The Performance
improvement program shall also address the fiscal management of the
organization.
(c) There shall be an
annual written plan for performance improvement activities. The plan shall
include, but not be limited to:
(1) Outcomes
management processes specific to each program component minimally measuring:
(A) efficiency;
(B) effectiveness; and
(C) client satisfaction.
(D) A quarterly record review to minimally
assess: quality of services delivered;
(E) appropriateness of services;
(F) patterns of service
utilization;
(G) clients, relevant
to:
i. their orientation to the Crisis
Stabilization Unit and services being provided; and
ii. their active involvement in making
informed choices regarding the services they receive;
(H) the client assessment information
thoroughness, timeliness and completeness;
(I) treatment goals and objectives are based
on:
i. assessment findings; and
ii. client input;
(J) services provided were related to the
goals and objectives;
(K) services
are documented as prescribed by policy;
(L) the treatment plan is reviewed and
updated as prescribed by policy
(2) Clinical privileging;
(3) Fiscal management and planning, which
shall include:
(A) an annual budget that is
approved by the governing authority and reviewed at least annually;
(B) the organization's capacity to generate
needed revenue to produce desired client and other outcomes;
(C) monitoring client records to ensure
documented dates of services provided coincide with billed service encounters;
and,
(4) Review of
critical incident reports and client grievances or complaints.
(d) The Crisis Stabilization Unit
shall monitor the implementation of the performance improvement plan on an
ongoing basis and make adjustments as needed. Performance improvement findings
shall be communicated and made available to, among others:
(1) the governing authority;
(2) Crisis Stabilization Unit staff;
and
(3) DHS if and when
requested.
157.00 Incident reporting
(a) The Crisis Stabilization Unit shall
report critical incidents to DHS in accordance with DHS Incident Reporting
Policy 1090 that include:
(1) Critical
incidents involving allegations constituting a sentinel event or resident abuse
shall be reported to DHS immediately via telephone or fax, but not less than
twenty-four (24) hours of the incident. If reported by telephone, the report
shall be followed with a written report within twenty-four (24)
hours.
(b) The Crisis
Stabilization Unit shall document and monitor internally, with a quality
assurance and improvement process that will be made available for review and/or
audit by an appropriate agency the following:
(1) Critical incidents requiring medical care
by a physician or nurse or follow-up attention and incidents requiring
hospitalization or immediate off-site medical attention shall be delivered via
fax or mail to DHS Provider Certification within twenty-four (24) hours of the
incident being documented.
161.00 Personnel policies and procedures
(a) The Crisis Stabilization Unit shall have
written personnel policies and procedures approved by the governing
authority.
(b) All employees shall
have access to personnel policies and procedures, as well as other Rules and
Regulations governing the conditions of their employment.
(c) The Crisis Stabilization Unit shall
develop, adopt, and maintain policies and procedures to promote the objectives
of the program and provide for qualified personnel during all hours of
operation to support the functions of the center and provide quality
care.
162.00 Job
descriptions
(a) The Crisis Stabilization Unit
shall have written job descriptions for all positions setting forth minimum
qualifications and duties of each position.
(b) All job descriptions shall include an
expectation of core competencies in relation to individuals with co-occurring
disorders.
165.000 STAFF
DEVELOPMENT AND TRAINING
166.00
Staff qualifications
(a) The Crisis
Stabilization Unit shall document the qualifications and training of staff
providing crisis stabilization services which shall be in compliance with the
Crisis Stabilization Unit's clinical privileging process.
(b) Failure to comply with Section 166.000
will result in the initiation of procedures to deny, suspend and/or revoke
certification.
167.00
Staff development
(a) The Crisis Stabilization
Unit shall have a written plan for the professional growth and development of
all administrative, professional clinical and support staff. This plan shall
include but not be limited to:
(1) orientation
procedures;
(2) in-service training
and education programs;
(3)
availability of professional reference materials; and
(4) mechanisms for insuring outside
continuing educational opportunities for staff members.
(b) The results of performance improvement
activities and accrediting and audit findings and recommendations shall be
addressed by and documented in the staff development and clinical privileging
processes.
(c) Staff competency
development shall be aligned with the organization's goals related to
co-occurring capability, and incorporate a training plan, training activities,
and supervision designed to improve co-occurring core competencies of all
staff.
(d) Staff education and
in-service training programs shall be evaluated by the Crisis Stabilization
Unit at least annually.
168.00 In-service
(a) Trainings are required annually for all
employees who provide clinical services within the Crisis Stabilization Unit
program on the following topics:
(1) Fire and
safety;
(2) Infection Control and
universal precautions;
(3) Client's
rights and the constraints of the Mental Health Client's Bill of
Rights;
(4)
Confidentiality;
(5) Arkansas Adult
and Long-Term Care Facility Resident Maltreatment Act, §12- 12-1701 et
seq.
(6) Facility policy and
procedures;
(7) Cultural
competence;
(8) Co-occurring
disorder competency and treatment principles; and
(b) Trauma informed and age and developmental
specific trainings. All staff providing clinical services shall have a current
certification in basic first aid and in Cardiopulmonary Resuscitation
(CPR).
(c) All clinical staff shall
have training in non-physical intervention techniques and philosophies
addressing appropriate non-violent interventions for potentially physical
interpersonal conflicts, staff attitudes which promote dignity and enhanced
self-esteem, keys to effective communication skills, verbal and non- verbal
interaction and non-violent intervention within 30 days of being hired with
annual updates thereafter. This training shall occur prior to direct patient
contact.
(d) The Crisis
Stabilization Unit Executive Director shall designate which positions and
employees, including temporary employees, will be required to successfully
complete physical intervention training. The employee shall successfully
complete this training within 30 days of being hired, with annual updated
thereafter. This training shall occur prior to direct patient
contact.
170.000 FACILITY
ENVIRONMENT
Crisis Stabilization Units shall apply these standards to all
sites operated. The primary concern of the Crisis Stabilization Unit should
always be the safety and well being of the clients and staff. Crisis
Stabilization Units shall be physically located in the State of Arkansas.
Crisis Stabilization Units shall provide a safe and sanitary
environment.
171.00 Facility
environment
(a) The Crisis Stabilization Unit
shall obtain an annual fire and safety inspection from the State Fire Marshall
or local authorities which documents approval for continued
occupancy.
(b) Crisis Stabilization
Unit staff shall know the exact location, contents, and use of first aid supply
kits and fire fighting equipment and fire detection systems. All fire fighting
equipment shall be annually maintained in appropriately designated areas within
the facility.
(c) The Crisis
Stabilization Unit shall post written plans and diagrams noting emergency
evacuation routes in case of fire, and shelter locations in case of severe
weather. All exits must be clearly marked.
(d) Facility grounds shall be maintained in a
manner, which provides a safe environment for clients, personnel, and
visitors.
(e) The Crisis
Stabilization Unit Facility Director or, designee, shall appoint a safety
officer.
(f) The Crisis
Stabilization Unit shall have an emergency preparedness program designed to
provide for the effective utilization of available resources so client care can
be continued during a disaster. The Crisis Stabilization Unit shall evaluate
the emergency preparedness program annually and update as needed. Policies for
the use and control of personal electrical equipment shall be developed and
implemented.
(g) The Crisis
Stabilization Unit shall have an emergency power system to provide lighting
throughout the facility.
(h) The
Crisis Stabilization Unit Facility Director shall ensure there is a written
plan to respond to internal and external disasters. External disasters include,
but are not limited to, tornadoes, explosions, and chemical spills.
(i) All Crisis Stabilization Units shall be
inspected annually by designated fire and safety officials of the municipality
who exercise fire/safety jurisdiction in the facility's location which results
in the facility being allowed to continue to operate.
(j) The Crisis Stabilization Unit shall have
a written Infection Control Program and staff shall be knowledgeable of Center
for Disease Control (CDC) Guidelines for Tuberculosis and of the Blood Borne
Pathogens Standard, location of spill kits, masks, and other personal
protective equipment.
(k) The
Crisis Stabilization Unit shall have a written Hazardous Communication Program
and staff shall be knowledgeable of chemicals in the workplace, location of
Material Safety Data Sheets, personal protective equipment; and toxic or
flammable substances shall be stored in approved locked storage
cabinets.
(l) The Crisis
Stabilization Unit's telephone number(s) and actual hours of operation shall be
posted at all public entrances.
(m)
Signs must be posted at all public entrances informing staff, clients and
visitors as to the following requirements:
(1)
No alcohol or illicit drugs are allowed in the Crisis Stabilization Unit
facility,
(2) No firearms, or other
dangerous weapons, are allowed in the Crisis Stabilization Unit facility with
the exception of law enforcement while in the performance of their duties,
and
(n) A copy of
compliance with law Title VI/Title VII of the 1964 Civil Rights Law shall be
prominently displayed within the Acute Crisis Unit Facility.
(o) Crisis Stabilization Units shall:
(1) Provide separate bedroom areas for males
and females,
(2) Provide sufficient
clean linens for clients, and
(3)
Provide adequate barriers to divide clients.
(p) Plumbing in Crisis Stabilization Units
shall be in working condition to avoid any health threat. All toilets, sinks
and showers shall be clean and in working order.
(q) There shall be at least one toilet, one
sink, and one shower or tub per every eight (8) Crisis Stabilization Unit beds.
This means that a Crisis Stabilizat ion Unit shall have no less than one
toilet, one sink, and one shower or tub.
(r) A secure locked storage shall be provided
for client valuables when requested.
(s) Separate storage areas are provided and
designated for:
(1) Food, kitchen, and eating
utensils,
(2) Clean
linens,
(3) Soiled linens and
soiled cleaning equipment, and
(4)
Cleaning supplies and equipment.
(t) When handling soiled linen or other
potentially infectious material, Universal Precautions are to be followed and
address in the Crisis Stabilization Unit policies and procedures. Hazardous and
regulated waste shall be disposed of in accordance with federal
requirements.
(u) Poisons, toxic
materials and other potentially dangerous items shall be stored in a secured
location.
172.00
Medication clinic, medication monitoring
(a)
Medication administration; storage and control; and client reactions shall be
continuously monitored.
(b) Crisis
Stabilization Units shall assure proper storage and control of medications,
immediate response if incorrect or overdoses occur, and have appropriate
emergency supplies available if needed.
(1)
Written procedures for medication administration shall be available and
accessible in all medication storage areas, and available to all staff
authorized to administer medications. All medications shall be kept in locked,
non-client accessible areas. Factors which shall be considered in medication
storage are light, moisture, sanitation, temperature, ventilation, and the
segregation and safe storage of poisons, external medications, and internal
medications.
(2) Telephone numbers
of the state poison centers shall be immediately available in all locations
where medications are prescribed, or administered, or stored.
(3) A Crisis Stabilization Unit physician
shall supervise the preparation and stock of an emergency kit which shall be
readily available, but accessible only to Crisis Stabilization Unit
staff.
173.000
Medication, error rates
(a) The Crisis
Stabilization Unit shall have an ongoing performance improvement program that
specifically, objectively, and systematically monitors medications
administration or dispensing or medication orders and prescriptions to evaluate
and improve the quality of client care.
174.00 Technology
(a) The Crisis Stabilization Unit shall have
a written plan regarding the use of technology and systems to support and
advance effective and efficient service and business practices. The plan shall
include, but not be limited to:
(1) Hardware
and software.
(2)
Security.
(3)
Confidentiality.
(4) Backup
policies.
(5) Assistive
technology.
(6) Disaster recovery
preparedness.
(7) Virus
protection.
175.00 Food and Nutrition
(a) If the Crisis Stabilization Unit prepares
meals on site, the Crisis Stabilization Unit shall have a current food
establishment health inspection as required by the Arkansas Department of
HealthWhen meals are provided by a food service, a written contract shall be
maintained and shall require the food service to have a current food
establishment health inspection as required by the Arkansas Department of
Health.
(b) Crisis Stabilization
Units shall provide at least three meals daily, with no more than fourteen (14)
hours between any two meals.
(c)
All food shall be stored, prepared, and served in a safe, healthy
manner.
(d) Perishable items shall
not be used once they exceed their sell by date.
