Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 306.00 - Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers
Section 306.02 - General Definitions
Current through Register 1531, September 27, 2024
Meaning of Terms. In addition to the general definitions contained in 101 CMR 306.00, terms used in 101 CMR 306.00 shall have the meaning ascribed in 101 CMR 306.02.
Behavioral Health Urgent Care Provider. A center that meets the requirements set forth in 130 CMR 429.405(D).
Case Consultation. An intervention, including scheduled telephonic or in person meetings, for behavioral and medical management purposes on a member's behalf with agencies, employers or institutions which may include the preparation of reports of the member's psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.
Certified Peer Specialist (CPS). A person who has been trained by an agency approved by the Department of Mental Health (DMH) who is a self-identified person with lived experience of a mental health disorder and wellness that can effectively share their experiences and serve as a mentor, advocate or facilitator for a member experiencing a mental health disorder.
Child and Adolescent Needs and Strengths (CANS). A tool that provides a standardized way to organize information gathered during a behavioral-health clinical assessments. A Massachusetts version of the tool has been developed and is intended to be used as a treatment decision support tool for behavioral-health providers serving MassHealth members younger than 21 years old.
Community Consultation and Education. Services provided by professional personnel to representatives of schools, courts, police, organizations, or agencies with the aim of problem solving and imparting knowledge in areas such as prevention, availability of resources and clinical procedures. Such consultation is distinct from case consultation in that it does not address the problems of a particular patient, but rather the community at large.
Community Health Center. A clinic which provides comprehensive ambulatory services and which is not financially or physically an integral part of a hospital.
Community Mental Health Center. A clinic which provides comprehensive ambulatory mental health services and which is not financially or physically an integral part of a hospital.
Couple Therapy. Psychotherapeutic services provided to a couple whose primary complaint is the disruption of their marriage, family, or relationship.
Counselor. An individual who has earned a master's degree in Counseling from a recognized educational program and who also meets conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.
Diagnostic Evaluation Services. The examination and determination of a member's physical, psychological, social, economic, educational, and vocational assets and disabilities for the purpose of designing a treatment plan.
Eligible Provider. A mental health center or community health center which meets the conditions of participation that have been or may be adopted by a governmental unit purchasing mental health services or by purchasers under M.G.L. c. 152.
Emergency Services. Services providing immediate face-to-face mental health evaluation, diagnosis, hospital prescreening, treatment, and arrangements for further care and assistance as required, up to 24 hours per day, seven days per week, to individuals showing sudden, incapacitating emotional stress.
Enhanced Structured Outpatient Addiction Program (E-SOAP). American Society of Addiction Medicine (ASAM) Intensive Outpatient Services is a program that provides short-term, clinically intensive, structured day and/or evening substance use disorder services. E-SOAP specifically serves specialty populations including: homeless individuals and people at risk of homelessness, pregnant individuals, and adolescents. E-SOAP services must meet requirements as set forth in 130 CMR 418.000.
EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.
Family Consultation. A preplanned meeting with one or more of the parents, legal guardian, or foster parents of a child who is being treated by clinical staff at the center when the parents, legal guardian, or foster parents are not clients of the center.
Family Therapy. The treatment of more than one member of a family simultaneously in the same visit.
Governmental Unit. The Commonwealth of Massachusetts, or any of its departments, agencies, boards, commissions, or political subdivisions.
Group Therapy. The application of psychotherapeutic or counseling techniques to a group of persons, most of whom are not related by blood, marriage, or legal guardianship.
Individual Consideration. Payment rates to eligible providers for services authorized in accordance with 101 CMR 306.03(2), but not listed herein, or authorized services performed in exceptional circumstances shall be determined on an Individual Consideration basis by the governmental unit or purchaser under M.G.L. c. 152 upon receipt of a bill which describes the services rendered. The determination of rates of payment for authorized Individual Consideration procedures shall be in accordance with the following criteria:
(a) Time required to perform the service;
(b) Degree of skill required for service rendered;
(c) Severity and/or complexity of the client's disorder or disability;
(d) Policies, procedures, and practices of other third party purchasers of care; and
(e) Such other standards and criteria as may be adopted from time to time by EOHHS pursuant to 101 CMR 306.03(4).
Individual Therapy. Psychotherapeutic services provided to an individual.
Intensive Outpatient Program (IOP). A mental health treatment service that provides time-limited, multi-disciplinary, multimodal structured treatment in an outpatient setting for a complex or refractory clinical presentation. Service includes individual, group, and family therapy as well as case management services.
Medication Visit. A member visit specifically for prescription, review, and monitoring of medication by a psychiatrist, a psychiatric clinical nurse specialist, Advanced Practice Registered Nurse, or Physician Assistant, or administration of prescribed intramuscular medication by a physician or a nurse, or Physician Assistant.
Mental Health Center (Center). An entity that delivers a comprehensive group of diagnostic and psychotherapeutic treatment services to individuals seeking treatment for mental health disorders, which may include co-occurring substance use disorder, and their families by an interdisciplinary team under the medical direction of a psychiatrist.
Modifiers. Listed services may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of the appropriate two digit number or letters.
Multiple Family Group Therapy. The treatment of more than one family unit at the same time in the same visit by one or more authorized staff members. There is more than one family member present per family unit and at least one of the family members per family unit must be an identified patient of the clinic program.
Occupational Therapist. An individual who is registered with the American Occupational Therapy Association and who also meets the conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.
Preventive Behavioral Health Services. Short-term group intervention, recommended by a physician or other licensed practitioner, practicing within their scope of licensure, that cultivate coping skills and strategies for symptoms of depression, anxiety, and other social/emotional concerns, to prevent the development of behavioral health disorders for children and adolescents younger than 21 years old.
Psychiatric Nurse. An individual who is currently registered by the Massachusetts Board of Registration in Nursing and who has earned a master's degree from an accredited graduate school of psychiatric nursing or who meets the conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.
Psychiatric Clinical Nurse Specialist. A licensed registered nurse who is authorized by the board of Registration in Nursing as practicing in an expanded role and who meets the requirements of 244 CMR 4.05(4): Psychiatric Clinical Nurse Specialist.
Psychiatric Social Worker. An individual who has earned a Master's degree from an accredited graduate school of social work or who meets the conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.
Psychiatrist. An M.D. or Doctor of Osteopathic Medicine who is registered in Massachusetts and who is certified or eligible for certification by the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry who meets such conditions of participation as have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.
Psychological Associate. A staff member trained in the field of clinical or counseling psychology or a closely related specialty who:
(a) has a minimum of a master's degree or the equivalent graduate study in clinical or counseling psychology or a closely related specialty from an accredited educational institution;
(b) is currently enrolled in or have completed a doctoral program in clinical or counseling psychology or a closely related specialty; and
(c) has had two years of full time supervised clinical experience subsequent to obtaining a master's degree in a multidisciplinary mental-health setting. (One year of supervised clinical work in an organized graduate internship program may be substituted for each year of experience.)
Psychological Testing. The use of standardized test instruments to evaluate aspects of an individual's functioning, including aptitudes, educational achievements, cognitive processes, emotional conflicts, and type and degree of psychopathology, subject to the limitations of 130 CMR 429.000: Mental Health Center Services.
Psychologist. An individual who, by training and experience, meets the requirements for licensing by the Massachusetts Board of Registration of Psychologists and is duly licensed to practice psychology in the Commonwealth or who meets the requirements of education and experience in psychology that have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.
Psychotherapy. The utilization of psychological and interpersonal theories and related practice methodologies to assess, interpret and modify conscious and unconscious processes of behavior.
Psychotherapy for Crisis. An urgent assessment and history of a crisis state, a mental status exam, and a disposition. The treatment includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma.
Publicly Aided Individual. A person for whose medical and other services a governmental unit is in the whole or in part liable under a statutory program.
Reevaluation. A session between a client and one or more staff members who are authorized to render mental health services for the determination and examination by interview techniques of a patient's physical, psychological, social, economic, educational and vocational assets and disabilities for the purpose of reevaluating the diagnostic formulation, treatment plan and procedures in order to assess aspects of an individual's functioning.
Structured Outpatient Addiction Program (SOAP). ASAM Intensive Outpatient Services. A substance use disorder treatment service that provides short-term, multi-disciplinary, clinically intensive structured treatment to address the sub-acute needs of members with substance use disorder and/or co-occurring disorders. These services may be used as a transition service in the continuum of care toward lower intensity outpatient services, or accessed directly. SOAP services must meet requirements as set forth in 130 CMR 418.000: Substance Use Disorder Treatment Services.
Staff Member Authorized to Render Billable Mental Health Services. An individual who provides the services referred to in 101 CMR 306.00 under the auspices of an eligible provider and meets the qualifications of any of the following professions: psychiatrist, psychologist, psychological associate, social worker, psychiatric nurse, psychiatric clinical nurse specialist, counselor or occupational therapist. This also includes staff members meeting the qualifications which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.
State-operated Community Mental Health Center. A community mental health center operated by the Commonwealth, which is not financially or physically an integral part of a hospital.
Telehealth. The use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology including, but not limited to:
(a) interactive audio-video technology;
(b) remote patient monitoring devices;
(c) audio-only telephone; and
(d) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient's physical health, oral health, mental health or substance use disorder condition.
Uniform Financial Statements and Independent Auditor's Report (UFR). The set of financial statements and schedules required of many human, social service and health care providers who deliver services to publicly-aided clients
