Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 352.00 - Rates of Payment for Certain Children's Behavioral Health Services
Section 352.02 - General Definitions

Current through Register 1518, March 29, 2024

Meaning of Terms. Terms used in 101 CMR 352.00 have the meaning ascribed in 101 CMR 352.02.

Behavior Management Monitoring. This service includes implementation of the behavior treatment plan; monitoring the youth's behavior; reinforcing implementation of the treatment plan by the parents, guardians, and caregivers; and reporting to the behavior management therapist on implementation of the treatment plan and progress toward behavioral objectives or performance goals. Phone contact and consultation may be provided as part of the intervention. Behavior management monitoring is provided by eligible providers.

Behavioral Management Therapy. This service includes a behavioral assessment (including observing the youth's behavior, antecedents of behaviors, and identification of motivators); development of a highly specific behavior treatment plan; supervision and coordination of interventions; and training other interveners to address specific behavioral objectives or performance goals. This service is designed to treat challenging behaviors that interfere with the child's successful functioning. The behavior management therapist develops specific behavioral objectives and interventions that are designed to diminish, extinguish, or improve specific behaviors related to the child's behavioral health condition(s) and that are incorporated into the behavior management treatment plan and the risk management/safety plan. Behavior management therapy is provided by eligible providers.

Care Manager. A single care manager who works with the child's parents and guardians to provide targeted case management.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Clinic. A clinic that is licensed by the Department of Mental Health as a provider of mental health clinic services that is not a community health center or a community mental health center.

Community-based Sites of Service. A service provided to a member located outside of a hospital.

Community Behavioral Health Center (CBHC). An entity that serves as a hub of coordinated and integrated behavioral health disorder treatment for individuals of all ages, including routine and urgent outpatient behavioral health services, mobile crisis services for adults and youth, and community crisis stabilization services for adults and youth.

Community Health Center. A clinic that provides comprehensive ambulatory services and that is not financially or physically an integral part of a hospital.

Community Mental Health Center. A clinic that provides comprehensive ambulatory mental health services and that is not financially or physically an integral part of a hospital.

Community Service Agency (CSA). A clinic, community health center, community mental health center, or other provider entity that meets all other requirements established by MassHealth.

Day. As used in 101 CMR 352.00 as a unit of payment, refers to a billable day in which the child is enrolled in the program.

Eligible Provider. Eligible providers of targeted case management are designated CSAs. Eligible providers of parent/caregiver peer-to-peer support, in-home behavior management services, in-home behavior monitoring services, in-home therapy services, therapeutic training and support, therapeutic mentoring, mobile crisis intervention, and crisis stabilization are providers that meet the conditions of participation established by MassHealth.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A: Executive Offices.

Family Partner. A family partner must have experience as a caregiver of youth with special needs, preferably youth with mental health needs, experience in navigating any of the youth-and family-serving systems, and either a bachelor's degree in a human services field from an accredited academic institution, or an associate's degree in a human services field from an accredited academic institution and one year of experience working with children, adolescents, or transition-age youth and families, or a high school diploma or equivalent and a minimum of two years of experience working with children, adolescents, or transition-age youth and families. If the bachelor's or associate's degree is not in a human services field, additional life or work experience may be considered in place of the human services degree.

Governmental Unit. The Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

Individual Consideration (I.C.). Payment rates to eligible providers for services authorized in accordance with 101 CMR 352.03(2), but not listed in 101 CMR 352.00 or authorized services performed in exceptional circumstances are determined on an individual consideration basis by the governmental unit or purchaser under M.G.L. c. 152: Workers' Compensation upon receipt of a bill that describes the services rendered. The determination of rates of payment for authorized individual consideration procedures are in accordance with the following criteria:

In-home Therapy. This service is a structured, consistent, therapeutic relationship between a licensed clinician and the youth and family for the purpose of treating the youth's behavioral health needs, including improving the family's ability to provide effective support for the youth to promote healthy functioning of the youth within the family. In-home therapy is provided by eligible providers.

Mobile Crisis Intervention. A behavioral health service available 24/7/365 providing short-term mobile, on-site, face-to-face crisis assessment, intervention, and stabilization to individuals younger than 21 years old experiencing a behavioral health crisis. Transition-aged youth older than 17 years of age and younger than 21 years old may be served by adult-trained clinicians with a certified peer specialist instead of a family partner based on an individual's clinical needs. Services may be provided in community-based settings, or in emergency department sites of services to support stabilization for transition into the community. Services may be provided via telehealth. The purpose is to identify, assess, treat, and stabilize the situation and reduce the immediate risk of danger to the youth or others consistent with the youth's risk management/safety plan, if any.

Parent-caregiver Peer-to-peer Support. This service provides a structured one-to-one relationship between a family partner and a parent or caregiver for the purpose of resolving or ameliorating the child's emotional and behavioral needs by improving the capacity of the parent or caregiver to parent the child with a serious emotional disturbance. Services may include education, support, and training for the parent or caregiver. Family partners do not provide respite care or babysitting services.

Per Diem. A unit of payment that refers to a billable day in which the member is enrolled in the program.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

Targeted Case Management (TCM). This service is for individuals younger than 21 years old with serious emotional disturbance and includes assessment of the member, development of an individualized care plan, referral and coordination of other services and supports, and monitoring and follow-up on the implementation of the care plan. Targeted case management is also referred to as intensive care coordination (ICC).

Therapeutic Mentoring. Therapeutic mentoring services are designed to support age-appropriate social functioning or ameliorate deficits in the youth's age-appropriate social functioning. Therapeutic mentoring offers structured, one-to-one, strength-based support services between a therapeutic mentor and a youth for the purpose of addressing daily living, social, and communication needs. Therapeutic mentoring services include supporting, coaching, and training the youth in age-appropriate behaviors, interpersonal communication, problem-solving and conflict resolution, and relating appropriately to other youth and adults. Therapeutic mentoring is provided by eligible providers.

Therapeutic Training and Support. This service is provided by a therapeutic training and support staff working under the supervision of an in-home therapist to support implementation of the licensed clinician's treatment plan to achieve the goals of that plan. The therapeutic training and support staff assists the in-home therapist in implementing the therapeutic objectives of the treatment plan designed to address the youth's emotional, behavioral, and mental health needs. This service includes teaching the youth to understand, direct, interpret, manage, and control feelings and emotional responses to situations, and to assist the family to address the youth's emotional, behavioral, and mental health needs. Therapeutic training and support is provided by eligible providers.