Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 429.000 - Mental Health Center Services
Section 429.422 - Staff Composition Requirements
Universal Citation: 130 MA Code of Regs 130.429
Current through Register 1531, September 27, 2024
(A) Minimum Staffing Requirements. Each center must meet the minimum staffing and staff composition requirements outlined in 130 CMR 429.422 to adequately provide the required scope of services set forth in 130 CMR 421.000: Family Planning Agency Services. The staff must include other related mental health professionals as appropriate to meet the needs of members, which includes staff necessary for the provision of intake, diagnostic evaluation, and treatment services.
(B) Minimum Staffing Composition.
(1)
Psychiatrist.
Each center must employ, whether on staff or by contract, at least one
psychiatrist licensed by the Massachusetts Board of Registration in Medicine
pursuant to M.G.L c. 112, §§ 2 through 12DD; c. 112 §§ 61
through 65 and 88 and 243 CMR 2.00: Licensing and the Practice of
Medicine and certified by the American Board of Psychiatry and
Neurology, the American Osteopathic Board of Neurology and Psychiatry, or board
eligible for such certification. Such psychiatrist shall be responsible for
prescribing, or monitoring and supervising the prescription of all
medications.
(2)
Multi-disciplinary Staff. In addition to the
requirements under
130
CMR 429.422(B)(1) each
center must have a multi-disciplinary staff that includes at least two of the
following mental health professionals:
(a)
Psychologist. A psychologist licensed by the
Massachusetts Board of Registration of Psychologist, and specializing in
clinical or counseling psychology, or a closely related specialty, pursuant to
M.G.L. c. 112, §§ 118 through 127 and 251 CMR 3.00:
Registration of Psychologists.
(b)
Social Worker.
An independent clinical social worker licensed by the Massachusetts Board of
Registration of Social Worker pursuant to M.G.L. c 13, § 84 and 258 CMR
9.00: Licensure Requirements and Procedures.
(c)
Advanced Practice Registered
Nurse. An advanced practice registered nurse who specializes in
psychiatric treatment as follows:
1.
Psychiatric Nurse. A registered nurse with a master's
degree in psychiatric nursing licensed by the Board of Registration in Nursing
pursuant to M.G.L. c. 112, § 80B and 244 CMR 4.00: Advanced
Practice Registered Nursing.
2.
Psychiatric Clinical Nurse
Specialist. A psychiatric clinical nurse specialist licensed by
the Board of Registration in Nursing pursuant to M.G.L. c. 112, § 80B and
244 CMR 4.00: Advanced Practice Registered Nursing.
(d)
Licensed Mental
Health Counselor. A licensed mental health counselor licensed by
the Board of Registration of Allied Mental Health and Human Service Professions
pursuant to M.G.L. c. 112, § 165 and 262 CMR 2.00: Requirements
for Licensure as a Mental Health Counselor.
(e)
Licensed Alcohol and Drug
Counselor I. An alcohol and drug counselor licensed by the
Department of Public Health pursuant to 105 CMR 168.000: Licensure of
Alcohol and Drug Counselors.
(f)
Licensed Marriage and Family
Therapist. A marriage and family therapist licensed by the Board
of Registration of Allied Mental Health and Human Services Professions pursuant
to M.G.L. c. 112, §§ 163 through 172 and 262 CMR 3.00:
Requirements for Licensure as a Marriage and Family
Therapist.
(g)
Other Licensed Mental Health and Substance Use Disorder
Practitioners. Other mental health and substance use disorder
practitioners licensed by the Division of Professional Licensure, the
Department of Public Health or any Board of Registration and deemed by the
Department of Public Health to be mental health and substance use disorder
professionals.
(3)
Staff to Administer Medication Services. In addition
to the staff required in
130
CMR 429.422(B)(1) and (2),
centers may optionally staff physicians, nurse practitioners, and physician's
assistants to support prescriptive practice and integrated medical services,
inclusive of addiction medicine, within the center.
(C) Minimum Requirements for Center Administrative and Clinical Management Staff
(1)
Administrator.
The mental health center must designate one individual as administrator. The
administrator is responsible for the overall operation and management of the
center and for ensuring compliance with MassHealth regulations. The
administrator must have previous training or experience in personnel, fiscal,
and data management, as described in
130
CMR 429.438.
(a) The same individual may serve as both the
administrator and clinical director.
(b) In a community health center, the
administrator of the entire facility may also administer the mental health
center.
(2)
Clinical Director. The mental health center must
designate a professional staff member to be the clinical director, responsible
to the administrator, for the direction and control of all professional staff
members and services.
(a) The clinical
director must be independently licensed, certified, or registered to practice
in one of the Core Disciplines listed in
130
CMR 429.422(B)(1) and (B)(2)(a) through
(d), and must have had at least five years of
fulltime, supervised clinical experience subsequent to obtaining a master's
degree, two years of which must have been in an administrative capacity. The
clinical director must be employed on a full-time basis. When the clinic is
licensed as a community health center, the clinical director must work at the
center at least half-time.
(b) The
specific responsibilities of the clinical director include:
1. selection of clinical staff and
maintenance of a complete staffing schedule;
2. establishment of job descriptions and
assignment of staff;
3. overall
supervision of staff performance;
4. accountability for adequacy and
appropriateness of member care;
5.
in conjunction with the medical director, accountability for employing adequate
psychiatric staff to meet the psychopharmacological needs of members;
6. establishment and maintenance of policies
and procedures for member care;
7.
provision of some direct member care in circumstances where the clinical
director is one of the three minimum full-time equivalent staff members of the
center;
8. development of
in-service training for professional staff; and
9. establishment of a Quality Management
Program.
(3)
Medical Director. Each center must designate a
psychiatrist, who is then responsible for establishing all medical policies and
protocols and for supervising all medical services provided by the staff. The
medical director must be available to the center and satellite sites during the
center's operating hours, either onsite or remotely, for consultation and
support of clinic operations to ensure the provision of high-quality care. The
medical directors must be available to be onsite during any hours of clinic
operation, as needed. When the clinic is dually-enrolled as a community health
center, the medical director must be available to the center at least four
hours per week, either on-site or remotely, provided that the medical director
must be available to be onsite during any hours of clinic operation, as
needed.
(4)
Psychiatrist.
(a) The
roles and duties of administrator, clinical director, and medical director, as
detailed in
130
CMR 429.422(C)(1) through
(3), may be performed, all or in part, by a
psychiatrist on the center's staff, provided that provision of services to
members and performance of all relevant duties in these regulations are carried
out to meet professionally recognized standards of health care, as required by
130 CMR 450.000: Administrative and Billing
Regulations.
(b) The role
of the psychiatrist in each center, apart from any duties that may be assumed
under
130
CMR 429.422(C)(1) through
(3), must include the following:
1. responsibility for the evaluation of the
physiological, neurological, and psychopharmacological status of members
receiving services;
2. involvement
in diagnostic formulations and development and refinement of treatment plans,
including reconciliation of psychopharmacological and other medications as
required;
3. direct psychotherapy,
when indicated;
4. participation in
utilization review or quality assurance activity, when indicated;
5. coordination of the center's relationship
with hospitals and provision of general hospital consultations as
required;
6. supervision of and
consultation to other disciplines; and
7. clinical coverage on an "on-call" basis at
all hours of center operation.
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