Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 448.000 - Community Behavioral Health Center Services
Section 448.413 - Staff Composition Requirements
Universal Citation: 130 MA Code of Regs 130.448
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 448.413 to adequately provide the required scope of services set forth in 130 CMR 448.412. The staff must include other related behavioral health professionals as appropriate to meet the needs of members, which includes staff necessary for the provision of intake, diagnostic evaluation, and treatment services. All licensure staffing requirements must be met.
(B) Minimum Staffing Composition.
(1)
Psychiatrists. 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 will be responsible for prescribing, or monitoring and supervising
the prescription of, all medications.
(2)
Psychopharmacology
Staff.
(a)
Prescribers of Medication for the Treatment of Opioid Use
Disorders. Each center must employ a board-certified or
board-eligible psychiatrist or other prescriber of medication for the treatment
of opioid use disorders who possesses DEA X waiver registrations for
prescribing of medication for the treatment of opioid use disorders sufficient
to meet regional need.
(b)
Medical Assistants or Phlebotomists. Each center must
employ a medical assistant or phlebotomist to draw blood using needles and
other equipment, obtain toxicology samples, label samples correctly, and send
them for testing as appropriate. Medical assistants may also assist with vital
signs, height/weight, and other relevant health data.
(3)
Multidisciplinary
Staff. In addition to the requirements under
130
CMR 448.413(B)(1) and (2)
each center must employ a multidisciplinary staff that includes at least two of
the following behavioral health professionals.
(a)
Psychologist. A
psychologist licensed by the Massachusetts Board of Registration of
Psychologists, 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 Workers pursuant to M.G.L. c. 13, § 84 and 258 CMR
9.00: Licensure Requirements and Procedures.
(c)
Licensed Mental Health
Counselor. A licensed mental health counselor licensed by the
Board of Registration of Allied Mental Health and Human Services Professions
pursuant to M.G.L. c. 112, § 165 and 262 CMR 2.00: Requirements
for Licensure as a Mental Health Counselor.
(d)
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.
(e)
Registered Nurse (RN). A registered nurse licensed by
the Board of Registration in nursing pursuant to M.G.L. c. 112, § 80B and
244 CMR 3.00: Registered Nurse and Licensed Practical
Nurse.
(f)
Certified Peer Specialists. The center must employ at
least one certified peer specialist. Certified peer specialists must meet all
applicable sections of 130 CMR 448.000.
(g)
Recovery Support
Staff. The center must employ at least one recovery support
navigator or at least one peer recovery coach staff member. Recovery support
navigators and peer recovery coach staff shall meet all applicable sections of
130 CMR 418.000: Substance Use Disorder Treatment
Services.
(h)
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.
(i)
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.
(j)
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.
(k)
Licensed Applied Behavior Analyst. An applied behavior
analyst 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 M.G.L. c. 13, §§ 88 through 90.
(l)
Staff to Administer
Medication Services. In addition to the staff required in
130
CMR 448.413(B)(1) through
(3), 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 community behavioral health center will 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 will have previous training or experience in
personnel, fiscal, and data management, as described in
130
CMR 448.421. The same individual may serve as
both the administrator and clinical program director.
(2)
Clinical Program
Director. The community behavioral health center will designate a
professional staff member to be the clinical program director responsible for
the direction and performance of all professional staff members and services.
The same individual may be designated as both the administrator and the
clinical program director. If the clinical program director is designated to a
separate individual, the clinical program director reports to the
administrator.
(a) The clinical program
director will be independently licensed, certified, or registered to practice
as a psychiatrist, psychologist, social worker, mental health counselor,
marriage and family counselor, or advanced practice registered nurse and will
be employed on a full-time basis.
(b) The specific responsibilities of the
clinical program director include
1. selection
of clinical staff and maintenance of a complete staffing schedule;
2. establishment of job descriptions and
assignment of staff;
3.
accountability for adequacy and appropriateness of member care;
4. in conjunction with the medical director,
accountability for employing adequate psychiatric staff to meet the
psychopharmacological needs of members;
5. establishment and maintenance of policies
and procedures for member care;
6.
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;
7. program
evaluation;
8. development of
in-service training for professional staff; and
9. establishment of a Quality Management
Program.
(3)
Medical Director.
(a)
Center. Each center will designate at least one
board-certified or board-eligible psychiatrist, responsible for establishing
all medical policies and protocols and for supervising all medical services
provided by the staff. The medical director for the center will possess a DEA X
waiver registration for prescribing medications for opioid use disorder
(MOUD).
(b)
YMCI and
YCCS. A medical director overseeing the medical services provided
in YMCI and YCCS will be a board-certified or board-eligible child
psychiatrist. YMCI and YCCS services will be under the clinical and medical
oversight of a single medical director. The same individual may serve as both
the center, AMCI, Adult CCS, YMCI, and YCCS medical director.
(c)
AMCI and Adult
CCS. AMCI and Adult CCS services will be under the clinical and
medical oversight of a single medical director. The medical director for the
AMCI and Adult CCS services will possess a DEA X waiver registration for
prescribing medications for opioid use disorder (MOUD). The same individual may
serve as both the center, AMCI, Adult CCS, YMCI, and YCCS medical
director.
(4)
Psychiatrist or Advanced Practice Registered Nurse.
The role of at least one psychiatrist or one advanced practice registered nurse
will include the provision of psychiatric assessment, medication evaluations,
and medical management and contribute to the comprehensive assessment and care
planning, as clinically needed.
(5)
Assistant Program Director. Each center will identify
an independently licensed behavioral health clinician who will support the
clinical program director with all leadership functions, including clinical and
administrative oversight, and quality of care across the community behavioral
health center.
(6)
Quality Director. Each center will identify an
individual to provide dedicated quality oversight. The quality director, or
their designees, will implement and provide oversight of quality management
programs for all services provided by the center.
(7)
Clinical
Supervisor. Each center will identify independently licensed
behavioral health clinicians sufficient to meet the needs of the center who
will provide clinical supervision to direct service staff within each of the
community behavioral health center service components, including AMCI, YMCI,
Adult CCS, and YCCS. Clinical supervisors of clinicians providing community
behavioral health center services to children and adolescents must have at
least two years of experience treating youth and/or families.
(8)
Nurse Manager.
Each center will employ a nurse manager (RN) to
(a) provide supervision to nursing staff and
oversight across community behavioral health center service
components;
(b) fill physician
orders, administer medication, take vital signs, and coordinate medical
care;
(c) contribute to
comprehensive assessment;
(d)
conduct brief crisis counseling and individualized risk management/safety
planning;
(e) provide
psycho-education to members; and
(f) assist with discharge planning and care
coordination.
(9) Each
center will employ other staff necessary to support all administrative
functions, such as clerical and security staff. Security staff will be trained
with an approved behavioral support and management program, including skills in
de-escalation, to maintain safety of all individuals and staff at all hours of
operation.
(D) Mobile Crisis Intervention Services Staff.
(1) Adult Mobile Crisis Intervention must be
provided under the direction of a physician and will utilize a
multidisciplinary team minimally comprised of the following.
(a)
Clinical Program
Director. An independently licensed, master's level clinician who
will serve as the AMCI clinical program director. The clinical program director
will be responsible for the clinical oversight and quality of care for AMCI
services and will ensure the provision of all service components, including
emergency or urgent consultations.
(b)
Psychopharmacology
Staff. At least one board-certified or board-eligible psychiatrist
or advanced practice registered nurse (APRN) responsible for urgent
psychopharmacology needs, including providing induction and bridging services
for MOUD and a DEA X waiver to prescribe buprenorphine and experience treating
individuals with SUD.
(c)
Other Multidisciplinary Staff. Each AMCI program will
employ master's and bachelor' s-level clinicians and staff sufficient to meet
the needs of the members served, pursuant to
130
CMR 418.413(B)(3) and (4),
including conducting medical screening, ongoing monitoring, and disposition
determinations. This AMCI staff will include at least one certified peer
specialist, and at least one recovery support navigator or peer recovery
coach.
(2) Youth Mobile
Crisis Intervention (YMCI) must be provided under the direction of a physician,
including a medical director, and will utilize a multidisciplinary team,
including the following.
(a)
Clinical Program Director. An independently licensed,
master's level clinician who must serve as the YMCI clinical program director.
The clinical program director must be responsible for the clinical oversight
and quality of care for YMCI services and must ensure the provision of all
service components, including emergency or urgent consultations.
(b)
Psychopharmacology
Staff. At least one board-certified or board-eligible child
psychiatrist or advanced practice registered nurse (APRN) will be responsible
for urgent psychopharmacology needs, including medication management
evaluations.
(c)
Multidisciplinary Staff. Each YMCI program will employ
master's and bachelor's-level clinicians and staff sufficient to meet the needs
of the members served, pursuant to
130
CMR 418.413(B)(3) and (4),
including conducting medical screening, ongoing monitoring, and disposition
determinations. This staff will include sufficient professional and
paraprofessional staff to meet member needs.
(E) Community Crisis Stabilization Services Staff. Adult Community Crisis Stabilization Services (Adult CCS) must be provided under the direction of a physician and shall employ a multidisciplinary team, including the following.
(1)
Clinical Program
Director. An independently licensed, master's level clinician who
will serve as the Adult ACCS clinical program director. The clinical program
director will be responsible for the clinical oversight and quality of care for
Adult CCS services and will ensure the provision of all service components,
including emergency or urgent consultations.
(2)
Psychopharmacology
Staff. Psychiatrist or advanced practice registered nurse (APRN)
responsible for urgent psychopharmacology needs, providing induction and
bridging services for MOUD and a DEA X waiver to prescribe buprenorphine and
experience treating individuals with SUD.
(3)
Nurse Manager.
At least one nurse manager (RN) responsible for supervision of all nursing
staff for Adult ACCS services. The nurse manager must meet all requirements
pursuant to
130
CMR 448.413(C)(8)(b) through
(d).
(4)
Multidisciplinary
Staff. Each Adult CCS program will employ master's and
bachelor's-level clinicians and staff sufficient to meet the needs of the
members served, pursuant to
130
CMR 418.413(B)(3) and (4),
including conducting medical screening, ongoing monitoring, and disposition
determinations. This staff will include at least one certified peer specialist,
or peer recovery coach, and at least one staff member per shift trained in CPR
and one staff member per shift trained in the use of Naloxone in the event of
overdose.
(F) Youth Community Crisis Stabilization (YCCS). YCCS must be provided under the direction of a physician, and will utilize a multidisciplinary team, including the following.
(1)
Clinical Program
Director. An independently licensed, master's level clinician who
will serve as the YCCS clinical program director. The clinical program director
will be responsible for the clinical oversight and quality of care for YCCS
services and will ensure the provision of all service components, including
emergency or urgent consultations.
(2)
Psychopharmacology
Staff. At least one child psychiatrist or psychiatric advanced
practice registered nurse (APRN) with child/youth training. The child
psychiatrist will provide psychiatric assessment, medication evaluations, and
medical management and will contribute to the comprehensive assessment and
discharge planning. The program may employ a psychiatric advanced practice
registered nurse (APRN) to provide psychiatric care, within the scope of their
license and under the supervision of a medical director or another attending
child psychiatrist.
(3)
Nurse Manager. At least one nurse manager (RN)
responsible for supervision of all nursing staff for YCCS services. The nurse
manager must meet all requirements pursuant to
130
CMR 448.413(C)(8)(b) through
(d).
(4)
Multidisciplinary
Staff. Each Youth CCS program will employ master's and
bachelor's-level clinicians and staff sufficient to meet the needs of the
members served, pursuant to
130
CMR 418.413(B)(3) and (4),
including conducting medical screening, ongoing monitoring, and disposition
determinations. This staff will include sufficient professional and
paraprofessional staff to meet member needs.
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