Current through September 17, 2024
002.01 Covered Outpatient Mental Health and
Substance Use Disorder Treatment Services
Covered services include:
1. Crisis Outpatient;
2. Client Assistance Program (managed care
benefit only);
3. The Initial
Diagnostic Interview;
4.
Psychological Testing;
5.
Comprehensive Child and Adolescent Assessment (CCAA);
6. Comprehensive Child and Adolescent
Assessment Addendum;
7. Individual
Psychotherapy;
8. Group
Psychotherapy;
9. Family
Psychotherapy;
10. Parent Child
Interaction Therapy (PCIT);
11.
Child-Parent Psychotherapy (CPP);
12. Individual Substance Use Disorder
Counseling;
13. Group Substance Use
Disorder Counseling;
14. Family
Substance Use Disorder Counseling;
15. Conferences;
16. Community Treatment Aide;
17. Medication Management; and
18. Sex Offender Risk Assessment.
002.02 Non-Covered Treatment
Services
Services not covered include, but are not limited to:
1. Applied Behavioral Analysis
(ABA);
2. Biofeedback
Services;
3. Educational
Services;
4. Behavior Modification
and Planning;
5. Eye Movement
Desensitization and Reprocessing (EMDR); and
6. Art, Play or Music Therapy.
002.03 Outpatient Services
Providers
Outpatient services shall be provided by licensed
practitioners whose scope of practice includes mental health and/or substance
use disorder services.
002.04 Crisis Outpatient
Crisis outpatient individual or family therapy is an
immediate, short-term treatment service provided to a client with urgent
psychotherapy needs.
32-002.04A: The
provider shall develop a short-term plan and shall identify ongoing treatment
services if services appear to be medically necessary following stabilization.
If services are to continue, the provider shall perform or arrange for an
assessment and develop a treatment plan if one has not already been
completed.
32-002.04B A client is
eligible to receive crisis outpatient services of no more than five sessions
per episode of crisis.
002.05 Client Assistance Program (CAP)
The Client Assistance Program is a short-term,
solution-focused set of interventions to assist a client in reducing or
eliminating the current stressors that are interfering with the client's daily
living and wellbeing. The client is eligible for up to five services per
calendar year. If it is determined that the client needs additional treatment,
the provider shall perform an Initial Diagnostic Interview and formulate a
treatment plan if this has not already been completed.
002.06 Initial Diagnostic Interview
An Initial Diagnostic Interview as set forth in 471 NAC
32-001.04.
002.07
Psychological Testing
Psychological Testing is the administration and
interpretation of standardized tests used to assess an individual's
psychological or cognitive functioning. It assists in gaining an understanding
of an individual's diagnostic presentation and informs the appropriate course
of treatment.
32-002.07A Testing
services shall be administered and scored by a licensed psychologist or, under
the supervision of a licensed psychologist, by a provisionally licensed
psychologist, a licensed psychological assistant or a licensed psychological
associate. All interpretation must be done by the licensed
psychologist.
32-002.07B
Psychological Testing must be prior authorized. Before psychological testing,
the individual must be assessed to determine the need for and extent of the
psychological testing. Testing may be authorized at the onset of treatment when
it is necessary for reaching a diagnosis and/or helps resolve specific
treatment planning questions. It may also occur later in treatment if the
individual's condition has not progressed and there is no clear explanation for
the lack of improvement. Psychological testing that is available in schools is
not covered by Medicaid.
002.08 Comprehensive Child and Adolescent
Assessment (CCAA)
A CCAA is a comprehensive assessment of a juvenile's social,
physical, psychological, and educational development and needs, including the
recommendation for an individualized treatment plan when treatment is necessary
and recommended.
32-002.08A A CCAA
shall be covered for an individual under the age of 19 who is a Medicaid
eligible ward of the State and who exhibits behaviors so severe that the
individual has come to the attention of juvenile or county court.
32-002.08B A CCAA must be court-ordered. If
the individual has received a CCAA in the previous 12 months and a subsequent
evaluation is ordered, the provider shall obtain clinical information to
complete an addendum to the current CCAA.
32-002.08C A CCAA shall be completed by a
team of licensed and contracted practitioners led by a CCAA lead. The team
shall include, at a minimum:
1. A
psychiatrist;
2. A
psychologist;
3. A physician to
complete a wellness check; and
4. A
Licensed Mental Health Practitioner (LMHP) or a Licensed Alcohol and Drug
Counselor (LADC) or a Licensed Practitioner with expertise to conduct sex
offender risk assessments.
32-002.08D Any CCAA provider conducting a
substance use evaluation shall have completed the Comprehensive Adolescent
Severity Inventory (CASI) training. All CCAA providers must be approved for the
CCAA network by the State or its designee.
32-002.08E The CCAA lead shall complete a
standardized report that coordinates all of the assessment information, makes a
final recommendation for treatment and sequences the order of treatment if more
than one recommendation is made. All treatment recommendations shall meet
medical necessity criteria for the level of care recommendation. The
Supervising Practitioner shall forward the report to the State or its designee
who will forward the report to the court through the Office of Juvenile
Services worker.
32-002.08F All
components of the CCAA, including the standardized report with supporting
documentation, shall be completed within ten working days of receipt of the
request to complete the CCAA. The components are:
1. Records Search: A review and summary of
the client's records including past evaluations, past psychiatric treatment
records, information from current providers, school records, child welfare
records, juvenile probation and juvenile diversion records and other relevant
historical information.
2.
Collateral Contacts: A review and summary of information obtained from
collateral contacts relevant to the comprehensive assessment. At a minimum, it
shall include the client's school, caseworker, care coordinator,
probation/parole officer and past/present treatment providers.
3. Family Assessment: A current assessment
addressing the family functioning, family dynamics and their impact on the
client's treatment needs. The family assessment shall include all parents
identified by the client's caseworker and shall be based on a direct
face-to-face interview.
4.
Comprehensive Adolescent Severity Inventory (CASI): Completion of all ten
elements of the Comprehensive Adolescent Severity Inventory including:
a. Health information;
b. Stressful life events;
c. Education;
d. Alcohol and drug use;
e. Use of free time;
f. Peer relationships;
g. Sexual behavior;
h. Family/household members
i. Legal issues; and
j. Mental health.
5. Initial Diagnostic Interview: The Initial
Diagnostic Interview includes a review of the first four components of the CCAA
and the client's wellness check, an interview with the client, an evaluation of
current medications or recommendation for medication and its management, a
mental status exam and a diagnosis on all five axes of the most current DSM, if
appropriate.
6. Wellness Check: A
current wellness check includes but is not limited to the following:
a. Client's height, weight, blood pressure,
pulse, temperature, vision test results, hearing test results and medical
history.
b. Any pertinent
laboratory test completed by medical professionals.
c. Sexually transmitted disease testing
(excluding HIV testing) when ordered by medical staff (if HIV testing is
indicated, it should be noted in the recommendation).
7. Psychological Testing: Psychological
testing and other mental health assessments if clinically applicable and
appropriate. Additional testing/assessment shall be authorized separately from
the CCAA but shall be incorporated into the CCAA and completed under the
direction of the Supervising Practitioner. This may include, but is not limited
to, psychological testing, sexual risk offender assessment, eating disorder
assessment and substance use disorder assessments.
32-002.08G The standardized report shall
contain and be signed by the CCAA lead:
1.
Demographics;
2. A list of records
reviewed and information sources contacted;
3. Presenting problem;
4. Medical history;
5. School/work/military history;
6. Alcohol/drug history and assessment
summary;
7. Legal
history;
8. Family/social/peer
history;
9. Psychiatric/behavioral
treatment history, including psychotropic medication;
10. Collateral information
(family/friends/criminal justice/victim issues);
11. Case formulation/Clinical
impression;
12. Psychological
testing and specialty assessment results;
13. Substance use treatment recommendations,
if applicable (include primary/ideal level of care recommendation, available
level of care, barriers to ideal recommendations and client/family response to
recommendations); and
14. Mental
health treatment recommendations, if applicable.
32-002.08H The Supervising practitioner of
the CCAA agency shall complete all necessary requests for authorization,
treatment referrals and written applications, as required for services such as,
but not limited to, PRTF, ThGH or PRFC. CCAA staff shall also participate in
all peer and reconsideration reviews associated with these requests, as
appropriate.
32-002.08I A
community-based evaluation shall be completed in the client's home, the
clinician's office or another setting in the community where the client
normally resides. If this is not possible due to the distance between the
client's residence and the CCAA provider, the evaluation may be completed in a
residential facility arranged by the provider. Residential evaluations may
include a maximum of three days room and board payment and must be prior
authorized by the State or its designee.
002.09 CCAA Addendum
If the court requests a revised CCAA and the request is
within 12 months of the original CCAA, a CCAA addendum may be authorized by the
State or its designee. The addendum shall clarify or update the treatment needs
and/or recommendations as well as provide information not included in the
original CCAA.
002.10
Individual Psychotherapy
A face-to-face active treatment session between a client and
an appropriately licensed practitioner for the purpose of improving the mental
health symptoms that are significantly impairing the client's functioning in at
least one life domain such as family, social, occupational or
educational.
32-002.10A The treatment
plan shall identify the diagnosis that is the focus of treatment, the specific
target symptoms, the goals, the frequency and the estimated duration of the
service and shall be individualized according to the client's needs and the
identified symptoms experienced by the client. Services must be treatment
focused and not rehabilitative or habilitative in nature.
32-002.10B The following services are not
covered:
1. Treatment that is primarily
supportive, social or educational in nature.
2. Services for prevention, maintenance,
socialization or skill building.
002.11 Group Psychotherapy
A face-to-face treatment session between a client and a
licensed practitioner in the context of a group setting of 3-12 clients. Group
psychotherapy shall be provided as an active treatment service for a primary
psychiatric disorder in which identified treatment goals, frequency and
duration of service are a part of the client's active treatment plan and there
is reasonable expectation that group psychotherapy will improve the client's
psychiatric symptoms so that therapy will no longer be needed.
32-002.11A The following services are not
covered:
1. Treatment that is primarily
supportive, social or educational in nature.
2. Treatment for prevention, maintenance,
socialization or skill building.
002.12 Family Psychotherapy
A face-to-face treatment session in which an identified
client and the client's nuclear or extended family interact with a practitioner
for the purpose of improving the functioning of the family system and decrease
or eliminate the mental health symptoms experienced by the family. Depending on
the clinical appropriateness, it is expected that all members of the family
residing in the same household as the client participate in family therapy.
Others significant to the client or the family may also be in attendance at
Family Psychotherapy if their attendance will be meaningful in improving family
functioning.
32-002.12A The following
services are not covered:
1. Treatment that
is primarily supportive, social or educational in nature.
2. Treatment for prevention, maintenance,
socialization or skill building.
002.13 Parent Child Interaction Therapy
(PCIT)
An evidence-based service provided to children age 2-12. This
therapy places emphasis on improving the quality of the parent-child
relationship and changing parent-child interaction patterns. As such, it is
used to treat clinically significant disruptive behaviors due to the child's
primary mental health disorder.
32-002.13A The goals, frequency and duration
of the service shall be identified in the child's treatment plan and shall vary
according to the child's individual needs and the identified symptoms
experienced by the child. Services must be treatment focused and not
rehabilitative or habilitative in nature. Young children should receive PCIT
services only after a recent appropriate medical evaluation to rule out
conditions of a general medical nature.
32-002.13B There shall be a reasonable
expectation that PCIT Therapy will improve the child's psychiatric symptoms so
that the services will no longer be necessary.
32-002.13C The following services are not
covered:
1. Treatment that is primarily
supportive, social or educational in nature.
2. Services for maintenance, socialization or
skill building.
3. Services not
following the PCIT evidence-based treatment model or performed by an individual
not appropriately trained in PCIT.
002.14 Child-Parent Psychotherapy (CPP):
An evidence-based service provided to children birth to age
5, who have experienced at least one traumatic event (e.g. maltreatment, the
sudden or traumatic death of someone close, a serious accident, sexual abuse,
exposure to domestic violence) and, as a result, are experiencing behavior,
attachment, and/or mental health problems, including post-traumatic stress
disorder (PTSD). The primary goal of CPP is to support and strengthen the
relationship between a child and his or her parent (or caregiver) as a vehicle
for restoring the child's sense of safety, attachment, and appropriate affect
and improving the child's cognitive, behavioral, and social functioning.
32-002.14A The goals, frequency and duration
of the service shall be identified in the child's treatment plan and shall vary
according to the child's individual needs and the identified symptoms
experienced by the child. Services must be treatment-focused and not
rehabilitative or habilitative in nature. Young children should receive CPP
services only after a recent appropriate medical evaluation to rule out
conditions of a general medical nature.
32-002.14B There shall be a reasonable
expectation that CPP therapy will improve the child's psychiatric symptoms so
that the services will no longer be necessary.
32-002.14C The following services are not
covered:
1. Treatment that is primarily
supportive, social or educational in nature.
2. Services for maintenance, socialization or
skill-building.
3. Services not
following the CPP evidence-based treatment model or performed by an individual
not appropriately trained in CPP.
002.15 Individual Substance Use Disorder
Counseling
A face-to-face counseling session between a client and a
licensed practitioner for a primary substance use disorder. Individual
substance use disorder counseling shall be designed to assist the client in
achieving and maintaining abstinence from alcohol and drug abuse. This includes
motivational enhancement and interventions defined in the Adolescent Placement
Criteria for Level 1 in the American Society of Addiction Medicine (ASAM)
Patient Placement Criteria for Treatment of Substance-Related Disorders
(current version).
32-002.15A
Outpatient substance use disorder counseling shall reasonably be expected to
improve the symptoms of the client's substance use disorder which are
identified in the client's treatment plan.
32-002.15B The treatment plan shall identify
the diagnosis that is the focus of treatment, the specific target symptoms,
goals, the frequency and the estimated duration of the service and shall be
individualized according to the client's needs and the identified symptoms
experienced by the client. Services must be treatment focused and not
rehabilitative or habilitative in nature.
32-002.15C The following services are not
covered:
1. Services that are primarily
supportive, social or educational in nature.
2. Services for prevention, maintenance,
socialization or skill building.
002.16 Group Substance Use Disorder
Counseling
A face-to-face counseling session during which a practitioner
directs interactions between 3-12 clients who have a substance use disorder
diagnosis for the purpose of all clients achieving abstinence from alcohol and
drug abuse.
32-002.16A The definition
of group substance use disorder counseling and the criteria for determining
whether outpatient group substance use disorder counseling is the most
appropriate treatment are listed in the Adolescent Placement Criteria Section
for Level 1 services in the American Society of Addiction Medicine (ASAM)
Placement Criteria for Treatment of Substance Related Disorders (current
version).
32-002.16B The following
services are not covered:
1. Counseling that
is primarily supportive, social or educational in nature.
2. Counseling for prevention, maintenance,
socialization or skill building.
002.17 Family Substance Use Disorder
Counseling
A face-to-face treatment session between an identified client
and the client's nuclear or extended family and a licensed practitioner. The
services shall focus on the client's substance use disorder needs and the
family as a system and shall include a comprehensive family assessment.
Depending on the clinical appropriateness, it is expected that all members of
the family residing in the same household as the client participate in family
substance use disorder counseling. The specific objectives shall be to increase
the functional level of the identified client and the client's family related
to substance use.
32-002.17A The
service shall be for a client with a substance related disorder and meet the
criteria of Level I treatment according to the youth criteria of the Patient
Placement Criteria for Treatment of Substance-Related Disorders of the American
Society of Addiction Medicine (ASAM).
32-002.17B The following services are not
covered:
1. Counseling that is primarily
supportive, social or educational in nature.
2. Counseling for prevention, maintenance,
socialization or skill building.
002.18 Conferences
Conferences with family or other persons advising them on how
to assist the client can be covered under limited circumstances.
32-002.18A These circumstances must
demonstrate a need for the therapeutic involvement and include:
1. Following Psychiatric Testing,
or
2. As required during the
provision of MST services, or
3. As
a treatment intervention, identified in the client's treatment plan and
requiring a progress note.
32-002.18B All conferences must be prior
approved by Medicaid or its designee.
32-002.18C Scheduling appointments and
reporting client progress are not considered conferences and shall not be
reimbursable. Supervisory meetings or care coordination meetings are not
conferences and shall not be reimbursable.
002.19 Community Treatment Aide Services
Community Treatment Aide (CTA) services are supportive and
psychoeducational interventions designed to assist the client and parents or
primary caregivers to learn and rehearse the specific strategies and techniques
that can decrease the severity of, or eliminate, symptoms and behaviors
associated with the client's mental illness that create significant impairments
in functioning. The client's CTA plan shall be a part of the comprehensive
treatment plan developed by the client's outpatient psychotherapy provider and
be developed in close collaboration with the therapy provider. The CTA
interventions, the client's progress and modifications to the CTA plan shall be
reviewed and approved by the outpatient therapist and shall be documented by
the CTA and the therapist.
32-002.19A
CTA services shall be provided primarily in the client's natural environment,
i.e., home or foster home, but may also include other appropriate community
locations where the parent or caregiver are present. CTA services shall not be
used in place of a school aide or other similar services not involving the
parent.
32-002.19B CTA services
shall be delivered under the direction and supervision of the therapist
providing family and/or individual therapy on a regular basis to the client and
the client's caregiver/family. The CTA and the licensed therapist shall
coordinate care and document their collaboration at least every other week to
ensure the CTA activities delivered to the client remain relevant to the
client's treatment plan.
32-002.19C
Activities designed by CTA providers may include activities related to:
1. Developing a written safety plan with
input from the therapist, the client and the parents or caregivers.
2. Instructing the parents or caregivers in
de-escalation techniques and strategies.
3. Teaching and modeling appropriate
behavioral treatment interventions and techniques and coping skills with the
client and the client's parents or caregivers.
4. Collecting information about medication
compliance and developing reminder strategies and other interventions to
enhance compliance as needed.
5.
Assisting parents or caregivers with reporting medication effects, side
effects, concerns regarding side effects or compliance problems and other
information regarding progress and barriers to the treating therapist and the
prescribing physician.
6. Teaching
and modeling proper and effective parenting practices.
7. Providing training and rehabilitation
regarding basic personal care and activities of daily living.
32-002.19D CTA services shall be
prior authorized by the State or its designee in order to be eligible for
reimbursement.
32-002.19E CTA
agencies shall have a program description approved by the State or its
designee.
32-002.19F The CTA
program/clinical director may be a licensed physician (M.D. or D.O) who has
completed a psychiatric residency or similar training program and preferably is
Board Certified in psychiatry or addiction medicine, psychologist, Licensed
Mental Health Practitioner (LMHP), a registered nurse (RN), an APRN or LIMHP.
The director shall have two years of professional experience in mental health
and/or substance use disorder treatment of individuals under the age of
21.
32-002.19G The CTA therapist
shall be a licensed physician (M.D. or D.O) who has completed a psychiatric
residency or similar training program and preferably is Board Certified in
psychiatry or addiction medicine, psychologist, LIMHP, LMHP or APRN. The CTA
may be a PLMHP or a provisionally licensed psychologist only if employed by an
accredited organization or by exception by the Department or its designee. The
CTA therapist shall meet all the requirements for outpatient therapy and must
coordinate and collaborate with the CTA direct staff.
32-002.19H The CTA direct care staff shall:
1. Have a bachelor's degree in psychology,
social work, child development or a related field and the equivalent of one
year of full-time experience in direct child/adolescent services or mental
health and/or substance use disorder services. Equivalent time in graduate
studies may substitute for work experience; or
2. Have two years post-high school education
in the human services or related fields and a minimum of two years experience
in direct child/adolescent services or mental health and/or substance use
disorder services.
32-002.19I Prior to allowing staff to treat
clients, CTA agencies shall gather information from abuse and neglect
registries and conduct criminal background checks of all potential CTA workers
and shall assure that all workers have completed the CTA agency's basic
training program.
32-002.19J The
unit of service for CTA staff persons shall be 15 minutes.
002.20 Medication Management
Medication management is the service provided by a physician,
physician assistant or advanced practice registered nurse focused on the
monitoring and prescribing of psychopharmacologic agents. The service shall
include relevant history, a mental status examination and medical decision
making regarding initiating or adjusting pharmacological
agents.
002.21 Sex Offender
Risk Assessment
A sex offender risk assessment is a structured evaluation for
the purpose of recommending whether sex offender specific treatment is
necessary, the most appropriate intensity, frequency and type[s] of sex
offender treatment and to recommend safety parameters, including the level of
supervision and monitoring needed during treatment. The resulting
recommendations should also address treatment needs for medical, mental health
and/or substance use disorder conditions that are diagnosed during the
assessment. The assessment is not a forensic evaluation.
32-002.21A Practitioners providing this
assessment shall provide a written report which includes the components listed
below that support the treatment recommendations.
32-002.21B The report shall be signed by the
psychologist although parts of the assessment may be conducted by others who
operate within the scope of their license and who are under the supervision of
the signing psychologist.
32-002.21C The components for a sexual
offender risk assessment include demographic, biopsychosocial, psychological
assessment results and treatment recommendations as follows:
1. Demographic Information: Reasons for the
assessment, police reports and other relevant court documents, clinical
interview of client, family members and other collateral contacts, Initial
Diagnostic Interview and review of previous mental health and substance use
disorder treatment and psychological testing records.
2. Biopsychosocial Information: Background
information, family relations and dynamics, family response to the current
symptoms and problems, social functioning, school/academic history, substance
use disorder history, legal history, mental health treatment history, sexual
offense history, trauma /victimization history and personal
strengths.
3. Psychological
Evaluations: Level of cognitive/adaptive functioning, personal and behavior
factors, sex offender risk assessment using both static and dynamic factors,
sexual misconduct patterns, perception/understanding/motivation/empathy for
victim, current supervision and access to victim as well as protective factors
and strengths.
4. Case Formulation
and Treatment Recommendations: An integrated discussion of the relevant factors
in determining the treatment recommendations and an assessment of the client's
current risk to reoffend.
