Current through September 17, 2024
Crisis intervention services are available to clients age 20
or younger when the treatment of a condition needing care leads to a HEALTH
CHECK (EPSDT) screen and the treatment is clinically necessary. Crisis
intervention services are appropriate for a family in the midst of a
child/adolescent mental health or substance abuse crisis. The interventions
focus on reducing stress and helping resolve the crisis in a positive manner,
and facilitating the client's involvement to treatment.
Crisis intervention services must meet all requirements in
471 NAC
32-001. All crisis intervention
service providers must facilitate a referral for a complete HEALTH CHECK
(EPSDT) screen within eight weeks of the crisis intervention. This referral
must be documented in the client's clinical record.
Crisis intervention services must be family-centered,
community-based, developmentally appropriate, culturally competent, and must
take into account the individual needs of clients age 20 and younger.
Providers must encourage family members to be involved in the
assessment of the client, the development of the treatment plan, and all
aspects of the client's treatment unless prohibited by the client, through
legal action, or because of federal confidentiality laws.
Providers must be available to schedule meetings and sessions
in a flexible manner to accommodate and work with a family's schedule. This
includes the ability to schedule sessions at a variety of times including
weekends or evenings.
The provider must document their attempts to involve the
family in treatment plan development and treatment plan reviews. A variety of
communication means should be considered. These may include, but should not be
limited to, including the family via conference telephone calls, using
registered letters to notify the family of meetings, and scheduling meetings in
the evening and on weekends.
003.01
Types of Crisis Intervention Services
One of the following services must be included in a crisis
intervention program to be approved for participation in the Nebraska Medical
Assistance Program.
32-003.01A
Non-Residential Crisis Intervention: Non-residential
crisis intervention services are provided to the family and client outside of a
residential or institutional setting. This service includes supportive services
therapy, brief assessment, and coordination services to help a family alleviate
a crisis. These services must be directed by a supervising practitioner and
psychiatric consultation must be readily available. Some assessment and
intervention activities may be carried out by a clinical professional (see 471
NAC 32-001.04, item 2) who is acting within his/her scope of practice under the
direction of a supervising practitioner.
The provider must have the capacity to respond to the family
to unscheduled crisis intervention contacts 24 hours a day, seven days a
week.
Providers of crisis intervention services must facilitate the
referral to or provide the Initial Diagnostic Interview, if it has not already
occurred.
32-003.01B
Day Residential Crisis Intervention: Day residential
crisis intervention services are provided to families when a safe and secure
setting is needed to provide a therapeutic milieu for a child or adolescent for
up to 23 hours and 59 minutes. This level is used when a brief stay in a secure
setting will facilitate a de-escalation of the crisis. These services must be
directed by a supervising practitioner with access to psychiatric consultation.
The milieu and direct care interventions may be staffed by clinical
professionals (see 471 NAC 32-001.04) or technicians, under the direction of a
supervising practitioner.
Providers of crisis intervention services must facilitate the
referral to or provide the Initial Diagnostic Interview if it has not already
occurred.
32-003.01C
Residential Acute Crisis Intervention: Residential
acute crisis intervention services are available to children and adolescents
experiencing acute psychiatric crisis. The program provides crisis treatment
and close supervision to stabilize a client and facilitate admission to the
most appropriate treatment setting. These services must be directed under the
cooperative supervision of a physician and other licensed practitioner of the
healing arts. The milieu and direct care interventions may be staffed by
clinical professionals (see 471 NAC 32-001.04) or technicians, under the
direction of a supervising practitioner.
Providers of crisis intervention services must facilitate the
referral to or provide the Initial Diagnostic Interview, if it has not already
occurred.
003.02
Standards for Participation as a Provider of Crisis Intervention Services
Programs shall meet the following standards to participate
in the NMAP as a provider of crisis intervention service in addition to the
standards listed in 471 NAC 32-001.03.
32-003.02A
Provider
Agreement: The provider shall submit the following with Form MC-19
(non-hospital) or Form MC-20 (hospital):
1. A
written overview of the program's philosophy and objectives of treating youth
including:
a. A description of each available
service;
b. A list of treatment
modalities available and the capacity for individualized treatment
planning;
c. A statement of
qualification, education, and experience of each staff member providing
treatment and the supervising practitioner and the therapeutic services each
provides;
d. A schedule covering
the total number of hours that the program operates;
e. A program overview, including admission
criteria, staff training information, etc.; and
f. Any other information requested by the
Department;
2. Copies of
licensure and certification, through the Nebraska Department of Health and
Human Services, Division of Public Health, JCAHO, COA, AOA and/or CARF as
appropriate.
32-003.02B
Staffing Standards for Participation: An agency
providing crisis intervention services for children and adolescents shall meet
the following staffing standards to participate in NMAP:
1. All services must be provided under the
supervision of the supervising practitioner. This practitioner must be
available at all times for consultation or face-to-face client
assessment.
2. Direct intervention
services must be provided by a clinical staff person who is acting within
his/her scope of practice (see 471 NAC 32-001.04).
32-003.02C
Location of
Services: Crisis intervention services may be provided in any of
the following locations:
1. The client's
home;
2. A physician's private
office;
3. A community mental
health program which meets the criteria for approval by JCAHO or is accredited
by CARF, COA, or AOA, and is appropriately licensed by the Nebraska Department
of Health and Human Services, Division of Public Health;
4. A hospital licensed and certified by the
State of Nebraska which is accredited by JCAHO or AOA and has in effect a
utilization review plan applicable to all Medicaid clients;
5. The private office of a licensed
practitioner of the healing arts who is licensed by the Nebraska Department of
Health and Human Services, Division of Public Health;
6. The client's school;
7. Other appropriate locations to meet the
client needs for intervention;
8. A
treatment foster home that is part of an agency enrolled to provide treatment
foster care through Medicaid; or
9.
A facility enrolled as a residential treatment center or therapeutic group home
under this chapter (Mental Health and Substance Abuse Services for Children and
Adolescents).
32-003.02D
Annual
Update: The provider shall submit the following information on an
annual basis:
1. An overview of any changes
in the program including any new services;
2. A current list of staff; and
3. Current copies of all licenses, letters of
accreditation, and certifications.
003.03 Covered Services
Payment for crisis intervention services under the Nebraska
Medical Assistance Program is limited to services for clinically necessary
primary psychiatric diagnoses. The Department covers the following crisis
intervention services:
1. Active
treatment, which must be
:
a. Provided under the supervision of the
supervising practitioner by clinical staff members acting within their scope of
practice (see 471 NAC 32-001.04); and
b. Reasonably expected to improve the
client's condition or resolve the crisis. The treatment interventions must, at
a minimum, be designed to reduce or control the client's symptoms to facilitate
the resolution of a crisis or prevent the need for care in a more restrictive
level of care.
32-003.03A
Special Treatment
Procedures in Crisis Intervention Services: If a child/adolescent
needs behavior management and containment beyond unlocked time outs or
redirection, special treatment procedures may be utilized. For Crisis
Intervention Services provided in Treatment Foster Care, Residential Treatment
Centers, or Treatment Group Homes, please refer to the sections covering those
services. For Crisis Intervention Services provided in the child/adolescent's
home, school, or other appropriate location, Special Treatment Procedures is
limited to physical restraint. Mechanical restraints and pressure point tactics
are not allowed. Parents, the legal guardian, or the Department case manager
must approve use of these procedures and must be informed within 24 hours each
time they are used.
Facilities must meet the following standards regarding
special treatment procedures:
1.
De-escalation techniques must be taught to staff and used appropriately before
the initiation of special treatment procedures;
2. Special treatment procedures may be used
only when a child/adolescent's behavior presents a danger to self or others, or
to prevent serious disruption to the therapeutic environment; and
3. The child/adolescent's treatment plan must
address the use of special treatment procedures and have a clear plan to
decrease the behavior requiring intervention.
These standards must be reflected in all aspects of the
treatment program. Attempts to de-escalate, the special treatment procedure and
subsequent processing must be documented in the clinical record and reviewed by
the supervising practitioner.
003.04 Admission Criteria
The provider of crisis intervention services shall develop
admission criteria for the types of services they provide. The admission
criteria must be approved by the Department Medicaid staff as part of the
provider enrollment.
003.05
Documentation in Client's Medical Record
Providers of crisis intervention services must follow the
standards for Clinical Records specified in 471 NAC 32-001.05.
Clinical records for crisis intervention services must also
include, at a minimum, the following:
1. The referral source and description of the
crisis;
2. The provider's plan to
facilitate referrals to the appropriate ongoing care for the family;
and
3. The follow-up contacts with
the client and/or family.
003.06 Limitations
NMAP limits payment for crisis intervention to medically
necessary services, subject to the Department's utilization review.
This period includes an average crisis resolution period of
three to five days with an occasional need for up to seven days when the
client's condition dictates. Payment for crisis intervention services is not
available for services past seven days.
003.07 Payment for Crisis Intervention
Services
Payment for crisis intervention services is made according
to the Nebraska Medicaid Practitioner Fee Schedule at 471-000-532.
If crisis intervention services are provided in the home
between the hours of 10:00 p.m. and 8:00 a.m., the fee will be paid at one and
one half times the regular rate. This shift differential is only available for
unscheduled emergency services that are part of a crisis intervention
service.
