The Assertive Community Treatment (ACT) Team provides high
intensity services, available to provide treatment, rehabilitation, and support
activities seven days per week, twenty-four hours per day, 365 days per year.
The team has the capacity to provide multiple contacts each day as dictated by
client need. The team provides ongoing continuous care for an extended period
of time, and clients admitted to the service who demonstrate any continued need
for treatment, rehabilitation, or support will not be discharged except by
mutual agreement between the client and the team.
Assertive Community Treatment (ACT) is provided by a
self-contained clinical team which:
1.
Assumes overall responsibility and clinical accountability for clients disabled
by severe and persistent mental illness by directly providing treatment,
rehabilitation and support services and by coordinating care with other
providers;
2. Does not refer
clients to outside service providers when services are identified as a
responsibility of the ACT program. See 471 NAC 35-013.04C Treatment,
Rehabilitation, and Supportive Interventions;
3. Provides services on a long-term basis
with continuity of care givers over time;
4. Delivers most of the services outside
program offices;
5. Emphasizes
outreach, relationship building, and individualization of services;
6. Provides psychiatric treatment and
rehabilitation that is culturally sensitive and competent; and
7. Shares team roles expecting each staff
member to know all the clients and assist in assessment, treatment planning,
and care delivery as needed.
This model of integrated treatment, rehabilitation, and
support services is intended to help clients stabilize symptoms, improve level
of functioning, and enhance the sense of well being and empowerment. Services
provided will focus on treatment and rehabilitation of the effects of serious
mental illness, as well as support and assistance in meeting such basic human
needs as housing, transportation, education, and employment as necessary for
client satisfaction with services and increased quality of life. The goal of
the program is to provide assistance to individuals in maximizing their
recovery, to ensure client directed goal setting, to assist clients in gaining
hope and a sense of empowerment, and provide assistance in helping clients
become respected and valued members of their community.
013.01 Admission and Discharge Criteria
35-013.01A
Admission
Criteria: NMAP covers ACT services for those persons disabled by
severe and persistent mental illness who are unable to remain stable in
community living without high intensity services. ACT services must be prior
authorized by the Division of Medicaid and Long-Term Care or its designee. To
be eligible for ACT services clients must meet all of the criteria described in
471 NAC 35-001.01, and demonstrate indicators of high need and
utilization.
35-013.01B
Discharge Criteria: The ACT Program is intended to
provide services over a long period of time. Clients admitted to the service
who demonstrate continued need for treatment, rehabilitation, or support must
not be discharged except by mutual agreement between the client and the ACT
Team.
Discharge from the ACT Team occurs when the client and
program staff mutually agree to termination of services. Specific documentation
must be included in the client's clinical chart when a discharge occurs.
Discharge may occur in the following situations:
1.
Geographic
Relocation: The client moves outside the team's geographic area of
responsibility. In such cases, the ACT Team must arrange for transfer of mental
health service responsibility to a provider wherever the client is moving. To
meet this responsibility, the ACT team must maintain contact with the client
until this service transfer is arranged.
2.
Significantly Improved
Functioning: The client demonstrates by functional assessment
measurement the ability to function in all major role areas (i.e., work,
social, self-care) with minimal assistance.
3.
Client Requested
Discharge: Requested discharge despite the team's best efforts to
develop an Individual Treatment, Rehabilitation, and Recovery Plan acceptable
to the client. Efforts to develop an acceptable Individual Treatment,
Rehabilitation, and Recovery Plan must be documented in the client's clinical
record.
4.
Hospitalization of the Client in an Institute for Mental Disease
(IMD): The NMAP is not able to reimburse for services provided to
clients over age 20 and under age 64 who are being treated in an Institute for
Mental Disease.
013.02 Staff Requirements
Each ACT Team must provide a comprehensively staffed team,
including a psychiatrist, team leader, a peer support person, and program
assistants. The ACT Team must have among its staff individuals who are
qualified to provide the required services. Each ACT Team must employ, at a
minimum, the following number of clinical staff persons, peer support, and
psychiatrists to provide the treatment, rehabilitative, and supportive
services. Providers are responsible for verifying that staff are appropriately
licensed or certified.
35-013.02A
Staff Qualifications: All clinical staff must be
appropriately licensed or credentialed as required by the Department of Health
and Human Services, Division of Public Health. All clinical staff must have at
least two years of experience working with persons with serious and persistent
mental illness. All clinical staff must maintain sufficient hours of continuing
education to maintain certification or licensure.
35-013.02B
Background
Checks: The employer of the ACT Team members is responsible and
accountable for the activities and interventions of the ACT Team staff. The
employer must consider which type of criminal background and Abuse/Neglect
Central Registry checks are appropriate for their staff and how the results
impact hiring decisions. The use of criminal background and Abuse/Neglect
Central Registry checks must be described in the employer's policy and
procedure manual and be available for review.
35-013.02C
Staff
Configuration: The configuration of an ACT Team depends on the
number of clients to be served. The ACT Team maintains a 1:10 staff to client
ratio (the
Team Psychiatrist, and APRN if used, and program assistant
are not included in the ratio).
1.
Minimum Staff Configuration: The following minimum
staffing configuration must be met in each ACT Team regardless of the number of
clients served. This configuration may serve up to 50 clients. The team must
have at least one member who demonstrates competency in drug/alcohol abuse and
dependence or is a licensed alcohol and drug counselor. The clinical staff must
include:
a.
Team
Psychiatrist: Psychiatric coverage at a minimum ratio of 16 hours
per week. This psychiatry time must be spent exclusively on the ACT Team
program activities. The minimum services which must be provided by the Team
Psychiatrist are:
(1) The initial in-depth
psychiatric assessment and initial determination for medical/pharmacological
treatment;
(2) Individual
Treatment, Rehabilitation, and Recovery Plan reviews;
(3) Weekly clinical supervision;
and
(4) Participation in at least
two daily meetings per week.
b.
Advanced Practice Registered
Nurse (APRN): An APRN may provide coverage for existing psychiatry
time while not replacing the team psychiatrist responsibility in the above
services, provided that the APRN:
(1) Is
practicing within his/her scope of practice;
(2) Has an integrated practice agreement with
the team psychiatrist;
(3) Defines
the relationship with the psychiatrist and provides a copy of the integrated
practice agreement between the team psychiatrist and the APRN at the time of
enrollment, prior to the initiation of services, and at anytime the agreement
is modified or terminated.
c.
Team Leader: Each
ACT Team must have one full time Team Leader. The Team Leader must have at
least a master's degree in nursing, social work, psychiatric rehabilitation,
psychology, physician's assistant or is a psychiatrist. The Team Leader must
have demonstrated clinical and administrative experience.
d.
Mental Health
Professionals: Each team must have one full time Mental Health
Professional. A Professional is defined as a person who has completed a
Master's or Doctoral degree in a core mental health discipline, and has
clinical training including internships and other supervised practical
experiences in a clinical or rehabilitation setting.
e.
Nursing Staff:
Each team must have one full time Registered Nurse.
f.
Mental Health
Worker: Each team must have one Mental Health Worker who meets one
of the following qualifications:
(1) Is a
licensed Alcohol and Drug Counselor;
(2) Has a bachelor's degree in rehabilitation
or a behavioral health field;
(3)
Has a bachelors' degree in a field other than behavioral sciences or have a
high school degree, and has work experience with adults with severe and
persistent mental illness or with individuals with similar human services
needs; OR
g.
Additional Staff: Each team must have one additional
full time staff person who meets the qualifications of the Mental Health
Professional or Mental Health Worker.
h.
Peer Support:
Each team must have a half time coverage of peer support. This team member
position must be a self-identified consumer of mental health services. The Peer
Support staff must have training, experience, and ability to work with the team
in carrying out appropriate aspects of the Individual Treatment,
Rehabilitation, and Recovery Plan. The Peer Support staff must have a
bachelor's degree or a high school diploma and either work experience with
adults with severe and persistent mental illness, or be able to demonstrate the
motivation, learning potential and interpersonal characteristics necessary to
benefit from on-the-job training.
i.
Support Staff:
Each ACT Team must have at least one full-time support staff person.
2.
Expanded Staff
Configuration: If an ACT Team will serve more than 50 clients, the
following staff must be added:
a.
Registered Nurse: Teams serving more than 50 clients
must have at least one additional Registered Nurse to meet the nursing needs of
the expanded population;
b.
Peer Support: Teams serving more than 50 clients must
have full time Peer Support;
c.
Team Psychiatrist: Teams serving more than 50 clients
must maintain additional psychiatric coverage of 2.6 hours for every eight
clients; and
d.
Mental
Health Professionals: Teams serving more than 50 clients must have
at least two Mental Health Professionals.
3.
Additional Staff:
Teams serving more than 50 clients must maintain a minimum 1:10 staff to client
ratio. This ratio excludes the Team Psychiatrist, and APRN if used, and the
program assistant. The configuration of the ACT Team must reflect the needs of
the client population.
35-013.02D
Staffing
Positions: Each ACT team must have qualified staff assigned to
each of the following positions:
1.
Team Leader: The Team Leader is the clinical and
administrative supervisor of the team and has overall responsibility and
accountability for assuring that the requirements and functions as stated in
these regulations are met. The Team Leader also functions as a practicing
clinician on the ACT Team. The Team Leader ensures that all clinical tasks are
completed or rescheduled and manages team response to all emergencies or crisis
situations in consultation with the Team Psychiatrist. This is a full time
position.
2.
Team
Psychiatrist: The Team Psychiatrist functions must be provided by
a psychiatrist who is Board-certified or Board-eligible on a full-time or
part-time basis. The Team Psychiatrist position may be shared by more than one
psychiatrist and/or an APRN (see 471 NAC 35-013.02C (a and b)). The Team
Psychiatrist provides clinical services including psychiatric assessment,
Individual Treatment, Rehabilitation, and Recovery Plan development and
approval, psychopharmacologic and medical treatment, and crisis intervention to
all ACT Team clients. The Team Psychiatrist is available 24 hours per day and
seven days per week for crisis management. The Team Psychiatrist works with the
Team Leader to monitor each client's clinical status and response to treatment,
provides staff clinical supervision, and participates in the development of all
Individual Treatment, Rehabilitation, and Recovery Plans. The rate of
reimbursement for ACT programs that provide psychiatric coverage with less than
16 hours of a psychiatrist's time (psychiatrist and APRN combination) will be
adjusted accordingly. (Please see the fee schedule for procedure code and
rate).
3.
Advanced
Practice Registered Nurse: If an ACT Team includes an APRN to
provide services included as part of the required team psychiatrist hours, the
APRN must work collaboratively with the psychiatrist. An APRN is able to
provide services, except for the mandatory services which must be delivered by
the team psychiatrist as described in 471 NAC 35-013.02C (1a.). The Team
Psychiatrist must be available for consultation and direction of the treatment
activities provided by an APRN, within his/her scope of practice. Psychiatric
24/7 coverage must be documented via a written agreement between the
psychiatrist and the APRN. A copy of the agreement must be sent to Medicaid at
the time of enrollment.
4.
Peer Support: The Peer Support staff performs clinical
work based on their credentials and abilities.
5.
Team Member: Team
Members carry out treatment, rehabilitation, and support interventions
consistent with their training and scope of licensure.
6.
Program
Assistant: The program assistant is a non-clinician responsible
for working under the direction of the Team Leader to support all non-clinical
operations of the ACT Team. This is a full time position and not considered in
the staff to client ratio.
35-013.02E
Staff
Functions: The ACT Team must perform the following functions:
1.
Clinical
Supervision: Clinical Supervision is regular contact between a
designated senior clinical supervisor and a member of the ACT Team to:
a. Review the client's clinical
status,
b. Ensure appropriate
treatment services are provided to the client, and
c. Review and improve the ACT Team member's
service provision. Clinical Supervision may occur during Daily Team Meetings,
Individual Treatment, Rehabilitation, and Recovery Plan Meetings, side-by-side
and face-to-face supervision sessions, and through a review of the client's
clinical record and in other appropriate activities. Clinical Supervision must
be appropriately documented. The Team Leader and/or the psychiatrist is
responsible for supervising and directing all ACT Team activities.
2.
Crisis Intervention
and Response: In addition to the client specific Crisis
Intervention plans, the ACT Team must have a procedure to respond to
3. emergencies and crises. This includes, but
is not limited to, 24-hour crisis intervention availability.
Assessment: Initial and updated
assessments of the client must be provided as described in 471 NAC 35-013.04A.
Appropriate staff must be assigned to this function based on individualized
client need. The client and his/her family (as allowed by client permission)
must be involved in all assessments.
4.
Treatment
Planning: Initial and updated Individual Treatment,
Rehabilitation, and Recovery Plans must be developed as described in 471 NAC
35-013.04B. In addition to the Team Leader and Team Psychiatrist, appropriate
staff must be assigned to this function based on individualized client need.
One specific staff person must be designated to document the Individual
Treatment, Rehabilitation, and Recovery Plan for the clinical record. The
client and his/her family (as allowed by client permission) must be involved in
development, review, and revision of all Individual Treatment, Rehabilitation,
and Recovery Plans.
5.
Individual Treatment, Rehabilitation, and Recovery Plan
Coordination: Individual Treatment, Rehabilitation, and Recovery
Plan Coordination is an organized process of coordination among the
multi-disciplinary team in order to provide a full range of appropriate
treatment, rehabilitation, and support services to a client in a planned,
coordinated, efficient and effective manner, as outlined in the Individual
Treatment, Rehabilitation, and Recovery Plan.
6.
Interventions:
Based on individualized client need and preference and ACT Team qualifications,
experience, and training, ACT Team members must be assigned to provide the
active treatment, rehabilitative, and supportive services described in 471 NAC
35-013.04C.
013.03 ACT Program Organization
35-013.03A
Hours of Operation,
Coverage, and Availability of Services: The ACT Team must meet the
following regulations related to availability and scheduling.
1.
Hours of Operation and
Availability of Services: The ACT Team must be available to
provide treatment, rehabilitation, and support interventions 24 hours per day,
seven days per week, 365 days a year. The ACT Team must be able to:
a. Meet the clients' needs at all hours of
the day including evenings, weekends, and holidays;
b. Provide services at the time that is most
appropriate and natural for the client as described in the client's Individual
Treatment, Rehabilitation, and Recovery Plan; and
c. Operate a minimum of 12 hours per day and
eight hours each weekend day and every holiday.
2.
Psychiatric
Coverage: Psychiatric coverage must be available at all times. If
availability of the Team Psychiatrist during all hours is not feasible,
alternative psychiatric backup (including the APRN) must be arranged.
The covering psychiatrist or APRN must have an orientation to
the ACT Team concept and be supportive of its services. The covering
psychiatrist or APRN must be able to get client specific information from an
ACT Team member.
35-013.03B
Service
Intensity: The ACT Team services must be able to provide the level
of service intensity as dictated by client need. Client need is determined
through the severity of symptoms and problems in daily living and is documented
in the client's Individual Treatment, Rehabilitation, and Recovery Plan. No
other psychiatric service or psychiatric rehabilitation service may be
reimbursed, except for acute and subacute inpatient hospitalization for
assessment and stabilization, when prior authorized by Medicaid and Long-Term
Care or its designee.
35-013.03C
Place of Service: The ACT Team must provide most of
the interventions and service contacts in the community, in non-office based
settings.
35-013.03D
Shared Responsibility: The responsibility of the total
client caseload is shared by the entire ACT Team, even though team members may
serve as a primary contact for certain clients. Over time, every team member
gets to know every client and every client gets to know every team
member.
35-013.03E
Staff Communication and Planning: The ACT Team must
use systems and methods for continuous daily communication and planning. These
must include:
1.
Daily
Organizational Staff Meeting: A Daily Organizational Staff Meeting
must be held to review the status of all program clients, update the Team on
contacts provided in the past 24 hours and to communicate essential information
on current events and activities as they relate to the interventions provided
by the ACT Team.
2.
Daily Team Assignment Schedule: The Daily Team
Assignment Schedule must list all of the interventions that need to be provided
on that day and the ACT Team member assigned to complete the
intervention.
3.
Daily
Log: The Daily Log must be used to document that a client review
has occurred.
4.
Client
Weekly Contact Schedule: The Client Weekly Contact Schedule must
be a written schedule of all treatment, rehabilitation, and support
interventions which staff must carry out to fulfill the goals and objectives in
the client's Individual Treatment, Rehabilitation, and Recovery Plan.
5.
Individual Treatment,
Rehabilitation, and Recovery Plan Meetings: Individual Treatment,
Rehabilitation, and Recovery Plan Meetings must be regularly scheduled meetings
to identify and assess individual client needs/problems; to establish
measurable long and short term treatment and service goals; to plan treatment
and service interventions; and to assign staff persons responsible for
providing the services if the client and their family are not able to
participate, the meeting must include their input. Appropriate support must be
provided to maximize the participation of the client and their family. If
necessary, the Individual Treatment, Rehabilitation and Recovery Plan should
address any barriers to participation. The ACT Team must conduct Individual
Treatment, Rehabilitation, and Recovery Plan Meetings, under the supervision of
the Team Leader and Team Psychiatrist.
013.04 Program Components and Interventions
Operating as a continuous treatment and rehabilitative
service, the ACT Team must have the capability to provide assessment,
comprehensive treatment, rehabilitation, and support services as a
self-contained clinical service unit. Services must be available 24 hours a
day, seven days a week, 365 days per year. Services must be provided by the
most appropriate ACT Team members operating within their scope of practice.
Services must include, but are not limited to:
35-013.04A
Assessment and
Evaluation
35-013.04A1
Initial Admission Assessment: Prior to accepting the
client for admission, the ACT Team must assess and determine the
appropriateness of the client for admission to the ACT Team program. The
assessment must include a review of clinical information and client interview
and may include additional assessment activities.
35-013.04A2
Comprehensive
Assessment: The Comprehensive Assessment is unique to the ACT
Program in its scope and completeness. A Comprehensive Assessment is the
process used to evaluate a client's past history and current condition in order
to identify strengths and problems, outline goals, and create a comprehensive
Individual Treatment, Rehabilitation, and Recovery Plan. The Comprehensive
Assessment reviews information from all available resources including past
medical records, client self report, interviews with family or significant
others if approved by the client, and other appropriate resources, as well as
current assessment by team clinicians from all disciplines. A Comprehensive
Assessment must be initiated and completed within 30 days after the client's
admission to the ACT program, according to the following requirements:
1. Each assessment area must be completed by
staff with skill and knowledge in the area being assessed and must be based
upon all available information, including client self-reports, reports of
family members and other significant parties, written summaries from other
agencies, including police, courts, and outpatient and inpatient facilities,
interviews with the client, and standardized assessment materials.
2. The Comprehensive Assessment must include
a thorough medical and psychiatric evaluation and must identify client
strengths as well as problems. The assessment must gather sufficient
information to develop an Individual Treatment, Rehabilitation, and Recovery
Plan.
3. The Comprehensive
Assessment may be revised during a client's tenure in the ACT Program.
Information may be added, revised, or clarified.
35-013.04B
Individual
Treatment, Rehabilitation, and Recovery Plan Development and
Coordination: Individual Treatment, Rehabilitation, and Recovery
Plan Development and Coordination is a continuing process involving each
client, the client's family, guardian, and/or support system as appropriate,
and the team which individualizes service activity and intensity to meet
client-specific treatment, rehabilitation and support needs. The written
Individual Treatment, Rehabilitation, and Recovery Plan documents the client's
goals and the services the client will receive in order to achieve them. The
plan also delineates the roles and responsibilities of the team members who
will carry out the services.
An Initial Individual Treatment, Rehabilitation, and Recovery
Plan must be developed upon the client's admission to the ACT Team.
The Comprehensive Individual Treatment, Rehabilitation, and
Recovery Plan must be developed for each client within 21 days of the
completion of the Comprehensive Assessment. This Individual Treatment,
Rehabilitation, and Recovery Plan will be developed and revised according to
the following regulations:
35-013.04B1
Comprehensive Individual Treatment, Rehabilitation, and Recovery
Plan Development: A comprehensive Individual Treatment,
Rehabilitation, and Recovery Plan is developed through an organized process of
coordination among the multi-disciplinary team in order to provide a full range
of appropriate treatment, rehabilitation, and support services to the client in
a planned, coordinated, efficient and effective manner. The Comprehensive
Individual Treatment, Rehabilitation, and Recovery Plan provides a systematic
approach for meeting a client's needs, treatment rehabilitation, and support
needs, and documenting progress on treatment, rehabilitation, and service
goals.
The following key areas must be addressed in the Individual
Treatment, Rehabilitation, and Recovery Plan based upon the individual needs of
the client: symptom stability, symptom management and education, housing,
activities of daily living, employment and daily structure, family and social
relationships, and crisis support.
This plan must:
1.
Identify the client's needs and problems;
2. List specific long and short term goals
with specific measurable objectives for these needs and problems;
3. List the specific treatment and
rehabilitative interventions and activities necessary for the client to meet
these objectives and to improve his/her capacity to function in the community;
and
4. Identify the ACT Team
members who will be providing the intervention.
The Individual Treatment, Rehabilitation, and Recovery Plan
must be developed in collaboration with the client and/or guardian, if any,
and, when appropriate, the client's family.
The client's participation in the development of the
Individual Treatment, Rehabilitation, and Recovery Plan must be documented. The
plan must be signed by the client and the Team Psychiatrist.
35-013.04B2
Individual
Treatment, Rehabilitation, and Recovery Plan Reviews: The ACT Team
must review and revise the client's Individual Treatment, Rehabilitation, and
Recovery Plan every six months, whenever there is a major decision point in the
client's course of treatment, or more often if necessary. The Team
Psychiatrist, Team Leader, and appropriate staff from the ACT Team must
participate in each Individual Treatment, Rehabilitation, and Recovery Plan
Review. The ACT Team must include the client in the review. Guardians and/or
family members should be encouraged to participate, as allowed by the client.
The Individual Treatment, Rehabilitation, and Recovery Plan
Review must be documented in the client's clinical record. This documentation
must include a description of the client's progress and functioning since the
last Individual Treatment, Rehabilitation, and Recovery Plan Review, the
client's current functional strengths and limitations, a list of attendees, the
discussion related to the Individual Treatment, Rehabilitation, and Recovery
Plan, and any changes to the plan. The plan and review will be signed by the
client and the Team Psychiatrist.
The signature of the Team Psychiatrist indicates this is the
most appropriate level of care for the client and that the treatment,
rehabilitative, and service interventions are medically
necessary.
35-013.04B3
Client and Family Participation: The ACT Team is
responsible for engaging the client in active involvement in the development of
the treatment/service goals. With the permission of the client, ACT Team staff
must involve pertinent agencies and members of the client's family and social
network in the formulation of Individual Treatment, Rehabilitation, and
Recovery Plans.
35-013.04C
Treatment,
Rehabilitative, and Supportive Interventions: The ACT Team must be
able to provide treatment, rehabilitative, and supportive interventions to
clients assigned to the ACT Team. The interventions are categorized into three
areas and the specific application of each type of intervention must be based
on the client's specific goals and objectives. The interventions must address
the needs identified in the Comprehensive Assessment. While there are no
requirements that the client receive a minimum number of a specific categories
of intervention, the client must receive the interventions that are appropriate
for their needs.
All interventions must be performed by professionals acting
within the appropriate scope of practice.
35-013.04C1
Treatment
Interventions:1.
Medical Assessment, Management, and Intervention: The
ACT Team must provide the interventions necessary to treat the client's
psychiatric and physical conditions.
2.
Individual, Family, and Group
Therapy or Counseling: The ACT Team must provide individual,
family, and group therapy or counseling to assist the client to gain skills in
interpersonal relationships, identify and resolve conflicts, and systematically
work on identified individual goals. These interventions focus on lessening
distress and symptomology, improving psychological defenses and role
functioning, and increasing and reinforcing the client's understanding of and
participation in treatment, rehabilitative services, and activities of daily
living.
3.
Medication: The ACT Team must provide the
prescription, preparation, delivery, administration, and monitoring, of
medications.
4.
Crisis
Intervention: The ACT Team must provide Crisis Intervention
Services by assessing client needs that require immediate attention and
initiate a resolution to the need.
5.
Substance Abuse
Services: The ACT Team must provide Substance Abuse Services to
assist the client in achieving periods of abstinence and stability. The
interventions include, but are not limited to assessment, individual and group
counseling, education, and skill development. The interventions should help the
client:
a. Learn to identify substance use,
effects, and patterns,
b. Recognize
the relationship between substance use, mental illness and psychotropic
medications, and
c. Develop
motivation to eliminate or decrease substance use and coping skills or
alternatives to minimize substance use.
35-013.04C2
Rehabilitative
Interventions:
1.
Symptom Management Skill Development: The ACT Team
must provide Symptom Management Skill Development to help the client cope with
and gain mastery over symptoms and functional impairments in the context of
adult role functioning.
2.
Vocational Skill Development: The ACT Team must
provide Vocational Skill Development that includes individualized assessment
and planning for employment based upon functional assessment and the client's
needs, desires, interests and abilities.
3.
Activities of Daily Living and
Community Living Skill Development: The ACT Team must provide
services to help the client rehabilitate their functional impairments and
limitations related to activities of daily living and living in a community
setting. The services will help clients carry out personal hygiene and grooming
tasks, perform household activities, find housing which is safe and affordable,
develop or improve money management skills, use available transportation, and
have and effectively use a personal physician and dentist.
4.
Social and Interpersonal Skill
Development: The ACT Team must provide interventions to help the
client rehabilitate their social functioning. The goals include, but are not
limited to improved communication skills, developing assertiveness, developing
social skills and meaningful personal relationships, appropriate and productive
use of leisure time, relating to others effectively, familiarity with available
social and recreational opportunities and support groups, and increased use of
such opportunities.
5.
Leisure Time Skill Development The ACT Team must
provide interventions to rehabilitate the client's ability to use leisure time
appropriately.
35-013.04C3
Supportive
Interventions:1.
Assistance: The ACT Team must provide support
services, direct assistance, and coordination to ensure that the client obtains
the basic necessities of daily life. These necessities include, but are not
limited to: medical and dental services, safe, clean, affordable housing,
financial support, social services, transportation, legal advocacy and
representation, education, employment, food, and clothing.
2.
Support: The ACT
Team must provide support to clients, on a planned and "as needed" basis, to
help them accomplish their personal goals, gain a sense of personal mastery and
empowerment, and to cope with the stresses of day-to-day living. This includes
interaction that focuses on decreasing distress, improving understanding and
reinforcing the client's participation in services.
3.
Family
Involvement: The ACT Team will provide education, support and
consultation to clients' families and other major supports, with client
agreement and consent. The ACT Team must encourage family members and other
major sources of support to be involved in the services received by the client
unless prohibited by the client, through legal action, or because of
confidentiality laws. This includes education about the client's illness and
condition and the role of the family in the therapeutic process, intervention
to resolve conflict, and ongoing communication and collaboration between the
ACT Team and the client's family.
4.
Positive Peer Role
Modeling: The ACT Team will offer opportunities for positive peer
role modeling and peer support including practical problem solving approaches
to daily challenges, peer perspective on steps to recovery and support,
mentoring toward greater independence, empowerment, and ability to manage
severe symptomology.
013.05 National Accreditation and
Certification
Providers must be nationally accredited under specific ACT
Team standards, such as CARF (Commission on Accreditation of Rehabilitation
Facilities), or must be actively pursuing accreditation in order to be
enrolled. Providers that are actively pursuing accreditation with a national
body must submit their accreditation plan for consideration. Providers actively
pursuing accreditation will be enrolled on a provisional
status.
013.06 Clinical
Documentation Requirements
Records must be kept in accordance with the national
accreditation body surveying the provider. The clinical records for ACT Team
services must include the following information:
1. Client identifying and demographic
information;
2. Assessments and
Evaluations;
3. Team Psychiatrist's
orders;
4. Treatment,
Rehabilitation and Service Planning;
5. Current Medications;
6. Progress and contact notes must be
recorded by all ACT Team members providing services to the client;
7. Reports of consultations, laboratory
results, and other relevant clinical and medical information;
8. Documentation of the involvement of family
and other significant others; and
9. Documentation of transition and discharge
planning.
35-013.06A
Discharge Documentation: Documentation of discharge
from the ACT program must included.
013.07 Performance Improvement and Program
Evaluation
The ACT Team must have a performance improvement and program
evaluation plan which meets the criteria for accreditation in the approved
national accreditation organization. In addition, the program will participate
in all aspects of statewide ACT evaluation projects.
013.08 Provider Enrollment
An ACT Team must complete Form MC-19, "Medical Assistance
Provider Agreement, " and submit the completed form and a program overview that
addresses the requirements in these regulations to the Division of Medicaid and
Long-Term Care for approval. The ACT Team must maintain written policies and
procedures that document compliance with all of the standards and requirements
in 471 NAC
35-002. The provider will be advised
in writing when its participation is approved. Annual updates of enrollment may
be required. The provider must submit updates of the identity and expertise of
ACT Team members as new staff are added to the program.
013.09 Program Review
The ACT Team will be reviewed regularly by the Division of
Medicaid and Long-Term Care or its designee.
013.10 Prior Authorization
Reimbursement for services from the ACT Team must be
authorized by the Division of Medicaid and Long-Term Care or its
designee.
013.11 Telehealth
ACT Team interventions may be provided via telehealth when
provided according to the regulations 471 NAC
1-006.
013.12 Reimbursement and Billing Information
NMAP pays for assertive community treatment services at
established rates. Providers must follow these billing requirements:
1. Claims for services provided by the ACT
Team must be billed on an appropriately completed Form CMS-1500 or the standard
electronic health claim form Professional transition ASC X 12N 837 (see claim
submission table 471-000-49);
2.
Claims for ACT Team services must use the procedure codes determined by the
Department; and
3. The unit of
service for ACT Team reimbursement is one day.
013.13 Hospital Admissions
In the event that a client requires hospitalization while
receiving services from the ACT Team, NMAP will continue to reimburse the ACT
Team services for up to 15 days per hospitalization. The ACT Team must maintain
as much involvement with the client as possible, based on client preference and
authorization to release information. This includes providing interventions to
the client, participating in transition and discharge planning, and any other
appropriate involvement.
013.14 Limitations on the Reimbursement for
ACT Team Services
The following situation limits NMAP reimbursement for ACT
Team Services. Because regulations prohibit federal financial participation in
the reimbursement of services to clients age 21 to 64 in an IMD (Institute for
Mental Disease), Medicaid eligibility for clients who are admitted to an IMD
for longer than 10 days will be closed.
