Current through Register Vol. 56, No. 18, September 16, 2024
(a) Intensive
in-community mental health rehabilitation services are intensive
community-based and family-centered mental health services delivered as a
defined set of interventions, within the context of an approved plan of care
and are restorative or preventative in nature. These services are geared toward
improving or stabilizing the child, youth or young adult's level of functioning
within the home and community in order to prevent, decrease or eliminate
behaviors or conditions that may lead to or that may place the child, youth or
young adult at increased clinical risk, or that may impact on the ability of
the child, youth or young adult to function in their home, school or community.
These services encompass a variety of mental health rehabilitative services
including, but not limited to, group, individual or family therapy, allied
behavioral therapies and modalities, clinical consultation, evaluation and
counseling.
(b) Intensive
in-community services shall be provided either individually or in a group of up
to three children/youth or young adults, as appropriate to the needs of the
child.
(c) Intensive in-community
services shall also include interaction and instruction, provided individually
or in a small group setting, to the child, youth or young adult's family and
caregiver(s) to enable them to provide the necessary support to the child,
youth or young adult to attain the goals of the service plan and sustain the
positive behavioral changes and improvement in functionality and quality of
life.
1. Intensive in-community services
provided in a group setting may be provided to the family member(s) and/or
caregiver(s) of up to three children/youth or young adults in one
session.
(d) Intensive
in-community mental health rehabilitation services may include, but are not
limited to, the following interventions:
1.
Clinical consultation/evaluation/assessment;
2. Counseling;
3. Group, individual or family
therapy;
4. Anger
management;
5. Parenting skill
development;
6. Stress
reduction;
7. Symptom
reduction;
8. Problem solving skill
development;
9. Adaptive and coping
skills; and
10. Psycho-educational
instruction related to mental health, including, but not limited to, improved
decision-making skills to manage behavior and reduce risk behaviors.
(e) Intensive in-community mental
health rehabilitation services shall be goal-oriented and focused, and are
intended to support the needs of the child, youth or young adult and his or her
family/caregiver to remain in the community. Intensive in-community services
are intended to be time-limited interventions that support the child and family
in the community while the child and family are connected with office-based
practitioner services or as a short term adjunct to office-based practitioner
services in order to support the child/family in their current living
arrangement.
(f) Intensive
in-community mental health rehabilitation services shall be delivered in
communitybased, clinically appropriate settings that are convenient to the
child or youth and his or her family. Intensive in-community mental health
rehabilitation services shall be available on a 24-hour basis, seven days per
week. These outreach services shall not be provided in an office setting,
hospital, or Joint Commission-accredited residential treatment center, nor
should they supplant existing services.
1.
For the purposes of this requirement, "providing services in an office setting"
describes a concept, whereby the provider is requiring the beneficiary to come
to the provider for services rather than the provider rendering services to the
child, youth or young adult in their natural environment. Examples are listed
below:
i. The family, child, youth, or young
adult is not comfortable meeting in their home and asks the provider to meet
them at a local community center or church recreation hall. The community
center or church agrees to provide a room for such a meeting. This is not
considered an office setting, since the provider is meeting the
family/beneficiary at the church or recreation center at the
family's/beneficiary's request.
ii.
Services provided to a child while the child is in a run away shelter and the
staff of the runaway shelter center offers the use of an empty office so that
the child and the professional providing the behavioral assistance services can
have a private conversation. As in the example above, this is not considered
"providing services in an office setting," even though the staff and the child
were physically in an "office" located in the building. The provider is
rendering services to the child in the place where the child is currently
residing, that is, the current home of the child.
iii. The provider has access to office space
in a community setting, such as a YMCA or a church's community youth center,
and children are scheduled to receive services and are required to come to that
site to receive the intensive in-community services. This is considered
"providing services in an office setting."
2. Services provided in any office of the
provider shall not be reimbursed as behavioral health rehabilitation services.
These services shall be reimbursed under the applicable Medicaid/NJ FamilyCare
provider rules which describe reimbursement for services rendered in the
provider's office.
3. Intensive
in-community mental health rehabilitation services cannot be provided to a
child, youth, or young adult who is in a Joint Commission-accredited
residential treatment center (see N.J.A.C. 10:75).
i. Intensive in-community mental health
rehabilitation services can be rendered to a child, youth, or young adult who
resides in a Joint Commission-accredited residential treatment center only
while the child is on an approved therapeutic leave from the facility; services
cannot be provided on-site.
4. Intensive in-community mental health
rehabilitation services cannot normally be provided to children, youth or young
adults in other residential mental health rehabilitation facilities, including,
but not limited to, group homes, psychiatric community residences for youth and
residential child care centers (see N.J.A.C. 10:77) if the residential
reimbursement includes these services. However, there may be exceptional
circumstances in which these services are clinically required to help support
the facility to admit the child into their program. These services are intended
to be short-term and must be clinically justified by the provider or the care
management entity and prior authorized by the contracted systems administrator.
i. Intensive in-community mental health
rehabilitation services can be rendered to a child, youth or young adult who
resides in other types of residential mental health rehabilitation facilities
while the child is on an approved therapeutic leave from the
facility.
(g)
Intensive in-community mental health rehabilitation services shall be provided
directly by mental health professionals that are licensed, or under the
supervision of a licensed clinician.
