Current through Register Vol. 41, No. 3, September 23, 2024
A. Service description. Center-based crisis
support service means planned crisis prevention and emergency crisis
stabilization services in a crisis therapeutic home using planned and emergency
admissions. Planned admissions shall be provided to individuals receiving
crisis services and who need temporary, therapeutic interventions outside of
their home setting to maintain stability. Emergency admissions shall be
provided to individuals who are experiencing an identified behavioral health
need or behavior challenge that is preventing them from reaching stability
within their home settings. Center-based crisis support service shall be
covered in the FIS, CL, and BI waivers.
B. Criteria and allowable activities.
1. Center-based crisis support service is
designed for individuals with a history of at least one of the following:
a. Psychiatric hospitalization;
b. Incarceration;
c. Residential or day placement that was
terminated; or
d. Behavior that has
significantly jeopardized placement.
2. In addition, the individual shall meet at
least one of the following:
a. Is currently
experiencing a marked reduction in psychiatric, adaptive, or behavioral
functioning;
b. Is currently
experiencing an increase in emotional distress;
c. Currently needs continuous intervention to
maintain stability; or
d. Is
causing harm to himself or others.
3. The individual shall also be:
a. At risk of psychiatric
hospitalization;
b. At risk of
emergency ICF/IID placement;
c. At
immediate risk of loss of community service due to severe situational reaction;
or
d. Actually causing harm to
himself or others.
4.
Allowable activities shall include as appropriate for the individual as
documented in the plan for supports:
a. A
variety of types of face-to-face assessments (e.g., psychiatric,
neuropsychiatric, psychological, behavioral) and stabilization
techniques;
b. Medication
management and monitoring;
c.
Behavior assessment and positive behavior support;
d. Intensive care coordination with other
agencies or providers to maintain the individual's community
placement;
e. Training for family
members/caregivers and providers in positive behavior supports;
f. Skill building related to the behavior
creating the crisis such as self-care or ADLs, independent living skills,
self-esteem, appropriate self-expression, coping skills, and medication
compliance; and
g. Supervising the
individual in crisis to ensure his safety and that of other persons in the
environment.
C. Service units and limitations.
Center-based crisis support service shall be limited to six months per ISP year
and shall be authorized in increments of up to a maximum of 30 consecutive days
with each authorization. Center-based crisis support service shall not be
provided during the occurrence of the following waiver services and shall not
be billed concurrently (i.e., same dates and times):
(i) group home residential service,
(ii) sponsored residential
service,
(iii) supported living
residential service, or
(iv)
respite service. Center-based crisis support service is available through a
waiver only when it is not available through the State Plan.
D. Provider qualifications and
requirements.
1. Providers shall meet all of
the requirements set out in 12VAC30-122-110 through 12VAC30-122-140.
2. Providers shall have current signed
participation agreements with DMAS and shall directly provide the services and
bill DMAS for Medicaid reimbursement.
3. Providers shall renew their participation
agreements as directed by DMAS.
4.
Providers for adults shall be licensed by DBHDS as providers of Group Home
Service-REACH (Regional Education Assessment Crisis Services Habilitation) or,
for children, a residential group home-REACH for children and adolescents with
co-occurring diagnosis of developmental disability and behavioral health
needs.
5. Center-based crisis
support service shall be provided by a licensed mental health professional
(LMHP), LMHP-supervisee, LMHP-resident, LMHP-RP, certified pre-screener, QMHP,
QDDP, or for skill-building and supervising the individual in crisis, a DSP
under the supervision of one of the professionals listed in this subdivision D
5.
6. Providers shall ensure that
DSP staff meet provider training and competency training requirements as
specified in 12VAC30-122-180.
7.
Providers shall develop and maintain individual-specific contemporaneous
documentation that supports the provider's claims for payment. Claims that are
not supported by individual-specific documentation shall be subject to payment
recovery actions by DMAS.
E. Service documentation and requirements.
1. Providers shall include signed and dated
documentation of the following in each individual's record:
a. The provider's plan for supports per
requirements detailed in 12VAC30-122-120.
b. Supporting documentation that has been
developed (or revised, in the case of a request for an extension) and submitted
to the to the support coordinator for authorization within 72 hours of the
face-to-face assessment or reassessment.
c. Documentation as detailed in
12VAC30-122-120.
d. Documentation
maintained for routine supervision and oversight of all services provided by
direct support professional staff. All significant contacts shall be documented
and dated.
2.
Supervision of DSPs shall be provided consistent with the requirements in
12VAC30-122-120 by a supervisor meeting the requirements of
12VAC35-105-590.
Providers shall make available for inspection documentation of supervision, and
this documentation shall be completed and signed by the staff person designated
to perform the supervision and oversight. This documentation shall include, at
a minimum, the following:
(i) date of contact
or observation,
(ii) person
contacted or observed,
(iii) a
summary about the direct support professional's performance and service
delivery, and
(iv) any action
planned or taken to correct problems identified during supervision and
oversight.
3. Provider
documentation shall support all claims submitted for DMAS reimbursement. Claims
for payment that are not supported by supporting documentation shall be subject
to recovery by DMAS or its designee as a result of utilization reviews or
audits.
Statutory Authority: §
32.1-325
of the Code of Virginia;
42 USC §
1396 et
seq.
