Current through Register Vol. 41, No. 3, September 23, 2024
A. Service description. Community-based
crisis support service means planned crisis prevention and emergency crisis
stabilization services provided to individuals experiencing crisis events that
put them at risk for homelessness, incarceration, or hospitalization or that
creates danger to self or others. This service shall provide supports to
individuals in their homes and other community settings. This service provides
temporary intensive services and supports that avert emergency psychiatric
hospitalization or institutional placement or prevent other out-of-home
placement. This service shall be designed to stabilize the individual and
strengthen the current living situation so that the individual can be
maintained during and beyond the crisis period. Community-based crisis support
service shall be covered in the FIS, CL, and BI waivers.
B. Criteria and allowable activities.
1. Community-based crisis support service
provides ongoing supports to the individual who may have:
a. A history of multiple psychiatric
hospitalizations, frequent medication changes, or setting changes; or
b. A history of requiring enhanced staffing
due to the individual's mental health or behavioral issues.
2. To be approved to receive this
service, the individual shall have a history of at least one of the following:
a. Previous psychiatric
hospitalization;
b. Previous
incarceration;
c. Residential or
day placement that was terminated; or
d. Behavior that has significantly
jeopardized placement.
3. In addition, the individual shall meet at
least one of the following:
a. Is
experiencing a marked reduction in psychiatric, adaptive, or behavioral
functioning;
b. Is experiencing an
increase in extreme emotional distress;
c. Needs continuous intervention to maintain
stability; or
d. Is actually
causing harm to himself or others.
4. The individual shall also be:
a. At risk of psychiatric
hospitalization;
b. At risk of
emergency ICF/IID placement;
c. At
immediate threat of loss of community service due to a severe situational
reaction; or
d. Actually causing
harm to himself or others.
5. Community-based crisis support service
allowable activities shall be provided in either the individual's home or in
community settings, or both. Crisis staff shall work directly with the
individual and with his current support provider or his family/caregiver, or
both. This service includes supports during the provision of any other waiver
service and may be billed concurrently (i.e., same dates and times).
6. This service is provided using, for
example, coaching, teaching, modeling, role-playing, problem solving, or direct
assistance. Allowable activities shall include, as may be appropriate for the
individual as documented in his plan for supports:
a. Psychiatric, neuropsychiatric
psychological, and behavioral assessments and stabilization
techniques;
b. Medication
management and monitoring;
c.
Behavior assessment and positive behavior support;
d. Intensive care coordination with agencies
or providers to maintain the individual's community placement;
e. Family/caregiver training in positive
behavioral supports to maintain the individual in the community;
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. Supervision to
ensure the individual's safety and the safety of others in the
environment.
C. Service units and limitations.
Community-based crisis support service is provided in an hourly service unit
and may be authorized for up to 24 hours per day if necessary in increments of
no more than 15 days at a time. The annual limit is 1,080 hours. Requests for
additional community-based crisis support service in excess of the 1,080-hour
annual limit will be considered if justification of individual need is
provided. This service is only available through a waiver 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 of all community-based crisis
support service shall have current signed participation agreements with DMAS
and shall directly provide the service and bill DMAS for Medicaid
reimbursement. These providers shall renew their participation agreements as
directed by DMAS.
3. Providers
shall be licensed by DBHDS as providers of crisis stabilization service-REACH
(Regional Education Assessment Crisis Services Habilitation). Community-based
crisis support service shall be provided by an LMHP, LMHP-supervisee,
LMHP-resident, LMHP-RP, a certified pre-screener, QMHP, or QDDP.
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 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
to support units of service delivered, and the documentation shall correspond
with billing. Providers shall maintain separate documentation for each type of
service rendered for an individual. Documentation shall include all
correspondence and contacts related to the individual.
2. Provider documentation shall support all
claims submitted for DMAS reimbursement. Claims for payment that are not
supported by supporting contemporaneous 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.
