Section 22-A3408. IRP/IPC DEVELOPMENT AND IMPLEMENTATION

 

3408.1 The IRP/IPC shall serve as authorization for the provision of MHRS. Certain services require pre-authorization or authorization by DMH, prior to commencement of the treatment planning process. All services, including those that require pre-authorization or authorization by DMH shall be addressed in the IRP/IPC.

 

3408.2The IRP/IPC shall serve as certification that the MHRS are medically necessary as indicated by the approving qualified practitioner's signature on the initial and subsequent IRP/IPC. The approving qualified practitioner's approval of an IRP/IPC shall occur by the fourth visit or within thirty (30) calendar days after the consumer enrolls with the CSA, whichever occurs first.

 

3408.3 Each CSA shall develop and maintain a complete and current IRP/IPC for each enrolled consumer.  The CSA is responsible for coordinating the development of the IRP/IPC with any sub-provider or specialty provider involved in the provision of services.

 

3408.4Development of the IRP/IPC shall commence after the first clinical contact with the consumer, so that payment may be made for MHRS delivered consistent with the initial IRP/IPC. Consumers in a crisis situation who are eligible for ACT, CBI or Crisis/Emergency shall receive such services while the IRP/IPC is being developed.

 

3408.5The IRP/IPC shall include the following elements:

 

(a)A description of the consumer's strengths or assets and challenges and how the consumer's strengths and assets will be utilized in achieving treatment goals.

 

(b)A statement of the mutually desired overall long-term results of each intervention, intermediate steps to be taken to achieve those long-term results and the overall treatment being provided for the consumer (Treatment Goals). Treatment Goals shall be based on the consumer's expressed needs and needs identified through Diagnostic/Assessment services, and referral information.

 

(c)A statement of the specific consumer or family skills that need to be developed or improved. This statement shall identify services and resources that need to be changed or modified to achieve each Treatment Goal (Objectives). Objectives shall be stated in terms of attainable and measurable results.

 

(d)A description of the interventions to be used to achieve each Objective and Treatment Goal including, but not limited to:

 

(1)A staff position or service component responsible for the intervention;

 

(2)The names of other agencies (and other human services systems if applicable) providing services for the consumer, a description of the service being provided, identification by name and title of the staff persons of those agencies or systems of care responsible for providing such services, and evidence of interagency service coordination;

 

(3)The intervention by service type, with the IRP/IPC identifying all services related to the provision of mental health services, regardless of the payment source for the service;

 

(4)The frequency and duration of the interventions;

 

(5)For each service, the MHRS provider chosen by the consumer; and

 

(6)A plan for addressing any medical problems that significantly impact or could be expected to affect the consumer's functioning which is to be carried out by either the CSA or another health-providing organization or practitioner.

 

(e)Development of psychiatric advance instructions, advance directives, crisis prevention plan, and relapse prevention plan.

 

3408.6The clinical manager shall discuss the IRP/IPC with the consumer on an ongoing basis.

 

3408.7Specific information describing the consumer's response to, participation in and agreement to the IRP/IPC shall be recorded in the consumer's clinical record.

 

3408.8The clinical manager shall document the consumer's participation in the development of the IRP/IPC by obtaining the consumer's signature on the IRP/IPC, and documenting the consumer's own words used to communicate with the Diagnostic/Assessment Team. A court-appointed guardian for adults, children and youth and the parent or family member of children and youth consumers may sign the IRP/IPC, if required by District laws and regulations.

 

3408.9In situations where the consumer does not demonstrate the capacity to sign or does not sign the IRP/IPC, the reasons the consumer does not sign shall be recorded in the consumer's clinical record, including each date where signature was attempted.

 

3408.10 The approving qualified practitioner and the clinical manager shall sign the IRP/IPC.

 

3408.11The clinical manager has an affirmative obligation to ask the consumer to document participation and agreement with the IRP/IPC at each subsequent encounter if the consumer did not sign the IRP/IPC.

 

3408.12Documentation of participation of the consumer's court-appointed guardian, family and significant others in the development of the IRP/IPC shall also be included in the consumer's clinical record, as appropriate. 

 

3408.13Each MHRS provider shall develop policies and procedures for IRP/IPC review (IRP/IPC Review Policy). The IRP/IPC Review Policy shall be part of the MHRS provider's Treatment Planning Policy as required by § 3410.12.

 

3408.14 The IRP/IPC Review Policy shall require that the IRP/IPC be reviewed and updated every one hundred eighty (180) days and at any time there is a significant change in the consumer’s condition or situation to reflect progress toward or the lack of progress toward the Treatment Goals. The IRP/IPC may be reviewed more frequently, as necessary, based on the consumer’s progress or circumstances.

 

3408.15Each IRP/IPC review shall include a review of each of the items stated in § 3408.5 including progress on Treatment Goals, re-identification of strengths and progress on Objectives.

 

3408.16The consumer, the consumer's clinical manager, approving qualified practitioner and other qualified practitioners as necessary or appropriate shall establish new Objectives and modify, add/or delete Treatment Goals based on the results of the IRP/IPC review, the consumer's assessment of progress toward meeting Treatment Goals and any new needs, and any other assessments provided by significant others, family or other professionals.

 

3408.17At a minimum the approving qualified practitioner and the consumer shall participate in the IRP/IPC review.

 

3408.18At the IRP/IPC review, the approving qualified practitioner shall identify all required MHRS re-authorizations and establish a target date for requesting the re-authorizations well in advance of their expiration dates.

 

3408.19The approving qualified practitioner shall document the consumer's participation in the IRP/IPC review by obtaining the consumer's signature on the revised IRP/IPC. A court-appointed guardian for adults, children and youth and the parent or family member of children and youth consumers may be required to sign the revised IRP/IPC, if required by District laws and regulations.

 

3408.20Documentation of participation of the consumer's court-appointed guardian, family and significant others in the review of the IRP/IPC shall also be included in the consumer's clinical record, as appropriate.

 

authority

The Director of the Department of Mental Health (Department), pursuant to the authority set forth in sections 104, and 105 of the Department of Mental Health Establishment Amendment Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.05 (2008 Repl.)).

source

Final Rulemaking published at 48 DCR 10297 (November 9, 2001); as amended by Final Rulemaking published at 51 DCR 9308 (October 1, 2004); as amended by Final Rulemaking published at 52 DCR 5682 (June 17, 2005); as amended by Notice of Emergency and Proposed Rulemaking published at 58 DCR 1482 (February 18, 2011)[EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 3476 (April 22, 2011); as amended by Notice of Final Rulemaking published at 58 DCR 8366, 8367 (September 30, 2011).