Section 22-A3411. CORE SERVICES AGENCY REQUIREMENTS

 

3411.1Each CSA shall comply with the general certification standards described in § 3410, the service specific certification standards applicable to core services and the certification standards set forth in this section, as well as the other certification standards in this Chapter.

 

3411.2Each CSA shall:

 

(a)Serve as the clinical home for the consumers it enrolls;

 

(b)Employ clinical managers, except that a psychiatrist serving as a clinical manager may be- under contract to the CSA;

 

(c)Be responsible for ensuring that IRPs/IPCs are developed and approved for its enrolled consumers; and

 

(d)Provide clinical management for its enrolled consumers.

 

3411.3Each CSA shall satisfy the following minimum staffing requirements:

 

(a)A Chief Executive Officer with professional qualifications and experience who meets the requirements established by the MHRS provider's governing authority. The Chief Executive Officer shall be charged with responsibility for day-to-day management of the CSA, and shall be a full-time employee devoting at least twenty (20) hours a week to administrative and management functions for the CSA;

 

(b)A Medical Director who is a board-eligible psychiatrist, responsible for the quality of medical and psychiatric care provided by the MHRS provider. A child and youth-serving CSA may have a staff or consulting board-eligible child psychiatrist or a staff board-eligible psychiatrist with substantial child and adolescent experience as its Medical Director;

 

(c)A Clinical Director who is a qualified practitioner with an appropriate, relevant behavioral health advanced degree, with overall responsibility for oversight of the clinical program of the MHRS provider. The Clinical Director may also serve as the Medical Director if the Clinical Director is a board-eligible psychiatrist;

 

(d)A full-time Controller, Chief Financial Officer, or designated individual responsible for executing or overseeing the financial operations of the MHRS provider. The designated financial officer shall have a Bachelors’ Degree plus two (2) years of fiscal experience and may also oversee administrative operations and information services;

 

(e)A Quality Improvement Director responsible for developing and implementing the CSA's QI program; and

 

(f)A Medical Records Administrator, responsible for:

 

(1)Ongoing quality control of clinical documentation;

 

(2)Assuring that clinical records are maintained, completed, and preserved in accordance with the MHRS provider's Clinical Records Policy;

 

(3)Assuring that information on enrolled consumers is immediately retrievable; and

 

(4)Establishing a central records index for the MHRS provider.

 

3411.4Each CSA shall comply with the following requirements regarding clinical operations:

 

(a)All consumers receiving treatment from or through a CSA shall choose a clinical manager from the CSA's staff.

 

(b)The clinical manager, along with the consumer and the approving practitioner, shall be responsible for the development of the consumer's IRP/IPC and coordinating the delivery of all MHRS received by the consumer.

 

(c)The clinical manager shall participate in the development of the IRP/IPC and shall periodically review its effectiveness with the consumer.

 

(d)The clinical manager shall be primarily responsible for assuring that the IRP assists the adult consumer in developing self-care skills and achieving recovery, and that the IPC assists the child or youth consumer and family to achieve age-appropriate growth and development.

 

(e)Each CSA shall establish and adhere to policies and procedures governing its relationship with sub-providers and specialty providers (Affiliated Provider Policy). The Affiliated Provider Policy shall address, at a minimum, access to records, clinical responsibility, treatment planning responsibility, and dispute resolution.

 

(f)Each CSA shall establish and adhere to policies and procedures governing its relationship with subcontractors (Subcontractor Policy). The Subcontractor Policy shall address, at a minimum, access to records, clinical responsibility and supervision, legal liability, insurance and dispute resolution.

 

(g)Each CSA shall establish and adhere to policies and procedures governing the means by which family education and support will be offered and provided (Consumer and Family Education Policy). The Consumer and Family Education Policy shall require, at a minimum, the following:

 

(1)The CSA shall make family education and support available for all consumer families;

 

(2)Family education and support shall include general information about mental health and psychiatric illness;

 

(3)Specific information about a consumer's situation shall be provided with the permission of the consumer, or in the case of child, with the permission of the parent or guardian in accordance with the CSA's Release of Consumer Information Policy;

 

(4)The availability of appointments for family members to meet with staff and availability of family support and education groups to be scheduled at times convenient for the family; and

 

(5)In written materials and face-to-face contacts provide information about available and needed services, as well as how the consumer may access Crisis/Emergency services. The materials shall be written at the 4th grade reading level and shall be printed in English and either Spanish or the secondary language conducive to facilitating communication with the majority of the CSA's target population.

 

(h)All materials regarding the availability of certified MHRS providers shall be reviewed and approved by DMH.

 

3411.5Each CSA shall comply with the following requirements regarding service accessibility:

 

(a)Each CSA shall operate an on-call system for its enrolled consumers twenty-four (24) hours per day, seven (7) days per week, which is staffed by qualified practitioners to respond to urgent, emergency and routine situations (CSA On-Call System).

 

(b)Each CSA shall establish and adhere to policies and procedures governing the operation of its On-Call System (On-Call System Policy). The On-Call System Policy shall require the CSA to provide:

 

(1)Direct telephone access to a qualified practitioner for consumers and their significant others to resolve problems telephonically, where possible;

 

(2)Timely access to a qualified practitioner in order to provide any needed face-to-face crisis support services; and

 

(3)Linkage to Crisis/Emergency services, including crisis stabilization services and "next day" appointments to assist the consumer to address urgent problems during the next business day; and

 

(4)Face-to-face response by a qualified practitioner within two (2) hours to the consumer's request for service.

 

(c)Each CSA shall, at a minimum, offer the core services as required by § 3414, § 3415, § 3416, § 3417 and § 3418 of these certification standards.

 

(d)Each CSA shall ensure that its business hours comply with the requirements of § 3410.20 and facilitate each enrolled consumer's ability to choose an MHRS provider.

 

(e)Each potential consumer presenting with an urgent need shall be provided an appointment by a CSA with a qualified practitioner for a face-to-face intervention within the same day that the consumer presents for service.

 

(f)Each potential consumer presenting with a routine need shall be provided an intake appointment by a CSA for an intake appointment within seven (7) business days of presentation for service.

 

(g)Each CSA shall have policies and procedures for the provision of outreach services, including means by which these services and individuals will be targeted for such efforts (Outreach Policy). The Outreach Policy shall include procedures for protecting the safety of staff who engage in outreach activities.

 

3411.6In addition to complying with the requirements set forth in § 3410.27, each CSA shall have a QI program directed by a committee comprised of qualified practitioners and staff directly involved in the provision of services (QI Committee). The QI Committee shall:

 

(a)Be chaired by a qualified practitioner with direct access to the Chief Executive Officer;

 

(b)Include consumers and family members;

 

(c)Review unusual incidents, deaths, and other sentinel events, monitor and review utilization patterns, and track consumer complaints and grievances; and

 

(d)Conduct an annual evaluation of the QI program, periodically revise the QI program description, and develop the annual QI plan.

 

3411.7Each CSA shall make a play area available for children in the waiting room area.

 

3411.8Each CSA shall have a full-time Controller, Chief Financial Officer, or a designated individual who is responsible for executing or overseeing the financial operations of the CSA, as described in § 3410.29, § 3410.33, § 3410.34, § 3410.35, § 3410.36, § 3410.37, § 3410.40, § 3410.41 and § 3411.9.

 

3411.9Each CSA shall have an annual audit by a certified public accounting firm, and the resulting audit report shall be consistent with formats recommended by the American Institute of Public Accountants. A copy of the most recently certified annual audit report shall be submitted to DMH within one hundred-twenty (120) days after the close of the CSA's fiscal year.

 

3411.10Each CSA shall enter into an affiliation agreement with its sub-providers and all specialty providers that specifies the responsibilities of the parties, except for sub-providers and specialty providers providing ACT or CBI services.  No affiliation agreement is needed for the provision of ACT or CBI services.

 

3411.11Each CSA shall be responsible for submitting IRP/IPC information to the DMH contract management system in order to register all medically necessary MHRS for its enrolled consumers and for updating and re-submitting the IRP/IPC for each of its enrolled consumers to the DMH contract management system at least once every one hundred eighty (180) days and more frequently as necessary.

 

3411.12Each CSA shall have the capability to submit timely and accurate claims, encounter data and other submissions as necessary directly to the DMH contract management system.

 

3411.13DMH shall review and approve each CSA's Affiliated Provider Policy, Subcontractor Policy, Consumer and Family Education Policy, On-Call System Policy and Outreach Policy.

 

 

authority

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 Final Rulemaking published at 57 DCR 10392, 10393 (November 5, 2010); as amended by Emergency and Proposed Rulemaking published at 58 DCR 1482 (February 18, 2011)[EXPIRED]; as amended by Final Rulemaking published at 58 DCR 3476, 3478 (April 22, 2011); as amended by Final Rulemaking published at 58 DCR 8366, 8369 (September 30, 2011).