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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 22. HEALTH |
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SubTilte 22-A. MENTAL HEALTH |
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Chapter 22-A34. MENTAL HEALTH REHABILITATION SERVICES PROVIDER CERTIFICATION STANDARDS |
Section 22-A3412. SUBPROVIDER AND SPECIALTY PROVIDER REQUIREMENTS
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3412.1Each sub-provider and specialty provider shall comply with the certification standards described in § 3410, the service specific standards applicable to the MHRS offered by the sub-provider or specialty provider and the certification standards described in this section, as well as the other certification standards in this Chapter.
3412.2Sub-providers shall provide one (1) or more of the core services only through an affiliation agreement with a CSA.
3412.3Each sub-provider shall establish and adhere to policies and procedures governing its relationship with a CSA which address access to records, clinical responsibility, legal liability, dispute resolution, and all other MHRS certification standards (CSA Affiliation Policy).
3412.4Except for the provision of ACT or CBI services, specialty providers shall provide one (1) or more of the specialty services only through a referral arrangement with a CSA which is documented in an affiliation agreement. An affiliation agreement is not necessary for the provision of ACT or CBI services.
3412.5Each specialty provider shall establish and adhere to policies and procedures governing its relationship with a CSA which address access to records, clinical responsibilities, legal liability, dispute resolution, and all other MHRS certification standards (CSA Referral Policy).
3412.6Each sub-provider and specialty provider shall satisfy the following minimum staffing requirements:
(a)A Chief Executive Officer or Program Director with professional qualifications and experience who shall meet requirements as established by the MHRS provider’s governing authority and is responsible for day-to-day management of the MHRS provider;
(b)A sub-provider or specialty provider who provides rehabilitation/day services must also have a Consulting Psychiatrist who is a board-eligible psychiatrist and advises the sub-provider or specialty provider on the quality of medical and psychiatric care provided;
(c)A Clinical Director who is a qualified practitioner with overall responsibility for oversight of the clinical program of the sub-provider or specialty provider;
(d)Each sub-provider who provides either Diagnostic/Assessment or Medication/Somatic Treatment shall demonstrate adequate oversight of quality of medical and psychiatric care by employing or contracting with a Medical Director or arranging for the Medical Director for the consumer's CSA to provide such oversight; and
(e)The required staff listed in this subsection shall be either employees of the sub-provider or specialty provider or under contract to the sub-provider or specialty provider for an amount of time sufficient to carry out the duties assigned.
3412.7 Each sub-provider and specialty provider shall establish and adhere to policies and procedures governing its collaboration with a referring CSA in the development, implementation, evaluation, and revision of each consumer’s IRP/IPC, that comply with DMH rules (Collaboration Policy). The Collaboration Policy shall:
(a) Be a part of each sub-provider and specialty provider’s Treatment Planning Policy;
(b) Require sub-providers and specialty providers to incorporate CSA-developed Diagnostic/Assessment material into the sub-provider and specialty provider’s treatment planning process; and
(c) Require sub-providers and specialty providers to coordinate the consumer’s treatment with the consumer’s clinical manager.
3412.8Each subprovider shall offer core services as required by § 3410.20. At a minimum, the subprovider shall offer services during these hours at its primary location.
3412.9At a minimum, each specialty provider shall offer access to specialty services as required by § 3410.20.
3412.10Each subprovider and specialty provider QI program shall be directed by a coordinator who is a qualified practitioner and who has direct access to the Chief Executive Officer (QI Coordinator). The QI Coordinator shall review unusual incidents, deaths, and other sentinel events, monitor and review utilization patterns, and track consumer complaints and grievances.
3412.11Each subprovider and specialty provider with total annual revenues at or exceeding three hundred thousand dollars ($ 300,000) shall have an annual audit by a certified public accounting firm in accordance with generally accepted auditing standards. The resulting financial audit report shall be consistent with formats recommended by the American Institute of Public Accountants. Each subprovider and specialty provider shall submit a copy of the financial audit report to DMH ninety (90) days after the end of its fiscal year.
3412.12Each subprovider and specialty provider with total annual revenues less than three hundred thousand dollars ($ 300,000) shall submit financial statements reviewed by an independent certified public accounting firm one hundred twenty (120) days after the end of its fiscal year.
3412.13Each sub-provider shall enter into an affiliation agreement with one (1) or more CSAs that specifies the terms of the arrangement between the parties.
3412.14Each specialty provider shall enter into an affiliation agreement with all CSAs that specifies the terms of the arrangement between the parties.
3412.15Each sub-provider and specialty provider shall have the capability to submit timely and accurate claims, encounter data, and other submissions as necessary directly to the DMH contract management system.
3412.16Each sub-provider and specialty provider shall only provide those MHRS to consumers that are specified in the consumers' IRP/IPC as designated by the consumers' CSA.
3412.17DMH shall review and approve the CSA Affiliation Policy, the CSA Referral Policy and the Collaboration Policy.