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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-A3422. COMMUNITY-BASED INTERVENTION
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3422.1CBI services are time-limited, intensive, mental health services delivered to children and youth ages six (6) through twenty-one (21). CBI services are intended to prevent the utilization of an out-of-home therapeutic resource or a detention of the consumer. CBI services may be provided at the time a child or youth is identified for a service, particularly to meet an urgent or emergent need during his or her course of treatment.
3422.2In order to be eligible for CBI services, a consumer shall have:
(a)Insufficient or severely limited individual or family resources or skills to cope with an immediate crisis; and
(b)Either individual or family issues, or a combination of individual and family issues, that are unmanageable and require intensive coordinated clinical and positive behavioral interventions.
3422.3There shall be four (4) levels of CBI services available to children and youth. A provider may be certified to offer one (1) or more level(s) of CBI services. The four (4) levels of CBI services are:
(a)CBI Level I, delivered using the Multisystemic Therapy (MST) treatment model adopted by DMH;
(b)CBI Level II, delivered using the Intensive Home and Community-Based Services (IHCBS) model adopted by DMH;
(c)CBI Level III, delivered using the IHCBS model adopted by DMH; and
(d)CBI Level IV, delivered using the Functional Family Therapy (FFT) model adopted by DMH.
3422.4All levels of CBI services shall include the services described in Subsection 3422.7, as medically necessary and clinically appropriate for the consumer.
3422.5The CBI provider shall be responsible for coordinating the treatment planning process for all consumers authorized to receive CBI for the duration of CBI services. CBI services shall be delivered primarily in natural settings and shall include in-home services.
3422.6The basic goals of all levels of CBI services are to:
(a)Defuse the consumer’s current situation to reduce the likelihood of a recurrence, which if not addressed, could result in the use of more intensive therapeutic interventions;
(b)Coordinate access to covered mental health services and other covered Medicaid services;
(c)Provide mental health services and support interventions for consumers that develop and improve consumer and family interaction and improve the ability of parents, legal guardians, or caregivers to care for the consumer; and
(d)Transition the consumer to an appropriate level of care following the end of CBI treatment services.
3422.7All levels of CBI services shall include the following services, as medically necessary and clinically appropriate for the consumer:
(a) Immediate crisis response for enrolled consumers;
(b) Stabilization services to:
(1)Reduce family conflict;
(2)Stabilize the family unit;
(3)Maintain the consumer in the home environment;
(4)Increase family support; and
(5)Monitor the consumer’s medication compliance with prescribed psychiatric medications;
(c) Environmental assessment to:
(1)Identify risk factors that may endanger either the consumer or the consumer’s family; and
(2)Assess the strengths of the consumer and the consumer’s family;
(d)Individual and family support interventions that develop and improve the ability of parents, legal guardians, or significant others to care for the consumer’s behavioral and emotional disturbance(s);
(e)Skills training related to:
(1) Consumer self-help;
(2)Parenting techniques to help the consumer’s family develop skills for managing the consumer’s emotional disturbance;
(3)Problem solving;
(4)Behavior management;
(5)Communication techniques, including the facilitation of communication and consistency of communication for both the consumer and the consumer’s family; and
(6)Medication management, monitoring, and follow-up for family members and other caregivers; and
(f)Coordination and linkage with other covered MHRS and supports and other covered Medicaid services in order to prevent the utilization of more restrictive residential treatment, including one (1) or more of the following activities:
(1)Referral of consumers to other MHRS providers;
(2)Assisting consumers in transition to less intensive or more intensive MHRS;
(3)Referral of consumers to providers of other Medicaid covered services (for example, physicians); or
(4)Supporting and consulting with the consumer’s family or support system, which is directed exclusively to the well-being and benefit of the consumer.
3422.8CBI Level I services are intended for children and youth who are experiencing serious emotional disturbance with either of the following:
(a)A documented behavioral concern with externalizing (aggressive or violent) behaviors; or
(b)A history of chronic juvenile offenses that has or may result in involvement with the juvenile justice system.
3422.9CBI Level I services shall not be authorized for:
(a)Children or youth who require the safety of a hospital or other secure setting;
(b)Children or youth in independent living programs; or
(c)Children or youth without a long-term placement option.
3422.10Eligible consumers of CBI Level I services shall have a permanent caregiver who is willing to participate with service providers for the duration of CBI Level I treatment services and be:
(a)At imminent risk for out-of-home placement within thirty (30) days; or
(b)Currently in out-of-home placement due to the consumer’s disruptive behavior, with permanent placement expected to occur within thirty (30) days.
3422.11CBI Level I Service providers shall obtain prior authorization of CBI Level I services from DMH for a period not to exceed six (6) months.
3422.12Readmission to CBI Level I services, after the six (6)-month period may be considered for prior authorization by DMH in accordance with medical necessity requirements specified by DMH.
3422.13CBI Level I services shall be delivered in accordance with the Multisystemic Treatment (MST) Model.
3422.14Eligible consumers of CBI Level II services shall have any one (1) or combination of the following:
(a)A history of involvement with the Child and Family Services Agency (CFSA) or the Department of Youth Rehabilitation Services (DYRS);
(b)A history of negative involvement with schools for behavioral-related issues; or
(c)A history of either chronic or recurrent episodes of negative behavior that have or may result in out-of-home placement.
3422.15CBI Level II services shall not be authorized for children or youth who require the safety of a hospital or other secure setting.
3422.16CBI Level II service providers shall obtain prior authorization of CBI Level II services from DMH for a period not to exceed six (6) months.
3422.17Readmission to CBI Level II services, after the six (6)-month period may be considered for prior authorization by DMH in accordance with medical necessity requirements specified by DMH.
3422.18CBI Level II services shall be delivered in accordance with the Intensive Home and Community-Based Services (IHCBS) model as adopted by DMH.
3422.19A consumer shall be eligible for CBI Level III services if the consumer:
(a)Has situational behavioral problems that require short-term, intensive treatment;
(b)Is currently dealing with stressor situations such as trauma or violence and requires development of coping and management skills;
(c)Recently experienced out-of-home placement and requires development of communication and coping skills to manage the placement change;
(d)Is undergoing transition from adolescence to adulthood and requires skills and supports to successfully manage the transition;
(e)Was recently discharged from an inpatient setting such as acute hospitalization or psychiatric residential treatment facility; or
(f)Is an adult parent or caregiver with a clinically significant mental health concern and the parent or caregiver will be parenting a child or youth returning from a residential treatment center within the next ninety (90) days.
3422.20CBI Level III services shall not be authorized for children or youth who require the safety of a hospital or other secure setting.
3422.21CBI Level III service providers shall obtain prior authorization for CBI Level III services from DMH for a period not to exceed ninety (90) days.
3422.22Readmission to CBI Level III services, after the ninety (90)-day period may be considered for prior authorization by DMH in accordance with medical necessity requirements specified by DMH.
3422.23CBI Level III services shall be delivered in accordance with the IHCBS model as adopted by DMH.
3422.24Eligible consumers of CBI Level IV services shall:
(a)Be between the ages of ten (10) and eighteen (18); and
(b)Have a documented history of moderate to serious behavioral problems which impair functioning in at least one (1) area (for example school or home), or
(c)Exhibit significant externalizing behavior which impairs functioning in at least one (1) area (for example school or home); or
(d)Be at risk of a disruption in placement; and
(e)Be:
(1)Willing to participate with service providers for the duration of CBI Level IV treatment services; or
(2)Involved with a caregiver who is willing to participate with service providers for the duration of CBI Level IV treatment services.
3422.25CBI Level IV services shall not be authorized for:
(a)Children or youth who require the safety of a hospital or other secure setting;
(b)Children or youth in congregate living programs; or
(c)Children or youth in an emergency or respite placement.
3422.26CBI Level IV Service providers shall obtain prior authorization of CBI Level IV services from DMH for a period not to exceed six (6) months.
3422.27Readmission to CBI Level IV services after the six (6)-month period may be considered for prior authorization by DMH in accordance with medical necessity requirements specified by DMH.
3422.28A maximum of twenty-four (24) additional units of CBI Level IV services may be delivered at the discretion of the provider, in consultation with the consumer and the consumer’s caregiver without an additional authorization, within twelve (12) months of the close of the initial six (6) month authorization period.
3422.29CBI Level IV services shall be delivered in accordance with the FFT model adopted by DMH.
3422.30Discharge from all levels of CBI services shall occur when the consumer has achieved the goals for CBI as outlined in the IPC or the consumer no longer benefits from CBI services. Discharge decisions shall be based on one (1) or a combination of the following:
(a)The consumer is performing reasonably well in relation to goals contained in the IPC and discharge to a lower level of care is indicated (for example, the consumer is not exhibiting risky behaviors or family functioning has improved);
(b)The consumer or the consumer’s family or caregiver has developed the skills and resources needed to step down to a less intensive service;
(c)The consumer is not making progress or is regressing and all realistic CBI treatment options have been exhausted;
(d)A family member or caregiver requests discharge and the consumer is not imminently dangerous to self or others;
(e)The consumer requires a higher level of care (for example, inpatient hospitalization or psychiatric residential treatment facility); or
(f)The consumer does not reside in the District and:
(1)Is not eligible to participate in the District’s Medicaid program;
(2)Is not within the physical or legal custody of the Child and Family Services Agency (CFSA); or
(3)Is not within the physical or legal custody of the Department of Youth Rehabilitation Services (DYRS).
3422.31Eligible providers of CBI Level I services shall:
(a)Meet the specialty service provider requirements in § 3412;
(b)Be licensed MST providers in good standing and utilize the MST treatment model;
(c)Have the capacity to provide or arrange for the non-Medicaid reimbursed wraparound services required by eligible consumers;
(1)Have the capacity to deliver CBI Level I services to four (4) to six (6) consumers for each full-time team member; and
(2)Be available to consumers twenty-four (24) hours per day, seven (7) days per week.
3422.32Eligible providers of CBI Level II services shall:
(a)Meet the specialty service provider requirements in § 3412;
(b)Utilize the IHCBS treatment model adopted by DMH to deliver CBI Level II services;
(c)Meet CBI Level II training requirements specified by DMH;
(1)Have the capacity to provide or arrange for the non-Medicaid reimbursed wraparound services required by eligible consumers;
(2)Have the capacity to deliver CBI Level II services to at least four (4) to six (6) consumers for each full-time team member; and
(3)Be available to consumers twenty-four (24) hours per day, seven (7) days per week.
3422.33Eligible providers of CBI Level III services shall:
(a)Meet the specialty service provider requirements in § 3412;
(b)Utilize the IHCBS treatment model adopted by DMH to deliver CBI Level III services;
(c)Meet CBI Level III training requirements specified by DMH;
(d)Have the capacity to provide or arrange for the non-Medicaid reimbursed wraparound services required by eligible consumers;
(e)Have the capacity to deliver CBI Level III services to at least four (4) to six (6) consumers for each full-time team member; and
(f)Be available to consumers twenty-four (24) hours per day, seven (7) days per week.
3422.34Eligible providers of CBI Level IV services shall:
(a)Meet the specialty service provider requirements in § 3412;
(b)Have current site certification as an FFT provider and utilize the FFT treatment model to deliver CBI Level IV services;
(c) Comply with the FFT site certification and staff training requirements;
(d)Comply with the CBI Level IV training and site certification requirements specified by DMH;
(e)Have the capacity to provide or arrange for the non-Medicaid reimbursed wraparound services required by eligible consumers;
(f)Have the capacity to deliver CBI Level IV services to at least ten (10) to twelve (12) consumers for each full-time therapist; and
(g)Be available to work a flexible schedule based on the needs of the consumer and the family or caregiver.
3422.35Providers of CBI services shall meet the staffing requirements applicable to the level of services offered in order to render CBI Level I, Level II, Level III or Level IV services.
3422.36Providers of all levels of CBI services shall:
(a)Individually design CBI services for each consumer and family to minimize intrusion and maximize independence;
(b)Provide more intensive services at the beginning of treatment and decrease the intensity of treatment over time as the strengths and coping skills of the consumer and family develop;
(c)Provide services utilizing a team approach;
(d)Maintain appropriate back-up coverage for team member absences and facilitate substitution of team members as necessary;
(e)Conduct face-to-face transition planning with consumers and families no later than thirty (30) days prior to the anticipated discharge date, including meetings with providers of more intensive or less intensive services;
(f)Conduct continuity of care planning with consumers and families prior to discharge from any level of CBI services, including facilitating follow-up mental health appointments and providing telephonic support until follow-up mental health services occur;
(g)Provide all of the components of treatment specified in §3422.7, as appropriate, based on each consumer’s needs;
(h)Provide CBI services with a family-focus;
(i)Assist the consumer and his or her family with the development of mental health relapse prevention strategies and plans, if none exist;
(j)Assist the consumer and his or her family with the development of a safety plan to address risk factors identified during the environmental assessment;
(k)Have policies and procedures included in its Service Specific Policies that address the provision of CBI (CBI Organizational Plan) which include the following:
(1)A description of the particular treatment models utilized, types of intervention practiced, and typical daily curriculum and schedule;
(2)A description of the staffing pattern and how staff is deployed to ensure that the required staff-to-consumer ratios are maintained, including how unplanned staff absences and illnesses are accommodated;
(3)A requirement to directly conduct or arrange for the provisions of Diagnostic/Assessment services within thirty (30) days before or after the initiation of CBI services through either an agreement with a CSA or a CSA’s affiliated sub-provider. DMH may approve alternative sources to serve as the diagnostic assessment instrument if similar assessments have been conducted within the past twelve (12) months of an individual’s referral to CBI services; and
(4)A requirement to collect and submit clinical outcome data using the process, timeline and tools specified or approved by DMH.
3422.37Each CBI Level I team shall include:
(a)A full-time clinical supervisor;
(b)A full-time team leader; and
(c)Four (4) to six (6) CBI clinicians.
3422.38The CBI Level I team clinical supervisor shall be a Master’s level qualified practitioner experienced in providing individual, group, marital or family counseling or psychotherapy in accordance with applicable District laws and regulations, with a minimum of two (2) years of post-graduate experience working with behaviorally challenged youth and their families in community-based settings.
3422.39The CBI Level I team leader shall be a Master’s level clinician with a minimum of one (1) year of post-graduate experience working with behaviorally challenged youth and their families in community-based settings.
3422.40The CBI Level I team clinicians shall be either Master’s level clinicians or Bachelor’s level clinicians with a minimum of one (1) year of experience working with behaviorally challenged youth and their families in community-based settings.
3422.41Each CBI Level II team shall include:
(a) A full-time clinical supervisor; and
(b)Four (4) to six (6) clinicians.
3422.42The CBI Level II team clinical supervisor shall be a Master’s level qualified practitioner experienced in providing individual, group, marital or family counseling or psychotherapy in accordance with applicable District laws and regulations, with a minimum of two (2) years of post-graduate experience working with behaviorally challenged youth and their families in community-based settings.
3422.43The CBI Level II team clinicians shall be either Master’s level clinicians or Bachelor’s level clinicians with a minimum of one (1) year of experience working with behaviorally challenged youth and their families in community-based settings.
3422.44Each CBI Level III team shall include:
(a) A full-time clinical supervisor; and
(b) Four (4) to six (6) clinicians.
3422.45The CBI Level III team clinical supervisor shall be a Master’s level qualified practitioner experienced in providing individual, group, marital or family counseling or psychotherapy in accordance with applicable District laws and regulations, with a minimum of two (2) years post-graduate experience working with behaviorally challenged youth and their families in community-based settings.
3422. 46The CBI Level III team clinicians shall be either Master’s level qualified practitioners or Bachelor’s level clinicians with a minimum of two (2) years of experience working with behaviorally challenged youth and their families in community-based settings.
3422.47Each CBI Level IV team shall include:
(a)A full-time clinical supervisor who has satisfied the FFT requirements for a clinical supervisor; and
(b)Three (3) to eight (8) full-time equivalent clinicians who have satisfied the FFT requirements for a therapist.
3422.48The CBI Level IV team clinical supervisor shall be a Master’s level qualified practitioner experienced in providing individual, group, marital or family counseling or psychotherapy in accordance with applicable District laws and regulations, with a minimum of two (2) years of post-graduate experience working with behaviorally challenged youth and their families in community-based settings who has satisfied the FFT requirements for a clinical supervisor.
3422.49The CBI Level IV clinicians shall be either Master’s level clinicians or Bachelor’s level clinicians with a minimum of one (1) year of experience working with behaviorally challenged youth and their families in community-based settings, and shall have satisfied the FFT requirements for FFT therapists.
3422.50Providers of all levels of CBI services shall ensure the availability and provision of alcohol and other drug addiction treatment services as well as services to facilitate consumers’ transition from adolescence to adulthood, as medically necessary for consumers.
3422.51Prior authorization from DMH is required for enrollment in all levels of CBI services.
3422.52CBI shall not be billed on the same day as Rehabilitation/Day Services, Intensive Day Treatment or ACT.
3422.53CBI shall not be billed on the same day as Counseling.
3422.54CBI shall not be billed on the same day as Community Support unless the Community Support services are provided within thirty (30) days prior to the consumer’s discharge from CBI.
3422.55CBI shall be provided in:
(a) MHRS provider service sites; or
(b) Natural settings, including the consumer’s home or other community setting.
3422.56Qualified practitioners of CBI are:
(a)Psychiatrists;
(b)Psychologists;
(c)Licensed Independent Clinical Social Workers (LICSWs);
(d)Advance Practice Registered Nurses (APRNs);
(e)Registered Nurses (RNs);
(f)Licensed Professional Counselors (LPCs);
(g)Licensed Independent Social Workers (LISWs); and
(h)Addiction counselors.
3422.57All credentialed staff, including recovery specialists, shall be authorized to provide CBI under the supervision of a qualified practitioner as set forth in § 3413.3.
3422.58CBI services shall not exceed thirty-two (32) units in a twenty-four (24) hour period, without prior authorization from DMH. DMH may conduct clinical record reviews to verify the medical necessity of services provided.