 |
D.C. Municipal Regulations (Last Updated: September 13, 2017) |
 |
Title 22. HEALTH |
|
SubTilte 22-A. MENTAL HEALTH |
|
Chapter 22-A34. MENTAL HEALTH REHABILITATION SERVICES PROVIDER CERTIFICATION STANDARDS |
Section 22-A3499. DEFINITIONS
-
3499.1The following terms have the meaning ascribed in this section:
Addiction counselor - a person who provides addiction counseling services to persons with co-occurring psychiatric and addictive disorders and is licensed or certified in accordance with applicable District laws and regulations. An addiction counselor is a qualified practitioner.
Advance Practice Registered Nurse or APRN - a person licensed as an advance practice registered nurse in accordance with applicable District laws and regulations, with psychiatry as an area of practice and working in a collaborative protocol with a psychiatrist. An Advance Practice Registered Nurse is an approving qualified practitioner.
Affiliation agreement - an agreement in the form approved by DMH by and between a CSA and a specialty provider or sub-provider that describes how they will work together to benefit consumers.
Approving practitioner - the qualified practitioner responsible for overseeing the development of and approval of the Individual Recovery Plan or Individual Plan of Care ("IRP/IPC"). The approving practitioner serves on the Diagnostic/Assessment team and may also serve as the clinical manager.
Approving qualified practitioner or AQP - the qualified practitioner responsible for overseeing the development and approval of the Individual Recovery Plan or Individual Plan of Care (IRP/IPC). The approving qualified practitioner serves on the Diagnostic/Assessment team and may also serve as the clinical manager. Only a psychiatrist, psychologist, LICSW, APRN or LPC may act as an AQP.
Assertive Community Treatment or ACT - intensive, integrated rehabilitative, crisis, treatment, and mental health rehabilitative community support provided by an interdisciplinary team to children and youth with serious emotional disturbance and to adults with serious and persistent mental illness by an interdisciplinary team. ACT is provided with dedicated staff time and specific staff to consumer ratios. Service coverage by the ACT team is required twenty-four (24) hours per day, seven (7) days per week. ACT is a specialty service.
Assertive Community Treatment team or ACT team - the mobile inter-disciplinary team of qualified practitioners and other staff involved in providing ACT to a consumer.
Authorized - MHRS services that are prior authorized or reauthorized by DMH, in accordance with these standards.
Behavioral concern - A behavioral and emotional disorder of childhood and adolescence that manifests by children acting out aggressively, expressing anger inappropriately, and engaging in a variety of antisocial and destructive acts, including violence towards people and animals, destruction of property, lying, stealing, truancy, and running away from home.
CBI team - The interdisciplinary team of qualified practitioners and other staff involved in providing CBI to a consumer.
CCP-FV Fidelity Audit - a process by which the implementation of CPP-FV, in accordance with the established standards and guiding principles, will be evaluated annually.
Certification - the written authorization from DMH rendering an entity eligible to provide MHRS. DMH grants certification to community-based organizations that submit an approved certification application and satisfy the certification standards.
Certification application - the application and supporting materials prepared and submitted to DMH by a community-based organization requesting certification to provide MHRS.
Certification standards - the minimum requirements established by DMH in this chapter that an MHRS provider shall satisfy to obtain and maintain certification to provide MHRS and receive reimbursement from DMH for MHRS.
Child and Family Services Agency or CFSA - The District agency responsible for the coordination of foster care, adoption and child welfare services and services to protect children against abuse or neglect.
Child-Parent Psychotherapy for Family Violence or “CPP-FV” - a psychotherapy treatment intervention for young children from birth through age six (6) who have experienced a traumatic life event and, as a result, are experiencing behavior, attachment, and/or mental health problems.
Clinical manager - the qualified practitioner chosen by the consumer to coordinate service delivery. The clinical manager shall participate in the development and review of the consumer's IRP/IPC, along with the approving practitioner. The clinical manager may also serve as the approving practitioner. The clinical manager shall be employed by the CSA, except that a psychiatrist serving as a clinical manager may be under contract to the CSA.
Clinical supervisor - The qualified practitioner responsible for monitoring consumer welfare, ensuring compliance with professional standards of service delivery, monitoring clinical performance and professional development of team members, and evaluating team members for performance, service delivery and credentialing purposes.
Clinician - An individual with either a Bachelor's or Master's degree in social work, counseling, psychology, family therapy or related social science or appropriate therapeutic experience with the target population. Clinicians are credentialed staff.
CMS - Centers for Medicare and Medicaid services, formerly known as the Health Care Financing Agency.
Community-Based Intervention or CBI - Time-limited, intensive mental health services delivered to children and youth ages six (6) through twenty-one (21) and intended to prevent the utilization of an out-of-home therapeutic resource or a detention of the consumer. CBI is primarily focused on the development of consumer skills to promote behavior change in the child or youth's natural environment and empower the child or youth to cope with his or her emotional disturbance.
Community Support - rehabilitation and environmental support considered essential to assist a consumer in achieving rehabilitation and recovery goals. Community Support services focus on building and maintaining a therapeutic relationship with the consumer. Community Support is a core service.
Consumer - a person eligible to receive MHRS as defined in the District of Columbia Department of Mental Health Establishment Congressional Review Emergency Amendment Act of 2001, effective July 23, 2001 (D.C. Act 14-101).
Core services - includes the following four categories of MHRS: Diagnostic/Assessment, Medication/Somatic Treatment, Counseling and Psychotherapy, and Community Support.
Core Services Agency or CSA - a DMH-certified community-based MHRS provider that has entered into a Human Care Agreement with DMH to provide specified MHRS. A CSA shall provide at least one core service directly and may provide up to three core services via contract with a sub-provider or subcontractor. A CSA may provide specialty services directly if certified by DMH as a specialty provider. However, a CSA shall also offer specialty services via an affiliation agreement with all specialty providers.
Corporate Compliance Plan - a written plan developed by each MHRS provider to ensure that the MHRS provider operates in compliance with all applicable federal and District laws and regulations.
Corrective Action Plan or CAP - a written plan prepared by either an applicant for certification or a DMH-certified MHRS provider describing the actions that the provider intends to take to correct or abate the violations described in a CMP issued by DMH.
Corrective Measures Plan or CMP - a written statement of non-compliance issued by DMH, which describes the areas in which an applicant for certification or a DMH-certified MHRS provider fails to comply with the certification standards.
Counseling - individual, group, or family face-to-face services for symptom and behavior management, development, restoration, or enhancement of adaptive behaviors and skills, and enhancement or maintenance of daily living skills. Mental health supports and consultation services provided to consumer's families are reimbursable only when such services and supports are directed exclusively to the well-being and benefit of the consumer. Counseling is a core service.
CPP-FV Fidelity Standards - the six established interconnected standards of fidelity, as set forth by the developers of CCP-FV, which guides treatment delivery.
Credentialed staff - unlicensed staff or staff who are not qualified practitioners that are credentialed by the MHRS provider to perform certain MHRS or components of MHRS under the clinical supervision of a qualified practitioner.
Crisis/Emergency - face-to-face or telephone immediate response to an emergency situation involving a consumer with mental illness or emotional disturbance that is available twenty-four (24) hours per day, seven (7) days per week. Crisis/Emergency services are provided to consumers involved in active mental health crisis and consist of immediate response to evaluate and screen the presenting mental health situation, assist in immediate crisis stabilization and resolution and ensure the consumer's access to mental health care at the appropriate level. Crisis/Emergency is a specialty service.
Crisis support services - mental health services that support the consumer through a crisis, such as meeting with the consumer in the community or an emergency department to help calm the consumer; implementing the crisis plan developed for the consumer; assisting the consumer to reach an emergency department; and providing pertinent mental health information about a consumer to an emergency department to assist in addressing a crisis.
Cultural competence - means the ability of an MHRS provider to deliver mental health services and mental health supports in a manner that effectively responds to the languages, values, and practices present in the various cultures of the MHRS provider's consumers.
DHCF - the Department of Health Care Finance, an agency which reports directly to the Mayor and which replaced MAA.
Department of Youth Rehabilitative Services or DYRS - The District agency responsible for providing security, supervision and residential and community support services for committed and detained juvenile offenders and juvenile persons in need of supervision.
Diagnostic/Assessment - intensive clinical and functional evaluation of a consumer's mental health condition that results in the issuance of a Diagnostic/Assessment report with recommendations for service delivery and may provide the basis for the development of the IRP/IPC. A Diagnostic/Assessment shall determine whether the consumer is appropriate for and can benefit from MHRS, based upon the consumer's diagnosis, presenting problems and recovery goals. Diagnostic/Assessment is a core service.
Diagnostic/Assessment report - the report prepared by the Diagnostic/ Assessment team that summarizes the results of the Diagnostic/Assessment service and includes recommendations for service delivery. The Diagnostic/Assessment report is used to initiate the IRP/IPC and, if necessary, the ISSP.
Diagnostic/Assessment team - at least two (2) qualified practitioners working together to complete the Diagnostic/Assessment and issue the Diagnostic/Assessment report.
Director - the director of DMH.
Disaster Recovery Plan - the policies and procedures developed by each MHRS provider to ensure that computerized data is properly maintained and can be retrieved in the event of a disaster.
District of Columbia or District - the government of the District of Columbia.
District of Columbia State Medicaid Plan - the plan approved by CMS that is developed and administered by MAA, pursuant to Section 1(b) of An Act to enable the District of Columbia to receive Federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purposes and Title XIX of the Social Security Act as added July 30, 1965 (79 Stat. 343; 42 U.S.C. §1396a et seq.), as amended. The program operated in accordance with the District of Columbia State Medicaid Plan is referred to as the "Medicaid" or "Medical Assistance" program.
DMH - the Department of Mental Health, the successor in interest to the District of Columbia Commission on Mental Health Services.
DMH Consumer Enrollment and Referral System - the system developed and administered by DMH to enroll eligible consumers into the MHRS system.
DSM IV - the most recent version of the Diagnostic and Statistical Manual of Mental Disorders.
Economic Security Administration or ESA – the unit within the District of Columbia Department of Human Services that determines eligibility for medical assistance programs for District residents.
Emergency - a situation in which a consumer is experiencing a mental health crisis and the immediate provision of mental health treatment is, in the written judgment of the consumer's attending physician, necessary to prevent serious injury to the consumer or others.
Foster home - a residence in which a foster parent is licensed by the District to provide care to a foster child in accordance with the requirements of Title 29, DCMR Chapter 60.
Functional Family Therapy or FFT – research-based prevention and intervention program for at-risk adolescents and their families provided by a team of trained therapists by a certified CBI Level IV provider with FFT site certification.
Governing authority - the designated individuals or governing body legally responsible for conducting the affairs of the MHRS provider.
Grievance - a description by any individual of his or her dissatisfaction with an MHRS provider, including the denial or abuse of any consumer right or protection provided by applicable federal and District laws and regulations.
Human Care Agreement - the written agreement entered into by the DMH-certified MHRS provider and DMH which describes how the parties will work together.
ICD-9CM - the most recent version of the International Classification of Diseases Code Manual.
Independent Living Program - A residential program licensed by the District in accordance with Title 29 DCMR Chapter 63, Licensing of Independent Living Programs for Adolescents and Young Adults.
Individualized Plan of Care or IPC - the individualized plan of care for children and youth, which is the result of the Diagnostic/Assessment. The IPC is maintained by the consumer’s CSA. The IPC includes the consumer’s treatment goals, strengths, challenges, objectives, and interventions. The IPC is based on the consumer’s identified needs as reflected by the Diagnostic/Assessment, the consumer’s expressed needs, and referral information. The IPC shall include a statement of the specific, individualized objectives of each intervention, a description of the interventions, and specify the frequency, duration, and scope of each intervention activity. The IPC is the authorization of treatment, based on certification that the MHRS are medically necessary by the approving practitioner.
Individualized Recovery Plan or IRP - an individualized recovery plan for adult consumers, which is the result of the Diagnostic/Assessment. The IRP is maintained by the consumer’s CSA. The IRP includes the consumer’s treatment goals, strengths, challenges, objectives, and interventions. The IRP is based on the consumer’s identified needs as reflected by the Diagnostic/Assessment, the consumer’s expressed needs, and referral information. The IRP shall include a statement of the specific, individualized objectives of each intervention, a description of the interventions, and specify the frequency, duration, and scope of each intervention activity. The IRP is the authorization of treatment, based upon certification that MHRS are medically necessary by an approving practitioner.
Inpatient mental health service - residence and treatment provided in a psychiatric hospital or unit licensed or operated by the District of Columbia.
Intensive Day Treatment - a structured, intensive, and coordinated acute treatment program that serves as an alternative to acute inpatient treatment or as a step-down service from inpatient care, rendered by an inter-disciplinary team to provide stabilization of psychiatric impairments. Its duration is time-limited. Intensive Day Treatment is provided in an ambulatory setting. Intensive Day Treatment is a specialty service.
Intensive Home and Community-Based Services or IHCBS - an intensive model of treatment adapted by DMH to prevent the utilization of out-of-home treatment resources by emotionally disturbed children and youth.
Licensed independent clinical social worker or LICSW - a person licensed as an independent clinical social worker in accordance with applicable District laws and regulations. An LICSW is an approving qualified practitioner.
Licensed independent social worker or LISW - a person licensed as a licensed independent social worker in accordance with applicable District laws and regulations. An LISW is a qualified practitioner.
Licensed professional counselor or LPC - a professional counselor licensed in accordance with applicable District laws and regulations. An LPC is an approving qualified practitioner.
Long-term placement option - either a permanent caregiver or permanent home. A group home or other residential placement is not a long-term placement option.
MAA - the Department of Health, Medical Assistance Administration, replaced by DHCF.
MAA/DMH Interagency Agreement - a written agreement entered into by MAA and DMH which describes how MAA and DMH will handle the operation and administration of the MHRS program.
Medicaid or Medical Assistance - the program described in the District of Columbia State Medicaid Plan, approved by CMS, and administered by MAA pursuant to Section 1(b) of An Act to enable the District of Columbia to receive Federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purposes and Title XIX of the Social Security Act, as amended July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396a et seq.).
Medical necessity or medically necessary - those services contained in an approved IRP/IPC reasonably calculated to prevent the worsening of, alleviate, correct, cure, or ameliorate an identified mental health condition that endangers life, causes suffering or pain, causes physical deformity or bodily malfunction, threatens to cause or aggravate a disability, or results in an illness or infirmity. For children through age twenty (20), services reasonably calculated to promote the development or maintenance of age-appropriate functioning are also considered medically necessary.
Medication/Somatic Treatment - medical interventions, including physical examinations, prescription, supervision or administration of mental-health related medications, monitoring and interpreting the results of laboratory diagnostic procedures related to mental health-related medications, and medical interventions needed for effective mental health treatment provided as either an individual or group intervention. Medication/Somatic Treatment is a core service.
Mental Health Rehabilitation Services or MHRS - mental health rehabilitative or palliative services provided by a DMH-certified community mental health provider to consumers in accordance with the District of Columbia State Medicaid Plan, the MAA/DMH Interagency Agreement, and this chapter.
Mental illness - a substantial disorder of thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life.
MHRS provider - an organization certified by DMH to provide MHRS. MHRS provider includes CSAs, sub-providers, and specialty providers.
Mobile Crisis Response Team – a team of mental health clinicians who provide face-to-face and telephone support to children and families in crisis.
Multisystemic therapy or MST - an intensive model of treatment based on empirical data and evidence-based interventions that target specific behaviors with individualized behavioral interventions.
Natural settings - the consumer's residence, workplace, or other locations in the community the consumer frequents, such as the consumer's home, school, workplace, community centers, homeless shelters, street locations, or other public facilities. Natural settings do not include inpatient hospitals or community residential facilities.
Neglect - any act or omission by an MHRS provider which causes or is likely to cause or contribute to, or which caused or is likely to have caused or contributed to, injury or death of a consumer.
Out of home therapeutic resource - a psychiatric hospital or psychiatric residential treatment facility.
Permanent caregiver - a natural or adoptive family or foster home that has cared for the consumer for at least six (6) consecutive months within the twelve (12) month period immediately preceding the referral for CBI. A group home or other residential placement is not a permanent caregiver.
Permanent home - a natural or adoptive family or foster home where the consumer has lived for at least six (6) consecutive months within the twelve month (12) month period immediately preceding the referral to CBI with a permanent caregiver. A group home or other residential placement is not a permanent home.
Policy - a written statement developed by an MHRS provider that gives specific direction regarding how the MHRS provider shall operate administratively and programmatically.
Prior authorization - approval by DMH in advance for the initiation of MHRS to a consumer, including the commencement of services such as Diagnostic/Assessment or Crisis Emergency services before a consumer is enrolled in the MHRS program.
Procedure - a written set of instructions describing the step-by-step actions to be taken by MHRS provider staff in implementing a policy of the MHRS provider.
Psychiatric residential treatment facility - shall have the meaning ascribed in 42 CFR Subpart G, Section 483.352.
Psychiatrist - a physician licensed in accordance with applicable District laws and regulations who has completed a residency program in psychiatry accredited by the Residency Review Committee for Psychiatry of the Accreditation Council for Graduate Medical Education and is eligible to sit for the psychiatric board examination. A Psychiatrist is an approving qualified practitioner.
Psychologist - a person licensed to practice psychology in accordance with applicable District laws and regulations. A Psychologist is an approving qualified practitioner.
Qualified practitioner - (i) a psychiatrist; (ii) a psychologist; (iii) an independent clinical social worker; (iv) an advance practice registered nurse; (v) a registered nurse; (vi) a licensed professional counselor; (vii) an independent social worker; and (viii) an addiction counselor.
Reauthorized - having received approval by DMH for the continued provision of medically necessary MHRS that are time-limited, such as Rehabilitation/Day Services, Intensive Day Treatment, CBI or ACT.
Referral - a recommendation to seek or request services or evaluation between a CSA and a sub-provider or specialty provider in order to assess or meet the needs of consumers.
Registered nurse or RN - a person licensed as a registered nurse in accordance with applicable District laws and regulations. An RN is a qualified practitioner.
Rehabilitation/Day Services - a structured, clinical program intended to develop skills and foster social role integration through a range of social, psycho-educational, behavioral, and cognitive mental health interventions. Rehabilitation/Day Services are curriculum-driven and psycho-educational and assist the consumer in the retention, or restoration of community living, socialization, and adaptive skills. Rehabilitation Day Services include cognitive- behavioral interventions and diagnostic, psychiatric, rehabilitative, psychosocial, counseling, and adjunctive treatment. Rehabilitation/Day Services are offered most often in group settings. Rehabilitation/Day Services is a specialty service.
Residential placement - a psychiatric residential treatment center, group home, independent living program or other residence where children or youth are temporarily receiving services. A permanent home is not a residential placement.
Service specific standards - the certification standards described in § 3414, § 3415, § 3416, § 3417, § 3418, § 3419, § 3420, § 3421, § 3422 and § 3423, which set forth the specific requirements applicable to each MHRS.
Specialty provider - a community-based organization MHRS provider certified by DMH to provide specialty services either directly or through contract. Each specialty provider shall enter into an affiliation agreement with each DMH-certified CSA.
Specialty provider - a community-based organization MHRS provider certified by DMH to provide specialty services either directly or through contract. Each specialty provider shall enter into an affiliation agreement with each DMH-certified CSA.
Specialty services - ACT, CBI, Crisis Intervention/Emergency, Intensive Day Treatment, and Rehabilitation.
Subcontractor - a licensed independent practitioner qualified to provide mental health services in the District. A subcontractor may provide one or more core service(s) under contract with a CSA. A subcontractor may also provide specialty service(s) under contract with a specialty provider.
Subcontractor - a licensed independent practitioner qualified to provide mental health services in the District. A subcontractor may provide one or more core service(s) under contract with a CSA. A subcontractor may also provide specialty service(s) under contract with a specialty provider.
Subcontractor Agreement - an agreement by and between an MHRS provider and a subcontractor that describes how they will work together to benefit consumers in the form approved by DMH.
Subprovider - a community-based organization certified by DMH to provide one or more core service(s) through an affiliation agreement with a CSA.
TF-CBT Practice Session Checklist - an instrument used to track whether supervisors and therapists are implementing TF-CBT in accordance with the established model.
Trauma-Focused Cognitive Behavioral Therapy or “TF-CBT” - a psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents.
Triaging - prioritizing the level of crisis services required by a consumer, based upon the assessed needs of the consumer.