Section 29-4902. PROGRAM SERVICES

 

4902.1Rehab services shall include the following services:

 

(a)Evaluation, assessment and Plan of Care development;

 

(b)Individual and group psychotherapy and counseling;

 

(c)Medical evaluations, including developmental, psychological, speech/language, occupational therapy and physical therapy assessments;

 

(d)Crisis intervention;

 

(e)Health service coordination through activities to assist and enable the client to receive services authorized in the Plan of Care;

 

(f)Medication management to assist the client or the client's caregiver in understanding and adhering to a prescribed pharmacological routine;

 

(g)Behavior management to assist the client who has a behavior problem in understanding the consequences of inappropriate behavior and to teach and reinforce appropriate behavior; and

 

(h)Plan of Care reassessment and revision.

 

4902.2Each evaluation and assessment provided pursuant to § 4902.1(a) shall meet the following requirements:

 

(a)Be based on an informed clinical opinion; and

 

(b)Include an evaluation of the client's cognitive, social, emotional and adaptive development.

 

4902.3Healthcare professionals qualified to perform the evaluation and assessment and participate in the development and reassessment of the Plan of Care are as follows:

 

(a)Psychiatrist;

 

(b)Psychologist;

 

(c)Licensed Professional Counselor;

 

(d)Licenced Independent Clinical Social Worker (LICSW);

 

(e)Advanced Practiced Registered Nurse; or

 

(f)Licensed Graduate Social Worker under the supervision of a psychiatrist, psychologist or LICSW.

 

4902.4The Plan of Care shall be developed by a multi-disciplinary team in consultation with the client and his or her caregiver. Each Plan of Care shall be signed and dated by a psychiatrist and contain the following information:

 

(a)A written plan that contains and is based on the information derived from the evaluation and assessment;

 

(b)A statement of the client's present level of functioning in the domains examined in the evaluation and assessment;

 

(c)Treatment objectives in measurable terms, including discharge planning, long and short term goals with appropriate timelines;

 

(d)A statement of the client's specific complaints, including the limitations and abilities, specific problems and specific needs of the patients;

 

(e)A statement of the specific services and supports necessary to meet the unique needs of the client and the setting in which the services are to be delivered; and

 

(f)Names and titles of persons responsible for implementing the Plan of Care.

 

4902.5Individual psychotherapy and counseling shall meet following requirements:

 

(a)Be provided in a face-to-face clinical intervention with an appropriate health care professional acting within the scope of their practice;

 

(b)Be provided in accordance with the Plan of Care;

 

(c)Be provided at a ratio of one therapist to one client; and

 

(d)Be provided at a minimum of 30 minutes per session.

 

4902.6Group psychotherapy and counseling shall meet the following requirements:

 

(a)Be provided in a face-to-face clinical intervention with an appropriate health care professional acting within the scope of their practice;

 

(b)Be provided in accordance with the Plan of Care;

 

(c)Be provided at a ratio of one therapist to no more than 12 clients; and

 

(d)Be provided at a minimum of 30 minutes per session.

 

4902.7Healthcare professionals qualified to perform individual and group counseling are as follows:

 

(a)Psychiatrist;

 

(b)Psychologist;

 

(c)Licensed Professional Counselor;

 

(d)Licensed Independent Clinical Social Worker;

 

(e)Licensed Graduate Social Worker under the supervision of a psychiatrist, psychologist or LICSW; or

 

(f)Advanced Practice Registered Nurse who is certified by the American Nurses Association to practice psychotherapy.

 

4902.8Healthcare professionals qualified to perform psychotherapy are as follows:

 

(a)Psychiatrist;

 

(b)Psychologist;

 

(c)Licensed Independent Clinical Social Worker;

 

(d)Licensed Graduate Social Worker under the supervision of a psychiatrist, psychologist or LICSW; or

 

(e)Advanced Practice Registered Nurse who is certified by the American Nurses Association to practice psychotherapy.

 

4902.9Each medical evaluation shall be provided by a licensed health care professional acting within the scope of his or her practice, who has a contract with CFSA to provide medical evaluation services. Each medical evaluation shall meet the following requirements:

 

(a)Be provided in a face-to-face clinical intervention; and

 

(b)Ensure that the client is assessed in all areas relating to a suspected disability including, when appropriate, health, vision, hearing, dental, social and emotional status, general intelligence, communicative status and motor abilities.

 

4902.10Each medical evaluation shall be used in developing or modifying the Plan of Care.

 

4902.11Reimbursement for a medical evaluation provided in a residential setting shall be allowed only when provided by a licensed health care professional who is not an employee of the residential facility and when necessary to supplement the capabilities of the facility's staff.

 

4902.12Crisis intervention shall be provided as clinically appropriate by a psychiatrist, psychologist, licensed professional counselor or licensed independent clinical social worker or licensed graduate social worker under the supervision of a psychiatrist, psychologist or LICSW for the purpose of:

 

(a)Reducing the client's acute psychiatric and emotional symptoms;

 

(b)Reducing the likelihood of the client harming himself or others; and

 

(c)Assisting the client in returning to his or her pre-crisis level of functioning.

 

4902.13Crisis intervention shall be provided at a ratio of one therapist to one client.

 

4902.14Health service coordination shall include the following activities:

 

(a)Coordinating the performance of evaluations and assessments;

 

(b)Facilitating and participating in the development, review and evaluation of the Plan of Care;

 

(c)Assisting and identifying available service providers; and

 

(d)Coordinating the provision of services with health care pracritioners.

 

4902.15Health service coordination shall be provided by a licensed independent clinical social worker or registered nurse.

 

4902.16Medication management shall be reimbursed only when provided by a lphysician or registered nurse who is authorized by the Provider to administer the Plan of Care. Medication management shall include the following:

 

(a)Educating the client/caregiver regarding the benefits and side effects of the medication;

 

(b)Instructing and assisting the client/caregiver in the self-administration of the medication;

 

(c)Reviewing with the client/caregiver the symptomatology of the illness; and

 

(d)Observing the client's vital signs and level of performance to ensure that adverse side effects are minimized.

 

4902.17Behavior management shall be reimbursed only when provided by a psychiatrist, psychologist, licensed professional counselor, advanced practice registered nurse, licensed independent clinical social worker or licensed graduate social worker under the supervision of a psychiatrist, psychologist or LICSW who is authorized by the Provider to administer the Plan of Care. Behavior management shall include the following:

 

(a)Individual and group therapeutic interventions to improve or maintain the client's skills needed to interact safely and securely with other persons;

 

(b)Symptom management to minimize the negative side effects of psychiatric or emotional symptoms which interfere with the client's personal development and community integration; and

 

(c)Supportive counseling with the client to develop, restore, manage and maintain the client's mental or emotional growth.

 

4902.18The Plan of Care reassessment and revision shall include:

 

(a)A thorough review of the initial Plan of Care and any subsequent revisions;

 

(b)A review of any current evaluations or information pertaining to the client's condition;

 

(c)A review of services authorized and delivered in the current Plan of Care;

 

(d)A determination of progress made or deficiencies arising from the current Plan of Care; and

 

(e)A re-authorization of current services that are determined to be beneficial, a discontinuation of services appearing to provide little or no benefit, and authorization of any additional services needed to meet the client's physical, mental or emotional needs.

 

4902.19Each Plan of Care shall be reassessed and revised, at least once every six months by the multi-disciplinary team. The health care professions responsible for the client's case shall conduct an on-going review of the Plan of Care.

 

source

Emergency Rulemaking published at 48 DCR 8872 (September 21, 2001) [EXPIRED]; as amended by Final Rulemaking published at 49 DCR 247 (January 11, 2002).