967301 These amendments to Chapter 34 eliminate the requirement for an individualized service support plan (ISSP) and extend the time that a individualized recovery plan (IRP) and individualized plan of care (IPC) is effective from 90 days to 180 ...

DEPARTMENT OF MENTAL HEALTH

 

NOTICE OF FINAL RULEMAKING

 

The Director of the Department of Mental Health (Department), pursuant to the authority set forth in 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), hereby gives notice of the adoption of amendments to chapter 34 (Mental Health Rehabilitation Services Provider Certification Standards) of subtitle A, (Mental Health) of title 22 (Health) of the District of Columbia Municipal Regulations (DCMR).

 

The purpose of these amendments is to make changes to the treatment planning process by extending the minimum amount of time that may elapse between treatment plan updates from ninety (90) to one hundred eighty (180) days, eliminating the requirement for community support and specialty providers to develop an individualized service support plan (ISSP), and eliminating the requirement for policies relating to the development of an ISSP.  These changes are critical to the Department’s urgent cost saving measures which will eliminate a redundant, time-consuming administrative burden on the Department’s providers and help alleviate the impact of planned rate reductions.    

 

The emergency rulemaking was adopted and became effective on February 3, 2011. The emergency and proposed rules were published on February 18, 2011, in the D.C. Register at 58 DCR 1482.    One comment was received and considered but no changes were made to the text of the emergency and proposed rule.  These final rules will be effective upon publication of this notice in the D.C. Register.

 

 

Chapter 34, MENTAL HEALTH REHABILITATION SERVICES PROVIDER CERTIFICATION STANDARDS, of subtitle A, MENTAL HEALTH, of title 22 of the DCMR is amended as follows:

 

Subsection 3407.2 is amended to read as follows:

 

3407.2             The treatment planning process for consumers shall, at a minimum, include:

(a)        The completion of a Diagnostic/Assessment service and required components as described in section 3415;

(b)        Development of an IRP/IPC as described in section 3408; and

(c)        Consideration of the consumer’s beliefs, values, and cultural norms in how, what, and by whom MHRS are to be provided.

Subsection 3408.1 is amended to read as follows:

 

3408.1             The IRP/IPC shall serve as authorization for the provision of MHRS. Certain services require pre-authorization or authorization by DMH, prior to commencement of the treatment planning process. All services, including those that require pre-authorization or authorization by DMH shall be addressed in the IRP/IPC.

 

Subsection 3408.3 is amended to read as follows:

 

3408.3             Each CSA shall develop and maintain a complete and current IRP/IPC for each enrolled consumer.  The CSA is responsible for coordinating the development of the IRP/IPC with any sub-provider or specialty provider involved in the provision of services.

 

Subsection 3408.14 is amended to read as follows:

3408.14           The IRP/IPC Review Policy shall require that the IRP/IPC be reviewed and updated every one hundred eighty (180) days and at any time there is a significant change in the consumer’s condition or situation to reflect progress toward or the lack of progress toward the Treatment Goals. The IRP/IPC may be reviewed more frequently, as necessary, based on the consumer’s progress or circumstances.

 

Section 3409 is deleted in its entirety and replaced by the following:

 

3409                IRP/IPC GUIDING PRINCIPLES AND ADDITIONAL REQUIREMENTS

 

3409.1             Each IRP/IPC shall:

 

(a)                Be person-centered;

 

(b)               Include the consumer’s self-identified recovery goals; and

 

(c)                Provide for the delivery of services in the most normative, least restrictive environment that is appropriate for the consumer.

 

Subsection 3410.12 is amended to read as follows:

 

3410.12           Each MHRS provider shall establish and adhere to policies and procedures governing the coordination of the treatment planning process (Treatment Planning Policy), including procedures for designing, implementing, reviewing, and revising each consumer’s IRP/IPC that comply with the requirements of sections  3407, 3408, and 3409.

 

Subsection 3410.16(c)(8) is amended to read as follows:

 

(8)        The IRP/IPC;

 

Subsection 3410.17 is amended to read as follows:

 

3410.17           Progress notes shall:

 

(a)        Be written at least once per month and more frequently as needed;

 

(b)        Reflect IRP/IPC implementation, including documentation of the choices and perceptions of the consumer regarding the service(s) provided; and

 

(c)        Be signed and dated by the credentialed staff or qualified practitioner making the entry. A qualified practitioner shall countersign progress notes made by credentialed staff.

 

Subsection 3411.11 is amended to read as follows:

 

3411.11           Each 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.

 

Subsection 3412.7 is amended to read as follows:

 

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.

 

Subsection 3416.5 is amended to read as follows:

 

3416.5             Consumers receiving Medication/Somatic Treatment shall participate in a psychoeducational session to discuss medication side effects, adverse reactions to medications, and medication self-monitoring and management at the following times:

 

(a)                During development of the IRP/IPC;

 

(b)               In conjunction with the one hundred eighty day (180) day IRP/IPC review; and

 

(c)        At any time the consumer’s medications are changed.

 

 

Subsection 3418.2(a) is amended to read as follows:

 

 (a)       Participation in the development and implementation of a consumer’s IRP/IPC;

 

 

Subsection 3418.6 is amended to read as follows:

 

3418.6             Each Community Support provider shall have policies and procedures included in its Service Specific Policies addressing the provision of Community Support (Community Support Organizational Plan) which addresses the following:

 

(a)        Description of the particular rehabilitation, recovery, and case management models utilized, types of intervention practiced, and typical daily curriculum and schedule;

 

(b)        Description of the staffing pattern and how staff are deployed to ensure that the required staff-to-consumer ratios are maintained, including how unplanned staff absences and illnesses are accommodated; and

 

(c)                The use of level of functioning assessments to determine the number of consumers each staff can serve based on DMH guidelines.

 

 

Subsection 3420.5 is amended to read as follows:

 

3420.5             Each Rehabilitation/Day Services provider shall have policies and procedures included in its Service Specific Policies addressing the provision of Rehabilitation/Day Services (Rehabilitation/Day Services Organizational Plan) which includes:

 

(a)        A description of the particular rehabilitation models utilized, types of intervention practiced, and typical daily curriculum and schedule; and

 

(b)        A description of the staffing pattern and how staff are deployed to ensure that the required staff-to-consumer ratios are maintained, including how unplanned staff absences and illnesses are accommodated.

 

 

Subsection 3421.8 is amended to read as follows:

 

3421.8             An interdisciplinary treatment team shall meet within one (1) working day of the consumer’s admission to develop an initial Intensive Day Treatment IRP.

 

Subsection 3421.9 is amended to read as follows:

 

3421.9             Each Intensive Day Treatment IRP shall be updated every three (3) days and shall be reviewed by the interdisciplinary treatment team on a weekly basis and upon termination of treatment.

 

Subsection 3421.11 is amended to read as follows:

 

3421.11           Each Intensive Day Treatment provider shall have policies and procedures included in its Service Specific Policies addressing the provision of Intensive Day Treatment (Intensive Day Treatment Organizational Plan) which includes the following:

 

(a)        A description of the particular treatment models utilized, types of intervention practiced, and typical daily curriculum and schedule;

 

(b)        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; and

 

(c)        A description of how the Intensive Day Treatment IRP is modified or adjusted to meet the needs specified in each consumer’s IRP/IPC.

 

 

Subsection 3422.30 is amended to read as follows:

 

3422.30           Discharge 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).

 

Subsection 3422.36(k) is amended to read as follows:

 

 (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.

 

Subsection 3423.3 is amended as follows:

 

3423.3             The consumer’s ACT team shall complete a comprehensive or supplemental assessment and develop a self care-oriented IRP (if a current and effective one does not already exist). 

 

Subsection 3423.8 is amended to read as follows:

 

3423.8             Each ACT provider shall have policies and procedures included in its Service Specific Policies that address the provisions of ACT (ACT Organizational Plan) which include the following:

(a)        A description of the particular treatment models utilized, types of intervention practice, and typical daily curriculum and schedule; and

(b)        A description of the staffing pattern and how staff are deployed to ensure that the required staff-to-consumer ratios are maintained, including how unplanned staff absences and illnesses are accommodated.

 

Subsection 3499.1 is amended as follows:

 

The existing definition for "Individualized Plan of Care" or "IPC" is deleted in its entirety and replaced with the following:

 

"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.

 

The existing definition for "Individualized Recovery Plan" or "IRP" is deleted in its entirety and replaced with the following:

 

"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.

 

The term “Individualized Service Specific Plan” or “ISSP” and its associated definition is deleted in their entirety.