1747860 Amendment to allow Licensed Professional Counselors to act as Approving Qualified Practitioners; to clarify the requirements for progress notes and service notes; and to require notification to the Department if a provider is excluded.
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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 (2008 Repl.)), hereby gives notice 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 provide a definition for an Approving Qualified Practitioner (AQP), and allow a Licensed Professional Counselor (LPC) to act as an AQP; to clarify the requirements for the monthly progress note and service notes; and to also require Mental Health Rehabilitation Services (MHRS) providers to check for excluded providers and to report to the Department if any of their employees or contractors is found to be excluded from billing for federal health care services.
The proposed rulemaking was published on August 19, 2011, in the D.C. Register at 58 DCR 7553. A minor edit was made to delete the obsolete acronym “ISSP” in subsection 3410.17(b), which has no effect on the meaning or impact of the rule. In addition, several punctuation edits, which do not have a substantive impact on the rulemaking, were made, including: (1) adding a slash (/) in between the terms “and” and “or” in subsection 3408.16; (2) adding a comma (,) after the acronym “LICSW” in subsection 3415.3(a); and (3) removing the quotation marks (“”) from around the acronym “IRP/IPC” in the definition for the term “Approving qualified practitioner” in subsection 3499.1. A comment was received from the American Counseling Association; the comment requested that the rule be amended to allow LPCs to diagnose mental illness, as the scope of practice for LPCs includes the ability to diagnose. However as the Department explained in its response to the American Counseling Association, the rule cannot be amended to allow LPCs to diagnose because the Medicaid State Plan Amendment, under which all MHRS is conducted, does not authorize LPCs to diagnose. Thus there has been no substantive change to the proposed rules as originally published on August 19, 2011.
The Department of Mental Health took final action on the rule on September 21, 2011. This amendment will become effective on the date of publication of this notice in the D.C. Register.
Chapter 34 of subtitle A of Title 22 of the DCMR is amended as follows:
Subsection 3402.3 is deleted in its entirety and amended to read as follows:
3402.3 MHRS are recommended by a physician or a licensed practitioner of the healing arts (approving qualified practitioners) and rendered by practitioners and clinicians (qualified practitioners) and credentialed staff under the supervision of qualified practitioners, in certified community mental health rehabilitation services agencies (MHRS providers) in accordance with the certification standards established in this chapter.
Subsection 3408.2 is deleted in its entirety and amended to read as follows:
3408.2 The IRP/IPC shall serve as certification that the MHRS are medically necessary as indicated by the approving qualified practitioner's signature on the initial and subsequent IRP/IPC. The approving qualified practitioner's approval of an IRP/IPC shall occur by the fourth visit or within thirty (30) calendar days after the consumer enrolls with the CSA, whichever occurs first.
Subsection 3408.10 is deleted in its entirety and amended to read as follows:
3408.10 The approving qualified practitioner and the clinical manager shall sign the IRP/IPC.
Subsection 3408.16 is deleted in its entirety and amended to read as follows:
3408.16 The consumer, the consumer's clinical manager, approving qualified practitioner and other qualified practitioners as necessary or appropriate shall establish new Objectives and modify, add/or delete Treatment Goals based on the results of the IRP/IPC review, the consumer's assessment of progress toward meeting Treatment Goals and any new needs, and any other assessments provided by significant others, family or other professionals.
Subsection 3408.17 is deleted in its entirety and amended to read as follows:
3408.17 At a minimum the approving qualified practitioner and the consumer shall participate in the IRP/IPC review.
Subsection 3408.18 is deleted in its entirety and amended to read as follows:
3408.18 At the IRP/IPC review, the approving qualified practitioner shall identify all required MHRS re-authorizations and establish a target date for requesting the re-authorizations well in advance of their expiration dates.
Subsection 3408.19 is deleted in its entirety and amended to read as follows:
3408.19 The approving qualified practitioner shall document the consumer's participation in the IRP/IPC review by obtaining the consumer's signature on the revised IRP/IPC. A court-appointed guardian for adults, children and youth and the parent or family member of children and youth consumers may be required to sign the revised IRP/IPC, if required by District laws and regulations.
Subsection 3410.4(c) is deleted in its entirety and amended to read as follows:
(c) Appropriate reference and background checks as required by federal and
District of Columbia law, including ensuring on an on-going basis that no individual is excluded from participation in a federal health care program as found on the Department of Health and Human Services List of Excluded Individuals/Entities (http://oig.hhs.gov/fraud/exclusion.asp) or the General Services Administration Excluded Parties List System (http://www.wpls.gov);
Subsection 3410.17 is deleted in its entirety and amended to read as follows:
3410.17 Progress notes shall:
(a) Be written at least once per month and as needed;
(b) Reflect IRP/IPC implementation, including documentation of the choices and perceptions of the consumer regarding the service(s) provided;
(c) Describe the progress the consumer has made towards his or her IRP/IPC goals;
(d) 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; and
(e) Clinical documentation to support billing for a service as described in subsection 3410.18 does not suffice as a Progress Note.
Subsection 3410.18(g) is deleted in its entirety and amended to read as follows:
(g) Dated and authenticated entries, with their authors identified, which are legible and concise, including the printed name and the signature of the person rendering the service, diagnosis and clinical impression recorded in the terminology of the ICD-9 CM, and the service provided.
Subsection 3410.37 is deleted in its entirety and amended to read as follows:
3410.37 Each MHRS provider shall operate according to all applicable federal and District laws and regulations relating to fraud and abuse in health care, the provision of mental health services, and the Medicaid program. An MHRS provider's failure to report potential or suspected fraud or abuse may result in sanctions, cancellation of contract, or exclusion from participation as an MHRS provider. Each MHRS provider shall:
(a) Cooperate and assist the District and any federal agency charged with the duty of identifying, investigating, or prosecuting suspected fraud and abuse;
(b) Be responsible for promptly reporting suspected fraud and abuse to DMH, taking prompt corrective actions consistent with the terms of any contract or subcontract with DMH, and cooperating with DHCF or other governmental investigations; and
(c) Ensure that none of its practitioners have been excluded from participation as a Medicaid or Medicare provider and, if a practitioner is determined to be excluded by the Center for Medicare and Medicaid Services (CMS), notify DMH immediately.
Subsection 3411.4(e) is amended by inserting the phrase “treatment planning responsibility,” after the phrase “clinical responsibility,”.
Subsection 3413.8 is amended to read as follows in the section captioned “Diagnostic/Assessment”:
Diagnostic/ Assessment
l Psychiatrist
l Psychologist
l LICSW
l APRN
May diagnose and assess
May serve as the approving
qualified practitioner for the development of the IRP/IPC
l Registered Nurse
l LPC
l LISW
l Addiction Counselor
l Credentialed Staff
May provide assessment services only
An LPC may serve as the approving qualified practitioner for the
development of the IRP/IPC
Subsection 3415.3 is deleted in its entirety and amended to read as follows:
3415.3 The Diagnostic/Assessment team shall consist of at least two (2) qualified practitioners, and shall include the following persons:
(a) A psychiatrist, psychologist, LICSW, or APRN to establish the diagnosis;
(b) An approving qualified practitioner; and
(c) A qualified practitioner who is knowledgeable about community resources, if one of the required Diagnostic/Assessment team members does not possess this knowledge.
Subsection 3415.8 is deleted in its entirety and amended to read as follows:
3415.8 A qualified practitioner shall complete the Diagnostic/Assessment report no later than ten (10) business days after the completion of the Diagnostic/Assessment by the Diagnostic/Assessment team. The qualified practitioner shall provide the Diagnostic/Assessment report to the approving qualified practitioner, and the approving qualified practitioner shall incorporate results of the Diagnostic/Assessment into the IRP/IPC.
Subsection 3415.9 is deleted in its entirety and amended to read as follows:
3415.9 The approving qualified practitioner shall convene the consumer, the consumer's family and significant others, if appropriate, and the consumer's clinical manager to review the Diagnostic/Assessment report and develop the IRP/IPC.
Section 3499, Definitions, subsection 3499.1 is amended by deleting in its entirety the definition for “Approving Practitioner” and inserting in its place the definition for “Approving Qualified Practitioner”, and by amending the definitions for “Advance Practical Registered Nurse,” “Licensed independent clinical social worker,” “Licensed professional counselor,” “Psychologist,” and “Psychiatrist” to read as follows:
"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.
"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.
"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 professional counselor" or "LPC" - a professional counselor licensed in accordance with applicable District laws and regulations. An LPC is an approving qualified practitioner.
"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.
