Substance Abuse – Crisis Intervention (H0050)

1. Department of Medical Assistance Services Substance Abuse – Crisis Intervention(H0050) DMAS Office of Behavioral Health 2013 www.dmas.virginia.gov 1

2. Department of Medical Assistance Services Disclaimer These slides contain only highlights of the Virginia Medicaid Community Mental Health Rehabilitative Services Manual (CHMRS) and are not meant to substitute for the comprehensive information available in the manual or state and federal regulations. *Please refer to the manual, available on the DMAS website portal, for in-depth information on Community Mental Health Rehabilitative Services criteria. Providers are responsible for adhering to related state and federal regulations. www.dmas.virginia.gov 2

3. Department of Medical Assistance Services Training Objectives • To define the criteria of Substance Abuse Crisis Intervention (SA-CI) • To identify staff qualifications; • To identify required activities; • To clarify eligibility criteria; • To review limitations of the service; and • To review service authorization requirements. www.dmas.virginia.gov 3

4. Department of Medical Assistance Services Service Definition Substance Abuse Crisis Intervention provides immediate substance abuse care, available 24 hours a day, seven days per week, to assist individuals who are experiencing acute dysfunction requiring immediate clinical attention. This service's objectives are to prevent exacerbation of a condition, to prevent injury to the client or others, and to provide treatment in the context of the least restrictive setting. This service includes therapeutic intervention, stabilization and referral assistance. www.dmas.virginia.gov 4

5. Department of Medical Assistance Services Licensing H0050 www.dmas.virginia.gov 5

6. Department of Medical Assistance Services Licensing Requirements The Substance Abuse – Crisis Intervention provider must be licensed by the Department of Behavioral Health and Developmental Services (DBHDS) as a provider of Substance Abuse Outpatient Services. www.dmas.virginia.gov 6

7. Department of Medical Assistance Services Staff Qualifications H0050 www.dmas.virginia.gov 7

8. Department of Medical Assistance Services Staff Qualifications • Be a Qualified Substance Abuse Professional (QSAP); or • Be a Certified Pre-screener • Monitoring and face-to-face support may be provided by a QSAP, a certified pre-screener, or a paraprofessional. A paraprofessional must be under the supervision of a QSAP and provide services in accordance with a plan of care www.dmas.virginia.gov 8

9. Department of Medical Assistance Services Required Activities H0050 www.dmas.virginia.gov 9

10. Department of Medical Assistance Services Required Activities • A certified pre-screener, or QSAP must complete and document a face-to-face service specific provider assessment of the crisis situation; provide short-term counseling to stabilize the individual or family unit; provide access to further immediate assessment and follow-up; and link the individual and family with ongoing care to prevent future crises. • There must be documentation of immediate substance abuse treatment with the objectives of preventing exacerbation of a condition, preventing injury to the individual and others, and providing treatment in the context of the least restrictive setting. • Services may include office visits, home visits, pre-admission screening, telephone contacts, or other client related activities for the prevention of institutionalization. Services may be provided to individuals outside of the clinic and billed if it is clinically or programmatically appropriate www.dmas.virginia.gov 10

11. Department of Medical Assistance Services Required Activities • Monitoring and face-to-face support may be provided by a QSAP, a certified pre-screener, or a paraprofessional to ensure the individual’s safety. A paraprofessional must be under the supervision of at least a QSAP. • A face-to-face contact with the individual must occur during the crisis episode. Other contacts, such as telephone calls and collateral contacts during the crisis episode may be reimbursed as long as the requirement for a face-to-face contact is met. Billable contacts which are directed toward crisis resolution for the member may occur prior the face-to-face contact. • An Individual Service Plan (ISP) is not required unless individuals are receiving scheduled, short-term counseling as part of the crisis intervention service. For those individuals an ISP must be developed or revised to reflect the short-term counseling goals by the fourth face-to-face contact. www.dmas.virginia.gov 11

12. Department of Medical Assistance Services Required Activities • Reimbursement may be provided for short-term crisis counseling contacts occurring within a 30-day period from the time of the first face-to-face crisis contact. • Services must be documented through daily notes and a daily log of time spent in the delivery of services. • The service provider must notify or document the attempt to notify the primary care provider of the individual’s receipt of community mental health rehabilitative services. • If case management is being provided, there must be coordination with the case management agency. www.dmas.virginia.gov 12

13. Department of Medical Assistance Services Eligibility Criteria H0050 www.dmas.virginia.gov 13

14. Department of Medical Assistance Services Eligibility • Substance abuse crisis intervention services are provided following a marked reduction in the individual’s psychiatric, adaptive, or behavioral functioning or an extreme increase in personal distress as a result of substance abuse. • If an individual has co-occurring mental health and substance use disorders, integrated treatment for both disorders is allowed. www.dmas.virginia.gov 14

15. Department of Medical Assistance Services Limitations H0050 www.dmas.virginia.gov 15

16. Department of Medical Assistance Services Limitations • Medicaid cannot be billed for SA-CI services for a member under Emergency Custody Orders (ECOs) or Temporary Detention Orders (TDOs). Services may be billed up to the time an order for TDO or ECO is received. If the ECO ends without a TDO being called, services rendered after the ECO ends may be reimbursed. • Staff travel time is excluded. • If other behavioral health services are billed at the same time as SA-CI, documentation must clearly support the separation of the services with distinct treatment goals. www.dmas.virginia.gov 16

17. Department of Medical Assistance Services Units and Reimbursement H0050 www.dmas.virginia.gov 17

18. Department of Medical Assistance Services Reimbursement Rate • A unit equals 15 minutes. • One-on-one monitoring $5/unit • Crisis Counseling $25/unit • The annual limit for crisis intervention is 720 units per fiscal year. • A fiscal year runs from July 1 to June 30. www.dmas.virginia.gov 18

19. Department of Medical Assistance Services Reminder Service authorization is not required for SA-CI www.dmas.virginia.gov 19

20. Department of Medical Assistance Services Contacts Helpful Resources: • 12VAC30-50-226 - Emergency Regulations for Community Mental Health Services • Virginia Medicaid Web Portal link www.virginiamedicaid.dmas.virginia.gov • DMAS Office of Behavioral Health: • Email Address CMHRS@dmas.virginia.gov • DMAS Helpline: 804-786-6273 Richmond Area 1-800-552-8627 All other www.dmas.virginia.gov 20