Crisis Stabilization

1. Department of Medical Assistance Services Crisis Stabilization H2019 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 Crisis Stabilization Objectives of this Training Are: • To define the criteria of Crisis Stabilization • To identify staff qualifications; • To clarify eligibility criteria; • To identify required activities; • To review limitations of the service; • To outline service units and reimbursement; and • To review service authorization requirements. www.dmas.virginia.gov 3

4. Department of Medical Assistance Services Crisis Stabilization Licensing H2019 www.dmas.virginia.gov 4

5. Department of Medical Assistance Services Crisis Stabilization Crisis Stabilization providers must have a Department of Behavioral Health and Developmental Services (DBHDS) license to provide Mental Health Crisis Stabilization and Outpatient Services. * DMAS requires the license in Outpatient Services and DBHDS requires a license in Crisis Stabilization www.dmas.virginia.gov 5

6. Department of Medical Assistance Services Crisis Stabilization Staff Qualifications H2019 www.dmas.virginia.gov 6

7. Department of Medical Assistance Services Crisis Stabilization • Licensed Mental Health Professional (LMHP) or LMHP Supervisee or Resident • Certified Pre-screener • Qualified Mental Health Professional-Adult (QMHP-A) • Qualified Mental Health Professional-Child (QMHP-C) • Qualified Mental Health Professional-Eligible (QMHP-E) * Qualification definitions may be found in Ch. II of the CMHRS Manual or through DBHDS www.dmas.virginia.gov 7

8. Department of Medical Assistance Services Crisis Stabilization Service Definition H2019 www.dmas.virginia.gov 8

9. Department of Medical Assistance Services Crisis Stabilization • Crisis Stabilization services are direct mental health care to non-hospitalized individuals experiencing an acute crisis of a psychiatric nature that may jeopardize their current community living situation or which puts them at risk of psychiatric hospitalization. • The goals are: • to avert hospitalization or re-hospitalization; • provide normative environments with a high assurance of safety and security for crisis intervention; • stabilize individuals in psychiatric crisis; and • mobilize the resources of the community support system, family members, and others for ongoing maintenance, and rehabilitation. www.dmas.virginia.gov 9

10. Department of Medical Assistance Services Crisis Stabilization • This service may be provided in any of the following settings, but shall not limited to: • The home of an individual who lives with family or other primary caregivers; • The home of an individual who lives independently; or • Community-based programs licensed by the Department of Behavioral Health and Developmental Services (DBHDS) to provide residential services but which are not institutions for mental disease (IMDs). www.dmas.virginia.gov 10

11. Department of Medical Assistance Services Crisis Stabilization Definition of an IMD and reason for the 16 bed restriction • An IMD is defined by federal law as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care, and related services. • Whether an institution is an IMD is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such. • The Center for Medicaid and Medicare Services (CMS) is prevented by Federal law from providing Medicaid funding for mental health services to any individual over the age of 21 and under the age of 65 residing in an IMD as defined above.  CMS will only provide Medicaid funding for “inpatient psychiatric services” (as defined in federal regulations) for individuals who are in an IMD and under the age of 21 or over the age of 64. This service is not an “inpatient psychiatric service.” www.dmas.virginia.gov 11

12. Department of Medical Assistance Services Crisis StabilizationEligibility Criteria H2019 www.dmas.virginia.gov 12

13. Department of Medical Assistance Services Crisis Stabilization • Individuals qualifying for this service must demonstrate a clinical necessity for the service arising from an acute crisis of a psychiatric nature that puts the individual at risk of psychiatric hospitalization. • Individuals must meet at least two of the following criteria at the time of admission to the service: • Experience difficulty in establishing or maintaining normal interpersonal relationships to such a degree that the individual is at risk of psychiatric hospitalization, homelessness, or isolation from social supports; www.dmas.virginia.gov 13

14. Department of Medical Assistance Services Crisis Stabilization • Experience difficulty in activities of daily living such as maintaining personal hygiene, preparing food and maintaining adequate nutrition, or managing finances to such a degree that health or safety is jeopardized; • Exhibit such inappropriate behavior that immediate interventions by the mental health, social services, or judicial system are necessary; or • Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or significantly inappropriate social behavior. www.dmas.virginia.gov 14

15. Department of Medical Assistance Services Crisis Stabilization • If an individual has co-occurring mental health and substance use disorders, integrated treatment for both is allowed as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition. The impact of the substance abuse condition on the mental health condition must be clearly documented in the assessment, treatment plan and progress notes. www.dmas.virginia.gov 15

16. Department of Medical Assistance Services Crisis StabilizationRequired Activities H2019 www.dmas.virginia.gov 16

17. Department of Medical Assistance Services Crisis Stabilization • Prior to treatment there must be a service-specific provider assessment which clearly documents the need for service and the anticipated duration of need. • The service-specific provider assessment must be completed by an Licensed Mental Health Provider (LMHP), LMHP Supervisee or Resident, a certified pre-screener, or a QMHP-A, QMHP-C or QMHP-E. • If the service-specific provider assessment is done by anyone other than an LMHP, an LMHP must review and approve the assessment within 72 hours. www.dmas.virginia.gov 17

18. Department of Medical Assistance Services Crisis Stabilization • An Individual service Plan (ISP) must be developed or revised within 10 business days of the approved service-specific provider assessment or reassessment. • An LMHP, certified pre-screener, or QMHP must develop the ISP. • Services must be documented in the individual’s records as having been provided consistent with the ISP in order to receive Medicaid reimbursement. • Services must be documented through daily notes and a daily log of time spent in the delivery of services. www.dmas.virginia.gov 18

19. Department of Medical Assistance Services Crisis Stabilization • If any case management is being provided, there must be coordination with the case management agency. • The service provider must notify or document the attempts to notify the primary care provider or pediatrician of the individual’s receipt of community mental health rehabilitative services. • The crisis stabilization program must provide to individuals, as appropriate, psychiatric assessment including medication evaluation, treatment planning, symptom and behavior management, and individual and group counseling. www.dmas.virginia.gov 19

20. Department of Medical Assistance Services Crisis StabilizationLimitations H2019 www.dmas.virginia.gov 20

21. Department of Medical Assistance Services Crisis Stabilization • This service will not be reimbursed if any of the following apply: • The individual has a medical condition that requires hospital care. • The individual has a primary diagnosis of substance abuse. • The individual has a psychiatric condition that cannot be managed in the community (i.e. individuals who are of imminent danger to themselves or others.) • Room and board, custodial care, and generally supervision are not components of this service. www.dmas.virginia.gov 21

22. Department of Medical Assistance Services Crisis Stabilization • Reimbursement for this service cannot be made in treatment settings with a bed capacity that is greater than 16. • The total number of beds will be determined by including all beds located within the program/facility, regardless of whether or not the services are billed Medicaid. • If a provider operates separate residences that are 16 beds or less and are more than one mile apart, the bed count will only apply to each residence. www.dmas.virginia.gov 22

23. Department of Medical Assistance Services Crisis Stabilization • No concurrent billing is allowed during the same time period for Clinic Option Outpatient Mental health treatment or Intensive Community Treatment. (Billing for medication management only is permitted.) • Staff Travel time is excluded. www.dmas.virginia.gov 23

24. Department of Medical Assistance Services Crisis StabilizationUnits and Reimbursement H2019 www.dmas.virginia.gov 24

25. Department of Medical Assistance Services Crisis Stabilization • Crisis stabilization may billed for up to a 15-day period per crisis episode following the documented face-to-face service-specific provider assessment. • The maximum limit on this service is up to eight hours per day up to 60 days annually (fiscal year). • A billing unit is one hour. • Each July 1st all service limits will be set to zero. • A fiscal year is July 1 through June 30. www.dmas.virginia.gov 25

26. Department of Medical Assistance Services Crisis StabilizationService Authorization H2019 www.dmas.virginia.gov 26

27. Department of Medical Assistance Services Crisis Stabilization Service authorization is not required for this service www.dmas.virginia.gov 27

28. Department of Medical Assistance Services Crisis Stabilization 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 28

29. Department of Medical Assistance Services Crisis Stabilization Thank you for attending this training and helping to serve Virginia’s Medicaid Recipients. www.dmas.virginia.gov 29