Crisis Intervention Department of Medical Assistance Services H0036 2013 www.dmas.virginia.gov 1

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.vita.virginia.gov www.dmas.virginia.gov 2

Objectives of this Training Are: Department of Medical Assistance Services Crisis Intervention Objectives of this Training Are: To define the criteria of Crisis Intervention 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.vita.virginia.gov www.dmas.virginia.gov 3

Crisis Intervention Service Definition Department of Medical Assistance Services Crisis Intervention Service Definition H0036 www.dmas.virginia.gov 4

Department of Medical Assistance Services Crisis Intervention Crisis intervention provides immediate mental health care, available 24 hours a day, seven days per week, to assist individuals who are experiencing acute psychiatric 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. www.vita.virginia.gov www.dmas.virginia.gov 5

Crisis Intervention Licensing Department of Medical Assistance Services Crisis Intervention Licensing H0036 www.dmas.virginia.gov 6

Department of Medical Assistance Services Crisis Intervention Crisis Intervention providers must have a Department of Behavioral Health and Developmental Services (DBHDS) license to provide Emergency Services/Crisis Intervention and Outpatient Services. * DMAS requires the license in Outpatient and DBHDS requires a license in Emergency Services/Crisis Intervention www.vita.virginia.gov www.dmas.virginia.gov 7

Crisis Intervention Staff Qualifications Department of Medical Assistance Services Crisis Intervention Staff Qualifications H0036 www.dmas.virginia.gov 8

Department of Medical Assistance Services Crisis Intervention 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 requirements may be found in Chapter II of the CMHRS Manual or through DBHDS www.vita.virginia.gov www.dmas.virginia.gov 9

Crisis Intervention Eligibility Criteria Department of Medical Assistance Services Crisis Intervention Eligibility Criteria H0036 www.dmas.virginia.gov 10

Department of Medical Assistance Services Crisis Intervention Admission to crisis interventions services is indicated following a marked reduction in the individual's psychiatric, adaptive or behavioral functioning or an extreme increase in personal distress. 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: www.vita.virginia.gov www.dmas.virginia.gov 11

Crisis Intervention Department of Medical Assistance Services Experience difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of psychiatric hospitalization, homelessness, or isolation from social supports; 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 mental health, social services, or the 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.vita.virginia.gov www.dmas.virginia.gov 12

Department of Medical Assistance Services Crisis Intervention 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.vita.virginia.gov www.dmas.virginia.gov 13

Crisis Intervention Required Activities Department of Medical Assistance Services Crisis Intervention Required Activities H0036 www.dmas.virginia.gov 14

Crisis Intervention Crisis intervention activities must include: Department of Medical Assistance Services Crisis Intervention Crisis intervention activities must include: Assessing the crisis situation, Providing short-term counseling designed to stabilize the individual, Providing access to further immediate assessment and follow-up, and Linking the individual and family with ongoing care to prevent future crisis. www.vita.virginia.gov www.dmas.virginia.gov 15

Crisis Intervention Services may include: Office visits Home visits Department of Medical Assistance Services Crisis Intervention Services may include: Office visits Home visits Preadmission screenings Telephone contacts Contacts with the family or significant others 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.vita.virginia.gov www.dmas.virginia.gov 16

Department of Medical Assistance Services Crisis Intervention An LMHP, LMHP Supervisee or Resident, certified pre-screener, or QMHP must conduct a face-to-face service specific-provider assessment. If the QMHP-A, QMHP-C, or QMHP-E performs the service-specific provider assessment, it must be reviewed and approved by an LMHP, LMHP Supervisee or Resident or a certified pre-screener within 72 hours. The service-specific provider assessment must document the need for and the anticipated duration of the crisis service. www.vita.virginia.gov www.dmas.virginia.gov 17

Department of Medical Assistance Services Crisis Intervention There must be documentation of immediate mental health care 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. An 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.vita.virginia.gov www.dmas.virginia.gov 18

Department of Medical Assistance Services Crisis Intervention Reimbursement will 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. Other than the annual service limits, there are no restrictions (regarding number of contacts or a given time period to be covered) for reimbursement for unscheduled crisis contacts. 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 attempts to notify the primary care provider of the individual’s receipt of this service. www.vita.virginia.gov www.dmas.virginia.gov 19

Department of Medical Assistance Services Crisis Intervention If case management is being provided, there must be coordination with the case management agency. For an admission to a freestanding inpatient psychiatric facility for individuals younger than age 21, federal regulations require certification of the admission by an independent team comprised of mental health professionals, including a physician. Preadmission screening cannot be billed unless the requirement for an independent team, with a physician’s signature, is met. www.vita.virginia.gov www.dmas.virginia.gov 20

Crisis Intervention Limitations and Supervision Requirements Department of Medical Assistance Services Crisis Intervention Limitations and Supervision Requirements H0036 www.dmas.virginia.gov 21

Department of Medical Assistance Services Crisis Intervention Medicaid cannot be billed for crisis intervention 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 clinic services are billed at the same time as crisis intervention, documentation must clearly support the separation of the services with distinct treatment goals. www.vita.virginia.gov www.dmas.virginia.gov 22

Crisis Intervention Units and Reimbursement Department of Medical Assistance Services Crisis Intervention Units and Reimbursement H0036 www.dmas.virginia.gov 23

Department of Medical Assistance Services Crisis Intervention There is a maximum of 720 units annually that are allowed based on medical necessity per fiscal year. A claim edit is in place that will cut back payment or deny claims for services beyond the maximum number of units allowed. One unit = 15 minutes A fiscal year is July 1 to June 30 www.vita.virginia.gov www.dmas.virginia.gov 24

Crisis Intervention Service Authorization Department of Medical Assistance Services Crisis Intervention Service Authorization H0036 www.dmas.virginia.gov 25

Department of Medical Assistance Services Crisis Intervention Service authorization is not currently required for this service. www.vita.virginia.gov www.dmas.virginia.gov 26

Crisis Intervention Helpful Resources: Department of Medical Assistance Services Crisis Intervention 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.vita.virginia.gov www.dmas.virginia.gov 27

Department of Medical Assistance Services Crisis Intervention Thank you for attending this training and helping to serve Virginia’s Medicaid Recipients. www.vita.virginia.gov www.dmas.virginia.gov 28