General Definitions

As used in 101 CMR 306.00, unless the context requires otherwise, terms have the meanings in 101 CMR 306.02. Adverse Incident. An occurrence that represents actual or potential serious harm to the well- being of a member, or to others under the care of the mental health center. Adverse incidents may be the result of the actions of a member served, actions of a staff member providing services, or incidents that compromise the health, safety, or operations of the center. American Society of Addiction Medicine (ASAM). A professional society in the field of addiction medicine that sets diagnostic and dimensional criteria for the delivery of substance use disorder treatment which includes a continuum of five basic levels of care from Early Intervention to Medically Managed Intensive Inpatient Treatment. Behavioral Health Disorder. Any disorder pertaining to mental health or substance use as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Behavioral Health Urgent Care Provider. A center that meets the requirements in 130 CMR 429.404(D). Care Coordination. The organization of a member’s care across multiple services and supports. Case Consultation. An intervention, including scheduled telephonic or in-person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers. Certified Peer Specialist (CPS). A person who has been trained by an agency approved by the Department of Mental Health (DMH) who is self-identified as having lived experience of a mental health disorder and wellness who can effectively share their experiences and serve as a mentor, advocate, or facilitator for a member experiencing a mental health disorder. Child and Adolescent Needs and Strengths (CANS). A standardized tool that organizes information gathered during a behavioral health clinical assessments. A Massachusetts version of the tool has been developed and is intended to be used as a treatment decision support tool for behavioral health providers serving MassHealth members younger than 21 years of age. Community Consultation and Education. Services provided by professional personnel to representatives of schools, courts, police, organizations, or agencies with the aim of problem solving and imparting knowledge in areas such as prevention, availability of resources, and clinical procedures. Such consultation is distinct from case consultation in that it does not address the problems of a particular patient but rather the community at large. Community Health Center. A clinic that provides comprehensive ambulatory services and is not financially or physically an integral part of a hospital. Co-occurring Disorder. A diagnosis of both a substance use disorder and one or more behavioral health disorders. Core Discipline. Licensed behavioral health disciplines, including but not limited to psychiatry, social work, psychology, and psychiatric nursing (including an advanced practice registered nurse). Counselor. An individual who has earned a master's degree in counseling from a recognized educational program and who also meets conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152: Workers’ Compensation. Couples Therapy. Psychotherapeutic services provided to a couple whose primary issue is the disruption of their marriage, family, or relationship. Crisis Intervention. An urgent evaluation including assessment of risk, diagnosis, short-term intervention, and rendering of a disposition for a member’s presenting crisis, which may include referral to an existing or new behavioral health provider. Developmental Assessment. The assessment of developmental status including the administration of developmental testing to assess fine and/or gross motor, language, cognitive level, social, memory and/or executive functions. Developmental Testing. The assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments, which may include the interpretation and reporting of results. Diagnostic Evaluation Services. The examination and determination of a member’s physical, psychological, social, economic, educational, and vocational assets and disabilities for the purpose of designing a treatment plan. Eligible Provider. A mental health center or community health center that meets the conditions of participation that have been or may be adopted by a governmental unit purchasing mental health services or by purchasers under M.G.L. c. 152: Workers’ Compensation. Encounter Bundle. A flat rate per date of services for the provision of any of a set of designated services, regardless of the number of services provided to the individual on that date. Enhanced Structured Outpatient Addiction Program (E-SOAP). American Society of Addiction Medicine (ASAM) Level 2.1 Intensive Outpatient Services is a program that provides short-term, clinically intensive, structured day and/or evening substance use disorder services. E-SOAP specifically serves specialty populations including homeless members and people at risk of homelessness, pregnant members, and adolescents. E-SOAP services must meet requirements in 130 CMR 418.000: Substance Use Disorder Treatment Services. EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A. Family Consultation. A preplanned meeting with one or more of the parents, legal guardian, or foster parents of a child who is being treated by clinical staff at the center when the parents, legal guardian, or foster parents are not clients of the center. Family Therapy. The treatment of more than one member of a family simultaneously in the same visit. Governmental Unit. The Commonwealth of Massachusetts, or any of its departments, agencies, boards, commissions, or political subdivisions. Group Therapy. The application of psychotherapeutic or counseling techniques to a group of persons, most of whom are not related by blood, marriage, or legal guardianship. Individual Consideration (IC). Payment rates to eligible providers for services authorized in accordance with 101 CMR 306.03, but not listed herein, or authorized services performed in exceptional circumstances must be determined on an IC basis by the governmental unit or purchaser under M.G.L. c. 152: Workers’ Compensation upon receipt of a bill that describes the services rendered. The determination of rates of payment for authorized IC procedures must be in accordance with the following criteria: (a) time required to perform the service; (b) degree of skill required for service rendered; (c) severity and/or complexity of the client's disorder or disability; (d) policies, procedures, and practices of other third-party purchasers of care; and (e) such other standards and criteria as may be adopted from time to time by EOHHS pursuant to 101 CMR 306.03(6). Individual Therapy. Psychotherapeutic services provided to an individual. Intensive Outpatient Program (IOP). A mental health treatment service that provides time- limited, multidisciplinary, multimodal structured treatment in an outpatient setting for members requiring a clinical intensity that exceeds outpatient treatment. Service includes individual, group, and family therapy as well as case management services. Medication for Addiction Treatment (MAT). Use of a medication approved by the Food and Drug Administration (FDA) for the treatment of a substance use disorder. Medication for Opioid Use Disorder (MOUD). Use of a medication approved by the FDA for the treatment of opioid use disorder. Medication Visit. A member visit specifically for prescription, review, and monitoring of medication by a psychiatrist, a psychiatric clinical nurse specialist, advanced practice registered nurse, or physician assistant, or administration of prescribed intramuscular medication by a physician, nurse, or physician assistant. Mental Health Center (Center). An entity that delivers a comprehensive group of diagnostic and psychotherapeutic treatment services to individuals seeking treatment for mental health disorders, which may include co-occurring substance use disorder, and their families by an interdisciplinary team under the medical direction of a psychiatrist. Mental Health Disorder. Any disorder pertaining to mental health as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Modifiers. Listed services may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of the appropriate two-digit number or letters. Multiple Family Group Therapy. The treatment of more than one family unit, at the same time in the same visit, by one or more authorized staff members. There must be more than one family member present per family unit and at least one of the family members per family unit must be an identified patient of the center. Neuropsychological Assessment. A battery of performance-based assessments rendered by an eligible provider that assesses cognitive functioning and developmental delays in order to examine the cognitive consequences of brain damage, brain disease, physical, and mental illness, and other conditions that may impact cognitive functioning and achievement of developmental milestones. A neuropsychological assessment may include tests of intelligence, attention and concentration, learning and memory, processing speed, visual spatial perception, language skills, visual motor and fine motor skills, sensory perception, executive functioning, and emotional functioning. Occupational Therapist. An individual who is registered with the American Occupational Therapy Association who also meets the conditions of participation that have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152: Workers’ Compensation. Peer Recovery Coach. An individual currently in recovery who has lived experience with substance use or other addictive disorders and/or co-occurring mental health disorders and has been trained to help their peers with a similar experience to gain hope, explore recovery, and achieve life goals. Peer recovery coaches engage in an equitable, nonclinical relationship with the member focused on removing obstacles to recovery. Peer recovery coaches link members to the recovery community and engage in mentoring. Peer recovery coaches must meet requirements in 130 CMR 418.000: Substance Use Disorder Treatment Services. Preventive Behavioral Health Services. Short-term group intervention, recommended by a physician or other licensed practitioner practicing within their scope of licensure, that cultivates coping skills and strategies for symptoms of depression, anxiety, and other social-emotional concerns, to prevent the development of behavioral health disorders for children and adolescents younger than 21 years of age. Psychiatric Nurse. An individual who is currently registered by the Massachusetts Board of Registration in Nursing and who has earned a master's degree from an accredited graduate school of psychiatric nursing or who meets the conditions of participation that have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152: Workers’ Compensation. Psychiatric Nurse Mental Health Clinical Specialist. A licensed registered nurse who is authorized by the Board of Registration in Nursing as practicing in an expanded role and who meets the requirements of 244 CMR 4.05(4): Psychiatric Nurse Mental Health Clinical Specialist. Psychiatric Social Worker. An individual who has earned a master's degree from an accredited graduate school of social work or who meets the conditions of participation that have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152: Workers’ Compensation. Psychiatrist. An MD or Doctor of Osteopathic Medicine who is registered in Massachusetts and who is certified or eligible for certification by the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry who meets such conditions of participation as have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152: Workers’ Compensation. Psychological Associate. A staff member trained in the field of clinical or counseling psychology or a closely related specialty who (a) has a minimum of a master's degree or the equivalent graduate study in clinical or counseling psychology or a closely related specialty from an accredited educational institution; (b) is currently enrolled in or have completed a doctoral program in clinical or counseling psychology or a closely related specialty; and (c) has had two years of full-time supervised clinical experience subsequent to obtaining a master's degree in a multidisciplinary mental health setting. (One year of supervised clinical work in an organized graduate internship program may be substituted for each year of experience.) Psychological Assessment. The use of standardized test instruments to evaluate aspects of a member’s functioning. Psychological assessment includes intelligence, neuropsychological and developmental, and personality assessments. Test instruments used for psychological assessment must be published, valid, and in general use as defined by listing in the Mental Measurement Yearbook or successor publication, or by conformity to the Standards for Educational and Psychological Testing of the American Psychological Association. Psychologist. An individual who by training and experience meets the requirements for licensing by the Massachusetts Board of Registration of Psychologists and is duly licensed to practice psychology in the Commonwealth or who meets the requirements of education and experience in psychology that have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152: Workers’ Compensation. Psychotherapy. The utilization of psychological and interpersonal theories and related practice methodologies to assess, interpret, and modify conscious and unconscious processes of behavior. Psychotherapy for Crisis. An urgent assessment and history of a crisis state, a mental status exam, and a disposition. The treatment includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma. Publicly Aided Individual. A person for whose medical and other services a governmental unit is in the whole or in part liable under a statutory program. Recovery Support Navigator. A paraprofessional specialist who receives specialized training in the essentials of substance use disorder and evidence-based techniques, such as motivational interviewing, who supports members in accessing and navigating the substance use disorder treatment system through activities that can include care coordination, case management, and motivational support. Recovery support navigators must meet requirements in 130 CMR 418.000: Substance Use Disorder Treatment Services. Reevaluation. A session between a client and one or more staff members who are authorized to render mental health services for the determination and examination by interview techniques of a patient's physical, psychological, social, economic, educational, and vocational assets and disabilities for the purpose of reevaluating the diagnostic formulation, treatment plan, and procedures in order to assess aspects of an individual's functioning. Staff Member Authorized to Render Billable Mental Health Services. An individual who provides the services referred to in 101 CMR 306.00 under the auspices of an eligible provider and meets the qualifications of any of the following professions: psychiatrist, psychologist, psychological associate, social worker, psychiatric nurse, psychiatric clinical nurse specialist, advanced practice registered nurse, counselor, or occupational therapist. This also includes staff members meeting the qualifications that have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152: Workers’ Compensation. State-operated Community Mental Health Center. A community mental health center operated by the Commonwealth that is not financially or physically an integral part of a hospital. Structured Outpatient Addiction Program (SOAP). ASAM Level 2.1 Intensive Outpatient Services. A substance use disorder treatment service that provides short-term, multidisciplinary, clinically intensive structured treatment to address the subacute needs of members with substance use disorder and/or co-occurring disorders. These services may be used as a transition service in the continuum of care toward lower intensity outpatient services or accessed directly. SOAP services must meet requirements in 130 CMR 418.000: Substance Use Disorder Treatment Services. Substance Use Disorder. Any disorder pertaining to substance use as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Telehealth. The use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to interactive audio-video technology; remote patient monitoring devices; audio-only telephone; and online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating, or monitoring of a patient's physical health, oral health, mental health, or substance use disorder condition. Uniform Financial Statements and Independent Auditor’s Report (UFR). The set of financial statements and schedules required of many human, social service, and healthcare providers who deliver services to publicly aided clients. Urgent Behavioral Health Needs. Needs characterized by changes in behavior or thinking, role dysfunction, emerging intent of self-injury, or threats to others. Urgent behavioral health needs do not rise to the level of immediate risk of harm to self or others.