Definitions

The following terms used in 130 CMR 425.000 will have the meanings given in 130 CMR 425.402 unless the context clearly requires a different meaning. Administrative Day — a day of inpatient hospitalization on which a member's care needs can be met in a less intensive setting than a psychiatric inpatient hospital, as defined in 130 CMR 425.402, and on which a member is clinically ready for discharge, but an appropriate institutional or noninstitutional setting is not readily available. Case Manager  an area-based coordinator of services employed by the Department of Mental Health (DMH) or, where appropriate, the Department of Children and Families (DCF), the Department of Youth Services (DYS), or the Department of Developmental Services (DDS). Child and Adolescent Needs and Strengths (CANS) — a tool that provides a standardized way to organize information gathered during 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. Day of Discharge – the day on which a member leaves the hospital regardless of the hour. The day of death is also considered the day of discharge. A leave of absence is not considered a discharge. Inpatient Psychiatric Treatment — treatment that encompasses multidisciplinary assessments and multimodal interventions. Twenty-four-hour skilled nursing care, daily medical care, provided by either a board certified psychiatrist, Psychiatric-Mental Health Clinical Nurse Specialist, or Psychiatric-Mental Health Nurse Practitioner, under supervision of a board certified psychiatrist, and a structured treatment milieu are required. Mental Illness — mental and emotional disorders as defined in the current International Classification of Diseases, Clinical Modification (ICD-CM) or the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), and manifested by impaired functioning in behavior, feeling, thinking, or judgment to the extent that the affected person, or someone else, can observe that the person affected is unable to fulfill reasonable personal and social expectations. Multidisciplinary Treatment Team  a team of mental-health professionals employed by or under contract with a psychiatric inpatient hospital that provides services to members in the facility. The team must include, at a minimum, a board-eligible or board-certified psychiatrist and one of the following: (1) an independent licensed clinical social worker; (2) a licensed registered nurse with specialized psychiatric training or at least one year's experience treating mentally ill individuals; (3) an occupational therapist who is licensed and who has specialized psychiatric training or at least one year's experience treating mentally ill individuals; or (4) a psychologist who has a master's degree in clinical psychology, or a closely related field such as counseling psychology, or who has been certified either by the state in which the psychiatric inpatient hospital is located or by that state's psychological association. Private Psychiatric Inpatient Hospital — any private psychiatric facility that is (1) licensed by the Massachusetts Department of Mental Health (if in-state), or by the governing or licensing agency in its state (if out-of-state); (2) accredited by the Joint Commission; and (3) is primarily engaged in treating persons, whose principal diagnosis is based on the current ICD-CM or the current DSM. "Primarily engaged in treating" means that over a six-month period inpatient care has been provided to a patient population of which over 50% consistently have a principal diagnosis that is psychiatric. Psychiatric Inpatient Hospital — a private psychiatric inpatient hospital or a state-operated psychiatric inpatient hospital. Screening Team — an independent team that certifies the need for services for members younger than 21 years of age. The team includes, but may not be limited to, a physician, and must (1) be competent in diagnosing and treating mental illness in children; and (2) have knowledge of the member’s condition. State-operated Psychiatric Hospital – a hospital that is accredited by a recognized accreditation body such as the Joint Commission and is operated by the Department of Mental Health pursuant to M.G.L. c. 19 and c. 123. Treatment Plan — a documented written plan developed for each member by the hospital multidisciplinary treatment team with the goal of improving the member's condition to the extent that inpatient care is no longer necessary. Working Days — Monday through Friday, except for holidays.