Staff Composition Requirements

(A) Minimum Staffing Requirements. Each center must meet the minimum staffing and staff composition requirements in 130 CMR 429.422 to adequately provide the required scope of services in 130 CMR 429.421. The staff must include other related mental health professionals as appropriate to meet the needs of members, which includes staff necessary for the provision of intake, diagnostic evaluation, and treatment services. (B) Minimum Staffing Composition. (1) Psychiatrist. Each center must employ, whether on staff or by contract, at least one psychiatrist licensed by the Massachusetts Board of Registration in Medicine pursuant to M.G.L c. 112, §§ 2 through 12DD; c. 112 §§ 61 through 65 and 88 and 243 CMR 2.00: Licensing and the Practice of Medicine and certified by the American Board of Psychiatry and Neurology, the American Osteopathic Board of Neurology and Psychiatry, or board- eligible for such certification. Such psychiatrist is responsible for prescribing, or monitoring and supervising, the prescription of all medications. (2) Multidisciplinary Staff. In addition to the requirements under 130 CMR 429.422(B)(1), each center must have a multidisciplinary staff that includes at least two of the following mental health professionals: (a) Psychologist. A psychologist licensed by the Massachusetts Board of Registration of Psychologists, and specializing in clinical or counseling psychology, or a closely related specialty, pursuant to M.G.L. c. 112, §§ 118 through 127 and 251 CMR 3.00: Registration of Psychologists. (b) Social Worker. An independent clinical social worker licensed by the Massachusetts Board of Registration of Social Workers pursuant to M.G.L. c 13, §84 and 258 CMR 9.00: Licensure Requirements and Procedures. (c) Advanced Practice Registered Nurse. An advanced practice registered nurse who specializes in psychiatric treatment as follows: 1. Psychiatric Nurse. A registered nurse with a master’s degree in psychiatric nursing licensed by the Board of Registration in Nursing pursuant to M.G.L. c. 112, § 80B and 244 CMR 4.00: Advanced Practice Registered Nursing. 2. Psychiatric Clinical Nurse Specialist. A psychiatric clinical nurse specialist licensed by the Board of Registration in Nursing pursuant to M.G.L. c. 112, § 80B and 244 CMR 4.00: Advanced Practice Registered Nursing. (d) Licensed Mental Health Counselor. A licensed mental health counselor licensed by the Board of Registration of Allied Mental Health and Human Service Professions pursuant to M.G.L. c. 112, § 165 and 262 CMR 2.00: Requirements for Licensure as a Mental Health Center. (e) Licensed Alcohol and Drug Counselor I. An alcohol and drug counselor licensed by the DPH pursuant to 105 CMR 168.000: Licensure of. Alcohol and Drug Counselors. (f) Licensed Marriage and Family Therapist. A marriage and family therapist licensed by the Board of Registration of Allied Mental Health and Human Services Professions pursuant to M.G.L. c. 112, §§ 163 through 172 and 262 CMR 3: Requirements for Licensure as a Marriage and Family Therapist. (g) Other Licensed Mental Health and Substance Use Disorder Practitioners. Other mental health and substance use disorder practitioners licensed by the Division of Professional Licensure, DPH, or any Board of Registration and deemed by DPH to be mental health and substance use disorder professionals. (3) Care Coordination Staff. Staff who help members identify service needs and access those services, and coordinate all services currently involved with the member. (4) Staff to Administer Medication Services. In addition to the staff required in 130 CMR 429.422(B)(1) and (2), centers may optionally staff physicians, nurse practitioners, and physician assistants to support prescriptive practice and integrated medical services, inclusive of addiction medicine, within the center. (C) Minimum Requirements for Center Administrative and Clinical Management Staff (1) Administrator. The mental health center must designate one individual as administrator. The administrator is responsible for the overall operation and management of the center and for ensuring compliance with MassHealth regulations. The administrator must have previous training or experience in personnel, fiscal, and data management, as described in 130 CMR 429.438. (a) The same individual may serve as both the administrator and clinical director. (b) In a community health center, the administrator of the entire facility may also administer the mental health center. (2) Clinical Director. The mental health center must designate a professional staff member to be the clinical director, responsible to the administrator, for the direction and control of all professional staff members and services. (a) The clinical director must be independently licensed, certified, or registered to practice in one of the core disciplines in 130 CMR 429.422(B)(1) and (B)(2)(a)-(d), and must have at least five years of full-time, supervised clinical experience subsequent to obtaining a master's degree, two years of which must have been in an administrative capacity. The clinical director must be employed full-time. When the clinic is licensed as a community health center, the clinical director must work at the center at least half-time. (b) The specific responsibilities of the clinical director include 1. selection of clinical staff and maintenance of a complete staffing schedule; 2. establishment of job descriptions and assignment of staff; 3. overall supervision of staff performance; 4. accountability for adequacy and appropriateness of member care; 5. in conjunction with the medical director, accountability for employing adequate psychiatric staff to meet the psychopharmacological needs of members; 6. establishment and maintenance of policies and procedures for member care; 7. provision of some direct member care in circumstances where the clinical director is one of the three minimum full-time equivalent staff members of the center; 8. development of in-service training for professional staff; and 9. establishment of a quality management program. (3) Medical Director. Each center must designate a psychiatrist who is responsible for establishing all medical policies and protocols and for supervising all medical services provided by the staff. The medical director must be available to the center and satellite sites during the center’s operating hours, either onsite or remotely, for consultation and support of clinic operations to ensure the provision of high-quality care. The medical director must be available to be onsite during any hours of clinic operation, as needed. When the clinic is dually enrolled as a community health center, the medical director must be available to the mental health center at least four hours a week, either onsite or remotely, provided that the medical director must be available to be onsite during any hours of clinic operation, as needed. (4) Psychiatrist. (a) The roles and duties of administrator, clinical director, and medical director, as detailed in 130 CMR 429.422(C)(1) through (3), may be performed, all or in part, by a psychiatrist on the center's staff, as long as provision of services to members and performance of all relevant duties in these regulations meet professionally recognized standards of health care, as required by 130 CMR 450.000: Administrative and Billing Regulations. (b) The role of the psychiatrist in each center, apart from any duties that may be assumed under 130 CMR 429.422(C)(1) through (3), must include 1. responsibility for the evaluation of the physiological, neurological, developmental, and psychopharmacological status of members receiving services; 2. involvement in diagnostic formulations and development and refinement of treatment plans, including reconciliation of psychopharmacological and other medications as required; 3. direct psychotherapy, when indicated; 4. participation in utilization review or quality-assurance activity, when indicated; 5. coordination of the center's relationship with hospitals and provision of general hospital consultations as required; 6. supervision of and consultation to other disciplines; and 7. clinical coverage on an on-call basis at all hours of center operation.