Staff Composition Requirements

(A) Minimum Staffing Requirements. Each center must meet the minimum staffing and staff composition requirements outlined in 130 CMR 448.413 to adequately provide the required scope of services set forth in 130 CMR 448.412. The staff must include other related behavioral health professionals as appropriate to meet the needs of members, which includes staff necessary for the provision of intake, diagnostic evaluation, and treatment services. All licensure staffing requirements must be met. (B) Minimum Staffing Composition. (1) Psychiatrists. 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 will be responsible for prescribing, or monitoring and supervising the prescription of, all medications. (2) Psychopharmacology Staff. (a) Prescribers of Medication for the Treatment of Opioid Use Disorders. Each center must employ a board-certified or board-eligible psychiatrist or other prescriber of medication for the treatment of opioid use disorders who possesses DEA X waiver registrations for prescribing of medication for the treatment of opioid use disorders sufficient to meet regional need. (b) Medical Assistants or Phlebotomists. Each center must employ a medical assistant or phlebotomist to draw blood using needles and other equipment, obtain toxicology samples, label samples correctly, and send them for testing as appropriate. Medical assistants may also assist with vital signs, height/weight, and other relevant health data. (3) Multidisciplinary Staff. In addition to the requirements under 130 CMR 448.413(B)(1) and (2) each center must employ a multidisciplinary staff that includes at least two of the following behavioral 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) Licensed Mental Health Counselor. A licensed mental health counselor licensed by the Board of Registration of Allied Mental Health and Human Services Professions pursuant to M.G.L. c. 112, § 165 and 262 CMR 2.00: Requirements for Licensure as a Mental Health Counselor. (d) 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 3.00: Requirements for Licensure as a Marriage and Family Therapist. (e) Registered Nurse (RN). A registered nurse licensed by the Board of Registration in Nursing pursuant to M.G.L. c. 112, § 80B and 244 CMR 3.00: Registered Nurse and Licensed Practical Nurse. (f) Certified Peer Specialists. The center must employ at least one certified peer specialist. Certified peer specialists must meet all applicable sections of 130 CMR 448.000. (g) Recovery Support Staff. The center must employ at least one recovery support navigator or at least one peer recovery coach staff member. Recovery support navigators and peer recovery coach staff shall meet all applicable sections of 130 CMR 418.000: Substance Use Disorder Treatment Services. (h) 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. 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. (i) Licensed Alcohol and Drug Counselor I. An alcohol and drug counselor licensed by the Department of Public Health pursuant to 105 CMR 168.000. (j) Other Licensed Mental Health and Substance Use Disorder Practitioners. Other mental health and substance use disorder practitioners licensed by the Division of Professional Licensure, the Department of Public Health, or any Board of Registration and deemed by the Department of Public Health to be mental health and substance use disorder professionals. (k) Licensed Applied Behavior Analyst. An applied behavior analyst 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 M.G.L. c. 13, § 88 through 90. (l) Staff to Administer Medication Services. In addition to the staff required in 130 CMR 448.413(B)(1) through (3), 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 community behavioral health center will 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 will have previous training or experience in personnel, fiscal, and data management, as described in 130 CMR 448.421. The same individual may serve as both the administrator and clinical program director. (2) Clinical Program Director. The community behavioral health center will designate a professional staff member to be the clinical program director responsible for the direction and performance of all professional staff members and services. The same individual may be designated as both the administrator and the clinical program director. If the clinical program director is designated to a separate individual, the clinical program director reports to the administrator. (a) The clinical program director will be independently licensed, certified, or registered to practice as a psychiatrist, psychologist, social worker, mental health counselor, marriage and family counselor, or advanced practice registered nurse and will be employed on a full-time basis. (b) The specific responsibilities of the clinical program director include 1. selection of clinical staff and maintenance of a complete staffing schedule; 2. establishment of job descriptions and assignment of staff; 3. accountability for adequacy and appropriateness of member care; 4. in conjunction with the medical director, accountability for employing adequate psychiatric staff to meet the psychopharmacological needs of members; 5. establishment and maintenance of policies and procedures for member care; 6. 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; 7. program evaluation; 8. development of in-service training for professional staff; and 9. establishment of a Quality Management Program. (3) Medical Director. (a) Center. Each center will designate at least one board-certified or board-eligible psychiatrist, responsible for establishing all medical policies and protocols and for supervising all medical services provided by the staff. The medical director for the center will possess a DEA X waiver registration for prescribing medications for opioid use disorder (MOUD). (b) YMCI and YCCS. A medical director overseeing the medical services provided in YMCI and YCCS will be a board-certified or board-eligible child psychiatrist. YMCI and YCCS services will be under the clinical and medical oversight of a single medical director. The same individual may serve as both the center, AMCI, Adult CCS, YMCI, and YCCS medical director. (c) AMCI and Adult CCS. AMCI and Adult CCS services will be under the clinical and medical oversight of a single medical director. The medical director for the AMCI and Adult CCS services will possess a DEA X waiver registration for prescribing medications for opioid use disorder (MOUD). The same individual may serve as both the center, AMCI, Adult CCS, YMCI, and YCCS medical director. (4) Psychiatrist or Advanced Practice Registered Nurse. The role of at least one psychiatrist or one advanced practice registered nurse will include the provision of psychiatric assessment, medication evaluations, and medical management and contribute to the comprehensive assessment and care planning, as clinically needed. (5) Assistant Program Director. Each center will identify an independently licensed behavioral health clinician who will support the clinical program director with all leadership functions, including clinical and administrative oversight, and quality of care across the community behavioral health center. (6) Quality Director. Each center will identify an individual to provide dedicated quality oversight. The quality director, or their designees, will implement and provide oversight of quality management programs for all services provided by the center. (7) Clinical Supervisor. Each center will identify independently licensed behavioral health clinicians sufficient to meet the needs of the center who will provide clinical supervision to direct service staff within each of the community behavioral health center service components, including AMCI, YMCI, Adult CCS, and YCCS. Clinical supervisors of clinicians providing community behavioral health center services to children and adolescents must have at least two years of experience treating youth and/or families. (8) Nurse Manager. Each center will employ a nurse manager (RN) to (a) provide supervision to nursing staff and oversight across community behavioral health center service components; (b) fill physician orders, administer medication, take vital signs, and coordinate medical care; (c) contribute to comprehensive assessment; (d) conduct brief crisis counseling and individualized risk management/safety planning; (e) provide psycho-education to members; and (f) assist with discharge planning and care coordination. (9) Each center will employ other staff necessary to support all administrative functions, such as clerical and security staff. Security staff will be trained with an approved behavioral support and management program, including skills in de-escalation, to maintain safety of all individuals and staff at all hours of operation. (D) Mobile Crisis Intervention Services Staff. (1) Adult Mobile Crisis Intervention must be provided under the direction of a physician and will utilize a multidisciplinary team minimally comprised of the following. (a) Clinical Program Director. An independently licensed, master’s level clinician who will serve as the AMCI clinical program director. The clinical program director will be responsible for the clinical oversight and quality of care for AMCI services and will ensure the provision of all service components, including emergency or urgent consultations. (b) Psychopharmacology Staff. At least one board-certified or board-eligible psychiatrist or advanced practice registered nurse (APRN) responsible for urgent psychopharmacology needs, including providing induction and bridging services for MOUD and a DEA X waiver to prescribe buprenorphine and experience treating individuals with SUD. (c) Other Multidisciplinary Staff. Each AMCI program will employ master’s and bachelor’s-level clinicians and staff sufficient to meet the needs of the members served, pursuant to 130 CMR 418.413(B)(3) and (4), including conducting medical screening, ongoing monitoring, and disposition determinations. This AMCI staff will include at least one certified peer specialist, and at least one recovery support navigator or peer recovery coach. (2) Youth Mobile Crisis Intervention (YMCI) must be provided under the direction of a physician, including a medical director, and will utilize a multidisciplinary team, including the following. (a) Clinical Program Director. An independently licensed, master’s level clinician who must serve as the YMCI clinical program director. The clinical program director must be responsible for the clinical oversight and quality of care for YMCI services and must ensure the provision of all service components, including emergency or urgent consultations. (b) Psychopharmacology Staff. At least one board-certified or board-eligible child psychiatrist or advanced practice registered nurse (APRN) will be responsible for urgent psychopharmacology needs, including medication management evaluations. (c) Multidisciplinary Staff. Each YMCI program will employ master’s and bachelor’s- level clinicians and staff sufficient to meet the needs of the members served, pursuant to 130 CMR 418.413(B)(3) and (4), including conducting medical screening, ongoing monitoring, and disposition determinations. This staff will include sufficient professional and paraprofessional staff to meet member needs. (E) Community Crisis Stabilization Services Staff. Adult Community Crisis Stabilization Services (Adult CCS) must be provided under the direction of a physician and shall employ a multidisciplinary team, including the following. (1) Clinical Program Director. An independently licensed, master’s level clinician who will serve as the Adult CCS clinical program director. The clinical program director will be responsible for the clinical oversight and quality of care for Adult CCS services and will ensure the provision of all service components, including emergency or urgent consultations. (2) Psychopharmacology Staff. Psychiatrist or advanced practice registered nurse (APRN) responsible for urgent psychopharmacology needs, providing induction and bridging services for MOUD and a DEA X waiver to prescribe buprenorphine and experience treating individuals with SUD. (3) Nurse Manager. At least one nurse manager (RN) responsible for supervision of all nursing staff for Adult CCS services. The nurse manager must meet all requirements pursuant to 130 CMR 448.413(C)(8)(b) through (d). (4) Multidisciplinary Staff. Each Adult CCS program will employ master’s and bachelor’s- level clinicians and staff sufficient to meet the needs of the members served, pursuant to 130 CMR 418.413(B)(3) and (4), including conducting medical screening, ongoing monitoring, and disposition determinations. This staff will include at least one certified peer specialist, or peer recovery coach, and at least one staff member per shift trained in CPR and one staff member per shift trained in the use of Naloxone in the event of overdose. (F) Youth Community Crisis Stabilization (YCCS). YCCS must be provided under the direction of a physician, and will utilize a multidisciplinary team, including the following. (1) Clinical Program Director. An independently licensed, master’s level clinician who will serve as the YCCS clinical program director. The clinical program director will be responsible for the clinical oversight and quality of care for YCCS services and will ensure the provision of all service components, including emergency or urgent consultations. (2) Psychopharmacology Staff. At least one child psychiatrist or psychiatric advanced practice registered nurse (APRN) with child/youth training. The child psychiatrist will provide psychiatric assessment, medication evaluations, and medical management and will contribute to the comprehensive assessment and discharge planning. The program may employ a psychiatric advanced practice registered nurse (APRN) to provide psychiatric care, within the scope of their license and under the supervision of a medical director or another attending child psychiatrist. (3) Nurse Manager. At least one nurse manager (RN) responsible for supervision of all nursing staff for YCCS services. The nurse manager must meet all requirements pursuant to 130 CMR 448.413(C)(8)(b) through (d). (4) Multidisciplinary Staff. Each Youth CCS program will employ master’s and bachelor’s- level clinicians and staff sufficient to meet the needs of the members served, pursuant to 130 CMR 418.413(B)(3) and (4), including conducting medical screening, ongoing monitoring, and disposition determinations. This staff will include sufficient professional and paraprofessional staff to meet member needs.