Program Requirement Four (4): Scope of Services – Crisis Behavioral Health

Program Requirement Four (4): Scope of Services – Crisis Behavioral Health Services A. The CCBHC shall provide crisis services directly or through a DCO agreement with existing state-sanctioned, certified, or licensed system or network for the provision of crisis behavioral health services. HHS recognizes that state-sanctioned crisis systems may operate under different standards than those identified in these criteria. If a CCBHC would like to have a DCO relationship with a state-sanctioned crisis system that operates under less stringent standards, they must request approval from DMH to do so. DMH will review and submit this request to HHS for approval. B. PAMA requires provision of these three (3) crises behavioral health services, whether provided directly by the CCBHC or by a DCO: 1. Emergency crisis intervention services: The CCBHC provides or coordinates with telephonic, text, and chat crisis intervention call centers that meet 988 Suicide and Crisis Hotline standards for risk assessment and engagement of people at imminent risk of suicide. The CCBHC should participate in any state, regional, or local air traffic control (ATC) systems which provide quality coordination of crisis care in real-time as well as any service capacity registries as appropriate. It may involve real-time connection to GPS-enabled mobile teams, true system-wide access to available beds, and outpatient appointment scheduling through the integrated crisis call center. Quality coordination means that protocols have been established to track referrals made from the call center to the CCBHC or its DCO crisis care provider to ensure the timely delivery of mobile crisis team response, crisis stabilization, and post crisis follow-up care. 2. Twenty-Four (24)-hour mobile crisis teams: The CCBHC provides community-based behavioral health crisis intervention services using mobile crisis teams 24 hours per day, seven (7) days per week to adults, children, youth, and families anywhere within the service area including at home, work, or anywhere else where the crisis is experienced. Mobile crisis teams are expected to arrive in-person within one (1) hour (two [2] hours in rural settings) from the time that they are dispatched, with response time not to exceed three (3) hours. Telehealth/telemedicine may be used to connect people in crisis to qualified mental health providers during the interim travel time. Technologies also may be used to provide crisis care to people when remote travel distances make the two (2)-hour response time unachievable, but the ability to provide an in-person response must be available when it is necessary to assure safety. The CCBHC should consider aligning their programs with the CMS Medicaid Guidance on the Scope of and Payments for Qualifying Community-Based Mobile Crisis Intervention Services. 3. Crisis receiving/stabilization: The CCBHC provides crisis receiving/stabilization services that must include at minimum, urgent care/walk-in mental health and substance use disorder services for voluntary persons. Urgent care/walk-in services that identify the person’s immediate needs, de-escalate the crisis, and connect them to a safe and least-restrictive setting for ongoing care (including care provided by the CCBHC). Walk-in hours are informed by the community needs assessment and include evening hours that are publicly posted. The CCBHC should have a goal of expanding the hours of operation as much as possible. Ideally, these services are available to people of any level of acuity; however, the facility need not manage the highest acuity people in this ambulatory setting. Crisis stabilization services should ideally be available 24 hours per day, seven (7) days a week, whether people present on their own, with a concerned person, such as a family member, or with a human service worker, and/or law enforcement, in accordance with state and local laws. In addition to these activities, the CCBHC may consider supporting or coordinating with peer-run crisis respite programs. The CCBHC is encouraged to provide crisis receiving/stabilization services in accordance with the SAMHSA National Guidelines for Behavioral Health Crisis Care. (Reference Source: Air traffic control (ATC) serves as a conceptual model for real- time coordination of crisis care and linkage to crisis response services. It may involve real-time connection to GPS-enabled mobile teams, true system-wide access to available beds, and outpatient appointment scheduling through the integrated crisis call center. For more information, refer to National Guidelines for Behavioral Health Crisis Care - SAMHSA.) C. Services provided must include suicide prevention and intervention, and services capable of addressing crises related to substance use including the risk of drug and alcohol related overdose and support following a non-fatal overdose after the person is medically stable. Overdose prevention activities must include ensuring access to naloxone for overdose reversal to people who are at risk of opioid overdose, and as appropriate, to their family members. The CCBHC or its DCO crisis care provider should offer developmentally appropriate responses, sensitive de-escalation supports, and connections to ongoing care, when needed. The CCBHC will have an established protocol specifying the role of law enforcement during the provision of crisis services. As a part of the requirement to provide training related to trauma-informed care, the CCBHC shall specifically focus on the application of trauma-informed approaches during crises. Note: Refer to the program requirement regarding access to crisis services and criterion regarding coordination of services and treatment planning, including after discharge from a hospital inpatient or emergency department following a behavioral health crisis. (Reference Source: For information on crisis services for children and youth, refer to SAMHSA’s National Guidelines for Child and Youth Behavioral Health Crisis Care and A Safe Place to Be: Crisis Stabilization Services and Other Supports for Children and Youth)