471 NAC 32-005. TREATMENT CRISIS INTERVENTION SERVICES

005. TREATMENT CRISIS INTERVENTION SERVICES. Crisis intervention services are available to beneficiaries age 20 or younger when the treatment of a condition needing care leads to a health check or Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screen and the treatment is clinically necessary. Crisis intervention services are appropriate for a family in the midst of a child or adolescent mental health or substance use disorder crisis. The interventions focus on reducing stress and helping resolve the crisis in a positive manner, and facilitating the beneficiary's involvement to treatment. Crisis intervention services must meet all requirements in this chapter. All crisis intervention service providers must facilitate a referral for a complete health check or Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screen within eight weeks of the crisis intervention. This referral must be documented in the beneficiary's clinical record. 005.01 SERVICE REQUIREMENTS. Crisis intervention services must be family-centered, community-based, developmentally appropriate, culturally competent, and must take into account the individual needs of beneficiaries age 20 and younger. 005.02 FAMILY COMPONENT. Providers must encourage family members to be involved in the assessment of the beneficiary, the development of the treatment plan, and all aspects of the beneficiary's treatment unless prohibited by the beneficiary, through legal action, or because of federal confidentiality laws. Providers must be available to schedule meetings and sessions in a flexible manner to accommodate and work with a family's schedule. This includes the ability to schedule sessions at a variety of times including weekends or evenings. The provider must document their attempts to involve the family in treatment plan development and treatment plan reviews. A variety of means of communication should be considered. 005.03 TYPES OF CRISIS INTERVENTION SERVICES. One of the following services must be included in a crisis intervention program to be approved for participation in Nebraska Medicaid . 005.03(A) NON-RESIDENTIAL CRISIS INTERVENTION. Non-residential crisis intervention services are provided to the family and beneficiary outside of a residential or institutional setting. This service includes supportive services therapy, brief assessment, and coordination services to help a family alleviate a crisis. These services must be directed by a supervising practitioner and psychiatric consultation must be readily available. Some assessment and intervention activities may be carried out by a clinical professional who is acting within their scope of practice under the direction of a supervising practitioner. The provider must have the capacity to respond to the family to unscheduled crisis intervention contacts 24 hours a day, seven days a week. 005.03(B) DAY RESIDENTIAL CRISIS INTERVENTION. Day residential crisis intervention services are provided to families when a safe and secure setting is needed to provide a therapeutic milieu for a child or adolescent for up to 23 hours and 59 minutes. This level is used when a brief stay in a secure setting will facilitate a de-escalation of the crisis. These services must be directed by a supervising practitioner with access to psychiatric consultation. The milieu and direct care interventions may be staffed by clinical professionals or technicians, under the direction of a supervising practitioner. 005.03(C) RESIDENTIAL ACUTE CRISIS INTERVENTION. Residential acute crisis intervention services are available to children and adolescents experiencing acute psychiatric crisis. The program provides crisis treatment and close supervision to stabilize a beneficiary and facilitate admission to the most appropriate treatment setting. The milieu and direct care interventions may be staffed by clinical professionals or technicians, under the direction of a supervising practitioner. 005.03(D) PROVIDERS OF CRISIS INTERVENTION SERVICES. Providers of crisis intervention services must facilitate the referral to or provide the initial diagnostic interview if it has not already occurred. 005.04 STANDARDS FOR PARTICIPATION AS A PROVIDER OF CRISIS INTERVENTION SERVICES. Programs must meet the following standards to participate in Nebraska Medicaid as a provider of crisis intervention service in addition to the standards listed in this chapter. 005.04(A) PROVIDER AGREEMENT. The provider must submit the following with the appropriate Nebraska Medicaid approved provider agreement form F: (i)A written overview of the program's philosophy and objectives of treating youth including: (1)A description of each available service; (2)A list of treatment modalities available and the capacity for individualized treatment planning; (3)A statement of qualification, education, and experience of each staff member providing treatment and the supervising practitioner and the therapeutic services each provides; (4)A schedule covering the total number of hours that the program operates; (5)A program overview; and (6)Any other information requested by Nebraska Medicaid; and (ii)Copies of licensure and certification, through the Nebraska Department of Health and Human Services, Division of Public Health, the Joint Commission , Council on Accreditation (COA), American Osteopathic Association (AOA) or Commission on the Accreditation of Rehabilitation Facilities (CARF) as appropriate. 005.04(B) STAFFING STANDARDS FOR PARTICIPATION. An agency providing crisis intervention services for children and adolescents must meet the following staffing standards to participate in Nebraska Medicaid : (i)All services must be provided under the supervision of the supervising practitioner. This practitioner must be available at all times for consultation or face-to-face beneficiary assessment; and (ii)Direct intervention services must be provided by a clinical staff person who is acting within their scope of practice . 005.04(C) PLACE OF SERVICE. Crisis intervention services may be provided in any of the following locations: (i)The beneficiary's home; (ii)A physician's private office; (iii)A community mental health program which meets the criteria for approval by the Joint Commission or is accredited by Commission on the Accreditation of Rehabilitation Facilities (CARF), Council on Accreditation (COA), or American Osteopathic Association (AOA), and is appropriately licensed by the Nebraska Department of Health and Human Services, Division of Public Health; (iv)A hospital licensed and certified by the State of Nebraska which is accredited by the Joint Commission or American Osteopathic Association (AOA) and has in effect a utilization review plan applicable to all Nebraska Medicaid beneficiaries; (v)The private office of a licensed practitioner of the healing arts who is licensed by the Nebraska Department of Health and Human Services, Division of Public Health; (vi)The beneficiary's school; (vii)Other appropriate locations to meet the beneficiary needs for intervention; or (viii)A facility enrolled as a residential treatment center or therapeutic group home (ThGH) under this chapter . 005.04(D) ANNUAL UPDATE. The provider must submit the following information on an annual basis: (i)An overview of any changes in the program including any new services; (ii)A current list of staff; and (iii)Current copies of all licenses, letters of accreditation, and certifications. 005.05 COVERED SERVICES. Payment for crisis intervention services under Nebraska Medicaid is limited to services for clinically necessary primary psychiatric diagnoses. Nebraska Medicaid covers the following crisis intervention services: (A)Active treatment, which must be: (i)Provided under the supervision of the supervising practitioner by clinical staff members acting within their scope of practice ; and (ii)Reasonably expected to improve the beneficiary's condition or resolve the crisis. The treatment interventions must, at a minimum, be designed to reduce or control the beneficiary's symptoms to facilitate the resolution of a crisis or prevent the need for care in a more restrictive level of care. 005.05(A) SPECIAL TREATMENT PROCEDURES IN CRISIS INTERVENTION SERVICES. If a child or adolescent needs behavior management and containment beyond unlocked time outs or redirection, special treatment procedures may be utilized. For crisis intervention services provided in therapeutic group homes (ThGH), please refer to the sections covering those services. For crisis intervention services provided in the child or adolescent's home, school, or other appropriate location, special treatment procedures is limited to physical restraint. Mechanical restraints and pressure point tactics are not allowed. Parents, the legal guardian, or Nebraska Medicaid case manager must approve use of these procedures and must be informed within 24 hours each time they are used. Facilities must meet the following standards regarding special treatment procedures: (i) De-escalation techniques must be taught to staff and used appropriately before the initiation of special treatment procedures; (ii) Special treatment procedures may be used only when a child or adolescent's behavior presents a danger to self or others, or to prevent serious disruption to the therapeutic environment; (iii) The child or adolescent's treatment plan must address the use of special treatment procedures and have a clear plan to decrease the behavior requiring intervention; and (iv) Attempts to de-escalate, the special treatment procedure, and subsequent processing must be documented in the clinical record and reviewed by the supervising practitioner. 005.06 ADMISSION CRITERIA. The provider of crisis intervention services must develop admission criteria for the types of services they provide. The admission criteria must be approved by Nebraska Medicaid as part of the provider enrollment. 005.07 DOCUMENTATION IN BENEFICIARY’S MEDICAL RECORD. Providers of crisis intervention services must follow the standards for clinical records specified in this chapter. Clinical records for crisis intervention services must also include, at a minimum, the following: (A)The referral source and description of the crisis; (B)The provider's plan to facilitate referrals to the appropriate ongoing care for the family; and (C)The follow-up contacts with the beneficiary or family, or both. 005.08 LIMITATIONS. Nebraska Medicaid limits payment for crisis intervention to medically necessary services, subject to Nebraska Medicaid's utilization review. This period includes an average crisis resolution period of three to five days with an occasional need for up to seven days when the beneficiary's condition dictates. Payment for crisis intervention services is not available for services past seven days. 005.09 PAYMENT FOR CRISIS INTERVENTION SERVICES. If crisis intervention services are provided in the home between the hours of 10:00 p.m. and 8:00 a.m., the fee will be paid at one- and one-half times the regular rate. This shift differential is only available for unscheduled emergency services that are part of a crisis intervention service.