471 NAC 35-009. ASSERTIVE COMMUNITY TREATMENT (ACT)

009. ASSERTIVE COMMUNITY TREATMENT (ACT). The assertive community treatment (ACT) team provides high intensity services and must be available to provide treatment, rehabilitation, and support activities seven days per week, 24 hours per day, 365 days per year. The team must have the capacity to provide multiple contacts each day as dictated by beneficiary need. The team must provide ongoing continuous care for an extended period of time, and beneficiaries admitted to the service who demonstrate any continued need for treatment, rehabilitation, or support must not be discharged except by mutual agreement between the beneficiary and the team. Services provided must focus on treatment and rehabilitation of the effects of serious mental illness, as well as support and assistance in meeting such basic human needs as housing, transportation, education, and employment. 009.01 CLINICAL TEAM. assertive community treatment (ACT) must be provided by a self-contained clinical team which: (A)Assumes overall responsibility and clinical accountability for beneficiaries disabled by severe and persistent mental illness by directly providing treatment, rehabilitation, and support services and by coordinating care with other providers; (B)Does not refer beneficiaries to outside service providers when services are identified as a responsibility of the assertive community treatment (ACT) program as outlined in this chapter. ; (C)Provides services on a long-term basis with continuity of caregivers over time; (D)Delivers most of the services outside program offices; (E)Emphasizes outreach, relationship building, and individualization of services; ( (F)Provides psychiatric treatment and rehabilitation that is culturally sensitive and competent; and (G)Shares team roles expecting each staff member to know all the beneficiaries and assist in assessment, treatment planning, and care delivery as needed. 009.02 ADMISSION AND DISCHARGE CRITERIA. 009.02(A) ADMISSION CRITERIA. Nebraska Medicaid covers assertive community treatment (ACT) services for those persons disabled by severe and persistent mental illness who are unable to remain stable in community living without high intensity services. Assertive community treatment (ACT) services must be prior authorized by Nebraska Medicaid or its designee. To be eligible for assertive community treatment (ACT) services, beneficiaries must meet all of the criteria described in this chapter , and demonstrate indicators of high need and utilization. 009.02(B) DISCHARGE CRITERIA. The assertive community treatment (ACT) program is intended to provide services over a long period of time. Beneficiaries admitted to the service who demonstrate continued need for treatment, rehabilitation, or support must not be discharged except by mutual agreement between the beneficiary and the assertive community treatment (ACT) team. Discharge from the assertive community treatment (ACT) team occurs when the beneficiary and program staff mutually agree to termination of services. Specific documentation must be included in the beneficiary's clinical chart when a discharge occurs. Discharge may occur in the following situations: (i) GEOGRAPHIC RELOCATION. The beneficiary moves outside the team's geographic area of responsibility. In such cases, the assertive community treatment (ACT) team must arrange for transfer of mental health service responsibility to a provider wherever the beneficiary is moving. To meet this responsibility, the assertive community treatment (ACT) team must maintain contact with the beneficiary until this service transfer is arranged; (ii) SIGNIFICANTLY IMPROVED FUNCTIONING. The beneficiary demonstrates by functional assessment measurement the ability to function with minimal assistance in the following functional areas: vocation and education, social skills, and activities of daily living; (iii) BENEFICIARY REQUESTED DISCHARGE. Requested discharge despite the team's best efforts to develop an individual treatment, rehabilitation, and recovery plan acceptable to the beneficiary. Efforts to develop an acceptable individual treatment, rehabilitation, and recovery plan must be documented in the beneficiary's clinical record; and (iv) HOSPITALIZATION OF THE BENEFICIARY IN AN INSTITUTION FOR MENTAL DISEASE (IMD). Nebraska Medicaid is not able to reimburse for services provided to beneficiaries over age 20 and under age 64 who are being treated in an institution for mental disease (IMD). 009.03 STAFF REQUIREMENTS. Each assertive community treatment (ACT) team must provide a comprehensively staffed team, including a psychiatrist, team leader, a peer support person, and program assistants. The assertive community treatment (ACT) team must have among its staff individuals who are qualified to provide the required services. Each assertive community treatment (ACT) team must employ, at a minimum, the following number of clinical staff persons, peer support, and psychiatrists to provide the treatment, rehabilitative, and supportive services. Providers are responsible for verifying that staff are appropriately licensed or certified. 009.03(A) STAFF QUALIFICATIONS. All clinical staff must be appropriately licensed or credentialed as required by the Department of Health and Human Services, Division of Public Health. All clinical staff must have at least two years of experience working with persons with serious and persistent mental illness. All clinical staff must maintain sufficient hours of continuing education to maintain certification or licensure. 009.03(B) BACKGROUND CHECKS. The employer of the assertive community treatment (ACT) team members is responsible and accountable for the activities and interventions of the assertive community treatment (ACT) team staff. The employer must consider which type of criminal background and Abuse and Neglect Central Registry checks are appropriate for their staff and how the results impact hiring decisions. The use of criminal background and Abuse and Neglect Central Registry checks must be described in the employer’s policy and procedure manual and be available for review. 009.03(C) STAFF CONFIGURATION. The configuration of an assertive community treatment (ACT) team depends on the number of beneficiaries to be served. The assertive community treatment (ACT) team must maintain a 1:10 staff to beneficiary ratio. The team psychiatrist or mental health advanced practice registered nurse (APRN), if used, and program assistant are not included in the ratio: (i) MINIMUM STAFF CONFIGURATION. The following minimum staffing configuration must be met in each assertive community treatment (ACT) team regardless of the number of beneficiaries served. This configuration may serve up to 50 beneficiaries. The team must have at least one member who demonstrates competency in drug and alcohol use and dependence or is a licensed alcohol and drug counselor (LADC). The assertive community treatment (ACT) team must include: (1) TEAM PSYCHIATRIST. One team psychiatrist, who must be a board certified or board eligible psychiatrist. The team psychiatrist must provide coverage at a minimum of 16 hours per week. This psychiatry time must be spent exclusively on assertive community treatment (ACT) team activities. The team psychiatrist provides clinical services including psychiatric assessment, individual treatment, rehabilitation, and recovery plan development and approval, psychopharmacologic and medical treatment, and crisis intervention to all assertive community treatment (ACT) team beneficiaries. The team psychiatrist must be available 24 hours per day and seven days per week for crisis management. The team psychiatrist works with the team leader to monitor each beneficiary’s clinical status and response to treatment, provides staff clinical supervision, and participates in the development of all individual treatment, rehabilitation, and recovery plans; (2) TEAM LEADER. The team leader must be a psychiatrist, physician, physician assistant (PA), or advanced practice registered nurse (APRN), or have at least a master’s degree in nursing, social work, psychiatric rehabilitation, psychology, or counseling. The team leader must have demonstrated clinical and administrative experience; (3) MENTAL HEALTH PROFESSIONAL. One full time mental health professional who is a licensed psychologist, provisionally licensed psychologist, licensed independent mental health practitioner (LIMHP), licensed mental health practitioner (LMHP), or provisionally licensed mental health practitioner (LMHP); (4) NURSING STAFF. One full time registered nurse (RN); (5) MENTAL HEALTH WORKER. One full time mental health worker who meets one of the following qualifications: (a)Is a licensed alcohol and drug counselor (LADC); (b)Has a bachelor’s degree in psychology, sociology, or a behavioral health field; or (c)Has a bachelors' degree in a field other than behavioral sciences or has a high school degree, and has work experience with adults with severe and persistent mental illness or with individuals with similar human services needs; (6) SUBSTANCE USE SPECIALIST. One full time substance use specialist who meets one of the following qualifications: (a) Is a licensed alcohol and drug counselor (LADC) or a provisionally licensed alcohol and drug counselor (LADC); (b) Has at least one year of training or experience in substance use disorder treatment and is a licensed independent mental health practitioner (LIMHP), licensed mental health practitioner (LMHP), or provisionally licensed mental health practitioner (LMHP); (7) VOCATIONAL SPECIALIST. One full time vocational specialist with at least one year of training or experience in vocational rehabilitation and support; (8) ADDITIONAL STAFF. One additional full time staff person who meets the qualifications of the mental health professional or mental health worker; (9) PEER SUPPORT. A half time coverage of peer support. This team member position must be a self-identified consumer of mental health services. The peer support staff must have training, experience, and ability to work with the team in carrying out appropriate aspects of the individual treatment, rehabilitation, and recovery plan. The peer support staff must hold a certification through the Department of Health and Human Services, Division of Behavioral Health as a certified peer support provider; (10) SUPPORT STAFF. At least one full-time support staff person. Support staff is defined as a non-clinician responsible for working under the direction of the team leader to support all non-clinical operations of the assertive community treatment (ACT) team. This is a full time position and not considered in the staff to beneficiary ratio; (ii)ADVANCED PRACTICE REGISTERED NURSE (APRN) OPTIONAL CONFIGURATION. When a psychiatrist is not providing coverage, an advanced practice registered nurse (APRN) may substitute for coverage. The advanced practice registered nurse (APRN) may provide coverage for existing psychiatry time while not replacing the team psychiatrist responsibility in the above services. The advanced practice registered nurse (APRN) must work collaboratively with the psychiatrist. An advanced practice registered nurse (APRN) can provide services within their scope of practice, except for the mandatory services which must be delivered by the team psychiatrist as described in this chapter. The team psychiatrist must be available for consultation and direction of the treatment activities provided by the advanced practice registered nurse (APRN). There must be a documented agreement between the team psychiatrist and the advanced practice registered nurse (APRN) for 24 hours per day, seven days per week psychiatric coverage. A copy of the agreement must be sent to Nebraska Medicaid at the time of enrollment, prior to the initiation of services, and at any time the agreement is modified or terminated; (iii) EXPANDED STAFF CONFIGURATION. If an assertive community treatment (ACT) team will serve more than 50 beneficiaries, the following staff must be added: (1) REGISTERED NURSE (RN). At least one additional registered nurse (RN) to meet the nursing needs of the expanded population; (2) PEER SUPPORT. At least one full time peer support specialist; (3) TEAM PSYCHIATRIST. Additional psychiatric coverage of 2.6 hours for every eight beneficiaries; (4) MENTAL HEALTH PROFESSIONAL. At least two mental health professionals; and 5) ADDITIONAL STAFF. Additional staff to maintain a minimum 1:10 staff to beneficiary ratio. This ratio excludes the team psychiatrist, and advanced practice registered nurse (APRN) if used, and the program assistant. The configuration of the assertive community treatment (ACT) team must reflect the needs of the beneficiary population. 009.03(D) STAFF FUNCTIONS. The assertive community treatment (ACT) team must perform the following functions: (i) CLINICAL SUPERVISION. All members of the assertive community treatment (ACT) team who are not licensed to practice independently must have clinical supervision. A member of the assertive community treatment (ACT) team who is a psychiatrist, advance practice registered nurse (APRN), or a licensed independent mental health practitioner (LIMHP), must be designated as the clinical supervisor. The clinical supervisor must have regular contact with the client and with members of the assertive community treatment (ACT) team who are not independently licensed to practice. Clinical supervision must include: (1)Review of the beneficiary’s clinical status; (2)Ensuring appropriate treatment services are provided to the beneficiary; (3)Review and improvement of the assertive community treatment (ACT) team member’s service provision; (4)Provision of clinical supervision during daily team meetings, individual treatment, rehabilitation, and recovery plan meetings, side-by-side and face-to-face supervision sessions, and through a review of the beneficiary’s clinical record; and (5) Appropriate documentation of clinical supervision activities; (ii) CRISIS INTERVENTION AND RESPONSE. In addition to the beneficiary specific crisis intervention plans, the assertive community treatment (ACT) team must have a procedure to respond to emergencies and crises; (iii) ASSESSMENT. Initial and updated assessments of the beneficiary must be provided as described in this chapter. Appropriate staff must be assigned to this function based on individualized beneficiary need. The beneficiary and their family, as allowed by beneficiary permission, must be involved in all assessments; (iv) TREATMENT PLANNING. Initial and updated individual treatment, rehabilitation, and recovery plans must be developed as described in this chapter. In addition to the team leader and team psychiatrist, appropriate staff must be assigned to this function based on individualized beneficiary need. One specific staff person must be designated to document the individual treatment, rehabilitation, and recovery plan for the clinical record. The beneficiary and their family, as allowed by beneficiary permission, must be involved in development, review, and revision of all individual treatment, rehabilitation, and recovery plans; (v) INDIVIDUAL TREATMENT, REHABILITATION, AND RECOVERY PLAN COORDINATION. individual treatment, rehabilitation, and recovery plan coordination is an organized process of coordination among the multi-disciplinary team in order to provide a full range of appropriate treatment, rehabilitation, and support services to a beneficiary in a planned, coordinated, efficient, and effective manner, as outlined in the individual treatment, rehabilitation, and recovery plan; and (vi) INTERVENTIONS. Based on individualized beneficiary need and preference and assertive community treatment (ACT) team qualifications, experience, and training, assertive community treatment (ACT) team members must be assigned to provide the active treatment, rehabilitative, and supportive services described in this chapter. 009.04 ACT PROGRAM ORGANIZATION. 009.04(A) HOURS OF OPERATION, COVERAGE, AND AVAILABILITY OF SERVICES. The assertive community treatment (ACT) team must meet the following requirements related to availability and scheduling: (i) HOURS OF OPERATION AND AVAILABILITY OF SERVICES. The assertive community treatment (ACT) team must be available to provide treatment, rehabilitation, and support interventions 24 hours per day, seven days per week, 365 days a year. The assertive community treatment (ACT) team must be able to: (1)Meet the beneficiaries needs at all hours of the day including evenings, weekends, and holidays; (2)Provide services at the time that is most appropriate and natural for the beneficiary as described in the beneficiary’s individual treatment, rehabilitation, and recovery plan; and (3)Operate a minimum of 12 hours per day and eight hours each weekend day and every holiday; and (ii) PSYCHIATRIC COVERAGE. Psychiatric coverage must be available at all times. If availability of the team psychiatrist during all hours is not feasible, alternative psychiatric backup must be arranged. The covering psychiatrist or advanced practice registered nurse (APRN) must have an orientation to the assertive community treatment (ACT) team concept and be supportive of its services. The covering psychiatrist or advanced practice registered nurse (APRN) must be able to get beneficiary specific information from an assertive community treatment (ACT) team member. 009.04(B) SERVICE INTENSITY. The assertive community treatment (ACT) team services must be able to provide the level of service intensity as dictated by beneficiary need. Beneficiary need is determined through the severity of symptoms and limitations in daily living and is documented in the beneficiary’s individual treatment, rehabilitation, and recovery plan. No other psychiatric service or psychiatric rehabilitation service may be reimbursed, except for acute and subacute inpatient hospitalization for assessment and stabilization, when prior authorized by Nebraska Medicaid or its designee. 009.04(C) PLACE OF SERVICE. The assertive community treatment (ACT) team must provide most of the interventions and service contacts in the community, in non-office-based settings. 009.04(D) SHARED RESPONSIBILITY. The responsibility of the total beneficiary caseload is shared by the entire assertive community treatment (ACT) team, even though team members can serve as a primary contact for certain beneficiaries. 009.04(E) STAFF COMMUNICATION AND PLANNING. The assertive community treatment (ACT) team must use systems and methods for continuous daily communication and planning. These must include: (i) DAILY ORGANIZATIONAL STAFF MEETING. A daily organizational staff meeting must be held to review the status of all program beneficiaries, update the team on contacts provided in the past 24 hours and to communicate essential information on current events and activities as they relate to the interventions provided by the assertive community treatment (ACT) team; (ii) DAILY TEAM ASSIGNMENT SCHEDULE. The daily team assignment schedule must list all of the interventions that need to be provided on that day and the assertive community treatment (ACT) team member assigned to complete the intervention; (iii) DAILY LOG. A daily log must be used to document that a beneficiary review has occurred; (iv) CLIENT WEEKLY CONTACT SCHEDULE. The client weekly contact schedule must be a written schedule of all treatment, rehabilitation, and support interventions which staff must carry out to fulfill the goals and objectives in the beneficiary’s individual treatment, rehabilitation, and recovery plan; and (v) INDIVIDUAL TREATMENT, REHABILITATION, AND RECOVERY PLAN MEETINGS. treatment, rehabilitation, and recovery plan meetings must be regularly scheduled meetings to identify and assess individual beneficiary needs and problems; to establish measurable long- and short-term treatment and service goals; to plan treatment and service interventions; and to assign staff persons responsible for providing the services. If the beneficiary and their family are not able to participate, the meeting must include their input. Appropriate support must be provided to maximize the participation of the beneficiary and their family. If necessary, the individual treatment, rehabilitation, and recovery plan should address any barriers to participation. The assertive community treatment (ACT) team must conduct individual treatment, rehabilitation, and recovery plan meetings, under the supervision of the team leader and team psychiatrist. 009.05 PROGRAM COMPONENTS AND INTERVENTIONS. Operating as a continuous treatment and rehabilitative service, the assertive community treatment (ACT) team must have the capability to provide assessment, comprehensive treatment, rehabilitation, and support services as a self-contained clinical service unit. Services must be available 24 hours a day, seven days a week, 365 days per year. Services must be provided by the most appropriate assertive community treatment (ACT) team members operating within their scope of practice. Services must include: 009.05(A) ASSESSMENT AND EVALUATION. : 009.05(A)(i) INITIAL ADMISSION ASSESSMENT. Prior to accepting the beneficiary for admission, the assertive community treatment (ACT) team must assess and determine the appropriateness of the beneficiary for admission to the assertive community treatment (ACT) team program. The assessment must include a review of clinical information and beneficiary interview and may include additional assessment activities. 009.05(A)(ii) COMPREHENSIVE ASSESSMENT. The comprehensive assessment is unique to the assertive community treatment (ACT) program in its scope and completeness. A comprehensive assessment is the process used to evaluate a beneficiary's past history and current condition in order to identify strengths and problems, outline goals, and create a comprehensive individual treatment, rehabilitation, and recovery plan. The comprehensive assessment reviews information from all available resources including past medical records, beneficiary self-report, interviews with family or significant others if approved by the beneficiary, and other appropriate resources, as well as current assessment by team clinicians from all disciplines. A comprehensive assessment must be initiated and completed within 30 days after the beneficiary's admission to the assertive community treatment (ACT) program, according to the following requirements: (1) Each assessment area must be completed by staff with skill and knowledge in the area being assessed and must be based upon all available information and resources, including beneficiary self-reports, reports of family members and other significant parties, written summaries from other agencies, including police, courts, and outpatient and inpatient facilities, interviews with the beneficiary, and standardized assessment materials; (2)The comprehensive assessment must include a thorough medical and psychiatric evaluation and must identify beneficiary strengths as well as problems. The assessment must gather sufficient information to develop an individual treatment, rehabilitation, and recovery plan; and (3)The comprehensive assessment may be added to, revised, or clarified during a beneficiary’s tenure in the assertive community treatment (ACT) program. 009.05(B) INDIVIDUAL TREATMENT, REHABILITATION, AND RECOVERY PLAN DEVELOPMENT AND COORDINATION. Individual treatment, rehabilitation, and recovery plan development and coordination is a continuing process involving each beneficiary, the beneficiary's family, guardian, and support system as appropriate, and the team, which individualizes service activity and intensity to meet beneficiary-specific treatment, rehabilitation, and support needs. The written individual treatment, rehabilitation, and recovery plan documents the beneficiary's goals and the services the beneficiary will receive in order to achieve them. The plan also delineates the roles and responsibilities of the team members who will carry out the services. An initial individual treatment, rehabilitation, and recovery plan must be developed upon the beneficiary’s admission to the assertive community treatment (ACT) team. The comprehensive individual treatment, rehabilitation, and recovery plan must be developed for each beneficiary within 21 days of the completion of the comprehensive assessment. This individual treatment, rehabilitation, and recovery plan will be developed and revised according to this section. 009.05(B)(i) COMPREHENSIVE INDIVIDUAL TREATMENT, REHABILITATION, AND RECOVERY PLAN DEVELOPMENT. A comprehensive individual treatment, rehabilitation, and recovery plan is developed through an organized process of coordination among the multi-disciplinary team in order to provide a full range of appropriate treatment, rehabilitation, and support services to the beneficiary in a planned, coordinated, efficient, and effective manner. The comprehensive individual treatment, rehabilitation, and recovery plan provides a systematic approach for meeting a beneficiary's needs, treatment rehabilitation, and support needs, and documenting progress on treatment, rehabilitation, and service goals. 009.05(B)(i)(1) KEY AREAS. The following key areas must be addressed in the individual treatment, rehabilitation, and recovery plan based upon the individual needs of the beneficiary: symptom stability, symptom management and education, housing, activities of daily living, employment and daily structure, family and social relationships, and crisis support. The individual treatment, rehabilitation, and recovery plan must be developed in collaboration with the beneficiary or guardian, if any, and, when appropriate, the beneficiary’s family. The beneficiary's participation and consent in the development of the individual treatment, rehabilitation, and recovery plan must be documented. The plan must be signed by the beneficiary and the team psychiatrist. This plan must: (a)Identify the beneficiary's needs and problems; (b)List specific long- and short-term goals with specific measurable objectives for these needs and problems; (c)List the specific treatment and rehabilitative interventions and activities necessary for the beneficiary to meet these objectives and to improve their capacity to function in the community; and (d)Identify the assertive community treatment (ACT) team members who will be providing the intervention. 009.05(B)(ii) INDIVIDUAL TREATMENT, REHABILITATION, AND RECOVERY PLAN REVIEWS. The assertive community treatment (ACT) team must review and revise the beneficiary's individual treatment, rehabilitation, and recovery plan every six months, whenever there is a major decision point in the beneficiary's course of treatment, or more often if necessary. The team psychiatrist, team leader, and appropriate staff from the assertive community treatment (ACT) team must participate in each individual treatment, rehabilitation, and recovery plan review. The assertive community treatment (ACT) team must include the beneficiary in the review. Guardians and family members should be encouraged to participate, as allowed by the beneficiary. 009.05(B)(ii)(1) DOCUMENTATION. The individual treatment, rehabilitation, and recovery plan review must be documented in the beneficiary's clinical record. This documentation must include a description of the beneficiary's progress and functioning since the last individual treatment, rehabilitation, and recovery plan review, the beneficiary's current functional strengths and limitations, a list of attendees, the discussion related to the individual treatment, rehabilitation, and recovery plan, and any changes to the plan. The plan and review will be signed by the beneficiary and the team psychiatrist, which indicates this is the most appropriate level of care for the beneficiary and that the treatment, rehabilitative, and service interventions are medically necessary. 009.05(B)(iii) BENEFICIARY AND FAMILY PARTICIPATION. The assertive community treatment (ACT) team is responsible for engaging the beneficiary in active involvement in the development of the treatment and service goals. With the permission of the beneficiary, assertive community treatment (ACT) team staff must involve pertinent agencies and members of the beneficiary's family and social network in the formulation of individual treatment, rehabilitation, and recovery plans. 009.05(C) TREATMENT, REHABILITATIVE, AND SUPPORTIVE INTERVENTIONS. The assertive community treatment (ACT) team must be able to provide treatment, rehabilitative, and supportive interventions to beneficiaries assigned to the assertive community treatment (ACT) team. The interventions are categorized into three areas and the specific application of each type of intervention must be based on the beneficiary’s specific goals and objectives. The interventions must address the needs identified in the comprehensive assessment. While there are no requirements that the beneficiary receive a minimum number of a specific categories of intervention, the beneficiary must receive the interventions that are appropriate for their needs. 009.05(C)(i) TREATMENT INTERVENTIONS. All interventions must be performed by professionals acting within the appropriate scope of practice. 009.05(C)(i)(1) MEDICAL ASSESSMENT, MANAGEMENT, AND INTERVENTION. The assertive community treatment (ACT) team must provide the interventions necessary to treat the beneficiary’s psychiatric and physical conditions. 009.05(C)(i)(2) INDIVIDUAL, FAMILY, AND GROUP THERAPY OR COUNSELING. The assertive community treatment (ACT) team must provide individual, family, and group therapy or counseling to assist the beneficiary to gain skills in interpersonal relationships, identify and resolve conflicts, and systematically work on identified individual goals. These interventions must focus on lessening distress and symptomology, improving psychological defenses and role functioning, and increasing and reinforcing the beneficiary's understanding of and participation in treatment, rehabilitative services, and activities of daily living. 009.05(C)(i)(3) MEDICATION. The assertive community treatment (ACT) team must provide the prescription, preparation, delivery, administration, and monitoring of medications. 009.05(C)(i)(4) CRISIS INTERVENTION. The assertive community treatment (ACT) team must provide crisis intervention services by assessing beneficiary needs that require immediate attention and initiate a resolution to the need. 009.05(C)(i)(5) SUBSTANCE USE DISORDER SERVICES. The assertive community treatment (ACT) team must provide Substance use disorder services to assist the beneficiary in achieving periods of abstinence and stability. The interventions must include assessment, individual and group counseling, education, and skill development. The interventions should help the beneficiary: (a)Learn to identify substance use, effects, and patterns; (b)Recognize the relationship between substance use, mental illness, and psychotropic medications; and (c)Develop motivation to eliminate or decrease substance use and coping skills or alternatives to minimize substance use. 009.05(C)(ii) REHABILITATIVE INTERVENTIONS. 009.05(C)(ii)(1) SYMPTOM MANAGEMENT SKILL DEVELOPMENT. The assertive community treatment (ACT) team must provide symptom management skill development to help the beneficiary cope with and gain mastery over symptoms and functional impairments in the context of adult role functioning. 009.05(C)(ii)(2) VOCATIONAL SKILL DEVELOPMENT. The assertive community treatment (ACT) team must provide vocational skill development that includes individualized assessment and planning for employment based upon functional assessment and the beneficiary's needs, desires, interests, and abilities. 009.05(C)(ii)(3) ACTIVITIES OF DAILY LIVING AND COMMUNITY LIVING SKILL DEVELOPMENT. The assertive community treatment (ACT) team must provide services to help the beneficiary rehabilitate their functional impairments and limitations related to activities of daily living and living in a community setting. The services will help beneficiaries carry out personal hygiene and grooming tasks, perform household activities, find housing that is safe and affordable, develop or improve money management skills, use available transportation, and have and effectively use a personal physician and dentist. 009.05(C)(ii)(4) SOCIAL AND INTERPERSONAL SKILL DEVELOPMENT. The assertive community treatment (ACT) team must provide interventions to help the beneficiary rehabilitate their social functioning. 009.05(C)(ii)(5) LEISURE TIME SKILL DEVELOPMENT. The assertive community treatment (ACT) team must provide interventions to rehabilitate the beneficiary’s ability to use leisure time appropriately. 009.05(C)(iii) SUPPORTIVE INTERVENTIONS. 009.05(C)(iii)(1) ASSISTANCE. The assertive community treatment (ACT) team must provide support services, direct assistance, and coordination to ensure that the beneficiary obtains the basic necessities of daily life. 009.05(C)(iii)(2) SUPPORT. The assertive community treatment (ACT) team must provide support to beneficiaries, on a planned and as needed basis, to help them accomplish their personal goals, gain a sense of personal mastery and empowerment, and to cope with the stresses of day-to-day living. This includes interaction that focuses on decreasing distress, improving understanding and reinforcing the beneficiary’s participation in services. 009.05(C)(iii)(3) FAMILY INVOLVEMENT. The assertive community treatment (ACT) team will provide education, support, and consultation to beneficiaries’ families and other major supports, with beneficiary agreement and consent. The assertive community treatment (ACT) team must encourage family members and other major sources of support to be involved in the services received by the beneficiary unless prohibited by the beneficiary, through legal action, or because of confidentiality laws. This includes education about the beneficiary's illness and condition and the role of the family in the therapeutic process, intervention to resolve conflict, and ongoing communication and collaboration between the assertive community treatment (ACT) team and the beneficiary’s family. 009.05(C)(iii)(4) POSITIVE PEER ROLE MODELING. The assertive community treatment (ACT) team will offer opportunities for positive peer role modeling and peer support including practical problem-solving approaches to daily challenges, peer perspective on steps to recovery and support, mentoring toward greater independence, empowerment, and ability to manage severe symptomology. 009.06 NATIONAL ACCREDITATION AND CERTIFICATION. Providers must be nationally accredited under specific assertive community treatment (ACT) team standards , or must be actively pursuing accreditation in order to be enrolled. Providers that are actively pursuing accreditation with a national body must submit their accreditation plan for consideration. Providers actively pursuing accreditation will be enrolled on a provisional status. 009.07 CLINICAL DOCUMENTATION REQUIREMENTS. Records must be kept in accordance with the national accreditation body surveying the provider. The clinical records for assertive community treatment (ACT) team services must include the following information: (A)Team psychiatrist's orders; (B)Treatment, rehabilitation, and service planning; (C)Progress and contact notes must be recorded by all assertive community treatment (ACT) team members providing services to the beneficiary; (D)Reports of consultations, laboratory results, and other relevant clinical and medical information; and (E)Documentation of transition and discharge planning. 009.08 PERFORMANCE IMPROVEMENT AND PROGRAM EVALUATION. The assertive community treatment (ACT) team must have a performance improvement and program evaluation plan that meets the criteria for accreditation in the approved national accreditation organization. In addition, the program will participate in all aspects of statewide assertive community treatment (ACT) evaluation projects. 009.09 PROVIDER ENROLLMENT. An assertive community treatment (ACT) team must complete the appropriate Nebraska Medicaid approved provider agreement form, and submit the completed agreement and a program overview that addresses the requirements in these regulations to Nebraska Medicaid for approval. The assertive community treatment (ACT) team must maintain written policies and procedures that document compliance with all of the standards and requirements in this chapter . Annual updates of enrollment may be required. The provider must submit updates of the identity and expertise of assertive community treatment (ACT) team members as new staff are added to the program. 009.10 PRIOR AUTHORIZATION. Reimbursement for services from the assertive community treatment (ACT) team must be prior authorized by Nebraska Medicaid or its designee. 009.11 TELEHEALTH. Assertive community treatment (ACT) team interventions can be provided via telehealth when provided according to this title . 009.12 REIMBURSEMENT AND BILLING INFORMATION. Nebraska Medicaid pays for assertive community treatment services at established rates. Providers must follow these billing requirements: (A)Claims for services provided by the assertive community treatment (ACT) team must be billed on the appropriate completed Nebraska Medicaid approved health care claim form ; (B)Claims for assertive community treatment (ACT) team services must use the procedure codes determined by Nebraska Medicaid ; and (C)The unit of service for assertive community treatment (ACT) team reimbursement is one day. 009.13 LIMITATIONS ON THE REIMBURSEMENT FOR ASSERTIVE COMMUNITY TREATMENT (ACT) TEAM SERVICES. Nebraska Medicaid eligibility for beneficiaries age 21 to 64 who are admitted to an institution for mental disease (IMD) for longer than ten days will end .