Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-44.1 - Community mental health rehabilitative services

Current through June, 2024
(a) Medical
				  payments to eligible providers may be made for the following types of community
				  mental health rehabilitative services:
(1)
				  Crisis management: This service provides mobile assessment for individuals in
				  active state of crisis (twenty-four hours per day, seven days a week).
				  Immediate response is required. Crisis management services include referral to
				  licensed psychiatrist, licensed psychologist, or to an inpatient acute care
				  hospital. The presenting crisis situation may necessitate that the services be
				  provided in the consumer's home or natural environment setting, such as the
				  home, school, work environment, or other community setting as well as in a
				  health care setting. These services are provided through agencies accredited by
				  a national accreditation organization. These agencies must have staff that
				  includes one or more qualified mental health professionals. If the services are
				  provided by staff other than a qualified mental health professional, the staff
				  shall be supervised at a minimum by a qualified mental health
				  professional.
(2) Crisis
				  Residential Services: Crisis Residential Services are short-term interventions
				  provided to individuals experiencing crisis, to address the cause of the crisis
				  and to avert or delay the need for acute psychiatric inpatient hospitalization
				  or inpatient hospital-based psychiatric care at levels of care below acute
				  psychiatric inpatient. Crisis Residential Services are for individuals who are
				  experiencing a period of acute stress that significantly impairs the capacity
				  to cope with normal life circumstances. The program provides psychiatric
				  services that address the psychiatric, psychological, and behavioral health
				  needs of the individuals. Specific services are:
(A) Psychiatric medical assessment;
(B) Crisis stabilization and
				  intervention;
(C) Medication
				  management and monitoring;
(D)
				  Individual, group or family counseling or all if necessary; and
(E) Daily living skills training. Services
				  are provided in a licensed residential program, licensed therapeutic group home
				  or foster home setting. All crisis residential programs shall have less than
				  sixteen beds. The services do not include payment for room and board. Staff
				  providing crisis residential services shall be qualified mental health
				  professionals. If the services are provided by staff other than a qualified
				  mental health professional, the staff must be supervised at a minimum by a
				  qualified mental health professional.
(3) Biopsychosocial Rehabilitative Programs:
				  This is a therapeutic day rehabilitative social skill building service which
				  allows individuals with serious mental illness to gain the necessary social and
				  communication skills necessary to allow them to remain in or return to
				  naturally occurring community programs. Services include group skill building
				  activities that focus on the development of problem-solving techniques, social
				  skills and medication education and symptom management. All services provided
				  must be part of the individual's plan of care. A plan of care must identify the
				  treatment goals and the scope, amount and duration of services that will assist
				  the individual to achieve the goals. A plan of care must be approved by a
				  licensed physician, licensed psychologist, advanced practice registered nurse
				  or licensed clinical social worker in behavioral health. Plans of care must be
				  reviewed and approved every ninety calendar days. The therapeutic value of the
				  specific therapeutic recreational activities must be clearly described and
				  justified in the plan of care. At a minimum, the plan of care must:
(A) Define the goals and objectives for the
				  individual;
(B) Educate the
				  individual about his or her mental illness;
(C) How to avoid complications and relapse;
				  and
(D) Provide opportunities for
				  him or her to learn basic living skills and improve interpersonal skills.
Services are provided by qualified mental health
					 professionals or staff that are under the supervision of a qualified mental
					 health professional. Provider qualifications to provide these services are
					 ensured by provider compliance with requirements and standards of a national
					 accreditation organization.
(4) Intensive Family Intervention: These are
				  time limited intensive interventions intended to stabilize the living
				  arrangement, promote reunification or prevent the utilization of out of home
				  therapeutic resources (i.e. psychiatric hospital, therapeutic foster care,
				  residential treatment facility) for children with serious emotional or
				  behavioral disturbances or adults with serious mental illness. These services:
(A) Diffuse the current crisis, evaluate its
				  nature and intervene to reduce the likelihood of a recurrence;
(B) Assess and monitor the service needs of
				  the identified individual so that he or she can be safely maintained in the
				  family;
(C) Ensure the clinical
				  appropriateness of services provided; and
(D) Improve the individual's ability to care
				  for self and the family's capacity to care for the individual.
This service includes focused evaluations and assessments,
					 crisis case management, behavior management, counseling, and other therapeutic
					 rehabilitative mental health services toward improving the individual's ability
					 to function in the family. Services are directed towards the identified
					 individual within the family. Services can be provided in-home, school or other
					 natural environment. Services are provided by a multidisciplinary team
					 comprised of qualified mental health professionals. If the services are
					 provided by staff other than a qualified mental health professional, the staff
					 shall be supervised at a minimum by a qualified mental health professional.
					 Additionally, provider qualifications must be in compliance with requirements
					 and standards of a national accreditation organization.
(5) Therapeutic Living Supports
				  and Therapeutic Foster Care Supports: These are services covered in settings
				  such as group living arrangements or therapeutic foster homes. Group living
				  arrangements usually provide services for three to six individuals, but not
				  more than fifteen individuals, per home. Therapeutic foster homes provide
				  services for a maximum of fifteen individuals per home. Although these group
				  living arrangements and therapeutic foster homes may provide twenty-four hour
				  per day of residential care, only the therapeutic services provided are
				  covered. There is no reimbursement of room and board charges. Covered
				  therapeutic supports are only available when the identified individual resides
				  in a licensed group living arrangement or licensed therapeutic foster home. The
				  identified individual must be either a child with serious emotional or
				  behavioral disturbance or an adult with a serious mental illness. Services
				  provided in therapeutic group homes and therapeutic foster homes include
				  supervision, monitoring and developing independence of activities of daily
				  living and behavioral management, medication monitoring, counseling and
				  training, directed at the amelioration of functional and behavioral deficits
				  and based on the individual's plan of care developed by a team of licensed and
				  qualified mental health professionals. Services shall be provided in a licensed
				  facility and provided by a qualified mental health professional or staff under
				  the supervision of a qualified mental health professional with twenty-four hour
				  on-call coverage by a licensed psychiatrist or psychologist.
(6) Intensive outpatient hospital services:
				  These are outpatient hospital services for the purpose of providing
				  stabilization of psychiatric impairments as well as enabling the individual to
				  reside in the community or to return to the community from a more restrictive
				  setting. Services are provided to an individual who is either a child with
				  serious emotional or behavioral disturbance or an adult with a serious mental
				  illness. In addition, the adult or child shall meet at least two of the
				  following criteria:
(A) Is at high risk for
				  acute inpatient hospitalization, homelessness or (for children) out-of-home
				  placement because of their behavioral health condition;
(B) Exhibits inappropriate behavior that
				  generates repeated encounters with mental health professionals, educational and
				  social agencies, or the police; or
(C) Are unable to recognize personal danger,
				  inappropriate social behavior, or recognize and control behavior that presents
				  a danger to others. The goals of service are clearly identified in an
				  individualized plan of care. The short term and long term goals and continuing
				  care plan are established prior to admission through a comprehensive assessment
				  of the consumer to include a severity-adjusted rating of each clinical issue
				  and strength. Treatment is time-limited, ambulatory and active offering
				  intensive, coordinated clinical services provided by a multi-disciplinary team.
				  This service includes medication administration and a medication management
				  plan. Services are available at least twenty hours per week. All services are
				  provided by qualified mental health professionals, or by individuals under the
				  supervision of a qualified mental health professional. Additionally, provider
				  qualifications must be in compliance with requirements and standards of a
				  national accreditation organization. Registered nurses or licensed practical
				  nurses must be available for nursing interventions and administration of
				  medications. Licensed psychiatrists or psychologists must be actively involved
				  in the development, monitoring, and modification of the plan of care. The
				  services must be provided in the outpatient area or clinic of a licensed
				  hospital certified by a national accreditation organization or other licensed
				  facility that is Medicare certified for coverage of partial hospitalization/day
				  treatment. These services are not provided to individuals in the inpatient
				  hospital setting and do not include acute inpatient hospital stays.
(7) Assertive Community Treatment
				  (ACT): This is an intensive community rehabilitation service for individuals
				  who are either children with serious emotional or behavioral disturbance or
				  adults with a serious mental illness. In addition, the adult or child must meet
				  at least two of the following criteria:
(A) At
				  high risk for acute inpatient hospitalization, homelessness or (for children)
				  out-of-home placement because of their behavioral health condition;
(B) Exhibits inappropriate behavior that
				  generates repeated encounters with mental health professionals, educational and
				  social agencies, or the police; or
(C) Is unable to recognize personal danger,
				  inappropriate social behavior, and recognize and control behavior that presents
				  a danger to others.
The ACT rehabilitative treatment services are to restore
					 and rehabilitate the individual to his or her maximum functional level.
					 Treatment interventions include:
(A)
				  Crisis management (crisis assessment, intervention and
				  stabilization);
(B) Individual
				  restorative interventions for the development of interpersonal, community
				  coping and independent living skills;
(C) Services to assist the individual develop
				  symptom monitoring and management skills;
(D) Medication prescription, administration
				  and monitoring medication and self medication; and
(E) Treatment for substance abuse or other
				  co-occurring disorders.
Services include twenty-four hours a day, seven days a
					 week coverage, crisis stabilization, treatment, and counseling. Also,
					 individuals included in ACT receive case management to assist them in obtaining
					 needed medical and rehabilitative treatment services within their ACT treatment
					 plan. Services can be provided to individuals in their home, work or other
					 community settings. ACT services are provided by agencies whose staffs include
					 one or more licensed qualified mental health professionals. If the services are
					 provided by staff other than a licensed qualified mental health professional,
					 the staff shall be supervised by a licensed qualified mental health
					 professional. Provider qualifications to provide these services are ensured by
					 provider compliance with requirements and standards of a national accreditation
					 organization. Case management is an integral part of this service and
					 reimbursement for case management as a separate service is not allowed. If
					 biopsychosocial rehabilitation is part of the individual's plan of care under
					 intensive case management, reimbursement for biopyschosocial rehabilitation as
					 a separate service is not allowed.