California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 4 - Intermediate Care Facilities › Article 3 - Services › Section 73417 - Special Rehabilitation Program Services-Mentally Disordered

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Mentally
				  disordered rehabilitation programs are designed to serve patients who have a
				  chronic psychiatric impairment and whose adaptive functioning is moderately
				  impaired. These patients require continuous supervision and can be expected to
				  benefit from an active rehabilitation program effort designed to improve their
				  adaptive functioning and develop a potential for placement in a less protected
				  living environment. A facility may, but is not required to, provide special
				  rehabilitation program services for the mentally disordered. If the facility
				  meets all of the requirements of this section, it shall be entitled to a
				  supplemental special program rate under the Medi-Cal program (Title 22,
				  California Administrative Code, Section
				  51335(k)) such
				  special program services are those therapeutic services provided to mentally
				  disordered persons having special needs or deficits in one or more of the
				  following general areas: Self-Help Skills, Behavior Adjustment, Interpersonal
				  Relationships, Prevocational Preparation and Prerelease Planning.
(b) To be approved by the Department to
				  furnish such special rehabilitation services to the mentally disordered, a
				  facility shall have:
(1) A minimum initially
				  of 30 patients in the facility who have been certified by the local mental
				  health director as eligible for special program services. Eligibility for
				  special program services shall be redetermined every four months by the local
				  mental health director. At any time that the number of eligible patients
				  receiving special program services drops below 27, total program reimbursement
				  shall be terminated unless otherwise agreed to by the Department.
(2) An approved facility plan.
(A) To participate in this program, a
				  facility shall submit to the Department's headquarters review and approval team
				  for approval an application and a facility plan which meets all the
				  requirements of Section
				  73417(c).
(B) When the Department through the
				  headquarters review and approval team determines that the facility plan meets
				  the specified needs of the patient population, it shall provide its written
				  approval of the plan to the facility.
(C) Where the headquarters review and
				  approval team disapproves a facility plan, it shall submit a written report to
				  the facility which specifies components of the plan which need to be improved
				  or corrected. The facility may submit a revised facility plan and a new
				  application to the headquarters review and approval team at any
				  time.
(3) Within 45 days
				  after written approval of the facility by the headquarters review and approval
				  team an on-site visit by the Department to evaluate the appropriateness of the
				  implementation of the facility plan. Upon the recommendation of the on-site
				  visit team, the Department shall certify the facility's Special Rehabilitation
				  Program Services--Mentally Disordered. Eligibility for Medi-Cal reimbursement
				  shall commence on the first day that the on-site visit team determined that
				  full implementation of the approved plan actually occurred; provided, however,
				  that the first day of payment shall not be prior to the actual date of written
				  approval of the plan.
(4) Executed
				  an approved Medi-Cal provider participation agreement.
(5) Maintained compliance with the approved
				  facility plan. Failure to comply with special program requirements of the plan
				  shall cause the termination of eligibility for reimbursement for special
				  program services, unless otherwise excused in writing by the
				  Department.