Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 23 - Behavioral Health Services › Rule 016.23.17-002 - DHS Behavioral Health Provider Certification Manuals and Forms

Current through Register Vol. 49, No. 6, June, 2024
100.000
GENERAL PROVISIONS
101.000
Purpose
This chapter sets forth the Standards and Criteria used in the
				certification of Acute Crisis Units by the Arkansas Department of Human
				Services. The rules regarding the certification processes including, but not
				necessarily limited to, applications, requirements for, levels of, and
				administrative sanctions are found in this manual.
102.000
Definitions
The following words or terms, when used in this Chapter, shall
				have the defined meaning, unless the context clearly indicates
				otherwise:
"Abuse"
means the causing or permitting of harm or
				threatened harm to the health, safety, or welfare of a resident by a staff
				responsible for the resident's health, safety, or welfare, including but not
				limited to: non-accidental physical injury or mental anguish; sexual abuse;
				sexual exploitation; use of mechanical restraints without proper authority; the
				intentional use of excessive or unauthorized force aimed at hurting or injuring
				the resident; or deprivation of food, clothing, shelter, or healthcare by a
				staff responsible for providing these services to a resident.
"Acute Crisis Unit"
means a program of
				non-hospital emergency services for mental health and substance use disorder
				crisis stabilization, including, but not limited to, observation, evaluation,
				emergency treatment and referral, when necessary, for inpatient psychiatric or
				substance use disorder treatment services. This service is limited to
				individual sites which are certified by the Arkansas Department of Human
				Services, (DHS) or facilities operated by the Arkansas Department of Human
				Services. Acute Crisis Units shall be freestanding facilities that must adhere
				to the following:
1.) Have 16 beds or
			 less
2.) Be independently certified
			 by DHS outside of an existing Hospital
"Adverse license action"
means any action by a
				licensing authority that is related to client care, any act or omission
				warranting exclusion under DHS Policy 1088, or that imposes any restriction on
				the licensee's practice privileges. The action is deemed to exist when the
				licensing entity imposes the adverse action except as provided in Ark. Code
				Ann. §
											25-15-211(c).
"Certification"
means a written designation,
				issued by DHS, declaring that the provider has demonstrated compliance as
				declared within and defined by this rule.
"Clinical privileging"
means an organized method
				for treatment facilities to authorize an individual permission to provide
				specific care and treatment services to clients within well-defined limits,
				based on the evaluation of the individual's license, education, training,
				experience, competence, judgment, and other credentials.
"Client"
means any person for whom an Acute Crisis
				Unit furnishes, or has agreed or undertaken to furnish, services.
"Co-occurring disorder"
means any combination of
				mental health and substance use disorder symptoms or diagnoses in a
				client.
"Co-occurring disorder capability"
means the
				organized capacity within any type of program to routinely screen, identify,
				assess, and provide properly matched interventions to individuals with
				co-occurring disorders.
"Compliance"
means conformance with:
1. Applicable state and federal laws, rules,
			 and regulations including, without limitation:
a. Titles XIX and XXI of the Social Security
			 Act and implementing regulations;
b. Other federal laws and regulations
			 governing the delivery of health care funded in whole or in part by federal
			 funds, for example, 42
			 U.S.C. §
													1320c-5;
c. All state laws and rules applicable to
			 Medicaid generally and to Acute Crisis Unit services specifically;
d. Title VI of the Civil Rights Act of 1964
			 as amended, and implementing regulations;
e. The Americans With Disabilities Act, as
			 amended, and implementing regulations;
f. The Health Insurance Portability and
			 Accountability Act ("HIPAA"), as amended, and implanting regulations.
"Crisis intervention"
means an immediately
				available service to meet the psychological, physiological and environmental
				needs of individuals who are experiencing a mental health and/or substance
				abuse crisis.
"Crisis stabilization"
means emergency psychiatric
				and substance abuse services for the resolution of crisis situations and may
				include placement of an individual in a protective environment, basic
				supportive care, and medical assessment and referral.
"Critical incident"
means an occurrence or set of
				events inconsistent with the routine operation of the facility, or the routine
				care of a client. Critical incidents specifically include but are not
				necessarily limited to the following: adverse drug events; self-destructive
				behavior; deaths and injuries to clients, staff and visitors; medication
				errors; clients that are absent without leave (AWOL); neglect or abuse of a
				client; fire; unauthorized disclosure of information; damage to or theft of
				property belonging to a clients or the facility; other unexpected occurrences;
				or events potentially subject to litigation. A critical incident may involve
				multiple individuals or results.
"Emergency examination"
For adults: means the
				examination of a person who appears to be a mentally ill person, an
				alcohol-dependent person, or drug-dependent person and a person requiring
				treatment, and whose condition is such that it appears that emergency detention
				may be warranted, by a licensed mental health professional to determine if
				emergency detention of the person is warranted. The examination must occur
				within twelve (12) hours of being taken into protective custody.
"DHS"
means the Arkansas Department of Human
				Services Division of Behavioral Health Services.
"
Deficiency
" means an item or area of
				noncompliance.
"
DHS
" means the Arkansas Department of Human
				Services.
"Initial Assessment"
means examination of current
				and recent behaviors and symptoms of an individual who appears to be mentally
				ill or substance dependent.
"Intervention plan"
means a description of
				services to be provided in response to the presenting crisis situation that
				incorporates the identified problem(s), strengths, abilities, needs and
				preferences of the individual served.
"Licensed mental health professional"
or
"LMHP"
as defined.
"Linkage services"
means the communication and
				coordination with other service providers that assure timely appropriate
				referrals between the Acute Crisis Unit and other providers.
"
Mental health professional
" or "
MHP
"
				means a person who possesses an Arkansas license to provide clinical behavioral
				health care. The license must be in good standing and not subject to any
				adverse license action.
"Minor"
means any person under eighteen (18) years
				of age.
"Performance Improvement"
or
"PI"
means an approach to the continuous study and improvement of the
				processes of providing health care services to meet the needs of clients and
				others. Synonyms, and near synonyms include continuous performance improvement,
				continuous improvement, organization-wide performance improvement and total
				quality management.
"Persons with special needs"
means any persons
				with a condition which is considered a disability or impairment under the
				"American with Disabilities Act of 1990" including, but not limited to the
				deaf/hearing impaired, visually impaired, physically disabled, developmentally
				disabled, persons with disabling illness, persons with mental illness and/or
				substance abuse disorders. See "Americans with Disabilities Handbook,"
				published by U.S. Equal Employment Opportunity Commission and U.S. Department
				of Justice.
"
Professionally recognized standard of care
" means
				that degree of skill and learning commonly applied under all the circumstances
				in the community by the average prudent reputable member of the profession.
				Conformity with Substance Abuse and Mental Health Services Administration
				(SAMHSA) evidence-based practice models is evidence of compliance with
				professionally recognized standards of care.
"Progress notes"
mean a chronological description
				of services provided to a client, the client's progress, or lack of, and
				documentation of the client's response related to the intervention plan.
"
Provider
" means an entity that is certified by
				DHS as an Acute Crisis Unit and enrolled by DMS as a Behavioral Health
				Agency.
"Psychosocial evaluations"
are in-person
				interviews conducted by professionally trained personnel designed to elicit
				historical and current information regarding the behavior and experiences of an
				individual, and are designed to provide sufficient information for problem
				formulation and intervention.
"Qualified Behavioral Health Provider
" means a
				person who:
1. Does not possess an
			 Arkansas license to provide clinical behavioral health care;
2. Works under the direct supervision of a
			 mental health professional;
3. Has
			 successfully completed prescribed and documented courses of initial and annual
			 training sufficient to perform all tasks assigned by a mental health
			 professional;
4. Acknowledges in
			 writing that all qualified behavioral health provider services are controlled
			 by client care plans and provided under the direct supervision of a mental
			 health professional.
"Restraint"
refers to manual, mechanical, and
				chemical methods that are intended to restrict the movement or normal
				functioning of a portion of the individual's body. Mechanical Restraints shall
				not be utilized within a certified Acute Crisis Unit.
"Sentinel event"
is a type of critical incident
				that is an unexpected occurrence involving the death or serious physical or
				psychological injury to a client, or risk thereof. Serious injury specifically
				includes loss of limb or function. The phrase "or risk thereof" includes a
				variation in approved processes which could carry a significant chance of a
				serious adverse outcome to a client. These events signal the need for immediate
				investigation and response. Sentinel events include, but are not limited to:
				suicide, homicide, criminal activity, assault and other forms or violence,
				including domestic violence or sexual assault, and adverse drug events
				resulting in serious injury or death.
"Triage"
means a dynamic process of evaluating and
				prioritizing the urgency of crisis intervention needed based on the nature and
				severity of clients' presenting situations.
"Trauma Informed"
means the recognition and
				responsiveness to the presence of the effects of past and current traumatic
				experiences in the lives of all clients.
103.000
Meaning of verbs in
			 rules
The attention of the facility is drawn to the distinction
				between the use of the words "shall," "should," and "may" in this
				chapter:
(1) "Shall" is the term used
			 to indicate a mandatory statement, the only acceptable method under the present
			 standards.
(2) "Should" is the term
			 used to reflect the most preferable procedure, yet allowing for the use of
			 effective alternatives.
(3) "May"
			 is the term used to reflect an acceptable method that is recognized but not
			 necessarily preferred.
104.000
Applicability
The standards and criteria for services as subsequently set
				forth in this chapter are applicable to Acute Crisis Units as stated in each
				section.
110.000
ACUTE CRISIS UNITS
111.000
Required services
Acute Crisis Units provide brief (96 hours or less) crisis
				treatment services to persons ages 18 and above who are experiencing a
				psychiatry- and/or substance abuse-related crisis and may pose an escalated
				risk of harm to self or others. Acute Crisis Units provide hospital diversion
				and step-down services in a safe environment with psychiatry and/or substance
				abuse services on-site at all times as well as on-call psychiatry available 24
				hours a day. Services provide ongoing assessment and observation; crisis
				intervention; psychiatric, substance, and co-occurring treatment; and initiate
				referral mechanisms for independent assessment and care planning as
				needed.
112.000
Acute Crisis Unit crisis stabilization
(a) The Acute Crisis Unit shall provide
			 crisis stabilization to individuals who are in crisis as a result of a mental
			 health and/or substance use disorder related problem. Each Acute Crisis Unit
			 must be specifically accessible to individuals who present with co-occurring
			 disorders. The Acute Crisis Unit may provide services in excess of 24 hours
			 during one episode, but not more than 96 hours during one episode.
(b) Acute Crisis Unit services shall be
			 provided in the least restrictive setting possible. Services should be provided
			 within, or as close to the community in which they reside as
			 possible.
(c) A physician shall be
			 available at all times for the crisis unit, either on-duty or on call. If the
			 physician is on call, he or she shall respond by telephone or in person to the
			 licensed staff on duty at the crisis unit within 20 minutes.
(d) Acute Crisis Unit services shall include,
			 but not be limited to, the following service components and each shall have
			 written policy and procedures and each shall be co-occurring disorder capable
			 and trauma informed, with policies and procedures that support this capability:
(1) Triage services;
(2) Co-occurring capable Psychiatric crisis
			 stabilization; and
(3) Co-occurring
			 capable Drug/alcohol crisis stabilization.
(e) The Acute Crisis Unit shall have written
			 policy and procedures addressing restraints, and these shall be in compliance
			 with Section 503.000.
113.000
Crisis stabilization,
			 triage
(a) Crisis stabilization
			 services shall include twenty-four (24) hour triage services and emergency
			 examination.
(b) Qualified staff
			 providing triage services shall be:
(1) A
			 Mental Health Professional (MHP) capable of providing crisis stabilization
			 services within the scope of their individual licensure; and
(2) Knowledgeable about applicable laws, DHS
			 rules, facility policy and procedures, and referral sources.
(c) Components of this service
			 shall minimally include the capacity to provide:
(1) Immediate response, on-site and by
			 telephone;
(2) Screening for the
			 presence of co-occurring disorders;
(3) integrated Emergency mental health and/or
			 substance use disorder examination on site or via telemedicine; and
(4) Referral, linkage, or a combination of
			 the two services.
(d)
			 The Acute Crisis Unit shall have written policy and procedures minimally:
(1) Providing twenty-four (24) hour, seven
			 (7) days per week, triage crisis services; and
(2) Defining methods and required content for
			 documentation of each triage crisis response service provided.
(3) Ensuring that individuals who present in
			 crisis with co-occurring disorders are identified, and that there are no
			 barriers to access triage crisis response based on arbitrary alcohol or drug
			 levels, types of diagnosis or medications while remaining in compliance with
			 facility certification, licensure, and medical standards. Nothing in this
			 Section shall require a facility to treat a client that is not medically
			 stable.
114.000
Crisis stabilization,
			 psychiatric, substance use disorder and co-occurring services
(a) Crisis stabilization services shall
			 provide continuous twenty-four (24) hour evaluation, observation, crisis
			 stabilization, and social services intervention seven (7) days per week for
			 clients experiencing mental health or substance use disorder related crises; or
			 those who present with co-occurring disorders.
(b) Licensed nurses and other support staff
			 shall be adequate in number to provide care needed by clients twenty-four (24)
			 hours a day seven (7) days per week.
(c) Crisis stabilization services shall be
			 provided by a co-occurring disorder capable multidisciplinary team of medical,
			 nursing, social services, clinical, administrative, and other staff adequate to
			 meet the clinical needs of the individuals served.
(d) Staff members assigned to a medical
			 supervised detoxification component shall be knowledgeable about the physical
			 signs of withdrawal, the taking of vital signs and the implication of those
			 vital signs, and emergency procedures as well as demonstrating core
			 competencies in addressing the needs of individuals receiving detoxification
			 services who may have co-occurring mental health disorders and be on
			 psychotropic medication.
(e)
			 Services shall minimally include:
(1)
			 Medically-supervised substance use disorder and mental health screening,
			 observation and evaluation;
(2)
			 Initiation and medical supervision of rapid stabilization regimen as prescribed
			 by a physician, including medically monitored detoxification where
			 indicated;
(3) Medically-supervised
			 and co-occurring disorder capable detoxification, in compliance with procedures
			 outlined in the Arkansas DHS Regional Alcohol and Drug Detoxification
			 Manual.
(4) Intensive care and
			 intervention during acute periods of crisis stabilization;
(5) Motivational strategies to facilitate
			 further treatment participation for mental health and/or substance abuse needs;
			 and,
(6) Providing referral,
			 linkage or placement, as indicated by client needs.
(f) Medically-supervised and co-occurring
			 disorder capable detoxification may be provided in an Acute Crisis Unit if
			 appropriately staffed and in compliance with procedures outlined in the
			 Arkansas DHS Regional Alcohol and Drug Detoxification Manual.
(g) Crisis stabilization services, whether
			 psychiatric, substance use disorder, or co-occurring, shall be utilized only
			 after less restrictive community resources have been determined to be
			 inadequate to meet the current needs of the client.
115.000
Linkage Services to higher or
			 lower levels of care, or longer term placement
(a) Persons needing mental health services
			 shall be treated with the least restrictive clinically appropriate
			 methods.
(b) In cases where clients
			 are not able to stabilize in or are not appropriate for the Acute Crisis Unit,
			 linkage services shall be provided, including the following steps:
(1) Qualified Acute Crisis Unit staff shall
			 perform the crisis intervention and referral process to the appropriate
			 treatment facility.
(2) The
			 referral process shall require referral to the least restrictive service to
			 meet the needs of the client. The referral shall be discussed with the client,
			 the client's legal guardian, or both the client and legal guardian as
			 applicable, and shall include a discussion of why a less restrictive community
			 resource was not utilized if applicable. This discussion shall be documented in
			 the client's record. If an adult client wishes to include family members in the
			 decision making process, appropriate releases should be obtained.
(3) Staff shall make referral to an
			 appropriate treatment facility to include demographic and clinical information
			 and documentation. Appropriate releases should be obtained as
			 indicated.
(c) The Acute
			 Crisis Unit shall have a written plan for addressing non-psychiatric medical
			 emergencies, including transfer to a general medical-surgical hospital when
			 necessary. All emergencies must be documented and reviewed by appropriate Acute
			 Crisis Unit staff.
(d) If the Acute
			 Crisis Unit is referring an adult to a state-operated inpatient facility, the
			 client must meet the Arkansas State Hospital admission criteria and the Acute
			 Crisis Unit must comply with Arkansas State Hospital admission
			 criteria.
116.000
Pharmacy services
(a) The Acute Crisis
			 Unit shall provide specific arrangements for pharmacy services to meet clients'
			 needs. Provision of services may be made through agreement with another program
			 or through a pharmacy in the community.
(b) Medical records must contain valid
			 prescriptions for medications administered while a client is in the care in an
			 Acute Crisis Unit.
(c) The Acute
			 Crisis Unit shall have the capacity to administer medications, including
			 injectables, twenty-four (24) hours per day.