Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 305.00 - Rates for Behavioral Health Services Provided in Community Behavioral Health Centers › Section 305.02 - General Definitions

Current through Register 1525, July 5, 2024
Meaning of Terms
. In addition to the
				general definitions contained in
				101 CMR
				305.00, terms used in
				101 CMR
				305.00 will have the meaning ascribed in
				101
				CMR 305.02.
Adult Community Crisis Stabilization (Adult
				CCS)
. A community-based program that serves as a medically
				necessary, less-restrictive alternative to inpatient psychiatric
				hospitalization when clinically appropriate and provides short-term
				staff-secure, safe, and structured crisis stabilization and treatment services
				for individuals 18 years of age or older with mental health and substance use
				disorders. Stabilization and treatment also includes the capacity to provide
				induction onto and bridging for medication for the treatment of opioid use
				disorders (MOUD) and withdrawal management for opioid use disorders (OUD) as
				clinically indicated.
Adult Mobile Crisis Intervention
				(AMCI)
. A community-based behavioral health service available
				24/7/365 and providing short-term mobile, on-site, face-to-face crisis
				assessment, intervention, and stabilization to individuals 21 years of age or
				older experiencing a behavioral health crisis. Services may be provided in
				community-based settings outside the CBHC, at the CBHC, or in emergency
				department sites of services to support stabilization for transition into the
				community, when necessary. Services may also be provided
via
telehealth. The purpose is to identify, assess, treat, and stabilize the
				situation and reduce the immediate risk of danger to the individual or others
				consistent with the individual's risk management/safety plan, if any.
Case Consultation
. Intervention,
				including scheduled audio-only telephonic, audio-video, or in person meetings,
				for behavioral and medical management purposes on a member's behalf with
				agencies, employers, or institutions which may include the preparation of
				reports of the member's psychiatric status, history, treatment, or progress
				(other than for legal purposes) for other physicians, agencies, or insurance
				carriers.
Certified Peer Specialist (CPS)
. A
				person who has been trained by an agency approved by the Department of Mental
				Health (DMH) who is a self-identified person with lived experience of a mental
				health disorder and wellness who can effectively share their experiences and
				serve as a mentor, advocate, or facilitator for a member experiencing a mental
				health disorder.
Child and Adolescent Needs and Strengths
				(CANS)
. A tool that provides a standardized way to organize
				information gathered during behavioral health clinical assessments. A
				Massachusetts version of the tool has been developed and is intended to be used
				as a treatment decision support tool for behavioral health providers serving
				MassHealth members younger than 21 years old.
Community Behavioral Health Center (CBHC or
				Center)
. An entity that serves as a hub of coordinated and
				integrated behavioral health disorder treatment for individuals of all ages,
				including routine and urgent outpatient behavioral health services, mobile
				crisis services for adults and youth, and community crisis stabilization
				services for adults and youth.
Counselor
. An individual who has
				earned a master's degree in counseling from a recognized educational program
				and who also meets conditions of participation which have been or may be
				adopted by a governmental unit purchasing mental health services from eligible
				providers or by purchasers of such services under M.G.L. c. 152.
Couple Therapy
. Psychotherapeutic
				services provided to a couple whose primary complaint is the disruption of
				their marriage, family, or relationship.
Diagnostic Evaluation Services
. The
				examination and determination of a member's physical, psychological, social,
				economic, educational, and vocational assets and disabilities for the purpose
				of designing a treatment plan.
Eligible Provider
. A community
				behavioral health center which meets the conditions of participation that have
				been or may be adopted by a governmental unit purchasing behavioral health
				services or by purchasers under M.G.L. c. 152.
Encounter Bundle
. A flat rate per date
				of services for the provision of any of a set of designated services,
				regardless of the number of services provided to the individual on that
				date.
Enhanced Structured Outpatient Addiction Program
				(E-SOAP): American Society of Addiction Medicine (ASAM) Intensive Outpatient
				Services
. A program that provides short-term, clinically
				intensive, structured day and/or evening substance use disorder (SUD) services.
				E-SOAP specifically serves specialty populations including: homeless
				individuals and people at risk of homelessness, pregnant individuals, and
				adolescents. E-SOAP services must meet requirements as set forth in
				130 CMR
				418.000:
Substance Use Disorder Treatment
				Services.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Family Consultation
. A scheduled
				meeting with one or more of the parents, legal guardian, or foster parents of a
				child who is being treated by clinical staff at the center, when the parents,
				legal guardian, or foster parents are not members of the center.
Family Therapy
. The psychotherapeutic
				treatment of more than one member of a family simultaneously in the same
				visit.
Governmental Unit
. The Commonwealth of
				Massachusetts, or any of its departments, agencies, boards, commissions, or
				political subdivisions.
Group Therapy
. The application of
				psychotherapeutic or counseling techniques to a group of persons, most of whom
				are not related by blood, marriage, or legal guardianship.
Individual Consideration (I.C.)
.
				Payment rates to eligible providers for services authorized in accordance with
				101
				CMR 305.03(2), but not
				listed herein, or authorized services performed in exceptional circumstances
				will be determined on an individual consideration basis by the governmental
				unit or purchaser under M.G.L. c. 152 upon receipt of a bill which describes
				the services rendered. The determination of rates of payment for authorized
				individual consideration procedures will be in accordance with the following
				criteria:
(a) time required to perform
			 the service;
(b) degree of skill
			 required for service rendered;
(c)
			 severity and/or complexity of the client's disorder or disability;
(d) policies, procedures, and practices of
			 other third party purchasers of care; and
(e) such other standards and criteria as may
			 be adopted from time to time by EOHHS pursuant to
			 101
			 CMR 305.03(4).
Individual Therapy
. Psychotherapeutic
				services provided to an individual.
Intensive Outpatient Program (IOP)
. A
				mental health treatment service that provides timelimited, multi-disciplinary,
				multimodal structured treatment in an outpatient setting for individuals
				requiring a clinical intensity that exceeds outpatient treatment. Services
				include individual, group, and family therapy as well as case management
				services.
Medication Visit
. A member visit
				specifically for prescription, review, and monitoring of psychotropic
				medication by a psychiatrist, psychiatric clinical nurse specialist, Advanced
				Practice Registered Nurse, or Physician Assistant or administration of
				prescribed intramuscular medication by a physician, nurse, or Physician
				Assistant.
Modifiers
. Listed services may be
				modified under certain circumstances. When applicable, the modifying
				circumstances should be identified by the addition of the appropriate two-digit
				number or letters.
Multiple-family Group Therapy
. The
				treatment of more than one family unit, at the same time in the same visit, by
				one or more authorized staff member. There is more than one family member
				present per family unit and at least one of the family members per family unit
				must be an identified patient of the center.
Psychiatric Nurse
. An individual who
				is currently registered by the Massachusetts Board of Registration in Nursing
				and who has earned a master's degree from an accredited graduate school of
				psychiatric nursing or who meets the conditions of participation which have
				been or may be adopted by a governmental unit purchasing mental health services
				from eligible providers or by purchasers of such services under M.G.L. c.
				152.
Psychiatric Clinical Nurse Specialist
.
				A licensed registered nurse who is authorized by the Board of Registration in
				Nursing as practicing in an expanded role and who meets the requirements of
				244
				CMR 4.05(4):
Psychiatric Nurse Mental Health Clinical Specialist
				(PNMHCS).
Psychiatric Social Worker
. An
				individual who has earned a Master's degree from an accredited graduate school
				of social work or who meets the conditions of participation which have been or
				may be adopted by a governmental unit purchasing mental health services from
				eligible providers or by purchasers of such services under M.G.L. c.
				152.
Psychiatrist
. An M.D. or Doctor of
				Osteopathic Medicine who is registered in Massachusetts and who is certified or
				eligible for certification by the American Board of Psychiatry and Neurology or
				the American Osteopathic Board of Neurology and Psychiatry who meets such
				conditions of participation as have been or may be adopted by a governmental
				unit purchasing mental health services from eligible providers or by purchasers
				of such services under M.G.L. c. 152.
Psychological Associate.
A staff
				member trained in the field of clinical or counseling psychology or a closely
				related specialty who meets the conditions of participation which have been or
				may be adopted by a governmental unit purchasing mental health services from
				eligible providers or by purchasers of such services under M.G.L. c. 152, and
				who
(a) has a minimum of a master's
			 degree or the equivalent graduate study in clinical or counseling psychology or
			 a closely related specialty from an accredited educational
			 institution;
(b) is currently
			 enrolled in or has completed a doctoral program in clinical or counseling
			 psychology or a closely related specialty; and
(c) has had two years of full-time supervised
			 clinical experience subsequent to obtaining a master's degree in a
			 multidisciplinary mental-health setting. (One year of supervised clinical work
			 in an organized graduate internship program may be substituted for each year of
			 experience.)
Psychological Testing
. The use of
				standardized test instruments to evaluate aspects of an individual's
				functioning, including aptitudes, educational achievements, cognitive
				processes, emotional conflicts, and type and degree of psychopathology, subject
				to the limitations of
				101 CMR
				329.00:
Rates for Psychological and
				Independent Clinical Social Work Services.
Psychologist
. An individual who by
				training and experience meets the requirements for licensing by the
				Massachusetts Board of Registration of Psychologists and is duly licensed to
				practice psychology in the Commonwealth or who meets the requirements of
				education and experience in psychology that have been or may be adopted by a
				governmental unit purchasing mental health services from eligible providers or
				by purchasers of such services under M.G.L. c 152.
Psychotherapy for Crisis
. An urgent
				assessment and history of a crisis state, a mental status exam, and a
				disposition. The treatment includes psychotherapy, mobilization of resources to
				defuse the crisis and restore safety, and implementation of psychotherapeutic
				interventions to minimize the potential for psychological trauma.
Staff Member Authorized to Render Billable Mental
				Health Services
. An individual who provides the services referred
				to in
				101 CMR
				305.00 under the auspices of an eligible provider and
				meets the qualifications of any of the following professions: psychiatrist,
				psychologist, psychological associate, social worker, psychiatric nurse,
				psychiatric clinical nurse specialist, counselor, or occupational therapist.
				This also includes staff members meeting the qualifications which have been or
				may be adopted by a governmental unit purchasing behavioral health services
				from eligible providers or by purchasers of such services under M.G.L. c.
				152.
Structured Outpatient Addiction Program
				(SOAP)
: ASAM Intensive Outpatient Services. A substance use
				disorder treatment service that provides short-term, multi-disciplinary,
				clinically intensive structured treatment to address the sub-acute needs of
				members with substance use disorders and/or co-occurring disorders. These
				services may be used as a transition service in the continuum of care toward
				lower intensity outpatient services or accessed directly. SOAP services must
				meet requirements as set forth in
				130 CMR
				418.000:
Substance Use Disorder Treatment
				Services.
Telehealth
. The use of synchronous or
				asynchronous audio, video, electronic media or other telecommunications
				technology, including, but not limited to
(a) interactive audio-video
			 technology;
(b) remote patient
			 monitoring devices;
(c) audio-only
			 telephone; and
(d) online adaptive
			 interviews, for the purpose of evaluating, diagnosing, consulting, prescribing,
			 treating, or monitoring of a patient's physical health, oral health, mental
			 health, or substance use disorder condition.
Uniform Financial Statements and Independent
				Auditor's Report (UFR)
. The set of financial statements and
				schedules required of many human, social service, and health care providers who
				deliver services to publicly aided clients.
Youth Community Crisis Stabilization
				(YCCS)
. Staff-secure, safe, and structured crisis stabilization
				and treatment services in a community-based program that provides active
				treatment that includes restoration of functioning; strengthening the resources
				and capacities of the youth, family, and other natural supports; and ensuring a
				timely return to previous living environment to individuals 18 years of age or
				younger.
Youth Mobile Crisis Intervention
				(YMCI)
. A community-based behavioral health service available
				24/7/365 providing short-term mobile, on-site, face-to-face crisis assessment,
				intervention, and stabilization to individuals younger than 21 years old
				experiencing a behavioral health crisis. Transition-aged youth older than 17
				years of age and younger than 21 years old may be served by adult-trained
				clinicians with a certified peer specialist instead of a family partner based
				on an individual's clinical needs. Services may be provided in community-based
				settings outside the CBHC, at the CBHC, or in emergency department sites of
				services to support stabilization for transition into the community. Services
				may be provided
via
telehealth. The purpose is to identify,
				assess, treat, and stabilize the situation and reduce the immediate risk of
				danger to the youth or others consistent with the youth's risk
				management/safety plan, if any.