Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter D - Resident Care Services › Section II-10141 - Mental Health Rehabilitation Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Mental health rehabilitation services are
					 defined as medically necessary services which can reasonable be expected to
					 reduce the resident's disability resulting from mental illness and to restore
					 the individual to his/her best possible functional level in the community. The
					 services are provided outside of a mental institution (or distinct part
					 psychiatric unit) on an as needed basis to assist residents in coping with the
					 symptoms of their illnesses, minimizing the disabling effects of mental illness
					 on their capacity for independent living, and preventing or limiting periods of
					 in-resident treatment. These services are an optional Medicaid service
					 authorized under section 440. 130(d) of the Code of Federal Regulations.
					 Residents in nursing facilities shall have been identified as needing these
					 services through the pre-admission screening and annual resident review process
					 (PASARR).
B. Mental health
					 rehabilitation services must be ordered by a physician and provided by or under
					 the supervision of a qualified mental health professional according to a
					 rehabilitation care plan which includes the comprehensive mix of services
					 recommended by the physician and the QMHP.
C. Mental health rehabilitation services
					 consist of the planning, delivery, and management of mental health therapeutic
					 services. These services differ from those provided under the Medicaid Clinic
					 Option by the location(s) in which they are provided. Mental health
					 rehabilitation services are not restricted to a community mental health clinic
					 or an in-resident setting. They may be provided in community settings or in any
					 facility which does not provide mental health services as part of its program.
					 They differ from case management services for the chronically mentally ill
					 which involve arranging access to and coordinating a wide range of services of
					 which mental health rehabilitation is only a party.
D. Mental Health Definitions
1. Specialized Services for Mental Illness.
					 Specialized services for the treatment of mental illness are those services for
					 people with mental illness whose needs are such that continuous supervision,
					 treatment, and training by qualified mental health personnel (QMHP's) is
					 necessary, and/or for persons who are experiencing an acute episode of serious
					 mental illness. These services are beyond the scope of services provided by the
					 nursing facility, and require high degree of intensity. These services,
					 combined with the services provided by the nursing facility, result in the
					 continuous and aggressive implementation of a plan of care.
2. The following are specialized services as
					 described above:
a. Mental Health
					 Rehabilitation Management-Services provided according to a care plan developed
					 by a licensed professional who is a QMHP, in conjunction with a
					 physician.
b. Psychiatric,
					 psychosocial, psychological and other evaluations or assessments-Discipline:
					 Specific information gathered and integrated for diagnosis, establishment of
					 specific treatment goals, analysis of programs, and/or updating the care plan
					 and goals, evaluating and ordering medications. This may include development
					 and implementation of a behavior program on an intensive basis.
c. Individual, group, and/or family
					 therapy-Face-to-face structured, time-limited, and verbal interactions between
					 counselors or therapists and person(s) receiving the service.
d. Psychosocial skills training-Services
					 specified in the individual's plan of care to be provided by a QMHP or
					 paraprofessionals under the supervision of a QMHP, with focus on the
					 remediation of mental and functional disabilities through skills training
					 and/or supportive interventions.
e.
					 Training in ADL's-Activities which enhance or develop the resident's basic
					 daily living skills.
f. In-resident
					 psychiatric services-Highly restricted, intensive and supervised services in a
					 hospital setting reserved for extreme situations for individuals exhibiting an
					 exacerbation of an acute disturbance or difficult ongoing problems.
3. Medication management is not a
					 billable service for a nursing facility resident.