Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 306.00 - Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers › Section 306.02 - General Definitions

Current through Register 1525, July 5, 2024
Meaning of Terms
. In addition to the
				general definitions contained in
				101 CMR
				306.00, terms used in
				101 CMR
				306.00 shall have the meaning ascribed in
				101
				CMR 306.02.
Behavioral Health Urgent Care
				Provider
. A center that meets the requirements set forth in
				130
				CMR 429.405(D).
Case Consultation
. An intervention,
				including scheduled telephonic 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 that 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 a 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 Consultation and Education
.
				Services provided by professional personnel to representatives of schools,
				courts, police, organizations, or agencies with the aim of problem solving and
				imparting knowledge in areas such as prevention, availability of resources and
				clinical procedures. Such consultation is distinct from case consultation in
				that it does not address the problems of a particular patient, but rather the
				community at large.
Community Health Center
. A clinic
				which provides comprehensive ambulatory services and which is not financially
				or physically an integral part of a hospital.
Community Mental Health Center
. A
				clinic which provides comprehensive ambulatory mental health services and which
				is not financially or physically an integral part of a hospital.
Couple Therapy
. Psychotherapeutic
				services provided to a couple whose primary complaint is the disruption of
				their marriage, family, or relationship.
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.
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 mental health
				center or community health center which meets the conditions of participation
				that have been or may be adopted by a governmental unit purchasing mental
				health services or by purchasers under M.G.L. c. 152.
Emergency Services
. Services providing
				immediate face-to-face mental health evaluation, diagnosis, hospital
				prescreening, treatment, and arrangements for further care and assistance as
				required, up to 24 hours per day, seven days per week, to individuals showing
				sudden, incapacitating emotional stress.
Enhanced Structured Outpatient Addiction Program
				(E-SOAP)
. American Society of Addiction Medicine (ASAM) Intensive
				Outpatient Services is a program that provides short-term, clinically
				intensive, structured day and/or evening substance use disorder 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.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Family Consultation
. A preplanned
				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 clients of the center.
Family Therapy
. The 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
. Payment
				rates to eligible providers for services authorized in accordance with
				101
				CMR 306.03(2), but not
				listed herein, or authorized services performed in exceptional circumstances
				shall 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 shall 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 306.03(4).
Individual Therapy
. Psychotherapeutic
				services provided to an individual.
Intensive Outpatient Program (IOP)
. A
				mental health treatment service that provides time-limited, multi-disciplinary,
				multimodal structured treatment in an outpatient setting for a complex or
				refractory clinical presentation. Service includes individual, group, and
				family therapy as well as case management services.
Medication Visit
. A member visit
				specifically for prescription, review, and monitoring of medication by a
				psychiatrist, a psychiatric clinical nurse specialist, Advanced Practice
				Registered Nurse, or Physician Assistant, or administration of prescribed
				intramuscular medication by a physician or a nurse, or Physician
				Assistant.
Mental Health Center (Center)
. An
				entity that delivers a comprehensive group of diagnostic and psychotherapeutic
				treatment services to individuals seeking treatment for mental health
				disorders, which may include co-occurring substance use disorder, and their
				families by an interdisciplinary team under the medical direction of a
				psychiatrist.
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 members. 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 clinic program.
Occupational Therapist
. An individual
				who is registered with the American Occupational Therapy Association and who
				also 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.
Preventive Behavioral Health Services
.
				Short-term group intervention, recommended by a physician or other licensed
				practitioner, practicing within their scope of licensure, that cultivate coping
				skills and strategies for symptoms of depression, anxiety, and other
				social/emotional concerns, to prevent the development of behavioral health
				disorders for children and adolescents younger than 21 years old.
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 Clinical Nurse Specialist.
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:
(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 have 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
				130 CMR
				429.000:
Mental Health Center
				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
. The utilization of
				psychological and interpersonal theories and related practice methodologies to
				assess, interpret and modify conscious and unconscious processes of
				behavior.
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.
Publicly Aided Individual
. A person
				for whose medical and other services a governmental unit is in the whole or in
				part liable under a statutory program.
Reevaluation
. A session between a
				client and one or more staff members who are authorized to render mental health
				services for the determination and examination by interview techniques of a
				patient's physical, psychological, social, economic, educational and vocational
				assets and disabilities for the purpose of reevaluating the diagnostic
				formulation, treatment plan and procedures in order to assess aspects of an
				individual's functioning.
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 disorder 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.
Staff Member Authorized to Render Billable Mental
				Health Services
. An individual who provides the services referred
				to in
				101 CMR
				306.00 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 mental health services from
				eligible providers or by purchasers of such services under M.G.L. c.
				152.
State-operated Community Mental Health
				Center
. A community mental health center operated by the
				Commonwealth, which is not financially or physically an integral part of a
				hospital.
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