Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 78 - Amount, Duration and Scope of Medical and Remedial Services › Rule 441-78.45 - Assertive Community Treatment

Current through Register Vol. 47, No. 3, July 24, 2024
Assertive community treatment (ACT) services are
				  comprehensive, integrated, and intensive outpatient services provided by a
				  multidisciplinary team under the supervision of a psychiatrist. ACT services
				  are directed toward the rehabilitation of behavioral, social, or emotional
				  deficits or the amelioration of symptoms of a mental disorder. Most services
				  are delivered in the member's home or another community setting.
(1)
Applicability.
ACT
				services may be provided only to a member who meets all of the following
				criteria:
a. The member is at least 17 years
				old.
b. The member has a severe and
				persistent mental illness or complex mental health symptomatology. A severe and
				persistent mental illness is a psychiatric disorder that causes symptoms and
				impairments in basic mental and behavioral processes that produce distress and
				major functional disability in adult role functioning (such as social,
				personal, family, educational or vocational roles). Specifically, the member
				has a degree of impairment arising from a psychiatric disorder such that:
(1) The member does not have the resources or
				skills necessary to maintain an adequate level of functioning in the home or
				community environment without assistance or support;
(2) The member's judgment, impulse control,
				or cognitive perceptual abilities are compromised; and
(3) The member exhibits significant
				impairment in social, interpersonal, or familial functioning.
c. The member has a validated
				principal mental health diagnosis consistent with a severe and persistent
				mental illness. For this purpose, a mental health diagnosis means a disorder,
				dysfunction, or dysphoria diagnosed pursuant to the current version of the
				Diagnostic and Statistical Manual of Mental Disorders published by the American
				Psychiatric Association, excluding neurodevelopmental disorders,
				substance-related disorders, personality disorders, medication-induced movement
				disorders and other adverse effects of medication, and other conditions that
				may be a focus of clinical attention. Members with a primary diagnosis of
				substance-related disorder, developmental disability, or organic disorder are
				not eligible for ACT services.
d.
				The member needs a consistent team of professionals and multiple mental health
				and support services to maintain the member in the community and reduce
				hospitalizations, as evidenced by:
(1) A
				pattern of repeated treatment failures with at least two hospitalizations
				within the previous 24 months, or
(2) A need for multiple or combined mental
				health and basic living supports to prevent the need for a more intrusive level
				of care.
e. The member
				presents a reasonable likelihood that ACT services will lead to specific,
				observable improvements in the member's functioning and assist the member in
				achieving or maintaining community tenure. Specifically, the member:
(1) Is medically stable;
(2) Does not require a level of care that
				includes more intensive medical monitoring;
(3) Presents a low risk to self, others, or
				property, with treatment and support; and
(4) Lives independently in the community or
				demonstrates a capacity to live independently and move from a dependent
				residential setting to independent living.
f. At the time of admission, the member has a
				comprehensive assessment that includes psychiatric history, medical history,
				work and educational history, substance use, problems with activities of daily
				living, social interests, and family relationships.
g. The member has a written treatment plan
				containing a work evaluation and the necessary psychiatric rehabilitation
				treatment and support services. The plan shall identify:
(1) Treatment objectives and
				outcomes,
(2) The expected
				frequency and duration of each service,
(3) The location where the services will be
				provided,
(4) A crisis plan,
				and
(5) The schedule for updates of
				the treatment plan.