Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 425.000 - Psychiatric Inpatient Hospital Services › Section 425.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130 CMR 425.000 will have
				the meanings given in 130 CMR 425.402 unless the context clearly requires a
				different meaning.
Administrative Day
. A day of inpatient
				hospitalization on which a member's care needs can be met in a less intensive
				setting than a psychiatric inpatient hospital, as defined in 130 CMR 425.402,
				and on which a member is clinically ready for discharge, but an appropriate
				institutional or noninstitutional setting is not readily available.
Case Manager
. An area-based
				coordinator of services employed by the Department of Mental Health (DMH) or,
				where appropriate, the Department of Children and Families (DCF), the
				Department of Youth Services (DYS), or the Department of Developmental Services
				(DDS).
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.
Day of Discharge
. The day on which a
				member leaves the hospital regardless of the hour. The day of death is also
				considered the day of discharge. A leave of absence is not considered a
				discharge.
Inpatient Psychiatric Treatment
.
				Treatment that encompasses multidisciplinary assessments and multimodal
				interventions. 24-hour skilled nursing care, daily medical care, provided by
				either a board certified psychiatrist, Psychiatric-mental Health Clinical Nurse
				Specialist, or Psychiatric-mental Health Nurse Practitioner, under supervision
				of a board certified psychiatrist, and a structured treatment milieu are
				required.
Mental Illness
. Mental and emotional
				disorders as defined in the current
International Classification of
				Diseases, Clinical Modification (ICD-CM)
or the
American
				Psychiatric Association's Diagnostic and Statistical Manual (DSM),
and
				manifested by impaired functioning in behavior, feeling, thinking, or judgment
				to the extent that the affected person, or someone else, can observe that the
				person affected is unable to fulfill reasonable personal and social
				expectations.
Multidisciplinary Treatment Team
. A
				team of mental-health professionals employed by or under contract with a
				psychiatric inpatient hospital that provides services to members in the
				facility. The team must include, at a minimum, a board-eligible or
				board-certified psychiatrist and one of the following:
(1) an independent licensed clinical social worker;
(2) a licensed registered nurse with specialized psychiatric
				training or at least one year's experience treating mentally ill
				individuals;
(3) an occupational therapist who is licensed and who has
				specialized psychiatric training or at least one year's experience treating
				mentally ill individuals; or
(4) a psychologist who has a master's degree in clinical
				psychology, or a closely related field such as counseling psychology, or who
				has been certified either by the state in which the psychiatric inpatient
				hospital is located or by that state's psychological association.
Private Psychiatric Inpatient
				Hospital
. Any private psychiatric facility that is
(1) licensed by the Massachusetts Department of Mental Health
				(if in-state), or by the governing or licensing agency in its state (if
				out-of-state);
(2) accredited by the Joint Commission; and
(3) is primarily engaged in treating persons, whose principal
				diagnosis is based on the current ICD-CM or the current DSM.
Primarily Engaged in Treating
means
				that over a six-month period inpatient care has been provided to a patient
				population of which over 50% consistently have a principal diagnosis that is
				psychiatric.
Psychiatric Inpatient Hospital
. A
				private psychiatric inpatient hospital or a state-operated psychiatric
				inpatient hospital.
Screening Team
. An independent team
				that certifies the need for services for members younger than 21 years old. The
				team includes, but may not be limited to, a physician, and must
(1) be competent in diagnosing and treating mental illness in
				children; and
(2) have knowledge of the member's condition.
State-operated Psychiatric Hospital
. A
				hospital that is accredited by a recognized accreditation body such as the
				Joint Commission and is operated by the Department of Mental Health pursuant to
				M.G.L. chs. 19 and 123.
Treatment Plan
. A documented written
				plan developed for each member by the hospital multidisciplinary treatment team
				with the goal of improving the member's condition to the extent that inpatient
				care is no longer necessary.
Working Days
. Monday through Friday,
				except for holidays.