Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 352.00 - Rates of Payment for Certain Children's Behavioral Health Services › Section 352.02 - General Definitions

Current through Register 1525, July 5, 2024
Meaning of Terms
. Terms used in
				101 CMR
				352.00 have the meaning ascribed in
				101
				CMR 352.02.
Behavior Management Monitoring
. This
				service includes implementation of the behavior treatment plan; monitoring the
				youth's behavior; reinforcing implementation of the treatment plan by the
				parents, guardians, and caregivers; and reporting to the behavior management
				therapist on implementation of the treatment plan and progress toward
				behavioral objectives or performance goals. Phone contact and consultation may
				be provided as part of the intervention. Behavior management monitoring is
				provided by eligible providers.
Behavioral Management Therapy
. This
				service includes a behavioral assessment (including observing the youth's
				behavior, antecedents of behaviors, and identification of motivators);
				development of a highly specific behavior treatment plan; supervision and
				coordination of interventions; and training other interveners to address
				specific behavioral objectives or performance goals. This service is designed
				to treat challenging behaviors that interfere with the child's successful
				functioning. The behavior management therapist develops specific behavioral
				objectives and interventions that are designed to diminish, extinguish, or
				improve specific behaviors related to the child's behavioral health
				condition(s) and that are incorporated into the behavior management treatment
				plan and the risk management/safety plan. Behavior management therapy is
				provided by eligible providers.
Care Manager
. A single care manager
				who works with the child's parents and guardians to provide targeted case
				management.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Clinic
. A clinic that is licensed by
				the Department of Mental Health as a provider of mental health clinic services
				that is not a community health center or a community mental health
				center.
Community-based Sites of Service
. A
				service provided to a member located outside of a hospital.
Community Behavioral Health Center
				(CBHC)
. 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.
Community Health Center
. A clinic that
				provides comprehensive ambulatory services and that is not financially or
				physically an integral part of a hospital.
Community Mental Health Center
. A
				clinic that provides comprehensive ambulatory mental health services and that
				is not financially or physically an integral part of a hospital.
Community Service Agency (CSA)
. A
				clinic, community health center, community mental health center, or other
				provider entity that meets all other requirements established by
				MassHealth.
Day
. As used in
				101 CMR
				352.00 as a unit of payment, refers to a billable day
				in which the child is enrolled in the program.
Eligible Provider
. Eligible providers
				of targeted case management are designated CSAs. Eligible providers of
				parent/caregiver peer-to-peer support, in-home behavior management services,
				in-home behavior monitoring services, in-home therapy services, therapeutic
				training and support, therapeutic mentoring, mobile crisis intervention, and
				crisis stabilization are providers that meet the conditions of participation
				established by MassHealth.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A:
Executive
				Offices
.
Family Partner
. A family partner must
				have experience as a caregiver of youth with special needs, preferably youth
				with mental health needs, experience in navigating any of the youth-and
				family-serving systems, and either a bachelor's degree in a human services
				field from an accredited academic institution, or an associate's degree in a
				human services field from an accredited academic institution and one year of
				experience working with children, adolescents, or transition-age youth and
				families, or a high school diploma or equivalent and a minimum of two years of
				experience working with children, adolescents, or transition-age youth and
				families. If the bachelor's or associate's degree is not in a human services
				field, additional life or work experience may be considered in place of the
				human services degree.
Governmental Unit
. The Commonwealth of
				Massachusetts or any of its departments, agencies, boards, commissions, or
				political subdivisions.
Individual Consideration (I.C.)
.
				Payment rates to eligible providers for services authorized in accordance with
				101
				CMR 352.03(2), but not
				listed in
				101 CMR
				352.00 or authorized services performed in exceptional
				circumstances are determined on an individual consideration basis by the
				governmental unit or purchaser under M.G.L. c. 152:
Workers'
				Compensation
upon receipt of a bill that describes the services
				rendered. The determination of rates of payment for authorized individual
				consideration procedures are 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 352.03(4).
In-home Therapy
. This service is a
				structured, consistent, therapeutic relationship between a licensed clinician
				and the youth and family for the purpose of treating the youth's behavioral
				health needs, including improving the family's ability to provide effective
				support for the youth to promote healthy functioning of the youth within the
				family. In-home therapy is provided by eligible providers.
Mobile Crisis Intervention
. A
				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, 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.
Parent-caregiver Peer-to-peer Support
.
				This service provides a structured one-to-one relationship between a family
				partner and a parent or caregiver for the purpose of resolving or ameliorating
				the child's emotional and behavioral needs by improving the capacity of the
				parent or caregiver to parent the child with a serious emotional disturbance.
				Services may include education, support, and training for the parent or
				caregiver. Family partners do not provide respite care or babysitting
				services.
Per Diem
. A unit of
				payment that refers to a billable day in which the member is enrolled in the
				program.
Publicly Aided Individual
. A person
				for whose medical and other services a governmental unit is in whole or in part
				liable under a statutory program.
Targeted Case Management (TCM)
. This
				service is for individuals younger than 21 years old with serious emotional
				disturbance and includes assessment of the member, development of an
				individualized care plan, referral and coordination of other services and
				supports, and monitoring and follow-up on the implementation of the care plan.
				Targeted case management is also referred to as intensive care coordination
				(ICC).
Therapeutic Mentoring
. Therapeutic
				mentoring services are designed to support age-appropriate social functioning
				or ameliorate deficits in the youth's age-appropriate social functioning.
				Therapeutic mentoring offers structured, one-to-one, strength-based support
				services between a therapeutic mentor and a youth for the purpose of addressing
				daily living, social, and communication needs. Therapeutic mentoring services
				include supporting, coaching, and training the youth in age-appropriate
				behaviors, interpersonal communication, problem-solving and conflict
				resolution, and relating appropriately to other youth and adults. Therapeutic
				mentoring is provided by eligible providers.
Therapeutic Training and Support
. This
				service is provided by a therapeutic training and support staff working under
				the supervision of an in-home therapist to support implementation of the
				licensed clinician's treatment plan to achieve the goals of that plan. The
				therapeutic training and support staff assists the in-home therapist in
				implementing the therapeutic objectives of the treatment plan designed to
				address the youth's emotional, behavioral, and mental health needs. This
				service includes teaching the youth to understand, direct, interpret, manage,
				and control feelings and emotional responses to situations, and to assist the
				family to address the youth's emotional, behavioral, and mental health needs.
				Therapeutic training and support is provided by eligible providers.