Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1153 - OUTPATIENT PSYCHIATRIC SERVICES › GENERAL PROVISIONS › Section 1153.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise:
Adult partial hospitalization program
-A
					 program licensed by the Department, Office of Mental Health and Substance Abuse
					 Services, to provide partial hospitalization services to individuals 15 years
					 of age or older.
Advanced practice professional
-A person
					 who holds a current Pennsylvania license as a certified registered nurse
					 practitioner or a physician assistant and:
(1) Holds a mental health certification,
				  or
(2) Obtains a mental health
				  certification within 2 years of being hired by the psychiatric outpatient
				  clinic or by July 30, 2020, whichever is later.
Children and youth partial hospitalization
					 program
-A program licensed by the Department, Office of Mental Health
					 and Substance Abuse Services, to provide partial hospitalization services to
					 individuals under 15 years of age.
Clinical staff
-A psychiatrist or a mental
					 health professional or mental health worker under the direct supervision of a
					 psychiatrist.
Collateral family
					 psychotherapy
-Psychotherapy provided to the family members of an
					 individual receiving psychiatric outpatient clinic services in the absence of
					 the individual.
Department
-The Department of Human
					 Services.
Facility
-A mental health establishment,
					 hospital, clinic, institution, center or other organizational unit or part
					 thereof, the primary function of which is the diagnosis, treatment, care and
					 rehabilitation of individuals with mental illness or emotional
					 disturbance.
Family
-A person living alone or the
					 following persons: spouses; parents and their unemancipated minor children and
					 other unemancipated minor children who are related by blood or marriage; or
					 other adults or emancipated minor children living in the household who are
					 dependent upon the head of the household.
Family psychotherapy
-Psychotherapy
					 provided to two or more members of a family. At least one family member shall
					 have a diagnosed mental illness or emotional disturbance. Sessions shall be
					 conducted by a clinical staff person.
Group psychotherapy
-Psychotherapy provided
					 to no less than 2 and no more than 12 persons with diagnosed mental illness or
					 emotional disturbance. These sessions shall be conducted by a clinical staff
					 person.
Individual psychotherapy
-Psychotherapy
					 provided to one person with a diagnosed mental illness or emotional
					 disturbance. These sessions shall be conducted by a clinical staff
					 person.
Inpatient services
-Treatment provided to
					 an individual who has been admitted to a treatment institution or an acute care
					 hospital or psychiatric hospital on the recommendation of a physician and is
					 receiving room, board and professional services in the facility on a continuous
					 24-hour-a-day basis.
Intake
-The first contact with an
					 individual for the initiation of or re-admission to outpatient behavioral
					 health services covered by this chapter.
Interactive audio and video
-Real-time
					 two-way or multiple-way communication.
LPHA-Licensed Practitioner of the Healing
					 Arts
-A person who is licensed by the Commonwealth to practice the
					 healing arts. This term is limited to a physician, physician's assistant,
					 certified registered nurse practitioner, licensed clinical social worker,
					 licensed marriage and family therapist, licensed professional counselor or
					 psychologist.
MMHT-Mobile Mental Health Treatment
-One or
					 more of the following services provided in an individual's residence or
					 approved community site:
(i)
				  Assessment.
(ii) Individual, group
				  or family therapy.
(iii) Medication
				  visits.
Mental health professional
-A person who
					 meets one of the following:
(i) Has a
				  graduate degree from a college or university that is accredited by an agency
				  recognized by the United States Department of Education or the Council for
				  Higher Education Accreditation (CHEA) in a generally recognized clinical
				  discipline in which the degree program includes a clinical practicum.
(ii) Has an equivalent degree from a foreign
				  college or university that has been evaluated by the Association of
				  International Credential Evaluators, Inc. (AICE) or the National Association of
				  Credential Evaluation Services (NACES). The Department will accept a general
				  equivalency report from the listed evaluator agencies to verify a foreign
				  degree or its equivalency.
(iii) Is
				  licensed in a generally recognized clinical discipline that includes mental
				  health clinical experience.
Mental health worker
-A person acting under
					 the supervision of a mental health professional to provide services who meets
					 one of the following:
(i) Has a
				  bachelor's degree from a college or university that is accredited by an agency
				  recognized by the United States Department of Education or the CHEA in a
				  recognized clinical discipline including social work, psychology, nursing,
				  rehabilitation or activity therapies.
(ii) Has a graduate degree in a clinical
				  discipline with 12 graduate-level credits in mental health or counseling from a
				  program that is accredited by an agency recognized by the United States
				  Department of Education or the CHEA.
(iii) Has an equivalent degree from a foreign
				  college or university that has been evaluated by the AICE or the NACES. The
				  Department will accept a general equivalency report from the listed evaluator
				  agencies to verify a foreign degree or its equivalency.
Mental illness
or
emotional
					 disturbance
-A mental disorder that meets the diagnostic criteria
					 within the current version of the
Diagnostic and Statistical Manual of
					 Mental Disorders
or the
International Classification of
					 Diseases (ICD)
.
Outpatient services
-Medical or behavioral
					 health services provided to an individual by a psychiatric outpatient clinic or
					 partial hospitalization outpatient facility that does not provide room, board
					 and professional services on a continuous 24-hour-a-day basis.
Psychiatric clinic clozapine monitoring and
					 evaluation visit
-A visit for the monitoring and evaluation of an
					 individual's physical and mental condition during the course of treatment with
					 clozapine. The term includes only a visit provided to an eligible individual
					 receiving clozapine therapy, and only by a psychiatrist, physician, certified
					 registered nurse practitioner, registered nurse or physician assistant.
Psychiatric clinic medication visit
-A
					 visit only for administration of a drug and evaluation of an individual's
					 physical or mental condition during the course of prescribed medication. This
					 visit is provided to an eligible individual only by a psychiatrist, physician,
					 certified registered nurse practitioner, physician assistant, registered nurse
					 or licensed practical nurse.
Psychiatric evaluation
-An initial mental
					 status examination and evaluation of an individual provided only by a
					 psychiatrist in a face-to-face interview or through the use of interactive
					 audio and video communication that conforms to industry-wide technology
					 standards and is in compliance with State and Federal privacy and security
					 laws. It must include a comprehensive history and evaluation of pertinent
					 diagnostic information necessary to arrive at a diagnosis and recommendations
					 for treatment or further diagnostic studies or consultation. The history must
					 include individual, social, family, occupational, drug, medical and previous
					 psychiatric diagnostic and treatment information.
Psychiatric outpatient clinic provider
-A
					 facility enrolled in the MA Program to provide psychiatric outpatient clinic
					 services and licensed by the Department, Office of Mental Health and Substance
					 Abuse Services, to provide specific medical, psychiatric and psychological
					 services for the diagnosis and treatment of mental illness or emotional
					 disturbance.
Psychiatric outpatient clinic
					 services
-Outpatient medical, psychiatric and psychological services
					 listed in the MA Program Fee Schedule furnished to an individual with mental
					 illness or emotional disturbance while the individual is not a resident of a
					 treatment institution, provided by or under the direction of a
					 psychiatrist.
Psychiatric outpatient partial hospitalization
					 provider
-A facility enrolled in the MA Program to provide partial
					 hospitalization outpatient services and licensed by the Department, Office of
					 Mental Health and Substance Abuse Services, to provide psychiatric, medical,
					 psychological and psychosocial services as partial hospitalization for the
					 diagnosis and treatment of mental illness or emotional disturbance.
Psychiatric partial hospitalization
-An
					 active outpatient psychiatric day or evening treatment session including
					 medical, psychiatric, psychological and psychosocial treatment listed in the MA
					 Program Fee Schedule. This service shall be provided to an individual with
					 mental illness or emotional disturbance on a planned and regularly scheduled
					 basis for a minimum of 3 hours but less than 24 hours in any 1 day. The session
					 shall be provided by a psychiatrist or by psychiatric partial hospitalization
					 personnel under the direction of a psychiatrist.
Psychologist in preparation for
					 licensure
-A person who has completed the educational requirements for
					 licensure and is accruing the required postdegree experience for
					 licensing.
Psychotherapy
-The treatment, by
					 psychological means, of the problems of an emotional nature in which a trained
					 person deliberately establishes a professional relationship with an individual
					 with the objective of removing, modifying or relieving existing symptoms of
					 mediating disturbed patterns of behavior and of promoting positive personality
					 growth and development.
Tele-behavioral health-
(i) The use of interactive audio and video
				  communication to provide clinical services at a distance using technology that
				  conforms to the industry-wide standards and is in compliance with State and
				  Federal privacy and security laws.
(ii) Tele-behavioral health does not include
				  telephone conversation, electronic mail message or facsimile transmission
				  between a psychiatrist or an advanced practice professional and an individual
				  receiving services or a consultation between two health care practitioners,
				  although these activities may support the delivery of tele-behavioral
				  health.
Treatment institution
-A facility approved
					 or licensed by the Department or its agents that provides full-time psychiatric
					 treatment services for resident individuals with mental illness or emotional
					 disturbance, residential facilities for individuals with intellectual
					 disabilities or community residential rehabilitation services are not
					 considered to be mental health treatment institutions.
Under the direction of a
					 psychiatrist
-Receiving oversight and consultation by a psychiatrist in
					 the medical, psychiatric and psychological services provided to individuals by
					 psychiatric outpatient clinic or partial hospitalization
					 personnel.