SECTION 13 - BENEFITS AND LIMITATIONSmanuals.momed.com/collections/collection_archive/collection_cpr/... · Section 13 - Benefits and Limitations Contemporaneous means at the time

Section 13 - Benefits and Limitations

SECTION 13 - BENEFITS AND LIMITATIONS

13.1 AUTHORIZATION ........................................................................................................................6

13.2 PROVIDER PARTICIPATION ....................................................................................................6

13.3 ADEQUATE DOCUMENTATION ..............................................................................................7

13.4 PARTICIPANT COPAY................................................................................................................9

13.5 PARTICIPANT NONLIABILITY ................................................................................................9

13.6 DEFINITIONS ..............................................................................................................................10

13.6.A CPR PROVIDER .................................................................................................................10

13.6.B QUALIFIED MENTAL HEALTH PROFESSIONAL ........................................................11

13.6.C SERIOUSLY MENTALLY ILL OR SERIOUS EMOTIONAL DISORDER .....................12

13.7 PLACE OF SERVICE ..................................................................................................................13

13.8 GENERAL LIMITATIONS ........................................................................................................13

13.9 DELIVERY OF COMMUNITY PSYCHIATRIC REHABILITATION SERVICES ...........14

13.9.A PARTICIPANT ELIGIBILITY—INTAKE EVALUATION .............................................14

13.9.B EVALUATION TEAM .......................................................................................................14

13.9.C INTAKE EVALUATION ....................................................................................................14

13.9.D TREATMENT PLANNING ................................................................................................15

13.9.E PERIODIC TREATMENT PLAN REVIEW .........................................................................15

13.9.F ANNUAL EVALUATION ....................................................................................................15

13.10 ADMISSION TO CPR ..............................................................................................................15

13.10.A DIAGNOSIS ........................................................................................................................15

13.10.B DISABILITY .......................................................................................................................16

13.10.C DURATION .........................................................................................................................16

13.10.D ELIGIBILITY REQUIREMENTS FOR CPR CHILDREN’S SERVICES .........................16

13.10.E PROVISIONAL ADMISSION FOR CHILDREN AND ADOLESCENTS ........................18

13. 10.F ENROLLMENT ..................................................................................................................19

13.11 COVERED SERVICES ............................................................................................................19

13.11.A MODIFIERS ........................................................................................................................19

13.11.B INTAKE EVALUATION ....................................................................................................20

1Community Psychiatric Rehabilitation Program Manual

Last Updated - 09/10/2013Archived - 02##2014

Archived


13.11.C ANNUAL EVALUATION ..................................................................................................21

13.11.D TREATMENT PLANNING ................................................................................................21

13.11.E BEHAVIORAL HEALTH ASSESSMENT ........................................................................23

13.11.F LIMITATIONS FOR EVALUATIONS AND TREATMENT PLANS ..............................24

13.11.G DOCUMENTATION REQUIREMENTS FOR EVALUATIONS AND TREATMENT

PLANS 25

13.11.H CRISIS INTERVENTION AND RESOLUTION ...............................................................25

13.11.H(1) Limitations ....................................................................................................................26

13.11.H(2) Documentation Requirements ......................................................................................26

13.11.I MEDICATION SERVICES ................................................................................................26

13.11.I(1) Limitations ....................................................................................................................27

13.11.I(2) Documentation Requirements ......................................................................................27

13.11.J MEDICATION ADMINISTRATION .................................................................................28

13.11.J(1) Limitations ....................................................................................................................29

13.11.J(2) Documentation Requirements ......................................................................................29

13.11.K METABOLIC SYNDROME SCREENING ........................................................................29

13.11.K(1) Limitations ....................................................................................................................30

13.11.K(2) Documentation Requirements ......................................................................................30

13.11.L COMMUNITY SUPPORT ..................................................................................................30

13.11.L(1) Limitations ....................................................................................................................36

13.11.L(2) Documentation Requirements ......................................................................................36

13.11.M INTENSIVE COMMUNITY PSYCHIATRIC REHABILITATION .................................36

13.11.M(1) Limitations ...................................................................................................................40

13.11.M(2) Documentation Requirements ......................................................................................40

13.11.N EVIDENCE BASED PRACTICES (EBP) ..........................................................................41

13.11.N(1) Limitations ....................................................................................................................41

13.11.N(2) Documentation Requirements ......................................................................................41

13.11.O TREATMENT FAMILY HOME .........................................................................................41

13.11.O(1) Limitations ...................................................................................................................42

13.11.O(2) Documentation Requirements .....................................................................................42



Archived


13.11.P PROFESSIONAL PARENT HOME ...................................................................................42

13.11.P(1) Limitations ....................................................................................................................44

13.11.P(2) Documentation requirements ........................................................................................44

13.11.Q CHILDREN’S INPATIENT DIVERSION ..........................................................................44

13.11.Q(1) Limitations ....................................................................................................................44

13.11.Q(2) Documentation requirements ........................................................................................45

13.11.R INTENSIVE CPR RESIDENTIAL-CLUSTERED APARTMENTS ..................................45

13.11.R(1) Limitations ....................................................................................................................45

13.11.R(2) Documentation requirements ........................................................................................45

13.11.S INTENSIVE CPR RESIDENTIAL-IRTS ...........................................................................45

13.11.S(1) Limitations ....................................................................................................................46

13.11.S(2) Documentation requirements ........................................................................................46

13.11.T INTENSIVE CPR RESIDENTIAL-PISL ............................................................................46

13.11.T(1) Limitations ....................................................................................................................46

13.11.T(2) Documentation requirements ........................................................................................46

13.11.U PEER SUPPORT SERVICES ..............................................................................................47

13.11.U(1) Limitations ....................................................................................................................49

13.11.U(2) Documentation Requirements ......................................................................................49

13.11.V PSYCHOSOCIAL REHABILITATION .............................................................................49

13.11.V(1) Limitations ....................................................................................................................51

13.11.V(2) Documentation Requirements ......................................................................................51

13.11.W INDIVIDUAL AND GROUP PROFESSIONAL PSR ........................................................51

13.11.W(1) Limitations ...................................................................................................................53

13.11.W(2) Documentation Requirements ......................................................................................53

13.11.X PSR ILLNESS MANAGEMENT/RECOVERY (IMR) ......................................................53

13.11.X(1) Limitations ....................................................................................................................54

13.11.X(2) Documentation Requirements ......................................................................................54

13.11.Y CONSULTATION SERVICES ...........................................................................................54

13.11.Y(1) Limitations ....................................................................................................................55

13.11.Y(2) Documentation Requirements ......................................................................................55



Archived


13.11.Z CO-OCCURRING SERVICES ...........................................................................................55

13.11.Z(1) Co-Occurring Individual Counseling ...........................................................................55

13.11.Z(1)A Limitations .................................................................................................................56

13.11.Z(1)B Documentation Requirements ....................................................................................56

13.11.Z(2) Co-Occurring Group Counseling..................................................................................56

13.11.Z(2)A Limitations .................................................................................................................56


13.11.Z(3) Co-Occurring Group Education....................................................................................57

13.11.Z(3)A Limitations .................................................................................................................57


13.11.Z(4) Co-Occurring Assessment Supplement ........................................................................58

13.11.Z(4)A Limitations .................................................................................................................58


13.11.AA DAY TREATMENT- YOUTH ......................................................................................58

13.11.AA(1) Limitations .................................................................................................................60

13.11.AA(2) Documentation Requirements ....................................................................................60

13.11.BB FAMILY SUPPORT .......................................................................................................60

13.11.BB(1) Limitations .................................................................................................................61

13.11.BB(2) Documentation Requirements ....................................................................................61

13.11.CC FAMILY ASSISTANCE ................................................................................................61

13.11.CC(1) Limitations .................................................................................................................62

13.11.CC(2) Documentation Requirements ....................................................................................62

13.11.DD ASSERTIVE COMMUNITY TREATMENT (ACT) ....................................................62

13.11.DD(1) Limitations .................................................................................................................62

13.11.DD(2) Documentation Requirements ....................................................................................63

13.12 LABORATORY SERVICES ...................................................................................................63

13.13 PRESCRIPTION DRUGS ........................................................................................................63

13.14 MANAGED HEALTH CARE PROGRAM ...........................................................................63

13.15 ADMINISTRATIVE LOCK-IN ..............................................................................................63

13.16 DIAGNOSIS CODES ................................................................................................................64



Archived

Section 13 - Benefits and Limitations 13.17 QUALITY ASSURANCE .........................................................................................................64



Archived

Section 13 - Benefits and Limitations SECTION 13-BENEFITS AND LIMITATIONS

Community Psychiatric Rehabilitation (CPR) Program coverage is targeted to certain seriously mentally ill MO HealthNet eligible participants. Services include assessment, treatment and community support services furnished by or under the supervision or recommendation of a physician. Reimbursement is limited to qualified MO HealthNet enrolled CPR providers. This program provides community based services designed to maximize independent functioning and promote community adjustment and integration. This section provides the general benefits and limitations for the program.

13.1 AUTHORIZATION

Section 208.152, RSMo authorizes coverage of CPR services when such services are provided by community mental health facilities that qualify as CPR providers in accordance with State Regulation 9 CSR 30-4.030 through 30-4.047 and 9 CSR 10-7.010 through 10-7.140.

13.2 PROVIDER PARTICIPATION

To participate in the MO HealthNet Program, the CPR provider must satisfy the following requirements:

• Be certified as a CPR provider by the Department of Mental Health (DMH) (State Regulation 9 CSR 30-4.030 through 30-4.047 and 9 CSR 10-7.010 through 10-7.140) and submit a copy of the current certification with the enrollment forms. In order to receive federal funds and participate in the MO HealthNet Program all providers must comply with all applicable State and Federal Laws, including but not limited to civil rights laws and regulations in the delivery of services. It is the provider's responsibility to review the civil rights information via the Internet at www.mmac.mo.gov/providers/provider-enrollment.

• Complete necessary Provider Enrollment documents and agreements required by the Missouri Medicaid Audit and Compliance Unit (MMAC). These documents can be requested by emailing the MMAC Provider Enrollment Section at [email protected].

• Agree to maintain for five (5) years, or longer if specified by a contract with DMH, auditable program records reflecting services provided, participant progress, number and kinds of participants served and other relevant program records;

• Allow the Department of Social Services (DSS) or its authorized representative, (MMAC, DMH, etc), to inspect and examine its premises and records that relate to the provision of services under this program; and



Archived


• Employ and retain qualified/licensed mental health professionals qualified to render the services covered through the MO HealthNet CPR Program or any additional State or Federal Regulations.

Please review Section 2 of the Community Psychiatric Rehabilitation Program Manual for a further discussion of provider participation. Requests for participation in the program should be sent to the Missouri Medicaid Audit and Compliance, Provider Enrollment Section, P.O. Box 6500, Jefferson City, MO 65102 or e-mail to [email protected].

The Department of Mental Health (DMH), through an inter-agency agreement with the Department of Social Services (DSS), Missouri Medicaid Audit and Compliance Unit (MMAC) reviews all requests for participation in CPR and provides validation of the applicant's certification status to MMAC. MMAC, based upon review of the application and certification by DMH, approves or denies the application request.

The Provider Enrollment Section must be notified in writing of any changes in the CPR provider's status. The notification must include the NPI number and the requested change. Examples of changes are: Address or telephone number change; change from a Social Security number to a Tax Payer I.D. number; change in certification status, etc.

Specific information about MO HealthNet participation requirements for CPR can be obtained from the Provider Enrollment Section, Missouri Medicaid Audit and Compliance Unit Division P.O. Box 6500, Jefferson City, Missouri 65102 or e-mail [email protected].

13.3 ADEQUATE DOCUMENTATION

All services provided must be adequately documented in the medical record. The Code of State Regulations, 13 CSR 70-3 (as applicable) defines "adequate documentation" and "adequate medical records" as follows:

Adequate documentation means documentation from which services rendered and the amount of reimbursement received by a provider can be readily discerned and verified with reasonable certainty.

Adequate medical records are records which are of the type and in a form from which symptoms, conditions, diagnoses, treatments, prognosis and the identity of the patient to which these things relate can be readily discerned and verified with reasonable certainty. All documentation must be made available at the same site at which the service was rendered, or available for review within one (1) hour of request. An adequate and complete patient record is a record which is legible, which is made contemporaneously with the delivery of the service, which addresses the patient specifics, which include, at a minimum, individualized statements that support the assessment or treatment encounter.



Archived


Contemporaneous means at the time the service was performed or within 72 hours or three (3) business days, whichever is longer, at the time the service was provided.

Documentation required for CPR MO HealthNet reimbursement of each session, service, or activity excluding psychosocial rehabilitation and day treatment shall consist of the following:

• First name, and last name, and either middle initial or date of birth of the MO HealthNet participant;

• An accurate, complete, and legible description of each service(s) provided;

• Name, title, and signature of the MO HealthNet enrolled provider delivering the service. Services provided by an individual under the direction or supervision of a MO HealthNet provider are not reimbursed by MO HealthNet. Services provided by a person not enrolled with MO HealthNet are not reimbursed by MO HealthNet;

• The name of the referring entity, when applicable;

• The date of service (month/day/year);

• For those MO HealthNet programs and services that are reimbursed according to the amount of time spent in delivering or rendering a service(s), the actual begin and end time taken to deliver the service (for example, 4:00 - 4:30 p.m.);

• The setting in which the service was rendered;

• The plan of treatment, evaluation(s), test(s), findings, results, and prescription(s) as necessary.

• The need for the service(s) in relationship to the MO HealthNet participant's treatment plan; and

• The MO HealthNet participant's progress toward the goals stated in the treatment plan (progress notes);

Documentation required in the clinical record for psychosocial rehabilitation and day treatment contains:

• Weekly notes that include a summary of the patient's participation, involvement in and response to the services received, and the relationship of the services to the treatment regiment described in the treatment plan; and

• Pertinent information reported by family members, or significant others, regarding a change in the participant's condition and/or an unusual or unexpected occurrence in the participant's life.

• Daily attendance records or logs that include actual attendance times, as well as activity or session attended. Daily attendance records or logs are not required to be filed in the individual clinical record. They may be kept in a separate file available for review.



Archived

Section 13 - Benefits and Limitations All of the documentation requirements listed above represent minimal elements for record keeping; however, additional documentation may be needed to satisfy the requirements of outside reviews.

Time spent documenting service interventions, when it is done collaboratively with the client during the course of the service activity/intervention, is considered billable time. Collaborative documentation occurs when the client is present face to face with the service provider/practitioner, and this process is integrated into the service session. It is done collaboratively with the client, and is a process of sharing the assessment, treatment plan, or progress note being written as a service provider with the client to assure a consistent understanding with regard to what was accomplished during the service session. Collaborative documentation is not typing or writing notes during the entire treatment session, nor is it taking time at the end of a session to write a note in front of a client while they are waiting to leave and uninvolved. The client must be actively involved and engaged in writing the note, including seeing and having input into the note. Providers utilizing collaborative documentation must have policies and procedures addressing its use.

A provider’s failure to furnish, reveal and retain adequate documentation for services billed to MO HealthNet can result in the recovery of the payments for those services not adequately documented and can result in sanctions to the provider’s participation in the MO HealthNet program. This policy continues to be applicable in the event the provider discontinues as an active participating MO HealthNet enrolled provider as the result of a change of ownership or any other circumstance.

Documents retained by CPR providers must include the treatment plan and the clinical records. Information must be sufficient to disclose the actual provider of the service, quantity, quality, appropriateness and timeliness of services provided under the agreement.

13.4 PARTICIPANT COPAY

Participants eligible to receive certain MO HealthNet services are required to pay a small portion of the cost of the services. This amount is referred to as copay. The copay amount is paid by the participant at the time services are rendered. Services of the Community Psychiatric Rehabilitation Program are not subject to a copay amount. The provider must accept in full the amounts paid by the state agency.

13.5 PARTICIPANT NONLIABILITY

MO HealthNet covered services rendered to an eligible participant are not billable to the participant if MO HealthNet would have paid had the provider followed the proper policies and procedures for obtaining payment through the MO HealthNet Program as set forth in 13 CSR 70-4.

9

Community Psychiatric Rehabilitation Program Manual


Archived

Section 13 - Benefits and Limitations 13.6 DEFINITIONS

13.6.A CPR PROVIDER

By definition, a provider of CPR services is an entity that is certified by the Department of Mental Health (DMH) as set forth in state regulation 9 CSR 30-4.030 through 30-4.047 and 9 CSR 10-7.010 through 10-7.140. Certification is contingent upon the provision of the core services listed below. These services may be provided directly or by subcontract. The required service functions include the following:

1. Intake evaluation

2. Annual evaluation

3. Treatment planning

4. Crisis intervention and resolution

5. Community Support

6. Medication services

7. Medication administration

8. Psychosocial rehabilitation

9. Physician consultation

10. Metabolic Syndrome Screening (for person receiving antipsychotic medications)

Optional service functions include:

1. Day Treatment-Youth

2. Family Support

3. Treatment Family Home

4. Professional Parent Home

5. Children’s Inpatient Diversion

6. Evidence Based Practices

7. Intensive Community Psychiatric Rehabilitation

8. Youth PSR

9. Family Assistance

10. Behavioral Health Assessment

11. Peer Support Services



Archived


12. Metabolic Syndrome Screening (for persons not receiving antipsychotic medications)

13. Assertive Community Treatment (ACT)

14. PSR-Illness Management and Recovery

15. Individual and Group Professional PSR

16. Co-Occurring Individual Counseling

17. Co-Occurring Group Counseling

18. Co-Occurring Group Education

19. Co-Occurring Assessment Supplement

13.6.B QUALIFIED MENTAL HEALTH PROFESSIONAL

A qualified mental health professional (QMHP) for the purpose of administration of the MO HealthNet CPR, is defined as:

• a physician licensed under Missouri law to practice medicine or osteopathy and with training in mental health services or one year of experience, under supervision, in treating problems related to mental illness or specialized training.

• a psychiatrist licensed under Missouri law as a physician and who has successfully completed a training program in psychiatry approved by the American Medical Association, the American Osteopathic Association, or other training program identified as equivalent by DMH.

• a psychologist licensed under Missouri law to practice psychology with specialized training in mental health services.

• a professional counselor licensed under Missouri law to practice counseling with specialized training in mental health services.

• a clinical social worker licensed under Missouri law with a master's degree in social work from an accredited program and with specialized training in mental health services.

• a psychiatric nurse licensed under Chapter 335 RSMo., as a registered professional nurse with at least two years of experience in a psychiatric or substance abuse treatment setting or a master's degree in psychiatric nursing.

• an individual possessing a master's or doctorate degree in counseling and guidance, vocational counseling, pastoral counseling, rehabilitation counseling and guidance, psychology, family therapy, or related field, who has successfully completed a



Archived


practicum or has one year of experience under the supervision of a qualified mental health professional.

• an occupational therapist certified by the National Board for Certification in Occupational Therapy, registered in Missouri, who has a bachelor's degree and has completed a practicum in a psychiatric setting or has one year experience in a psychiatric setting or has a master's degree and has completed either a practicum in a psychiatric setting or has one year of experience in a psychiatric setting.

• an advanced practice nurse under Chapter 335.016 RSMo who has had education beyond the basic nursing education and is certified by a nationally recognized professional organization as having a nursing specialty, or who meets criteria for advanced practice nurses established by the board of nursing.

• a psychiatric pharmacist who is a registered pharmacist in good standing with the Missouri Board of Pharmacy who is a board certified pharmacist (BCPP) through the Board of Pharmaceutical Specialties or a registered pharmacist currently in a psychopharmacy residency where the service has been supervised by a board certified psychiatric pharmacist.

13.6.C SERIOUSLY MENTALLY ILL OR SERIOUS EMOTIONAL DISORDER

Persons with serious mental illness (SMI) or a serious emotional disorder (SED) experience mental disorders that interfere with functional/developmental capacities in relation to such primary aspects of daily life as self-care, interpersonal relationships and work or schooling. These disorders may often necessitate prolonged mental health care.

The following conditions are not included in the definition of serious mental illness unless accompanied by one of the specific principal diagnoses of mental illness listed in Section 18 of this manual:

• Mental retardation, developmental disabilities, or narcolepsy;

• Simple intoxication caused by substance abuse such as alcohol or drugs;

• Dependence upon or addiction to any substance such as alcohol or drugs; and

• Any other disorders such as organic brain syndrome, which are not of an actively psychotic nature.

The following conditions are not included in the definition of serious emotional disorder:

• An ‘exclusive’ diagnosis of V code, conduct disorder, mental retardation, developmental disorder, or substance abuse as determined by a DMH-CPS provider.

12



Archived

Section 13 - Benefits and Limitations 13.7 PLACE OF SERVICE

A CPR provider may provide care in the following places of service (POS):

03 - School

11- Office

12 - Home

56 - Psychiatric Residential Treatment Center

99 - Other

13.8 GENERAL LIMITATIONS

The following general limitations apply to all services provided through CPR:

• All services must be a medical necessity*.

• The service must be rendered by or under the direction or recommendation of a physician who participates in and approves the treatment plan. A licensed psychologist may approve the treatment plan only when the participant is currently receiving no prescribed psychiatric medications and the clinical recommendations do not include a need for prescribed psychiatric medications. An advanced practice nurse may approve the treatment plan if that individual is providing medication management services to the participant.

• The service must be rendered by an appropriate and qualified individual or professional as defined in this manual and in State Regulation 9 CSR 30-4.030 through 30-4.047 and 9 CSR 10-7.010 through 10-7.140.

• The service must be reasonable to the treatment of an individual's specific mental illness or disorder.

• All other payers, e.g. Medicare, Veterans Administration and third party insurance must be billed prior to billing MO HealthNet when applicable.

• Services are not covered by MO HealthNet for persons who are receiving psychiatric inpatient hospital treatment or who are residents of a MO HealthNet participating nursing facility. However, services are covered on the day of admission to and day of discharge from those types of settings.

• Certain CPR services are covered for persons who are receiving medical inpatient hospital treatment. Please refer to Section 19 of the Community Psychiatric Rehabilitation Program Manual for information on services covered.

• Services are not covered by MO HealthNet for individuals residing in a jail or detention facility. However, services are covered on the day of admission to and day of discharge



Archived


from those types of settings. In addition, services for youth in the custody of the Division of Youth Services (DYS) and not placed in the highest level detention facility are covered by MO HealthNet.

*Medical Necessity is defined as services or supplies that: are reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the function of a malformed body member. Medical necessity shall be reasonable and necessary for the prevention of illness, not mainly for the convenience of the participant or the participants’ doctor. The services or supplies shall be provided for the diagnosis, direct care, and treatment of your medical condition, and furnished in accordance with accepted medical standards.

13.9 DELIVERY OF COMMUNITY PSYCHIATRIC REHABILITATION SERVICES

13.9.A PARTICIPANT ELIGIBILITY—INTAKE EVALUATION

An intake evaluation must be performed for each participant considered for entry into CPR. This applies to any organized program or course of treatment that a participant enters or attends for the purpose of receiving scheduled or planned mental health treatment that is to be reimbursed under MO HealthNet CPR.

The intake evaluation shall be the basis for determining the participant's program eligibility according to disability, diagnosis, duration and the need for mental health treatment.

For each participant, the written clinical record must include a recommendation by the evaluation team that community psychiatric rehabilitation services are appropriate to meet the participant's individual treatment needs.

13.9.B EVALUATION TEAM

The intake evaluation for participants in the rehabilitation level of care must be performed by an evaluation team that includes, at a minimum, a physician and one other QMHP experienced in the diagnosis and treatment of mental illness. The intake evaluation for participants in the maintenance level of care must be performed by a qualified mental health professional.

13.9.C INTAKE EVALUATION

The diagnosis, disability and duration determination shall be based on the findings of a psychosocial/clinical assessment as described in Section 13.11.B.

14



Archived


13.9.D TREATMENT PLANNING

The completion of an initial treatment plan is required for all participants. The treatment plan must include components required by DMH. The treatment plan shall be based on the participant's intake evaluation findings and contain those items specified in Section 13.11.D.

13.9.E PERIODIC TREATMENT PLAN REVIEW

A team, which is minimally composed of a QMHP and community support specialist, if appropriate, shall review the participant's treatment plan, goals and objectives on a regular basis as determined by department policy. Refer to Section 13.11.D. The review determines the participant's progress toward the treatment objectives, the appropriateness of the services being furnished and the need for the participant's continued participation in specific community psychiatric rehabilitation services. The CPR provider shall ensure the individual participates in the treatment plan review and signs the treatment plan. For participants with legal guardians, the CPR provider shall ensure the legal guardian participates in the treatment plan review and signs the treatment plan.

13.9.F ANNUAL EVALUATION

The evaluation team shall conduct an annual evaluation for each participant who continues to require treatment. The annual evaluation shall meet all the requirements described in Section 13.11.C. and must be completed within 30 days prior to or following the anniversary date of the participant's intake evaluation or the previous annual evaluation.

13.10 ADMISSION TO CPR

The administrative agent and its approved designee are authorized by the Division of Comprehensive Psychiatric Services as entry and exit points into the state mental health service delivery system for a geographic service area defined by the Division of Comprehensive Psychiatric Services (9 CSR 30.4-030 (2) A).

13.10.A DIAGNOSIS

Program eligibility is restricted to those participants who are MO HealthNet eligible and who have one of the specific diagnoses listed in Section 18. A physician or licensed psychologist shall certify a primary diagnosis as defined in 9 CSR 10-7.140(2)(OO) or International Classification of Diseases, Ninth Revision with Clinical Modification (ICD-9-CM), using the current edition of the manual. This diagnosis may coexist with other psychiatric diagnoses in Axis I or other areas. See Section 18 for common ICD-9-CM and DSM-IV diagnoses for CPR. Whenever discrepancies occur regarding the appropriateness of an ICD-9-CM versus a



Archived


DSM diagnosis, the DSM diagnosis shall prevail. A functional assessment may be used to establish eligibility and the need for and amount of services, including results from a standardized assessment prescribed by the Department of Mental Health. Participants enrolled in the Disease Management 3700 project and participants enrolled in CMHC Healthcare Home are not required to have one of the specific diagnoses listed in section 18 of the Community Psychiatric Rehabilitation Program Manual.

13.10.B DISABILITY

There shall be clear evidence of serious and/or substantial impairment in the ability to function at an age or developmentally appropriate level due to serious psychiatric disorder in each of the following two areas of behavioral functioning, as indicated by intake evaluation and assessment.

• Social role functioning/family life—the ability to sustain functionally the role of a worker, student, homemaker, family member or a combination of these; and

• Daily living skills/self-care skills—the ability to engage in personal care (such as grooming, personal hygiene) and community living (handling personal finances, using community resources, performing household chores), learning ability/self-direction and activities appropriate to the individual's age, developmental level and social role functioning.

13.10.C DURATION

Rehabilitation services shall be provided to those individuals whose mental illness is of sufficient duration as evidenced by one or more of the following occurrences:

1. Persons who have undergone psychiatric treatment more intensive than outpatient more than once in a lifetime (crisis services, alternative home care, partial hospital, inpatient);

2. Persons who have experienced an occurrence of continuous residential care other than hospitalization, for a period long enough to disrupt the normal living situation;

3. Persons who have exhibited the psychiatric disability for one year or more; or

4. Persons whose treatment of psychiatric disorders has been or will be required for longer than six months.

13.10.D ELIGIBILITY REQUIREMENTS FOR CPR CHILDREN’S SERVICES

ELIGIBILITY REQUIREMENTS FOR CPR CHILDREN’S SERVICES: A child can be determined eligible for CPR, by one of the following means.

1) Child has a qualifying diagnosis as per 9 CSR 30.4.042. 16



Archived


2) Child has a serious emotional disorder as defined by the Department of Mental Health and a score on the DLA20 of 50 or below for children between 6 and 18 years of age.

For children age 2 through 5, the following are the DMH approved functional tools. Total scores should be documented in the child’s record. At the present time, there is not a location in CIMOR to enter these scores.

• Devereaux Early Childhood Assessment Clinical Form (DECA-C) is the DMH recommended tool. The criterion score to qualify for CPR would be a Total Behavior Concerns scale of 60 or higher.

• Ages and Stages Social Emotional Screening tool; cutoff scores identified with the specific age ranges as identified in the manual are eligible for CPR.

• Preschool and Early Childhood Functional Assessment Scale (PECFAS) total score of 90 or above.

AGE RANGE: The youth version of the DLA20 is for children and youth between the ages of 6 and 18.

TIME FRAME FOR THE DLA20 ADMINISTRATION: Upon admission of the child to CPR, quarterly thereafter, and then at discharge.

WHO COMPLETES THE DLA20: The initial, annual, and discharge DLA20 shall be completed by a Qualified Mental Health Professional. Quarterly updates can be completed by the community support specialist.

DATA ENTRY: The DLA20 scores shall be entered into CIMOR under diagnosis axis V (GAF). The initial score shall be entered within 30 days of the admission date into CIMOR.

DISCHARGE OF YOUTH AND DLA20: Presently, there are no requirements for CPR discharge in relation to the DLA20 score.

BILLING OF DLA20: The community support specialist can bill up to two (2) units of community support for the time spent completing the DLA20. The billable time should be the actual time spent completing the DLA20, and may vary from one child to another.

The QMHP can bill up to two (2) units of Behavioral Health Assessment (H0002) for the time spent completing the DLA20. The billable time should be the actual time spent completing the DLA20, and may vary from one child to another.

For the completion of the early childhood screening tools (Devereaux Early Childhood Assessment Clinical Form, Ages and Stages Social Emotional Screening tool, and Preschool and Early Childhood Functional Assessment Scale), the same guidelines above



Archived


apply for billing. Only those staff that have received appropriate clinical training in these tools can bill.

YOUNG ADULTS 18 YEARS AND OLDER: In the case of young adults that are 18 and over that continue to receive youth funded services, the provider is encouraged to administer either the Youth, or the Adult version of the DLA20 based on the young adults functioning. Administration of the DLA20 for this age range is not required at this point, but may be in the near future.

There is flexibility between 18-21 years of age in what services are provided and how they are funded. For example, if a youth turns 18 and does not have a qualifying adult diagnosis, providers may continue serving them in the Youth CPR program up to the age of 21, if needed to assist in transition to independence. If the Children’s Division (CD) is involved providers may want to consider maintaining the individual in the Youth CPR program, but eventually the individual will need to be discharged or qualify under Adult CPR program eligibility. Good clinical practice would mean that the provider would start working on that transition between ages 18-21 and CD take an active role in family support meeting if the youth doesn’t meet the adult criteria. When a youth is in service with a provider prior to age 18, and will continue with the provider after 18, the specific needs of the youth and clinical judgment should guide the services. If an individual is not currently in service and comes to a provider at the age of 18, child or adult services could be provided.

13.10.E PROVISIONAL ADMISSION FOR CHILDREN AND ADOLESCENTS

Under the following circumstances, children and adolescents under the age of 18 years of age may be provisionally admitted to Community Psychiatric Rehabilitation Program services:

• Disability: There shall be clear evidence of serious and/or substantial impairment in the ability to function at an age or developmentally appropriate level due to serious psychiatric disorder in each of the following two areas of behavioral functioning as indicated by intake and assessment:

1. Social role functioning/family life—the individual is at risk of out-of-home or out-of-school placement; and

2. Daily living skills/self-care skills—the individual is unable to engage in personal care (such as grooming, personal hygiene) and community living (performing school work or household chores), learning, self-direction or activities appropriate to the individual's age, developmental level and social role functioning;



Archived


• Diagnosis: If a person is exhibiting behaviors or symptoms that are consistent with a non-established CPR eligible diagnosis, they may be provisionally admitted to CPR for further evaluation. There may be insufficient clinical information because of rapidly changing developmental needs to determine if a CPR diagnosis is appropriate without an opportunity to observe and evaluate the person's behavior, mood and functional status. In such cases, there must be documentation that clearly supports the individual's level of functioning as defined in 9 CSR 30-4.042 (5)(A) "Disability".

• Duration: There must be documented evidence of an individual's functional disability as defined in 9 CSR 30-4.042 (5)(A) "Disability" for a period of 90 days prior to provisional admission.

• Provisional admissions shall not exceed 90 days. Immediately upon completion of the 90 days or sooner, if the individual has been determined to have an eligible diagnosis as listed in 9 CSR 30-4.042 (4) (B) of the rule, the diagnosis must be documented and the individual may continue in the CPR Program.

• If an individual who has been provisionally admitted is determined to be ineligible for CPR services, staff shall directly assist the individual and/or family in arranging appropriate follow-up services. Follow-up services shall be documented in the discharge summary of the clinical record.

• All admission documentation is required for those provisionally admitted, with the exception of the comprehensive evaluation which may be deferred for 90 days

13. 10.F ENROLLMENT

To be eligible for reimbursement of services, the provider must enroll the participant for CPR services by submitting required information to the DMH participant information system data base (CIMOR).

13.11 COVERED SERVICES

CPR services must be billed using the appropriate modifiers listed below. Also refer to Section 19 for a complete list of procedure codes and the corresponding modifiers.

13.11.A MODIFIERS

MODIFIER DESCRIPTION

HO ........................Master’s level

HH ........................Mental health/substance abuse program



Archived


HQ ........................Group Setting

52..........................Reduced services

TN ........................Telemedicine

HA ........................

HK ........................

TG ........................

TF .........................

TD ........................

TE .........................

AF ........................

Child/adolescent program

Specialized mental health programs for high risk populations

Complex/high tech level of care

Intermediate level of care

RN

LPN

Child Psychiatrist

The following CPR services are covered for MO HealthNet eligible participants when medically necessary and the diagnosis is related to mental illness.

13.11.B INTAKE EVALUATION

At intake, for participants in the rehabilitation and intensive levels of care, each CPR provider shall complete in a format acceptable to the department, and file in the participant record a comprehensive intake evaluation which shall include:

• Presenting problem, request for assistance, symptoms and functional deficits;

• Personal, family, educational, treatment and community history;

• Reported physical and medical complaints and the need for screening for medical, psychiatric, or neurological assessment or other specialized evaluation;

• Findings of a brief mental status examination;

• Current functional strengths and weaknesses obtained through interview and behavioral observation;

• Specific problem indicators for individualized treatment;

• Existing personal support systems and current use of community resources;

• Diagnostic formulation;

• Specific recommendations for further evaluation and treatment;



Archived


• Consultation between a physician and the psychologist or other mental health professional(s) conducting the psychosocial/clinical evaluation addressing the participant's need and the appropriateness of community psychiatric rehabilitation. Consultation may be performed by an advanced practice nurse if that individual is providing medication management services to the participant; and

• The clinical record must support the level of care.

13.11.C ANNUAL EVALUATION

An annual evaluation consists of updating annually any elements from the intake evaluation that have changed. Participants in the rehabilitation and intensive levels of care shall have annual evaluations completed. A comprehensive annual evaluation includes all of the following components.

• Presenting problem and request for assistance;

• Changes in personal, family, educational, treatment and community history;

• Reported physical/medical complaints;

• Current functional weaknesses and strengths;

• Changes in existing personal support systems and use of community resources;

• Description of the participant's apparent change in condition from one year ago;

• Specific problem indicators required by the department;

• Update of the diagnostic formulation;

• Specific recommendations for further evaluation and/or treatment;

• Information obtained through interview and behavioral observations that contribute to the formulation of a new treatment plan; and

• Consultation between a physician and/or psychologist and the mental health professional(s) conducting the psychosocial/clinical evaluation addressing the participant's need and appropriateness for continued community psychiatric rehabilitation.

13.11.D TREATMENT PLANNING

Treatment planning is covered for the development, review and/or revision of a participant's treatment/rehabilitation plan including documentation. An individualized treatment/rehabilitation plan is a document that sets forth the care, treatment and rehabilitation goals and objectives for individuals with mental illness and that details the treatment program as required by law, rules and funding sources. An Individual Treatment



Archived


Plan (ITP) is required for each CPR participant. Planning includes the participant's and/or other concerned individual's input and participation.

The Individual Treatment Plan shall be completed no later than 30 days after admission to the CPR program; however, it should be completed earlier if clinically indicated. For participants in the rehabilitation and intensive levels of care, a physician shall approve the treatment plan. A licensed psychologist may approve the treatment plan only in instances when the participant is currently receiving no prescribed psychiatric medications and the clinical recommendations do not include a need for prescribed psychiatric medications. An advanced practice nurse may approve the treatment plan if that individual is providing medication management services to the participant. For participants in the maintenance level of care, a QMHP shall approve the treatment plan. The individual shall participate in the development of the treatment plan and sign the plan, unless detrimental to their well-being. If the participant does not sign the treatment plan, the CPR provider shall insert a progress note in the case record explaining the reason the participant did not sign the treatment plan. For participants with legal guardians, the legal guardians shall participate in the development of the treatment plan and sign the plan.

The CPR provider shall develop and maintain for each participant an Individual Treatment Plan using a standardized format furnished by the department, at its discretion, which is filed in the master participant record.

The treatment plan shall record at a minimum; the following as indicated:

1) Service data.

• the reason(s) for admission into rehabilitation services;

• criteria or plans, or both for movement;

• criteria for discharge;

• a list of agencies currently providing program/services, the type(s) of service, date(s) initiation of program/services;

• a summary statement of prioritized problems and assets; and

2) Treatment goals and objectives for the treatment plan and any components.

• specific individualized medication, psychosocial rehabilitation, behavior management, critical intervention, community support goals and other services and interventions as prescribed by the team;

• the treatment regimen, including specific medical and remedial services, therapies and activities that will be used to meet the treatment goals and objectives;



Archived


• a projected schedule for service delivery that includes the expected frequency and duration of each type of planned therapeutic session or encounter;

• the type of personnel who will be providing the services;

• a projected schedule for completing reevaluations of the participant's condition and for updating the treatment plan.

• resources required to implement recommended services;

• level of care (maintenance, rehabilitation, intensive)

The Individual Treatment Plan shall be reviewed on a regular basis, as determined by Department of Mental Health policy and rewritten annually. For participants in the rehabilitation level of care, an evaluation team, consisting of at least, a qualified mental health professional (QMHP) and the participant's community support specialist, if applicable, shall review the treatment plan, goals and objectives. For participants in the maintenance level of care, a QMHP shall review the treatment plan. The participant, and family or guardian as applicable, shall participate in the treatment plan review. The review shall determine:

• the participant's progress toward treatment objectives;

• the appropriateness of the services being furnished;

• the need for the individual’s continued participation in specific community psychiatric rehabilitation services.

For participants in the rehabilitation level of care, treatment plans shall be reviewed at a minimum, every 90 calendar days and the review documented in the case record. For participants in the maintenance level of care, treatment plans shall be reviewed at a minimum, annually, and the review documented in the case record. For participants in the maintenance level of care who reside in residential care facilities, treatment plans shall be reviewed at a minimum, every 90 calendar days, and the review documented in the case record.

13.11.E BEHAVIORAL HEALTH ASSESSMENT

Behavioral Health Assessment is a covered service for the screening and assessment of participants in the maintenance level of care. The required provider of the service is a QMHP.

The Behavioral Health Assessment procedure code may be billed in the following situations: 1. Evaluations of persons being admitted to the Maintenance level of care.



Archived


2. A level of care transition summary when persons are moving from one level of care to another.

3. Any additional evaluation activities needed when an individual is moving from the Maintenance to the Rehabilitation level of care.

4. Any additional evaluation activities needed when an individual transfers from one CPR provider to another, or is admitted to a new CPR provider less than 11 months since the last intake or Annual Evaluation was completed.

5. Evaluation activities for person admitted to CPR through Disease Management (DM) 3700 program.

6. Time spent completing the DLA20. A QMHP may bill up to two (2) units of Behavioral Health Assessment. The billable time should be the actual time spent completing the DLA20, and may vary from one child to another.

When billing the Behavioral Health Assessment and documenting an evaluation of a person being admitted to the Maintenance level of care, the format of the evaluation should include the following:

a. Identifying Information b. Presenting Problem/Challenges c. Pertinent Psychiatric History d. Pertinent Medical History e. Pertinent Family History f. Diagnostic Formulation g. Treatment Recommendations

13.11.F LIMITATIONS FOR EVALUATIONS AND TREATMENT PLANS

• Comprehensive Evaluation services are limited to one initial intake or annual evaluation per participant per provider during an 11 month period beginning with the initial intake.

Generally, it is expected that only one intake evaluation is performed for each participant per lifetime. If the participant changes providers, the new provider should obtain the intake evaluation from the prior provider.

• The rate for the comprehensive initial intake and the comprehensive annual evaluation includes the cost of treatment planning.

• Behavioral Health Assessment is limited to 25 hours (100 units) annually per participant.

• Treatment planning is limited to 50 hours (200 units) annually per participant.



Archived


13.11.G DOCUMENTATION REQUIREMENTS FOR EVALUATIONS AND TREATMENT PLANS

All treatment plans must be maintained in the participant's clinical record.

PROC CODE

DESCRIPTION

H0031 ............... Comprehensive Intake Evaluation/Treatment Plan

H003152 ...........

H0002 ...............

H0032 ...............

Comprehensive Annual Evaluation/Treatment Plan

Behavioral Health Assessment

Treatment Planning

13.11.H CRISIS INTERVENTION AND RESOLUTION

Crisis intervention and resolution face-to-face emergency or telephone intervention services are available 24 hours a day on an unscheduled basis to the individual. The services are designed to resolve the crisis, provide support and assistance, and to promote a return to routine adaptive functioning. Crisis intervention is reimbursable only when the participant's community support specialist is unavailable or unable to resolve a particular situation.

Key service functions for crisis intervention action include:

• Interacting with identified participant family members, legal guardian, significant others, or a combination of these;

• Specifying factors that led to the participant's crisis state, when known;

• Identifying maladaptive reactions exhibited by the participant;

• Evaluating potential for rapid regression;

• Attempting to resolve the crisis; and

• Referring the participant for treatment in an alternative setting, when indicated.

Treatment is designed to resolve the participant's presenting crisis, furnish support and assistance, develop symptomatic relief and facilitate return to routine adaptive functioning.

The service must be provided by a QMHP as defined in 9 CSR 30-4.030 and in Section 13.6.B of the manual.

Non-medical staff providing crisis intervention and resolution shall have immediate 24 hour telephone access to consultation with a physician.



Archived


13.11.H(1) Limitations

Reimbursement for crisis intervention is not allowable when the service is provided by the participant's community support specialist.

13.11.H(2) Documentation Requirements

When billing for crisis intervention and resolution the following written documentation must be maintained in the participant's clinical record:

• Description of the precipitating event(s)/situation when known;

• Description of the participant's mental status;

• Interventions initiated to resolve the participant's crisis state;

• Participant's response to intervention;

• Disposition;

• Planned staff follow-up; and

• Other documentation requirements for each session, service and activity as specified in Section 13.3.

PROC CODE

DESCRIPTION

H2011 ......... Crisis Intervention & Resolution

13.11.I MEDICATION SERVICES

Medication services consist of goal oriented interaction regarding the need for psychoactive medications and management of the medication regimen.

Key service functions include, but are not limited to:

• an assessment of the participant's presenting condition;

• a mental status exam;

• a review of symptoms and medication side effects;

• a review of participant functioning;

• assessment of the participant's ability to self-administer medications;

• participant education regarding the effects of medication and its relationship to the participant's mental illness; and

• prescription of medications, when indicated.



Archived


This service is covered by advanced practice nurses and psychiatric pharmacists, subject to guidelines and limitations promulgated for each specialty in statutes and administrative rules. Psychiatric pharmacists are allowed to provide all key service functions with the exception of prescribing medications. A physician shall review and evaluate medications at least every six months.

Through December 31, 2012, Medication Services was billed using the CPT procedure code 90862, with appropriate modifiers when the procedure was performed by an advance practice nurse/psychiatrist pharmacist or child psychiatrist, when the procedure was delivered through telehealth, and when the procedure was delivered by a prescriber on an Assertive Community Treatment (ACT) team. 90862 was a fifteen (15) minute unit of service with a daily limit of 2 hours (8 units) per day.

Effective January 1, 2013, procedure code 90862 was discontinued and replaced with CPT codes for evaluation/management (99201-99205, 99212-99215, 99334-99335) and psychiatric diagnostic evaluation with medical services (90792).

Definitions for the CPT codes for billing of Medication Services are described in the guideline section of the CPT manual. Please refer to the definitions and explanations given for the use of the codes when determining the level of service to be used for each participant.

These procedure codes may also have modifiers to distinguish when the service is provided by an advance practice nurse/psychiatrist pharmacist or child psychiatrist, when the procedure is delivered through telehealth, and when the procedure is delivered by a prescriber on an Assertive Community Treatment (ACT) team.

13.11.I(1) Limitations

CPT procedure codes 99201-99205, 99212-99215, and 99334-99335 are per event codes and are limited to one unit per day per participant. CPT procedure code 90792 is a fifteen minute unit of service and is limited to 2 hours (8 units) per day per participant and 3 hours (12 units) per year per participant. None of these procedure codes may be billed on the same date of service for the same participant as any of the other procedure codes.

13.11.I(2) Documentation Requirements

The following written documentation must be maintained in the participant's clinical record:

• Description of the participant's presenting condition;

• Pertinent medical and psychiatric findings;

• Observations and conclusions;



Archived


• Participant's response to medications including identifying and tracking target symptoms for each medication prescribed;

• Actions and recommendations regarding the participant's ongoing medication regimen;

• Pertinent/significant information reported by family members or significant others regarding a change in the participant's condition, an unusual or unexpected occurrence in the participant's life, or both; and

• Additional items as required for each service, session, or activity as specified in Section 13.3.

Medication Services must occur at least every 6 months for anyone on psychiatric medications. Review of relevant documentation in the participant record, such as progress notes and treatment plan reviews, shall constitute the review and evaluation.

PROC CODE

DESCRIPTION

90862 ......... Medication Service (ended 12/31/12)

90862EP ..... Medication Service (Child Psychiatrist) (ended 06/30/12)

9086252 ..... Medication Services/Professional (APN and Psychiatric Pharmacist) (ended 12/31/12)

90862TN .... Telepsychiatry, Medication Service (ended 12/31/12)

90862TNEP Telepsychiatry, Medication Service (Child Psychiatrist) (ended 6/30/12)

90862HK ....

9086252HK

90862AF ....

90862FNAF Telepsychiatry, Medication Services (Child Psychiatrist) (ended 12/31/12)

Medication Services – ACT (ended 12/31/12)

Medication Services – ACT (APN) (ended 12/31/12)

Medication Services (Child Psychiatrist) (ended 12/31/12)

For a complete listing of the CPT codes that replaced 90862 on January 1, 2013, please refer to Section 19 – Procedure Codes, of the Community Psychiatric Rehabilitation Program Manual.

13.11.J MEDICATION ADMINISTRATION

Key service functions for medication administration include:



Archived


• administrating a therapeutic injection of medication (subcutaneous or intramuscular);

• monitoring lab levels including consultation with physicians, participants and caseworkers;

• coordinating medication needs with pharmacies, participants, and families, including the use of indigent drug programs (excluding the routine placing of prescription orders and refills with pharmacies);

• setting up medication boxes;

• dropping off medications to participant residences;

• educating patient regarding medications;

• recording initial patient histories and vital signs;

• monitoring medication compliance;

• monitoring medication side- effects including the use of standardized evaluations; and

• monitoring physician orders for treatment modifications requiring patient education.

This service is covered by a physician, registered professional nurse (RN), licensed practical nurse (LPN), advanced practice nurse, or psychiatric pharmacist.

13.11.J(1) Limitations

Medication administration is limited to 4 hours (16 units) per day per participant.

13.11.J(2) Documentation Requirements

Documentation requirements are specified in Section 13.3.

PROC CODE

DESCRIPTION

H2010 ......... Medication Administration

13.11.K METABOLIC SYNDROME SCREENING

Metabolic screening is an annual screening of adults and children enrolled in the CPR program. The screening is performed by a nurse (RN or LPN) and screens for the following risk factors: obesity, hypertension, hyperlipidemia, and diabetes. The screening is required for participants receiving antipsychotic medications and optional for others. Specific activities may include but are not limited to:

• Taking and recording of vital signs



Archived


• Conducting lab tests to assess lipid levels and blood glucose levels and/or HgbA1c. If the lab tests are conducted by the nurse, they must use an analyzer approved by the Department of Mental Health.

• Arranging for and coordinating lab tests to assess lipid levels and blood glucose levels and/or HgbA1c.

• Obtaining results of recently completed lab tests from other health care providers to assess lipid levels and blood glucose levels and/or HgbA1c.

• Recording the results of the Metabolic Screening on the Metabolic Syndrome Screening and Monitoring tool, or on a form approved by the Department of Mental Health.

13.11.K(1) Limitations

Payment is limited to one (1) screening per participant per ninety (90) days.

13.11.K(2) Documentation Requirements

Documentation requirements consist of the completion of the Metabolic Syndrome Screening and Monitoring tool, or a form approved by the Department of Mental Health. In addition, a summary progress note verifying completion of the screening shall be filed in the clinical record.

PROC CODE DESCRIPTION

H2010TD Metabolic Screening – RN

H2010TE Metabolic Screening - LPN

13.11.L COMMUNITY SUPPORT

Community Support Qualifications

A Community Support Specialist (CSS) must meet one of the following qualification requirements:

1. A mental health professional as defined in 9 CSR 10-7.140 (2) (QQ); 2. An individual with a bachelor’s degree in a human services field, which includes

social work, psychology, nursing, education, criminal justice, recreational therapy, human development and family studies, counseling, child development, gerontology, sociology and rehabilitation counseling;



Archived


3. An individual with at least two (2) years of higher education and two years of qualifying experience;

4. An individual with any four year degree and two years of qualifying experience; or 5. An individual with four years of qualifying experience.

Qualifying experience must include delivery of service to individuals with mental illness, substance abuse disorders, or developmental disabilities. Experience must include some combination of the following: 1. Providing one-on-one or group services with a rehabilitation/habilitation and

recovery/resiliency focus; 2. Teaching and modeling for individuals how to cope and manage psychiatric,

developmental or substance abuse issues while encouraging the use of natural resources;

3. Supporting efforts to find and maintain employment for individuals and/or to function appropriately in families, school and communities;

4. Assisting individuals to achieve the goals and objectives on their individualized treatment or person centered plans.

It is also required that the community support specialist complete the necessary orientation and training requirements specified by DMH.

Community support services are individualized rehabilitative services and include the following billable activities:

• Direct contact in person or by phone with consumers • Direct contact in person or by phone with families, staff within the provider

agency, and other agencies on behalf of the consumer (excluding staff within the provider agency who are other CSS’s, CSS supervisors, PSR staff, and Program Directors)

• Direct contact in person or by phone between two CSS’s for the purpose of care coordination, in the course of transitioning an individual from a youth CPR program to an adult CPR program.

• Direct contact in person or by phone between two CSS’s for the purpose of care coordination one of whom is working with a child or youth and one of whom is working with a parent, when both are MO HealthNet participants enrolled in CPR.

• Travel time required for making face-to-face contact with consumers, families, and other agencies



Archived


Community Support consists of specific activities with or on behalf of a person in accordance with an individualized treatment plan. Services are provided to maximize an individual’s immediate and continued community functioning while achieving and sustaining recovery/resiliency from mental illness and/or substance use disorders. These services are delivered in an amount and scope defined by each individual’s plan, and not all plans will contain all services.

Community support services for both adults and children focus on helping individuals develop skills, access resources and learn to manage illness in order to be successful in the living, working, learning, and social environments of their choice. Community Support staff teach, model, and practice skills with persons served in order to increase self sufficiency and independence. The specific skills and supports are addressed on an individualized treatment plan (ITP) and based on the life domains that the person has identified as being impacted directly or indirectly by their serious mental illness, or substance abuse, or both. Community support services are time-limited based on participant need, and rehabilitative in nature.

Community Support for children and youth is designed to coordinate and provide services and resources to children, adolescents and their families as necessary to promote resiliency. The focus is on teaching/modeling developmentally appropriate skills, necessary for positive self esteem, a sense of identity, positive relationships with family and peers, social competence, and success in school. The specific skills and supports are addressed on an individualized treatment plan (ITP) and based on the life domains that the child/family have identified as being impacted directly or indirectly by their serious emotional disturbance, or substance abuse, or both. A key in promoting resiliency is building on the strengths of the child’s natural support system which is also a key element of the ITP.

Key service functions include but are not limited to:

1. Providing holistic, person-centered care with emphasis on personal strengths, skill

acquisition and harm reduction, while using stage-wise and motivational approaches that promote active participation by the individual in decision making and self-advocacy in all aspects of services and recovery/resiliency.

2. Using interventions, based on individual strengths and needs, to develop interpersonal/social, family, community and independent living functional skills including adaptation to home, school, family and work environments when the natural acquisition of those skills is negatively impacted by the individual’s mental illness and/or substance use disorder.

3. Facilitating and supporting recovery/resiliency through activities including: defining recovery/resiliency concepts in order to develop and attain recovery/resiliency goals;



Archived


identifying needs, strengths, skills, resources and supports and teaching how to use them; and identifying barriers to recovery/resiliency and finding ways to overcome them.

4. Developing, implementing, updating, and revising as needed, a treatment plan that identifies specific, measurable and individualized interventions to reduce and manage symptoms, improve functioning and develop stability and independence. This plan is developed by a team consisting of the following as appropriate: the individual, family, community support specialist, community support supervisor, therapist, medication providers, schools, child welfare, courts and other supports.

5. Providing services that result in positive outcomes including but not limited to the following areas: employment/education, housing, social connectedness, abstinence/harm reduction, decreased criminality/legal involvement, family involvement, decreased psychiatric hospitalizations, and improved physical health.

6. Documenting services that clearly describes the need for the service, the intervention provided, the relationship to the treatment plan, the provider of the service, the date, actual time and setting of the service, and the individual’s response to the service.

7. Developing a discharge and aftercare/continuing recovery plan to include, if applicable, securing a successful transition to continued services.

8. Contacting individuals and/or referral sources following missed appointments in order to re-engage and promote recovery/resiliency efforts.

9. Supporting individuals in crisis situations including locating and coordinating resources to resolve a crisis.

10. Maintaining contact with individuals who are hospitalized for medical or psychiatric reasons and participate in and facilitate discharge planning for psychiatric hospitalization and for medical hospitalization as appropriate.

11. Provide information and education in order to learn about and manage mental illness/serious emotional disturbance and/or substance use disorders including symptoms, triggers and cravings, and reinforce the importance of taking medications as prescribed, while facilitating the persons’ served communication with prescribers as needed.

12. Building skills for effective illness self-management including psycho-education, behavioral tailoring for medication adherence, wellness/recovery planning, coping skills training, and social skills training.

13. In conjunction with the individual, family, significant others and referral sources, identifying risk factors related to relapse in mental illness and/or substance use disorders and develop a plan with strategies to support recovery and prevent relapse.

14. Ensuring that individuals gain and maintain access to necessary rehabilitative services, general entitlement benefits, employment, housing, schools, legal services, wellness or other services; and gain skills in independently accessing needed services.



Archived


15. Ensuring communication and coordination with and between other interested parties such as service providers, medical professionals, referral sources, employers, schools, child welfare, courts, probation/parole, landlords, and natural supports.

16. Ensuring follow through with recommended medical care, to include scheduling appointments, finding financial resources and arranging transportation when individuals are unable to perform these tasks independently.

17. Developing and supporting wellness and recovery goals in collaboration with the individual, family and/or medical professionals, including healthy lifestyle changes such as healthy eating, physical activity and tobacco prevention and cessation.

18. Assisting to develop natural supports including identification of existing and new natural supports in relevant life domains.

19. In coordination with the treatment team, improving skills in communication, interpersonal relationships, problem solving, conflict resolution; stress management; and identifying risky social situations and triggers that could jeopardize recovery.

20. Providing family education, training and support to develop the family as a positive support system to the individual. Such activities must be directed toward the primary well-being and benefit of the individual.

21. Helping individuals develop skills and resources to address symptoms that interfere with seeking or successfully maintaining a job, including but not limited to, communication, personal hygiene and dress, time management, capacity to follow directions, planning transportation, managing symptoms/cravings, learning appropriate work habits, and identifying behaviors that interfere with work performance.

22. Building skills associated with obtaining and maintaining success in school such as communication with teachers, personal hygiene and dress, age appropriate time management, capacity to follow directions and carry out school assignments, appropriate study habits, and identification of behaviors that interfere with school performance.

23. Building personal self care and home management skills associated with achieving and maintaining housing in the least restrictive setting by addressing issues like nutrition, meal preparation; household maintenance including house cleaning and laundry; money management and budgeting; personal hygiene and grooming; identification and use of social and recreational skills; use of available transportation; and personal responsibility.

Appropriate use of Community Support in Workplace Environments Community Support interventions may be provided in workplace environments when the focus is on helping a person overcome or address psychiatric symptoms that interfere with



Archived


seeking, obtaining, and maintaining a job. Symptoms being addressed may be both positive (auditory/visual hallucinations, incoherence or marked loosening of associations, delusions, etc.) or negative (apathy, lethargy or lack of motivation, ambivalence, flattening of emotions, isolation, and withdrawal). Medicaid will reimburse for supports related to these symptoms and focusing on illness management and recovery. Specific examples include but are not limited to:

• Role playing and practicing communication skills and self-presentation in community settings; working with the person to establish routines including appropriate sleep schedules; assisting the person to explore local employment options including discussions about interests and monitoring or assisting with finding job openings in the local paper; reviewing employment assistance resources including Vocational Rehabilitation, career centers, employment services, and media; accompanying into the community if needed to look at employment options and researching and assisting with transportation options.

• Discussing ways to self manage increasing symptoms at work; helping to coordinate with the persons psychiatrist or mental health clinician to develop a plan on ways to deal with symptoms being experienced in a job situation; planning and practicing strategies to try when symptoms occur at work; meeting with work supervisors to discuss accommodations to be made and developing and monitoring a plan to address work problems.

• Assessing poor job performance related to psychiatric symptoms; rehearsing with the person how to identify triggers and effective coping strategies; identifying and modeling alternative strategies using accommodations to minimize effect of symptoms.

• Work with the person to identify strategies to manage symptoms such as anxiety, panic, and fear with techniques based on interventions prescribed by the persons psychiatrist or clinician.

In general, Medicaid will not pay for the following activities:

• Job skills training and coaching for specific job skills and job tasks

• Tuition for training programs

• Supplies for work (boots, computers, uniforms, etc.)

• Speeches to community groups and cold calls to employers for generic job leads



Archived


13.11.L(1) Limitations

The CPR provider shall ensure that an adequate number of appropriately qualified staff is available to support the functions of the program. The department shall prescribe caseload size and supervisory to staff ratios as necessary.

Community support services are limited to eight (8) hours (32 units) per day per participant. The total number of hours of community support allowed per month per participant is 50 hours (200 units).

13.11.L(2) Documentation Requirements

In order to bill for community support written documentation must be maintained in the participant's clinical record as required for each session, service or activity. See Section 13.3. Additional documentation should include any of the following:

• Phone contact reports; and/or

• Pertinent/significant information reported by family members or significant others regarding a change in the participant's condition and/or an unusual or unexpected occurrence in the participant's life.

PROC CODE

DESCRIPTION

H0036 ......... Community Support

13.11.M INTENSIVE COMMUNITY PSYCHIATRIC REHABILITATION

Intensive community psychiatric rehabilitation is a level of support designed to help participants who are experiencing a severe psychiatric condition, alleviating or eliminating the need to admit them into a psychiatric inpatient setting. It is a comprehensive, time limited, community based service delivered to participants who are exhibiting symptoms that interfere with individual/family life in a highly disabling manner.

Intensive community psychiatric rehabilitation is intended for the following participants:

• Persons who would be hospitalized without provision of intensive community based interventions; or

• Persons who have extended or repeated hospitalizations; or

• Persons who have crisis episodes; or



Archived


• Persons who are at risk of being removed from their home or school to a more restrictive environment; or

• Persons who require assistance in transitioning from a highly restrictive setting to a community-based alternative, including specifically persons being discharged from inpatient psychiatric settings who require assertive outreach and engagement

Admission criteria for persons for this level of service must meet admission criteria as defined in Section 13.10. Persons will be in need of intensive clinical intervention or support to alleviate or eliminate the need for admission into a psychiatric inpatient or restrictive living setting and must meet one of the following descriptions:

• A person who is being discharged from a Department of Mental Health facility or Department of Mental Health purchased bed;

• A person who has had extended or repeated psychiatric inpatient hospitalizations or crisis episodes within the past six (6) months;

• A person who has had multiple out-of-home placements due to their mental disorder; or

• A person who is at risk of being removed from his/her home, school or current living situation.

A treatment team comprised of individuals required to provide specific services identified on the Individualized Treatment Plan (ITP), delivers this level of service to participants who meet the community psychiatric rehabilitation (CPR) eligibility criteria.

Intensive CPR shall be delivered by a treatment team responsible for coordinating a comprehensive array of services available to the individual through CPR with amount of frequency of service commensurate with the individual's assessed acuity and need.

The treatment team shall be supervised by a Qualified Mental Health Professional as defined in 9 CSR 30-4.030 (2) (JJ) and shall include the following:

1. Individuals required to provide specific services identified on the ITP; and

2. The participant, and family if developmentally appropriate.

Intensive CPR shall include:

1. Multiple face-to-face contacts on a weekly basis and may require contact on a daily basis;

2. Services that are available twenty-four (24) hours per day and seven (7) days per week;



Archived


3. Crisis response services that may be coordinated with an existing crisis system.

Individuals can be moved out of the intensive level when:

1. There is a reduction of severe and significant symptoms; and

2. The individual is able to function in the rehabilitation level of CPR; or

3. The individual chooses to move from the intensive level.

Intensive CPR for Children and Youth

Intensive community psychiatric rehabilitation is provided by treatment teams delivering services that will maintain the participant within the family and significant support systems and assist participants in meeting basic living needs and age appropriate developmental needs.

Treatment team models shall follow one of two options:

1. The treatment team may serve exclusively individuals enrolled in the intensive CPR-level; or,

2. The treatment team may serve individuals enrolled in intensive CPR and individuals enrolled in rehabilitation levels.

A full array of CPR services as defined in 9 CSR 30-4.043 shall be available to each individual based upon identified needs. In addition, the following services are available:

1. Outreach and engagement;

2. Behavioral aide/family assistance worker;

3. Targeted case management;

4. Clinical interventions for the purpose of stabilizing the individual offered twenty-four (24) hours per day and seven (7) days per week;

5. Increased services to assist the individual with medication stabilization;

6. Utilization of natural services and supports needed to maintain the individual in the community;

7. Day treatment.

If a child is receiving Intensive Community Psychiatric Rehabilitation services H0037, they can also receive and bill for Psychosocial Rehabilitation (PSR) service H2017HA at the same time.

The frequency of service delivery shall be based upon the individual’s assessed acuity and need.



Archived


For children and youth the intensive level is limited to 90 days. Exceptions may be granted by DMH. Exceptions must be documented in the client record.

Intensive CPR for Adults in non-Residential Settings

Service Delivery Modes:

Two primary service delivery modes are appropriate for delivering Intensive CPR for adults in non-residential settings. Additional service delivery modes may be identified in the future by the CPS Division.

1. Teams for linking and transitioning individuals from acute or long term settings to routine care and treatment:

• These teams may be designated exclusively for persons needing Intensive CPR, or may be mixed teams of persons needing Intensive CPR and persons needing regular CPR in the rehabilitation level of care.

• The expected time frame for treatment in this model is approximately 60 days or less, but may vary according to client need.

• Treatment plans must be developed upon admission, modified and updated as necessary, and reviewed at least monthly. The monthly treatment plan review shall be documented in the client record.

2. Teams providing modified Assertive Community Treatment:

• This should be a dedicated team, intended for intensive services but may lack elements of full fidelity ACT teams, such as one or more specialists, or particular staff to client ratios.

• The expected time frame should vary according to client need.

• Treatment plans must be developed upon admission, modified and updated as necessary, and reviewed at least every 90 days. The treatment plan review shall be documented in the client record.

Persons receiving Intensive CPR must be enrolled in CIMOR, assigned to the CPS Adult CPR service category, and assigned to the rehabilitation level of care.

When a person is being served by an Intensive CPR team, the provider may bill the daily procedure code each day from the date of admission to the team until they are transitioned to regular CPR services. It is expected that service intensity will be consistent with the needs of the individual.

39CPR Community Support services (procedure code H0036) may not be billed while a person



Archived


is being served by an Intensive CPR non-residential team. Intensive CPR for residential settings (H0037HK, H0037TF, H0037TG) may not be billed while the person is being served by an Intensive CPR non-residential team. All other CPR services, including medication management and other physician services, may be provided and billed according to individualized need.

For each intervention provided by Intensive CPR team members, a progress note meeting standard DMH/CPR criteria must be present in the client record. In addition, a weekly note summarizing services and progress must be present in the client record.

13.11.M(1) Limitations

This is a per diem service rate and is limited to one (1) unit per day.

13.11.M(2) Documentation Requirements

A weekly note summarizing services and progress must be present in the client chart. In addition, all services provided in Intensive CPR must have documentation in the form of progress notes that include:

• Specific type of service rendered as defined in the CPR menu of services;

• Date and actual time the service was rendered;

• Who rendered the service;

• The setting in which the service was rendered;

• The amount of time it took to deliver the service;

• The relationship of services to the treatment regimen described in the treatment plan;

• Updates describing the participant’s response to prescribed care and treatment; and

• Signature and title of staff member delivering the service.


H0037 Intensive Community Psychiatric Rehabilitation



Archived

Section 13 - Benefits and Limitations 13.11.N EVIDENCE BASED PRACTICES (EBP)

Support services for Intensive EBP is service implementation of supports for treatments that have been proven demonstratively effective for children and youth. The selected EBP is based on the specific child’s needs and desired outcomes and is identified on the treatment plan. Activities associated with the service include but are not limited to:

1. Extensive monitoring and data collection

2. Specific skills training components in a prescribed or natural environment

3. Prescriptive responses to psychiatric crisis and/or frequent contact with the child or family in addition to the arranged therapy sessions.

13.11.N(1) Limitations

EBP is a daily rate that cannot be billed in conjunction with H0037 or with H0037TGHA. Evidenced based practices billable to this procedure code are limited to: Functional Family Therapy, Multi-Systematic Therapy, and Dialectical Behavior Therapy. Additional evidenced based practices may be added as billable under this procedure code.

13.11.N(2) Documentation Requirements

Minimum daily note for support services in EBP and providers will follow requirements for fee for service Medicaid (e.g. therapy).


H0037HA Evidence Based Practices

13.11.O TREATMENT FAMILY HOME

Treatment Family Home (TFH) is a home-like setting that provides intensive therapeutic interventions to children. Each child placed in a TFH will have an individualized care plan developed by the family, child, natural supports, agencies, and community partners. Each child will also have an emergency crisis/care plan.

Treatment parents perform the following tasks and functions:

• Pre-placement meetings and contact • Participation in treatment planning • Treatment implementation as outlined in the plan



Archived


• Participation in treatment team meetings • Record keeping • Maintaining contact with child’s family • Community relations • Advocacy

Treatment parents may maintain employment outside the home, if they are able to meet the needs of children placed within their home and meet the requirements of their employment.

Treatment parents must pass all background checks. Treatment parents will complete the standard TFH training package.

• 40 hours minimum for Tool Kit training • Level 1 Medication Aide training • CPR/First Aid • Non-Violent Crisis Intervention (NVCI) • Home Study

13.11.O(1) Limitations

Daily rate cannot be billed in conjunction with the following services: H0037TFHA, H0037TGHA

13.11.O(2) Documentation Requirements

Documentation requirements are specified in Section 13.3. In addition, TFH treatment parents will record a weekly summary of their progress on the relevant treatment goals.


H0037HKHA Treatment Family Home

13.11.P PROFESSIONAL PARENT HOME

Professional Parent Home (PPH) is a home like setting that provides intensive therapeutic mental health interventions to children. Each child placed in a PPH will have an individualized care plan developed by the family, child, natural supports, agencies and community partners. Each child will have an emergency crisis/care plan.

Only one (1) child placed per PPH.

Professional parents perform the following tasks and functions:

• Pre-Placement Meetings and Contact



Archived


• Participation in Treatment Planning

• Provision of a documented and monitored therapeutic milieu

• Treatment Implementation as outlined in the plan

• Participation in Treatment Team Meetings

• In-home therapeutic, social, and recreational activities

• Medication Administration

• Community-based therapeutic, social, and recreational activities

• Transportation

• Participation in Day Treatment Program at least 2 days per week or presence in the school as outlined by the individualized care plan

• Record Keeping

• Generalization from PPH to Natural Home

• Contact with Child’s Family

• Community Relations

• Advocacy

Professional Parenting is their sole employment. Professional Parent must pass all background checks.

Professional Parent must complete standard training (same as for TFH) and in addition complete enhanced training which includes:

• Training on implementation of a behavior support plan developed by Board Certified Behavior Analyst

• Family Support Provider training • Self-help skills training • CPRC orientation/training • Monthly in-service trainings • Additional trainings that are made available which may include Motivational

Interviewing, Person-centered planning, Dialectical Behavior Therapy, Trauma-Informed Care, etc.



Archived

Section 13 - Benefits and Limitations 13.11.P(1) Limitations

Daily rate cannot be billed in conjunction with the following services: H0037HKHA, H0037TGHA

13.11.P(2) Documentation Requirements

Documentation requirements are specified in Section 13.3. In addition, PPH treatment parents will record a weekly summary of their progress on the relevant treatment goals.


H0037TFHA Professional Parent Home

13.11.Q CHILDREN’S INPATIENT DIVERSION

Inpatient Diversion is a secure 24 hour service environment designed to provide clinical services at the highest level of service intensity and restrictiveness for the protection of the child. Each child will have a well defined crisis plan that anticipates and accommodates complications during transition to lower levels of care. Emergency medical services are available on-site or in close proximity.

Each child will have a comprehensive individualized care plan developed by the family, child, natural supports, agencies and community partners.

There shall be one (1) staff person for every two (2) participants served at this level of care during waking hours. During sleeping hours, the staff to client ratio may decrease to one (1) to six (6).

A child and adolescent psychiatrist supervises the care provided by a multi disciplinary treatment team.

There shall be daily availability of licensed nursing personnel to the clients served in this level of care.

There shall be availability of licensed occupational and recreational therapists to clients served in this level of care.

13.11.Q(1) Limitations

Cannot be billed in conjunction with H0037TFHA, H0037HKHA, H0037HA or H0037.



Archived

Section 13 - Benefits and Limitations 13.11.Q(2) Documentation Requirements

A minimum daily note is required for services provided in Inpatient Diversion.


H0037TGHA Inpatient Diversion

13.11.R INTENSIVE CPR RESIDENTIAL-CLUSTERED APARTMENTS

Medically necessary on site services, interventions, and supports in a clustered apartment setting as an alternative to long term hospitalization. Services include but are not limited to monitoring points of ingress/egress, room checks, supportive rehabilitation services around specific activities of daily living or when participants are in crisis.

13.11.R(1) Limitations

Limited to providers who operate certified CPR programs for adults who are approved by the Department of Mental Health to provide this service. The team of staff providing this service must be supervised by a QMHP. May not be billed on the same day as procedure codes H0037TF or H0037TG. Participants must be enrolled in the CPR- Rehabilitation level of care to receive this service.

13.11.R(2) Documentation Requirements

Intensive CPR Clustered Apartments is a daily (per diem) unit rate. For each day that this service is billed, the medical record must reflect documentation of services and supports provided that day. Examples of documentation include: daily summary progress notes; weekly summary progress notes; group notes; shift change notes; treatment team staffing notes; safety monitoring notes or logs; individualized progress notes documenting interventions including crisis assistance, conflict management, behavior redirection, prompting or reminders.


H0037HK Intensive CPR Residential-Adults-Clustered Apartments

13.11.S INTENSIVE CPR RESIDENTIAL-IRTS

Medically necessary on site services, interventions, and supports in an intensive residential treatment setting (IRTS) as an alternative to long term hospitalization. Participants in this setting typically have significant difficulties with activities of daily living and may require round the clock observation on site. Services include but are not limited to monitoring points of ingress/egress, room checks, supportive rehabilitation services around specific activities of daily living or when participants are in crisis.



Archived

Section 13 - Benefits and Limitations 13.11.S(1) Limitations

Limited to providers who operate certified CPR programs for adults who are approved by the Department of Mental Health to provide this service. The team of staff providing this service must be supervised by a QMHP. This service may not be billed on the same day as procedure codes H0037HK or H0037TG. Participants must be enrolled in the CPR-Rehabilitation level of care to receive this service.

13.11.S(2) Documentation Requirements

Intensive CPR Residential IRTS is a daily (per diem) unit rate. For each day that this service is billed, the medical record must reflect documentation of services and supports provided that day. Examples of documentation include: daily summary progress notes; weekly summary progress notes; group notes; shift change notes; treatment team staffing notes; safety monitoring notes or logs; individualized progress notes documenting interventions including crisis assistance, conflict management, behavior redirection, prompting or reminders.


H0037TF Intensive CPR Residential-Adults-IRTS

13.11.T INTENSIVE CPR RESIDENTIAL-PISL

Medically necessary on site services, interventions, and supports in a psychiatric individualized supported living environment (PISL). This type of setting is a private home with 2-4 bedrooms and is an alternative to long term hospitalization. Participants in this setting typically have significant difficulties with activities of daily living and may require round the clock observation on site. Services include but are not limited to monitoring points of ingress/egress, room checks, supportive rehabilitation services around specific activities of daily living or when participants are in crisis.

13.11.T(1) Limitations

Limited to providers who operate certified CPR programs for adults who are approved by the Department of Mental Health to provide this service. The team of staff providing this service must be supervised by a QMHP. This service may not be billed on the same day as procedure codes H0037HK or H0037TF. Participants must be enrolled in the CPR-Rehabilitation level of care to receive this service.

13.11.T(2) Documentation Requirements

Intensive CPR Residential PISL is a daily (per diem) unit rate. For each day that this service is billed, the medical record must reflect documentation of services and



Archived


supports provided that day. Examples of documentation include: daily summary progress notes; weekly summary progress notes; group notes; shift change notes; treatment team staffing notes; safety monitoring notes or logs; individualized progress notes documenting interventions including crisis assistance, conflict management, behavior redirection, prompting or reminders.


H0037TG Intensive CPR Residential-Adults-PISL

13.11.U PEER SUPPORT SERVICES

Peer support services are delivered by a Certified Missouri Peer Specialist with at least a high school diploma or equivalent and applicable training and testing as required by the department, supervised by a qualified mental health professional as defined in 9 CSR 30-4.030. Certified Peer Specialists shall be considered a member of the treatment team and shall participate in staff meeting discussions regarding the individual care of persons served. The purpose of peer support services is to assist individuals served in their recovery from mental illness. The individualized treatment plan of the person served shall determine the focus of this service. Peer support services are person-centered with a recovery focus. Services allow individuals the opportunity to direct their own recovery and advocacy processes. Peer support services promote skills for coping with and managing symptoms while facilitating the utilization of natural supports and the preservation and enhancement of community living skills. Peer support services are defined as helping relationships between individuals and Certified Missouri Peer Specialists that promote respect, trust, and empower individuals to make changes and decisions to enhance their lives. Peer support services are directed toward achievement of specific goals that have been defined by the person serviced and specified in the individualized treatment plan. Activities provided by the Certified Missouri Peer Specialists emphasize the acquisition, developments, and expansion of the rehabilitation skills needed to move forward in recovery. Interventions are built on the unique therapeutic relationship between the Certified Missouri Peer Specialists, the individual served, and the individual’s family unit. Certified Missouri Peer Specialists are trained to assist their peers in the process of recovery and the power of resilience and provide hope that recovery is possible. Certified Missouri Peer Specialists may provide the following peer support services: Assisting an individual to recover by helping an individual recognize what he or she thinks would improve the quality of his or her life such as setting a recovery goal and helping an individual identify and remove the barriers to achieving that life; Certified Missouri Peer Specialists use the power of peers to support, encourage, and model recovery and resilience from mental illness in ways that are specific to the needs of each individual including the following:



Archived


• peer support services are individualized services with a rehabilitation and recovery focus;

• peer support services promote skills for coping with and managing psychiatric symptoms while encouraging the use of natural supports and enhancing community living;

• peer support activities assist in achieving goals and objectives set forth by the individual in their individualized treatment or recovery plan;

• peer support activities emphasize the opportunity for individuals to support each other as they move forward in their recovery;

Certified Missouri Peer Specialists services include the same billable activities as allowed with Community Support. Community Support activities are specified in section 13.11.L.

Certified Missouri Peer Specialists interventions may include, but are not limited to, the following:

• sharing lived experiences of recovery and sharing and supporting the use of recovery tools and modeling successful recovery behaviors;

• helping individuals recognize their capacity for resilience;

• helping individuals connect with other consumers and their communities at large;

• helping individuals who have mental illness develop a network for information and support;

• assisting individuals who have mental illness to make independent choices and to take a proactive role in their treatment;

• assisting individuals with identifying strengths and personal resources to aid in their recovery; and

• helping individuals set and achieve recovery goals.

The job description for a Certified Missouri Peer Specialists shall include supportive activites including but not limited to the following:

• starting and sustaining mutual support groups;

• promoting dialogues on recovery and resilience;

• teaching and modeling symptom management skills;

• teaching and modeling problem-solving skills;

• supporting efforts to find and maintain paid employment;

• using the stages in recovery concept to promote self-determination; and



Archived


• assisting peers in setting goals and following through on wellness and health activities.

Certified Missouri Peer Specialists shall follow a code of ethics determined by the department.

13.11.U(1) Limitations

Certified Peer Specialists shall not be assigned an individual participant caseload.

13.11.U(2) Documentation Requirements

Documentation Requirements are specified in section 13.3.

PROC CODE

DESCRIPTION

H0038 ......... Peer Support Services

13.11.V PSYCHOSOCIAL REHABILITATION

Psychosocial rehabilitation services cover a combination of goal-oriented service functions delivered through a group activity which promotes development of a personal support system, social skill development, training and rehabilitation in community living skills and pre-vocational skills according to individual need. Transportation to and from community facilities is provided or arranged by the CPR provider. For adults, staff to client ratio may not exceed 1:16. Program needs or client mix may require a lower staff to client ratio. At least one (1) staff must be present at all times at the program site. The director of the adult PSR program must be a qualified mental health professional.

Key service functions include the following:

• Initial screening to evaluate the appropriateness of the individual’s participation in the program;

• Development of individualized program goals and objectives;

• The provision of rehabilitative services which may occur during the day, evenings, weekends or a combination of these. Services should be structured, but are not limited to a program site;

• Services that enhance independent living skills;

• Services that address basic self-care needs;

• Services that enhance the use of personal support systems;



Archived


• Transportation to and from community facilities and resources as a part of program strategies;

• Services shall be provided according to individual need toward goals of community inclusion, integration, and independence; and

• Services should be available to adults as well as children and youth who need age-appropriate developmental focused rehabilitation.

PSR Youth

Psychosocial Rehabilitation for Youth is a combination of goal-oriented and rehabilitative services provided in a group setting to improve or maintain the youth’s ability to function as independently as possible within the family or community. Services shall be provided according to the individual treatment plan with an emphasis on community integration, independence and resiliency. Hours of operation shall be determined by the individual providers based on capacity, staffing availability, geography, and space requirements. For psychosocial rehabilitation (PSR) for youth, the director shall be a qualified mental health professional with two (2) years experience working with children and youth. One (1) full time equivalent mental health professional shall be available during the provision of services. The staffing ratios shall be based on the client’s age. For those clients between the ages of three (3) and 11, the staffing ratio shall be one (1) staff to four (4) clients. For those clients between the ages of 12 and 17, the staffing ratio shall be one (1) staff to six (6) clients. Other staff of the PSR team shall be composed of the following providers as needed by the children:

1. a registered nurse;

2. an occupational therapist;

3. a recreational therapist;

4. a rehabilitation therapist;

5. a community support specialist; or,

6. family assistance worker.

Providers may deliver PSR group sessions for parents of participant, aimed at teaching and developing appropriate parenting skills. In these situations the PSR services and expected goals and outcomes must be documented in the participant’s treatment plan, and the documentation must clearly relate to the treatment and rehabilitation goals of the participant.

If a child is receiving Intensive Community Psychiatric Rehabilitation services H0037, they can also receive and bill for Psychosocial Rehabilitation (PSR) service H2017HA at the same time.



Archived


13.11.V(1) Limitations

Psychosocial rehabilitation services are limited to six hours (24 units) per day.

13.11.V(2) Documentation Requirements

In order to bill for psychosocial rehabilitation, the following documentation must be maintained:

1. A weekly note that summarizes specific services rendered, participant response to the services, and pertinent information reported by family members or significant others regarding a change in the participant's condition, or an unusual/unexpected occurrence in the participant's life, or both; and

2. Daily attendance records or logs that include actual attendance times, as well as activity or session attended. These program attendance records/logs must be available for audit and monitoring purposes, however integration into each clinical record is not required.

PROC CODE

DESCRIPTION

H2017 .........

H2017HA ...

Psychosocial Rehabilitation

Psychosocial Rehabilitation – Children and Youth

13.11.W INDIVIDUAL AND GROUP PROFESSIONAL PSR

Individualized and group mental health interventions using a skills based approach to address identified behavioral problems and functional deficits relating to a mental disorder that interferes with an individual’s personal, family, or community adjustment. Qualified staff must be a professional counselor licensed or provisionally licensed under Missouri law and with specialized training in mental health services; or, a clinical social worker licensed or master social worker licensed under Missouri law and with specialized training in mental health services; or, a psychologist licensed or provisionally licensed or temporary licensed under Missouri law with specialized training in mental health services.

Staff providing individual and group professional psychosocial rehabilitation services must have the following initial training:

• Orientation and training to the CPR program as described in 9 CSR 30-4.034 7 A (1-7)



Archived


• Documentation and Medicaid compliance training (materials available on the DMH web site at: http://www.dmh.mo.gov/cps/provider/training/DocumentationTraining.htm

Staff providing individual/group professional psychosocial rehabilitation services must have the following additional training within six (6) months:

• Additional training as described in 9 CSR 30-4.034 7 D (1-9)

• Cognitive behavioral therapy – 2.5 hrs

• Creating a recovery based mental treatment plan – 2 hrs

• Illness management and recovery – 2.5 hrs

• Introduction to DBT – 2 hrs

• IDDT including motivational interviewing and stage-wise treatment – 2 hrs

• Motivational interviewing – 4 hrs

• Suicide prevention – 2 hours

• PTSD – 1 hr

• Medications, basic diagnostic principles and collaboration with prescribers – 1 hr

• Older adults with psychiatric illness – 1 hr

Staff providing children and youth individual/group professional psychosocial rehabilitation services must have the following additional training within six (6) months:

Below are additional trainings specific to child and adolescent care that must be completed within six (6) months:

• Trauma sensitive services and interventions- 2 hours

• Motivational Interviewing for adolescents- 2 hours

• Substance Use Group Therapy- 1 hour

• Issues pertaining to transitional youth- 1 hour

• Implementation of a behavior support plan- 2 hours

• Supported Education- 2 hours

• Mental Health and Substance Use Co-occurring Disorders- 1 hour

• Mental Health and Development Disabilities Co-occurring Disorders- 1 hour 52



Archived


• Family/Peer Support- 2 hours

• Stigma and myths about mental illness- 1 hour

• What is Psychosocial Rehabilitation for children/youth?- 1 hour

• Suicide prevention for children and adolescents- 1 hour

• Resilience in children and youth- 1 hour

Much of the continuing training/education is available in the E-Learning catalog. If a provider has any questions regarding the appropriateness of a particular training protocol, the Department should be consulted. If a staff person has already received training in an area, the requirement may be waived if the training is documented in the personnel record. In the event that a staff person will be specializing in a particular type of service approach, the agency may request an exception to the portions of the training curriculum not relevant to their work.

13.11.W(1) Limitations

This service is only covered for an agency that is certified to provide a Community Psychiatric Rehabilitation program for adults and/or children and youth. For Group Professional PSR the maximum group size is one professional to eight (8) consumers.

13.11.W(2) Documentation Requirements



H2017HO Individual Professional PSR

H2017HOHQ Group Professional PSR

13.11.X PSR ILLNESS MANAGEMENT/RECOVERY (IMR)

The psychosocial rehabilitation program may provide illness management and recovery services that promote physical and mental wellness; well-being; self-direction; personal empowerment; respect, and responsibility in individual and group settings. Services shall be person-centered and strength-based and include, but are not limited to, the following:

(A) psychoeducation;

(B) relapse prevention;

(C) coping skills training.



Archived


13.11.X(1) Limitations

This service is only covered for an agency that has been approved to provide the service by the Division of Comprehensive Psychiatric Services. The maximum group size for Psychosocial Rehabilitation Illness Management and Recovery shall not exceed eight (8) participants; however if there are other curriculum based approaches that suggest different group size guidelines, larger group sizes may be approved by the department.

13.11.X(2) Documentation Requirements

1. A weekly note that summarizes services rendered, participant response to the services, and pertinent information reported by family members or significant others regarding a change in the participant’s condition or an unusual/unexpected occurrence in the client’s life, or both. If a provider is billing both PSR-IMR and PSR, there shall be either a single weekly summary progress note that clearly addresses both the PSR-IMR and PSR sessions and activities during the week, or two separate weekly summary progress notes addressing each type of PSR provided during the week.

2. Daily attendance records or logs that include the actual attendance times, as well as description of the activity or session attended clearly identifying and distinguishing PSR-IMR as the specific type of psychosocial session and activity. These program attendance records/logs must be available for audit and monitoring purposes, however integration into each clinical record is not required.


H2017TG PSR Illness Management/Recovery

13.11.Y CONSULTATION SERVICES

Physician consultation and professional consultation are medical services provided by a physician, an advanced practice nurse, or a psychiatric pharmacist and consists of a review of a participant's current medical situation either through consultation with one staff person or in team discussions related to the specific participant. The intent is to provide direction to treatment. This is an optional service which may not substitute for supervision nor for face-to-face intervention with participants.

Services include the following:

• An assessment of the participant's presenting condition as reported by staff;

• Review of treatment plan through consultation;



Archived


• Participant-specific consultation to staff especially in situations which pose high risk of psychiatric decompensation, hospitalization or safety issues;

• Participant-specific recommendations regarding high risk issues and when needed to promote early intervention.

13.11.Y(1) Limitations

Consultation services are limited to 2 hours (8 units) per day per participant. This service is only covered when provided by a physician, psychiatrist, psychiatric pharmacist or advanced practice nurse.

Physician time is already included in the rates for intake evaluation, annual evaluation and treatment planning. Physician consultation should not be billed separately in these instances.

13.11.Y(2) Documentation Requirements



99241 Physician Consultation

99241EP Physician Consultation (Child Psychiatrist) ended 6/30/12

9924152 Professional Consultation (APN and Psychiatric Pharmacist)

99241TN Telepsychiatry, Physician Consultation

9241TNEP Telepsychiatry, Physician Consultation (Child Psychiatrist) ended 6/30/12

99241HK Consultation Services – ACT

9924152HK. Consultation Services – ACT (APN)

99241AF Physician Consultation (Child Psychiatrist)

99241TNAF Telepsychiatry, Physician Consultation (Child Psychiatrist)

13.11.Z CO-OCCURRING SERVICES

13.11.Z(1) Co-Occurring Individual Counseling

This service is a structured, goal-oriented therapeutic process in which an individual interacts on a face-to-face basis with a counselor in accordance with the participant's rehabilitation plan in order to resolve problems related to the participant's documented mental disorders and substance use disorders that interfere with the participant's functioning. Individual co-occurring counseling involves the use of evidence-based practices such as motivational interviewing,



Archived


cognitive behavior therapy and relapse prevention. Individual co-occurring counseling may include face-to-face interaction with one or more members of the participant's family for the purpose of assessment or supporting the participant's recovery. Eligible providers must be either a qualified mental health professional (QMHP) or a qualified substance abuse professional (QSAP) and meet co-occurring counselor competency requirements established by the Department of Mental Health.

13.11.Z(1)A Limitations

Co-occurring individual counseling services are limited to three (3) hours (12 units) per day per participant.

13.11.Z(1)B Documentation Requirements



H0004 HH Co-Occurring Individual Counseling

13.11.Z(2) Co-Occurring Group Counseling

Co-occurring group counseling is a face-to-face, goal-oriented therapeutic interaction among a counselor and two or more participants as specified in individual rehabilitation plans designed to promote participants' self-understanding, self-esteem and resolution of personal problems related to the participant's documented mental disorders and substance use disorders through personal disclosure and interpersonal interaction among group members. This service utilizes evidence-based practices. Eligible providers must be either a QMHP or a QSAP and meet co-occurring counselor competency requirements established by the Department of Mental Health. Group size may not exceed 10 participants.


Co-occurring group counseling services are limited to three (3) hours (12 units) per day per participant.





Archived



H0005 HH Co-Occurring Group Counseling

13.11.Z(3) Co-Occurring Group Education

These informational and experiential services are designed to assist individuals, family members, and others identified by the individual as a primary natural support, in the management of substance use and mental health disorders. Services are delivered through systematic, structured, didactic methods to increase knowledge of mental illnesses and substance use disorders which includes integrating emotional aspects in order to enable the participants, as well as family members, cope with the illness and understand the importance of their individual plan of care. The primary goal is to restore lost functioning and promote reintegration and recovery through knowledge of one's disease, symptoms, understanding of the "triggers" of crisis, crisis planning, community resources, recovery management, medication action and interaction, etc. Co-occurring group education focuses on evidence-based practices such as promotion of patient participation in peer self-help, brain chemistry and functioning, latest research on illness causes and treatments, medication education and management, symptom management; behavior management; stress management; improving daily living skills, independent living skills; etc. Group size is limited to 20 participants. Eligible providers must have documented education and experience related to the topic presented and either be or be supervised by a QMHP or a QSAP who meets co-occurring counselor competency requirements established by the Department of Mental Health.


Co-occurring group education services are limited to three (3) hours (12 units) per day per participant.




H0025 HQ HH Co-Occurring Group Education



Archived


13.11.Z(4) Co-Occurring Assessment Supplement

Participants with suspected co-occurring substance use disorders and mental disorders must receive additional assessments to document the co-occurring disorders and assess the interaction of the co-occurring disorders over time. The completion of the co-occurring assessment is documented by the submission to the Department of Mental Health of data required by the Department, and the development of a comprehensive integrated treatment plan which utilizes evidence-based practices to address problems related to the co-occurring disorders. Eligible providers must be either a QMHP or a QSAP and meet co-occurring counselor competency requirements established by the Department of Mental Health.


Co-occurring assessment supplement services are limited to one per treatment occurrence and annual assessments if needed.




H0031 HH Co-Occurring Assessment Supplement

13.11.AA DAY TREATMENT- YOUTH

Day Treatment for Youth is an intensive array of services provided in a structured, supervised environment designed to reduce symptoms of a psychiatric disorder and maximize functioning. Services are individualized based on the child’s needs and include a multidisciplinary approach of care under the direction of a physician. The provision of educational services shall be in compliance with Individuals with Disabilities Education Act 2004 and Section 167.126, RSMo. Services shall be provided in the following manner:

1. Hours of operation shall be determined by the individual providers based on capacity, staffing availability, and space requirements.

2. Eligibility criteria shall include the following:

a. For children six (6) years of age or older, the child must be at risk of inpatient or residential placement as a result of their serious emotional disturbance; or,

b. For children five (5) years of age or younger, the child must have one or more of the following:



Archived


1. Has been expelled from multiple day care/early learning programs due to emotional or behavioral dysregulation in relation to serious emotional disturbance or Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood Zero to Three, Revised (DC03R) diagnosis and previous services provided in an early childhood program were unsuccessful.

2. At risk for an acute psychiatric hospital or residential treatment center placement as a result of their serious emotional disturbance.

3. Score in the seriously impaired functioning level on the standardized functional tools approved by DMH for this age range.

3. Key service functions include, but are not limited to the following:

a. providing integrated treatment combining education, counseling and family interventions;

b. promoting active involvement of parents or guardians in the program;

c. providing consultation and coordination to establish and maintain continuity of care with the child/family’s private service providers;

d. coordinating and information sharing, consistent with Family Educational Rights and Privacy Act and Health Insurance Portability and Accountability Act, and discharge planning with the school;

e. requesting screening and assessment reports for special education from the school;

f. planning with the school how the individualized education needs of each child will be addressed; and,

g. additional core services as prescribed by the department.

The qualified provider for day treatment for youth: one (1) qualified mental health professional and one (1) appropriately certified, licensed, or credentialed ancillary staff for children age three (3) to five (5) years of age; and, one (1) qualified mental health professional and, at a minimum, two (2) appropriately certified, licensed, or credentialed ancillary staff for school-aged children. Ancillary staff shall meet at least one of the following criteria:

1. Occupational therapist;

2. Physical therapist;



Archived


3. Assistant behavior analyst;

4. Individual with a bachelor’s degree in child development, psychology, social work or education;

5. Individual with an associate degree with two (2) years experience in related mental health or child related fields;

6. Individual with two (2) years of college and two (2) years experience in related mental health or child related fields.

13.11.AA(1) Limitations

The child shall be in attendance for a minimum of three (3) hours per day, four (4) days per week and no more than seven (7) hours per day.

13.11.AA(2) Documentation Requirements

Minimum daily note for billing to day treatment and providers will follow requirements for fee for service Medicaid (e.g. therapy).


H2012HA Day Treatment

13.11.BB FAMILY SUPPORT

Services designed to provide a support system for parents of children up to age 25 with serious emotional disorders. Activities are directed and authorized by the child’s individualized treatment plan. Key service functions include, but are not limited to the following:

1. assisting the parent in understanding the child’s special needs;

2. engaging the parents or guardians to actively participate in the child and family team meetings by helping them predetermine their roles and the roles of natural supports;

3. assisting the parents or guardians in identifying their natural supports or surrogate supports;

4. helping the parents or guardians identify the child’s strengths and strengths of the family;

5. supporting the parents or guardians at child and family team meetings and modeling good advocacy skills;



Archived


6. assisting in trouble shooting and problem solving with strategies that are not working;

7. connecting families to community resources; and,

8. helping the parents or guardians find and empower their own voice to become part of the system of care for their child.

The eligible provider must be a family member of a child or youth who had or currently has a behavioral or emotional disorder, has a high school diploma or equivalent and has completed training approved by or provided by the department, and is supervised by a qualified mental health professional as defined in 9 CSR 30-4.030.

The specific skills and activities that are the focus of this intervention will be identified on the child’s treatment plan and are developmentally appropriate. Collateral contact (e.g. phone calls with Children’s Division, schools, etc.) may be billed. Travel time required for making face-to-face contact with consumers, families, and other agencies may be billed.

13.11.BB(1) Limitations

Family Support services are limited to 8 hours (32 units) per day and 24 hours (96 units) per month per participant. Family Support cannot be billed if the only service being provided is transportation.

13.11.BB(2) Documentation Requirements



H0038HA Family Support

13.11.CC FAMILY ASSISTANCE

Services designed to focus on the child or adolescent and the development of home and community living skills, communication, socialization, and identifying and arranging for appropriate community services. Key service functions include, but are not limited to the following:

1. modeling appropriate behaviors and coping skills for the child;

2. exposing the child to activities that encourage positive choices, promote self-esteem, support academic achievement, and develop problem solving skills regarding home and school;

3. teaching appropriate social skills through hands on experiences; and,



Archived


4. mentoring appropriate social interactions with the child or adolescent or resolving conflict with peers

The specific skills and activities that are the focus of this intervention will be identified on the child’s treatment plan and are developmentally appropriate. Collateral contact (e.g. phone calls with Children’s Division, schools, etc.) may be billed.

The eligible provider must be an individual with a high school diploma and two (2) years experience working with children who have a severe emotional disorder or have experienced abuse and neglect; has completed training approved by or provided by the department; and shall be supervised by a qualified mental health professional as defined in 9 CSR 30-4.030.

13.11.CC(1) Limitations

Family Assistance services are limited to 8 hours (32 units) per day and 24 hours (96 units) per month per participant. Family Assistance cannot be billed if the only service being provided is transportation.

13.11.CC(2) Documentation Requirements



H2014HA Family Assistance

13.11.DD ASSERTIVE COMMUNITY TREATMENT (ACT)

Community based services and interventions provide by a multidisciplinary team. Team members must include physicians, nurses, vocational specialists, substance abuse specialists, and community support specialists. Interventions include but are not limited to: specialized assessments and treatment planning; case management; crisis intervention; assistance in locating and maintaining safe, affordable housing; skills training to support daily living skills, self care skills, and financial management; illness and symptoms management; supporting and facilitating access to necessary medical and social services; and substance abuse treatment and supports.

13.11.DD(1) Limitations

The procedure code for ACT services may be billed once per day on any day in which the participant receives a direct intervention from an ACT team member, excluding medication management and consultation by physicians and advance practice nurses.



Archived


Medication management services provided by physicians and advance practice nurses may not be billed to the daily ACT team rate. Those services are billed as Medication Services as described in 13.11.I.

Consultation services provided by physicians and advance practice nurses may not be billed to the daily ACT team rate. Those services are billed as Consultation Services as described in 13.11.Y.

This service may only be provided by an agency meeting the Missouri ACT Team Operating Standards established by the Division of Comprehensive Psychiatric Services. Contact the Department of Mental Health (DMH), Division of Comprehensive Psychiatric Services (CPS) for these operating standards.

13.11.DD(2) Documentation Requirements



H0040 Assertive Community Treatment (ACT)

13.12 LABORATORY SERVICES

Laboratory services are not covered through CPR. Laboratory services may be reimbursable to other appropriate MO HealthNet enrolled provider types subject to program limitations.

13.13 PRESCRIPTION DRUGS

The MO HealthNet Program covers only drugs, regardless of dosage forms (except for DESI drugs), produced by manufacturers that have entered into a rebate agreement with the federal government. Reimbursement for drugs is limited to MO HealthNet participating Pharmacy Providers.

13.14 MANAGED HEALTH CARE PROGRAM

CPR services are not included as a plan benefit for the MO HealthNet Managed Care Program.

13.15 ADMINISTRATIVE LOCK-IN

Some MO HealthNet participants are restricted or "locked in" to authorized MO HealthNet providers of certain services to aid the participant in proper utilization of the MO HealthNet Program. Refer to



Archived



64

Section 1, Client Conditions of Participation, for additional information about the program and information on identifying lock-in participants.

13.16 DIAGNOSIS CODES

The diagnosis codes are required on the CMS-1500 claim form when billing MO HealthNet and are contained in the International Classification of Diseases, Clinical Modification (ICD-CM) code book. Refer to Section 18 for further information.

13.17 QUALITY ASSURANCE

All CPR providers are surveyed to assure compliance and quality of care by the Missouri Department of Mental Health. Surveys occur annually unless a provider has national accreditation.

END OF SECTION

TOP OF PAGE


Archived