016.06.17 Ark. Code R. 015

Current through Register Vol. 49, No. 10, October, 2024

Rule 016.06.17-015 - Outpatient Behavioral Health Services Update 1-17, Inpatient Psychiatric Services for Persons Under Age 21 Update 1-17 and Residential Communuty Reintegration Program Certification

Section IIOutpatient Behavioral Health Services

254.003Residential Community Reintegration Program

CPT®/HCPCS PROCEDURE CODE	PROCEDURE CODE DESCRIPTION
H2020, U4	Therapeutic behavioral services, per diem
SERVICE DESCRIPTION	MINIMUM DOCUMENTATION REQUIREMENTS
The Residential Community Reintegration Program is designed to serve as an intermediate level of care between Inpatient Psychiatric Facilities and Outpatient Behavioral Health Services. The program provides twenty-four hour per day intensive therapeutic care provided in a small group home setting for children and youth with emotional and/or behavior problems which cannot be remedied by less intensive treatment. The program is intended to prevent acute or sub-acute hospitalization of youth, or incarceration. The program is also offered as a step-down or transitional level of care to prepare a youth for less intensive treatment. Services include all allowable Outpatient Behavioral Health Services (OBHS) based upon the age of the beneficiary as well as any additional interventions to address the beneficiary's behavioral health needs. A Residential Community Reintegration Program shall be appropriately certified by the Department of Human Services to ensure quality of care and the safety of beneficiaries and staff. A Residential Community Reintegration Program shall have, at a minimum, 2 direct service staff available at all times. Direct service staff may include any allowable performing provider in the Outpatient Behavioral Health Services (OBHS) manual, teachers, or other ancillary educational staff. A Residential Community Reintegration Program shall ensure the provision of educational services to all beneficiaries in the program. This may include education occurring on campus of the Residential Community Reintegration Program or the option to attend a school off campus if deemed appropriate in according with the Arkansas Department of Education.	. Date of Service . Place of Service . Diagnosis and pertinent interval history . Daily description of activities and interventions that coincide with master treatment plan and meet or exceed minimum service requirements . Mental Status and Observations . Rationale and description of the treatment used that must coincide with objectives on the master treatment plan . Staff signature/credentials/date of signature

NOTES	EXAMPLE ACTIVITIES
Eligibility for this service is determined by the standardized Independent Assessment. Prior to reimbursement for the Residential Community Reintegration Program in Intensive Level Services, a beneficiary must be eligible for Intensive Level Services as determined by the standardized Independent Assessment.
APPLICABLE POPULATIONS	UNIT	BENEFIT LIMITS
Children and Youth	Per Diem	DAILY MAXIMUM OF UNITS THAT MAY BE BILLED: 1 YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED (extension of benefits can be requested): 90
ALLOWED MODE(S) OF DELIVERY	TIER
Face-to-face	Intensive
ALLOWABLE PERFORMING PROVIDERS	PLACE OF SERVICE
The Residential Community Reintegration Program must be provided in a facility that is certified by the Department of Human Services as a Residential Community Reintegration Program provider.	14

Provider Manual Update Transmittal INPPSYCH-1-17

Section II

Inpatient Psychiatric Services for Under Age 21

212.100Covered Locations

Inpatient psychiatric services are covered by Arkansas Medicaid only when provided in:

A. An inpatient psychiatric hospital

B. A residential treatment unit within a psychiatric hospital

C. A residential treatment center (freestanding)

D. A Sexual Offender Program

221.802Federal Provider Identification Numbers

A federal provider identification number is assigned to each provider who meets the attestation requirement. The identification numbers for PRTFs will have five digits and one letter. The first two digits identify the state in which the facility is located. This number is then followed by the letter L and then by three digits and is numbered according to the order in which a facility was identified.

A. Federal provider numbers are assigned by the State Medicaid agency (SMA).

B. A provider number is coded based on where the PRTF is physically located.

221.803Roles and Responsibilities for the Reporting of Deaths, Serious Injuries and Attempted Suicides

The interim process for reporting deaths will follow a similar process as currently in place for the death reporting process for hospitals. The roles and responsibilities of the appropriate entities are outlined below.

A. PRTFs

1. Report to the SMA, no later than close of business the next business day, all deaths, serious injuries, and attempted suicides via fax at (501) 682-6171.

2. Report to the CMS regional office (RO) all deaths no later than close of business the next business day after the resident's death. Death reporting information should be reported to CMS at (214) 767-4434.

3. Document in the resident's record that the death was reported to the CMS regional office.

B. CMS Regional Office (RO)

1. The regional office should receive the report directly from the PRTF. Pursuant to 42 CFR 483.374(b)(1), the report must include the name of the resident, a description of the occurrence, and the name, street address and telephone number of the facility.

2. The CMS regional office should make sure the survey agency (SA) has received the report. The SA is responsible for carrying out the investigation in conjunction with instructions from the State Medicaid agency.

3. Since the PRTF is responsible for reporting to the agencies listed previously in addition to the CMS RO, the regional office should obtain the completed investigation from the SA.

4. The report should be received from the PRTF, according to 42 CFR 483.374(c)(1), no later than close of business the next business day after the resident's death.

5. The CMS regional office will send the death report to the CMS central office (CMS CO).

C. CMS Central Office (CO)

The CMS CO is responsible for maintaining a central log of the death information reported from the CMS RO.

221.804PRTF Staff Education and Training

The facility must require staff to have ongoing education, training and demonstrated knowledge of:

A. Techniques to identify staff and resident behaviors, events and environmental factors that may trigger emergency safety situations;

B. The use of nonphysical intervention skills, such as de-escalation, mediation conflict resolution, active listening, and verbal and observational methods, to prevent emergency safety situations; and

C. The safe use of restraint and the safe use of seclusion, including the ability to recognize and respond to signs of physical distress in residents who are restrained or in seclusion.

1. Certification in the use of cardiopulmonary resuscitation, including periodic recertification, is required.

2. Individuals who are qualified by education, training and experience must provide staff training.

3. Staff training must include training exercises in which staff members successfully demonstrate in practice the techniques they have learned for managing emergency safety situations.

4. The staff must be trained and demonstrate competency before participating in an emergency safety intervention.

5. The staff must demonstrate their competencies as specified in paragraph A of this section on a semiannual basis and their competencies as specified in paragraph B of this section on an annual basis.

6. The facility must document in the staff personnel records that the training and demonstration of competency were successfully completed. Documentation must include the date training was completed and the name of persons certifying the completion of training.

7. All training programs and materials used by the facility must be available for review by CMS, the SMA and the State SA.

251.000Cost Report

Inpatient psychiatric hospitals, residential treatment units and Sexual Offender Programs must submit an annual or partial period hospital cost report to the Arkansas Medicaid Program. Providers with less than a full 12-month reporting period are also required to submit a hospital cost report for the shorter period. Cost reports are due no later than five months following the close of the provider's fiscal year end. Extensions will not be allowed. Failure to file the cost report within the prescribed period may result in suspension of reimbursement until the cost report is filed.

Providers will submit all required hospital cost reports and budgets in accordance with Medicare Principles of Reasonable Cost Reimbursement identified in 42 CFR, Part 413 . All cost settlements will be made using these principles.

262.100Inpatient Psychiatric Revenue Codes

Revenue Code	Revenue Code Description
114	Inpatient Psychiatric Hospital only
124	Residential Treatment Center only
128	Sexual Offender Program only
129	Residential Treatment Unit only

016.06.17 Ark. Code R. 015

9/20/2017