Section 448.412 - Scope of Services(A)Required Services. Each center must have services available to treat a wide range of behavioral health disorders, including co-occurring substance use disorders. All services must be clinically determined to be medically necessary and appropriate and must be delivered by qualified staff in accordance with 130 CMR 448.415, and as part of the treatment plan in accordance with 130 CMR 448.412(A)(3). A center must have the capacity to provide at least the services set forth in 130 CMR 448.412(A). In certain rare circumstances, the MassHealth agency may waive the requirement that the center directly provide one or more of these services if the center has a written referral agreement with another source of care to provide such services and makes such referrals according to the provisions of 130 CMR 448.412(A)(7). (1)Intake Services. Intake services must be completed on the initial date of service. Intake must include(a) a brief assessment to determine appropriate services; and(b) triage to appropriate services.(2)Diagnostic Evaluation Services.(a) Diagnostic Evaluation Services that may occur on a member's initial date of service or over subsequent visits to complete the diagnostic evaluation, develop a treatment plan, and substantiate treatment rendered, must include 1. an assessment of the current status and history of the member's physical and psychological health, including any current or former substance use;2. current and former behavioral health disorder treatment, or any other related treatment, including pharmacotherapy or substance use disorder treatment; and3. current and former social, economic, developmental, and educational functioning, describing both strengths and needs.(b) As treatment progresses, further diagnostic information must be gathered and documented to inform longitudinal treatment planning.(c) For members younger than 21 years old, a CANS assessment must be completed during the initial behavioral health assessment before the initiation of therapy and be updated at least every 90 days thereafter by a CANS-certified provider.(3)Treatment Planning Services. (a) Each center must complete a treatment plan for every member receiving ongoing treatment by the later of the member's fourth visit or 30 days after the initiation of treatment. Where an existing written treatment plan has been completed by a different provider prior to the member's initiation of treatment with the center, the center may rely on such treatment plan, provided that the treatment plan satisfies the requirements of 130 CMR 448.412(A)(3), and that the center reviews the treatment plan and updates the treatment plan as clinically appropriate upon initiation of treatment.(b) The member's written treatment plan must be appropriate to the member's presenting complaint or problem and based on information gathered during the intake and diagnostic evaluation process.(c) The treatment plan must be in writing, and must include at least the following information, as appropriate to the member's presenting complaint or problem: 1. identified problems and needs relevant to treatment and discharge expressed in behavioral, descriptive terms;2. the member's strengths and needs;3. measurable treatment goals addressing identified problems, with time guidelines for accomplishing goals and working towards discharge;4. identified clinical interventions, including pharmacotherapy, to obtain treatment goals;5. evidence of member's input in formulation of the treatment plan, for example, the member's stated goals, and direct quotes from the member;6. clearly defined staff responsibilities and assignments for implementing the plan;7. the date the plan was last reviewed or revised; and8. the signatures and licenses or degrees of staff involved in the review or revision.(d) Treatment plans must be updated at least every six months or sooner in the event of a significant change in clinical presentation or treatment needs, which may include, but is not limited to, admission to inpatient level of care or initiation of psychopharmacology or therapy services.(e) Upon the member meeting the goals and objectives within the treatment plan, a written discharge summary must be completed by the clinician that describes the member's response to the course of treatment and referrals to aftercare and other resources.(4)Case and Family Consultation and Therapy Services. These services must include case and family consultation, individual, group, couple, and family therapies provided by or supervised by the mental health professionals identified in 130 CMR 448.413.(5)Pharmacotherapy Services.(a) Pharmacotherapy services must include, but are not limited to, an assessment of the patient's 1. psychiatric symptoms and disorders;2. health status including medical conditions and medications;3. use or misuse of alcohol or other substances; and4. prior experience with psychiatric medications.(b) Pharmacotherapy services must include medication prescribing, reviewing, and monitoring.(c) Pharmacotherapy services must be provided by an appropriately licensed individual with the authority to prescribe medications.(d) Pharmacotherapy services may be provided by a provider that is not employed by the center, who is operating under a documented agreement with the center.(e) These requirements do not preclude the one-time administration of a medication in an emergency in accordance with a prescribing practitioner's order.(f) Storage and administration of medications must be limited to the scope of the center's DPH clinic licensure referred to in 105 CMR 140.357 and 105 CMR 140.520: Adequate Mental Health Services.(g) The center must have the capacity to conduct medical monitoring of pharmacotherapy for behavioral health conditions and must address requests such as prescription refills and/or medication questions related to behavioral health. These activities will include documentation of2. updated medication lists;3. reviewing side effects;4. performing medication adjustment;5. prescribing of a. Buprenorphine, including for same-day induction, bridging, and maintenance for members 16 years of age or older, including treatment referral services for follow-up treatment;b. Oral Naltrexone. Storage and administration of medications must be limited to the scope of the center's DPH clinic licensure; providers are encouraged to check MassPAT prior to prescribing MOUD; andc. Antipsychotic medications that require monitoring.(h) The center must provide access to and distribution of Naloxone. The center must have a Massachusetts Controlled Substance Registration to store Naloxone on-site. The center must have at least one staff member trained in the administration of Naloxone onsite 24/7. Distribution or administration of Naloxone must be documented in the member's medical record.(6)Crisis Intervention Services. Each center must provide clinic coverage to respond to members experiencing a crisis 24 hours per day, seven days per week, 365 days per year.(a) During business hours, clinic coverage must include, at minimum, crisis evaluation by a qualified professional and triage to appropriate services for the member's presenting crisis.(b) After hours crisis intervention services must include live telephonic access to qualified professionals and, if indicated, triage in real-time to an appropriate provider to determine whether a higher level of care and/or additional diversionary services are necessary. A pre-recorded message will not fulfill the requirement for access to a qualified professional.(c) During standard hours of operation, each center must provide individual and family crisis counseling.(7)Mobile Crisis Intervention Services. Each center must provide the following mobile crisis intervention services 24 hours per day, seven days per week, 365 days per year.(a)Adult Mobile Crisis Intervention (AMCI). AMCI must utilize a multi-disciplinary team, and AMCI services must include1. capacity to screen for substance intoxication or withdrawal, and to provide access to medications for opioid use disorder for induction and urgent psychopharmacology;2. adherence to the Expedited Psychiatric Inpatient Admissions (EPIA) protocol;3. telehealth services as requested and clinically appropriate;4. continued crisis intervention and stabilization services, including follow-up care, as clinically indicated, for up to 72 hours after the initial day of service;5. a disposition plan that includes referrals to the least-restrictive, clinically appropriate levels of care, and follow-up instructions and when a member requires 24-hour level of care, AMCI teams will facilitate admission to such levels of care; and6. care coordination with existing medical and behavioral health providers and existing social service providers, as clinically indicated.(b)Youth Mobile Crisis Intervention (YMCI). YMCI must utilize a multi-disciplinary team, and YMCI services must include1. capacity to screen for substance intoxication or withdrawal, and to provide access to medications for opioid use disorder for induction and urgent psychopharmacology;2. capacity to assess for parent/guardian/caregiver strengths and resources to identify how such strengths and resources impact their ability to care for the youth's behavioral health needs;3. adherence to the Expedited Psychiatric Inpatient Admissions (EPIA) protocol;4. telehealth services as clinically appropriate and agreed upon by the member;5. continued crisis intervention and stabilization services, including follow-up care, as clinically indicated, for up to seven days after the initial day of service;6. a disposition plan that includes referrals to appropriate levels of care, and follow-up instructions, and when a member requires 24-hour level of care, YMCI teams will facilitate admission to such levels of care; and7. care coordination with existing medical and behavioral health providers and existing social service providers, as clinically indicated.(8)Community Crisis Stabilization Services. Each center must provide access to the following community crisis stabilization services 24 hours per day, seven days per week, 365 days per year.(a)Adult Community Crisis Stabilization (Adult CCS). Each center providing Adult CCS must utilize a multi-disciplinary team, and Adult CCS services must include1. crisis stabilization and treatment;3. induction for FDA-approved medications for opioid use disorder;4. psychiatric evaluation and medication management;5. peer support and/or other recovery-oriented services;6. daily re-evaluation and assessment of readiness for discharge; and7. psychoeducation, including information about recovery, wellness, and crisis self-management.(b)Youth Community Crisis Stabilization (YCCS). Each center providing YCCS must utilize a multi-disciplinary team, and YCCS services must include1. Intensive Therapeutic Milieu (1:3 minimum Direct Care: youth ratio);2. comprehensive assessment;3. pharmacological evaluation and treatment (including daily medication reconciliation);4. treatment planning that develops a youth- and family-centered treatment plan that specifies the goals and actions to address the medical, social, therapeutic, educational, and other strengths and needs of the youth;5. daily wellness and therapy services focused on skills building and stabilization;6. parent/caregiver contact and involvement; and7. development of behavioral plans and crisis/safety plans.(9)Referral Services.(a) Each center must have written policies and procedures for addressing a member's behavioral health disorder needs that exceed the scope of services provided by the center, including but not limited to substance use disorder needs. Policies and procedures must minimally include personnel, referral, coordination, and other procedural commitments to address the referral of members to the appropriate health care providers.(b) When referring a member to another provider for services, each center must ensure continuity of care, exchange of relevant health information, such as test results and records, and avoidance of service duplication between the center and the provider to whom a member is referred. Each center must also ensure that the referral process is completed successfully and documented in the member's medical record.(c) In the case of a member who is referred to services outside of the center, the rendering provider must bill the MassHealth agency directly for any services rendered to a member. The rendering provider may not bill through the referring community behavioral health center.(10)Medical Services.(a) Each center must conduct withdrawal management for individuals with opioid use disorder who do not meet inpatient level of care, with or without extended onsite monitoring in a stable environment that ensures patient confidentiality, dignity, and privacy for members. These services must be in compliance with requirements referred to in 130 CMR 418.000: Substance Use Disorder Treatment Services and 105 CMR 164.000: Substance Use Disorder Treatment Programs.(b) Each center must offer on-site toxicology screenings including collection and testing of specimens using CLIA-waived testing procedures, including rapid or point-of-care testing, at all locations to support medication initiation, withdrawal management, and ongoing treatment for both mental health and substance use disorders.(c) Each center must conduct screenings for health indicators based on member presentation and refer members to primary care and/or specialized providers for further assessment or treatment as clinically appropriate.(11)Certified Peer Specialist (CPS) Services. The MassHealth agency will pay for CPS services that promote empowerment, self-determination, self-advocacy, understanding, coping skills, and resiliency through a specialized set of activities and interactions when provided by a qualified Certified Peer Specialist to an individual with a mental health disorder.(12)Peer Recovery Coach Services. The MassHealth agency will pay for peer recovery coach services delivered by centers in conformance with all applicable sections of 130 CMR 418.000: Substance Use Disorder Treatment Services.(13)Recovery Support Navigator Services. The MassHealth agency will pay for recovery support navigator services delivered by centers in conformance with all applicable sections of 130 CMR 418.000: Substance Use Disorder Treatment Services.(14)Community Support Program (CSP). The MassHealth agency will pay for community support program services delivered by centers in conformance with all applicable sections of 130 CMR 461.000: Community Support Program Services.(B)Optional Services. The below services are reimbursed by the MassHealth agency and are intended to complement the required services set forth in 130 CMR 448.421(A). The following services set forth in 130 CMR 448.421(B) are billable services and are allowed but not required to be provided by a center. All optional services provided by the center will be set forth and documented in a member's Treatment Plan developed pursuant to 130 CMR 448.421(A)(2). (1)Psychological Testing. The MassHealth agency will pay for Psychological Testing services delivered by centers in conformance with all applicable sections of 130 CMR 411.000: Psychologist Services.(2)Structured Outpatient Addiction Program (SOAP). The MassHealth agency will pay for SOAP services delivered by centers in conformance with all applicable sections of 130 CMR 418.000: Substances Use Disorder Treatment Services.(3)Enhanced Structured Outpatient Addiction Program (E-SOAP). The MassHealth agency will pay for E-SOAP services delivered by centers in conformance with all applicable sections of 130 CMR 418.000: Substance Use Disorder Treatment Services.(4)Intensive Outpatient Program (IOP). The MassHealth agency will pay for IOP services delivered by centers in conformance with all applicable sections of 130 CMR 429.000: Mental Health Center Services.Adopted by Mass Register Issue 1485, eff. 1/1/2023.