D.C. Mun. Regs. r. 22-A3425

Current through Register Vol. 71, No. 24, June 14, 2024

Rule 22-A3425 - COMMUNITY BASED INTERVENTION

3425.1

CBI services are time-limited, intensive, mental health services delivered to children and youth. CBI services are intended to prevent the utilization of an out-of-home therapeutic resource or a detention of the consumer. CBI services may be provided at the time a child or youth is identified for a service, particularly to meet an urgent or emergent need during their course of treatment.

3425.2

In order to be eligible for CBI services, a consumer shall have:

(a) Insufficient or severely limited individual or family resources or skills to cope with an immediate crisis; and

(b) Either individual or family issues, or a combination of individual and family issues, that are unmanageable and require intensive coordinated clinical and positive behavioral interventions.

3425.3

There shall be three (3) levels of CBI services available to children and youth. A provider may be certified to offer one (1) or more level(s) of CBI services. The three (3) levels of CBI services are:

(a) CBI Level I, delivered using the MST treatment model adopted by the Department;

(b) CBI Level II, delivered using the Intensive Home and Community-Based Services (IHCBS) model adopted by the Department; and

(c) CBI Level III, delivered using the IHCBS model adopted by the Department.

3425.4

The CBI provider shall be responsible for coordinating the treatment planning process for all consumers authorized to receive CBI for the duration of CBI services. CBI services shall be delivered primarily in natural settings and shall include in-home services.

3425.5

The basic goals of all levels of CBI services are to:

(a) Defuse the consumer's current situation to reduce the likelihood of a recurrence which, if not addressed, could result in the use of more intensive therapeutic interventions;

(b) Coordinate access to covered mental health services and other covered Medicaid services;

(c) Provide mental health services and support interventions for consumers that develop and improve consumer and family interaction and improve the ability of parents, legal guardians, or caregivers to care for the consumer; and

(d) Assess the needs of the consumer and transition the consumer to an appropriate level of care following the end of CBI treatment services.

3425.6

All levels of CBI services shall include the following services, as medically necessary and clinically appropriate for the consumer:

(a) Immediate crisis response for enrolled consumers;

(b) Stabilization and behavioral support services to:

(1) Reduce family conflict;

(2) Stabilize the family unit;

(3) Maintain the consumer in the home environment;

(4) Increase family support; and

(5) Monitor the consumer's medication compliance with prescribed psychiatric medications;

(c) Environmental assessment to:

(1) Identify risk factors that may endanger either the consumer or the consumer's family; and

(2) Assess the strengths of the consumer and the consumer's family;

(d) Individual and family support interventions that develop and improve the ability of parents, legal guardians, or significant others to care for the consumer's behavioral and emotional disturbance(s);

(e) Skills training related to:

(1) Consumer self-help;

(2) Parenting techniques to help the consumer's family develop skills for managing the consumer's emotional disturbance;

(3) Problem solving;

(4) Behavior management;

(5) Communication techniques, including the facilitation of communication and consistency of communication for both the consumer and their family;

(6) Medication management, monitoring, and follow-up for family members and other caregivers; and

(f) Coordination and linkages with other covered MHRS services, behavioral health services or supports and other covered Medicaid services to prevent the utilization of more restrictive residential treatment, including one (1) or more of the following activities:

(1) Referral of consumers to other MHRS providers;

(2) Assisting consumers in transition to less intensive or more intensive MHRS;

(3) Referral of consumers to providers of other Medicaid-covered services; or

(4) Supporting and consulting with the consumer's family or support system directed exclusively to the well-being and benefit of the consumer.

3425.7

Each level of CBI provider shall have policies and procedures included in its Service Specific Policies that address the provision of CBI (CBI Organizational Plan) which include the following:

(a) A description of the particular treatment models utilized, types of intervention practiced, and typical daily curriculum and schedule;

(b) A description of the staffing pattern and how staff is deployed to maintain the required staff-to-consumer ratios, including a plan for unplanned staff absences;

(c) A requirement to directly conduct or arrange for Diagnostic Assessment services within thirty (30) calendar days before or after the initiation of CBI services. The Department may approve alternative sources to serve as the diagnostic assessment instrument if similar assessments have been conducted within the past twelve (12) months of an individual's referral to CBI services; and

(d) A requirement to collect and submit clinical outcome data and any other requested information using the process, timeline, and tools specified or approved by the Department.

3425.8

CBI Level I services are intended for children and youth ages twelve (12) through seventeen (17) who are experiencing serious emotional disturbance with either of the following:

(a) A documented behavioral concern with externalizing (aggressive or violent) behaviors; or

(b) A history of chronic juvenile offenses that has resulted or may result in involvement with the juvenile justice system.

3425.9

CBI Level I services shall not be authorized for:

(a) Children or youth who require the safety of a hospital or other secure setting;

(b) Children or youth in independent living programs; or

(c) Children or youth without a long-term placement option.

3425.10

Eligible consumers of CBI Level I services shall have a permanent caregiver who is willing to participate with service providers for the duration of CBI Level I treatment services and be:

(a) At imminent risk for out-of-home placement within thirty (30) calendar days; or

(b) Currently in out-of-home placement due to the consumer's disruptive behavior, with permanent placement expected to occur within thirty (30) calendar days.

3425.11

Providers shall obtain prior authorization from the Department before rendering CBI Level I services. Authorizations shall not exceed one hundred eighty (180) calendar days.

3425.12

The Department may consider reauthorization of CBI Level I services after one hundred eighty (180) calendar days in accordance with medical necessity requirements specified by the Department. Providers must obtain prior authorization from the Department before rendering CBI Level I services after one hundred eighty (180) calendar days.

3425.13

CBI Level II is intended for consumers ages birth through twenty-one (21) who meet at least one (1) of the following criteria:

(a) A history of involvement with the Child and Family Services Agency (CFSA) or the Department of Youth Rehabilitation Services (DYRS);

(b) A history of negative involvement with schools for behavioral-related issues;

(c) A history of either chronic or recurrent episodes of negative behavior that has resulted or may result in out-of-home placement; or

(d) Recently discharged or being discharged within the next thirty (30) calendar days from an inpatient setting such as a hospital or psychiatric residential treatment facility.

3425.14

The Department shall not authorize CBI Level II services for children or youth who require the safety of a hospital or other secure setting.

3425.15

Providers shall obtain prior authorization from the Department before rendering CBI Level II services. Authorizations shall not exceed one hundred and eighty (180) calendar days.

3425.16

The Department may consider reauthorization of CBI Level II services in accordance with medical necessity criteria established by the Department. Providers shall obtain prior authorization from the Department before rendering CBI Level II services after one hundred and eighty (180) days.

3425.17

CBI Level III is intended for consumers ages birth through twenty-one (21) who meet at least one (1) of the following criteria:

(a) Have situational behavioral problems that require short-term, intensive treatment;

(b) Are currently dealing with stressor situations such as trauma or violence and require development of coping and management skills;

(c) Have recently experienced out-of-home placement and require development of communication and coping skills to manage the placement change;

(d) Are undergoing transition from adolescence to adulthood and require skills and supports to successfully manage the transition; or

(e) Were recently discharged or are being discharged within the next thirty (30) calendar days from an inpatient setting such as a hospital or psychiatric residential treatment facility.

3425.18

The Department shall not authorize CBI Level III services for children or youth who require the safety of a hospital or other secure setting.

3425.19

Providers shall obtain prior authorization from the Department before rendering CBI Level III services. Authorizations shall not exceed ninety (90) calendar days.

3425.20

The Department may consider reauthorization of CBI Level III services after ninety (90) calendar days in accordance with medical necessity requirements specified by the Department. Providers shall obtain prior authorization from the Department before rendering CBI Level III services after ninety (90) calendar days.

3425.21

Discharge from all levels of CBI services shall occur when the consumer has achieved the goals for CBI outlined in the Plan of Care, or the consumer no longer benefits from CBI services. Discharge decisions shall be based on one (1) or a combination of the following:

(a) The consumer is performing reasonably well in relation to goals contained in the Plan of Care and discharge to a lower level of care is indicated (for example, the consumer is not exhibiting risky behaviors or family functioning has improved);

(b) The consumer or their family or caregiver has developed the skills and resources needed to step down to a less intensive service;

(c) The consumer is not making progress or is regressing and all realistic CBI treatment options have been exhausted;

(d) A family member or caregiver requests discharge and the consumer is not imminently dangerous to self or others;

(e) The consumer requires a higher level of care (for example, inpatient hospitalization or psychiatric residential treatment facility); or

(f) The consumer does not reside in the District of Columbia (District) and:

(1) Is not eligible to participate in the District's Medicaid program;

(2) Is not within the physical or legal custody of the CFSA; or

(3) Is not within the physical or legal custody of the DYRS.

3425.22

Eligible providers of CBI Level I services shall:

(a) Be licensed MST providers in good standing;

(b) Be either a Network Partner that is providing the MST services and receiving MST consultation services from another MST Network Partner, or a non-Network Partner that is receiving MST consultant services from a MST Network Partner or MST Services;

(c) Have the capacity to provide or arrange for the non-Medicaid reimbursed wraparound services required by eligible consumers;

(d) Meet CBI Level I training requirements specified by the Department;

(e) Have the capacity to deliver CBI Level I services to four (4) to six (6) consumers for each full-time team member; and

(f) Be available to consumers twenty-four (24) hours per day, seven (7) days per week.

3425.23

Eligible providers of CBI Level II services shall:

(a) Meet CBI Level II training requirements specified by the Department;

(b) Have the capacity to provide or arrange for the non-Medicaid reimbursed wraparound services required by eligible consumers;

(c) Have the capacity to deliver CBI Level II services to at least four (4) to six (6) consumers for each full-time team member; and

(d) Be available to consumers twenty-four (24) hours per day, seven (7) days per week.

3425.24

Eligible providers of CBI Level III services shall:

(a) Meet CBI Level III training requirements specified by the Department;

(b) Have the capacity to provide or arrange for the non-Medicaid reimbursed wraparound services required by eligible consumers;

(c) Have the capacity to deliver CBI Level III services to at least four (4) to six (6) consumers for each full-time team member; and

(d) Be available to consumers twenty-four (24) hours per day, seven (7) days per week.

3425.25

Providers of all levels of CBI services shall:

(a) Individually design CBI services for each consumer and their family to minimize intrusion and maximize independence;

(b) Provide more intensive services at the beginning of treatment and decrease the intensity of treatment over time as the strengths and coping skills of the consumer and family develop;

(c) Provide services utilizing a team approach;

(d) Maintain appropriate back-up coverage for team member absences and facilitate substitution of team members, as necessary;

(e) Conduct face-to-face transition planning with consumers and their families no later than thirty (30) calendar days prior to the anticipated discharge date, including meetings with providers of more intensive or less intensive services;

(f) Conduct continuity of care planning with consumers and families prior to discharge from any level of CBI services, including facilitating follow-up mental health appointments and providing telephonic support until followup mental health services occur;

(g) Provide all of the components of treatment specified in § 3425.6, as appropriate, based on each consumer's needs;

(h) Provide CBI services with a family-focus;

(i) Assist the consumer and their family with the development of mental health relapse prevention strategies and plans, if none exist; and

(j) Assist the consumer and their family with the development of a safety plan to address risk factors identified during the environmental assessment.

3425.26

Each CBI Level I team shall include:

(a) A full-time CBI Level I clinical supervisor; and

(b) Two (2) to four (4) full-time CBI Level I clinicians.

3425.27

The CBI Level I team clinical supervisor shall be an independently licensed qualified practitioner pursuant to § 3425.39 practicing within the scope of their license. The clinical supervisor shall be experienced in providing individual, group, marital, or family counseling or psychotherapy, and have a minimum of two (2) years of post-graduate experience working with behaviorally challenged youth and their families in community-based settings.

3425.28

The CBI Level I team clinicians shall be qualified practitioners pursuant to § 3425.39 practicing within the scope of their license.

3425.29

Each CBI Level II team shall include:

(a) A full-time clinical supervisor dedicated at a minimum fifty percent (50%) to IHCBS; and

(b) At a minimum, two (2) full-time clinicians dedicated to IHCBS.

3425.30

The CBI Level II team clinical supervisor shall be a Master's level independently licensed qualified practitioner pursuant to § 3425.39 practicing within the scope of their license. The clinical supervisor shall be experienced in providing individual, group, marital, or family counseling or psychotherapy and have a minimum of two (2) years of post-graduate experience working with behaviorally challenged youth and their families in community-based settings.

3425.31

The CBI Level II team clinicians shall be qualified practitioners pursuant to § 3425.39 practicing within the scope of their license and have a minimum of one (1) year of experience working with behaviorally challenged youth and their families in community-based settings.

3425.32

Each CBI Level III team shall include:

(a) A full-time clinical supervisor dedicated at a minimum fifty percent (50%) to IHCBS; and

(b) At a minimum, two (2) full-time clinicians dedicated to IHCBS.

3425.33

The CBI Level III team clinical supervisor shall be a Master's-level independently licensed qualified practitioner pursuant to § 3425.39 practicing within the scope of their license. The clinical supervisor shall be experienced in providing individual, group, marital, or family counseling or psychotherapy, with a minimum of two (2) years post-graduate experience working with behaviorally challenged youth and their families in community-based settings.

3425.34

The CBI Level III team clinicians shall be qualified practitioners pursuant to § 3425.39 practicing within the scope of their license and have a minimum of one (1) year of experience working with behaviorally challenged youth and their families in community-based settings.

3425.35

Providers of all levels of CBI services shall ensure referral to and coordination with any medically necessary substance use disorder treatment and recovery support services and any services to facilitate consumers' transition from adolescence to adulthood.

3425.36

CBI shall not be billed on the same day as:

(a) Counseling;

(b) FFT;

(c) ACT; or

(d) TF-CBT.

3425.37

CBI Level II and CBI Level III shall not be billed on the same day as TREM.

(a) At the MHRS provider's service site; or

(b) In natural settings, including the consumer's home or community settings.

3425.39

The following are qualified practitioners of CBI:

(a) Psychiatrists;

(b) Psychologists;

(c) Licensed Independent Clinical Social Workers (LICSWs);

(d) Advanced Practice Registered Nurses (APRNs);

(e) Licensed Professional Counselors (LPCs);

(f) Licensed Marriage and Family Therapists (LMFTs);

(g) Licensed Graduate Social Workers (LGSWs);

(h) Licensed Graduate Professional Counselors (LGPCs);

(i) Licensed Independent Social Workers (LISWs); and

(j) Psychology Associates.

3425.40

The provider shall not render CBI services in excess of thirty-two (32) units in a twenty-four (24) hour period without prior authorization from the Department. The Department may conduct clinical record reviews to verify the medical necessity of services provided.

3425.41

CBI providers shall comply with training requirements:

(a) For CBI Level I through nationally recognized body;

(b) For CBI Level II and CBI Level III in accordance with the Department CBI Policy; and

(c) All other trainings provided through the Department's Training Institute during the calendar year as requested by the Department.

D.C. Mun. Regs. r. 22-A3425

Final Rulemaking published at 48 DCR 10297 (November 9, 2001); as amended by Final Rulemaking published at 51 DCR 9308 (October 1, 2004); as amended by Final Rulemaking published at 52 DCR 5682 (June 17, 2005); amended by Final Rulemaking published at 67 DCR 10674 (9/4/2020); amended by Final Rulemaking published at 68 DCR 012400 (11/26/2021); amended by Final Rulemaking published at 70 DCR 3050 (3/10/2023), effective date corrected to 4/7/2023, by Errata Notice published at 71 DCR 4474 (4/19/2024).