D.C. Mun. Regs. r. 22-A8025

Current through Register Vol. 71, No. 25, June 21, 2024

Rule 22-A8025 - COMPREHENSIVE PSYCHIATRIC EMERGENCY PROGRAM (CPEP) REQUIREMENTS

8025.1

A comprehensive psychiatric emergency program ("CPEP") shall directly provide or ensure the provision of psychiatric emergency services, which shall include assessments, brief and extended stabilization visits, and extended observation visits for individuals eighteen (18) years of age and older experiencing a behavioral health crisis.

8025.2

Psychiatric emergency services shall be provided by the CPEP twenty-four (24) hours per day, seven (7) days per week year-round. Services shall include psychiatric and medical evaluations and assessments which are used to determine the appropriateness of admission to and retention in the CPEP.

8025.3

A CPEP shall not operate more than sixteen (16) beds.

8025.4

Each CPEP shall permit, as appropriate, each individual served to bring reasonable personal possessions, including clothing and personal articles, to the facility unless the provider demonstrates that it is not practical, feasible, or safe.

8025.5

Each CPEP shall, as appropriate, provide individuals with access to reasonable individual storage space for private use.

8025.6

Upon an individual's discharge, the CPEP shall return, as appropriate, to the individual or the individual's representative any personal articles held by the provider for safekeeping. The provider shall also ensure that the individual is permitted to take all of their personal possessions from the facility. The provider may require the individual or the individual's representative to sign a statement acknowledging receipt of the property. A copy of that receipt shall be placed in the individual's record.

8025.7

Each CPEP shall maintain, as appropriate, a separate and accurate record of all funds that the individual, individual's representative or representative payee deposits with the provider for safekeeping. This record shall include the signature of the individual for each withdrawal and the signature of facility staff for each deposit and disbursement made on behalf of an individual served.

8025.8

Each CPEP shall be equipped with a functioning landline or mobile telephone for use by individuals served, as appropriate. The telephone numbers shall be provided to residents and to the Department.

8025.9

Each CPEP shall ensure each individual's privacy and safety in the bathroom.

8025.10

Each CPEP shall ensure that individuals can access all scheduled or emergency medical and dental appointments.

8025.11

Each CPEP shall inventory each individual's personal property, secure any valuables and medications, and maintain a current written inventory of secured property. Each CPEP shall ensure that both the staff and individual (and guardian as appropriate) sign the written inventory. The CPEP shall provide a copy of the written inventory to the individual (or guardian, as appropriate) upon request copy of which shall be provided, signed by the individual and staff, to the individual. The written inventory shall note any personal articles to be held by the provider for safekeeping.

8025.12

Each CPEP shall take appropriate measures to safeguard and account for personal property brought into the facility.

8025.13

Each item of bed linen, towel, and washcloth shall be changed and cleaned as often as necessary to maintain cleanliness.

8025.14

Each CPEP shall offer at least three (3) meals per day and in-between- meal snacks that:

(a) Are nourishing and well-balanced in accordance with dietary guidelines established by the United States Department of Agriculture;

(b) Are suited to the special needs of each individual; and

(c) Are adjusted for seasonal changes and allow for the use of fresh fruits and vegetables.

8025.15

Each meal shall be scheduled so that the maximum interval between each meal is no more than six (6) hours, with no more than fourteen (14) hours between a substantial evening meal and breakfast the following day.

8025.16

If an individual refuses food or misses a scheduled meal, the CPEP shall offer appropriate food substitutions of comparable nutritional value.

8025.17

If an individual will be away from the CPEP during mealtime for necessary medical care, work, or other scheduled appointments, the program shall provide an appropriate meal and in-between- meal snack for the individual to carry with him or her and shall ensure that the meal is nutritious as required by these rules and suited to the individual's special needs.

8025.18

A CPEP shall implement a written Nutritional Standards Policy that outlines their procedures to meet the dietary needs of the individuals in its program, ensuring access to nourishing, well-balanced, and healthy meals. The policy shall identify the methods and parties responsible for food procurement, storage, inventory, and preparation.

8025.19

The Nutritional Standards Policy shall include procedures for individuals unable to have a regular diet as follows:

(a) Providing clinical diets for medical reasons, when necessary;

(b) Recording clinical diets in the individual's record;

(c) Providing special diets for individuals' religious needs; and

(d) Maintaining menus of special diets or a written plan stating how special diets will be developed or obtained when needed.

8025.20

A CPEP shall make reasonable efforts to prepare meals that consider the cultural background and personal preferences of the individuals.

8025.21

Any individual with a need for medical or surgical care or treatment which cannot be provided in the CPEP shall be transported to a hospital for appropriate observation and treatment.

8025.22

Any CPEP certified pursuant to this chapter shall receive and retain voluntary and involuntarily admissions for any individual experiencing a behavioral health crisis that is likely to result in serious harm to the individual or others and for whom immediate observation, care, and treatment in the CPEP is appropriate. No individual may be involuntarily retained in a CPEP for more than twenty- four (24) hours unless the individual is admitted for extended observation in accordance with § 8025.29(c).

8025.23

The CPEP shall develop a contingency plan with other local affiliated hospitals, emergency medical services, and law enforcement for the diversion of admissions during periods of high demand and overcrowding.

8025.24

The CPEP clinical director or their designee may prevent new admissions to the CPEP emanating from emergency medical services, ambulance services, and law enforcement if the program's ability to deliver quality service would be jeopardized. The CPEP clinical director or their designee shall review the continued necessity for such prevention at least once every twenty- four (24) hours.

8025.25

In order to assure that individuals admitted to the CPEP are adequately supervised and are cared for in a safe and therapeutic manner, the CPEP shall meet each of the following requirements:

(a) Appropriate professional staff shall be available to assist in emergencies on at least an on-call basis at all times; and

(b) A psychiatrist shall be available on-site at all times.

8025.26

A CPEP shall continuously employ an adequate number of staff and an appropriate staff composition to carry out its goals and objectives as well as to ensure the continuous provision of sufficient ongoing and emergency supervision. A CPEP shall submit a staffing plan to the Department as part of its certification and recertification process, which shall include the qualifications and duties of each staff position by title. The staffing plan and its rationale shall be subject to approval by the Department.

8025.27

The CPEP shall have on-site the following types and numbers of staff:

(a) At least one (1) board-certified or board-eligible psychiatrist (24-hour coverage);

(b) At least two (2) registered nurses (24- hour coverage);

(c) At least one (1) clinician licensed to practice independently in the District of Columbia (at minimum during business hours);

(d) At least two (2) staff to provide mental health counseling services who at a minimum meet the qualifications described in §§ 8025.39 or 8025.40 (24-hour coverage); and

(e) A sufficient number of security personnel (24-hour coverage).

8025.28

A CPEP shall only use restraint and seclusion in compliance with all governing Federal and District laws and regulations.

8025.29

A CPEP shall provide the following array of visits in accordance with the individual's needs:

(a) Brief psychiatric crisis visit:

(i) A brief psychiatric crisis visit includes a face-to- face interaction between an individual experiencing a behavioral health crisis and CPEP staff operating within the scope of their licensure to determine the services required. It shall include a mental health diagnostic examination, and, as appropriate, treatment interventions on the individual's behalf and a discharge plan. Other activities include medication monitoring, observation, and care coordination with other providers.

(ii) A brief psychiatric crisis visit requires documentation using at least one encounter note explaining the array of services provided during the visit.

(iii) A brief psychiatric crisis visit may last up to four (4) hours. If an individual cannot be reasonably treated and discharged in less than four (4) hours, the individual shall be admitted to an extended psychiatric crisis visit in accordance with § 8025.29(b).

(b) Extended psychiatric crisis visit:

(i) An extended psychiatric crisis visit includes a face-to-face interaction between an individual experiencing a behavioral health crisis and CPEP staff operating within the scope of their licensure to determine the services required. It shall include a psychiatric or mental health diagnostic examination; psychosocial assessment; and medical examination; which results in a comprehensive psychiatric emergency treatment plan and a discharge plan. Other activities include any clinically indicated examinations an d assessments as appropriate for the individual's presenting problems, medication monitoring, observation, and care coordination with other providers.

(ii) An extended psychiatric crisis visit requires documentation using at least one encounter note explaining the array of services provided during the visit.

(iii) An extended psychiatric crisis visit may last up to twenty- four (24) hours. If an individual cannot be reasonably treated and discharged in that time, the individual shall be admitted to an extended observation visit in accordance with § 8025.35(c).

(c) Extended observation visit:

(i) An extended observation visit includes a face-to-face interaction between an individual experiencing a behavioral health crisis and CPEP staff operating within the scope of their licensure to determine the services required. This shall include a psychiatric or mental health diagnostic examination; psychosocial assessment; and medical examination; which results in a comprehensive psychiatric emergency treatment plan and a discharge plan. Other activities include any clinically indicated examinations and assessments as appropriate for the individual's presenting problems, medication monitoring, observation, and care coordination with other providers.

(ii) An extended observation visit requires documentation using at least one encounter note explaining the array of services provided during the visit.

(iii) An extended observation visit is used for individuals retained in a CPEP for more than twenty-four(24) hours but not to exceed seventy-two (72) hours, voluntarily or involuntarily. If an individual cannot be reasonably treated and discharged in that time, the individual shall be transferred to a hospital for inpatient treatment.

8025.30

Brief psychiatric visits, extended psychiatric visits, and extended observation visits shall not be billed on the same day as one another.

8025.31

The duration of psychiatric emergency services varies with the severity of the individual's symptoms and their response to treatment but shall not last more than seventy-two (72) hours in total at a CPEP.

8025.32

Qualified Practitioners of services delivered in accordance with brief psychiatric visits, extended psychiatric visits, and extended observation visits and within their scope of practice are:

(a) Psychiatrists;

(b) Physicians;

(c) Psychologists;

(d) LICSWs;

(e) APRNs;

(f) RNs;

(g) PAs;

(h) LISWs;

(i) LPCs;

(j) LGSWs;

(k) LGPCs;

(l) Psychology Associates;

(m) Certified Peer Specialists; and

(n) Certified Recovery Coaches.

8025.33

Credentialed staff shall be permitted to provide CPEP services under the supervision of an independently licensed practitioner.

8025.34

Discharge planning shall be conducted for all individuals discharged from a CPEP who require additional mental health services after a brief or extended psychiatric visit and individuals admitted to extended observation beds who require additional mental health services. Discharge planning criteria shall include at least the following activities prior to discharge from the CPEP:

(a) A review of the individual's psychiatric, social, and physical needs;

(b) Completion of referrals to appropriate community services providers, where the individual so desires, to address the individual's identified needs;

(c) If the individual so desires, the CPEP shall arrange for appointments with community providers which shall be made as soon as possible after release from the CPEP; and

(d) The CPEP shall give each individual the opportunity to participate in the development of his or her discharge plan, including development of a crisis plan. With the consent of the individual and when clinically appropriate, the CPEP shall make reasonable attempts to contact family members for their participation in the discharge planning process. However, no individual or family member shall be required to agree to a discharge. The CPEP shall make a notation in the individual's record if any objection is raised to the discharge plan.

D.C. Mun. Regs. r. 22-A8025

Final Rulemaking published at 68 DCR 1623 (2/5/2021)