La. Admin. Code tit. 50 § II-10141

Current through Register Vol. 50, No. 11, November 20, 2024

Section II-10141 - Mental Health Rehabilitation Services

A. Mental health rehabilitation services are defined as medically necessary services which can reasonable be expected to reduce the resident's disability resulting from mental illness and to restore the individual to his/her best possible functional level in the community. The services are provided outside of a mental institution (or distinct part psychiatric unit) on an as needed basis to assist residents in coping with the symptoms of their illnesses, minimizing the disabling effects of mental illness on their capacity for independent living, and preventing or limiting periods of in-resident treatment. These services are an optional Medicaid service authorized under section 440. 130(d) of the Code of Federal Regulations. Residents in nursing facilities shall have been identified as needing these services through the pre-admission screening and annual resident review process (PASARR).

B. Mental health rehabilitation services must be ordered by a physician and provided by or under the supervision of a qualified mental health professional according to a rehabilitation care plan which includes the comprehensive mix of services recommended by the physician and the QMHP.

C. Mental health rehabilitation services consist of the planning, delivery, and management of mental health therapeutic services. These services differ from those provided under the Medicaid Clinic Option by the location(s) in which they are provided. Mental health rehabilitation services are not restricted to a community mental health clinic or an in-resident setting. They may be provided in community settings or in any facility which does not provide mental health services as part of its program. They differ from case management services for the chronically mentally ill which involve arranging access to and coordinating a wide range of services of which mental health rehabilitation is only a party.

D. Mental Health Definitions

1. Specialized Services for Mental Illness. Specialized services for the treatment of mental illness are those services for people with mental illness whose needs are such that continuous supervision, treatment, and training by qualified mental health personnel (QMHP's) is necessary, and/or for persons who are experiencing an acute episode of serious mental illness. These services are beyond the scope of services provided by the nursing facility, and require high degree of intensity. These services, combined with the services provided by the nursing facility, result in the continuous and aggressive implementation of a plan of care.

2. The following are specialized services as described above:

a. Mental Health Rehabilitation Management-Services provided according to a care plan developed by a licensed professional who is a QMHP, in conjunction with a physician.

b. Psychiatric, psychosocial, psychological and other evaluations or assessments-Discipline: Specific information gathered and integrated for diagnosis, establishment of specific treatment goals, analysis of programs, and/or updating the care plan and goals, evaluating and ordering medications. This may include development and implementation of a behavior program on an intensive basis.

c. Individual, group, and/or family therapy-Face-to-face structured, time-limited, and verbal interactions between counselors or therapists and person(s) receiving the service.

d. Psychosocial skills training-Services specified in the individual's plan of care to be provided by a QMHP or paraprofessionals under the supervision of a QMHP, with focus on the remediation of mental and functional disabilities through skills training and/or supportive interventions.

e. Training in ADL's-Activities which enhance or develop the resident's basic daily living skills.

f. In-resident psychiatric services-Highly restricted, intensive and supervised services in a hospital setting reserved for extreme situations for individuals exhibiting an exacerbation of an acute disturbance or difficult ongoing problems.

3. Medication management is not a billable service for a nursing facility resident.

E. Services of a Lesser Intensity for Mental Illness. Services may be provided at a lesser intensity and frequency and level of aggressiveness for the treatment of mentally ill persons who are in need of some types of services for their condition. These services are within the scope of services which are provided or arranged by the nursing facility. They are intended to help nursing facility residents with a diagnosis of mental illness to achieve the highest possible level of mental and psychosocial well being.

1. The following are examples of services of a lesser intensity:

a. medical management, including medication management (provided by the nursing facility), as specified in the resident's plan of care: Services designed for the individual, taking into account the resident's total needs and problems, including prescribing, administering, and monitoring all medications;

b. counseling regarding adjustment to the nursing facility, interpersonal relations, and family involvement (provided by the nursing facility): Short term counseling designed to assist the resident in his adjustment to the facility;

c. training and support to maintain functional level (provided by the nursing facility) as specified in the resident's plan of care: Activities tailored to the individual's physical, emotional, and social needs, including ADL's, independent living skills, and communication skills, which may include coordination with primary therapist(s), follow through, and support of a behavior program;

d. social services support (provided by the nursing facility): Activities and/or services tailored to the individual's social needs, in consideration of the total medical needs such as transportation, referrals to other agencies or community programs, or assistance in obtaining medical appliances and devices;

e. age and functional level activity program (provided by the nursing facility) as specified in the resident's plan of care: Activities designed individually to address the needs of the resident, such as structured work and leisure activities.

F. Mental Health Rehabilitation Option in Nursing Facilities. Criteria for participation in program:

1. resident shall be an adult with chronic mental illness. The program is not for persons who are newly diagnosed with a mental illness;

2. the attending physician shall order the assessment and sign off on the plan of care when developed by the agency which will be providing services;

a. documentation to be maintained by the facility:

i. the rehabilitation agency will obtain consent from the resident to gain access to information in the facility medical record;

ii. a BCSW will do a psychosocial evaluation in order to develop a plan of care;

iii. the plan of care will be developed and incorporated into the medical record. This process should include the resident, residents legal representative or sponsor, and facility staff;

iv. the plan of care should be updated every 90 days;

v. there should be documentation of symptoms and progress or lack of progress toward goals.

La. Admin. Code tit. 50, § II-10141

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 22:34 (January 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153.