Crisis intervention services are available to clients age 20 or younger when the treatment of a condition needing care leads to a HEALTH CHECK (EPSDT) screen and the treatment is clinically necessary. Crisis intervention services are appropriate for a family in the midst of a child/adolescent mental health or substance abuse crisis. The interventions focus on reducing stress and helping resolve the crisis in a positive manner, and facilitating the client's involvement to treatment.
Crisis intervention services must meet all requirements in 471 NAC 32-001. All crisis intervention service providers must facilitate a referral for a complete HEALTH CHECK (EPSDT) screen within eight weeks of the crisis intervention. This referral must be documented in the client's clinical record.
Crisis intervention services must be family-centered, community-based, developmentally appropriate, culturally competent, and must take into account the individual needs of clients age 20 and younger.
Providers must encourage family members to be involved in the assessment of the client, the development of the treatment plan, and all aspects of the client's treatment unless prohibited by the client, through legal action, or because of federal confidentiality laws.
Providers must be available to schedule meetings and sessions in a flexible manner to accommodate and work with a family's schedule. This includes the ability to schedule sessions at a variety of times including weekends or evenings.
The provider must document their attempts to involve the family in treatment plan development and treatment plan reviews. A variety of communication means should be considered. These may include, but should not be limited to, including the family via conference telephone calls, using registered letters to notify the family of meetings, and scheduling meetings in the evening and on weekends.
003.01 Types of Crisis Intervention Services One of the following services must be included in a crisis intervention program to be approved for participation in the Nebraska Medical Assistance Program.
32-003.01ANon-Residential Crisis Intervention: Non-residential crisis intervention services are provided to the family and client outside of a residential or institutional setting. This service includes supportive services therapy, brief assessment, and coordination services to help a family alleviate a crisis. These services must be directed by a supervising practitioner and psychiatric consultation must be readily available. Some assessment and intervention activities may be carried out by a clinical professional (see 471 NAC 32-001.04, item 2) who is acting within his/her scope of practice under the direction of a supervising practitioner. The provider must have the capacity to respond to the family to unscheduled crisis intervention contacts 24 hours a day, seven days a week.
Providers of crisis intervention services must facilitate the referral to or provide the Initial Diagnostic Interview, if it has not already occurred.
32-003.01BDay Residential Crisis Intervention: Day residential crisis intervention services are provided to families when a safe and secure setting is needed to provide a therapeutic milieu for a child or adolescent for up to 23 hours and 59 minutes. This level is used when a brief stay in a secure setting will facilitate a de-escalation of the crisis. These services must be directed by a supervising practitioner with access to psychiatric consultation. The milieu and direct care interventions may be staffed by clinical professionals (see 471 NAC 32-001.04) or technicians, under the direction of a supervising practitioner. Providers of crisis intervention services must facilitate the referral to or provide the Initial Diagnostic Interview if it has not already occurred.
32-003.01CResidential Acute Crisis Intervention: Residential acute crisis intervention services are available to children and adolescents experiencing acute psychiatric crisis. The program provides crisis treatment and close supervision to stabilize a client and facilitate admission to the most appropriate treatment setting. These services must be directed under the cooperative supervision of a physician and other licensed practitioner of the healing arts. The milieu and direct care interventions may be staffed by clinical professionals (see 471 NAC 32-001.04) or technicians, under the direction of a supervising practitioner. Providers of crisis intervention services must facilitate the referral to or provide the Initial Diagnostic Interview, if it has not already occurred.
003.02 Standards for Participation as a Provider of Crisis Intervention Services Programs shall meet the following standards to participate in the NMAP as a provider of crisis intervention service in addition to the standards listed in 471 NAC 32-001.03.
32-003.02AProvider Agreement: The provider shall submit the following with Form MC-19 (non-hospital) or Form MC-20 (hospital): 1. A written overview of the program's philosophy and objectives of treating youth including: a. A description of each available service;b. A list of treatment modalities available and the capacity for individualized treatment planning;c. A statement of qualification, education, and experience of each staff member providing treatment and the supervising practitioner and the therapeutic services each provides;d. A schedule covering the total number of hours that the program operates;e. A program overview, including admission criteria, staff training information, etc.; andf. Any other information requested by the Department;2. Copies of licensure and certification, through the Nebraska Department of Health and Human Services, Division of Public Health, JCAHO, COA, AOA and/or CARF as appropriate. 32-003.02BStaffing Standards for Participation: An agency providing crisis intervention services for children and adolescents shall meet the following staffing standards to participate in NMAP: 1. All services must be provided under the supervision of the supervising practitioner. This practitioner must be available at all times for consultation or face-to-face client assessment.2. Direct intervention services must be provided by a clinical staff person who is acting within his/her scope of practice (see 471 NAC 32-001.04). 32-003.02CLocation of Services: Crisis intervention services may be provided in any of the following locations: 2. A physician's private office;3. A community mental health program which meets the criteria for approval by JCAHO or is accredited by CARF, COA, or AOA, and is appropriately licensed by the Nebraska Department of Health and Human Services, Division of Public Health;4. A hospital licensed and certified by the State of Nebraska which is accredited by JCAHO or AOA and has in effect a utilization review plan applicable to all Medicaid clients;5. The private office of a licensed practitioner of the healing arts who is licensed by the Nebraska Department of Health and Human Services, Division of Public Health;7. Other appropriate locations to meet the client needs for intervention;8. A treatment foster home that is part of an agency enrolled to provide treatment foster care through Medicaid; or9. A facility enrolled as a residential treatment center or therapeutic group home under this chapter (Mental Health and Substance Abuse Services for Children and Adolescents). 32-003.02DAnnual Update: The provider shall submit the following information on an annual basis: 1. An overview of any changes in the program including any new services;2. A current list of staff; and3. Current copies of all licenses, letters of accreditation, and certifications.003.03 Covered Services Payment for crisis intervention services under the Nebraska Medical Assistance Program is limited to services for clinically necessary primary psychiatric diagnoses. The Department covers the following crisis intervention services:
1. Active treatment, which must be :a. Provided under the supervision of the supervising practitioner by clinical staff members acting within their scope of practice (see 471 NAC 32-001.04); andb. Reasonably expected to improve the client's condition or resolve the crisis. The treatment interventions must, at a minimum, be designed to reduce or control the client's symptoms to facilitate the resolution of a crisis or prevent the need for care in a more restrictive level of care.32-003.03ASpecial Treatment Procedures in Crisis Intervention Services: If a child/adolescent needs behavior management and containment beyond unlocked time outs or redirection, special treatment procedures may be utilized. For Crisis Intervention Services provided in Treatment Foster Care, Residential Treatment Centers, or Treatment Group Homes, please refer to the sections covering those services. For Crisis Intervention Services provided in the child/adolescent's home, school, or other appropriate location, Special Treatment Procedures is limited to physical restraint. Mechanical restraints and pressure point tactics are not allowed. Parents, the legal guardian, or the Department case manager must approve use of these procedures and must be informed within 24 hours each time they are used. Facilities must meet the following standards regarding special treatment procedures:
1. De-escalation techniques must be taught to staff and used appropriately before the initiation of special treatment procedures;2. Special treatment procedures may be used only when a child/adolescent's behavior presents a danger to self or others, or to prevent serious disruption to the therapeutic environment; and3. The child/adolescent's treatment plan must address the use of special treatment procedures and have a clear plan to decrease the behavior requiring intervention. These standards must be reflected in all aspects of the treatment program. Attempts to de-escalate, the special treatment procedure and subsequent processing must be documented in the clinical record and reviewed by the supervising practitioner.
003.04 Admission Criteria The provider of crisis intervention services shall develop admission criteria for the types of services they provide. The admission criteria must be approved by the Department Medicaid staff as part of the provider enrollment.
003.05 Documentation in Client's Medical Record Providers of crisis intervention services must follow the standards for Clinical Records specified in 471 NAC 32-001.05.
Clinical records for crisis intervention services must also include, at a minimum, the following:
1. The referral source and description of the crisis;2. The provider's plan to facilitate referrals to the appropriate ongoing care for the family; and3. The follow-up contacts with the client and/or family.003.06 Limitations NMAP limits payment for crisis intervention to medically necessary services, subject to the Department's utilization review.
This period includes an average crisis resolution period of three to five days with an occasional need for up to seven days when the client's condition dictates. Payment for crisis intervention services is not available for services past seven days.
003.07 Payment for Crisis Intervention Services Payment for crisis intervention services is made according to the Nebraska Medicaid Practitioner Fee Schedule at 471-000-532.
If crisis intervention services are provided in the home between the hours of 10:00 p.m. and 8:00 a.m., the fee will be paid at one and one half times the regular rate. This shift differential is only available for unscheduled emergency services that are part of a crisis intervention service.
471 Neb. Admin. Code, ch. 32, § 003