The Assertive Community Treatment (ACT) Team provides high intensity services, available to provide treatment, rehabilitation, and support activities seven days per week, twenty-four hours per day, 365 days per year. The team has the capacity to provide multiple contacts each day as dictated by client need. The team provides ongoing continuous care for an extended period of time, and clients admitted to the service who demonstrate any continued need for treatment, rehabilitation, or support will not be discharged except by mutual agreement between the client and the team.
Assertive Community Treatment (ACT) is provided by a self-contained clinical team which:
7. Shares team roles expecting each staff member to know all the clients and assist in assessment, treatment planning, and care delivery as needed. This model of integrated treatment, rehabilitation, and support services is intended to help clients stabilize symptoms, improve level of functioning, and enhance the sense of well being and empowerment. Services provided will focus on treatment and rehabilitation of the effects of serious mental illness, as well as support and assistance in meeting such basic human needs as housing, transportation, education, and employment as necessary for client satisfaction with services and increased quality of life. The goal of the program is to provide assistance to individuals in maximizing their recovery, to ensure client directed goal setting, to assist clients in gaining hope and a sense of empowerment, and provide assistance in helping clients become respected and valued members of their community.
013.01 Admission and Discharge Criteria 35-013.01AAdmission Criteria: NMAP covers ACT services for those persons disabled by severe and persistent mental illness who are unable to remain stable in community living without high intensity services. ACT services must be prior authorized by the Division of Medicaid and Long-Term Care or its designee. To be eligible for ACT services clients must meet all of the criteria described in 471 NAC 35-001.01, and demonstrate indicators of high need and utilization.35-013.01BDischarge Criteria: The ACT Program is intended to provide services over a long period of time. Clients admitted to the service who demonstrate continued need for treatment, rehabilitation, or support must not be discharged except by mutual agreement between the client and the ACT Team. Discharge from the ACT Team occurs when the client and program staff mutually agree to termination of services. Specific documentation must be included in the client's clinical chart when a discharge occurs. Discharge may occur in the following situations:
1.Geographic Relocation: The client moves outside the team's geographic area of responsibility. In such cases, the ACT Team must arrange for transfer of mental health service responsibility to a provider wherever the client is moving. To meet this responsibility, the ACT team must maintain contact with the client until this service transfer is arranged.2.Significantly Improved Functioning: The client demonstrates by functional assessment measurement the ability to function in all major role areas (i.e., work, social, self-care) with minimal assistance.3.Client Requested Discharge: Requested discharge despite the team's best efforts to develop an Individual Treatment, Rehabilitation, and Recovery Plan acceptable to the client. Efforts to develop an acceptable Individual Treatment, Rehabilitation, and Recovery Plan must be documented in the client's clinical record.4.Hospitalization of the Client in an Institute for Mental Disease (IMD): The NMAP is not able to reimburse for services provided to clients over age 20 and under age 64 who are being treated in an Institute for Mental Disease.013.02 Staff Requirements Each ACT Team must provide a comprehensively staffed team, including a psychiatrist, team leader, a peer support person, and program assistants. The ACT Team must have among its staff individuals who are qualified to provide the required services. Each ACT Team must employ, at a minimum, the following number of clinical staff persons, peer support, and psychiatrists to provide the treatment, rehabilitative, and supportive services. Providers are responsible for verifying that staff are appropriately licensed or certified.
35-013.02AStaff Qualifications: All clinical staff must be appropriately licensed or credentialed as required by the Department of Health and Human Services, Division of Public Health. All clinical staff must have at least two years of experience working with persons with serious and persistent mental illness. All clinical staff must maintain sufficient hours of continuing education to maintain certification or licensure.35-013.02BBackground Checks: The employer of the ACT Team members is responsible and accountable for the activities and interventions of the ACT Team staff. The employer must consider which type of criminal background and Abuse/Neglect Central Registry checks are appropriate for their staff and how the results impact hiring decisions. The use of criminal background and Abuse/Neglect Central Registry checks must be described in the employer's policy and procedure manual and be available for review.35-013.02CStaff Configuration: The configuration of an ACT Team depends on the number of clients to be served. The ACT Team maintains a 1:10 staff to client ratio (the Team Psychiatrist, and APRN if used, and program assistant are not included in the ratio).
1.Minimum Staff Configuration: The following minimum staffing configuration must be met in each ACT Team regardless of the number of clients served. This configuration may serve up to 50 clients. The team must have at least one member who demonstrates competency in drug/alcohol abuse and dependence or is a licensed alcohol and drug counselor. The clinical staff must include: a.Team Psychiatrist: Psychiatric coverage at a minimum ratio of 16 hours per week. This psychiatry time must be spent exclusively on the ACT Team program activities. The minimum services which must be provided by the Team Psychiatrist are: (1) The initial in-depth psychiatric assessment and initial determination for medical/pharmacological treatment;(2) Individual Treatment, Rehabilitation, and Recovery Plan reviews;(3) Weekly clinical supervision; and(4) Participation in at least two daily meetings per week.b.Advanced Practice Registered Nurse (APRN): An APRN may provide coverage for existing psychiatry time while not replacing the team psychiatrist responsibility in the above services, provided that the APRN: (1) Is practicing within his/her scope of practice;(2) Has an integrated practice agreement with the team psychiatrist;(3) Defines the relationship with the psychiatrist and provides a copy of the integrated practice agreement between the team psychiatrist and the APRN at the time of enrollment, prior to the initiation of services, and at anytime the agreement is modified or terminated.c.Team Leader: Each ACT Team must have one full time Team Leader. The Team Leader must have at least a master's degree in nursing, social work, psychiatric rehabilitation, psychology, physician's assistant or is a psychiatrist. The Team Leader must have demonstrated clinical and administrative experience.d.Mental Health Professionals: Each team must have one full time Mental Health Professional. A Professional is defined as a person who has completed a Master's or Doctoral degree in a core mental health discipline, and has clinical training including internships and other supervised practical experiences in a clinical or rehabilitation setting.e.Nursing Staff: Each team must have one full time Registered Nurse.f.Mental Health Worker: Each team must have one Mental Health Worker who meets one of the following qualifications: (1) Is a licensed Alcohol and Drug Counselor;(2) Has a bachelor's degree in rehabilitation or a behavioral health field;(3) Has a bachelors' degree in a field other than behavioral sciences or have a high school degree, and has work experience with adults with severe and persistent mental illness or with individuals with similar human services needs; ORg.Additional Staff: Each team must have one additional full time staff person who meets the qualifications of the Mental Health Professional or Mental Health Worker.h.Peer Support: Each team must have a half time coverage of peer support. This team member position must be a self-identified consumer of mental health services. The Peer Support staff must have training, experience, and ability to work with the team in carrying out appropriate aspects of the Individual Treatment, Rehabilitation, and Recovery Plan. The Peer Support staff must have a bachelor's degree or a high school diploma and either work experience with adults with severe and persistent mental illness, or be able to demonstrate the motivation, learning potential and interpersonal characteristics necessary to benefit from on-the-job training.i.Support Staff: Each ACT Team must have at least one full-time support staff person.2.Expanded Staff Configuration: If an ACT Team will serve more than 50 clients, the following staff must be added: a.Registered Nurse: Teams serving more than 50 clients must have at least one additional Registered Nurse to meet the nursing needs of the expanded population;b.Peer Support: Teams serving more than 50 clients must have full time Peer Support;c.Team Psychiatrist: Teams serving more than 50 clients must maintain additional psychiatric coverage of 2.6 hours for every eight clients; andd.Mental Health Professionals: Teams serving more than 50 clients must have at least two Mental Health Professionals.3.Additional Staff: Teams serving more than 50 clients must maintain a minimum 1:10 staff to client ratio. This ratio excludes the Team Psychiatrist, and APRN if used, and the program assistant. The configuration of the ACT Team must reflect the needs of the client population. 35-013.02DStaffing Positions: Each ACT team must have qualified staff assigned to each of the following positions: 1.Team Leader: The Team Leader is the clinical and administrative supervisor of the team and has overall responsibility and accountability for assuring that the requirements and functions as stated in these regulations are met. The Team Leader also functions as a practicing clinician on the ACT Team. The Team Leader ensures that all clinical tasks are completed or rescheduled and manages team response to all emergencies or crisis situations in consultation with the Team Psychiatrist. This is a full time position.2.Team Psychiatrist: The Team Psychiatrist functions must be provided by a psychiatrist who is Board-certified or Board-eligible on a full-time or part-time basis. The Team Psychiatrist position may be shared by more than one psychiatrist and/or an APRN (see 471 NAC 35-013.02C (a and b)). The Team Psychiatrist provides clinical services including psychiatric assessment, Individual Treatment, Rehabilitation, and Recovery Plan development and approval, psychopharmacologic and medical treatment, and crisis intervention to all ACT Team clients. The Team Psychiatrist is available 24 hours per day and seven days per week for crisis management. The Team Psychiatrist works with the Team Leader to monitor each client's clinical status and response to treatment, provides staff clinical supervision, and participates in the development of all Individual Treatment, Rehabilitation, and Recovery Plans. The rate of reimbursement for ACT programs that provide psychiatric coverage with less than 16 hours of a psychiatrist's time (psychiatrist and APRN combination) will be adjusted accordingly. (Please see the fee schedule for procedure code and rate).3.Advanced Practice Registered Nurse: If an ACT Team includes an APRN to provide services included as part of the required team psychiatrist hours, the APRN must work collaboratively with the psychiatrist. An APRN is able to provide services, except for the mandatory services which must be delivered by the team psychiatrist as described in 471 NAC 35-013.02C (1a.). The Team Psychiatrist must be available for consultation and direction of the treatment activities provided by an APRN, within his/her scope of practice. Psychiatric 24/7 coverage must be documented via a written agreement between the psychiatrist and the APRN. A copy of the agreement must be sent to Medicaid at the time of enrollment.4.Peer Support: The Peer Support staff performs clinical work based on their credentials and abilities.5.Team Member: Team Members carry out treatment, rehabilitation, and support interventions consistent with their training and scope of licensure.6.Program Assistant: The program assistant is a non-clinician responsible for working under the direction of the Team Leader to support all non-clinical operations of the ACT Team. This is a full time position and not considered in the staff to client ratio. 35-013.02EStaff Functions: The ACT Team must perform the following functions: 1.Clinical Supervision: Clinical Supervision is regular contact between a designated senior clinical supervisor and a member of the ACT Team to: a. Review the client's clinical status,b. Ensure appropriate treatment services are provided to the client, andc. Review and improve the ACT Team member's service provision. Clinical Supervision may occur during Daily Team Meetings, Individual Treatment, Rehabilitation, and Recovery Plan Meetings, side-by-side and face-to-face supervision sessions, and through a review of the client's clinical record and in other appropriate activities. Clinical Supervision must be appropriately documented. The Team Leader and/or the psychiatrist is responsible for supervising and directing all ACT Team activities.2.Crisis Intervention and Response: In addition to the client specific Crisis Intervention plans, the ACT Team must have a procedure to respond to3. emergencies and crises. This includes, but is not limited to, 24-hour crisis intervention availability. Assessment: Initial and updated assessments of the client must be provided as described in 471 NAC 35-013.04A. Appropriate staff must be assigned to this function based on individualized client need. The client and his/her family (as allowed by client permission) must be involved in all assessments.
4.Treatment Planning: Initial and updated Individual Treatment, Rehabilitation, and Recovery Plans must be developed as described in 471 NAC 35-013.04B. In addition to the Team Leader and Team Psychiatrist, appropriate staff must be assigned to this function based on individualized client need. One specific staff person must be designated to document the Individual Treatment, Rehabilitation, and Recovery Plan for the clinical record. The client and his/her family (as allowed by client permission) must be involved in development, review, and revision of all Individual Treatment, Rehabilitation, and Recovery Plans.5.Individual Treatment, Rehabilitation, and Recovery Plan Coordination: Individual Treatment, Rehabilitation, and Recovery Plan Coordination is an organized process of coordination among the multi-disciplinary team in order to provide a full range of appropriate treatment, rehabilitation, and support services to a client in a planned, coordinated, efficient and effective manner, as outlined in the Individual Treatment, Rehabilitation, and Recovery Plan.6.Interventions: Based on individualized client need and preference and ACT Team qualifications, experience, and training, ACT Team members must be assigned to provide the active treatment, rehabilitative, and supportive services described in 471 NAC 35-013.04C.013.03 ACT Program Organization35-013.03AHours of Operation, Coverage, and Availability of Services: The ACT Team must meet the following regulations related to availability and scheduling. 1.Hours of Operation and Availability of Services: The ACT Team must be available to provide treatment, rehabilitation, and support interventions 24 hours per day, seven days per week, 365 days a year. The ACT Team must be able to: a. Meet the clients' needs at all hours of the day including evenings, weekends, and holidays;b. Provide services at the time that is most appropriate and natural for the client as described in the client's Individual Treatment, Rehabilitation, and Recovery Plan; andc. Operate a minimum of 12 hours per day and eight hours each weekend day and every holiday.2.Psychiatric Coverage: Psychiatric coverage must be available at all times. If availability of the Team Psychiatrist during all hours is not feasible, alternative psychiatric backup (including the APRN) must be arranged. The covering psychiatrist or APRN must have an orientation to the ACT Team concept and be supportive of its services. The covering psychiatrist or APRN must be able to get client specific information from an ACT Team member.
35-013.03BService Intensity: The ACT Team services must be able to provide the level of service intensity as dictated by client need. Client need is determined through the severity of symptoms and problems in daily living and is documented in the client's Individual Treatment, Rehabilitation, and Recovery Plan. No other psychiatric service or psychiatric rehabilitation service may be reimbursed, except for acute and subacute inpatient hospitalization for assessment and stabilization, when prior authorized by Medicaid and Long-Term Care or its designee.35-013.03CPlace of Service: The ACT Team must provide most of the interventions and service contacts in the community, in non-office based settings.35-013.03DShared Responsibility: The responsibility of the total client caseload is shared by the entire ACT Team, even though team members may serve as a primary contact for certain clients. Over time, every team member gets to know every client and every client gets to know every team member.35-013.03EStaff Communication and Planning: The ACT Team must use systems and methods for continuous daily communication and planning. These must include: 1.Daily Organizational Staff Meeting: A Daily Organizational Staff Meeting must be held to review the status of all program clients, update the Team on contacts provided in the past 24 hours and to communicate essential information on current events and activities as they relate to the interventions provided by the ACT Team.2.Daily Team Assignment Schedule: The Daily Team Assignment Schedule must list all of the interventions that need to be provided on that day and the ACT Team member assigned to complete the intervention.3.Daily Log: The Daily Log must be used to document that a client review has occurred.4.Client Weekly Contact Schedule: The Client Weekly Contact Schedule must be a written schedule of all treatment, rehabilitation, and support interventions which staff must carry out to fulfill the goals and objectives in the client's Individual Treatment, Rehabilitation, and Recovery Plan.5.Individual Treatment, Rehabilitation, and Recovery Plan Meetings: Individual Treatment, Rehabilitation, and Recovery Plan Meetings must be regularly scheduled meetings to identify and assess individual client needs/problems; to establish measurable long and short term treatment and service goals; to plan treatment and service interventions; and to assign staff persons responsible for providing the services if the client and their family are not able to participate, the meeting must include their input. Appropriate support must be provided to maximize the participation of the client and their family. If necessary, the Individual Treatment, Rehabilitation and Recovery Plan should address any barriers to participation. The ACT Team must conduct Individual Treatment, Rehabilitation, and Recovery Plan Meetings, under the supervision of the Team Leader and Team Psychiatrist.013.04 Program Components and Interventions Operating as a continuous treatment and rehabilitative service, the ACT Team must have the capability to provide assessment, comprehensive treatment, rehabilitation, and support services as a self-contained clinical service unit. Services must be available 24 hours a day, seven days a week, 365 days per year. Services must be provided by the most appropriate ACT Team members operating within their scope of practice. Services must include, but are not limited to:
35-013.04AAssessment and Evaluation35-013.04A1Initial Admission Assessment: Prior to accepting the client for admission, the ACT Team must assess and determine the appropriateness of the client for admission to the ACT Team program. The assessment must include a review of clinical information and client interview and may include additional assessment activities.35-013.04A2Comprehensive Assessment: The Comprehensive Assessment is unique to the ACT Program in its scope and completeness. A Comprehensive Assessment is the process used to evaluate a client's past history and current condition in order to identify strengths and problems, outline goals, and create a comprehensive Individual Treatment, Rehabilitation, and Recovery Plan. The Comprehensive Assessment reviews information from all available resources including past medical records, client self report, interviews with family or significant others if approved by the client, and other appropriate resources, as well as current assessment by team clinicians from all disciplines. A Comprehensive Assessment must be initiated and completed within 30 days after the client's admission to the ACT program, according to the following requirements: 1. Each assessment area must be completed by staff with skill and knowledge in the area being assessed and must be based upon all available information, including client self-reports, reports of family members and other significant parties, written summaries from other agencies, including police, courts, and outpatient and inpatient facilities, interviews with the client, and standardized assessment materials.2. The Comprehensive Assessment must include a thorough medical and psychiatric evaluation and must identify client strengths as well as problems. The assessment must gather sufficient information to develop an Individual Treatment, Rehabilitation, and Recovery Plan.3. The Comprehensive Assessment may be revised during a client's tenure in the ACT Program. Information may be added, revised, or clarified. 35-013.04BIndividual Treatment, Rehabilitation, and Recovery Plan Development and Coordination: Individual Treatment, Rehabilitation, and Recovery Plan Development and Coordination is a continuing process involving each client, the client's family, guardian, and/or support system as appropriate, and the team which individualizes service activity and intensity to meet client-specific treatment, rehabilitation and support needs. The written Individual Treatment, Rehabilitation, and Recovery Plan documents the client's goals and the services the client will receive in order to achieve them. The plan also delineates the roles and responsibilities of the team members who will carry out the services. An Initial Individual Treatment, Rehabilitation, and Recovery Plan must be developed upon the client's admission to the ACT Team.
The Comprehensive Individual Treatment, Rehabilitation, and Recovery Plan must be developed for each client within 21 days of the completion of the Comprehensive Assessment. This Individual Treatment, Rehabilitation, and Recovery Plan will be developed and revised according to the following regulations:
35-013.04B1Comprehensive Individual Treatment, Rehabilitation, and Recovery Plan Development: A comprehensive Individual Treatment, Rehabilitation, and Recovery Plan is developed through an organized process of coordination among the multi-disciplinary team in order to provide a full range of appropriate treatment, rehabilitation, and support services to the client in a planned, coordinated, efficient and effective manner. The Comprehensive Individual Treatment, Rehabilitation, and Recovery Plan provides a systematic approach for meeting a client's needs, treatment rehabilitation, and support needs, and documenting progress on treatment, rehabilitation, and service goals. The following key areas must be addressed in the Individual Treatment, Rehabilitation, and Recovery Plan based upon the individual needs of the client: symptom stability, symptom management and education, housing, activities of daily living, employment and daily structure, family and social relationships, and crisis support.
This plan must:
1. Identify the client's needs and problems;2. List specific long and short term goals with specific measurable objectives for these needs and problems;3. List the specific treatment and rehabilitative interventions and activities necessary for the client to meet these objectives and to improve his/her capacity to function in the community; and4. Identify the ACT Team members who will be providing the intervention. The Individual Treatment, Rehabilitation, and Recovery Plan must be developed in collaboration with the client and/or guardian, if any, and, when appropriate, the client's family.
The client's participation in the development of the Individual Treatment, Rehabilitation, and Recovery Plan must be documented. The plan must be signed by the client and the Team Psychiatrist.
35-013.04B2Individual Treatment, Rehabilitation, and Recovery Plan Reviews: The ACT Team must review and revise the client's Individual Treatment, Rehabilitation, and Recovery Plan every six months, whenever there is a major decision point in the client's course of treatment, or more often if necessary. The Team Psychiatrist, Team Leader, and appropriate staff from the ACT Team must participate in each Individual Treatment, Rehabilitation, and Recovery Plan Review. The ACT Team must include the client in the review. Guardians and/or family members should be encouraged to participate, as allowed by the client. The Individual Treatment, Rehabilitation, and Recovery Plan Review must be documented in the client's clinical record. This documentation must include a description of the client's progress and functioning since the last Individual Treatment, Rehabilitation, and Recovery Plan Review, the client's current functional strengths and limitations, a list of attendees, the discussion related to the Individual Treatment, Rehabilitation, and Recovery Plan, and any changes to the plan. The plan and review will be signed by the client and the Team Psychiatrist.
The signature of the Team Psychiatrist indicates this is the most appropriate level of care for the client and that the treatment, rehabilitative, and service interventions are medically necessary.
35-013.04B3Client and Family Participation: The ACT Team is responsible for engaging the client in active involvement in the development of the treatment/service goals. With the permission of the client, ACT Team staff must involve pertinent agencies and members of the client's family and social network in the formulation of Individual Treatment, Rehabilitation, and Recovery Plans.35-013.04CTreatment, Rehabilitative, and Supportive Interventions: The ACT Team must be able to provide treatment, rehabilitative, and supportive interventions to clients assigned to the ACT Team. The interventions are categorized into three areas and the specific application of each type of intervention must be based on the client's specific goals and objectives. The interventions must address the needs identified in the Comprehensive Assessment. While there are no requirements that the client receive a minimum number of a specific categories of intervention, the client must receive the interventions that are appropriate for their needs. All interventions must be performed by professionals acting within the appropriate scope of practice.
35-013.04C1Treatment Interventions:1.Medical Assessment, Management, and Intervention: The ACT Team must provide the interventions necessary to treat the client's psychiatric and physical conditions.2.Individual, Family, and Group Therapy or Counseling: The ACT Team must provide individual, family, and group therapy or counseling to assist the client to gain skills in interpersonal relationships, identify and resolve conflicts, and systematically work on identified individual goals. These interventions focus on lessening distress and symptomology, improving psychological defenses and role functioning, and increasing and reinforcing the client's understanding of and participation in treatment, rehabilitative services, and activities of daily living.3.Medication: The ACT Team must provide the prescription, preparation, delivery, administration, and monitoring, of medications.4.Crisis Intervention: The ACT Team must provide Crisis Intervention Services by assessing client needs that require immediate attention and initiate a resolution to the need.5.Substance Abuse Services: The ACT Team must provide Substance Abuse Services to assist the client in achieving periods of abstinence and stability. The interventions include, but are not limited to assessment, individual and group counseling, education, and skill development. The interventions should help the client: a. Learn to identify substance use, effects, and patterns,b. Recognize the relationship between substance use, mental illness and psychotropic medications, andc. Develop motivation to eliminate or decrease substance use and coping skills or alternatives to minimize substance use. 35-013.04C2Rehabilitative Interventions:1.Symptom Management Skill Development: The ACT Team must provide Symptom Management Skill Development to help the client cope with and gain mastery over symptoms and functional impairments in the context of adult role functioning.2.Vocational Skill Development: The ACT Team must provide Vocational Skill Development that includes individualized assessment and planning for employment based upon functional assessment and the client's needs, desires, interests and abilities.3.Activities of Daily Living and Community Living Skill Development: The ACT Team must provide services to help the client rehabilitate their functional impairments and limitations related to activities of daily living and living in a community setting. The services will help clients carry out personal hygiene and grooming tasks, perform household activities, find housing which is safe and affordable, develop or improve money management skills, use available transportation, and have and effectively use a personal physician and dentist.4.Social and Interpersonal Skill Development: The ACT Team must provide interventions to help the client rehabilitate their social functioning. The goals include, but are not limited to improved communication skills, developing assertiveness, developing social skills and meaningful personal relationships, appropriate and productive use of leisure time, relating to others effectively, familiarity with available social and recreational opportunities and support groups, and increased use of such opportunities.5.Leisure Time Skill Development The ACT Team must provide interventions to rehabilitate the client's ability to use leisure time appropriately. 35-013.04C3Supportive Interventions:1.Assistance: The ACT Team must provide support services, direct assistance, and coordination to ensure that the client obtains the basic necessities of daily life. These necessities include, but are not limited to: medical and dental services, safe, clean, affordable housing, financial support, social services, transportation, legal advocacy and representation, education, employment, food, and clothing.2.Support: The ACT Team must provide support to clients, on a planned and "as needed" basis, to help them accomplish their personal goals, gain a sense of personal mastery and empowerment, and to cope with the stresses of day-to-day living. This includes interaction that focuses on decreasing distress, improving understanding and reinforcing the client's participation in services.3.Family Involvement: The ACT Team will provide education, support and consultation to clients' families and other major supports, with client agreement and consent. The ACT Team must encourage family members and other major sources of support to be involved in the services received by the client unless prohibited by the client, through legal action, or because of confidentiality laws. This includes education about the client's illness and condition and the role of the family in the therapeutic process, intervention to resolve conflict, and ongoing communication and collaboration between the ACT Team and the client's family.4.Positive Peer Role Modeling: The ACT Team will offer opportunities for positive peer role modeling and peer support including practical problem solving approaches to daily challenges, peer perspective on steps to recovery and support, mentoring toward greater independence, empowerment, and ability to manage severe symptomology.013.05 National Accreditation and Certification Providers must be nationally accredited under specific ACT Team standards, such as CARF (Commission on Accreditation of Rehabilitation Facilities), or must be actively pursuing accreditation in order to be enrolled. Providers that are actively pursuing accreditation with a national body must submit their accreditation plan for consideration. Providers actively pursuing accreditation will be enrolled on a provisional status.
013.06 Clinical Documentation Requirements Records must be kept in accordance with the national accreditation body surveying the provider. The clinical records for ACT Team services must include the following information:
1. Client identifying and demographic information;2. Assessments and Evaluations;3. Team Psychiatrist's orders;4. Treatment, Rehabilitation and Service Planning;6. Progress and contact notes must be recorded by all ACT Team members providing services to the client;7. Reports of consultations, laboratory results, and other relevant clinical and medical information;8. Documentation of the involvement of family and other significant others; and9. Documentation of transition and discharge planning.35-013.06ADischarge Documentation: Documentation of discharge from the ACT program must included.013.07 Performance Improvement and Program Evaluation The ACT Team must have a performance improvement and program evaluation plan which meets the criteria for accreditation in the approved national accreditation organization. In addition, the program will participate in all aspects of statewide ACT evaluation projects.
013.08 Provider Enrollment An ACT Team must complete Form MC-19, "Medical Assistance Provider Agreement, " and submit the completed form and a program overview that addresses the requirements in these regulations to the Division of Medicaid and Long-Term Care for approval. The ACT Team must maintain written policies and procedures that document compliance with all of the standards and requirements in 471 NAC 35-002. The provider will be advised in writing when its participation is approved. Annual updates of enrollment may be required. The provider must submit updates of the identity and expertise of ACT Team members as new staff are added to the program.
013.09 Program Review The ACT Team will be reviewed regularly by the Division of Medicaid and Long-Term Care or its designee.
013.10 Prior Authorization Reimbursement for services from the ACT Team must be authorized by the Division of Medicaid and Long-Term Care or its designee.
013.11 Telehealth ACT Team interventions may be provided via telehealth when provided according to the regulations 471 NAC 1-006.
013.12 Reimbursement and Billing Information NMAP pays for assertive community treatment services at established rates. Providers must follow these billing requirements:
1. Claims for services provided by the ACT Team must be billed on an appropriately completed Form CMS-1500 or the standard electronic health claim form Professional transition ASC X 12N 837 (see claim submission table 471-000-49);2. Claims for ACT Team services must use the procedure codes determined by the Department; and3. The unit of service for ACT Team reimbursement is one day.013.13 Hospital Admissions In the event that a client requires hospitalization while receiving services from the ACT Team, NMAP will continue to reimburse the ACT Team services for up to 15 days per hospitalization. The ACT Team must maintain as much involvement with the client as possible, based on client preference and authorization to release information. This includes providing interventions to the client, participating in transition and discharge planning, and any other appropriate involvement.
013.14 Limitations on the Reimbursement for ACT Team Services The following situation limits NMAP reimbursement for ACT Team Services. Because regulations prohibit federal financial participation in the reimbursement of services to clients age 21 to 64 in an IMD (Institute for Mental Disease), Medicaid eligibility for clients who are admitted to an IMD for longer than 10 days will be closed.