N.J. Admin. Code § 10:37J-2.5

Current through Register Vol. 56, No. 7, April 1, 2024

Section 10:37J-2.5 - Services to be provided and service coordination

(a) This section delineates the services, which PACT teams must provide to eligible consumers and also sets requirements for service coordination among PACT teams and other service providers.

(b) In order to help the consumer cope with and gain mastery over symptoms, overcome barriers, achieve wellness and recovery in the context of daily living, the PACT team shall be available to provide symptom assessment, management, and supportive counseling. These services shall include, but not necessarily be limited to:

1. Ongoing assessment of the consumer's mental illness symptoms, behaviors, and concerns (that is, the consumer's unique experience with the mental illness), and the consumer's response to treatment;

2. Ongoing assessment of the consumer's response to treatment, including the team's strategies for engaging the consumer in PACT services;

3. Education of the consumer regarding his or her illness and the effects and side effects of prescribed medications;

4. Symptom management efforts directed to helping each consumer identify the symptoms and occurrence patterns of his or her mental illness and develop methods (internal, behavioral, or adaptive) to help lessen their effects;

5. Provision, both on a planned and "as needed" basis, of such psychological support as is necessary to help consumers accomplish their recovery goals and to cope with the stresses of day-to-day living;

6. For any interested consumer, an evidence-based program, such as an Illness Management and Recovery Program, which involves regular sessions between PACT team staff and the consumer, aimed at assisting the consumer to identify and pursue personally meaningful recovery goals and is founded upon a core set of interventions that, at a minimum, include: psycho-education, social skills training, cognitive-behavioral techniques, motivational interviewing, and relapse prevention planning;

7. Education of and, where applicable, assistance to the consumer regarding psychiatric advance directives (in accordance with N.J.A.C. 10:37); and

8. Education of and, where applicable, assistance to the consumer regarding Wellness Recovery Action Plans (WRAP), and/or other crisis planning tools.

(c) The PACT team shall be available to provide crisis assessment and intervention 24 hours per day, seven days per week, including telephone and face-to-face contact. These services may be provided in conjunction with the catchment area's designated screener or emergency services.

1. Response to crisis shall be rapid and flexible.

2. If screening center services, extended crisis evaluation beds, crisis housing, short-term-care and voluntary and involuntary inpatient units are necessary, then PACT staff shall fully collaborate in treatment. PACT shall provide support to the maximum extent possible, including accompanying the consumer to the local screening center or psychiatric emergency service and remaining with the consumer during the assessment process.

(d) The PACT team shall provide services in the areas of medication prescription, administration, monitoring, and documentation.

1. The PACT team psychiatrist shall:

i. Assess each consumer's stated concerns, mental illness symptoms, and behavior and prescribe appropriate medication;

ii. Regularly review and document the consumer's stated concerns, mental illness symptoms, as well as his or her response to prescribed medication treatment;

iii. Monitor, treat, and document any medication side effects; and

iv. Participate in outreach contacts as needed.

2. In accordance with applicable law, PACT provider agencies shall establish medication policies and procedures, which identify processes to:

i. Record physician's orders;

ii. Order medications;

iii. Arrange for all consumer medications to be organized through the team and integrated into staff daily and weekly schedules;

iv. Provide security for medications (that is, daily supplies, long-term injectable and longer-term supplies) and set aside a private, designated area for set up of medications; and

v. Administer medications to program consumers; train other team members regarding medication education, medication delivery, observation of self-administration of medication, and medication monitoring; and regularly assess other team members' competency in this area.

3. All PACT team staff shall assess the consumer's stated concerns, mental illness symptoms, and behavior in response to medication and shall monitor for medication side-effects during the provision of observed self-administration and during ongoing face-to-face contacts.

4. Regarding PACT enrollees residing in Department of Health licensed residential health care facilities (RHCFs), pursuant to 8:43-10.1(a), the RHCF is responsible for providing resident supervision and/or assistance during self-administration of medications and for documenting any observed instance where medications are not taken.

i. After obtaining the consumer's consent, PACT team staff shall collaborate with appropriate RHCF staff to ensure that PACT consumers are receiving prescribed medications. This shall include mutual sharing of information regarding PACT consumers' mental illness symptoms and behavior in response to medication and medication side effects. After obtaining the consumer's consent, a PACT team member shall meet in person with the RHCF operator and/or staff at least once per month to discuss the status of each PACT consumer residing in the RHCF and shall document the results of these meetings in the consumer's PACT record.

ii. PACT team staff shall also regularly advise the RHCF nurse(s) as to which medications are being prescribed and ordered by the PACT psychiatrist, communicate to the RHCF staff about PACT consumers' treatment plans, for example, goals, objectives, and interventions, and provide medication education for PACT consumers.

iii. For those RHCFs which are not "registered generators" under the applicable law (see, for example, 7:26-3A.8 ) and thus are unable to dispose of syringes and cannot administer injectable medications, PACT nurses shall administer injectable psychotropic medications, maintain a record of these injections in the consumer's PACT record, and communicate to the RHCF that such injections have been given.

5. Where a PACT enrollee resides in a boarding home ("BH") licensed by the Department of Community Affairs, the PACT team, after obtaining the consumer's consent, shall collaborate with appropriate BH staff to ensure that the consumer is receiving prescribed medications.

i. Collaboration shall include mutual sharing of information regarding PACT consumers' mental illness symptoms and behavior in response to medication and medication side-effects as permitted in 5:27-10.5.

ii. The PACT team shall regularly review the BH's records of residents who are PACT consumers as permitted in 5:27-8.1(c).

iii. The PACT team shall also provide regular communication to BH staff about PACT consumers' treatment plans, for example, goals, objectives, and interventions; and provide medication education. A PACT team member shall meet in person at least once per month with the BH staff and/or operator to discuss the status of each resident who is a PACT consumer and shall record the results of these meetings in the consumer's PACT record.

iv. Where mutually agreed upon between the PACT team and the BH operator, the PACT team may supervise the observed self-administration of medication. A PACT team member shall meet in person at least once per month with the BH staff and/or operator to review medication provision to each PACT consumer resident and shall record the results of these meetings in the consumer's PACT record.

(e) The PACT team shall provide whatever direct assistance is reasonable and necessary to ensure that the consumer obtains the basic necessities of daily life, including, but not limited to:

1. Safe, clean, affordable housing;

2. Food and clothing;

3. Medical and dental services;

4. Appropriate financial support, which may include supplemental security income, social security disability insurance, general relief, and money management services.

i. The PA shall ensure that PACT team members are able to have on-hand, in their possession, during regular working hours, and when appropriate, during on-call hours, an adequate amount of petty cash with which to make emergency purchases of food, shelter, clothing, prescriptions, transportation, or other items and services as needed for PACT consumers.

ii. The PA shall ensure that PACT team members have efficient, rapid access to larger sums of client assistance funds for security deposits, purchases of furniture, and other items needed by PACT consumers.

iii. The team or another party may serve as "representative payee" for some consumers' SSI/SSD benefits, provided that the consumer's case record includes written justification for such an arrangement and the approval of an administrator outside of the PACT team.

iv. PACT may utilize client assistance funds to assist consumers with short-term loans or grants, as necessary.

v. Provider agencies are obligated to attempt to procure entitlement benefits on behalf of consumers, including, but not limited to, Medicaid/NJ FamilyCare, housing and other public assistance;

5. Social services;

6. Transportation; and

7. Legal advocacy and representation.

(f) The PACT team shall provide training and instruction, including individual support, problem-solving, skill development, modeling, and supervision, in home and community settings to teach the consumer to:

1. Carry out personal hygiene tasks;

2. Perform household chores, including housekeeping, cooking, laundry, and shopping;

3. Develop or improve money management skills;

4. Use community transportation; and

5. Locate, finance, and maintain safe, clean, affordable housing.

(g) The PACT team shall develop and support the consumer's participation in recreational and social activities and relationships. The highest priority shall be given to supporting and helping individual consumers establish positive social relationships and activities in normative community settings. Such services shall include, but not be limited to, assisting consumers in:

1. Developing social skills, and where needed, the skills to develop meaningful personal relationships;

2. Planning appropriate and productive use of leisure time including familiarizing consumers with available social and recreational opportunities and increasing their use of these activities;

3. Interacting with landlords, neighbors, and others effectively and appropriately;

4. Developing assertiveness and self-esteem; and

5. Use of existing self-help centers, self-help groups and other social, church and recreational clubs to combat the isolation and withdrawal experienced by many persons coping with severe and persistent mental illness.

(h) The PACT team shall provide highly individualized dual disorder services for enrollees who have co-occurring mental health and substance abuse disorders. Interventions may be offered via individual and group modalities. Enrollees who do not benefit from (for example, do not or cannot attend) group treatments must be offered individual services. Interventions must take into account each consumer's stage of treatment and will assist consumers in:

1. Identifying substance use effects and patterns;

2. Recognizing the interactive effects of substance use, psychiatric symptoms, and psychotropic medications;

3. Developing motivation for decreasing substance use;

4. Developing coping skills and alternatives to minimize substance use;

5. Relapse prevention planning;

6. Attending appropriate recovery or self-help meetings; and

7. Acquiring information about the use of alcohol, tobacco, prescribed medications, and other drugs of abuse, and the impact that chemicals have on the ability to function in major life areas.

(i) The PACT team shall provide information about eating disorders, gambling, overspending, and sexual and other addictions, as appropriate.

(j) The PACT team shall make appropriate referrals and linkages to addiction services that are beyond the scope of PACT services to individuals with co-occurring mental health and substance abuse disorders.

(k) The PACT team shall act to minimize consumer involvement with the criminal justice system, with services to include, but not limited to:

1. Helping the consumer identify precipitants to the consumer's criminal involvement;

2. Providing necessary treatment, support, and education to help eliminate any unlawful activities or criminal involvement that may be a consequence of the consumer's mental illness; and

3. Collaborating with police, court personnel, and jail/prison officials to ensure appropriate use of legal and mental health services.

(l) The PACT team shall provide rehabilitation and support to assist consumers to find and maintain employment. Services to be provided shall include, but not be limited to:

1. Assessment of job-related interests and abilities based on a complete education and work history.

i. This assessment shall include a thorough evaluation of the consumer's strengths.

ii. This assessment shall consider the effect of the consumer's mental illness on employment, with identification of specific behaviors that interfere with the consumer's work performance and development of interventions to address such behaviors.

iii. Assessment of consumer's employment needs is on-going during the course of the consumer's enrollment with PACT;

2. Assistance with each consumer's individual needs with regard to job-seeking skills, on-the-job assessment, and support, so that consumers will acquire and maintain appropriate job and social skills necessary to get and keep employment;

3. Job development;

4. Individual supportive counseling to assist the consumer to identify and cope with the symptoms of mental illness that may interfere with his or her work performance;

5. On-the-job or work-related crisis intervention; and

6. Work-related supportive services, such as assistance with grooming and personal hygiene, securing appropriate clothing, wake-up calls, and transportation.

(m) The PACT team shall provide support to the consumer's family and other members of the consumer's social network to help them manage the symptoms and related consequences of the consumer's illness, reduce the level of family and social stress associated with the illness, and achieve wellness. PACT shall assist them and the consumer to relate in a positive and supportive manner through such means as:

1. Education about the consumer's illness and the role of the family in the therapeutic process;

2. Education about wellness and recovery principles, advance directives for mental health care (N.J.A.C. 10:32), and Wellness and Recovery Action Plans (WRAPs);

3. Supportive counseling;

4. Intervention to resolve conflict;

5. Referral, as appropriate, of the family to therapy, self-help and other family support services;

6. Provision, as appropriate, of the consumer's other support systems with education and information about serious mental illnesses and PACT treatment;

7. Education about co-morbidity and the importance of maintaining primary health care and healthy lifestyle habits; and

8. Where necessary, and in accordance with 10:37J-2.6(b)6 the PACT team shall engage in ongoing efforts to obtain the consumer's consent to disclose to family members confidential information related to a consumer's mental health treatment.

(n) The PA shall coordinate services with other community mental health and non-mental health providers, as well as other medical professionals, and shall provide the following functions for all consumers served:

1. Development of formal and informal affiliations with appropriate mental health, health care, addictions, and other human service providers, and inpatient units;

2. Involvement of other pertinent agencies, the consumer's family, and members of the consumer's social network in the coordination of the assessment, and in the development, implementation and revision of recovery plans;

3. Advocacy for and assistance to consumers to obtain needed benefits and services such as supplemental security income, housing subsidies, food stamps, medical assistance, and legal services;

4. Coordination of meetings of the consumer's service providers in the community;

5. Maintenance of ongoing communication with all other agencies serving the consumer including hospitals, rehabilitation services and housing providers;

6. Maintenance of working relationships with other community services, such as education, law enforcement and social services;

7. Coordination with existing community agencies to develop needed community support resources including housing, employment options and income assistance; and

8. Maintenance of a clinical treatment relationship with the consumer on a continuing basis whether the consumer is in the hospital, in the community, involved with other agencies or the criminal justice system.

(o) Methods for service coordination and communication between PA's and other service providers serving the same consumers shall be developed and implemented consistent with confidentiality rules in 10:37-6.79.

(p) In the event that the PACT team determines that a PACT consumer requires referral to more specialized services to any DMHAS-funded program other than PACT, the PACT team shall first request and obtain approval from the appropriate DMHAS Regional Office. Referrals to extra-PACT services for Medicaid-eligible consumers shall be subject to the reimbursement conditions delineated in the State Medicaid PACT rules (10:76-2.4 ).

(q) The following are among the mechanisms that may be utilized to monitor provision of the services in this section:

1. A review of documentation in the clinical file of program consumers;

2. A review of documentation in agency/program records;

3. Observation of PACT team staff members performing the functions of their roles;

4. Observation of the PACT team during daily meetings;

5. An interview with PACT program staff;

6. An interview with program consumers; or

7. An interview with family members of consumers.

N.J. Admin. Code § 10:37J-2.5

Amended by 48 N.J.R. 420(b), effective 3/7/2016