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Volume of Mental Health Services (re: community mental health centers, clinics and agencies for provision and/or purchase of services) (2 CCR 502-2)
AP MENTAL HEALTH SERVICES (MHS) ADMINISTRATIVE PROCEDURES
AP.1 Purpose
The purpose of this document is to establish rules for approving mental health centers, clinics, and other agencies (hereinafter collectively referred to as "organizations") for provision and/or purchase of mental health services subject to available appropriations. These rules are intended to protect the public from unsafe practices and to set forth requirements that will promote high quality care in the least restrictive setting as well as assuring that clients of the system are treated with dignity and respect. MHS will purchase services only from those organizations approved under these rules.
From time to time, MHS may purchase additional services or impose additional requirements. Such additional requirements or services purchased will be specified in the contract with each provider. MHS may from time to time issue guidelines or policies in addition to the rules, and contract provisions. Compliance with the rules, guidelines, and policies is mandatory unless a waiver is granted.
AP.2 Statutory Authority/Basis
Section 27-1-202, C.R.S., empowers the Department of Human Services (DHS) to administer and enforce the purchase of mental health services and to adopt reasonable and proper rules and regulations relative to the article. Section 27-1-204(1), C.R.S., provides for purchase of mental health services from clinics, community mental health centers, local general and psychiatric hospitals, and other organizations that have been approved by the executive director of DHS. Section 27-1-205, C.R.S., provides standards for approval for the purchase of mental health services.
AP.3 Applicability of the Rules
These rules are applicable to all organizations seeking approval for purchase of mental health services by MHS. The organization must meet all of the requirements herein in order to be approved. All agencies approved under these rules shall be held responsible for achieving the outcomes stated in the rules. Failure to comply with these rules shall result in enforcement against an organization as provided in AP.5. Sub-contractors and affiliates of approved organizations that are providing core services need not be approved by MHS pursuant to these rules; however, approved organizations are responsible for ensuring that the specific service(s) provided by sub-contractors and affiliates meets the requirements of these rules. Approval of an organization does not constitute a commitment on the part of MHS to purchase mental health services from the organization.
AP.4 Application for Approval
A. Any organization may apply for approval by MHS for the provision and/or purchase of mental health services. A letter of application shall be submitted to MHS and shall state that the applicant organization has thoroughly reviewed these rules and believes the applicant organization to be in full compliance with these rules, or, where it believes it is not in compliance, to specify the areas of noncompliance and a plan of correction, or request a waiver.
B. MHS shall acknowledge in writing receipt of the letter of application and shall state which documents, if any, are required to be forwarded to MHS for review prior to an on-site review. The date of the review shall be mutually determined by the applicant and MHS.
Applicants who have received a site review by MHS within the 12 months prior to the effective date of these rules may be approved by MHS on the basis of that review for a period to expire on the anniversary of the last review.
C. The applicant shall be advised in writing within 60 calendar days of the initial site review of the decision of MHS approval, denial, or continuation of the site review process, and in the case of denial or continuation, the reasons for denial or continuation. If MHS does not approve an organization following the completion of the site review process, the organization may request a hearing as provided in Section 24-4-104, C.R.S.
D. An organization found to be in substantial compliance with these rules shall be approved by MHS for the provision and/or purchase of mental health services. Full compliance must be attained within 90 calendar days or revocation or limitation proceedings may be instituted. Approval shall be effective for a one-year period, renewable yearly by MHS following review. Another letter of application is not required. Approval shall be evidenced by issuing the organization a certificate of approval.
E. If, after inspection and review of an organization, MHS finds that the organization is not in substantial compliance with these rules, the application shall be denied.
AP.5 Enforcement and Review Process
A. MHS will review all approved centers, clinics, and other organizations periodically at intervals deemed necessary by MHS. Review of sub-contractors and affiliates may also be conducted at the discretion of MHS, but the review will be concerning those elements of these rules pertaining to mental health services that are provided pursuant to contract or affiliation agreement with the approved organization.
B. If MHS finds that an approved organization or one of its contractors or affiliates is not in compliance with these rules, MHS shall notify the organization in writing within 30 calendar days of the review of the specific areas found to be out of compliance.
C. The organization shall have 30 calendar days from the receipt of the notice of non-compliance to submit data and/or a plan of correction with anticipated dates for achieving full compliance with respect to the compliance issues. If the organization does not agree with some or all of the findings regarding non-compliance, the organization has 15 calendar days from the date of receipt of the notice of non-compliance to seek review of the findings by submitting information in support of its position to the MHS director or designee. MHS will review the information and respond to the organization within 15 calendar days. If MHS determines that the submitted information is sufficient, MHS shall indicate that the organization is in compliance with these rules. If MHS continues to find the organization not in compliance with these rules, the organization shall have 15 days from the date of receipt of the MHS review findings to submit a plan of correction with anticipated dates for achieving full compliance.
D. MHS, after reviewing the organization's plan of correction, may take action as follows:
1. approve the proposed plan and schedule for achieving full compliance;
2. approve an agreed upon modified plan and schedule for achieving full compliance;
3. increase monitoring by MHS;
4. disapprove the proposed plan of correction and institute proceedings under section 24-4-104, C.R.S. (1988) to revoke, suspend, limit or modify MHS approval for the purchase of mental health services and notify any organization from which the approved facility receives reimbursement for mental health services of the pending action;
5. in cases where MHS approves a plan of correction, MHS shall continue the approval of the organization for the purchase of mental health services, but shall note that the approval is subject to the achievement of the plan of correction.
E. Notwithstanding any of the foregoing provisions, if MHS has reasonable grounds to believe and finds that the organization has deliberately and willfully violated these rules, or that the public health, safety, and welfare imperatively requires emergency action and incorporates such findings in its report, MHS may summarily suspend approval pending proceedings for suspension or revocation, which shall be promptly instituted and determined, as provided in 24-4-101 et. seq., C.R.S.
F. Pursuant to 27-1-202(1)(a), C.R.S. (1989 and 1995 Cum. Supp.) the Executive Director of DHS delegates to the manager of the Office of Health and Rehabilitation the authority to conduct hearings and render decisions relating to the denial of an application of an organization or the revocation, suspension, modification or limitation of approval of an organization for the purchase of mental health services. The hearings shall be in accordance with section 24-4-105, C.R.S. (1988) and shall constitute final agency action subject to judicial review as provided in section 24-4-106, C.R.S. (1988).
AP.6 Waiver
A. Although it is the policy of MHS that each approved organization comply in all respects with these rules, a waiver of specific requirements of the rules may be granted by MHS in accordance with this section.
B. A waiver of specific requirements of these rules may be granted to approved organizations and organizations seeking initial approval for a period not to exceed one year. The waiver may be renewed for additional one-year periods. A waiver may be granted upon a finding that the waiver would not adversely affect the health, safety, and welfare of clients and the further finding that either it would improve client care or that application of a specific requirement of these rules would create a demonstrated, undue financial hardship on the organization seeking the waiver. The organization seeking the waiver has the burden of proof. Consideration will be given as to whether the intent of the specific requirement of these rules has been met.
C. Where an organization provides mental health services through sub-contract or affiliation, and a waiver is sought for such services, the organization and not the sub-contractor or affiliate, shall request the waiver.
D. Requests for waivers shall be submitted to MHS, and shall be signed by the board president and/or the executive director of the organization. The request shall contain a detailed description of the mental health services provided by the organization, how the organization would avoid adverse impact to the safety, and welfare of the clients, and the effect of the waiver on client care, or the degree of financial hardship on the organization.
E. At the time of receipt of the waiver request, at the discretion of MHS, a date may be set within 60 calendar days of receipt of the waiver request, convenient to all parties, for a meeting to discuss the waiver in detail if MHS determines that a meeting would be beneficial in considering the waiver request. When this date has been set, the organization shall post notice of the request, a meaningful description of its substance, and the date, time and place of the meeting in a conspicuous place in all buildings used by the organization at least 10 calendar days prior to the meeting. MHS shall hold no meeting unless such a notice has been posted.
F. The meeting shall be open to public attendance and participation. The organization shall send representatives to attend the meeting.
G. Unless additional time is required to make inspection or obtain additional information from the organization, MHS shall notify the organization in writing within 30 calendar days following the date of the meeting, or following the date of the request if no meeting is scheduled, of the decision upon the waiver request. Pursuant to 27-1-202(1)(a), C.R.S., the Executive Director of DHS delegates to the MHS director or designee the power to make such decisions upon waiver requests.
AP.7 Definitions
"Assessment" - The process of collecting and evaluating information about a client for the purpose of developing a profile on which to base service planning and referral. The assessment process is both initial and ongoing.
"Case Management" - Case management activities are community-based, and are delivered either in the client's environment or in the organization by a designated person or team. Case management assists a client to function at his/her highest level and includes but is not limited to service planning, linkage, referral, monitoring/follow-up, advocacy, and crisis management.
"Client Representative" - The client representative has demonstrated training and/or experience in advocacy and is knowledgeable of client rights and advocacy mechanisms. The client representative is not the executive director, medical director, nor complainant’s clinician.
"Clinical Treatment Services" - Face-to-face, group or family psychotherapeutic or psychoeducational intervention with (not on behalf of) a client to positively impact the client's mental health status, behavior, and functioning.
"Consumer Advocacy and Family Support" - Assistance to clients and families in the establishment of client-operated, self-help, and mutual support services.
"Core Mental Health Services" - The services defined by MHS that organizations are required to provide either directly, or through affiliation or contract.
"Critical Incidents" - Critical incidents are reported in a timely manner to the executive director of the organization and the individual or group responsible for Quality Improvement, and include but are not limited to deaths of clients or staff as a result of accidents, suicides, murders, assaults or any causes other than natural while staff are on duty at the facility or for clients who are enrolled at the organization; accidents that occur at the facility or suicide attempts resulting in injuries that require medical attention; assaults occurring at the facility that result in summoning of law enforcement officials; abuse, neglect or exploitation of clients while at any facility operated by the organization that result in investigation by law enforcement or social services agencies; or fires or destruction of property that are deemed to be critical in the judgment of the executive director of the organization.
"Emergency" - Services provided during a mental health emergency which involves unscheduled, immediate, or special interventions in response to an urgent or crisis situation with a client.
"Evaluation" - Face-to-face meeting between client and clinician in which an assessment is performed.
"Family Support Services" - Community-based activities which alleviate family stress and promote family functioning and stability that will increase the ability of families to nurture their family members; enable families to use other resources in the community; and create supportive networks to enhance family strengths and decrease social isolation and vulnerability of families (e.g., respite care for parents and other caregivers, wrap around services, family support groups, and home visiting programs).
"Inpatient Services" - Care provided in a facility licensed as a hospital by the Department of Public Health and Environment.
"Interagency Consultation" - Assistance given to human services agencies, health care professionals, and other practitioners regarding the mental health treatment needs of their clients.
"Organization" - Includes, but is not limited to, clinics, community mental health centers, hospitals and agencies which provide clinic-type services but do not serve specific areas.
"Psychiatric/Medication Management Services" - The prescribing and monitoring of medications, and the consultation provided to clients and staff by a psychiatrist.
"Public Education" - Providing information about mental health, mental illness, available services, child development, and other topics to the public and interested groups.
"Rehabilitation Services" - Rehabilitation services are client-centered and help clients improve or recover functional capacity and to promote mastery in daily living, social interaction, and work life. Rehabilitation services focus on client strengths and improving functioning.
"Residential Services" - A program that provides room, board, and supervision to clients in facilities licensed by the Department of Public Health and Environment or the Department of Human Services.
"Residential Support Services" - Provision of mental health services for, and consultation services on behalf of, children and adolescents with severe emotional disturbances who are in community placements, in order to lessen the need for more restrictive placement. Such services may also involve, as necessary, assisting the child in reunifying with the family or, in the case of older youth, helping prepare for the transition to independent living. Residential support services are provided in a coordinated manner with other child-serving agencies, including, but not limited to, child welfare, juvenile justice, schools, and alternative youth service agencies. Residential support services include, to the extent possible, families and surrogate families in service planning and delivery.
"Standard of Care" - Assessment, monitoring, evaluation and treatment in accordance with current standards of care, published in reputable scientific, professional and trade publications in mental health fields. In the event of disputes, MHS may retain an expert consultant or convene an expert panel to arbitrate any dispute about what constitutes a national standard of care.
"Vocational Services" - Those services which directly assist clients in achieving employment. They include, but are not limited to, job development, job shadowing, on-the-job training, job coaching, and so on.
CF CONFIDENTIALITY
CF.1
The organization shall keep information obtained and records prepared about clients confidential. Confidential information may be disclosed only after clients, parents (for clients under 15 years of age) or legal guardian give informed, written consent unless otherwise authorized by law or court order. The organization shall document the legal basis for the release of information and the client shall be informed what information was released and to whom, in the absence of consent.
CF.2
The consent form shall specify that the consent is valid not longer than one year and may be revoked in writing by the client, parent or legal guardian at any time.
CF.3
The organization shall provide all staff with information on state and federal laws and regulations on confidentiality, when first employed, and reasonable steps are taken on a periodic basis to ensure that staff are knowledgeable about confidentiality.
CR CLINICAL RECORDS
CR.1
Information pertaining to care provided to clients shall be kept in a clinical record, including:
A. client identification;
B. information on presenting illness and complaint;
C. an individual assessment with information about physical health status, including evaluation of medical conditions producing psychiatric signs and symptoms, problems and strengths in the areas of emotional, behavioral, vocational and social needs of clients and families;
D. growth and development for children and adolescents;