H2019 1 Department of Medical Assistance Services Crisis Stabilization 2013.

H2019

www.dmas.virginia.gov 1

Department of Medical Assistance Services

Crisis Stabilization

2013

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DisclaimerThese slides contain only highlights of the Virginia Medicaid Community Mental Health Rehabilitative Services Manual (CHMRS) and are not meant to substitute for the comprehensive information available in the manual or state and federal regulations.

*Please refer to the manual, available on the DMAS website portal, for in-depth information on Community Mental Health Rehabilitative Services criteria. Providers are responsible for adhering to related state and federal regulations.

www.vita.virginia.govwww.dmas.virginia.gov 2


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Crisis StabilizationObjectives of this Training Are:

• To define the criteria of Crisis Stabilization• To identify staff qualifications;• To clarify eligibility criteria;• To identify required activities;• To review limitations of the service; • To outline service units and reimbursement; and• To review service authorization requirements.



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Crisis Stabilization Licensing

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Crisis Stabilization providers must have a Department of Behavioral Health and Developmental Services (DBHDS) license to provide Mental Health Crisis Stabilization and Outpatient Services.

* DMAS requires the license in Outpatient Services and DBHDS requires a license in Crisis Stabilization



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Crisis Stabilization Staff Qualifications

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Crisis Stabilization Licensed Mental Health Professional (LMHP) or LMHP

Supervisee or Resident

Certified Pre-screener

Qualified Mental Health Professional-Adult (QMHP-A)

Qualified Mental Health Professional-Child (QMHP-C)

Qualified Mental Health Professional-Eligible (QMHP-E)

* Qualification definitions may be found in Ch. II of the CMHRS Manual or through DBHDS



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Crisis Stabilization Service Definition

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Crisis Stabilization Crisis Stabilization services are direct mental health care to

non-hospitalized individuals experiencing an acute crisis of a psychiatric nature that may jeopardize their current community living situation or which puts them at risk of psychiatric hospitalization.

The goals are:– to avert hospitalization or re-hospitalization; – provide normative environments with a high assurance of

safety and security for crisis intervention; – stabilize individuals in psychiatric crisis; and – mobilize the resources of the community support system,

family members, and others for ongoing maintenance, and rehabilitation.



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This service may be provided in any of the following settings, but shall not limited to:

1. The home of an individual who lives with family or other primary caregivers;

2. The home of an individual who lives independently; or3. Community-based programs licensed by the Department of

Behavioral Health and Developmental Services (DBHDS) to provide residential services but which are not institutions for mental disease (IMDs).



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Crisis StabilizationDefinition of an IMD and reason for the 16 bed restriction

An IMD is defined by federal law as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care, and related services.

Whether an institution is an IMD is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such.

The Center for Medicaid and Medicare Services (CMS) is prevented by Federal law from providing Medicaid funding for mental health services to any individual over the age of 21 and under the age of 65 residing in an IMD as defined above. CMS will only provide Medicaid funding for “inpatient psychiatric services” (as defined in federal regulations) for individuals who are in an IMD and under the age of 21 or over the age of 64. This service is not an “inpatient psychiatric service.”



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Crisis StabilizationEligibility Criteria

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Individuals qualifying for this service must demonstrate a clinical necessity for the service arising from an acute crisis of a psychiatric nature that puts the individual at risk of psychiatric hospitalization.

Individuals must meet at least two of the following criteria at the time of admission to the service:

a. Experience difficulty in establishing or maintaining normal interpersonal relationships to such a degree that the individual is at risk of psychiatric hospitalization, homelessness, or isolation from social supports;



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b.Experience difficulty in activities of daily living such as maintaining personal hygiene, preparing food and maintaining adequate nutrition, or managing finances to such a degree that health or safety is jeopardized;

c.Exhibit such inappropriate behavior that immediate interventions by the mental health, social services, or judicial system are necessary; or

d.Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or significantly inappropriate social behavior.



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If an individual has co-occurring mental health and substance use disorders, integrated treatment for both is allowed as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition. The impact of the substance abuse condition on the mental health condition must be clearly documented in the assessment, treatment plan and progress notes.



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Crisis StabilizationRequired Activities

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Prior to treatment there must be a service-specific provider assessment which clearly documents the need for service and the anticipated duration of need.

The service-specific provider assessment must be completed by an Licensed Mental Health Provider (LMHP), LMHP Supervisee or Resident, a certified pre-screener, or a QMHP-A, QMHP-C or QMHP-E.

If the service-specific provider assessment is done by anyone other than an LMHP, an LMHP must review and approve the assessment within 72 hours.



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Crisis Stabilization An Individual service Plan (ISP) must be developed or

revised within 10 business days of the approved service-specific provider assessment or reassessment.

An LMHP, certified pre-screener, or QMHP must develop the ISP.

Services must be documented in the individual’s records as having been provided consistent with the ISP in order to receive Medicaid reimbursement.

Services must be documented through daily notes and a daily log of time spent in the delivery of services.



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Crisis Stabilization If any case management is being provided, there must be

coordination with the case management agency.

The service provider must notify or document the attempts to notify the primary care provider or pediatrician of the individual’s receipt of community mental health rehabilitative services.

The crisis stabilization program must provide to individuals, as appropriate, psychiatric assessment including medication evaluation, treatment planning, symptom and behavior management, and individual and group counseling.



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Crisis StabilizationLimitations

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This service will not be reimbursed if any of the following apply:

The individual has a medical condition that requires hospital care.

The individual has a primary diagnosis of substance abuse. The individual has a psychiatric condition that cannot be

managed in the community (i.e. individuals who are of imminent danger to themselves or others.)

Room and board, custodial care, and generally supervision are not components of this service.



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Reimbursement for this service cannot be made in treatment settings with a bed capacity that is greater than 16.

The total number of beds will be determined by including all beds located within the program/facility, regardless of whether or not the services are billed Medicaid.

If a provider operates separate residences that are 16 beds or less and are more than one mile apart, the bed count will only apply to each residence.



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No concurrent billing is allowed during the same time period for Clinic Option Outpatient Mental health treatment or Intensive Community Treatment. (Billing for medication management only is permitted.)

Staff Travel time is excluded.



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Crisis StabilizationUnits and Reimbursement

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Crisis stabilization may billed for up to a 15-day period per crisis episode following the documented face-to-face service-specific provider assessment.

The maximum limit on this service is up to eight hours per day up to 60 days annually (fiscal year).

A billing unit is one hour.

Each July 1st all service limits will be set to zero.

A fiscal year is July 1 through June 30.



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Crisis StabilizationService Authorization

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Service authorization is not required for this service



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Crisis Stabilization Helpful Resources:

• 12VAC30-50-226 - Emergency Regulations for Community Mental Health Services

• Virginia Medicaid Web Portal link www.virginiamedicaid.dmas.virginia.gov

• DMAS Office of Behavioral Health:– Email Address [email protected]

• DMAS Helpline: 804-786-6273 Richmond Area1-800-552-8627 All other



http://www.virginiamedicaid.dmas.virginia.gov/

mailto:[email protected]

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Thank you for attending this training and helping to serve Virginia’s Medicaid Recipients.



H2019 1 Department of Medical Assistance Services Crisis Stabilization 2013.

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