Mental Health Medi-Cal: Service Definitions for "Outpatient Bundle"
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1 Mental Health Medi-Cal: Service Definitions for "Outpatient Bundle" 1. Assessment 2. Plan Development 3. Therapy 4. Rehabilitation 5. Collateral 6. Targeted Case Management 7. Crisis Intervention 8. Medication Support DHCS Mental Health Services Division Program Oversight & Compliance; FY15-16 Annual Review Protocol for Consolidated Specialty Mental Health Services and Other Funded Page 1 of 9
2 Assessment means a service activity designed to evaluate the current status of a beneficiary s mental, emotional, or behavioral health. Assessment includes but is not limited to one or more of the following: mental status determination, analysis of the beneficiary s clinical history; analysis of relevant cultural issues and history; diagnosis; and the use of testing procedures. CCR Title 9, Section Assessment (p4); NOTE: Authority: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, , and 14684, Welfare and Institutions Code. This is one of the five named service activities in "Mental Health Services" (p14). Page 2 of 9
3 Plan Development means a service activity that consists of development of client plans, approval of client plans, and/or monitoring of a beneficiary s progress. CCR Title 9, Plan Development (p16); NOTE: Authority: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, , and 14684, Welfare and Institutions Code. This is one of the five named "Mental Health Services" from p 14. Page 3 of 9
4 Therapy means a service activity that is a therapeutic intervention that focuses primarily on symptom reduction as a means to improve functional impairments. Therapy may be delivered to an individual or group of beneficiaries and may include family therapy at which the beneficiary is present. CCR Title 9, Therapy (p22); NOTE: Authority: Section 14680, Welfare and Institutions Code.Reference: Sections 5777, , and 14684, Welfare and Institutions Code.. This is one of the five named "Mental Health Services" from p 14. Page 4 of 9
5 Rehabilitation means a service activity which includes, but is not limited to assistance in improving, maintaining, or restoring a beneficiary s or group of beneficiaries functional skills, daily living skills, social and leisure skills, grooming and personal hygiene skills, meal preparation skills, and support resources; and/or medication education. CCR Title 9, Rehabilitation (p19); NOTE: Authority: Section 14680, Welfare and Institutions Code.Reference: Sections 5777, , and 14684, Welfare and Institutions Code. This is one of the five named "Mental Health Services" from p 14. Page 5 of 9
6 Collateral means a service activity to a significant support person in a beneficiary s life for the purpose of meeting the needs of the beneficiary in terms of achieving the goals of the beneficiary s client plan. Collateral may include but is not limited to consultation and training of the significant support person(s) to assist in better utilization of specialty mental health services by the beneficiary, consultation and training of the significant support person(s) to assist in better understanding of mental illness, and family counseling with the significant support person(s). The beneficiary may or may not be present for this service activity. CCR Title 9, Collateral (p5); NOTE: Authority: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, , and 14684, Welfare and Institutions Code. This is one of the five named "Mental Health Services" from p 14. Page 6 of 9
7 Targeted Case Management means services that assist a beneficiary to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services. The service activities may include, but are not limited to, communication, coordination, and referral; monitoring service delivery to ensure beneficiary access to service and the service delivery system; monitoring of the beneficiary s progress; placement services; and plan development. CCR Title 9, Targeted Case Management (p22); NOTE: Authority: Section 14680, Welfare and Institutions Code.Reference: Sections 5777, , and 14684, Welfare and Institutions Code. Page 7 of 9
8 Crisis Intervention means a service, lasting less than 24 hours, to or on behalf of a beneficiary for a condition that requires more timely response than a regularly scheduled visit. Service activities include but are not limited to one or more of the following: assessment, collateral and therapy. Crisis intervention is distinguished from crisis stabilization by being delivered by providers who do not meet the crisis stabilization contact, site, and staffing requirements described in Sections and CCR Title 9, Crisis Intervention (p6); NOTE: Authority: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, , and 14684, Welfare and Institutions Code. Page 8 of 9
9 Medication Support means those services that include prescribing, administering, dispensing and monitoring of psychiatric medications or biologicals that are necessary to alleviate the symptoms of mental illness. Service activities may include but are not limited to evaluation of the need for medication; evaluation of clinical effectiveness and side effects; the obtaining of informed consent; instruction in the use, risks and benefits of and alternatives for medication; and collateral and plan development related to the delivery of the service and/or assessment of the beneficiary Medication Support Services.(p13); NOTE: Authority: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, , and 14684, Welfare and Institutions Code. Page 9 of 9
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