Clinical Coverage Policy 8P: Crisis Services

Transcription

1 Clinical Coverage Policy 8P: Crisis Services

2 When are Crisis Services Appropriate? When a crisis situation occurs that presents a threat to the beneficiary s health and safety or the health and safety of others Behaviors result in the beneficiary losing their home, job, or access to activities and community involvement When there is an immediate need for support (due to intensity of behaviors) of the person who is primarily responsible for the beneficiary s care. (Note: Crisis Services should be implemented when the beneficiary is in crisis and manage the crisis in the moment) As an alternative to institutional placement or psychiatric hospitalization

3 What are the Specific Crisis Services? Primary Crisis Response (PCR)-H2011HI -PCR is provided by a Qualified Professional Please note: THIS IS NOT MOBILE CRISIS. THE MODIFIER CODE IS VERY IMPORTANT Crisis Behavioral Consultation (CBC)-T2025U3 -CBC is provided by a NC licensed Psychologist or a Psychological Associate Out of Home Crisis-T2034 -Out of Home Crisis must take place in a license facility

4 Primary Crisis Response- H2011 HI

5 Primary Crisis Response Primary Crisis Response is provided by Trained staff - Trained Staff: is defined as a Qualified Professional, and cannot be provided by an Associate Professional or Paraprofessional Staff should be available to provide first response crisis services to waiver beneficiary in the event of a crisis. - First Responder: A person or personnel of an agency designated as the primary Provider by the person-centered plan/crisis plan who will have access to the individual s crisis plan at all times and be knowledgeable of the local crisis response system - Those with first responder responsibilities should clearly define in their policy and procedures as well as ISP crisis plans, how to access after-hours crisis calls and make those crisis plans available to their after hours/on-call staff

6 Primary Crisis Response: Initial Contact First Response services can be implemented telephonically or in person Primary Crisis Response include: initial contact, implementation, and Follow-up

7 Primary Crisis Response: Initial Contact Primary Crisis response could include the following: Assess the nature of the crisis (telephonic or in person) Determine whether the situation can be stabilized, or if a higher level of intervention is needed If higher level is needed: Determine contact agencies needed to secure higher level of intervention or Out of home services

8 Primary Crisis Response: Implementation Primary Crisis Response could include the following: Provide direction to staff present First responder should provide crisis intervention techniques (telephonic or in person) to the staff. Provide direct intervention to de-escalate behaviors Protect others living with the beneficiary during behavioral episode

9 Primary Crisis Response: Follow-up Primary Crisis Response could include the following: Update Care Coordinator on the Crisis -What was the outcome? -What is the status of the individual? -What worked/didn t work? -What direction was provided to 1:1 support staff? Contact Care Coordinator following the intervention to arrange for Crisis Behavioral Consultation (if needed) Provide direction to service providers The on-call staff shall be responsible for assuring the beneficiary s individual treatment provider (or direct supervisor) is notified of the situation no later than the next business day.

10 Primary Crisis Response: Follow-up Incident reports submitted (when appropriate)

11 Primary Crisis Response Requirements for Other Services Clinical Coverage Policy 8P lists the following as a requirement for each of the four services listed below: Enrolled to provide Crisis Services or has an arrangement with an enrolled Crisis Services Provider to respond to beneficiary crisis situations. The Beneficiary may select any enrolled Crisis Services provider in lieu of this provider however. Residential Supports (all levels) Personal Care Services In-Home Skill Building In-Home Intensive Supports

12 Primary Crisis Response: Question and Answers 1.What is the goal of Primary Crisis Response? The goal of this service is to avoid call 911 and hospitalization 2.Can Primary Crisis Response be used for 2:1 staffing? No, Primary Crisis Response can provide enhanced staffing to provide direct intervention to de-escalate behavior or protect others during a behavioral episode 3.Can the Service be used for case staffing? No, only when the beneficiary is in crisis. 4.When can service be provided? Only when a beneficiary is in crisis

13 Primary Crisis Response: Question and Answers 5. Who submits documentation, Incident Reports, and Services notes? Primary Service Provider - service note & incident report (if necessary) Primary Crisis Response Provider service note only Please note that documentation is not a billable service

14 Crisis Behavioral Consultation: T2025-U3

15 Crisis Behavioral Consultation Crisis Behavioral Consultation should be provided by a NC Licensed Psychologist or Psychological Associate Available when a beneficiaries behavior has resulted in a crisis situation Should be used to develop or refine interventions that address behaviors or issues precipitating the behavioral crisis and/or Train and provide technical assistance to the first responder and others (staff and natural supports) on the crisis intervention and strategies

16 Crisis Behavioral Consultation: Question and Answers 1.How does Crisis Behavioral Consultation differ from Specialized Consultation services? -Specialized Consultation Service provides expertise, training, and technical assistance in a specialty area. Specialized Consultation service is a long term service (authorized for a year) - Crisis Behavioral Consultation is available to beneficiaries that have intensive, significant and challenging behaviors that have resulted in a crisis. Crisis Behavioral Consultation is an acute service. 2. Can Crisis Behavioral Consultation and Primary Crisis Response be authorized at the same time? Yes, services may be authorized at the same time, but may not be billed at the same time of day.

17 Out of Home Crisis:T2034

18 Out of Home Crisis:T2034 Occurs when a beneficiary cannot be safely supported in the home due to behaviors Implementation of formal behavior interventions have failed All other approaches to insure health and safety have failed Is a short term service (up to 14 calendar days) Must take place in a licensed facility Provides a period of structured support and/or programming May be used as planned respite for beneficiaries who are unable to access regular respite due to the nature of their behaviors

19 Out of Home Crisis 1. How do I access Out of Home Crisis for my beneficiary? Contact the Care Coordinator 2. What is the difference between Out of Home Crisis and S5150 Respite Individual? Out of Home Crisis may be used as a planned Respite stay for beneficiaries who are unable to access regular respite due to the nature of their behaviors. 3. What type of facility license is required to provided Out of Home Crisis? NCAC27G.5100 (Community Respite) and a waiver from the Division of Health Service Regulation (DHSR) to provide crisis services

20 How are Services Accessed and Implemented? Crisis services are available 24 hours/day 7 days/week -During business hours contact the Care Coordinator -After hours contact Alliance Behavioral Healthcare Access # Crisis services can be accessed via telephone or planned through the ISP Following the verbal authorization, a modified Individual Support Plan and individual budget will be completed within 5 working days

21 Who Should Provide Crisis Services? Staff should be trained in the following DMA Staff Competencies located on pages 2-4 in following link. elf_competencies.pdf

22 Documentation Requirements for Crisis Services Requirements for Service Documentation of Crisis Services can be found in Clinical Coverage Policy 8P in sections and on pages 12 and 15 respectively Service Note For Service Note requirements, refer to the Records Management and Documentation Manual (chapter 8 & 9) Crisis Services The provider agency shall maintain a service note signed by the individual providing the service that documents the date of the service, the amount of time involved in the service and a description of the activities related to the long-range outcomes and the shortrange goal regarding intervention plans.

23 Can my Agency Provide Crisis Services? Qualified Professionals: May provide Primary Crisis Response services (H2011-HI) NC Licensed Psychologist and Psychological Associates: may provide Crisis Behavioral Consultation (T2025-U3) Licensed facility: may provide Out of Home Crisis (T2034) If you are interested in having these services added to your contract please contact provider network:

24 Resources The following slides list some crisis resources by county. For additional information about crisis services please visit

25 Resources Wake County Crisis and Assessment Centers UNC Health Care at Wake Brook (Wake Crisis and Assessment Services) 107 Sunnybrook Road Raleigh, NC (24 hours a day) *If 911 is called please request a CIT (Crisis Intervention Team) officer

26 Resources Durham Crisis and Assessment Durham Center Access 309 Crutchfield Street Durham, NC (24 hours a day) *If 911 is called please request a CIT (Crisis Intervention Team) officer

27 Resources Cumberland Crisis and Assessment Community Mental Health Center at Cape Fear Valley 1724 Roxie Avenue Fayetteville, NC (8:00am-10:00pm, seven days a week) *If 911 is called please request a CIT (Crisis Intervention Team) officer

28 Resources Johnston County Crisis and Assessment Mental Health Division, Johnston County Health Department 521 North Brightleaf Boulevard Smithfield, NC (Monday-Friday, 8:00am-5:00pm) *If 911 is called please request a CIT (Crisis Intervention Team) officer