Cal. Code Regs. Tit. 22, § 73417 - Special Rehabilitation Program Services-Mentally Disordered
(a) Mentally
disordered rehabilitation programs are designed to serve patients who have a
chronic psychiatric impairment and whose adaptive functioning is moderately
impaired. These patients require continuous supervision and can be expected to
benefit from an active rehabilitation program effort designed to improve their
adaptive functioning and develop a potential for placement in a less protected
living environment. A facility may, but is not required to, provide special
rehabilitation program services for the mentally disordered. If the facility
meets all of the requirements of this section, it shall be entitled to a
supplemental special program rate under the Medi-Cal program (Title 22,
California Administrative Code, Section
51335(k)) such
special program services are those therapeutic services provided to mentally
disordered persons having special needs or deficits in one or more of the
following general areas: Self-Help Skills, Behavior Adjustment, Interpersonal
Relationships, Prevocational Preparation and Prerelease Planning.
(b) To be approved by the Department to
furnish such special rehabilitation services to the mentally disordered, a
facility shall have:
(1) A minimum initially
of 30 patients in the facility who have been certified by the local mental
health director as eligible for special program services. Eligibility for
special program services shall be redetermined every four months by the local
mental health director. At any time that the number of eligible patients
receiving special program services drops below 27, total program reimbursement
shall be terminated unless otherwise agreed to by the Department.
(2) An approved facility plan.
(A) To participate in this program, a
facility shall submit to the Department's headquarters review and approval team
for approval an application and a facility plan which meets all the
requirements of Section
73417(c).
(B) When the Department through the
headquarters review and approval team determines that the facility plan meets
the specified needs of the patient population, it shall provide its written
approval of the plan to the facility.
(C) Where the headquarters review and
approval team disapproves a facility plan, it shall submit a written report to
the facility which specifies components of the plan which need to be improved
or corrected. The facility may submit a revised facility plan and a new
application to the headquarters review and approval team at any
time.
(3) Within 45 days
after written approval of the facility by the headquarters review and approval
team an on-site visit by the Department to evaluate the appropriateness of the
implementation of the facility plan. Upon the recommendation of the on-site
visit team, the Department shall certify the facility's Special Rehabilitation
Program Services--Mentally Disordered. Eligibility for Medi-Cal reimbursement
shall commence on the first day that the on-site visit team determined that
full implementation of the approved plan actually occurred; provided, however,
that the first day of payment shall not be prior to the actual date of written
approval of the plan.
(4) Executed
an approved Medi-Cal provider participation agreement.
(5) Maintained compliance with the approved
facility plan. Failure to comply with special program requirements of the plan
shall cause the termination of eligibility for reimbursement for special
program services, unless otherwise excused in writing by the
Department.
(c) The
following requirements shall be met if the facility is to receive approval for
providing special rehabilitation program services to mentally disordered
individuals with identified program needs.
(1)
A facility plan for providing special rehabilitation program services shall be
developed and submitted to the Department for approval initially and annually
thereafter. The facility plan shall include:
(A) A description of the population group to
be served.
(B) Names and number of
patients to be served.
(C) An
identification of special patient needs and grouping criteria.
(D) A description of the program design to
meet the identified patient's needs.
(E) A description of the method and frequency
of evaluating patient progress.
(F)
Facility program staffing pattern which includes:
1. An organization chart for special program
services staff.
2. A description of
staffing ratios for program staff.
3. A description of interdisciplinary
professional staff by discipline and hours provided per
week.
(G) A description
of program space provisions.
(H)
Description of equipment utilized for program services.
(I) A plan for use of community
resources.
(J) Sample patient
program days.
(K) In-service
training program in effect or planned.
(L) Provisions for accomplishing the
following:
1. The facility in conjunction
with the local mental health director shall make an initial individual
assessment on each patient from which to identify the current level of
functioning and program needs of its patients. The assessment shall be
standardized on forms approved by the Department.
2. At least every four months, the facility
in conjunction with the local mental health director shall make a written
reassessment of each patient's program needs to evaluate patient progress and
reassess program needs.
3. A
minimum average of 27 hours of direct group or individual program service for
each patient per week.
4. The
facility shall have the capability of providing all of the following special
rehabilitation program services. Actual programs shall be provided based on the
specific needs identified through the patient assessments.
a. Self-Help Skills Training. This shall
include but not be limited to:
(i) Personal
care--use of medications
(ii) Money
management
(iii) Use of public
transportation
(iv) Use of
community resources
(v) Behavior
control, impulse control
(vi)
Frustration tolerance
(vii) Mental
health education
(viii) Physical
fitness
b. Behavioral
Intervention Training. This shall include but not be limited to:
(i) Behavior modification
modalities
(ii) Remotivation
therapy
(iii) Patient government
activities
(iv) Group
counseling
(v) Individual
counseling
c.
Interpersonal Relationships. This shall include but not be limited to:
(i) Social counseling
(ii) Educational and recreational
therapy
(iii) Socialization
activities such as outings, dances, etc.
d. Prevocational Preparation Services. This
shall include but not be limited to:
(i)
Homemaking
(ii) Work
activity
(iii) Vocational
counseling
e. Prerelease
Planning.
(i) Out-of-home
placement
Notes
2. Certificate of Compliance filed 12-15-76 (Register 76, No. 51).
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