Cal. Code Regs. Tit. 22, § 73425 - Special Subacute Psychiatric Program Services-Mentally Disordered
(a) Mentally
disordered subacute psychiatric programs are designed to serve patients who
have a chronic psychiatric impairment and whose adaptive functioning is
severely impaired. These patients require continuous and intensive supervision
and can be expected to benefit from an active subacute psychiatric program
effort designed to improve their adaptive functioning to the point of entry
into a rehabilitation program. A facility may, but is not required to, provide
special subacute psychiatric program services. 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 subacute psychiatric programs 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 subacute psychiatric program
services. Eligibility for special subacute psychiatric services shall be
redetermined every 30 days by the local mental health director. Patient
eligibility for the special subacute psychiatric program shall be limited to a
maximum of 90 days. The Department may authorize exceptions to this provision
in writing to the local mental health director on an individual patient basis.
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
73425(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 plan, 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 Subacute Psychiatric 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 subacute program
services to mentally disordered individuals with identified program needs.
(1) A facility plan for providing special
subacute psychiatric 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 30 days, 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 30 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 subacute
psychiatric 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, parties, 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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