405 IAC 5-21.5-8 - Crisis intervention
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 8.
(a) The
services reimbursable as crisis intervention services are short-term emergency
behavioral health services, available twenty-four (24) hours per day, seven (7)
days per week.
(b) These services
include crisis assessment, planning, and counseling specific to the crisis,
intervention at the site of the crisis when clinically appropriate, and
pre-hospital assessment.
(c) The
goal of crisis services is to resolve the crisis and transition the member to
routine care through stabilization of the acute crisis and linkage to necessary
services. This service may be provided in an emergency room, crisis clinic
setting, or in the community.
(d)
The requirements for crisis intervention services shall be as follows:
(1) Services may be provided for all Medicaid
members who are as follows:
(A) At imminent
risk of harm to self or others.
(B)
Experiencing a new symptom that places the member at risk.
(2) Providers must meet any of the following
qualifications:
(A) A licensed
professional.
(B) A QBHP.
(C) An OBHP.
(e) Program standards shall be as follows:
(1) The consulting physician, AHCP, or HSPP
must be accessible twenty-four (24) hours per day, seven (7) days per
week.
(2) Services are provided
face-to-face with the member.
(3)
Services may include contacts with the family and other nonprofessional
caretakers to coordinate community service systems. Contacts are not required
to be face-to-face and must be in addition to face-to-face contact with the
member.
(4) Services should be
limited to occasions when a member suffers an acute episode despite the
provision of other community behavioral health services.
(5) The intervention should be
member-centered and delivered on an individual basis.
(6) These services are available to any
Medicaid eligible individual in crisis, as defined in this section.
(7) Documentation of action to facilitate a
face-to-face visit must be made within one (1) hour of the initial contact with
the provider for members at imminent risk of harm to self or others.
(8) Documentation of action to facilitate a
face-to-face visit must be made within four (4) hours of initial contact with
the provider for members experiencing a new symptom that places the member at
risk.
(9) Crisis intervention does
not require prior authorization.
(10) The individualized integrated care plan
must be updated to reflect the crisis intervention for members currently active
with the provider.
(11) A brief
individualized integrated care plan must be developed and certified for members
new to the provider, with a full individualized integrated care plan developed
following the resolution of the crisis.
(f) Exclusions shall be as follows:
(1) Interventions targeted to groups are not
billable as crisis intervention.
(2) Time spent in an inpatient setting is not
billable as crisis intervention.
(3) Interventions to address an established
problem or need documented in the individualized integrated care plan may not
be billed under crisis intervention.
(4) Routine intakes provided without an
appointment or after traditional hours do not constitute crisis
intervention.
(5) Declared disaster
crisis activities and services delivered by a disaster crisis team are
excluded.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 8.
(a) The services reimbursable as crisis intervention services are short-term emergency behavioral health services, available twenty-four (24) hours per day, seven (7) days per week.
(b) These services include crisis assessment, planning, and counseling specific to the crisis, intervention at the site of the crisis when clinically appropriate, and pre-hospital assessment.
(c) The goal of crisis services is to resolve the crisis and transition the member to routine care through stabilization of the acute crisis and linkage to necessary services. This service may be provided in an emergency room, crisis clinic setting, or in the community.
(d) The requirements for crisis intervention services shall be as follows:
(1) Services may be provided for all Medicaid members who are as follows:
(A) At imminent risk of harm to self or others.
(B) Experiencing a new symptom that places the member at risk.
(2) Providers must meet any of the following qualifications:
(A) A licensed professional .
(B) A QBHP .
(C) An OBHP .
(e) Program standards shall be as follows:
(1) The consulting physician, AHCP, or HSPP must be accessible twenty-four (24) hours per day, seven (7) days per week.
(2) Services are provided face-to-face with the member.
(3) Services may include contacts with the family and other nonprofessional caretakers to coordinate community service systems. Contacts are not required to be face-to-face and must be in addition to face-to-face contact with the member.
(4) Services should be limited to occasions when a member suffers an acute episode despite the provision of other community behavioral health services.
(5) The intervention should be member-centered and delivered on an individual basis.
(6) These services are available to any Medicaid eligible individual in crisis, as defined in this section.
(7) Documentation of action to facilitate a face-to-face visit must be made within one (1) hour of the initial contact with the provider for members at imminent risk of harm to self or others.
(8) Documentation of action to facilitate a face-to-face visit must be made within four (4) hours of initial contact with the provider for members experiencing a new symptom that places the member at risk.
(9) Crisis intervention does not require prior authorization.
(10) The individualized integrated care plan must be updated to reflect the crisis intervention for members currently active with the provider.
(11) A brief individualized integrated care plan must be developed and certified for members new to the provider, with a full individualized integrated care plan developed following the resolution of the crisis.
(f) Exclusions shall be as follows:
(1) Interventions targeted to groups are not billable as crisis intervention.
(2) Time spent in an inpatient setting is not billable as crisis intervention.
(3) Interventions to address an established problem or need documented in the individualized integrated care plan may not be billed under crisis intervention.
(4) Routine intakes provided without an appointment or after traditional hours do not constitute crisis intervention.
(5) Declared disaster crisis activities and services delivered by a disaster crisis team are excluded.