CHAPTER He-M 400  COMMUNITY MENTAL HEALTH

 

PART He-M 401  ELIGIBILITY DETERMINATION AND INDIVIDUAL SERVICE PLANNING

 

Statutory Authority:  RSA 135-C:13, 18, 19, 57 and 61

 

REVISION NOTE:

 

Document #4194, effective 1-1-87, made extensive changes to the wording, format, structure, and numbering of rules in Part He-M 401.  Document #4194 supersedes all prior filings for the sections in this part.  The prior filings for former Part He-M 401 include the following documents:

 

#2422, eff 7-13-83

#3050, eff 7-8-85

#4065, eff 6-3-86

 

He-M 401.01  Purpose.  The purpose of these rules is to establish the requirements and procedures for determining eligibility for state-funded community mental health services and for developing and monitoring the individual service plan.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.02  Definitions.  The words and phrases in these rules shall mean the following:

 

(a)  “Adult” means a person 18 years of age or older.

 

(b)  “Applicant” means any person who requests state-funded services from a CMHP.

 

(c)  “Area of origin” means the city or town in which a consumer resides or, if the consumer is in a state institution, the city or town in which the consumer resided immediately prior to entering the institution.

 

(d)  “Bureau” means the bureau of behavioral health.

 

(e)  “Case manager” means a person designated by a CMHP to monitor, advocate for, and facilitate the delivery of services to consumers.

 

(f)  “Child” means a person who is less than 18 years of age.

 

(g)  “Child and family service plan” means a written document developed for a child that specifies the services and supports that are needed for the family and child to attain their identified goals.

 

(h)  “Clinician” means a person who has been authorized by a CMHP to render consumer services and who is qualified to provide such services pursuant to He-M 426.05 (e)-(j).

 

(i)  “Community mental health program (CMHP)” means a community mental health program operated by the state or a city, town, county, or nonprofit corporation and approved pursuant to He-M 403 for the purposes of planning, establishing, and administering an array of mental health services.

 

(j)  “Conference” means a meeting or series of meetings held to develop or revise an individual or family service plan pursuant to He-M 401.10 or He-M 401.11.

 

(k)  “Consumer” means any person receiving state-funded services from a CMHP.

 

(l)  “Crisis plan” means a written agreement between a consumer and a CMHP that:

 

(1)  Outlines the interventions to be utilized and/or considered during an impending or acute psychiatric crisis;

 

(2)  Promotes illness self-management;

 

(3)  Emphasizes a preventive approach through the identification of early warning signs of acute psychiatric episodes and specific treatment approaches to be used in the event of a psychiatric crisis;

 

(4)  Reflects a team effort among the consumer, CMHP staff, and others invited by the consumer; and

 

(5)  May include the use of peer supports.

 

(m)  “Eligibility” means the determination that a person meets the criteria for one or more of the eligibility categories in He-M 401.05 through He-M 401.09.

 

(n)  “Employment or education plan” means a written plan that is based on the consumer’s own job and career goal(s) and includes the following:

 

(1)  Identification of the skills, supports, and resources necessary to help the consumer achieve and maintain his or her job and educational goal; and

 

(2)  Determination of whether or not assistance in job acquisition or placement is needed and, if so, a plan describing such.

 

(o)  “Guardian” means a guardian, or a temporary guardian, of the person appointed pursuant to RSA 464-A or the parent of a consumer under the age of l8 whose parental rights have not been terminated or limited by law.

 

(p)  “Individual service plan (ISP)” means a written document that specifies the services and supports that a consumer, aged 18 or older, needs to attain his or her personal goals.

 

(q)  “Interagency involvement” means the services provided to a child who:

 

(1)  Meets the criteria specified in He-M 401.09 (a) and has been identified by a school administrative unit as being educationally handicapped; or

 

(2)  Is referred to a CMHP and is under the legal jurisdiction of the division for children, youth and families (DCYF).

 

(r)  “Master's level clinician” means a person who graduated from an accredited college or university program with a graduate degree in psychology or counseling and who is working under the supervision of a psychiatrist or psychologist  as specified in He-M 401.04.

 

(s)  “Mental illness” means the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR, 2000), available as noted in Appendix A:

 

(1)  Schizophrenia and other psychotic disorders;

 

(2)  Mood disorders;

 

(3)  Borderline personality disorder;

 

(4)  Post traumatic stress disorder;

 

(5)  Obsessive compulsive disorder;

 

(6)  Eating disorders;

 

(7)  Dementia, where the psychiatric symptoms cause the functional impairments and one or more of the following co-morbid symptoms exist:

 

a.  Anxiety;

 

b.  Depression;

 

c.  Delusions;

 

d.  Hallucinations; or

 

e.  Paranoia; or

 

(8)  Panic disorder.

 

(t)  “Region” means a geographic area identified in He-M 425.03 for the purpose of assigning primary responsibility for providing mental health services to the residents of certain communities.

 

(u)  “Serious emotional disturbance” means severe mental disability in persons under the age of 18, and includes psychiatric disorders classified as  axis I disorders or an axis II borderline personality disorder in the DSM-IV-TR with the exception of substance abuse disorders and V codes, which are conditions not attributable to a mental disorder.

 

(v)  “Serious psychosocial dysfunction” means a significant disruption in functioning, due to a mental illness, in the areas of role performance, thinking, behavior toward self or others, and/or moods or emotions.

 

(w)  “Severely functionally-impaired” means that as a result of a person's mental illness he or she requires intensive supervision or is in acute psychiatric crisis and cannot function in an autonomous or semi-autonomous fashion.

 

(x)  “Severely mentally disabled” means “severely mentally disabled” as defined in RSA 135-C:2, XV, namely, “having a mental illness which is either so acute or of such duration as to cause a substantial impairment of a person’s ability to care for himself or herself or to function normally in society in accordance with rules authorized by RSA 135-C: 61.”

 

(y)  “Suspension” means a time limited, specific withholding of any available service(s) from a consumer for well-defined and documented reasons and pursuant to He-M 401.14 (a)-(c).

 

(z)  “Support” means informal assistance or resources provided by friends, family members, neighbors, or others to enable an individual to participate in community life.

 

(aa)  “Termination” means the cessation for an indefinite period of all services to a consumer.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.03  Intake Process.

 

(a)  Intake application shall be made as follows:

 

(1)  All persons seeking community mental health services shall make application to the CMHP by providing to the CMHP such information as required by He-M 408.04 (b)(1); or

 

(2)  For those persons who have been determined eligible for state-funded services and who are returning to the community from New Hampshire hospital or a designated receiving facility, the discharge plan, when developed in conjunction with the CMHP, shall constitute application for admission into the state-funded service delivery system.

 

(b)  The provisions of He-M 401.03 (a)(2) above shall not preclude any individual from applying directly to a CMHP for services.

 

(c)  The CMHP shall be responsible for the inclusion of all components listed in He-M 408.04 (b)(1) in intake applications.

 

(d)  In the event that a psychiatric emergency regarding an applicant exists pursuant to He-M 401.03 (e) below, the CMHP shall refer the applicant to emergency services pursuant to He-M 426.09.

 

(e)  A CMHP shall determine that a psychiatric emergency regarding an applicant or consumer exists if, due to the applicant's or consumer's mental illness:

 

(1)  There is the potential of a serious increase in psychiatric symptoms likely to result in impaired functioning;

 

(2)  The person is in danger of psychiatric hospitalization; or

 

(3)  There is likelihood of danger to the person or to others if CMHP services are not provided.

 

(f)  For all persons applying, the CMHP shall identify the services it anticipates providing.  This listing shall function as the individual service plan until the full service planning process can be completed.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.04  Eligibility Determination.

 

(a)  The CMHP shall be responsible for conducting an eligibility determination pursuant to He-M 401 for each applicant.

 

(b)  An eligibility determination shall be conducted by:

 

(1)  A psychiatrist who meets the definition in RSA 135-C:2, XIII;

 

(2)  A psychologist who is licensed in accordance with RSA 330-A:16, I;

 

(3)  A pastoral psychotherapist who is certified in accordance with RSA 330-A:17;

 

(4)  A clinical social worker who is licensed in accordance with RSA 330-A:18;

 

(5)  A nurse who is registered as required by RSA 326-B and has a master’s degree in psychiatric nursing or is certified as an advanced practice registered nurse with a psychiatric mental health specialty in accordance with RSA 326-B:10;

 

(6)  A clinical mental health counselor licensed in accordance with RSA 330-A:19;

 

(7)  A registered nurse (RN-C) certified in psychiatric nursing by the American Nurses Association;

 

(8)  A marriage and family therapist licensed in accordance with RSA 330-A:21; or

 

(9)  Any of the following, provided that the eligibility determination is reviewed and cosigned by a professional identified in He-M 401.04 (b) (1) through (7):

 

a.  A case manager, including staff members who possess a bachelors’ degree and staff who meet the criteria to provide individual resiliency and recovery oriented services (IROS) under He-M 426; or

 

b.  A master’s level clinician.

 

(c)  An eligibility determination shall be effective on the date that the determination is signed by the professional(s) making the determination.

 

(d)  A redetermination shall be conducted and signed no later than 30 days after the expiration date of the previous determination. The person shall be deemed eligible during that 30 day period.

 

(e)  A CMHP shall notify an applicant of the services for which he or she is eligible within 15 days of the effective date of eligibility determination.

 

(f)  Once an applicant’s eligibility for state-funded services is determined, the CMHP shall do one of the following:

 

(1)  If the applicant, including an applicant returning to the community from New Hampshire hospital or a designated receiving facility who does not have a current individual service plan, is determined eligible for state-funded services, an individual service plan shall be developed; or

 

(2)  If the applicant does not meet the eligibility criteria specified under He-M 401, that applicant shall be referred to non-state-funded services and the CMHP shall document the referral.

 

(g)  The eligibility determination shall be documented in the consumer’s clinical record.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.05  Eligibility Criteria for Adults with Severe and Persistent Mental Illness.

 

(a)  An adult shall be eligible for community mental health services if he or she has a severe and persistent mental illness (SPMI) pursuant to (b) below.

 

(b)  An adult shall be determined by a CMHP to have a severe and persistent mental illness (SPMI) if he or she meets each of the following criteria:

 

(1)  The adult has a diagnosed mental illness;

 

(2)  The adult has a severe functional impairment as a result of his or her mental illness as determined through assessment of the person’s ability to function in the following functional domains:

 

a.  Activities of daily living;

 

b.  Interpersonal functioning;

 

c.  Adaptation to change; and

 

d.  Concentration and task performance or pace; or

 

e.  Equivalent domains as defined in an outcome measurement tool approved by the commissioner;

 

(3)  For adults age 18-59, the assessment of functional impairment required by (2) above demonstrates:

 

a.  Moderate impairment causing chronic or durable problems in each of the four functional domains such that the person requires regular support and a variety of services;

 

b.  Marked impairment causing ongoing symptoms in two or more of the functional domains such that the person requires intensive and frequent supportive interventions;

 

c.  Extreme impairment causing risk of death in at least one functional domain such that the person requires a constant level of services; or

 

d.  Equivalent impairment ratings based on an outcome measurement tool approved by the commissioner;

 

(4)  For adults age 60 and older, the assessment of functional impairment required by (2) above demonstrates, without regard to the older adult’s score on the General Assessment of Functioning (GAF) scale:

 

a.  Moderate impairment causing chronic or durable problems in three or more of the functional domains such that the person requires regular support and a variety of services; or

 

b.  Marked impairment causing ongoing symptoms in one or more of the functional domains such that the person that requires intensive and frequent supportive interventions; and

 

(5)  The adult has had the severe functional impairment for one year or more.

 

(c)  An adult shall be eligible for community mental health services as a result of having SPMI if he or she meets the criteria specified in (b)(1) and (5) above but does not meet the criteria currently as a result of the use of clozaril or clozapine or as a result of close supervision such as that provided in a community residence as defined in He-M 1002.02.

 

(d)  Redetermination of eligibility in this category shall occur every 2 years.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.06  Eligibility Criteria for Adults with Severe Mental Illness.

 

(a)  An adult shall be eligible for community mental health services if he or she has a severe mental illness (SMI) pursuant to (b) below.

 

(b)  An adult shall be determined by a CMHP to have a severe mental illness (SMI) if he or she meets each of the following criteria:

 

(1)  The adult has one of the following:

 

a.  A diagnosis of mental illness; or

 

b.  A provisional diagnosis of mental illness, if the person has not previously applied for community mental health services;

 

(2)  The adult has a severe functional impairment as a result of his or her mental illness as determined through assessment of the person's abilities in the following functional domains:

 

a.  Activities of daily living;

 

b.  Interpersonal functioning;

 

c.  Adaptation to change; and

 

d.  Concentration and task performance or pace; or

 

e. Equivalent domains as defined in an outcome measurement tool approved by the commissioner;

 

(3)  For adults age 18-59, the assessment of functional impairment required by (2) above demonstrates:

 

a.  Moderate impairment causing chronic or durable problems in each of the four functional domains such that the person requires regular support and a variety of services;

 

b.  Marked impairment causing ongoing symptoms in two or more of the functional domains such that the person requires intensive and frequent supportive interventions;

 

c.  Extreme impairment causing risk of death in at least one functional domain such that the person requires a constant level of services; or

 

d.  Equivalent impairment ratings based on an outcome measurement tool approved by the commissioner; and

 

(4)  The assessment of functional impairment of adults age 60 and older demonstrates, without regard to the older adult’s score on the General Assessment of Functioning (GAF) scale:

 

a.  Moderate impairment causing chronic or durable problems in three or more of the functional domains; or

 

b.  Marked impairment causing ongoing symptoms that require intensive and frequent supportive interventions in one or more of the functional domains; and

 

(5)  The adult has had the severe functional impairment for less than one year.

 

(c)  Redetermination of eligibility in this category shall occur every 2 years.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 EMERGENCY, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.07  Eligibility Criteria for Adults with Severe or Severe and Persistent Mental Illness with Low Service Utilization.

 

(a)  An adult shall be eligible for community mental health services if he or she has SMI or SPMI with low service utilization pursuant to He-M 401.07 (b) below.

 

(b)  A CMHP shall determine that an adult has SMI or SPMI with low service utilization if he or she:

 

(1)  Has a mental illness but no longer meets all the criteria for SPMI or SMI and receives services that are designed to prevent relapse;

 

(2)  Has functional impairments that are due to a developmental disability or receives services primarily through another agency such as a provider for persons with developmental disabilities or New Hampshire hospital; or

 

(3)  Meets criteria for SPMI or SMI but has refused recommended services and for whom the CMHP is providing outreach.

 

(c)  Attempts by the CMHP to engage the adult with SMI or SPMI with low service utilization in further services shall be made in accordance with his or her clinical needs and be documented in the person's record.

 

(d)  Redetermination of eligibility in this category shall occur every 2 years.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.08  Eligibility Criteria for Children with Serious Emotional Disturbance.

 

(a)  To be eligible for community mental health services as a result of having a serious emotional disturbance, a child shall:

 

(1)  Have a serious emotional disturbance;

 

(2)  Have a serious psychosocial impairment as determined through an assessment of the following domains:

 

a.  The child’s:

 

1.  School or work role performance;

 

2.  Home role performance;

 

3.  Community role performance;

 

4.  Behavior towards others;

 

5.  Mood and emotions;

 

6.  Behavior towards self;

 

7.  Substance use; and

 

8.  Thinking; and

 

b.  The child’s caregiver’s ability to provide physical and emotional support to the extent necessary to promote the child’s emotional health; and

 

(3)  Have the assessment of psychosocial impairment required by (2) above demonstrate:

 

a.  At least mild impairment in three or more of the child centered domains causing periodic difficulty or distress;

 

b.  At least moderate impairment in one or more child centered domains causing chronic or durable problems; or

 

c.  At least mild impairment in the caregiver’s ability to provide physical and emotional support to the extent necessary to promote the child’s emotional health.

 

(b)  Redetermination of eligibility in this category shall occur annually.

 

(c)  Redetermination of eligibility in this category shall occur every 2 years.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.09  Eligibility Criteria for Children with Serious Emotional Disturbance and Having Current Interagency Involvement.

 

(a)  To be eligible for community mental health services as a result of having a serious emotional disturbance and interagency involvement, a child shall:

 

(1)  Have a diagnosed serious emotional disturbance;

 

(2)  Have a serious psychosocial impairment as determined through an assessment of the following domains:

 

a.  The child’s:

 

1.  School or work role performance;

 

2.  Home role performance;

 

3.  Community role performance;

 

4.  Behavior towards others;

 

5.  Moods or emotions;

 

6.  Behavior towards self;

 

7.  Substance use; and

 

8.  Thinking; and

 

b.  The child’s caregiver’s ability to provide physical and emotional support to the extent necessary to promote the child’s emotional health;

 

(3)  Have the assessment of psychosocial impairment required by (2) above demonstrate:

 

a.  At least mild impairment in three or more of the child centered domains causing periodic difficulty or distress;

 

b.  At least moderate impairment in one or more child centered domains causing chronic or durable problems; or

 

c.  At least mild impairment in the caregiver’s ability to provide physical and emotional support to the extent necessary to promote the child’s emotional health; and

 

(4)  Have current interagency involvement.

 

(b)  Redetermination of eligibility in this category shall occur annually.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.10  Adult Service Planning Process.

 

(a)  A CMHP shall complete a written individual service plan within 90 calendar days after the determination that the person is eligible for services.

 

(b)  Development of the ISP shall be a collaborative effort between the consumer and the CMHP.  If the consumer has a guardian, the guardian shall play an active role in the process.

 

(c)  The case manager or primary clinician shall fully explain to the consumer or guardian, verbally and in writing:

 

(1)  The purpose of the Individual Service Planning process as specified in 401.10(h), and

 

(2)  The components of the ISP, including goals, measurable objectives, services, timelines, referrals, quarterly reviews, a crisis plan and employment or education plan, as appropriate.

 

(d)  The case manager or primary clinician shall fully explain to the consumer or guardian, verbally and in writing that the consumer or guardian has the power to choose either of the following methods by which his or her ISP is developed:

 

(1)  Through a formal client centered conference that is a meeting at a mutually convenient time and place with the psychiatrist and other involved persons as approved by the consumer, such as family members, CMHP staff, representatives of other agencies providing services to the consumer such as vocational rehabilitation, friends, an attorney, legal representative, a peer advocate and/or others with relevant knowledge or expertise; or

 

(2)  Through a less formal method that shall include one or more one-on-one or small group meetings with the psychiatrist and/or others listed in 401.10 (d)(1) by phone, in person and/or through other effective means of communication such as electronic mail.

 

(e)  The consumer or guardian shall be advised that he or she may consult with family, friends, therapists, advocates and others before making the decision regarding the method to develop the ISP.

 

(f)  The consumer or guardian shall have 10 days to make a decision after receiving the written explanation regarding the methods to develop the ISP, which the consumer or guardian shall indicate by his or her signature.

 

(g)  The decision of the consumer or guardian, indicating that the choices were explained, shall be documented in the clinical record.

 

(h)  The outcome of the process described in (b)-(g) above shall be the development of an ISP that:

 

(1)  Focuses on recovery;

 

(2)  Focuses on strengths;

 

(3)  Promotes community integration and participation;

 

(4)  Enhances natural community supports and relationships, with particular emphasis on maintaining and improving family relationships;

 

(5)  Fosters employment, self sufficiency, and other similar, socially valued roles;

 

(6)  Identifies functional impairments which are a result of mental illness;

 

(7)  Identifies treatment interventions;

 

(8)  Promotes access to generic services and resources;

 

(9)  Establishes time specific, sequentially stated objectives for improved personal functioning;

 

(10)  Establishes a crisis plan as defined in He-M 401.02; and

 

(11)  Establishes an employment or educational plan, as appropriate.

 

(i)  Consumers determined eligible in a low utilizer category pursuant to He-M 401.07 shall have a service planning process which shall at a minimum:

 

(1)  On a biennial basis:

 

a.  Redetermine eligibility pursuant to He-M 401.07;

 

b.  Assess the level of need for continued mental health services;

 

c.  Assess the need for referral to other services;

 

d.  Result in the development or continuation of goals and objectives; and

 

e.  If the consumer is receiving only medication-related services, result in medication related objectives, as appropriate, developed by the psychiatrist and the consumer to serve as the individual service plan; and

 

(2)  Follow the comprehensive service planning process pursuant to He-M 401.10 if there is any increased need for more extensive utilization of mental health services.

 

(j)  A case manager, if needed, or primary clinician, shall be assigned to each consumer who has been determined to have a severe and persistent mental illness.

 

(k)  A case manager, if needed, or primary clinician, shall be assigned to each consumer who has been determined to have a severe mental illness.

 

(l)  A CMHP shall not deny available, appropriate services to any eligible consumer who lives within the CMHP's region.  Upon inquiry, a CMHP shall provide information about available services.

 

(m)  The individual service plan shall include the signature of the consumer/guardian as indication of approval of the plan.  If it is necessary to notify the consumer/guardian by mail, the consumer/guardian shall have 15 days from the date notice was sent to respond in writing, indicating approval or disapproval of the ISP.  Failure to respond within the time allowed shall constitute approval of the ISP.

 

(n)  If the consumer or guardian refuses to sign the individual service plan, the dispute shall be resolved:

 

(1)  Through informal discussions with the CMHP;

 

(2)  By convening or reconvening a service planning meeting; or

 

(3)  By the individual or guardian filing an appeal with the bureau pursuant to He-M 204.

 

(o)  The individual service plan shall be signed by a psychiatrist as indication of CMHP approval of the plan and as indication that the services to be provided that are covered by medicaid are medically necessary.

 

(p)  The consumer shall receive a copy of the final version of the individual service plan.

 

(q)  If necessary services are not available, such service shall be documented through individual service plans.

 

(r)  When services have been documented to be necessary but unavailable, each agency responsible for provision of such services shall notify the department of the need for these services by submitting an annual report due July 1 and submitted no later than July 15 of each year.

 

(s)  The department shall utilize such information as is provided pursuant to (q)-(r) above for budgetary planning purposes.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.12), EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.11  Child, Adolescent and Family Service Planning Process.

 

(a)  For children determined eligible due to a severe emotional disturbance pursuant to He-M 401.08 or He-M 401.09, the service planning process shall include a child and family service plan written within 90 calendar days from the date of eligibility determination and annually thereafter.

 

(b)  The purpose of the service planning process shall be to assure the development of an individualized plan based on the family’s and child’s expressed goals and objectives.  The service planning process may include a conference if the parent(s) or guardian so desire.  The case manager or primary clinician shall notify the parent(s) or guardian of the right to a conference and document the notification in the clinical record.  The record shall contain a signed acknowledgement that such notification was provided.

 

(c)  Each child and family service plan shall:

 

(1)  Focus on strengths;

 

(2)  Promote community integration and participation;

 

(3)  Enhance natural community supports and relationships;

 

(4)  Identify functional impairments which are a result of mental illness;

 

(5)  Identify treatment interventions; and

 

(6)  Promote access to generic services and resources.

 

(d)  If the parent(s) or guardian requests a conference, those invited to participate may include:

 

(1)  The child's parent(s) or legal guardian;

 

(2)  The child's case manager and/or primary therapist;

 

(3)  Staff from agencies with which the child has involvement such as DCYF, the local school system, or the juvenile justice system;

 

(4)  The child's psychiatrist;

 

(5)  Other involved CMHP staff; and

 

(6)  The child, if his or her attendance is determined by CMHP staff to be clinically appropriate.

 

(e)  The child and family service plan shall include the signature of the consumer or guardian as indication of approval of the plan.  If it is necessary to notify the consumer/guardian by mail, the consumer or guardian shall have 15 days from the date notice was sent to respond, in writing, indicating approval or disapproval of the child and family service plan.  Failure to respond within the time allowed shall constitute approval of the child and family service plan.

 

(f)  If the consumer or guardian refuses to sign the child and family service plan, the dispute shall be resolved:

 

(1)  Through informal discussions with the CMHP;

 

(2)  By convening or reconvening a service planning meeting; or

 

(3)  By the individual, parent, or guardian filing an appeal with the bureau pursuant to He-M 204.

 

(g)  The child and family service plan shall be signed by a psychiatrist as indication of CMHP approval of the plan.

 

(h)  The psychiatrist may order, based on legitimate treatment considerations, the continuation of services by the child and adolescent program for a person who has turned age 18, up to the age of 21.

 

(i)  The child and family shall receive a copy of the final version of the child and family service plan.

 

(j)  If necessary services are not available, such service shall be documented through child and family service plans.

 

(k)  When services have been documented to be necessary but unavailable, each agency responsible for provision of such services shall notify the department of the need for these services by submitting an annual report due July 1 and submitted no later than July 15 of each year.

 

(l)  The department shall utilize such information as is provided pursuant to (k) above for budgetary planning purposes.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.13), EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.12  Review of the Individual Service Plan.

 

(a)  Consumers determined eligible in a low utilizer category pursuant to He-M 401.07 shall have a service plan review process as follows:

 

(1)  Each contact with a consumer shall be documented;

 

(2)  Such documentation, if services are provided at least quarterly, shall serve as the periodic review;

 

(3)  If no service has been provided in the last quarter, a review regarding the continued need for services shall occur and be documented; and

 

(4)  The annual review and modification of the objectives by the primary service provider(s) and the consumer shall serve as the annual consumer conference.

 

(b)  All eligible consumers other than those referenced in He-M 401.12 (a) shall have their individual service plans reviewed on a quarterly basis and revised as necessary.

 

(c)  The quarterly review shall include the following:

 

(1)  A review of the consumer's progress toward the goals in the individual service plan;

 

(2)  Documentation that all needed services are being provided;

 

(3)  Revision of the individual service plan, as appropriate;

 

(4)  Determination of continued need for services;

 

(5)  A review of any residential, vocational, social, or other changes in the consumer's life; and

 

(6)  A review of psychiatric hospitalizations.

 

(d)  The CMHP shall document the results of a quarterly review in a quarterly review note pursuant to He-M 408.11.

 

(e)  The CMHP shall indicate on the quarterly review note as to whether or not the information was reviewed with the consumer.  Whenever possible, the consumer shall be asked to sign his or her quarterly review note to indicate participation in, and agreement with, the results of the review.

 

(f)  An annual plan review shall meet the requirements of He-M 401.10 and He-M 401.12(c) and shall constitute the fourth quarter review.

 

(g)  Following an annual plan review, an annual individual service plan shall be written, or reviewed and revised as necessary.

 

Source.  (See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93

 

New.  #6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.14), EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

He-M 401.13  Review of the Child and Family Service Plan.

 

(a)  All eligible children and adolescents shall have their child and family service plan reviewed and revised as necessary on a quarterly basis. 

 

(b)  The quarterly review shall include the following:

 

(1)  A review of the child’s progress toward the goals in the child and family service plan;

 

(2)  Assessment that all needed services are being provided;

 

(3)  Revision of the child and family service plan, as appropriate;

 

(4)  Determination of continued need for services;

 

(5)  A review of any residential, educational, social, or other changes in the child’s life; and

 

(6)  A review of psychiatric hospitalizations.

 

          (c)  The results of a quarterly review shall be documented pursuant to He-M 408.11.

 

          (d)  CMHP staff shall indicate on the quarterly review note as to whether or not the information was reviewed with the consumer.  Whenever possible, the consumer shall be asked to sign his or her quarterly review note to indicate participation in, and agreement with, the results of the review.

 

          (e)  An annual plan review shall meet the requirements of He-M 401.11 and He-M 401.13(b) and shall constitute the fourth quarter review.

 

          (f)  Following an annual plan review, the CMHP staff shall write an annual child and family service plan or review and revise the existing plan, as necessary.

 

Source.  #6644, eff 12-2-97; ss and moved by #8155, eff
9-2-04 (from He-M 401.15), EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

          He-M 401.14  Suspension and Termination of Services.

 

          (a)  A consumer shall be suspended from a CMHP's service(s) if:

 

(1)  The consumer:

 

a.  Endangers or threatens to endanger other consumers or staff and the clinical circumstances would not result in an involuntary emergency admission pursuant to RSA 135-C:27-33;

 

b.  Is no longer benefiting from service(s) he or she is receiving; or

 

c.  Meets suspension provisions as part of the treatment program as specified in the consumer's individual service plan or as specified in the CMHP's policies and procedures;

 

(2)  The suspension has been approved by the CMHP's chief executive officer or designee as meeting the criteria specified herein; and

 

(3)  The consumer and his or her guardian, if any, have received written and verbal notice prior to the suspension which shall:

 

a.  Specify the effective date of the suspension;

 

b.  Specify the length of time the suspension is to last;

 

c.  List the clinical or management reasons for the suspension; and

 

d.  Explain the rights to appeal and the appeal process pursuant to He-M 204.

 

          (b)  Suspension of a consumer shall not exceed 5 program days except as required by He-M 401.14 (h);

 

          (c)  A CMHP shall maintain documentation in the record of a consumer who has been suspended that:

 

(1)  The consumer has been notified of the suspension; and

 

(2)  The suspension has been approved by the CMHP's chief executive officer or designee.

 

          (d)  A consumer shall be terminated from a CMHP's service(s), with the exception of emergency services, if:

 

(1)  The consumer:

 

a.  Endangers or threatens to endanger, other consumers or staff requiring intervention of law enforcement, or engages in illegal activity on the property of the CMHP; and

 

b.  The clinical circumstances would not appropriately result in an involuntary emergency admission pursuant to RSA 135-C:27-33;

 

(2)  The consumer is no longer benefiting from the service(s) he or she is receiving;

 

(3)  The consumer refuses to pay for the services that he or she is receiving despite having the financial resources to do so; or

 

(4)  The consumer refuses to apply for benefits that could cover the cost of the services that he or she is receiving despite the fact that the consumer is or may be eligible for such benefits.

 

          (e)  A termination from CMHP services shall not occur unless:

 

(1)  It has been approved by the CMHP's chief executive officer or designee as meeting the criteria specified herein; and

 

(2)  The CMHP has given a written and verbal notice to the consumer and consumer's guardian, if any, at least 30 days prior to the termination which shall:

 

a.  Give the effective date of termination;

 

b.  List the clinical or management reasons for termination; and

 

c.  Explain the rights to appeal and the appeal process pursuant to He-M 204.

 

          (f)  A CMHP shall document in the record of a consumer who has been discharged that:

 

(1)  The consumer has been notified of the termination; and

 

(2)  The termination has been approved by the CMHP's program director.

 

          (g)  A CMHP shall notify the bureau of all terminations of service.

 

          (h)  If a consumer is endangering or threatens to endanger other consumers or staff, or engages in illegal activity on the property of the CMHP and 30 days' notice would place at risk those threatened, the CMHP shall suspend the consumer from the services and then start the termination process.

 

Source.  #6644, eff 12-2-97; ss and moved by #8155, eff
9-2-04 (from He-M 401.16), EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

 

          He-M 401.15  Waivers.

 

          (a)  A CMHP or consumer may request a waiver of specific procedures outlined in this chapter, in writing, from the department.

 

          (b)  A request for waiver shall include:

 

(1)  A specific reference to the section of the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternative provisions or procedures proposed by the CMHP or consumer.

 

          (c)  No provision or procedure prescribed by statute shall be waived.

 

          (d)  A request for waiver shall be granted after the commissioner determines that the alternative proposed by the CMHP or consumer meets the objective or intent of the rule and:

 

(1)  Does not negatively impact the health or safety of the consumer(s); or

 

(2)  Is administrative in nature, and does not affect the quality of consumer care.

 

          (e)  Upon receipt of approval of a waiver request, the CMHP’s or consumer's subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which waiver was sought.

 

          (f)  Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

 

          (g)  Those waivers which relate to the following shall be effective for the CMHP’s current certification period only:

 

(1)  Fire safety; or

 

(2)  Other issues relative to consumer health, safety or welfare that require periodic reassessment.

 

          (h)  A CMHP or consumer may request a renewal of a waiver from the department.  Such request shall be made at least 90 days prior to the expiration of a current waiver.

 

Source.  #6644, eff 12-2-97; ss and moved by #8155, eff
9-2-04 (from He-M 401.17), EXPIRED: 9-2-12

 

New.  #10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13


PART He-M 402  PEER SUPPORT

 

Statutory Authority:  RSA 126-N:4

 

          He-M 402.01  Purpose.

 

          (a)  The purpose of this part is to define the criteria and procedures for the operation of Peer Support Agencies (PSAs).

 

          (b)  The purpose of a PSA is to provide peer supports, peer education and peer programming approved by the state mental health authority that:

 

(1)  Foster wellness in participants by supporting peers in identifying, and achieving an evolving and hopeful vision for their future;

 

(2)  Foster self-advocacy skills, autonomy, and independence;

 

(3)  Foster the ability to enhance a quality of life for participants including:

 

a.  Connection with their families;

 

b.  Connection with communities of their choice; and

 

c.  Personally meaningful occupation;

 

(4)  Emphasize mutuality as demonstrated by:

 

a.  Shared decision making;

 

b.  Strong conflict resolution;

 

c.  Non-medical approaches to support; and

 

d.  Non-static roles, such as, staff who are members and participants, and members and participants who are educators;

 

(5)  Offer alternative views on wellness and the effects of trauma and abuse;

 

(6)  Encourage informed decision-making about all aspects of participant’s lives;

 

(7)  Support peers in understanding how they came to know what they know, by challenging perceived self-limitations, while encouraging the development of beliefs that enhance personal and relational growth and moving towards the life the peer desires; and

 

(8)  Emphasize a holistic approach to health that includes a vision of the “whole” person.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.02  Definitions.

 

          (a)  “Board of directors” means the governing body of a nongovernmental PSA.

 

          (b)  “Culturally competent” means having attained the knowledge, skills and attitudes necessary to provide effective supports, services, education and technical assistance to populations in the geographic area served by the agency.

 

          (c)  “Department” means the New Hampshire department of health and human services

 

          (d)  “Guest” means any person who is invited to visit the PSA by a member, a participant, or the PSA.

 

          (e)  “Member” means any peer, who has made an informed decision to join, and agrees to support the goals and objectives of the PSA.

 

          (f)  “Participant” means a consumer, whether or not he or she is a member, who participates in any aspect of the peer support agency.

 

          (g)  “Peer” means any individual, 18 years of age or older, who self identifies as having lived experience as a former recipient, or as at significant risk of becoming a recipient of publicly funded mental health services.

 

          (h)  “Peer support agency (PSA)” means an organization whose primary purpose is to provide culturally competent peer support to peers 18 years of age or older. 

 

          (i)  “Peer support services” means services that:

 

(1)  Are provided for peers and by peers;

 

(2)  Are designed to assist peers in their recovery;

 

(3)  Include an educational environment in which people have the opportunity to learn wellness strategies while developing mutually beneficial relationships; and

 

(4)  Include other educational, vocational or housing opportunities, as determined by the PSA.

 

          (j)  “Recovery” means, development of personal and social skills, beliefs and characteristics that:

 

(1)  Support choice;

 

(2)  Increase quality of life;

 

(3)  Decrease dependence on the most restrictive services.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.03  Composition and Responsibilities of a PSA.

 

          (a)  A PSA shall be incorporated and shall have an established plan for governance.

 

          (b)  The plan for governance shall comply with the following:

 

(1)  A PSA’s board of directors shall:

 

a.  Have responsibility for the programmatic, fiduciary and policy oversight of the corporation; and

 

b.  Have the powers usually vested in the board of directors of a nonprofit corporation, except as regulated in He-M 402;

 

(2)  The responsibility and powers described in (1) above shall be stated in a set of bylaws maintained by the PSA board;

 

(3)  A PSA’s board of directors shall not allow more than 20% of the board members to serve for more than 6 consecutive years;

 

(4)  A PSA’s board of directors shall specify in its bylaws a procedure by which inactive PSA members are removed from the PSA board; 

 

(5)  The size and composition of the board of directors of a PSA shall be as follows:

 

a.  The number of persons serving as board members shall be no fewer than 9;

 

b.  Consumers shall comprise a minimum of 51% of the membership of the PSA board;

 

c.  No more than 20% of board members shall be related by blood, marriage or cohabitation to other board members;

 

d.  Board membership shall not be open to the following individuals:

 

1.  Employees of a PSA, the spouses or significant others of employees, or anyone living in the same household as an employee, except that the executive director shall be eligible as an ex officio member;

 

2.  Employees of the New Hampshire department of health and human services or their spouses; and

 

3.  Individuals or the spouses of individuals who are under contract with a PSA;

 

(6)  By-laws shall include term limits for board of director officers; and

 

(7)  By-laws shall include a nominating process that actively recruits diverse individuals whose skills and life experiences will serve the needs of the agency.

 

          (c)  The PSA’s board of directors shall establish policies for the governance and administration of the PSA and all services provided through contract with the PSA.

 

          (d)  Policies shall be developed to ensure efficient and effective operation of the PSA and adherence to requirements of federal funding sources and rules and contracts established by the department.

 

          (e)  The PSA shall be responsible and accountable for all PSA services whether administrated directly by a PSA or provided under contracts with other organizations.

 

          (f)  Upon dissolution of the PSA or upon the event that the PSA no longer contracts with the department, ownership and possession of all assets and property obtained with funds granted by the department shall revert to the department.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.04  Fiscal Management.

 

          (a)  A PSA shall utilize federal, third party, and other public and private sources of funds that are available for the agency to carry out the purposes of the PSA.

 

          (b) The board of directors shall establish and document an orientation process for educating new board members regarding:

 

(1)  Fiduciary responsibilities of board membership; and

 

(2)  Trainings for treasurer and all board members regarding reviewing and analyzing financial statements and general financial oversight.

 

          (c)  The department shall conduct announced or unannounced reviews of PSAs and audit PSAs including all or part of any services, finances, or operations of the PSAs, whether operated directly by the PSA or for services contracted through or with another organization.

 

          (d)  A PSA shall submit annually to the department an independent audit of the PSA and an independent audit of any subcontractor of the PSA that provides peer support services.  The independent audits shall be performed by a certified public accountant and be submitted together with a management letter, if issued, by October 31 for the previous fiscal year ending June 30.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.05  Staff Training, Staff Development and Orientation.

 

          (a)  A PSA shall provide a training orientation for all new staff providing peer support that includes at a minimum:

 

(1)  The statewide peer support system;

 

(2)  All department rules applicable to peer support;

 

(3)  Protection of member and participant rights pursuant to He-M 315;

 

(4)  Agency policies and procedures;

 

(5)  PSA grievance procedures;

 

(6)  Procedures regarding harassment, discrimination, and diversity;

 

(7)  Documentation such as incident reports, attendance records, and telephone logs; and

 

(8)  Procedures regarding confidentiality.

 

          (b)  The executive director shall arrange for peer support agency employees to receive training to have the necessary skills to perform their job functions.

 

          (c)  A PSA shall establish and implement written staff development policies applicable to all staff that specifically address the following:

 

(1)  Job descriptions;

 

(2)  Staffing pattern;

 

(3)  Conditions of employment;

 

(4)  Grievance procedures;

 

(4)  Performance reviews; and

 

(6)  Individual staff development plans.

 

          (d)  Prior to employment, each staff member shall demonstrate evidence of, or willingness to verify:

 

(1)  Citizenship or authorization to work;

 

(2)  Motor vehicles record check to ensure that the potential employee has a valid driver's license, if such employee will be transporting members or participants;

 

(3)  Criminal records check;

 

(4)  Previous employment; and

 

(5)  References.

 

          (e)  Prior to employment each staff member shall be screened for tuberculosis (TB) as follows:

 

(1)  All newly employed employees, including those with a history of bacille calmette guerin (BCG) vaccination, who will have direct contact with members and participants and the potential for occupational exposure to Mantoux TB through shared air space with persons with infectious TB shall have a TB symptom screen, consisting of a Mantoux tuberculin skin test or QuantiFERON-TB test, performed upon employment;

 

(2)  Baseline 2-step testing, if performed in association with Mantoux testing, shall be conducted in accordance with the “Guidelines for Environmental Infection Control in Health-Care Facilities” (2003) published by the Centers for Disease Control and Prevention (CDC) as updated (August 1, 2014), available as listed in Appendix A;

 

(3)  Employees with a documented history of TB, documented history of a positive Mantoux test, or documented completion of treatment for TB disease or latent TB infection may substitute that documentation for the baseline two-step test;

 

(4)  All positive TB test results shall be reported to the department's bureau of disease control, at 271-4469, in accordance with RSA 141-C:7, He-P 301.02 and He-P 301.03;

 

(5)  All employees with a diagnosis of suspect active pulmonary or laryngeal TB shall be excluded from the PSA until a diagnosis of TB is excluded or until the employee is on TB treatment and a determination has been made that the employee is noninfectious;

 

(6)  All employees with a newly positive tuberculin skin test shall be excluded from the PSA until a diagnosis of TB disease is ruled out;

 

(7)  Repeat TB testing shall be conducted in accordance with the Guidelines for Environmental Infection Control in Health-Care Facilities” (2003) published by the Centers for Disease Control and Prevention (CDC) as updated (August 1, 2014), available as listed in Appendix A; and

 

(8)  Those employees with a history of previous positive results shall have a symptom screen and, if symptomatic for TB disease, be referred for a medical evaluation.

 

          (f)  Each staff person employed by a PSA shall have an annual performance review based upon that staff person's job description and conducted by his or her supervisor.

 

          (g)  An individual staff development plan shall be prepared annually with each staff person by his or her supervisor. Such a plan shall be based upon an annual performance review and shall identify objectives and methods for improving the staff person's work-related skills and knowledge.

 

          (h)  A PSA shall conduct, or refer staff to, training activities that address objectives for improving staff competencies.  Each staff member shall participate in such training activities as specified in that person's individual staff development plan and, in addition, receive ongoing training in protection of member and participant rights.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.06  Peer Support Services.

 

          (a)  PSAs shall provide the following supports and services:

 

(1)  Peer support, consisting of supportive interactions among members, participants, staff and volunteers, are based on shared experience which are:

 

a.  Face-to-face or by telephone;

 

b.  Intended to assist people to understand their potential and ability to move towards wellness; and

 

c.  Based on acceptance, trust, respect, and mutual support;

 

(2)  Outreach, consisting of any community-based activity, face-to-face or by telephone, that:

 

a.  Is designed to contact peers; and

 

b.  Includes, at a minimum, the following:

 

1.  Providing support to members and participants and other peers who are unable to attend activities of the peer support agency;

 

2.  Visiting peers, at their request, who are psychiatrically hospitalized; and

 

3.  Reaching out to people who meet membership criteria and are homeless;

 

(3)  Telephone peer support, consisting of peer support provided to members and participants of a PSA or to others who contact the agency during business hours;

 

(4)  A monthly newsletter published and distributed by the PSA that describes:

 

a.  Agency services and activities;

 

b.  Social and recreational opportunities;

 

c.  Other community services that might be of interest to members and participants; and

 

d.  Other relevant topics;

 

(5)  Wellness training, consisting of training provided by or sponsored by a PSA intended to enhance members’ and participants’ ability to attain and maintain their wellness;

 

(6)  Monthly educational events, which over the course of a year shall include:

 

a.  Rights protection;

 

b.  Peer advocacy;

 

c.  Wellness management; and

 

d.  Community resources; and

 

(7)  Individual peer assistance provided to peers to:

 

a.  Locate, obtain and maintain services and supports through referral, consumer education and self-empowerment;

 

b. Provide support for individuals who are identifying problems to be addressed or resolving grievances; and

 

c.  Promote self-advocacy.

 

          (b)  PSAs may provide additional services not identified in (a) above including the following:

 

(1)  Peer respite, which shall:

 

a.  Consist of a 24-hour, short-term, non-medical program designed as an alternative to hospitalization; and

 

b.  Be operated by PSA staff  trained in methods designed to address the needs of peers experiencing psychiatric crises;

 

(2)  Residential services, which shall consist of support and assistance provided by a PSA to a member or participant;

 

(3)  Vocational support, which shall consist of the provision of peer support intended to promote a member’s or participant’s competitive employment;

 

(4)  Warmline, which shall:

 

a.  Be a separate program within the PSA;

 

b.  Offer on-call telephone peer support services;

 

c.  Be available to members, participants, and others who want or need support; 

 

d.  Have staff trained to provide warmline services; and

 

e.  Be provided in the specific scheduled hours during which the PSA is closed; and

 

(5)  Transportation.

 

          (c)  A PSA shall conduct community education activities, including the provision of education and consultation to members of the community at large, with the goal of increasing the acceptance of persons recovering from mental illness. Activities shall include working with the media, public speaking, and information dissemination.

 

          (d)  A PSA shall collaborate with other local human service providers that serve consumers in order to:

 

(1)  Facilitate referrals; and

 

(2)  Share information about services and other local resources.

 

          (e)  A PSA shall offer training and technical assistance to help peers advocate on their own behalf regarding health care.

 

          (f)  A PSA shall ensure through the monthly newsletter that peers are informed and provided with the opportunity for involvement in local and system-wide service planning, program evaluation, education, wellness, and training activities as described in (a) above.

 

          (g)  Guests may be invited to participate in peer support activities.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.07  Executive Director Selection and Evaluation.

 

          (a)  Each PSA shall employ an executive director who is a peer and has, at a minimum the following qualifications:

 

(1)  Demonstrated knowledge of the values and philosophy of peer support as determined by the board of directors of the PSA;

 

(2)  One year of supervisory or management experience; and

 

(3)  An associate’s degree or higher in administration, business management, education, health, or human services; or

 

(4)  Each year of experience in the peer support field may be substituted for one year of academic experience.

 

          (b)  An executive director of a PSA shall be appointed and evaluated as follows:

 

(1)  Each board of directors shall appoint an executive director of the PSA;

 

(2)  The executive director shall be selected, employed, and supervised by the PSA board of directors in accordance with a published job description and a competitive application process; and

 

(3)  The executive director shall be evaluated annually by the PSA board of directors to ensure that programming is provided in accordance with:

 

a.  The performance expectations approved by the board;

 

b.  The department's rules;

 

c.  Contract provisions; and

 

d.  Quality improvement reviews.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.08  Quality Improvement.

 

          (a)  The department shall conduct announced or unannounced quality assurance reviews of PSAs to assure that such services and programs are operated in accordance with the department's rules and contract provisions.

 

          (b)  A PSA shall perform active monitoring and comprehensive quality assurance activities including, at a minimum:

 

(1)  Participation in quality improvement reviews conducted by the department;

 

(2)  Member satisfaction surveys;

 

(3)  Review of personnel files for completeness; and

 

(4)  Review of the complaint process.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.09  Life Safety.

 

          (a)  A PSA shall be located in a building that is in compliance with local health, building, and fire safety codes.

 

          (b)  Each PSA shall be maintained in good repair and be free of hazard.

 

          (c)  A PSA shall have:

 

(1)  At least one indoor bathroom which includes a sink and toilet;

 

(2)  At least one telephone for incoming and outgoing calls;

 

(3)  A functioning septic or other sewage disposal system; and

 

(4)  A source of potable water for drinking and food preparation, as follows:

 

a.  If drinking water is supplied by a non-public water system, the water shall be tested and found to be in accordance with and as often as required by Env-Dw 700; and

 

b. If the water is not approved for drinking, an alternative method for providing safe drinking water shall be implemented.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

          He-M 402.10  Waivers.

 

          (a)  A PSA or peer may request a waiver of specific procedures outlined in this part, in writing, from the department.

 

          (b)  A request for a waiver shall include:

 

(1)  A specific reference to the section of the rule for which a waiver is being sought;

 

(2)  A full description of why a waiver is necessary; and

 

(3)  A full explanation of alternative provisions or procedures proposed by the PSA or peer.

 

          (c)  No provision or procedure prescribed by statute shall be waived.

 

          (d)  A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the PSA or peer:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health or safety of the people who participate in peer support activities; and

 

(3)  Does not affect the quality of peer support activities.

 

          (e)  Upon receipt of approval of a waiver request, the PSA’s or peer’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

 

          (f)  Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (h) below.

 

          (g)  Those waivers which relate to the following shall be effective for the PSA’s current certification period only:

 

(1)  Fire safety; or

 

(2)  Other issues relative to peer health, safety or welfare that require periodic reassessment. 

 

          (h)  A PSA or peer may request a renewal of a waiver from the department.  Such request shall be made at least 90 days prior to the expiration of a current waiver.

 

Source.  #2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97

 

New.  #8445, eff 10-6-05, EXPIRED: 10-6-13

 

New.  #12193, eff 5-26-17

 

PART He-M 403  APPROVAL AND OPERATION OF COMMUNITY MENTAL HEALTH PROGRAMS

 

Statutory Authority:  RSA 135-C:10

 

          He-M 403.01  Purpose.  The purpose of these rules is to define the criteria and procedures for approval and operation of community mental health programs.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.02  Definitions. 

 

          (a)  “Advisory board” means the governing body of a governmental community mental health program (CMHP).

 

          (b)  “Applicant” means a city, town, county, or nonprofit corporation that has submitted the required materials to the bureau for consideration for approval as a CMHP.

 

          (c)  “Approval” means a written decision by the administrator that an applicant has been determined to be in compliance with the eligibility requirements set forth in He-M 403 and has been approved as a CMHP for the region.

 

          (d)  “Area agency” means “area agency” as defined in RSA 171-A:2, I-b.

 

          (e)  “Board of directors” means the governing body of a nongovernmental CMHP. The term includes board.

 

          (f)  “Bureau” means the bureau of mental health services of the department of health and human services.

 

          (g)  “Commissioner” means the commissioner of the department of health and human services.

 

          (h)  “Community mental health program (CMHP)” means a program operated by the state, city, town, or county, or a community based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

 

          (i)  “Conditional reapproval” means a written ruling by the administrator that a CMHP has partially complied with the reapproval criteria listed in He-M 403.09 and that continued approval is contingent upon fulfilling certain requirements determined by the administrator.

 

          (j)  “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

 

(1)  Which is attributable to intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

 

(2)  Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe handicap to such individual's ability to function normally in society.”

 

(k)  “Director” means the director of the bureau of mental health services and the director of the bureau of children’s mental health.

 

          (l)  “Disaster” means any event that causes major upheaval or turmoil in a community, such as floods, fires, and earthquakes, transportation accidents, violent acts, or other events causing mass casualties, with one result being that many citizens require related support, comfort, and assistance.

 

          (m) “Facility” means New Hampshire hospital or a  receiving facility designated pursuant to RSA 135-C:26 and He-M 405, any psychiatric hospital, Glencliff Home, or an acute psychiatric residential treatment program.

 

          (n)  “Generic services” means services available to the general population that are not specifically designed for persons with mental illness.

 

          (o)  “Governmental CMHP” means a program operated by the state, city, town, or county, for the purpose of planning, establishing, and administering an array of community-based mental health services pursuant to He-M 403.

 

          (p)  “Individual” means any person receiving or applying for services from a CMHP or community residence. The term includes client.

          (q)  “Intake” means the process used to determine eligibility for CMHP services pursuant to He-M 401.03.

 

          (r)  “Integrated activity” means personal interaction between persons with and without mental illness which occurs within community settings.

 

             (s)  “Least restrictive environment” means the program or service which least inhibits a client's freedom of movement, informed decisions, and participation in the community, while achieving the purposes of habilitation and treatment.

 

(t)  “Mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.05 through He-M 401.07 and who has at least one of the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as listed in Appendix A:

(1)  Schizophrenia spectrum and other psychotic disorders except for the following:

 

a.  Schizotypal personality disorder;

 

b.  Substance or medication induced psychotic disorder; and

 

c.  Psychotic disorder due to another medical condition;

 

(2)  Bipolar and related disorders except for the following:

 

a.  Substance or medication induced bipolar and related disorder; and

 

b.  Bipolar disorder and related disorder due to another medical condition;

 

(3)  Depressive disorders except for the following:

 

a.  Disruptive mood dysregulation disorder;

 

b.  Premenstrual dysphoric disorder;

 

c.  Substance or medication induced depressive disorder; and

 

d. Depressive disorder due to another medical condition;

 

(4)  Borderline personality disorder;

 

(5)  Panic disorder;

 

(6)  Obsessive compulsive disorder;

 

(7)  Post traumatic stress disorder;

 

(8)  Bulimia nervosa;

 

(9)  Anorexia nervosa;

 

(10)  Other specific feeding or eating disorders;

 

(11)  Unspecified feeding or eating disorders; and

 

(12)  Major neurocognitive disorders where psychiatric symptom clusters cause significant functional impairment and one or more of the following symptom categories are the focus of psychiatric treatment:

 

a.  Anxiety;

 

b.  Depression;

 

c.  Delusions;

 

d.  Hallucinations; and

 

e.  Paranoia.

 

          (u)  “Natural environments” means integrated community settings where persons with and without mental illness live, work and pursue leisure activity.

 

          (v)  “Nongovernmental CMHP” means an incorporated nonprofit program operated for the purpose of planning, establishing and administering an array of community-based mental health services pursuant to He-M 403.

 

(w) “Office of Inspector General's List of Excluded Individuals/Entities” means a database maintained by the Office of Inspector General of the U.S. Department of Health and Human Services that provides information to the health care industry and the public regarding persons and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs due to a conviction related to the Medicare or Medicaid program, a conviction related to patient abuse, or an action taken by a state licensing authority.

 

          (x)  “Person with mental illness” means an adult with a severe mental illness or a child or adolescent with a severe emotional disturbance who has been determined eligible pursuant to He-M 401.

 

          (y) “Preadmission screening and resident review (PASRR)” means procedures by which the department, in conformance with section 1919(b)(3)(F)(i) and (ii) of the Social Security Act, determines whether persons with mental illness who are applying for placement, or currently residing in, nursing facilities are in need of nursing facility level of service  and, if so, whether they are in need of specialized services pursuant to He-M 1302.07.

 

          (z)  “Recovery” for a person with a mental illness means development of personal and social skills that minimize susceptibility to symptoms of illness and minimize dependence on professional supports.

 

          (aa) “Region” means a geographic area defined and designated in He-M 425 for the purpose of assigning primary responsibility for providing mental health services to the residents of certain communities.

 

          (ab)  “Serious emotional disturbance” means severe mental disability in persons from birth to age 18 who currently, or at any time within the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified with the DSM 5, that resulted in functional impairment, which substantially interfered with or limited the child’s role or functioning in the family, school, or community activities. This definition excludes substance abuse disorders and conditions due to another medical condition or substance and medication induced disorders.

 

(ac)  “Transitional housing services program” means a residential program for persons with a severe mental illness, or severe and persistent mental illness which has contracted with the department.

 

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.03  Composition of a Nongovernmental CMHP.

 

          (a)  A nongovernmental CMHP shall be incorporated and shall have an established plan for governance.

 

          (b)  The plan for governance shall comply with the following:

 

(1)  A CMHP board of directors shall have responsibility for the entire management and control of the property and affairs of the corporation and shall have the powers usually vested in the board of directors of a nonprofit corporation, except as regulated herein, and such responsibility and powers shall be stated in a set of bylaws maintained by the CMHP board;

 

(2)  A CMHP board of directors shall ensure that no more than 50% of the board members shall have served for more than 6 consecutive years;

 

(3)  A CMHP board of directors shall specify in its bylaws a procedure by which inactive CMHP board members are removed from the CMHP board; and

 

(4)  The size and composition of the board of directors of a CMHP shall be as follows:

 

a.  The number of persons serving as members shall be no fewer than 9 and no more than 25;

 

b.  Members shall be generally representative of the geographic area served by the CMHP and shall include representation by individuals and family members of individuals;

 

c.  Membership shall be open to all persons who reside in the region except for persons excluded as follows:

 

1.  Persons or the spouses of persons who are under contract with a CMHP;

 

2.  Employees or the spouses of employees of agencies or programs which are under contract with a CMHP;

 

3.  Employees or the spouses of employees of a CMHP, except that the executive director shall be eligible as an ex officio member; and

 

4.  Employees of the New Hampshire department of health and human services or their spouses; and

 

d.  Board members or the spouses of board members of agencies or programs under contract with a CMHP shall be eligible for membership on the CMHP board but shall comprise no more than one third of the board.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.04  Composition of a Governmental CMHP.

 

          (a)  A governmental CMHP shall have an advisory board and an established plan for governance.

 

          (b)  A CMHP advisory board shall:

 

(1)  Have the authority to review, monitor, and advise the governmental entity responsible for the CMHP regarding the entire management of the CMHP;

 

(2)  Include in its bylaws a statement that, in the event of dissolution of the CMHP or in the event that the agency is no longer approved as a CMHP, ownership and possession of all assets and property obtained with funds granted by the department and in which the department has a security interest shall revert to the department; and

 

(3)  Comply with the requirements of He-M 403.03 (b) (2)-(4) regarding board membership.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.05  Role and Responsibilities of Governmental and Nongovernmental CMHPs.

 

          (a)  A CMHP shall plan, establish, and maintain a comprehensive and coordinated array of programs and services for persons with mental illness who are residing in the region or are moving to the region from a facility, or a transitional housing program pursuant to He-M 426.

 

          (b)  A CMHP shall use funds provided by the department for use in planning, establishing, operating, and administering programs and services and coordinating the service delivery system with existing generic services on behalf of persons with mental illness in the region.  A CMHP may receive funds from sources other than the department to assist it in carrying out its responsibilities.

 

          (c)  A CMHP shall utilize federal, third party, and other public and private sources of funds that are available for mental health services to carry out the purposes of the CMHP.

 

          (d) A CMHP shall ensure that all programs and services it administers:

 

(1)  Foster integrated activity for persons with mental illness;

 

(2)  Build upon the individual’s  strengths and mitigate, as much as possible, the disabling effects of mental illness;

 

(3)  Enhance the capacity of individuals to manage the symptoms of their mental illness and to foster the process of recovery to the greatest extent possible; and

 

(4)  Enhance the capacity of families and other community members to support persons with mental illness.

 

          (e)  A CMHP board of directors shall establish policies for the governance and administration of the CMHP and all services through contracts with the CMHP.  Policies shall be developed to ensure efficient and effective operation of the CMHP-administered service delivery system and adherence to requirements of federal funding sources and rules and contracts established by the department.

 

          (f) Each board of directors/advisory board shall establish and document an orientation process for educating new board members regarding:

 

(1)  The regional and state mental health system;

 

(2)  The principles of recovery and family support; and

 

(3)  The fiduciary responsibilities of board membership.

 

          (g)  Each program shall employ a senior executive officer who has at a minimum:

 

(1)  The following:

 

a.  Five years of full-time employment experience in programs for persons with long-term mental illness;

 

b.  Two years of supervisory, management, or administrative experience; and

 

c.  A master’s degree in public administration, business management, or human services; or

 

(2)  An equivalent combination of education and experience, such that one additional year of education in a human services field may be substituted for one year of professional experience, up to a maximum of 2 years.

 

          (h)  A senior executive officer, as described in (g) above, of a CMHP shall be appointed as follows:

 

(1)  Each board of directors/advisory board shall appoint a senior executive officer of the CMHP who shall serve at the pleasure of the board and as a full-time employee of the agency;

 

(2)  The senior executive officer shall be selected, employed, and supervised by the CMHP board of directors/advisory board in accordance with a published job description and a competitive application process; and

 

(3)  The senior executive officer shall be evaluated annually by the CMHP board of directors/advisory board to ensure that services are provided in accordance with the performance expectations approved by the board, based on the department’s rules and contract provisions.

 

          (i)  Each program shall employ a medical director who shall:

 

(1)  Possess a valid license to practice medicine in the United States; and

 

(2) Be board eligible or board certified in psychiatry according to the regulations of the American Board of Psychiatry and Neurology, Inc., or its successor organization at the time of hiring; and

 

(3)  Maintain board eligibility or certification throughout hisor her tenure as medical director.

 

          (j)  Each program shall employ a children's services coordinator who shall work with the department in service system planning for children and adolescents and all inpatient admissions and discharges.

 

          (k)  Each program shall employ a service coordinator who oversees program development, training, and interagency collaboration, supporting persons age 60 and older, and who participates in regional and state-wide planning activities with other agencies serving older adults.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.06  CMHP Services and Programs.

 

          (a)  A CMHP shall provide the following, either directly or through a contractual relationship:

 

(1)  Supports and services pursuant to He-M 426 and He-M 401;

 

(2)  Protection of consumers’ rights pursuant to He-M 204 and He-M 309;

 

(3)  Planning, coordination, and implementation of a regional mental health disaster response plan which shall specify responsibilities and procedures for:

 

a.  Coordination with other local and regional agencies that provide emergency management services including relief from a disaster;

 

b.  Identification of members of the community at large who are vulnerable to behavioral health crises during times of disaster;

 

c.  Provision of on site crisis assessment and diagnostic and counseling services; and

 

d.  Addressing the acute psychiatric treatment needs of community members and assuring the availability of community support and treatment services to consumers of the state mental health system who are vulnerable during times of disaster due to the nature of their mental illness;

 

(4)  Outreach to persons with mental illness who are homeless for the purpose of engaging such persons in the service system and providing non-office-based diagnostic and treatment services;

 

(5)  Services to emergency shelters and providers of services to homeless persons, including:

 

a.  Liaison services to ensure service coordination and problem solving;

 

b. Education and training of staff in topics regarding mental illness, psychiatric medications, available treatments and services, and other relevant topics through inclusion in related and appropriate CMHP staff development activities; and

 

c.  Consultation regarding specific individuals with mental illness;

 

(6)  Collaboration with state and local housing agencies and providers to promote access to existing housing and the development of housing for persons with mental illness, including home ownership and rental options;

 

(7)  Consultation, as requested, and support to peer-run programs promoting the development of self-help or, peer support for the individual;

 

(8)  NHH census management services, including a staff liaison who has NHH privileges and participates in NHH treatment and discharge planning meetings on a regular basis; and

 

(9) Specialized treatment services to eligible persons with mental illness and a concomitant alcohol and/or substance use disorder, including assessment of alcohol/substance use disorders, as part of the clinical evaluation process and provision of treatment for both the substance use disorder and the mental illness, as necessary.

 

          (b)  In addition to those services identified above, a CMHP shall provide developmentally appropriate services to children who are eligible for services pursuant to He-M 401 and elderly persons residing in community settings who are eligible for services pursuant to He-M 401 and shall give priority to children connected to the division for children, youth and families when there is an inability to serve all applicants at a given time.

 

          (c)  Services provided to eligible children and elderly persons shall be community-based.

 

          (d)  Services provided to children shall include the following:

 

(1)  Family support and education, including designation of a family liaison;

 

(2)  Psychiatric diagnostic and medication services;

 

(3)  Case management, including appropriate interagency involvement;

 

(4)  Individual, family, and group therapy;

 

(5)  Intake and assessment;

 

(6)  Crisis intervention;

 

(7) Outreach support to children and their families, both in their homes and in community settings;

 

(8)  Functional support services;

 

(9)  Sexual offender assessments and treatment; and

 

(10)  Specialty services for the treatment of attachment disorder.

 

          (e)  Services provided to elderly persons residing in community settings shall include:

 

(1)  Intake and assessment;

 

(2)  Psychiatric diagnosis and treatment;

 

(3)  Case management;

 

(4)  Consultation and education to families, community agencies, and the general public;

 

(5)  Outreach support to elders and their families, both in their homes and in community settings;

 

(6)  PASRR evaluations, coordinated with nursing homes, hospitals, and the bureau, as needed; and

 

(7)  Referral Education Assistance and Prevention Program.

 

          (f)  A CMHP shall make services available to persons who have both a mental illness pursuant to

He-M 401 and a developmental disability pursuant to He-M 503.

 

          (g)  A CMHP shall participate in regular interagency team meetings with representatives of the other agencies serving mutual clients.

 

          (h)  A CMHP shall conduct community education activities, including the provision of education and consultation to members of the community at large, with the goal of increasing the acceptance of persons with mental illness.  Activities shall include working with the media, public speaking and information dissemination.

 

          (i)  A CMHP shall perform active monitoring of services through a comprehensive quality assurance program that:

 

(1) Is based on a written quality assurance plan which includes outcome indicators and incorporates input from individuals and family members;

 

(2)  Includes the following activities:

 

a.  Utilization review;

 

b.  Peer review;

 

c.  Evaluation of clinical services;

 

d.  Consumer satisfaction surveys;

 

e.  Validation of staff credentials to practice;

 

f.  Complaints review; and

 

g.  Reporting and assessment of serious incidents; and

 

(3)  Results in an annual report.

 

          (j)  A CMHP shall strive to provide all services within the least restrictive environment in each consumer's own community, and in a manner which promotes the personal self-sufficiency, dignity, and maximum community participation of each individual.

 

          (k)  A CMHP shall provide services that are responsive to the particular needs of members of minority communities within the region.

 

          (l)  The services and programs for which a CMHP is responsible may be administered directly by the CMHP, or the CMHP may enter into agreement(s) with individuals and organizations for the provision of designated services or programs.

 

          (m)  A CMHP shall be responsible and accountable for all CMHP services and programs, whether administered directly by the CMHP or provided under contracts with individuals or organizations.

 

          (n)  A CMHP shall ensure that services and programs shall be operated in compliance with rules and contract requirements.

 

          (o)  In order to ensure the best possible coordination and continuity of services for clients and their families, a CMHP shall establish working relationships with other human service agencies in the region who serve consumers, including but not limited to:

 

(1)  Independent peer support programs, which shall include coordination with and referral to individual operated peer support programs such as telephone support lines where available;

 

(2)  Homeless shelters;

 

(3)  The division of vocational rehabilitation of the department of education;

 

(4)  Area agencies;

 

(5)  Criminal justice agencies;

 

(6)  The division for children, youth, and families; and

 

(7)  Local interagency family assistance teams that are made up of:

 

a.  The division for children youth, and families;

 

b.  Local school districts; and

 

c.  Other child-serving agencies.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.07  Staff Training and Development.

 

          (a) A CMHP shall establish and implement an effective employee recruitment, retention, and development program applicable to all staff, and which shall addresses the following:

 

(1)  Job descriptions;

 

(2)  Staffing patterns;

 

(3)  Conditions of employment;

 

(4)  Staff grievance procedures;

 

(5)  Staff performance reviews; and

 

(6)  Individual staff development plans.

 

          (b)  A CMHP shall conduct criminal background checks, bureau of elderly and adult services at the department (BEAS) registry checks, and a review of the Office of Inspector General’s List of Excluded Individuals/Entities for each newly hired and re-hired staff member.  In addition, motor vehicle record checks shall be conducted for staff who will be transporting individuals pursuant to employment.

 

          (c)  Each staff person employed by a CMHP shall have an annual performance review based upon that staff person's job description and conducted by his or her supervisor, which shall include an individual staff development plan.

 

          (d)  A CMHP shall conduct or refer staff to training activities which address objectives for improving staff competencies.  Each staff member shall participate in such training activities as specified in that person's individual staff development plan and in addition shall receive ongoing training in protection of client rights pursuant to He-M 204 and He-M 309.

 

          (e)  A CMHP shall provide an orientation for all new staff providing services to persons with mental illness, which, at a minimum, includes:

 

(1)  The service delivery system at the state and local level, including family support and consumer self-help programs for individuals;

 

(2)  Mental illness, including the effects of mental illness on persons having such illness and current practices in treatment and rehabilitation;

 

(3)  All department rules applicable to community mental health services provided by the staff member;

 

(4)  Accessing generic services, so that such staff are familiarized with social, medical, and other services available in the local community; and

 

(5)  Protection of client rights pursuant to He-M 204 and He-M 309.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.08  CMHP Application Procedures and Criteria.

 

          (a)  In regions where there is a CMHP that has been approved by the administrator, the CMHP shall retain its approved status until it is reapproved pursuant to He-M 403.11, or He-M 403.12, or until reapproval is denied pursuant to He-M 403.13.

 

(b)  Not less than 90 days before the end of the designation period, the department shall initiate the CMHP approval process by publishing a notice on its website http://www.dhhs.nh.gov and in one or more newspapers of regional distribution to convey information about the role and responsibilities of a CMHP, and the CMHP application and approval process, including the closing date for submission of application materials required by (c) below.

 

          (c)  Cities, towns, or counties, or boards of community based New Hampshire private, non-profit agencies, may apply for approval as a CMHP provided that the applicable requirements under He-M 403.03 (c), He-M 403.04 (b) (1)-(3), and (d) below have been met.

 

          (d)  An applicant shall submit application materials to the department as follows:

 

(1)  The applicant shall submit to the department written assurances of adherence to, and capacity to provide services pursuant to,  rules adopted by the department relating to the delivery of mental health services and the protection of client rights;

 

(2)  The applicant shall demonstrate that there is a documented need for services to individuals meeting certification or eligibility criteria pursuant to He-M 401 and shall describe the unmet service needs of individuals and how the applicant proposes to meet those service needs;

 

(3)  The applicant shall submit a written proposal which shall include a line item budget and a description of all programs and services to be provided; and

 

(4)  If the applicant is the board of a currently operating CMHP, the application materials shall also include the following:

 

a.  A description of all current programs and services operated by the applicant;

 

b.  A description of staffing patterns and current staff qualifications, including psychiatric staff; and

 

c.  A copy of the current operating budget and most recent external audit.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.10)

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.09  CMHP Approval.

 

          (a)  The administrator shall solicit and consider comments from individuals and groups in the region as to the ability of each applicant to carry out its responsibilities as stated in He-M 403.05 and He-M 403.06.

 

          (b)  The administrator shall review the completed applications and shall assign staff to conduct a site visit for any applicant that appears to meet the requirements of He-M 403.  Such site visit and review shall be completed within 90 days of the date of referral for site visit and shall result in a determination of the compliance or non-compliance of the CMHP with He-M 403 and all other applicable department rules.

 

          (c)  Within 15 days of the date of the site reviews, the administrator shall approve an applicant that has been determined to be in compliance with He-M 403 and all other applicable rules.

 

          (d)  Approval of a CMHP shall be for a 5-year term, unless suspended or revoked pursuant to He-M 403.10.

 

          (e)  The administrator shall notify each applicant that does not receive approval and shall explain the reason why the applicant was not approved.

 

          (f)  If there is no applicant selected for approval in the region, the administrator shall notify each applicant and request a second submission of application materials.

 

          (g)  If no applicant in the region receives approval following the second submission of CMHP application materials, or if no operating CMHP applies for reapproval pursuant to He-M 403.11, the administrator shall:

 

(1)  Initiate or re-initiate the application procedure for approval of a CMHP; and

 

(2)  Appoint as an interim CMHP a nonprofit agency that the administrator determines has the capacity to operate in the region; or

 

(3)  If an interim CMHP that has the capacity to operate programs and services in accordance with department rules cannot be identified, designate department staff to temporarily operate CMHP services and programs until a new CMHP can be approved.

 

          (h)  An applicant denied approval by the administrator may appeal pursuant to He-C 200.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New. #9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.11)

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.10  Suspension and Revocation of Approval.

 

          (a)  If the administrator finds at any time that the health, safety, or welfare of individuals or the public is endangered by the continued operation of services by a CMHP, the administrator shall immediately suspend that CMHP's approval and shall issue the CMHP and board written notice of suspension, which shall specify the reason(s) therefor, and the process for a hearing pursuant to He-M 403.15.

 

          (b)  In the event that the administrator determines that a CMHP is not providing services and programs in accordance with the department’s rules or contract, the administrator shall send a written notice to the CMHP and board specifying the nature of the deficiencies and/or the remedial action which is required.  Such notice shall contain time limitations stating when the remedial action shall be completed.  Said time limitations shall not exceed 180 days.

 

          (c) If a CMHP has not complied with the remedial action required pursuant to (b) above, the administrator shall issue the CMHP and board written notice of revocation, which shall specify the reason(s) therefor.

 

          (d)  If the administrator determines that changes to federal or state laws necessitate restructuring of the state's community mental health service delivery system through revocation of a CMHP's approval, the administrator shall issue the CMHP and board written notice of revocation, which shall specify the reason(s) therefor.

 

          (e)  A notice of revocation of approval shall specify the reasons for the revocation and the effective date.  The effective date of the revocation shall be at least 90 days from the date of the notice, except that revocation of a suspended approval shall be effective immediately upon notice. 

 

          (f)  Upon issuance of an order to revoke a CMHP's approval, the administrator shall initiate the process to approve a successor CMHP pursuant to He-M 403.08.  Final approval of a successor CMHP shall not be made unless and until a revocation order is issued and any appeals to the administrator have been decided upon.

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.12) 

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.11  Reapproval.

 

          (a)  CMHPs shall apply to the administrator for reapproval no later than 180 days prior to the expiration of their current approval.

 

          (b)  A CMHP that is in operation shall retain its approved status until the application for reapproval is acted upon by the administrator pursuant to these rules.

 

          (c)  A CMHP shall submit the following as part of its application for reapproval:

 

(1)  A comprehensive self-assessment of the CMHP’s current abilities and past performance;

 

(2)  A comprehensive listing of critical unmet service needs within the region;

 

(3)  Assurances of compliance with applicable federal and state laws and rules; and

 

(4)  A copy of the mission statement of the organization.

 

          (d)  The administrator shall review application materials and written comments from the CMHP, department personnel, provider agencies, individuals, family members, and the general public regarding the CMHP’s past performance and current ability to provide services.

 

          (e)  The administrator shall consider the following during review of the application:

 

(1)  Materials collected as part of the reapproval process, which shall include, at a minimum, the following:

 

a.  Written comments and other documentary evidence, solicited from area citizens, CMHP subcontractors, and community groups through means which shall include publication of public notice of the CMHP's application for reapproval in a newspaper or newspapers of regional distribution, demonstrating the CMHP's ability to offer satisfactory services and provide leadership in addressing the needs of its clientele;

 

b.  Comments of individuals and family members of individuals of the CMHP illustrating responsiveness and overall quality within the service system; and

 

c.  Any complaints that have been filed by or on behalf of individuals regarding service provision and have been resolved by the CMHP; and

 

(2)  Other available documents which shall demonstrate:

 

a.  CMHP compliance with all contract requirements, including adherence to the annual budget;

 

b.  CMHP compliance with federal and state rules;

 

c.  Corrective action taken by the CMHP in response to the department's quality assurance reviews, when such reviews have determined that a CMHP is not in compliance with department rules;

 

d.  The CMHP's internal quality assurance activities; and

 

e.  The CMHP's ability to articulate its legal mandates, including the setting of annual goals and agency priorities.

 

          (f)  If the administrator determines, after considering the information gathered pursuant to (e) (1) and (2) above, that a CMHP is providing services that comply with all applicable state and federal rules and laws, the administrator shall reapprove the CMHP for a period of 5 years.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.13)

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.12  Conditional Reapproval.

 

          (a)  The administrator shall reapprove a CMHP on a conditional basis for a period of 180 days if he or she determines, after considering the information gathered pursuant to He-M 403.11 (e) (1) and (2), that the CMHP:

 

(1)  Is not currently providing services that comply with applicable state and federal rules and laws; or

 

(2)  Is projected to lack the capacity to provide services in accordance with state and federal rules and laws beyond the next 6 months for reasons such as, but not limited to:

 

a.  Lack of adequate operating funds, as determined by an independent audit performed by a certified public accountant and submitted with a management letter;

 

b.  Failure to hire or retain staff sufficient to comply with He-M 403.05 through He-M 403.07;

 

c.  Matters related to illegal activities, such as fraud, abuse, neglect, exploitation, sexual misconduct, or other illegal activity; or

 

d.  Other similar matters that prohibit the CMHP from providing services.

 

          (b)  The administrator shall specify, in writing, conditions and time frames that shall be met by the CMHP in order to be eligible for reapproval.

 

          (c)  At least 30 days prior to the expiration date of the conditional approval, department staff designated by the administrator shall review, and issue a written report regarding, a CMHP's compliance with the conditions and time frames identified in (b) above.

 

          (d)  Except as allowed in (e) below, at least 15 days prior to the expiration of the conditional reapproval, the administrator shall:

 

(1)  Reapprove the CMHP, effective as of the date of conditional reapproval, if all conditions have been met; or

 

(2)  Deny the reapproval if all conditions have not been met.

 

          (e)  A CMHP may request a 180-day extension of the conditional reapproval by filing a written request for the extension with the bureau at least 30 days prior to the expiration date of the conditional approval.

 

          (f)  The director shall approve a request for an extension upon receipt except in cases where the health or safety of consumers is at risk.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.14)

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.13  Denial of Reapproval.

 

          (a)  If the administrator denies an application for reapproval, the administrator shall notify the CMHP in writing of the decision.  Such a notice shall specify the reasons for the decision and its effective date.  The effective date of the decision shall be at least 90 days from the date of said notice.  The CMHP shall have 20 days following the date of the notice to request reconsideration of the denial and submit additional information to the administrator.

 

          (b)  The administrator shall review the submission of any additional information by the CMHP.  Following this review, the administrator shall issue his/her final decision.  In the event that that decision denies reapproval, the CMHP may request a hearing pursuant to He-M 403.15.

 

          (c)  Upon issuance of a decision to deny reapproval, the administrator shall initiate the process to approve a successor CMHP as outlined in He-M 403.08.  Final approval of a successor CMHP shall not be made until any appeal to the commissioner has been decided.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.15)

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.14  Relinquishment of Approval by a CMHP.

 

          (a)  In the event that the board of directors of a CMHP decides, after the conclusion of negotiations, not to enter into a contract with the department of health and human services for provision of community behavioral health services, the board shall provide 180 days advance notice to the department of its intent to relinquish its approval as a CMHP.

 

          (b)  During the 180-day notice period, the CMHP shall continue to provide services to individuals and shall continue to be compensated for those services, in accordance with the last contract in effect.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

          He-M 403.15  Hearings.

 

          (a)  A CMHP may request a hearing regarding a denial of approval or reapproval or suspension or revocation of approval.

 

          (b)  A request for hearing shall be submitted to the commissioner in writing within 20 days following the date of the notification of denial or suspension or revocation.

 

          (c)  The commissioner or his or her designee shall conduct a hearing in accordance with the procedures set forth in He-C 200 within 30 days of receipt of a request.  The presiding officer shall submit a written proposed decision to the commissioner in accordance with RSA 126-A:5, VIII(d), and He-C 203.22(d).

 

          (d)  Within 10 days of the hearing, the commissioner shall issue a proposed decision in accordance with RSA 126-A:5, VIII(e), and He-C 203.22(e).

 

          (e)  The CMHP may appeal the commissioner’s decision to a court of competent jurisdiction.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

          He-M 403.16  Waivers.

 

          (a)  A CMHP may request a waiver of specific requirements outlined in this part, in writing, from the department.

 

          (b)  A request for a waiver shall include:

 

(1)  A specific reference to the section of the rule for which a waiver is being sought;

 

(2)  A full description of why a waiver is necessary; and

 

(3)  A full explanation of alternative provisions or procedures proposed by the CMHP or community mental health provider.

 

          (c)  No provision or procedure prescribed by statute shall be waived.

 

          (d)  A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the CMHP meets the objective or intent of the rule, and:

 

(1)  Does not negatively impact the health or safety of recipients; and

 

(2)  Does not affect the quality of CMHP services.

 

          (e)  Upon receipt of approval of a waiver request, the CMHP’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

 

          (f)  Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

 

          (g)  Those waivers which relate to the following shall be effective for the CMHP’s current certification period only:

 

(1)  Fire safety; or

 

(2)  Other issues relative to consumer health, safety or welfare that require periodic reassessment. 

 

          (h)  A CMHP may request a renewal of a waiver from the department.  Such request shall be made at least 30 days prior to the expiration of a current waiver.

 

Source.  #4195, eff 1-1-87, EXPIRED: 1-1-93

 

New.  #6816, eff 7-25-98, EXPIRED: 7-25-06

 

New.  #8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07

 

New.  #9533, eff 9-1-09, EXPIRED: 9-1-17

 

New.  #12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18

 

New.  #12522, eff 4-3-18

 

PART He-M 404 - RESERVED

 

Source.  #1700, eff 1-1-81; ss by #1968, eff 3-1-82; ss by #2926, 12-18-84; ss by #4340, 12-1-87; rpld by #5340, eff
3-3-92

 

PART He-M 405  DESIGNATION OF RECEIVING FACILITIES

 

Statutory Authority:  RSA 135-C:26

 

          He-M 405.01  Purpose.  The purpose of these rules is to outline standards and procedures for the designation and operation of designated receiving facilities (DRFs) for involuntary treatment of minors and adults with mental illness.

 

Source.  #1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-90

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; ss by #13299, eff 12-2-21

 

          He-M 405.02  Definitions.

 

          (a)  “Adult” means a person 18 years of age or older.

 

          (b)  “Applicant” means that legal entity that requests designation as a designated receiving facility.

 

          (c)  “Client” means a person who is receiving the services of a designated receiving facility.

 

          (d)  “Commissioner” means the commissioner of the department of health and human services, or his or her designee.

 

          (e)  “Departmentmeans the New Hampshire department of health and human services.

 

          (f)  “Designated receiving facility (DRF)” means a hospital-based psychiatric unit or a non-hospital-based residential treatment program designated by the commissioner to provide care, custody, and treatment to persons involuntarily admitted to the state mental health services system.

 

          (g)  “Designation” means a decision by the commissioner that a facility that has not been operating as a DRF immediately prior to its application is approved to operate as a DRF pursuant to He-M 405.

 

          (h)  “Minor” means a person less than 18 years of age.

 

          (i)  “Redesignation” means a decision by the commissioner that a DRF whose designation is effective has been approved to continue to operate as a DRF pursuant to He-M 405.15.

 

          (j)  “Region” means a geographic area designated pursuant to He-M 425.03 for the purpose of assigning primary responsibility for providing mental health services to the residents of certain communities.

 

Source.  #1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; ss by #13299, eff 12-2-21

 

          He-M 405.03  Designation Requirements.

 

          (a)  A DRF may be designated to receive clients for any of the following purposes:

 

(1)  Involuntary emergency admission (IEA) pursuant to RSA 135-C:27-33 beginning with initial custody and continuing through the day following the probable cause hearing;

 

(2)  Involuntary emergency admission pursuant to RSA 135-C:27-33 for the period of such admission following the probable cause hearing; or

 

(3)  Non-emergency involuntary admission (IA) pursuant to RSA 135-C:34-54.

 

          (b)  A DRF shall establish written procedures by which each client’s ability to pay for services is determined and shall provide services to clients in the same manner and of the same quality whether or not they have been determined to be unable to pay.

 

          (c)  The inpatient capacity of a non-hospital-based DRF shall not exceed 16.

 

          (d)  A DRF shall have comprehensive general liability insurance against all claims of bodily injury, death, or property damage in amounts of not less than $250,000 per claim and $2,000,000 per occurrence.

 

          (e)  A DRF shall maintain the inpatient capacity applied for, and approved by the department, at all times, except as provided in He-M 405.14(c).

 

          (f)  A DRF shall adopt policies and procedures which limit the use of seclusion and restraint and which shall be consistent with He-M 305 and RSA 126-U.

 

Source.  #1806, eff 9-7-81; amd by #2358, eff 5-2-83; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (e)); ss by #13299, eff 12-2-21

 

          He-M 405.04  Application Procedure and Designation/Redesignation Criteria.

 

          (a)  An application for designation or redesignation as a DRF shall be made in writing to the commissioner, and shall include a description of all programs and services operated by the applicant, including services to be available through the proposed DRF, as required by (c) below.

 

          (b)  An application for redesignation shall be submitted by a DRF to request redesignation or to alter the service capacity or type of services a facility is designated to provide.  An application for redesignation shall be submitted to the commissioner at least 6 months prior to the expiration date of the DRF’s designation.  Submission of such application shall cause the DRF’s current designation to be effective until the commissioner issues a decision pursuant to (g) below.

 

          (c)  The description of a DRF submitted pursuant to He-M 405.04(a) above shall include the following:

 

(1)  The name and address of the applicant;

 

(2)  A description of the physical location of the DRF, including whether the facility is hospital-based or non-hospital-based;

 

(3)  A statement of intent to provide services pursuant to He-M 405.03(a)(1), He-M 405.03(a)(2), and/or He-M 405.03(a)(3);

 

(4)  A statement describing the capacity of the DRF to provide services pursuant to He-M 405.11 and He-M 405.12;

 

(5)  A description of staffing patterns and staff qualifications, including psychiatric staff, that demonstrates compliance with He-M 405.11; and

 

(6)  Documentation which demonstrates that the DRF meets the requirements set forth in He-M 405.03(c)-(f).

 

          (d)  A hospital-based DRF which submits an application for designation or redesignation shall include a certification of compliance with the Conditions of Participation for hospital-based psychiatric services as set forth by the federal Centers for Medicare and Medicaid Services (CMS) in accordance with 42 CFR Part 482.  Such certification of compliance shall be obtained from either the department on behalf of the Centers for Medicare and Medicaid Services or a national accrediting organization that has been deemed by CMS as having standards and a survey process that meets the Medicare conditions of participation and federal survey requirements.

 

          (e)  A non-hospital-based DRF which submits an application for designation or redesignation shall include documentation demonstrating that the DRF is licensed by the department in accordance with RSA 151 and He-P 830 and/or certified as a community residence pursuant to He-M 1002.

 

          (f)  The commissioner shall assign staff to review the application materials and conduct a site visit of any DRF applying for designation or redesignation.  Such review and site visit shall result in a determination of the compliance or non-compliance of the DRF with He-M 405 and all other applicable department rules.

 

          (g)  Upon completion of a review and site visit, the commissioner shall:

 

(1)  Designate or redesignate as a DRF those facilities which have been determined, pursuant to (f) above, to be in compliance with He-M 405 and all other applicable rules;

 

(2)  Conditionally designate or redesignate as a DRF for a period of up to 180 days, those facilities which have been determined, after considering the information gathered pursuant to (f) above, to be substantially in compliance with He-M 405 and all other applicable rules, provided that there is no indication the health or safety of clients is at risk; or

 

(3)  Deny designation or redesignation as a DRF to those facilities which have been determined, pursuant to (f) above, not to comply with He-M 405 and all other applicable rules.

 

          (h) A conditional designation or redesignation pursuant to (g)(2) above may be renewed only if the DRF has engaged with the department in good faith efforts to address any areas of non-compliance leading to the initial conditional designation or redesignation.

          

          (i)  The commissioner shall notify an applicant in writing upon approval or denial of application for designation or redesignation.  Designation or redesignation shall be effective for 5 years from the date of notification.  A DRF shall be designated or redesignated to provide only those services described by the applicant pursuant to (a) above and those required pursuant to He-M 405.12.

 

             (j)  Notification of a decision to deny designation or redesignation shall specify the reasons for the decision and its effective date.  The effective date of the decision denying a redesignation shall be at least 90 days from the date of the denial notice.  The DRF may appeal a decision pursuant to He-C 200.

 

          (k) Following designation or redesignation, a DRF shall undergo a bi-annual review by the department that evaluates:

 

(1)  Any policies that have changed since the designation, re-designation, or bi-annual review; and

 

(2)  The applicable medical record specified below:

 

a.  One record shall be for an individual affiliated with a community mental health program; and

 

b.  One record shall be for an individual who is not affiliated with a community mental health program.

 

 

Source.  #1806, eff 9-7-81; ss by #2579, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED: 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (g)); ss by #13299, eff 12-2-21

 

          He-M 405.05  Collaboration with Community Mental Health Programs.

 

          (a)  For individuals engaged with a community mental health program (CMHP), at the time of admission, and the client has signed all necessary release documents, the DRF shall:

 

(1)  Jointly develop with the CMHP all treatment plans, discharge plans, and referrals for clients whom they both serve as evidenced by care coordination notes within the clients chart;

 

(2)  Maintain consistent contact with the CMHP to ensure the CMHP is informed of the individual’s progress while in the DRF;

 

(3)  If the client is agreeable, schedule an appointment for the individual with the CMHP to occur within 7 days after discharge at a date and time that is agreeable for the client or if the DRF is unable to schedule an appointment, document the attempts made to schedule an appointment and identify the reasons why the appointment could not be scheduled;

 

(4)  Give notice to the CMHP of the individual’s discharge prior to, or within no more than one hour after discharge; and

 

(5)  If an individual was previously receiving Assertive Community Treatment (ACT) services at a CMHP at the time of admission and the client is willing, a DRF shall ensure that an appointment with the CMHP is scheduled to occur within 2 calendar days after discharge or if the client is not willing to schedule an appointment with the CMHP, document the client’s unwillingness for the appointment and identify the reasons why the client did not want the appointment.

 

          (b)  If an individual was not engaged with a CMHP at the time of admission, but is agreeable to engagement and has signed all the necessary release documents, a DRF shall inform the appropriate regional CMHP and facilitate the scheduling of an intake appointment to occur within 7 days after discharge.

 

          (c)  If an individual is engaged with non-CMHP providers at the time of admission and has signed all necessary release documents, a DRF shall:

 

(1)  Jointly develop with the non-CMHP providers all treatment plans, discharge plans, and referrals for the individual they both serve as evidenced by care coordination notes within the clients chart;

 

(2)  Maintain consistent contact with the non-CMHP providers to ensure the providers are informed of the individual’s progress while in the DRF;

 

(3)  If the client is agreeable, schedule appointments with the non-CMHP providers to occur within 7 days after discharge at a date and time that is agreeable for the client or if the DRF is unable to schedule an appointment, document the attempts made to schedule an appointment and identify the reasons why the appointment could not be scheduled.

 

Source.  #1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; ss by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21; ss by #13299, eff 12-2-21

 

          He-M 405.06  Admission Procedures.

 

          (a)  Involuntary admissions shall be made according to the procedures for IEAs under RSA 135-C:27-54.

 

          (b)  A DRF shall not refuse admission of a person sent to such facility pursuant to RSA 135-C:28 or 135-C:36-45, unless there are no beds available at the time of admission.

 

          (c)  A DRF shall have admission policies which require that involuntary emergency admissions be given priority over non-emergency and voluntary admissions and clearly outline the circumstances of when prioritization of IEAs cannot be fulfilled.

 

 

Source.  #1806, eff 9-7-81; ss by #2579, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.05); amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (c)); ss by #13299, eff 12-2-21

 

          He-M 405.07  Criteria and Procedures for Medical Transfer.

 

          (a)  Non-medically related transfer from a DRF to another facility shall be conducted in accordance with He-M 612.

 

          (b)  An involuntarily admitted client shall be transferred to an acute care hospital only if the following conditions apply:

 

(1)  The client has acute, non-psychiatric, medical needs requiring treatment which cannot be provided at the DRF;

 

(2)  The acute care hospital to which the client is to be transferred can provide the treatment that the client requires; and

 

(3)  The transfer has been approved by the client, the client’s legal guardian if the guardian has been granted decision-making authority regarding medical care, or the division for children, youth and families if that division has custody of a client who is a minor.

 

          (c)  A medical transfer may occur without the approval in (b)(3) above if a physician has determined that a personal safety emergency exists pursuant to He-M 305.03.

 

          (d)  The order for IEA shall remain in effect for a person who is transferred from a DRF for medical treatment.

 

          (e)  If a client is being transferred under (a) and (b) above, and the client, the client’s legal guardian, or the division for children, youth and families, if that division has custody of a client who is a minor, objects to the transfer, the challenge shall be treated as a client complaint in accordance with He-M 204.  Except as provided in (c) above, such a transfer shall not occur until the complaint has been resolved.

 

Source.  #1806, eff 9-7-81; amd by #2104, eff 8-1-82; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.06); ss by #13299, eff 12-2-21

 

          He-M 405.08  Discharge Pursuant to Voluntary Admission.

 

          (a)  If a client is at a DRF on a voluntary basis, he or she or, if the client is under age 18, his or her parent(s) or legal guardian may request withdrawal from the facility whether or not such withdrawal is made against medical advice.

 

          (b)  A client or the parent(s) or legal guardian of a client who wishes to withdraw shall state such intent in writing to staff of the DRF.

 

          (c)  The time and date of receipt of a notice of intent to withdraw shall be indicated on the notice, if applicable, and in the client’s medical record.

 

          (d)  A client who has requested withdrawal or whose parent(s) or legal guardian has requested withdrawal shall be discharged by a DRF within 24 hours of receipt of such request, excluding weekends and holidays, except as provided in (f) below.

 

          (e)  If the division for children, youth and families has custody of a client who is a minor, that division shall have such rights and responsibilities as are assigned to the parent(s) or legal guardian of a client pursuant to this section.

 

          (f)  At any time prior to discharge of a client admitted for inpatient care on a voluntary basis, any person, pursuant to RSA 135-C:28, may petition for an involuntary emergency admission of the client.  If a physician certifies that the criteria for involuntary emergency admission in RSA 135-C:27 are met, the admission of the client shall be continued on an involuntary basis in accordance with RSA 135-C:30-33.

 

          (g)  A client’s discharge plan shall include information about community supports such as peer support agencies, the availability of family support and education, and other supportive services such as emergency services, housing supports, and financial services.

 

Source.  #1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.07); amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (g)); ss by #13299, eff 12-2-21

 

          He-M 405.09  Discharge Pursuant to Involuntary Emergency Admission.

 

          (a)  Pursuant to RSA 135-C:32, if a person is a client at a DRF subsequent to an involuntary emergency admission, such involuntary confinement shall be limited to a 10-day period unless a petition for involuntary emergency admission is filed pursuant to RSA 135-C:28 or unless a petition is filed in the probate court within the 10 day period requesting a judicial hearing on the issue of involuntary admission.  Subsequent to the filing of such petition, confinement shall continue only until issuance of the probate court order or until such time as is specified in that order.

 

          (b)  Pursuant to RSA 135-C:33, any person involuntarily admitted to a DRF on an emergency basis shall be granted discharge by the administrator or his/her designee if the administrator determines that the person no longer meets the criteria for admission identified in RSA 135-C:27.

 

          (c)  Discharge shall be made according to the following:

 

(1)  The DRF shall give notice of the discharge to the community mental health program in the region from which the person was admitted and the region to which the person was discharged;

 

(2)  The DRF shall issue written notice to the person discharged and that person’s legal guardian, if applicable, or the division for children, youth and families if that division has custody of the person, that notification pursuant to (c)(1) above was made; and

 

(3)  The DRF shall, with the consent of the person admitted, return such person to the place where the person resided at the time the petition and  certificate were completed and signed.  If the person admitted does not consent to be returned to his or her place of residence, the DRF may agree to provide transportation to another location such as the home of a relative or friend, a peer support agency, or a CMHP.

 

          (d)  A client’s discharge plan shall include information about community supports such as peer support agencies, the availability of family support and education, and other supportive services such as emergency services, housing supports, and financial services.

 

Source.  #1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.08); amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (d)); ss by  #13299, eff 12-2-21

 

          He-M 405.10  Discharge Pursuant to Non-emergency Involuntary Admission.

 

          (a)  Pursuant to RSA 135-C:39, if a person is a client at a DRF subsequent to an involuntary admission, such involuntary confinement shall not continue beyond the time allowed by the probate court order unless a petition requesting a judicial hearing on the issue of involuntary admission is filed within the period of involuntary admission.  Subsequent to the filing of such petition, confinement shall only continue until issuance of the probate court order or until such time as is specified in that order.

 

          (b)  Discharge of any person involuntarily admitted to a DRF on a non-emergency basis shall be made in accordance with RSA 135-C:49-54.

 

          (c)  Upon discharge from a DRF of any person admitted on a non-emergency, involuntary basis, the administrator shall immediately, and in writing, notify the person’s parent(s) or legal guardian, the division for children, youth and families, if that division has custody of the person who is a minor, and the probate court entering the original order of commitment that a discharge has been granted to the person.

 

          (d)  Any person who has been involuntarily admitted to a DRF on a non-emergency basis may be conditionally discharged under the conditions specified in He-M 609.

 

          (e)  A client’s discharge plan shall include information about community supports such as peer support agencies, the availability of family support and education, and other supportive services such as emergency services, housing supports, and financial services.

 

Source.  #1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84

 

New.  #2712, eff 5-16-84, EXPIRED, 5-16-90

 

New.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.09); ); amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (e)); ss by  #13299, eff 12-2-21

 

          He-M 405.11  Staffing.

 

          (a)  Hospital-based DRFs shall be staffed in accordance with the Centers for Medicare and Medicaid Services conditions of participation in 42 CFR 482.62.

 

          (b)  Non-hospital-based DRFs shall be staffed by a multidisciplinary team which includes:

 

(1)  A psychiatrist who shall either be present in the facility or on call at all times;

 

(2)  A registered nurse who shall be present in the facility at all times; and

 

(3)  Additional staff such that:

 

a.  At least 2 staff shall be on duty in the facility at all times, to include:

 

1.  The registered nurse in (2) above; and

 

2.  A person who has been determined by the DRF to have received specific training in providing treatment to persons with mental illness; and

 

b.  A ratio of at least one staff person to 6 clients shall be maintained.

 

          (c)  In addition to the requirements of (a) and (b) above, DRFs that provide services to minors shall employ the following staff on a full-time, part-time, or consultant basis:

 

(1)  A child psychiatrist;

 

(2)  A medical doctor specializing in pediatrics;

 

(3)  A psychologist; and

 

(4)  A social worker.

 

          (d)  In addition to the requirements of (a) through (c) above, staff of DRFs that provide services to minors whose length of stay exceeds 30 days shall include:

 

(1)  A rehabilitation counselor; and

 

(2)  A teacher certified as a general special education teacher by the department of education in accordance with Ed 507.39.

 

          (e)  Professional staff and consultants of a non-hospital-based DRF who provide psychotherapy shall meet the requirements of He-M 426.04.

 

 

Source.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.11); ss by #13299, eff 12-2-21

 

          He-M 405.12  Services to Be Provided.

 

          (a)  The following shall be basic services provided to all clients of DRFs:

 

(1)  Psychiatric evaluation, including mental status and alcohol/substance abuse evaluations, as determined necessary by the treating psychiatrist;

 

(2)  Administration of psychotropic medication, where appropriate;

 

(3)  Medical monitoring, as ordered by the treating psychiatrist;

 

(4)  Clinical supervision of clients by DRF staff, including monitoring signs and symptoms of mental illness, monitoring responses to medication and other treatment, and monitoring implementation of treatment plans;

 

(5)  Individual and group therapeutic activity directed toward short-term stabilization of psychiatric crisis;

 

(6)  Family support, including family education, consultation, and, when clinically indicated, therapy;

 

(7)  For minors, family support services unless clinically contraindicated; and

 

(8) Case coordination, including coordination of client evaluation, treatment planning, discharge, and linkage with appropriate community services, as follows:

 

a.  Clients who are not currently assigned to a CMHC case manager shall receive case coordination services from either CMHC or DRF staff upon admission to a DRF and continuing through discharge; and

 

b.  Clients who are currently assigned to a CMHC case manager shall continue to receive such services, which shall include those services outlined in He-M 405.12(a)(8).

 

          (b)  In addition to the services identified in (a) above, a DRF shall provide the following rehabilitative services to clients whose lengths of admission exceed 30 days:

 

(1)  For adults:

 

a.  A functional assessment of each client’s independent living skills; and

 

b.  Instruction in independent living skills to prepare each client for discharge, as specified in a client treatment plan; and

 

(2)  For minor clients:

 

a.  A therapeutic milieu which provides behavioral management and structured activities;

 

b.  Educational screening;

 

c.  Educational programming which meets board of education standards; and

 

d.  Treatment and discharge planning which shall include participation of family members, guardians, teachers, and representatives of other agencies which provide services to the clients.

 

          (c)  Services shall be age and developmentally appropriate such that discrete, physically separate residential quarters and programmatically separate program areas shall be provided for minors and adults.  Services shall be provided such that language barriers are overcome.

 

Source.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.11); ss by #13299, eff 12-2-21

 

          He-M 405.13  Safety Procedures.  A DRF shall maintain written policies on safety procedures in accordance with the Centers for Medicare and Medicaid Services conditions of participation in 42 CFR 482, He-P 830, or He-M 1002, as applicable, and He-M 305 and RSA 126-U.

 

Source.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.12); ss by #13299, eff 12-2-21

 

          He-M 405.14  Annual Reporting.

 

          (a)  A DRF shall submit monthly client-level reporting to the department’s bureau of mental health services, on or before the 15th day of the following month that includes the following client-level data:

 

(1)  Demographic information;

 

(2)  Insurance information;

 

(3)  Admission and discharge data;

 

(4)  Whether an individual was involuntary during any part of the admission period;

 

(5)  The number of seclusions and restraints that occurred during the reporting period; and

 

(6)  Discharge disposition.

 

          (b)  A DRF shall submit monthly reports to the department’s bureau of mental health services, on or before the 15th day of the following month that summarizes:

 

(1)  Total number of completed referrals received by the DRF;

 

(2)  Total number of referrals that were declined; and

 

(3)  Reasons for declined referrals.

 

          (c)  If a DRF is unable to maintain its designated inpatient capacity, the DRF shall inform the department why the capacity cannot be met and shall notify the department when it returns to its designated capacity as required by He-M 405.03(e).

 

Source.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.13); ss by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21; ss by #13299, eff 12-2-21

 

          He-M 405.15  Denial and Revocation of Designation.

 

          (a)  An application for designation shall be denied or designation shall be revoked, following written notice pursuant to (b)(2) below and opportunity for appeal pursuant to He-C 200, due to:

 

(1)  Failure of the DRF to comply with this part or any other applicable rule adopted by the department;

 

(2)  The DRF administrator or applicant failing to provide information required by the department or knowingly giving false or misleading information to the department;

 

(3)  Refusal by personnel at the DRF to admit any employee of the department authorized to monitor or inspect the DRF;

 

(4)  Any reported abuse, neglect, or exploitation of clients by DRF personnel or persons living in the DRF, if:

 

a.  Such personnel have not been prevented from having contact with clients; and

 

b.  Such abuse, neglect, or exploitation is founded based on a protective investigation performed by the department in accordance with He-E 700 and an administrative hearing held pursuant to He-C 200, if such a hearing is requested;

 

(5)  Revocation of licensure or denial of an application for licensure pursuant to RSA 151; or

 

(6)  Revocation of certification or denial of an application for certification pursuant to He-M 1001.

 

          (b)  Revocation of designation or denial of application for designation shall be in accordance with the following:

 

(1)  Upon determination that a DRF meets any of the criteria for revocation or denial of application listed in (a)(1)-(6) above, the commissioner shall issue a notice of intent to revoke or deny the designation of the DRF;

 

(2)  Revocation or denial of application shall only occur following:

 

a.  The provision of 30 days’ written notice by the commissioner to the DRF stating the specific rule(s) with which the DRF does not comply; and

 

b.  Opportunity for an adjudicative proceeding pursuant to He-C 200, if requested by the DRF;

 

(3)  The commissioner shall withdraw a notice of revocation or denial if, within the notice period, the DRF complies with the specified rule(s); and

 

(4)  Pending compliance with all requirements for designation specified in the written notice made pursuant to (b)(2) above, a DRF shall not accept additional clients if a notice of revocation has been issued concerning a violation which presents potential danger to the health or safety of the clients being served. 

 

Source.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.14); ss by #13299, eff 12-2-21

 

          He-M 405.16  Suspension of Designation.

 

          (a)  The department shall order the immediate suspension of a DRF, the cessation of operations, and the transfer of care of clients when it finds that the health, safety, or welfare of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (b)  If an immediate suspension is upheld, the DRF shall not resume operating until the department determines through a site visit that compliance with He-M 405 is achieved.

 

          (c)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

Source.  #5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99

 

New.  #7051, eff 6-29-99, EXPIRED: 6-29-07

 

New.  #10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.15); ss by #13299, eff 12-2-21

 

            He-M 405.17  Waivers.

 

          (a)  A DRF may request a waiver of specific procedures outlined in this part, in writing, from the department.

 

          (b)  A request for a waiver shall include:

 

(1)  A specific reference to the section of the rule for which a waiver is being sought;

 

(2)  A full description of why a waiver is necessary; and

 

(3)  A full explanation of alternative provisions or procedures proposed by the DRF.

 

          (c)  No provision or procedure prescribed by statute shall be waived.

 

          (d)  A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the DRF meets the objective or intent of the rule and:

 

(1)  Does not negatively impact the health or safety of clients; and

 

(2)  Does not affect the quality of DRF services.

 

          (e)  Upon receipt of approval of a waiver request, the DRF’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

 

          (f)  Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

 

          (g)  Those waivers which relate to the following shall be effective for the DRF’s current designation period only:

 

(1)  Fire safety; or

 

(2)  Other issues relative to consumer health, safety or welfare that require periodic reassessment.

 

          (h)  A DRF may request a renewal of a waiver from the department.  Such request shall be made at least 30 days prior to the expiration of a current waiver.

 

Source.  #10516, eff 1-28-14 (from He-M 405.16); ss by #13299, eff 12-2-21

 

PART He-M 406  HOUSING BRIDGE SUBSIDY PROGRAM

 

Statutory Authority:  RSA 135-C:61, III and RSA 135-C:5, I.

 

          He-M 406.01  Purpose.  The housing bridge subsidy program provides supported housing to people who have serious mental illness.  The purpose of supported housing is to reduce institutionalization by combining mental health outreach services with a subsidy to help pay rent.  The rental subsidy terminates when the individual receives a Section 8 Housing Choice Voucher. Accordingly, in order for a person to be eligible for the housing bridge subsidy program, the person must apply for the Section 8 Housing Choice Voucher.  The purpose of this rule is to describe the eligibility criteria, the application process, the services offered, the wait list and the appeal procedures for the housing bridge subsidy program.

 

Source.  #2745, eff 6-14-84; rpld by #4215, eff 1-22-87, EXPIRED: 1-22-93

 

New.  #11191, eff 9-27-16

 

          He-M 406.02  Definitions.

 

          (a)  “Applicant” means a person or guardian who is applying for acceptance into the housing bridge subsidy program.

 

          (b) “Assertive Community Treatment” (ACT) means a team-based approach to delivering comprehensive and flexible treatment, support, and services.

 

          (c)  “Commissioner” means the commissioner of the department of health and human services.

 

          (d)  “Community mental health program (CMHP)” means “community mental health program” as defined in RSA 135-C: 2, IV.

 

          (e)  “Controlled drug(s)” means controlled drugs as defined in RSA 318-B:1, VI.

 

          (f)  “Department” means the New Hampshire department of health and human services.

 

          (g)  “Facility” means New Hampshire hospital or a receiving facility designated pursuant to RSA 135-C:26 and He-M 405, Glencliff Home, or an acute psychiatric residential treatment program.

 

          (h)  “Individual” means any person who is an applicant for or recipient of services from the housing bridge subsidy program.

 

          (i)  “Household” means the people who will occupy a housing unit under the HBSP including related family members, and all the unrelated people, if any, such as lodgers, foster children, wards, or employees.  A person living alone in a housing unit, or a group of unrelated people sharing a housing unit such as partners or roomers, is also a household.

 

          (j) “Permanent” means community-based housing with a designated length of stay.

 

          (k)  “Program” means the housing bridge subsidy program (HBSP) administered by the department either directly or through a contract for the provision of services under this rule.

 

          (l)  “Severe mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.05 or He-M 401.07.

 

          (m)  “Severe and persistent mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.06 or He-M 401.07.

 

          (n)  “State fiscal year” means the period of time extending from July 1 of one year through June 30 of the following year.

 

          (o)  “Transitional housing services program” means the residential program for persons with a severe mental illness or severe and persistent mental illness operated on the grounds of New Hampshire Hospital.

 

          (p)  “Violent criminal offense” means any conviction that has as one of its elements the use, attempted use, or threatened use of physical force substantial enough to cause, or be reasonably likely to cause, serious bodily injury or property damage including but not limited to murder, manslaughter, assault, rape, robbery, burglary, arson, and kidnapping.  This term does not include simple assault by itself.

 

          (q)  “Wait list” means a list of individuals who have been determined eligible for the housing bridge subsidy program but for whom funding is not available.

 

Source.  #11191, eff 9-27-16

 

          He-M 406.03  Eligibility Criteria.

 

          (a)  In order to be eligible for HBSP a person shall meet the following eligibility criteria:

 

(1)  The person shall have a severe mental illness or a severe and persistent mental illness;

 

(2)  The person shall be 18 years or older;

 

(3)  The person shall be eligible for services from a CMHP, facility, or the transitional housing services program;

 

(4)  The person and any member of the person’s household who is 18 years or older, shall have applied for or be listed on the person’s application for the Section 8 Housing Choice Voucher Program; and

 

(5)  The person shall lack safe and permanent housing options in the community, and meet one of the following criteria:

 

a.  Be ready for discharge from a facility;

 

b.  Be ready for discharge from the transitional housing services program or a community residence as defined in  He-M 1002;

 

c.  Be on an Assertive Community Treatment Team (ACT);

 

d.  Be incarcerated as a result of mental illness and ready for release;

 

e.  Have a minimum of two admissions to New Hampshire Hospital within the last two years;

 

f.  Have used crisis, or emergency services as defined in He-M 426.09, for psychiatric reasons within the last two years; or

 

g.  Be unable to access needed community mental health services within the last two years.

 

          (b)  Eligibility for the HBSP shall not be conditioned on an individual participating in treatment or complying with mandatory programmatic criteria.

 

          (c)  The following persons shall not be eligible for services under the program:

 

(1)  Individuals who have been convicted of:

 

a.  A violent criminal offense within the past 15 years; or

 

b.  The illegal manufacture, sale, or distribution of a controlled drug, or the possession of a controlled drug with intent to manufacture, sell, or distribute within the past 7 years;

 

(2)  Individuals who are current required to register for any sexual offense as defined in 651-B, “Registration of Criminal Offenders;”

 

(3)  Individuals with a household member who meets the criteria in (1) or (2) above; and

 

(4)  Individuals with a house hold income in excess of the “Area Income Limits” for the area in which housing is sought, as listed by the New Hampshire Housing Finance Authority, (May 1,2015), and available on–line under “Publications” at http://www.nhhfa.org/rental-housing-choice-vouchers.cfm.

 

          (d)  Individuals meeting the criteria in He-M 406.03(a) and in paragraphs (c) (1) or (2) above, may request an eligibility accommodation whereby the individual demonstrates to the department:

 

(1)  That there is a link between the mental illness and the behavior; and

 

(2) That the behavior is controlled through on-going treatment, a completed rehabilitation program, or the terms of a conditional discharge.

 

          (e) The department shall grant the eligibility accommodation if it determines, that based on the information provided in (d) above good cause exists to believe that the individual will not otherwise possess a threat to the health, safety, or wellbeing of another tenant, so long as the conditions of (d)(2) are followed.

 

Source.  #11191, eff 9-27-16

 

          He-M 406.04  Notice and Income Verification.

 

          (a)  An individual shall inform the program within 30 days if:

 

(1)  The individual or a household member is convicted of any offense in He-M 406.03(b);

 

(2)  The household income increases by more than 20%; or

 

(3)  Any other event occurs that causes the individual to become ineligible for services under the program.

 

          (b)  The applicable income level shall be verified by the program annually. 

 

Source.  #11191, eff 9-27-16

 

          He-M 406.05  Application For Services.

 

          (a)  Applicants shall apply for services under this program by completing and submitting the “Housing Bridge Subsidy Program Application,” (October 2015), which shall be:

 

(1)  Prepared by the applicant with the assistance of the CMHP, facility, or the transitional housing services program;

 

(2)  Signed and dated by the applicant; and

 

(3)  Submitted by a CMHP, a facility, or the transitional housing services program.

 

          (b)  In addition to the application in (a) above, applicants shall provide:

 

(1)  A signed and dated authorization for a New Hampshire criminal background check of the applicant as prepared by the NH Department of Safety;

 

(2)  A signed and dated authorization for a New Hampshire criminal background check of any other member of the household 18 years of age or older;

 

(3)  For applicants or other members of the household 18 years of age or older who have lived outside of New Hampshire within the last 5 years, a signed and dated authorization for a state criminal background check from the appropriate agency in the state(s) where the applicant lived; and

 

(4)  A signed and dated certification stating, “I certify, under penalty of unsworn falsification, that all of the information in this application is true and complete to the best of my knowledge and belief.  False information will result in denial of application or dismissal from this program.”

 

          (c)  Any applicant shall participate in a face-to face interview with the program, if necessary for the program to clarify any information provided in or with the application.

 

          (d)  Individuals may request a reasonable modification pursuant to 28 CFR 35.130(b)(7) at any time, and will be provided with information and assistance by the HBSP about their fair housing rights.

 

          (e)  Within 45 days of its receipt of an application, which includes all requirements in (a)-(c) above, the department shall determine whether the applicant is eligible for the program.

 

          (f)  An application shall be denied if the individual does not meet the eligibility requirements in He-M 406.03 above.

 

          (g)  The department shall notify the applicant, in writing, if the application has been accepted or denied, and:

 

(1)  If accepted, the notice shall include a statement as to whether the individual has been placed on the wait list in accordance with He-M 406.07; and

 

(2)  If denied, the notice shall state the basis for denial and provide notice of appeal rights in accordance with RSA 126-A:5, VIII and He-C 200, along with information on obtaining legal assistance.

 

(h)  Individuals who do not meet (a)(1) and (3) above and would like to apply to the HBSP shall complete and submit the “Housing Bridge Subsidy Program Intake Form” (February 2016) directly to the department.

 

          (i)  When an individual has been accepted into the HBSP, the program shall make every reasonable effort to obtain housing. However, the HBSP cannot guarantee that housing will be found.

 

Source.  #11191, eff 9-27-16

 

          He-M 406.06 Services to be Provided.

 

          (a) The program shall assist the individual in identifying safe and affordable housing in the community chosen by the individual.

 

          (b)  The program shall provide case management services if the individual does not otherwise have a case manager.

 

          (c)  The program shall provide support services that are flexible and available as needed and desired, and that enable individuals to attain and maintain integrated housing.

 

          (d)  The program shall assist the individual with obtaining, but not paying for, the following:

 

(1)  A security deposit;

 

(2)  Utility services; and

 

(3)  Furniture.

 

          (e)  The program shall provide a monthly subsidy toward rent in an amount to be determined based on the amount of rent, the individual’s household income, and cost projections of available program funding.

 

          (f)  The individual shall be responsible to pay up to 30% of the household income toward the rent.

 

Source.  #11191, eff 9-27-16

 

          He-M 406.07  Wait List.

 

          (a)  When annual departmental cost projections reflect that available funds will be over-expended for the current state fiscal year, a wait list shall be established.

 

          (b)  The wait list shall include any individual that has applied and been deemed eligible for the HBSP and for whom a subsidy is not available.

 

          (c)  The individual shall be determined eligible in accordance with He-M 406.03 above before being placed on the wait list.

 

          (d)  The wait list shall be prioritized as follows:

 

(1)  Individuals ready for discharge from a facility, but who lack safe and permanent housing options in the community will be given the first priority;

 

(2)  Individuals who are on an ACT team, but who lack safe and permanent options in the community, will be given the second priority;

 

(3)  Individuals ready for discharge from the transitional housing services program, but who lack safe and permanent options in the community, will be given third priority; and

 

(4)  Any other individual who has been found eligible in accordance with He-M 406.03.

 

          (e)  Individuals shall be added to the wait list according to the date that eligibility is determined;

 

          (f)  The program shall confirm the individual’s continued eligibility as of the date the individual is removed from the wait list to receive the subsidy.

 

Source.  #11191, eff 9-27-16

 

          He-M 406.08  Termination from the Program.

 

          (a)  An individual shall be terminated from the program if the individual:

 

(1)  Is convicted of any offense described in section He-M 406.03(c)(1) or (2) above;

 

(2)  Has a household member who meets the criteria in (c)(1) or (2) above;

 

(3)  Has an increase in household income above the allowable amount listed in He-M 406.03(c) above;

 

(4)  Is no longer eligible on the date his or her name is removed from the wait list to receive the subsidy;

 

(5)  Fails to pay their portion of rent for at least three consecutive months;

 

(6)  Has received two or more eviction notices based on the individual’s conduct; or

 

(7)  Commits an act of bodily harm, or makes threats of bodily harm toward department or program staff that requires intervention of law enforcement.

 

          (b)  The department shall provide 30 days advance notice of the termination in writing. If a person is being terminated pursuant to He-M 406.08 (a)(7) and there is risk to those threatened or endangered if the bridge subsidy is not immediately suspended, the 30 day notice shall be waived.

 

          (c)  An individual shall not be terminated from the program if he or she is eligible for services under He-M 401, but chooses not to receive mental health or housing support services.

 

Source.  #11191, eff 9-27-16

 

          He-M 406.09  Appeals.

 

          (a)  Persons may request a hearing regarding termination, denial of an eligibility accommodation, or to contest the amount of the subsidy as calculated pursuant to He-M 406.06(e) above.

 

          (b)  Appeals shall be submitted, in writing, to the department in care of the office of client and legal services within 30 days following the date of the notification of denial or termination of services, or amount of subsidy as calculated.

 

          (c)  The office of client and legal services shall immediately forward the appeal to the department’s administrative appeals unit (AAU) which shall assign a presiding officer to conduct a hearing or independent review, as provided in He-C 200.

 

          (d)  If a hearing is requested, the following actions shall occur:

 

(1)  Services and payment shall be continued until the decision is made; and

 

(2)  An expedited hearing shall be scheduled as provided in He-C 200.

 

Source.  #11191, eff 9-27-16

 

          He-M 406.10  Waivers.

 

          (a)  An applicant, community mental health program, facility, or the transitional housing services program, may request a waiver of specific rules in this part, in writing, from the department.

 

          (b)  A request for waiver shall include:

 

(1)  A specific reference to the section of the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternative provisions or procedures proposed.

 

          (c)  No provision or procedure prescribed by statute shall be waived.

 

          (d) A request for waiver shall be granted if the commissioner determines that the alternatives proposed meet the objective or intent of the rule and either:

 

(1)  Do not negatively impact the health or safety of the individual; or

 

(2)  Are administrative in nature, and do not affect the quality of individual care.

 

Source.  #11191, eff 9-27-16

 

PART He-M 407 - RESERVED

 

PART He-M 408  CLINICAL RECORDS

 

Statutory Authority:  New Hampshire RSA 135-C:5, I(e); RSA 135-C:61, III

 

          He-M 408.01  Purpose.  These rules establish the required components of the clinical records maintained by community mental health programs and their subcontracted service providers for persons eligible to receive state-funded services pursuant to RSA 135-C:13 and He-M 401 and identify the contents of those components.

 

Source.  #2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83

 

New.  #3051, eff 7-8-85, EXPIRED: 7-8-91

 

New.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.02  Definitions.

 

          (a) “Case manager” means the person employed by the community mental health program who provides targeted case management services in accordance with He-M 426.

 

          (b) “Clinical record” means the cumulative documents, collected and preserved, containing information relative to the care and treatment of each individual.

 

          (c)  “Commissioner” means the commissioner of the department of health and human services, or his or her designee.

 

          (d)  “Community mental health program (CMHP)” means a program operated by the state, city, town, or county, or a community-based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

 

          (e)  “Credentials” means the abbreviation of one’s academic degree and title as it pertains to the person’s role in providing services to an individual.

 

          (f)  “Department” means the department of health and human services.

 

          (g) “Electronic clinical record” means the cumulative documents collected and preserved by the CMHP and containing information relative to the health record of an individual’s care and treatment in digital format.

 

          (h)  “Electronic prescribing” means a prescriber’s ability to electronically send an accurate, error-free, and understandable prescription directly to a pharmacy from the point-of-care.

 

          (i)  “Electronic signature” means a computer data compilation of any symbol or series of symbols executed, adopted, or authorized by an individual to be the legally binding equivalent of the individual’s handwritten signature.

 

          (j)  “Facility” means New Hampshire hospital or a community receiving facility designated pursuant to RSA 135-C:26 and He-M 405, or an acute psychiatric residential treatment program.

 

          (k)  “Family member” means the parent, foster parent, legal guardian, child, brother, sister, spouse, significant other, grandparent, grandchild, stepparent, aunt, uncle, or first cousin of the individual.

 

          (l)  “Goals” means long-term, observable, desired accomplishments or changes to be achieved by an individual.

 

          (m)  “Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or the parent of an individual under the age of l8 whose parental rights have not been terminated or limited by law.

 

          (n) “Individual” means a person who is receiving or applying for a service from a program or community residence.

 

          (o)  “Individual service plan (ISP)” means a written document that:

 

(1)  Is developed annually as the result of a service planning process pursuant to He-M 401; and

 

(2)  Includes the identification of the individual’s:

 

a.  Goals and objectives;

 

b.  Treatments and services; and

 

c.  Criteria for achieving the stated goals.

 

          (p)  “Licensed practitioner of the healing arts” means a person who meets the qualifications and provides psychotherapy or other services identified pursuant to He-M 426.

 

          (q)  “Medical necessity” means that the services and supports provided to an individual are:

 

(1)  Consistent with the generally accepted clinical practice for diagnosis and treatment of the symptoms of mental illness or serious emotional disturbance;  

 

(2)  The most efficient and economical that can be safely provided, as prescribed by a physician; and

 

(3)  Not solely for the convenience of the individual or the providers.

 

          (r)  “Mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401 and who has at least one of the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), available as listed in Appendix A:

 

(1)  Schizophrenia spectrum and other psychotic disorders except for the following:

a.  Schizotypal personality disorder:

b.  Substance or medication induced psychotic disorder; and

c.  Psychotic disorder due to another medical condition:

(2)  Bipolar and related disorders except for the following:

a.  Substance or medication induced bipolar and related disorder; and

b.  Bipolar disorder and related disorder due to another medical condition;

(3)  Depressive disorders except for the following:

a.  Disruptive mood dysregulation disorder;

b. Premenstrual dysphoric disorder;

c. Substance or medication induced depressive disorder; and

d.  Depressive disorder due to another medical condition;

(4)  Borderline personality disorder;

(5)  Panic disorder;

(6)  Obsessive compulsive disorder;

(7)  Post-traumatic stress disorder;

(8)  Bulimia nervosa;

(9)  Anorexia nervosa;

(10)  Other specific feeding or eating disorders;

(11)  Unspecified feeding or eating disorders; and

(12)  Major neurocognitive disorders where psychiatric symptom clusters cause significant functional impairment and one or more of the following symptom categories are the focus of psychiatric treatment:

a.  Anxiety;

b.  Depression;

c.  Delusions; and

d.  Hallucinations.

 

          (s) “Objectives” means short-term, desired accomplishments designed to assist the individual in achieving the long-term goals identified on the individual service plan.

 

          (t)  “Person-centered” means that individuals receiving mental health services are the center of the system of care, and their needs and direction drive the care and services provided.

 

          (u)  “Rehabilitation” means the reinstatement of a former level of functioning or achieving a higher level of functioning than existed on admission to a program or residence through the provision of therapy, education, and activities as specified in the individual service plan.

 

          (v)  “Residential program” means a non-facility based residence for the care and treatment of people with a mental illness.

 

          (w)  “Serious emotional disturbance” means severe mental disability in persons from birth to age 18 who currently, or at any time within the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified with the DSM-5, that resulted in functional impairment, which substantially interfered with or limited the child’s role or functioning in the family, school, or community activities. This definition excludes substance abuse disorders and conditions due to another medical condition or substance ormedication induced disorders.

 

          (x)  “Service planning process” means the annual review conducted in accordance to He-M 401 to develop or revise an individual service plan.

 

          (y)  “Suspension” means a time limited, specific withholding of any available service(s) from an individual for well-defined and documented reasons and pursuant to He-M 401.

 

          (z)  “Termination” means the cessation for an indefinite period of all services to an individual in accordance with He-M 401.

 

          (aa)  “Treatment” means the examination, assessment, diagnosis, training, rehabilitation therapy, pharmaceuticals and other services provided to individuals within the mental health service system, excluding examination or diagnosis for the purpose of determining the need for involuntary emergency admissions pursuant to RSA 135-C:27-33 or involuntary admissions pursuant to RSA 135-C:34-54.

 

Source.  #2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83

 

New.  #3051, eff 7-8-85, EXPIRED: 7-8-91

 

New.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.03  Establishment of the Clinical Record.

 

          (a)  Each community mental health and residential program shall have a written clinical records policy that:

 

(1)  Outlines the content, maintenance, and monitoring requirements for its clinical records in both paper and electronic formats;

 

(2)  Addresses the completeness, accuracy, and timeliness of documentation;

 

(3)  Addresses confidentiality;

 

(4)  Stipulates how and when individuals may access their own records;

 

(5)  Addresses electronic signatures; and

 

(6)  Addresses electronic prescribing procedures.

 

          (b)  Every individual shall have a clinical record that meets the requirements of He-M 408 and the program’s policy.

 

          (c)  The clinical record shall be:

 

(1)  Accessible to staff providing services;

 

(2)  Accessible to the individual or the parent or guardian if the individual is a minor or legally incompetent, unless otherwise prohibited by law; and

 

(3)  Available for supervisory and quality assurance activities conducted by the CMHP or the department of health and human services’ bureau of mental health services.

 

          (d)  If an individual, his or her guardian, an attorney or other advocate representing the individual, after review of the record, requests copies of the record, such copies in paper format, shall be made available free of charge for the first 25 pages and not more than 25 cents per page thereafter. If available, copies of records electronically stored and produced, shall be made available free of charge for the first 25 pages and at actual cost per page thereafter. The individual, his or her guardian, attorney or other advocate representing the individual may choose whether to receive the record in paper form or, if available, in electronic form.

 

          (e)  Each documentation in the clinical record of a CMHP service shall include:

 

(1)  The signature of the service provider;

 

(2)  The service provider’s credentials;

 

(3) The legible name of the service provider including a typed name, name stamp, or printed name within proximity of the credentials and signature of the service provider;

 

(4)  The date of service; and

 

(5)  The date of documentation.

 

          (f)  Documentation shall not be altered or changed by erasure or masking, such as through the use of liquid correction fluid.  Corrections shall be made by drawing a line through the mistake.  All corrections shall be signed and dated by the person making the change. Corrections to entries made in the electronic medical record shall clearly show the correction that was made, and the date, time, and name of the person making the correction.

 

          (g)  Service documentation shall be completed prior to the service being billed.

 

          (h)  The individual or guardian shall document informed consent for all planned services except as otherwise prohibited by law or where emergency treatment is indicated pursuant to RSA 135:21-b.

 

          (i)  Clinical records shall be retained by a program or facility for 7 years after closure of a record for an adult and for 7 years beyond the age of 18 for a child.

 

          (j)  Subcontracted service providers shall comply with all the provisions of He-M 408.

 

Source.  #2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83

 

New.  #3051, eff 7-8-85, EXPIRED: 7-8-91

 

New.  #7281, eff 5-23-00, EXPIRED:  5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.04  Clinical Record Components.

 

          (a)  The clinical record shall be designed to:

 

(1)  Document the medical necessity for services provided;

 

(2)  Document the response to and effectiveness of services;

 

(3) Document the extent of coordination of care by system-wide providers and, when appropriate, with providers outside the mental health system; and

 

(4)  Provide documentation substantiating the delivery and appropriateness of services as required by He-M 401 and He-M 426.

 

          (b)  The clinical record shall include, at a minimum, the following components:

 

(1)  Intake and assessment information in accordance with He-M 408.06;

 

(2)  Demographic data in accordance with He-M 408.05;

 

(3)  Annual notification of an individual’s rights in accordance with He-M 309;

 

(4)  Documentation of eligibility determination in accordance with He-M 401;

 

(5)  Individual service planning documentation pursuant to He-M 401;

 

(6)  Individual service plan;

 

(7)  Documentation of service delivery and outcomes;

 

(8)  Suspension, transfer, and discharge notes, if applicable;

 

(9)  Documentation of ISP reviews;

 

(10)  Medication orders, laboratory results, and general health information;

 

(11)  Pertinent legal data;

 

(12)  Admission and discharge reports from mental health facilities and from other providers, when applicable; and

 

(13)  Targeted case management assessment and care plan pursuant to He-M 426, which shall include documentation of the following, when applicable:

 

a.  Identification of the individual’s targeted case management needs;

 

b.  The referral and monitoring activities to be provided; and

 

c.  An individual’s refusal to receive specific services in the care plan.

 

Source.  #2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83

 

New.  #3051, eff 7-8-85, EXPIRED: 7-8-91

 

New.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.05  Application and Demographic Data.

 

          (a)  Pursuant to He-M 401, an application for services shall be completed and signed by the individual or guardian at or before the intake interview.

 

          (b)  The following demographic data shall be collected and documented:

 

(1)  Name, address, and telephone number of the individual or applicant;

 

(2)  Date of application for services;

 

(3)  Date of birth of the individual or applicant;

 

(4)  Name, address, and telephone number of guardian, if applicable;

 

(5)  Financial information including:

 

a.  Insurance;

 

b.  Private resources; and

 

c.  Eligibility determinations for financial assistance from programs such as Supplemental Security Income, Aid to the Permanently and Totally Disabled, Medicare, Medicaid, and food stamps;

 

(6)  Emergency contact information;

 

(7)  Educational history;

 

(8)  Marital or civil union status;

 

(9)  Living situation;

 

(10)  Employment status and history;

 

(11)  Race, ethnicity, and primary language;

 

(12)  Gender;

 

(13)  Gender identification; and

 

(14)  Current legal involvement, such as:

 

a.  Probation or parole;

 

b.  Conditional discharge;

 

c.  Guardianship; and

 

d.  Any other court ordered involvement.

 

          (c)  Data collected in (b) above shall be reviewed and a hard copy signed by the individual at least annually and updated as needed.

 

Source.  #2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83

 

New.  #3051, eff 7-8-85, EXPIRED: 7-8-91

 

New.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.06  Intake Assessment.

 

          (a)  The CMHP shall complete and document an intake assessment for each individual.

 

          (b)  The intake assessment shall:

 

(1)  Include medical, psychiatric, and social information;

 

(2)  Include historical and current information and assessments; and

 

(3)  Serve as a basis for ISP development.

 

          (c)  The components of an intake assessment shall include, at a minimum;

 

(1)  Medical information including:

 

a.  A statement of the individual’s general physical health status;

 

b.  Medical history, including current weight, height, blood pressure, pulse, and smoking status;

 

c.  When applicable, medical diagnoses, and the results of any medical or neurological screenings, examinations, or tests; and

 

d.  The name and contact information for the individual’s primary care physician;

 

(2)  Psychiatric information including:

 

a.  History of mental illness or serious emotional disturbance, including onset and severity;

 

b.  Previous services and treatments, including medications and hospitalizations;

 

c.  Individual’s strengths;

 

d.  Illness self-management skills;

 

e.  Precipitating events for current psychiatric symptoms, as applicable;

 

f.  Documentation of the medical necessity for services;

 

g.  Current diagnosis;

 

h.  Medication orders;

 

i.  Current medications;

 

j.  Results of  formalized psychiatric and/or psychological tests, if applicable;

 

k.  Mental status examination results; and

 

l.  Diagnostic formulation by a psychiatrist or other licensed practitioner of the healing arts under the auspices of a psychiatrist licensed to practice in the state of New Hampshire; and

 

(3)  Social information including:

 

a.  Developmental history;

 

b.  Educational history and current status, if applicable;

 

c.  Family history and current family status;

 

d.  History of childhood abuse and  neglect;

 

e.  History of trauma, including domestic violence;

 

f.  Results of a substance use screening tool; 

 

g.  Employment history including work skills and types, and lengths of employment;

 

h.  Military history and veterans status, if applicable;

 

i.  Current living situation including type of environment and nature of relationship with any room/house mates or family;

 

j.  Social and leisure time activities and skills;

 

k.  Ability to develop and maintain friendships;

 

l.  Involvement with or history of involvement with other social service agencies or the criminal justice system;

 

m.  Guardianship, if applicable; and

 

n.  Other legal documents.

 

          (d)  Intake assessments that are completed to function as the initial ISP shall include the initial services to be provided and a physician’s signature.

 

          (e)  The intake assessment and updates shall be signed and dated by the person completing the assessment.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.07  Medication Orders.

 

          (a)  A complete list of all prescribed medications, laboratory testing, and, when applicable, dietary and other specific orders shall be maintained in the clinical record on the medication order sheet, and shall be visible and available within the electronic medical record.

 

          (b)  Medication order sheets or progress notes shall specify, at a minimum:

 

(1)  Date ordered;

(2)  Name, credentials, and signature of prescriber;

(3)  Medication name;

(4)  Medication dosage;

(5)  Amount dispensed;

(6)  An individual’s allergies;

(7)  Route of medication administration;

 

(8)  Medication frequency;

 

(9)  Medication start and stop dates;

 

(10)  Date medication expired or was discontinued;

 

(11)  Special instructions, if any;

 

(12)  Reason for pro re nata medication; and

 

(13)  Whether or not the individual has the cognitive ability to self-administer or control access to their medications, or both.

 

          (c)  At a minimum, a copy of each medication prescription shall be maintained in the clinical record for individuals who self-administer and control access to the individual’s own medications.

 

          (d)  Each time a medication is added or deleted or when a dosage is adjusted, the prescriber shall document the change, the reason for the change, and the individual’s ability to understand and follow the new orders.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.08  Individual Service Plan.

 

          (a)  The ISP shall be developed in accordance with He-M 401 and documented and maintained within the clinical record.

 

          (b)  The ISP shall be a comprehensive document which identifies:

 

(1)  Individual’s strengths, problems, and functional impairments due to the mental illness;

 

(2)  The treatment and rehabilitative goals and objectives; and

 

(3)  The services to be provided.

 

          (c)  The ISP shall be person-centered and written in a style and language that is understandable to the individual and other non-professionals.

 

          (d)  The ISP shall include:

 

(1)  The effective date of the plan;

 

(2)  The individual strengths;

 

(3)  Family strengths, as applicable;

 

(4)  The level and nature of family involvement;

 

(5)  Numbered goals and objectives;

 

(6)  Specific completion criteria for each objective;

 

(7)  The specific rehabilitative services and modalities to be used to achieve the desired goals and objectives;

 

(8)  The start and anticipated completion dates for each objective;

 

(9)  The specific services for each objective;

 

(10)  The frequency, duration, and purpose of each service;

 

(11)  The discipline of personnel that will provide each service;

 

(12)  A list of names of participants including their titles and/or relationship to the individual;

 

(13)  A crisis plan as defined in He-M 401; and

 

(14)  A projected schedule for completing reevaluations of the individual’s condition and updating the ISP.

 

          (e)  For those individuals whose ISPs indicate residential or supported housing services, plans shall include specific, measurable objectives to be achieved through the provision of these services.

 

          (f)  For those individuals whose ISPs indicate employment, an employment goal shall be indicated.

 

          (g)  For those individuals whose ISPs indicate wellness management, wellness goals and objectives shall be indicated.

 

          (h)  Prior to the implementation of the plan, a psychiatrist’s signature shall be required to indicate the medical necessity of the services to be provided.

 

          (i)  For individuals whose ISPs indicate “medication monitoring only” services, the physician shall enter in the ISP, at least quarterly, a comprehensive statement, indicating:

 

(1)  The continued medical necessity of “medication monitoring only” services; or

 

(2)  The need for additional services, and the initiation of the ISP planning processes as outlined in He-M 401.

 

          (j)  The clinical record shall include documentation indicating that the choices regarding the development of the ISP were explained to the individual or guardian pursuant to He-M 401.

 

          (k)  The clinical record shall include documentation of the decision of the individual or guardian regarding the method of ISP development pursuant to He-M 401.

 

          (l)  The clinical record shall include the signature of the individual or guardian indicating:

 

(1)  Involvement in the ISP development;

 

(2)  The receipt of a written copy of the ISP;

 

(3)  The explanation of the rights of the individual in accordance with He-M 309; and

 

(4)  The receipt of a written copy of the individual’s rights.

 

          (m)  Documentation of any amendments to the ISP shall include the signature of the individual and the physician.

 

          (n)  Documentation of the addition of new services to the ISP shall include the signature of a physician prior to the services being provided or billed.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.09  Documentation of Service Delivery.

 

          (a)  Progress notes shall be written for each:

 

(1)  Therapeutic face-to-face encounter;

 

(2)  Contact related to a crisis or change in health status; and

 

(3)  Activity related to assessment, monitoring, or referral.

 

          (b)  Progress notes shall document:

 

(1)  The therapeutic services provided;

 

(2)  The objective(s) in the ISP for which the service was provided;

 

(3)  The individual’s response to the service including progress towards objectives;

 

(4)  The date the service was provided;

 

(5)  The start and stop time of the service provided;

 

(6) The setting where the service was provided; and

 

(7)  The signature, credentials, and title of the person providing services.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.10  ISP Reviews.

 

          (a)  Timeframes identified in this section shall not replace any more frequent timeframes for reviews required by insurers or other agency or federal regulations.

 

          (b)  For each individual, the CMHP shall conduct and document a quarterly ISP review at least every 90 days from the effective date of the ISP.

 

          (c)  The quarterly review shall be based on the individual’s current status and progress, or lack thereof, in achieving the goals and objectives identified in the ISP, as documented in the progress notes for the reporting quarter.

 

          (d)  Documentation of the quarterly review shall include:

 

(1)  The time period covered by the review;

 

(2)  Description of the individual’s current functional impairments due to mental illness;

 

(3)  Any other clinically relevant information regarding changes in status during the reporting quarter;

 

(4)  Services received during the reporting quarter;

 

(5)  The individual’s progress toward achieving ISP goals and objectives during the reporting quarter and the reasons for failure, if any, to meet the goals or objectives;

 

(6)  Changes in the ISP during the reporting quarter;

 

(7)  A statement and a dated, physician’s signature indicating participation in the quarterly review and the medical necessity of services to be provided;

 

(8)  The date the documentation was completed and the signature and title of the person documenting the review; and

 

(9)  Indication of individual/family/guardian participation in the review including signatures and dates whenever possible.

 

          (e)  All signatures required in (d) above, shall be obtained within 90 days of the date of the completion of the quarterly review.

 

          (f)  The CMHP shall conduct and document the annual ISP as the fourth quarterly review in accordance with the requirements in He-M 408.08 and (d) above.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.11  Service Suspension and Termination Notes.

 

          (a)  All suspensions and terminations shall comply with the procedures identified in He-M 401.

 

          (b)  Whenever an individual has been suspended or terminated from a program or service, a note shall be entered into the clinical record and include:

 

(1)  If a suspension of services, the effective date and length of the suspension of services;

 

(2)  If a termination of services, the effective date of the termination of services;

 

(3)  The reason(s) for the suspension or termination;

 

(4)  The approval of the appropriate CMHP personnel; and

 

(5)  Documentation that notification of the suspension or termination has been provided to the individual.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.12  Discharge and Transfer Notes.

 

          (a)  For the purposes of this rule, “transfer” means when an individual moves from one treatment team to another within the same CMHP.

 

          (b)  For the purposes of this rule, “discharge” means when an individual discontinues treatment at a CMHP.

 

          (c)  A discharge/transfer note shall be entered into the clinical record:

 

(1)  Within 15 days after an individual’s discharge or transfer from a program; or

 

(2)  No later than the date of the next scheduled quarterly review.

 

          (d)  The discharge or transfer note shall consist of a summary which includes, at a minimum:

 

(1)  The reasons for admission;

 

(2)  Progress made by the individual while in the program;

 

(3)  The individual’s diagnosis;

 

(4)  The individual’s physical and mental status at time of discharge or transfer;

 

(5)  A brief service history and medication history;

 

(6)  A listing of the individual’s current medication(s);

 

(7)  The treating clinicians’ recommendations for further services and treatment including referrals, if indicated;

 

(8)  The reason(s) for discharge or transfer;

 

(9)  A statement that notification of the discharge or transfer was given to the individual; and

 

(10)  The prognosis.

 

          (e)  Discharge and transfer notes shall be available to other service providers with the permission of the individual.

 

          (f)  The discharge due to the death of an individual shall be documented and include:

 

(1)  The cause of death, when known;

 

(2)  The date and time of death; and

 

(3)  Results of an autopsy, when available.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.13  Confidentiality.

 

          (a)  Each agency and facility, other than state facilities, shall develop and implement a policy regarding the confidentiality, storage, and disposal of clinical records and the circumstances under which information may be released.

 

          (b)  Confidentiality policies shall conform with He-M 309.

 

          (c)  The individual’s written authorization for the release of information shall be maintained in the clinical record.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

          He-M 408.14  Waivers.

 

          (a)  A CMHP may request a waiver of specific procedures outlined in this part, in writing, from the department.

 

          (b)  A request for a waiver shall include:

 

(1)  A specific reference to the section of the rule for which a waiver is being sought;

 

(2)  A full description of why a waiver is necessary; and

 

(3)  A full explanation of alternative provisions or procedures proposed by the CMHP.

 

          (c)  No provision or procedure prescribed by statute shall be waived.

 

          (d)  A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the CMHP meets the objective or intent of the rule and:

 

(1)  Does not negatively impact the health or safety of recipients; and

 

(2)  Does not affect the quality of CMHP services.

 

          (e)  Upon receipt of approval of a waiver request, the CMHP’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

 

          (f)  Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

 

          (g)  Those waivers which relate to the following shall be effective for the CMHP’s current certification period only:

 

(1)  Fire safety; or

 

(2) Other issues relative to health, safety or welfare of the individual that require periodic reassessment.

 

          (h)  A CMHP may request a renewal of a waiver from the department.  Such request shall be made at least 30 days prior to the expiration of a current waiver.

 

Source.  #7281, eff 5-23-00, EXPIRED: 5-23-08

 

New.  #9512 eff 7-9-09; ss by #12409, eff 10-24-17

 

PART He-M 409 through He-M 413 - RESERVED

 

PART He-M 414 - RESERVED

 

Source.  #2424, eff 7-13-83; ss by #3052, eff 7-8-85, EXPIRED: 7-8-91

 

PART He-M 415 - RESERVED

 

Source.  #2425, eff 7-13-83; ss by #3053, eff 7-8-85, EXPIRED: 7-8-91

 

PART He-M 416 - RESERVED

 

Source.  #2426, eff 7-13-83; ss by #3054, eff 7-8-85, EXPIRED: 7-8-91

 

PART He-M 417 - RESERVED

 

Source.  #2427, eff 7-13-83; ss by #3055, eff 7-8-85, EXPIRED: 7-8-91

 

PART He-M 418 - RESERVED

 

Source.  #2428, eff 7-13-83; ss by #3056, eff 7-8-85, EXPIRED: 7-8-91

 

PART He-M 419 - RESERVED

 

Source.  #4066, eff 6-3-86, EXPIRED: 6-3-92

 

PART He-M 420 - RESERVED

 

PART He-M 421 - RESERVED

 

Source.  #4450, eff 7-1-88; ss by #5226, eff 9-20-91; rpld by #6035, eff 5-18-95

 

PARTS He-M 422-424 - RESERVED

 

PART He-M 425  COMMUNITY MENTAL HEALTH REGIONS

 

Statutory Authority:  RSA 135-C:61, III, IV, XII

 

          He-M 425.01  Purpose.  The purpose of these rules is to designate the community mental health regions.

 

Source.  #4117, eff 8-22-86, EXPIRED 8-22-92

 

New.  #5582, eff 2-12-93, EXPIRED 2-12-99

 

New. #6951, eff 2-27-99; ss by #8821, eff 2-17-07, EXPIRED: 2-17-14

 

New.  #12523, eff 4-20-18

 

          He-M 425.02  Definitions.  The words and phrases in this rule shall mean the following:

 

          (a)  "Commissioner" means the commissioner of the department of health and human services.

 

          (b)  "Community mental health program (CMHP)” means a program operated by the state, city, town, or county, or a community based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

 

          (c)  "Region" means a geographic area designated in He-M 425.03 for the purpose of assigning primary responsibility for providing mental health services to the residents of certain communities.

 

Source.  #4117, eff 8-22-86, EXPIRED 8-22-92

 

New.  #5582, eff 2-12-93, EXPIRED 2-12-99

 

New. #6951, eff 2-27-99; ss by #8821, eff 2-17-07, EXPIRED: 2-17-14

 

New.  #12523, eff 4-20-18

 

          He-M 425.03  Designation of Community Mental Health Regions.

 

          (a)  Regions designated for the purpose of providing community mental health services shall be the 10 community mental health regions specified in table 425-1, which sets forth the numerical designation of the regions and lists towns and cities by region:

 

Table 425-1, TOWNS AND CITIES BY REGION

REGION 1

 

Albany

Dummer

Lisbon

Shelburne

Bartlett

Easton

Littleton

Stark

Bath

Eaton

Livermore

Stewartstown

Benton

Effingham

Lyman

Stratford

Berlin

Errol

Madison

Sugar Hill

Bethlehem

Franconia

Milan

Tamworth

Brookfield

Freedom

Monroe

Tuftonboro

Carrol

Gorham

Moultonboro

Wakefield

Chatham

Hart's Location

Northumberland

Warren

Clarksville

Haverhill

Ossipee

Waterville

Colebrook

Jackson

Piermont

Wentworth Location

Columbia

Jefferson

Pittsburg

Whitefield

Conway

Lancaster

Randolph

Wolfeboro

Dalton

Landaff

Sandwich

Woodstock

Dixville

Lincoln

 

 

 

REGION 2

 

Acworth

Dorchester

Langdon

Orford

Canaan

Enfield

Lebanon

Plainfield

Charlestown

Goshen

Lempster

Springfield

Claremont

Grafton

Lyme

Sunapee

Cornish

Grantham

Newport

Unity

Croydon

Hanover

Orange

Washington

 

REGION 3

 

Alexandria

Bristol

Groton

Plymouth

Alton

Campton

Hebron

Rumney

Ashland

Center Harbor

Holderness

Sanbornton

Barnstead

Ellsworth

Laconia

Thornton

Belmont

Gilford

Meredith

Tilton

Bridgewater

Gilmanton

New Hampton

Wentworth

 

REGION 4

 

Allenstown

Danbury

Hopkinton

Salisbury

Andover

Deering

Loudon

Sutton

Boscawen

Dunbarton

Newbury

Warner

Bow

Epsom

New Loudon

Weare

Bradford

Franklin

Northfield

Webster

Canterbury

Henniker

Pembroke

Wilmot

Chichester

Hill

Pittsfield

Windsor

Concord

Hillsboro

 

 

 

REGION 5

 

Alstead

Greenville

Nelson

Surry

Antrim

Hancock

New Ipswich

Swanzey

Bennington

Harrisville

Peterborough

Temple

Chesterfield

Hinsdale

Richmond

Troy

Dublin

Jaffrey

Rindge

Walpole

Fitzwilliam

Keene

Roxbury

Westmoreland

Francestown

Lyndeborough

Sharon

Wilton

Gilsum

Marlborough

Stoddard

Winchester

Greenfield

Marlow

Sullivan

 

 

REGION 6

 

Amherst

Hudson

Merrimack

Mont Vernon

Brookline

Litchfield

Milford

Nashua

Hollis

Mason

 

 

 

REGION 7

 

Auburn

Candia

Hooksett

Manchester

Bedford

Goffstown

Londonderry

New Boston

 

 

REGION 8

 

Brentwood

Greenland

Newfields

Portsmouth

Deerfield

Hampton

Newington

Raymond

East Kingston

Hampton Falls

Newmarket

Rye

Epping

Kensington

North Hampton

Seabrook

Exeter

Kingston

Northwood

South Hampton

Fremont

New Castle

Nottingham

Stratham

 

REGION 9

 

Barrington

Lee

Milton

Rolinsford

Dover

Madbury

New Durham

Somersworth

Durham

Middleton

Rochester

Strafford

Farmington

 

 

 

 

REGION 10

 

Atkinson

Derry

Pelham

Sandown

Chester

Hampstead

Plaistow

Windham

Danville

Newton

Salem

 

 

          (b)  The community mental health program approved for each region pursuant to He-M 403.11 shall be responsible for providing mental health services to the residents of the region.

 

Source.  #4117, eff 8-22-86, EXPIRED 8-22-92

 

New.  #5582, eff 2-12-93, EXPIRED 2-12-99

 

New. #6951, eff 2-27-99; ss by #8821, eff 2-17-07, EXPIRED: 2-17-14

 

New.  #12523, eff 4-20-18

 

PART He-M 426  COMMUNITY MENTAL HEALTH SERVICES

 

REVISION NOTE:

 

          Document #5433, effective 7-2-92, readopted with amendments Part He-M 426.  Document #5433 superseded all prior filings for the section in this Part.  The prior filings for former Part He-M 426 included the following documents:

 

                  #4313, eff 9-25-87

                  #4798, eff 4-24-90 Interim

                  #4921, eff 8-22-90

                  #5178, eff 7-19-91

 

          Document #5589, effective 2-25-93, and Document #5703, effective 9-17-93, superseded or amended different sections in He-M 426 after Document #5433 as noted in the source notes.

 

          Document #5971, effective 2-1-95, superseded or amended several sections in He-M 426.  Document #5971 also adopted a new section He-M 426.13 entitled "Case Management Services" and renumbered existing sections He-M 426.13 through He-M 426.20 as He-M 426.14 through He-M 426.21.  The source notes for He-M 426.14 through He-M 426.21 therefore now contain the filing history of rules which had been numbered He-M 426.13 through He-M 426.20 prior to Document #5971.

 

          He-M 426.01  Purpose.  The purpose of these rules is to describe the services provided by CMHPs and community mental health providers that are offered to persons eligible for services pursuant to He-M 401 and are reimbursable under the medicaid program.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98

 

New.  #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.02  Definitions.  The words and phrases in this rule shall mean the following:

 

          (a)  “Assertive Community Treatment (ACT)” means the evidence-based practice of delivering comprehensive and effective services to individuals by a multidisciplinary team primarily in their homes, communities, and other natural environments.

 

          (b)  “Acute episode” means a sudden, generally unexpected, debilitating, and precipitous event in a psychiatric disorder.

 

          (c)  “Advanced practice registered nurse (APRN)” means a registered nurse who is licensed as having specialized clinical qualifications as provided in RSA 326-B:18 and is certified in psychiatric mental health.

 

          (d)  “Affiliated agency” means an agency that provides mental health or related services to individuals served by a community mental health program and that coordinates services and service planning with the community mental health program.

 

          (e)  “Commissioner” means the commissioner of the department of health and human services.

 

          (f)  “Community mental health program (CMHP)” means a program operated by the state, city, town, or county, or a community based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

 

          (g)  “Community mental health provider” means a medicaid provider of community mental health services that has been previously approved by the commissioner to provide specific mental health services pursuant to He-M 426.

 

          (h)  “Competitive employment” means community-based employment at prevailing wage jobs, which reflect consumer preferences, strengths, and goals.  The term includes positions in mainstream settings that are part or full time for any number of hours and result in payment of the Federal Insurance Contributions ACT (FICA) tax.  The term refers to employment in which an individual earns the same pay and benefits as everyone else who holds the same position.  The term includes self-employment that results in, or has the potential to result in, payment of the Self-Employment Contributions Act Tax (SECA).  The term does not include employment that is set aside for mental health consumers or work that is controlled by a service agency.

 

          (i)  “Continuous treatment team” means a team of licensed practitioners of the healing arts and other mental health clinicians whose caseload is 12 or fewer individuals per direct service staff and who provide intensive treatment through an array of services to individuals who have mental illness and may have a history of substance abuse.

 

          (j)  “Covered services” means rehabilitative, treatment, and other community mental health services that are funded by the department and are available through CMHPs, community mental health providers, or agencies affiliated with such programs or providers.

 

          (k)  “Current Procedural Terminology” means a listing of descriptive terms and identifying codes for reporting and billing medical services and procedures, developed by the American Medical Association (AMA)  in 2007 CPT available as listed in Appendix A.

 

          (l)  “Department” means the New Hampshire Department of Health and Human Services.

 

          (m)  “Evidence-based practices” means mental health practices that have consistently demonstrated their ability to help consumers achieve desired outcomes in mental health service research trials, where such trials have been conducted by multiple researchers with similar outcomes.

 

          (n)  “Evidence-based supported employment (EBSE)” means the provision of vocational supports to individuals following the Supported Employment Evidence Based Practice Kit (2010), available as listed in Appendix A,   to ensure successful competitive employment in the community.

 

          (o)  “Facility” means New Hampshire hospital or a receiving facility designated pursuant to RSA 135-C:26 and He-M 405, Glencliff Home, or an acute psychiatric residential treatment program.

 

          (p)  “Functional support services” means medically necessary individual and group interventions that support optimal functioning and enhance resiliency, recovery, and integration in the community.

 

          (q)  “Family member” means the parent, foster parent, legal guardian, child, stepchild, brother, sister, spouse, significant other, grandparent, grandchild, stepparent, aunt, uncle, or first cousin of the individual.

 

          (r)  “Illness management and recovery (IMR)” means a specific set of services aimed at promoting recovery that are based on the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A.

 

          (s)  “Individual” means any person receiving or applying for services from a program or community residence.  The term includes client.

 

          (t)  “Individual service plan (ISP)” means a written proposal that:

 

(1)  Is developed annually as the result of a service planning process pursuant to He-M 401; and

 

(2)  Includes the identification of an individual’s:

 

a.  Goals and objectives;

 

b.  Treatments and services;

 

c.  Timelines for achieving the stated goals; and

 

d.  Referrals to other specialized health services when appropriate.

 

          (u)  “Individualized resiliency and recovery oriented services (IROS)” means the following set of services:

 

(1)  Illness management and recovery (IMR);

 

(2)  Supported employment (SE);

 

(3)  Crisis intervention;

 

(4)  Therapeutic behavioral services;

 

(5)  Family support; and

 

(6)  Medication support.

 

          (v)  “Institution for mental diseases (IMD)” means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.  Further, an institution is an IMD if its overall character is that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases.

 

          (w)  “Intensive partial hospitalization services” means clinically oriented programs designed to promote stabilization and rapid amelioration of the symptoms of any combination of acute or severe psychiatric disturbances.

 

          (x)  “Licensed practitioner of the healing arts” means a person who provides psychotherapy or other services identified pursuant to He-M 426 and meets the qualifications of He-M 426.08(h).

 

          (y)  “Long-term care” means services covered by Medicaid for Medicaid recipients who have been determined eligible pursuant to the criteria outlined in He-M 401.

 

          (z)  “Mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.05 through He-M 401.07 and who has at least one of the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as listed in Appendix A:

 

(1)  Schizophrenia spectrum and other psychotic disorders except for the following:

 

a.  Schizotypal personality disorder;

 

b.  Substance or medication induced psychotic disorder; and

 

c.  Psychotic disorder due to another medical condition;

 

(2)  Bipolar and related disorders except for the following:

 

a.  Substance or medication induced bipolar and related disorder; and

 

b.  Bipolar disorder and related disorder due to another medical condition;

 

(3)  Depressive disorders except for the following:

 

a.  Disruptive mood dysregulation disorder;

 

b.  Premenstrual dysphoric disorder;

 

c.  Substance or medication induced depressive disorder; and

 

d.  Depressive disorder due to another medical condition;

 

(4)  Borderline personality disorder;

 

(5)  Panic disorder;

 

(6)  Obsessive compulsive disorder;

 

(7)  Post traumatic stress disorder;

 

(8)  Bulimia nervosa;

 

(9)  Anorexia nervosa;

 

(10)  Other specific feeding or eating disorders;

 

(11)  Unspecified feeding or eating disorders; and

 

(12) Major neurocognitive disorders where psychiatric symptom clusters cause significant functional impairment and one or more of the following symptom categories are the focus of psychiatric treatment:

 

a.  Anxiety;

 

b.  Depression;

 

c.  Delusions;

 

d.  Hallucinations; and

 

e.  Paranoia.

 

          (aa)  “Natural support” means a reference to people in a variety of roles who are engaged in supportive relationships with people in recovery outside of behavioral health settings.  Examples of natural supports include family, friends, and other loved ones, landlords, employers, neighbors, or any other person who plays a positive, but non-professional, role in someone’s recovery.

 

          (ab)  “Not otherwise classified” means a category of covered CMHP services consisting of treatment or services rendered which do not meet the requirements of the procedures identified in He-M 426.07 - He-M 426.14 but meet the requirements identified pursuant to He-M 426.14(b).

 

          (ac)  “Nursing facility” means an institution as defined pursuant to He-E 802.01(s).

 

          (ad)  “Pre-admission screening and resident review (PASRR)” means procedures by which the department, in conformance with section 1919(b)(3)(F)(i) and (ii) of the Social Security Act, determines whether persons with mental illness who are applying for placement or currently residing in nursing facilities are in need of nursing facility level of service and, if so, whether they are in need of specialized services pursuant to He-M 1302.07.

 

          (ae)  “Peer support specialist” means CMHP staff who self-identify as having experience with a mental health or substance use condition and who chooses to become a service practitioner in the health care system.

 

          (af)  “Psychotherapy” means face to face clinical intervention or assessment and monitoring necessary to determine the course and progress of therapy that:

 

(1)  Is based on psychological treatment principles;

 

(2)  Has as its purpose the improvement of interpersonal and self-care skills, psychological understanding, or a change in behavior(s), or any combination of these;

 

(3)  Is provided by a professional qualified pursuant to He-M 426.08(h)-(l);

 

(4)  Is monitored through the clinical record; and

 

(5)  Is based on an ISP.

 

          (ag)  “Recipient” means an individual who is eligible for reimbursement of CMHP and community mental health provider services under the state medicaid program.

 

          (ah)  “Restorative partial hospitalization services” means evidenced informed services that address integrated health care goals and objectives and are intended to impact the person’s whole health status, improve physical and overall health status indicators, as these factors have an important impact the individual’s mental health, maximize a recipient’s strengths, increase his or her ability to function in his or her living environments, and lead to integration of the recipient into the community.

 

          (ai)  “Serious emotional disturbance (SED)” means severe mental disability in persons under the age of 18, and includes all psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 with the exception of developmental disabilities, intellectual disabilities, neurocognitive disorders, anti-social personality disorders, and and conditions “due to another medical condition.”

 

          (aj)  “State fiscal year” means the period of time extending from July 1 of one year through June 30 of the following year.

 

          (ak)  “Subcontractor” means an person or organization that enters into an agreement with a CMHP to receive payments from the CMHP for the delivery of medicaid funded mental health services described in an ISP.

 

          (al) “Transitional employment” means time-limited employment for the purpose of vocational assessment or training.

 

          (am)  “Unit” means a period of time during which services are rendered.  Where units refer to a specific length of time, units are reimbursed in whole units and time of service is rounded to the nearest whole unit.

 

          (an)  “Visit” means all services provided to a recipient per appointment or encounter with a provider.

 

          (ao)  “Work preparation” means interventions that assist in obtaining or maintaining competitive employment, and may include cues for social norms and activities of daily living (ADL).

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; amd by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff
4-13-07; ss by #9285, eff 9-30-08; ss by #9581, eff 10-24-09; amd by #12079, eff 12-29-16; ss by #12154, eff 3-28-17

 

          He-M 426.03  Recipient Eligibility.  All medicaid recipients who are not residents of an IMD shall be eligible to receive the services of CMHPs and community mental health providers when services are delivered in accordance with an ISP.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.04  Community Mental Health Providers.

 

          (a)  Community mental health providers approved prior to August 22, 1997 shall be authorized to continue to provide medicaid funded mental health services until the date of expiration of provider status as long as the provider:

 

(1)  Is in compliance with applicable rules;

 

(2)  The provider shall have a plan which describes:

 

a.  Methods for collaborative service planning and service delivery with the regional CMHP, including joint development and approval of an ISP for each individual;

 

b.  Service planning which includes the individual’s family members and other persons significant to the individual, to the extent that the individual wishes such persons to be involved;

 

c.  Service linkages so there is continuity of care between the community mental health provider and CMHP with minimal resource duplication; and

 

d.  Provision of 24 hour emergency services, which:

 

1.  Are contracted or provided directly by the community mental health provider or CMHP; and

 

2.  Include contingency plans for each individual; and

 

(3)  Maintains a quality assurance plan which shall:

 

a. Include quality assurance indicators to identify problems that impact directly or indirectly on individuals or on areas which influence individual care;

 

b. Provide for the development and monitoring of corrective action plans to correct identified problems or deficiencies, where such plans specify time frames and persons responsible for corrective action;

 

c. Specify how quality assurance findings are utilized in staff development and annual staff evaluations; and

 

d.  Allow the department to conduct announced or unannounced quality assurance reviews of the community mental health providers to assure that such services and programs are operated in accordance with the department’s rules, contract provisions, and the federally approved state plan mandated by Public Law 106-310.

 

          (b) Only CMHPs or their subcontractors shall be authorized to provide the medicaid funded community mental health services described in these rules.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff
9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

          He-M 426.05  Provider Participation.

 

          (a)  Providers of services shall provide sufficient privacy to maintain confidentiality of communication between recipient and staff members.

 

          (b)  CMHPs shall be staffed by a multidisciplinary team consisting of licensed practitioners of the healing arts in:

 

(1)  Psychiatry;

 

(2)  Psychology;

 

(3)  Psychiatric social work;

 

(4)  Psychiatric nursing; and

 

(5)  Mental health counseling.

 

          (c)  CMHPs shall have as a medical director a psychiatrist who is either board certified or eligible for application for certification according to the most recent regulations of the American Board of Psychiatry and Neurology, Inc., or its successor organization, to assume medical responsibility for all clinical diagnoses and treatment programs.  The medical director shall be at the CMHP a minimum of 20 hours per week.

 

          (d)  Services offered by CMHPs shall be overseen by a psychiatrist responsible for the individual’s care as documented in the ISP.

 

          (e)  An M.D. or APRN enrolled in a residency training program in psychiatry from a college or university accredited by an accrediting agency recognized by the U.S. Department of Education shall deliver services in accordance with his or her specific board of licensure.

 

          (f)  Providers of community mental health services shall have multidisciplinary staff conferences pursuant to He-M 401.12 to review the progress of current cases.  Each CMHP shall have a quality assurance program including utilization and peer review to evaluate the effectiveness of covered services as contained in He-M 426.04.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.06  Provider Limitations.

 

          (a)  The services listed in He-M 426.07 - He-M 426.17 shall be covered services, available under the medicaid program to all eligible medicaid recipients when provided by, or recommended by, a licensed practitioner of the healing arts pursuant to these rules.  Services identified in He-M 426.07 - He-M 426.17 may be provided by CMHPs.  Community mental health providers shall only provide those services identified in He-M 426.07 - He-M 426.17 for which they have received approval pursuant to He-M 426.04.

 

          (b)  Services provided in an inpatient hospital setting shall only be reimbursable through medicaid if provided by a legally qualified psychiatrist. Services provided in an IMD shall not be reimbursable.

 

          (c) Services recommended by a licensed practitioner of the healing arts shall be provided in accordance with department rules and state law.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98

 

New.  #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.07  Medication-Related Services.

 

          (a)  Administration of medication by injection shall:

 

(1)  Be a covered CMHP service;

 

(2)  Be performed by a physician, physician assistant, registered nurse, or licensed practical nurse licensed to practice in New Hampshire; and

 

(3)  Include administering intramuscular medication required for the treatment of a recipient’s mental illness.

 

          (b)  The service outlined in (a) above shall not include administration of oral medication, or medical analysis and review performed pursuant to a medication check.  Administration of medication by injection and medication check may be billed, using the respective billing codes, as part of the same visit.

 

          (c)  Nursing assessment and evaluation for the purpose of reviewing medication compliance, education and symptomatology shall be a covered service when provided by a registered nurse or licensed practical nurse. There shall be no more than one procedure billed per recipient per day.

 

          (d)  Brief office visit shall be a covered service when conducted for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental, psychoneurotic or personality disorders by physicians, physician assistants or APRNs within the purview of their respective professions. This service shall be billed in accordance with current procedural terminology.

 

          (e)  Pharmacological management, including prescription, use, and review of medication with no more than minimal medical psychotherapy conducted by physicians, physician assistants, or APRNs within the purview of their respective professions shall be a covered service.

 

          (f)  Brief office visits, nursing assessment and evaluation, or pharmacologic management shall not be billed for recipients on days during which the recipient is in attendance at a partial hospitalization program.  A nurse assessment and evaluation shall not be billable on the same day as a medication check.

 

          (g)  Comprehensive medication service for clozapine or clozaril management shall be a covered service provided by a physician, physician assistant, APRN, registered nurse, or licensed practical nurse within the purview of their respective profession to prescribe, monitor the effects of, review, or adjust prescribed clozapine or clozaril.  Treatment may be provided up to a maximum of once per day, when a documented drop in the individual’s white blood cell count (WBC) occurs.

 

          (h) Comprehensive medication service for clozapine or clozaril management shall include the following:

 

(1)  Ensuring that the required blood sample is drawn;

 

(2)  Ensuring that the WBC is within established limits;

 

(3)  Recording the WBC;

 

(4)  Sending the results of the WBC to the prescribed clozapine or clozaril monitoring system;

 

(5)  Writing the prescription for clozapine or clozaril as appropriate;

 

(6)  Ensuring that the individual is provided with a supply of clozapine or clozaril as appropriate; and

 

(7)  Signature by a physician, physician assistant, or APRN.

 

          (i)  Medication services described in (c) through (f) above shall be limited to one service per day and shall not be billed on the same day as any other service described in (c) through (f) above.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.08  Psychotherapeutic Services.

 

          (a)  Individual psychotherapy shall:

 

(1)  Be a covered CMHP service;

 

(2)  Include therapy, crisis intervention, or assessment and monitoring necessary to determine the course and progress of therapy or to stabilize an individual experiencing an acute psychiatric episode; and

 

(3)  Be verbal, with the therapist in direct, personal, involvement with the recipient to the exclusion of other recipients, individuals, and duties.

 

          (b)  Individual psychotherapy shall be billed in accordance with current procedural terminology. Individual therapy with medication management shall be billed as one procedure when delivered during the same visit.

 

          (c)  Group psychotherapy per person shall:

 

(1)  Be a covered CMHP service; and

 

(2)  Be therapy, or assessment and monitoring necessary to determine the course and progress of therapy, that is performed in a direct, personal, involvement with the recipient in a setting with other recipients or individuals.

 

          (d)  Group psychotherapy shall be billed in accordance with current procedural terminology.

 

          (e)  Group psychotherapy shall meet the following criteria:

 

(1)  A minimum of 2 unrelated recipients and a maximum of 10 recipients shall be in attendance to constitute a group;

 

(2)  Sessions shall be scheduled often enough to provide effective treatment consistent with the ISP;

 

(3)  The group focus shall be face-to-face dialogue of a verbal rather than performance nature; and

 

(4)  Individual progress notes for each session shall be recorded in each recipient’s record with specific attention directed toward goal achievement as stated in the recipient’s ISP.

 

          (f)  Family therapy shall be:

 

(1)  A covered service; and

 

(2)  Psychotherapy with:

 

a. The primary identified recipient and that recipient’s natural or surrogate family member(s); or

 

b.  The natural or surrogate family member(s) without the recipient present. 

 

          (g)  Billing for family therapy shall be as follows:

 

(1)  Only one family member’s medicaid identification number shall be billed regardless of the eligibility of other members or their inclusion in the problem;

 

(2)  If a child who has been determined eligible for services pursuant to He-M 401 is the primary reason for the family to be receiving therapy, then that child’s medicaid identification number shall be used when billing for services;

 

(3)  If the primary recipient is not present but continues to be the focus of the therapy, that recipient’s medicaid identification number shall be used when billing for services and the reason why the recipient was not present shall be documented; and

 

(4)  This procedure shall be billed in accordance with current procedural terminology.

 

          (h)  For the purpose of providing psychotherapy without supervision, clinical staff of CMHPs or providers shall meet the applicable following minimum qualifications:

 

(1)  Psychiatrists shall meet the requirements of RSA 135-C:2, XIII;

 

(2)  Psychologists shall be licensed in accordance with RSA 329-B;

 

(3)  Pastoral psychotherapists shall be licensed in accordance with RSA 330-A:17;

 

(4)  Marriage and family therapists shall be licensed in accordance with RSA 330-A:21;

 

(5)  Clinical mental health counselors shall be licensed in accordance with RSA 330-A:19;

 

(6)  Clinical social workers shall be licensed in accordance with RSA 330-A:18; and

 

(7)  Nurses shall be registered as required by RSA 326-B:6 and have a master’s degree in psychiatric nursing or be licensed as an advanced registered nurse practitioner (APRN) with a psychiatric mental health specialty in accordance with RSA 326-B:11.

 

          (i)  Except as provided pursuant to (k) and (m) below, anyone providing psychotherapy services who does not meet the established standards as indicated in (h) above shall:

 

(1)  Have completed at least one year of work in the field of psychiatric or mental health services under the supervision of a psychiatrist, doctoral level psychologist or a licensed mental health professional or person authorized pursuant to RSA 329-B:28, I(e); and

 

(2)  Have at least a master’s degree in marriage and family therapy, psychology, social work, rehabilitation counseling, or education/counseling from a college or university accredited by an accrediting agency recognized by the U.S. Department of Education; or

 

(3)  Be a registered nurse with a certificate in mental health nursing from the American Nurses’s Association.

 

          (j) Persons who qualify to provide psychotherapy pursuant to (i) above shall have ongoing supervision of at least 2 hours per month.  There shall be direct individual or group supervision of at least one hour per month by a licensed practitioner of the healing arts.  The second hour may be peer review or case review, such as client centered conferences.  Direct supervision shall occur when the supervisor meets with the clinician to review his or her clinical practice in order to evaluate his or her performance.

 

          (k)  Persons who are enrolled in formal internships in a professional field of study of mental health services and provide psychotherapy services shall:

 

(1)  Be enrolled in at least a master’s degree program in psychology, social work, rehabilitation counseling, education/counseling, or nursing at a college or university accredited by an accrediting agency recognized by the U.S. Department of Education; or

 

(2)  Be enrolled in a doctoral or post-doctoral program at a college or university accredited in psychology by an accrediting agency recognized by the U.S. Department of Education.

 

          (l)  Persons providing psychotherapy pursuant to (k) above shall receive direct supervision of at least one hour per week from a licensed practitioner of the healing arts, appropriate to the intern’s field of study.  The medicaid program shall reimburse CMHPs and community mental health providers only when supervision occurs and is documented.  Direct supervision shall occur when the supervisor meets with the intern to review his or her clinical practice in order to evaluate his or her performance.  The supervisor shall write and sign a weekly note in the intern’s supervisory record stating his or her observations and recommendations relative to the intern’s performance, and a monthly note summarizing his or her evaluation.

 

          (m)  Pursuant to RSA 135-C:3, persons providing medicaid reimbursed psychotherapy services in approved CMHPs prior to July 1, 1987, the initial effective date of He-M 426, shall be considered to have met the standards for other providers of psychotherapy set forth in (i) above and shall be supervised in accordance with the applicable requirements in (j) above.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.09  Emergency Services.

 

          (a)  Emergency services shall be:

 

(1)  Covered CMHP services;

 

(2)  Face to face interventions for the purposes of:

 

a.  Reducing a recipient’s acute psychiatric symptoms;

 

b.  Reducing the likelihood of the recipient harming self or others; or

 

c.  Assisting the recipient to return to his or her pre-crisis level of functioning; and

 

(3)  Conducted with the therapist in direct, personal, involvement with the recipient and at the recipient’s request, natural and surrogate family members.

 

          (b)  Emergency services shall be available 24 hours a day, 7 days per week and be accessible to individuals anywhere in the region served by the CMHP.

 

          (c)  As follow-up to the initial emergency response, an individual shall be eligible to receive a maximum of 5 emergency service sessions, consisting of not more than 6 15-minute units per session, for the purpose of stabilization of the emergency situation prior to intake or referral to another service or agency.

 

          (d)  Emergency services shall be billed in 15-minute units, and shall be limited to 6 units per recipient per day to a maximum of 6 sessions per period of acute psychiatric crisis.

 

          (e)  Emergency services shall be provided by staff of discrete emergency services programs or other staff serving as part of a formalized emergency services rotation.

 

          (f)  Emergency assessment shall be provided for the purpose of emergency evaluation for hospital placement, crisis respite care, revocation of conditional discharge, or other out-of-home placement.

 

          (g) The providers of emergency assessment shall meet the qualifications established in He-M 426.08(h)-(m).

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98

 

New.  #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.08); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.10  Evaluations and Testing.

 

          (a)  Psychiatric diagnostic interview exam shall include:

 

(1)  History of present illness;

 

(2)  Mental status examination; and

 

(3)  Disposition.

 

          (b)  Psychiatric diagnostic interview exam shall:

 

(1)  Be a covered CMHP service when conducted by staff meeting qualifications as outlined in He-M 426.08(h)-(k);

 

(2)  Be billed for the initial intake service;

 

(3)  Be billed as one event;

 

(4)  Be billed in accordance with current procedural terminology; and

 

(5)  Be co-signed by a licensed supervisor when completed by CMHC staff qualified pursuant to He-M 426.08 (i)-(l).

 

          (c)  Evaluation and management shall include:

 

(1)  History of present illness;

 

(2)  Examination; and

 

(3)  Medical decision-making.

 

(d)  Evaluation and management shall:

 

(1)  Be a covered CMHP service;

 

(2)  Be billed as one event; and

 

(3)  Be billed in accordance with current procedural terminology.

 

          (e)  Psychological testing shall be a covered CMHP service and consist of psychometric or projective tests, or both, with a written report.  This procedure shall be billed per hour and be limited to 6 hours per recipient per 6 month period.

 

          (f)  Neuropsychological tests shall be evaluations that are:

 

(1)  Designed to determine the functional consequences of known or suspected brain injury through testing of the neurocognitive domains responsible for language, including:

 

a.  Perception;

 

b.  Memory;

 

c.  Language;

 

d.  Problem solving;

 

e.  Adaptation; and

 

f.  Constructional praxis; and

 

(2)  Carried out on persons who have suffered neurocognitive effects of medical disorders that impinge directly or indirectly on the brain.

 

          (g)  Neuropsychological tests shall be billed per hour and be limited to 6 hours per recipient per 6 month period.  Persons licensed by state statute to provide psychological services shall provide this service. 

 

(h)  Neuropsychological testing may be performed by persons enrolled in formal internship in a professional field of study of psychology or neuropsychological testing if they are enrolled in a doctoral or postdoctoral program at a college or university accredited in psychology by an accrediting agency recognized by the U.S. Department of Education.

 

          (i)  Persons providing neuropsychological testing pursuant to (h) above shall receive direct supervision of at least one hour per week from a person licensed by state statute to provide psychological services:

 

(1)  Direct supervision shall occur when the supervisor meets with the intern to review his or her neurological testing practice in order to evaluate his or her performance;

 

(2)  The supervisor shall write and sign a weekly note in the intern’s supervisory record stating his or her observations and recommendations relative to the intern’s performance;

 

(3)  The supervisor shall write and sign a monthly note summarizing his or her evaluation; and

 

(4)  The person shall meet the supervision requirements relative to meeting his or her internship requirements, if applicable.

 

(j)  The medicaid program shall reimburse CMHPs and community mental health providers only when supervision occurs and is documented.

 

          (k)  PASRR evaluations shall be covered CMHP services and include psychiatric evaluations and related services to determine appropriateness for nursing home placement.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.09);ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.11  Partial Hospitalization Services.

 

          (a)  Partial hospitalization shall be a covered service and shall consist of intensive partial hospitalization services and restorative partial hospitalization services as described in (e) and (f) below.

 

          (b)  Only individuals certified to receive long-term care services pursuant to He-M 426.19 shall be eligible for partial hospitalization services.

 

          (c)  Programs shall operate a minimum of 6 hours per day on weekdays and 4 hours per day on holidays and weekends for each day for which services are billed.

 

          (d)  Billing for partial hospitalization services shall be in half day or full day units, as follows:

 

(1)  One half day of partial hospitalization shall be attendance at staff directed programs for at least 2 and less than 3 hours; and

 

(2)  A full day of partial hospitalization shall be attendance at staff directed programs for 3 or more hours.

 

          (e)  Intensive partial hospitalization services shall be provided as follows:

 

(1)  Placement into intensive partial hospitalization shall be made only with a written order from a psychiatrist, and be based on symptoms affecting the recipient’s ability to function adequately in a community setting;

 

(2)  Intensive partial hospitalization shall be offered no fewer than 5 days per week and be designed to provide short-term, structured, and active treatments which are problem-solving in nature and which are directed toward full or partial recovery from the prevailing crisis and the return of the recipient to a pre-crisis level of functioning;

 

(3)  The provision of intensive partial hospitalization services shall be based on identified recipient needs as documented in the recipient’s ISP;

 

(4)  Intensive partial hospitalization services shall include:

 

a.  Individual or group psychotherapy;

 

b.  Psychological evaluations and testing;

 

c.  Medication monitoring, evaluation, administration, and education;

 

d.  Clinical assessments to assist in individual service planning;

 

e.  Family or significant other psychotherapy; and

 

f.  Psychologically supportive individual or group activities. 

 

(5)  The daily services and activities of an intensive partial hospitalization program shall consist of:

 

a.  A minimum of 2 hours per day of any combination of activities contained in (e)(4)a. - e. above; and

 

b.  The remainder of the day may consist of activities contained in (e)(4)f. above;

 

(6)  Participation in this program shall not exceed 20 treatment days per acute episode without a written order from a psychiatrist and a documented service plan review; and

 

(7)  There shall be no reimbursement from medicaid for any treatment exceeding 30 days per episode, or 90 days per state fiscal year.

 

          (f)  Restorative partial hospitalization shall be provided as follows:

 

(1)  Services shall encourage the development of those skills necessary for transfer to a variety of community living environments, including employment settings, and, as much as possible, reduce a recipient’s dependency on state or federally funded programs while enabling the recipient to become a productive member of society, earn a wage, and live as independently as possible;

 

(2)  Placement and participation in restorative partial hospitalization services shall be based on the needs of the recipient as documented in the ISP and functional deficits identified in the eligibility determination process pursuant to He-M 401;

 

(3)  Restorative treatment shall:

 

a.  Promote emotional, behavioral, physical health, and psychological change;

 

b.  Minimize the effects of mental disorders;

 

c.  Promote health maintenance through clinical activities which foster the reduction of psychological stress;

 

d.  Promote independent living;

 

e.  Help maintain the individual in a community setting;

 

f.  Teach skills necessary for an individual to function in the environments in which he or she lives and works; and

 

g.  Utilize accepted principles of psychosocial rehabilitation;

 

(4)  Restorative partial hospitalization services shall consist of the following components:

 

a.  A comprehensive identification of the recipient’s skills, strengths, and deficits in relation to the skill demands and supports required in the particular environment in which the recipient wants or needs to function, as such environment is consistent with the goals listed in the individual’s ISP;

 

b.  Active recipient involvement which requires that assessment and intervention procedures be explained to and understood by the recipient;

 

c. Teaching of skills necessary for the recipient to succeed in his or her chosen environments;

 

d.  A crisis management plan which shall serve to avert crises or mobilize resources rapidly to respond to crises and be implemented by intensive partial hospitalization services staff, emergency services staff, or other appropriate staff within the CMHP; and

 

e.  Case management to assure linkage with all necessary services and people involved in the recipients’ care, coordinated service planning, and monitoring of progress toward goals;

 

(5)  Restorative partial hospitalization services shall include the following services:

 

a.  Individual or group counseling and psychotherapy;

 

b.  Medication monitoring, evaluation, administration, and education;

 

c.  Family or significant other services, counseling, and psychotherapy;

 

d.  Teaching daily living skills, community living skills, and self-care skills;

 

e.  Nutritional services;

 

f.  Basic education;

 

g.  Recreational services;

 

h.  Psychological evaluations and testing; and

 

i.  Psychologically supportive individual or group activities;

 

(6)  Recreational activities such as bowling, swimming, and field trips shall be billable only when they are adjunct to, but not the only component of, the restorative partial hospitalization service; and

 

(7)  Medicaid reimbursement for restorative partial hospitalization services shall not be made for a recipient for any day in which the recipient receives fewer than 2 hours of service, exclusive of recreational activities, unless in a given week the average per day participation in non-recreational activities exceeds 2 hours per day of service to the recipient.

 

          (g)  In addition to requirements listed in (e) and (f) above, reimbursement criteria for intensive and restorative partial hospitalization services shall include the following:

 

(1)  Out-of-facility activities shall be covered under the following circumstances:

 

a.  The activities shall be directed by the partial hospitalization staff as part of a program based in the CMHP; and

 

b.  Stipends shall not be paid to recipients of partial hospitalization services in connection with the activities;

 

(2)  The medicaid rate for partial hospitalization shall be all inclusive;

 

(3)  On a day that a recipient receives partial hospitalization services, no reimbursement for other covered services shall be made except as allowed in (4) below;

 

(4)  The following services shall be reimbursable on any day that a recipient receives partial hospitalization services:

 

a.  Case management services when provided under an approved case management option of the medicaid program;

 

b. Emergency visits if they occur outside of the normal operating hours of the partial hospitalization program;

 

c.  Services provided by an assertive community treatment  team;

 

d.  Individualized resiliency and recovery oriented services;

 

e.  Medication checks for clozaril and clozapine management;

 

f.  Psychiatric evaluation for medicaid eligibility; and

 

g. Services provided by a mobile crisis team, which is a multidisciplinary team that provides crisis stabilization and case management services as an alternative to hospitalization.

 

(5)  Services provided on a day the recipient did not attend partial hospitalization shall be billed in the normal manner for the service; and

 

(6) Reimbursement for partial hospitalization services shall be limited to services for outpatients.

 

          (h)  Staff who provide partial hospitalization services shall meet the following criteria:

 

(1)  A partial hospitalization program shall employ a partial hospitalization supervisor who performs the following duties:

 

a.  Supervises all staff of the partial hospitalization program;

 

b.  Provides program administration; and

 

c. Ensures partial hospitalization services are coordinated with other services to assure continuity of recipient service; and

 

(2)  The supervisor of partial hospitalization services shall minimally have:

 

a.  Full time employment equaling 3 years’ experience in programs for persons with long term mental illness;

 

b.  One year of supervisory, management, or administrative experience; and

 

c.  A baccalaureate degree in social work, rehabilitation, psychology, education, or a related human services field.

 

          (i)  Each staff person providing partial hospitalization services shall at a minimum have:

 

(1)  Either:

 

a. A baccalaureate degree in social work, rehabilitation, psychology, education, or a related human services field; or

 

b.  An associate’s degree in social work, rehabilitation, psychology, education, or a related human services field and the following experience:

 

1.  Two years of experience working with persons who have severe mental disability; or

 

2.  Two years of experience that provides an person with an understanding of mental illness and that was acquired as an adult in the provision of significant supports to persons with mental illness, including the experience acquired by family members of persons with mental illness or by other persons who have personal knowledge of mental illness; and

 

(2)  Completed the training curriculum based on the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, if the staff will be providing IMR services.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.10); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.12  Individualized Resiliency and Recovery Oriented Services (IROS).

 

          (a)  IROS shall be a covered service and consist of:

 

(1)  Evidence-based practices delivered in accordance with the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, which describes the following services:

 

a.  Illness management and recovery (IMR), group;

 

b.  Illness management and recovery, individual; and

 

c.  Evidence-based supported employment (EBSE); and

 

(2)  Functional support services including the following:

 

a.  Crisis intervention;

 

b.  Group therapeutic behavioral services;

 

c.  Individual therapeutic behavioral services;

 

d.  Family support; and

 

e.  Medication support.

 

          (b)  IROS shall be provided in the individual’s current living, employment or educational situation. or other community setting taking into account the individual’s preferences.

 

          (c)  IROS provided in any office setting shall not exceed 1 hour per month, or 12 hours per state fiscal year with the exception of computer-based EBSE, IMR, crisis intervention, and medication support.

 

          (d)  IROS shall not be eligible for reimbursement if provided in an office setting with the exception of (c) above, with the exception of computer-based EBSE, IMR, crisis intervention and medication support.

 

          (e)  Only individuals eligible to receive long-term services pursuant to He-M 426.19 shall be eligible to receive IROS.

 

          (f)  Quality assurance reviews shall be as follows:

 

(1)  A sample of clinical records for recipients of IROS services shall be reviewed as part of a quality assurance review;

 

(2)  The purpose of this review shall be to determine whether documentation in the clinical record conforms with all requirements outlined in He-M 408 and He-M 426.12; and

 

(3) Fidelity review process utilizing the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A.

 

          (g)  IROS shall be face-to-face individual and group interventions that include the elements and objectives in (h)-(j) below. IROS shall be billed as a group intervention when 2 or more unrelated recipients are in attendance, not to exceed 10 participants.

 

          (h)  Illness management and recovery (IMR), delivered on an individual and group basis, shall:

 

(1)  Be based on the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, and ensure fidelity to that model;

 

(2)  Have as its objective teaching individuals with a mental illness, strategies for:

 

a.  Collaborating actively in their treatment with professionals;

 

b.  Reducing their risk of relapses and rehospitalizations;

 

c.  Reducing the severity and distress related to symptoms; and

 

d.  Improving their social support;

 

(3)  Include the following specific components, at a minimum:

 

a.  Psychoeducation about the nature of mental illness and its treatment;

 

b.  Behavioral tailoring to help individuals incorporate the taking of medications into their daily routines;

 

c.  Relapse prevention planning;

 

d.  Teaching coping strategies to manage distressing, persistent symptoms;

 

e.  Cognitive behavior therapy strategies for psychosis, depression, and bipolar disorder; and

 

f.  Social skills training;

 

(4)  Incorporate the following:

 

a. An assessment, identification, and documentation of the target symptom(s) or problem(s);

 

b.  The specification of the goals or desired outcomes; and

 

c.  The specific interventions that will be used to achieve the desired outcomes;

 

(5)  Be of a duration that allows the time necessary to complete the IMR curriculum; and

 

(6)  Be individual or group interventions that support recipients’ optimal functioning and enhance resiliency, recovery, and integration in the community.

 

(i)  Evidence-based supported employment (EBSE) shall:

 

(1)  Be based on the Supported Employment Evidence Based Practice Kit (2010) as, available as listed in Appendix A, and fidelity to that model;

 

(2)  Have as its objective the participation in competitive employment for individuals eligible under He-M 401;

 

(3)  Utilize a team approach inclusive of an employment specialist for treatment;

 

(4)  Include medicaid and non-medicaid funded services, funded in part by New Hampshire Vocational Rehabilitation;

 

(5)  Include the following specific components and criteria:

 

a. Support of an individual’s entry into or return to competitive employment on a permanent status, where potential applicants include persons in the general population;

 

b.  Full integration of SE staff with other CMHP staff;

 

c. Eligibility based primarily on consumer choice, where eligibility criteria such as the following shall be irrelevant:

 

1.  Job readiness;

 

2.  Lack of substance abuse;

 

3.  No history of violent behavior;

 

4.  Minimal intellectual functioning; and

 

5.  Mild symptoms;

 

d.  Supports for individuals that are:

 

1.  Provided on an ongoing basis;

 

2.  Not time limited; and

 

3.  Based on the individual’s continued need for services, as documented in the ISP;

 

e.  Vocational assessment which shall gather information about psychiatric history, symptoms, functional limitations, coping skills and strengths and how these affect the consumer’s employment history and daily functioning as it is relates to employment, and excludes competency testing, screening for exclusionary criterion, work readiness evaluations, vocational testing, interest inventories, situational assessments, and transitional employment;

 

f.  Job search support which shall assist an individual in managing symptoms so that they may develop a plan for approaching employers, identify personal preferences, identify and develop supports around work preparation, have individual outreach to employers, obtain support related to interviews, and include other interventions around meeting with other providers regarding benefits, work incentives, and other vocational supports; and

 

g.  Follow-along supports which shall include interventions, strategies, and prompts to assist individuals in managing their psychiatric symptoms as they affect employment and address the following:

 

1.  Managing social conflicts or challenges in the workplace;

 

2.  Managing symptoms that impact getting to and from employment;

 

3.  Managing work related income;

 

4.  Coordinating benefits and entitlement as impacted by work; and

 

5.  Improving ability to communicate on and off the job;

 

(6)  Be direct, active, face-to-face clinical interventions necessary for the individual to achieve the goals and objectives identified on the ISP;

 

(7)  Be individual interventions; and

 

(8)  Be delivered as a clinical service if they are directly related to an individual’s symptoms due to a mental illness which inhibits the individual from participating in or obtaining competitive employment.

 

          (j)  The individual’s treatment planning team shall include an EBSE specialist to assure services effectively address symptoms and challenges that prevent the individual from successfully achieving their employment goals.

 

          (k)  The EBSE components in(j)(5)e.-g. above shall not be a medicaid billable service when they, either:

 

(1)  Do not include the individual; or

 

(2)  Do not address symptoms related to an individual’s mental illness.

 

          (l)  Documentation of interventions for EBSE shall comply with He-M 408.09.

 

          (m)  Functional support services (FSS) shall be medically necessary individual or group interventions that shall:

 

(1)  Be direct, active, face-to-face clinical interventions necessary for the individual to achieve the goals and objectives identified on the ISP;

 

(2)  Actively engage the individual in planned and unplanned, therapeutic activities;

 

(3)  Be billed as an individual service when provided on a one-to-one basis;

 

(4)  Be billed as a group service when provided with 2 or more recipients present;

 

(5) Exclude activities that are social and recreational in nature without active clinical intervention;

 

(6)  Enhance resiliency, recovery, and integration in the community;

 

(7)  Support the restoration of an individual to the best possible functional level; and

 

(8)  Include interventions consisting of:

 

a.  Crisis intervention services, delivered on an individual basis, that:

 

1.  Are designed for individuals who are experiencing acute exacerbation of symptoms that increase the likelihood that the individual will harm himself, herself or others, or that imminently jeopardize the individual’s ability to remain in the community;

 

2.  Include continuous assessment and monitoring of safety and symptoms;

 

3.  Include family, friends, or significant others when appropriate; and

 

4.  Are delivered based on a direct benefit to the service recipient with each crisis intervention service specifically documented in the clinical record;

 

b.  Therapeutic behavioral services, delivered on an individual and group basis, that are specific and individualized interventions whose primary objective is to develop, reinforce and apply skills and strategies to ameliorate or reduce symptoms and behaviors that impede an individual’s ability to function in an age and developmentally appropriate manner and return the individual to an optimal level of functioning;

 

c.  Family support, delivered on an individual basis, that:

 

1. Consists of face-to-face, specific interventions provided to family members, caregivers, or significant others;

 

2.  Supports and maintains the management of the eligible recipient’s mental illness or serious emotional disturbance, and maintains the individual’s tenure in the community;

 

3.  Has as its primary objective the enhancement and promotion of the recipient’s resiliency and recovery;

 

4.  Includes assistance to the family member or caregiver, in delivering specific interventions to the individual to promote the goals and objectives identified in the individual service plan as required by He-M 401; and

 

5.  Is provided in accordance with the following:

 

(i)  The ISP shall specify who shall be present during the delivery of this service; and

 

(ii)  Family support services shall be delivered based on a direct benefit to the service recipient, and documented as such; and

 

d.  Medication support, delivered on an individual basis, that:

 

1. Is a specific and individualized intervention that is designed to support the individual in maintaining his or her medication regimen, as prescribed in the clinical record, as a strategy to promote effective management of his or her mental illness;

 

2.  Is modeled on the concept of “behavioral tailoring” which includes developing strategies for incorporating medication into the individual’s daily routine, as outlined in the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A;

 

3.  Is not billed when these interventions are delivered during the course of a routine or comprehensive medication check as outlined in He-M 426.07; and

 

4.  Includes the following as described in the Illness Management and Recovery Evidence Based Practice Kit (2010):

 

(i) Providing accurate information about medications for mental illness, including both their advantages and disadvantages;

 

(ii)  Providing an opportunity for recipients to talk openly about their beliefs about medication and their experience with taking various medications;

 

(iii) Helping recipients weigh the advantages and disadvantages of taking medications; and

 

(iv) Helping recipients who have decided to take medications to develop strategies for taking medication regularly, including behavioral tailoring and simplifying the medication regimen.

 

          (n)  The following IROS services shall be billed separately from one another, with one claim submitted per day for each category below:

 

(1)  Illness management and recovery, group;

 

(2)  Illness management and recovery, individual;

 

(3)  Evidence-based supported employment;

 

(4)  Crisis intervention;

 

(5)  Group therapeutic behavioral services; and

 

(6)  Individual therapeutic behavioral services, family support services, and medication support services.

 

          (o)  The CMHP shall separately aggregate the minutes for each category listed in (n) above that are provided in a single day into a single claim before determining the number of billable 15 minute units for each category.

 

          (p)  Billing for functional support services provided to each individual, except for crisis intervention services, those who are served on an ACT team, and all functional support services provided to individuals eligible to receive children’s program services under He-M 401, shall be limited as follows: 

 

(1)  Individual therapeutic behavioral services, family support services, and medication support services shall be limited to a combined total of 10 units per day; and

 

(2)  Group therapeutic behavioral services shall be limited to 10 units per day.

 

          (q)  A CMHP or community mental health provider may request a waiver of the 10 unit daily limit by submitting the request in writing to the department in accordance with He-M426.24.

 

          (r)  In addition to the requirements in He-M 426.24, the waiver request shall include the following:

 

(1)  Supporting documentation that the provision of functional support services beyond the 2.5 hours per day is necessary to allow the individual to achieve the desired outcome;

 

(2)  A statement by the clinician most familiar with the needs of the individual that there are no other treatment modalities available, such as peer support, community support, or other natural supports, that will enable the individual to achieve the desired outcome;

 

(3)  A copy of the current and previous ISP, signed by the psychiatrist, which specifies the frequency, duration and purpose of the requested functional support services in excess of 10 units per day;

 

(4)  A copy of the current eligibility determination form; and

 

(5)  The date range for the waiver, which shall not exceed the date range specified on the ISP.

 

          (s)  A waiver request shall be granted by the commissioner, or designee, in accordance with He-M 426.24 and the following:

 

(1)  The commissioner, or designee, determines that there are extenuating circumstances unique to the individual that would make a denial of the waiver request clinically contraindicated; or

 

(2)  The commissioner, or designee, determines that approval of the waiver can reasonably be expected to prevent the need for more costly services within the following 12 months, including prevention of hospitalization or institutionalization.

 

          (t)  A recipient whose waiver request to exceed 10 units per day is not granted by the commissioner or his or her designee may appeal pursuant to He-C 200.

 

          (u)  IROS shall be reimbursed at a per diem rate if services are provided in:

 

(1)  A non-hospital receiving facility designated pursuant to He-M 405 or He-M 1005; or

 

(2)  A facility licensed by the department or certified as a community residence by the department, if such facilities meet the following criteria:

 

a.  A psychiatrist shall be available 24 hours per day for consultation or treatment, as appropriate, to address medical, medication, and other issues under the domain of a psychiatrist;

 

b.  Supervision shall be provided by program staff who meet the criteria of (a) above;

 

c.  Supervision shall be sufficient to ensure the individual’s safety and implementation of ISPs;

 

d.  Supervision of individuals shall be provided whenever individuals are present in the facility unless an individual’s ISP requires that that individual be left alone;

 

e.  All service components shall be available within the program and may be provided on site or off; and

 

f.  There shall be regular communication between residential staff and each resident’s case manager to ensure that services are provided in accordance with an ISP and that there is no duplication of service.

 

          (v)  Reimbursement for IROS pursuant to (u) above shall preclude the possibility of billing for IROS in 15-minute units within the community residence with the exception of IMR provided by non-residential staff.  For any day on which an individual receives per diem services, residential staff of the same program shall not also bill for IROS in 15-minute units for that individual.

 

          (w)  Reimbursement for services provided on a per diem basis in an acute psychiatric residential treatment program designated pursuant to He-M 1005.04 shall preclude the possibility of billing for any other service described in He-M 426.07 through He-M 426.12 except case management services, emergency services, psychological testing, and intake psychiatric diagnostic interview.

 

          (x)  Documentation for IROS services shall include:

 

(1)  The start and duration of each event; or

 

(2)  The start and stop time for each event.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98

 

New.  #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #9581, eff 10-24-09; ss by #12154, eff 3-28-17

 

          He-M 426.13  IROS Staff Qualifications.

 

          (a)  All staff providing IROS shall be supervised by a supervisor who:

 

(1)  Provides program administration and coordinates such services with other service providers to assure continuity of recipient service;

 

(2)  Has at least 3 years of full-time employment experience in programs for persons with long term mental illness or SED;

 

(3)  Has at least one year of supervisory, management, or administrative experience;

 

(4)  Has a baccalaureate degree or higher in social work, rehabilitation, psychology, education, or a related human services field; and

 

(5)  Has received training in the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, if the staff will be providing IMR.

 

          (b)  Each staff person providing IROS shall at a minimum have:

 

(1)  Either:

 

a.  A baccalaureate degree in social work, rehabilitation, psychology, education, or a related human services field; or

 

b.  An associate’s degree in social work, rehabilitation, psychology, education, or a related human services field and the following experience:

 

1.  Two years of experience working with persons who have severe mental disability or SED; or

 

2.  Two years of experience that provides a person with an understanding of mental illness and that was acquired as an adult in the provision of significant supports to persons with mental illness, including the experience acquired by family members of persons with mental illness or by other persons who have personal knowledge of mental illness; and

 

(2) Received training in the evidence-based practice in Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, developed by Dartmouth, if those staff will be providing those services.

 

          (c)  CMHPs and providers shall document completion of training pursuant to (a)(5) and (b)(2) above in personnel files.

 

          (d)  Any staff person who does not meet the criteria of (b) above shall be eligible to provide IROS services if:

 

(1)  Such staff person was providing mental illness management services under former He-M 426.11 for at least 2 years prior to the 4/13/2007 effective date of former He-M 426.11; and

 

(2)  The following criteria are met:

 

a.  The staff person shall receive individual or group supervision of at least one hour per week provided by a supervisor meeting the qualifications of (a) above;

 

b.  A supervisor meeting the criteria of (a) above shall be available at all times to provide back-up support or consultation; and

 

c.  A record of the following shall be maintained in the staff person’s personnel file:

 

1.  The staff person’s educational background; and

 

2.  Supervision provided, including:

 

(i)  The professional title and level of education of the supervisor;

 

(ii)  The supervisory schedule; and

 

(iii) The staff development and training needs and how they have been addressed; and

 

(3)  In instances when the staff will provide IMR services, the staff person has received training in the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A.

 

(4)  Such person is a peer support specialist;

 

a.  Peer support specialists shall:

 

1. Enter into a mutually supportive, non-authoritative relationship that support wellness and recovery as defined by the individual being serviced;

 

2.  Participate in trainings as required by the employer and the department;

 

3.  Function as a member of the individual’s treatment team;

 

4.  Function as an advocate for the individuals served;

 

5.  Provide services pursuant to the individual service plan;

 

6.  Participate in and attend treatment team meetings;

 

7.  Be supervised by a supervisor as defined in He-M 426.13(a);

 

8. Meet quarterly with a peer trained in intentional peer support (IPS) for a peer review to evaluate effectiveness of IPS and to review the principles of IPS;

 

9.  Be certified in wellness action recovery plans, intentional peer support, whole health action management or equivalents authorized by the department within 12 months of employment at the CMHC; and

 

10.  Receive annually:

 

(i)  One evidence based practice training; 

 

(ii)  Client rights training; and

 

(iii)  One suicide prevention training.

 

Source.  (See Revision Note at part heading for He-M 426) #5971, eff 2-1-95; ss by #7088, eff 8-31-99; amd by #8282, eff 2-8-05; ss and moved by #8867, eff 4-13-07 (from He-M 426.12); ss by #9285, eff 9-30-08; ss by #9581, eff 10-24-09; ss by #12154, eff 3-28-17

 

          He-M 426.14  Services to Determine Medicaid Eligibility.

 

          (a)  Copying a portion of a recipient’s record to be used for medicaid eligibility determination shall:

 

(1)  Be a covered CMHP service; and

 

(2)  Be limited to one unit per 6 month period.

 

          (b)  Psychiatric evaluation for medicaid eligibility shall:

 

(1)  Be a covered CMHP service;

 

(2)  Refer to one evaluation session of any duration; and

 

(3)  Be limited to one session per recipient per 6-month period.

 

          (c)  Psychiatric evaluation for medicaid eligibility shall include the following:

 

(1)  History of present illness;

 

(2)  Family and social history;

 

(3)  Current mental status examination;

 

(4)  Psychiatric diagnosis;

 

(5)  Associated medical problems; and

 

(6)  An assessment of disability including a suggested individual treatment plan and further diagnostic evaluation studies, with a written report to the office of family services.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss by #5589, eff 2-25-93; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.13); ss by #9118, EMERGENCY RULE, eff 4-1-08, EXPIRES: 9-28-08; ss by #9285, eff 9-30-08 (from He-M 426.13); ss by #11182, INTERIM, eff 9-29-16, EXPIRES:
3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.15  Targeted Case Management Services.

 

          (a)  Case management shall:

 

(1)  Assist individuals eligible under the state plan in gaining access to needed medical, social, educational, and other services, on a one to one basis only;

 

(2)  Be a covered CMHP service;

 

(3)  Consist of at least one direct contact, either face-to-face or by telephone, with the individual or guardian within every 90 days;

 

(4)  Be documented in the clinical record, including:

 

a.  Whether the goals specified in the care plan have been achieved;

 

b.  Whether the individual has declined services in the care plan;

 

c.  Timelines for providing services and reassessment; and

 

d.  The need for, and occurrences of, coordination with case managers of other programs.

 

(5)  For each event, the documentation shall include:

 

a.  The name of the individual;

 

b.  The dates of case management service;

 

c.  The name of the provider agency;

 

d.  The nature, content, and units of case management service received, including, for units:

 

1.  The start time and duration of each event; or

 

2.  The start and stop time for each event; and

 

e.  The signature of the person who provided the service.

 

(6)  Be billed only by the agency that is the primary service provider for individuals who receive services from both the behavioral health and developmental services systems.

 

          (b)  The primary service provider shall be:

 

(1)  The agency that provides the greater dollar value of services to the individual; or

 

(2)  The agency chosen by the consumer to provide case management subject to the following:

 

a.  Persons who are conditionally discharged from a designated receiving facility in accordance with He-M 609 shall be considered eligible for a case manager from the behavioral health system in addition to a case manager from the developmental services system in cases where the developmental services system is the primary service provider;

 

b.  Pursuant to He-M 426.24, providers may, with the consent of the consumer, request a waiver from He-M 426.16(a)(6) to enable consumers to receive case management by both systems; and

 

c.  The commissioner shall grant a waiver if a review of the person’s clinical condition establishes that the person has symptoms that are acute or severe and that require multiple services from the secondary service provider.

 

          (c)  Case management services shall be limited to the following:

 

(1)  Assessment and periodic reassessment of an eligible individual to determine service needs, including the following activities:

 

a.  Taking the individual’s history;

 

b.  Gathering information from other sources such as family members, medical providers, social workers and educators, if necessary, to form a complete assessment of the eligible individual;

 

c.  Assessing the individual’s strengths; and

 

d.  Determining the individual’s preferences;

 

(2)  The assessment shall determine the need for the following services:

 

a.  Medical services including, but not limited to, primary care, dental care, home health care, and assistance with activities of daily living (ADL);

 

b.  Educational services including, but not limited to, obtaining high school or advanced degrees, skill-building classes, parenting education, and other support groups;

 

c.  Social services including, but not limited to, employment, housing, and transportation; and

 

d.  Other services, including but not limited to, opportunities for personal development, maintenance and support of social and familial relationships and the pursuit of hobbies and interests such as spiritual development;

 

(3)  Development and periodic revision of a specific and comprehensive care plan based on the information collected through an assessment or reassessment that specifies the goals and actions to address the medical, social, educational, and other services needed by the eligible individual.  An individual may decline to receive services in the care plan;

 

(4)  Referral and related activities to help an individual obtain needed services, such as scheduling appointments, but not including transportation, escort, and childcare services; and

 

(5)  Monitoring and follow-up activities, including activities and contacts that are necessary to ensure that the care plan is effectively implemented and adequately addresses the needs of the eligible individual. Monitoring shall occur no less frequently than annually.

 

          (d)  An individual shall be eligible to receive case management services when:

 

(1)  Services are delivered in accordance with an ISP; and

 

(2)  The individual is:

 

 

a.  A severely mentally disabled person who is eligible to receive department-funded services pursuant to He-M 401; or

 

b.  A family member of a person who is eligible for long-term care as defined in He-M 401 and is under age 21.

 

          (e)  Case management services for an individual who has been admitted to a hospital or nursing facility shall include:

 

(1)  Providing ongoing case management services on behalf of the individual in order to ensure that services and supports are established and maintained within the community and within the community mental health system;

 

(2)  Establishing and maintaining contact with community agencies and individuals to develop community resources, to foster access to services other than those offered through the state mental health system, and to encourage community support to the individual when he or she returns to the community;

 

(3)  Arranging, in collaboration with the hospital or nursing facility, community supports appropriate to the individual’s need;

 

(4)  Participating in the service planning process, from initial treatment planning through discharge planning, and supporting the participation of the individual, the family, and the guardian in the treatment planning process and, with the individual’s or guardian’s consent, involving significant others;

 

(5)  Providing information necessary for individual service planning, with the consent of the individual, pursuant to He-M 408;

 

(6)  Participating in making discharge plans and in securing access to available community resources of choice in order to foster a smooth transition to the community; and

 

(7)  After an individual involuntary commitment and conditional discharge pursuant to He-M 609, advising the administrators of the CMHP or provider and the hospital concerning the individual’s progress with, and suggesting revisions in, the discharge conditions.

 

          (f)  Transitional case management shall:

 

(1) Be provided to individuals, under the age of 22 and over the age of 64, who are transitioning from a hospital or nursing facility to the community;

 

(2)  Be a covered service during the last 180 consecutive days of a medicaid eligible person’s institutional stay if provided for the purpose of community transition; and

 

(3)  Be billed if the following conditions are met:

 

a.  The individual has been discharged from the hospital or nursing facility;

 

b.  The individual is enrolled with the community case management provider; and

 

c.  The individual is receiving medically necessary services in a community setting.

 

          (g)  Case managers shall not exercise the state agency’s authority to authorize or deny the provision of other services under the state plan.

 

          (h)  All staff providing case management services shall be supervised in accordance with the requirements contained in He-M 426.13(a) relative to supervision of staff providing functional support services.

 

          (i)  Each staff person providing case management services shall meet the requirements contained in He-M 426.13(b) and (d) relative to requirements for staff providing functional support services.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5703, eff 9-17-93; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.14); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

 

          He-M 426.16  Assertive Community Treatment (ACT).

 

          (a)  Assertive community treatment (ACT) services shall be:

 

(1)  Based on “The Assertive Community Treatment Implementation Resource Kit” (Evaluation Edition 2003) available as noted in Appendix A;

 

(2)  Provided with fidelity to the Dartmouth Assertive Community Treatment Scale (DACTS) found in “The Assertive Community Treatment Implementation Resource Kit” (Evaluation Edition 2003);

 

(3)  Customized to the individual’s needs, and shall vary over time as the individual’s needs change; and

 

(4)  Provided to allow the individual a reasonable opportunity to live independently in the community.

 

          (b)  ACT teams shall be available:

 

(1)  To the individual 24 hours per day, 7 days per week.

 

(2)  From midnight to 8:00 a.m. services shall be provided on an on-call basis;

 

(3)  In the event of a crisis and consistent with safety concerns, to conduct a face to face meeting within 3 hours, to de-escalate the crisis.

 

          (c)  Every individual eligible for services under He-M 401 shall be assessed for ACT services at the time of intake, at quarterly service reviews, upon request, and in the event of discharge from a facility, the Glencliff Home, or from emergency department admission.

 

          (d)  The decision to provide ACT services shall be made on an individualized basis with careful consideration for the individual’s clinical needs and shall utilize the following criteria:

 

(1)  The individual shall have a severe mental illness or a severe and persistent mental illness;

 

(2)  The individual shall have a primary diagnosis of psychotic or major mood disorder, with or without a co-occurring substance use disorder;

 

(3)  An individual diagnosed with a personality disorder shall not be excluded from ACT services solely due to diagnosis;

 

(4)  The individual shall be 18 years or older; and

 

(5)  The individual shall meet at least one of the following criteria:

 

a.  Has had lengthy or multiple uses of acute psychiatric hospitalization in past 12 months;

 

b.  Has used multiple  emergency services or crisis services within the past 12 months due to symptoms of a mental illness;

 

c. Has consistently demonstrated the inability to engage in and benefit from other community based mental health services as a result of symptoms of mental illness for the past 12 months;

 

d.  Had involvement with the legal system as a result of symptoms of mental illness that have resulted in arrest, incarceration, probation, or parole within the past 12 months;

 

e.  Is currently in-patient at a facility and could move to a less restrictive environment if the individual were to receive ACT services; or

 

f.  Is currently residing in a community residence as identified in He-M 1002 and could move to a less restrictive environment if the individual were to receive ACT services.

 

          (e)  The decision to transfer individuals to a less intensive level of care shall be made on an individualized basis with careful consideration of the individual’s clinical needs and shall utilize the following criteria:

 

(1)  The individual has maintained stable housing in the community for more than 12 months;

 

(2)  The individual has utilized an emergency room due to psychiatric symptoms no more than twice in the past 12 months;

 

(3)  The individual has consistently demonstrated the ability to engage in and benefit from community based mental health services;

 

(4)  The individual has not been arrested or incarcerated during the past 12 months due to psychiatric symptoms;

 

(5)  The individual has mutually agreed with ACT team members that he or she is ready to transition to a less intensive level of care; and

 

(6)  The individual has required no more than 2 ACT team contacts for the  month in a 6 month period.

 

          (f)  Once the individual has satisfied criteria in He-M 426.16(e), the ACT team shall take steps below to commence transition planning.  Once these steps have been accomplished, the individual shall be transitioned from ACT to lower intensity services:

 

(1)  The ACT team meets with the individual to identify and discuss individual transition planning goals and objectives;

 

(2)  The ACT team and the individual have identified and met with appropriate non-ACT service providers in order to coordinate continuity of care;

 

(3)  The individualized service plan is updated to reflect transition planning goals and identified service needs; and

 

(4)  The crisis plan has been updated and developed with the assistance of identified non-ACT service providers.

 

          (g)  No ACT team shall terminate services provided to an individual because that individual has withdrawn consent or cannot be located unless the ACT team can document at least 3 months of persistent, caring attempts to engage that individual.

 

          (h)  The requirement in (g) above shall not limit the individual’s right to decline ACT services in accordance with RSA 135-C:16 and RSA 135-C:57, III.

 

          (i)  The community mental health program (CMHP) providing ACT services shall make available written information provided by the department to individuals that describes ACT services, the right to file a complaint, and contact information for legal assistance.

 

          (j)  The written information in (i) shall be given directly to any individual who has specifically requested ACT service but for whom the treatment team has determined that ACT services are not clinically appropriate.

 

          (k)  Commencing in 2017, the department shall conduct an ACT fidelity assessment of each CMHP every other year.  The CMHP shall conduct a self-assessment fidelity review in the year(s) the department does not conduct the review.

 

Source.  #12079, eff 12-29-16

 

          He-M 426.17  Services Not Otherwise Classified.

 

          (a)  The invoice for services not otherwise classified in this rule shall be accompanied by a statement describing the service including the following:

 

(1)  The name of the recipient receiving the service(s);

 

(2)  The type, frequency, and duration of the service(s);

 

(3)  The name, title, and professional qualifications of the person(s) providing the service(s); and

 

(4) The reason(s) why the service(s) was provided, which shall include reference to the recipient’s ISP.

 

          (b)  Services not otherwise classified shall be:

 

(1)  Designed to meet a specific need identified in a recipient’s ISP; and

 

(2)  Allowed by federal requirements.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5589, eff 2-25-93; ss by #5703, eff 9-17-93; amd by #5971, eff 2-1-95; amd by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8282, eff 2-8-05; ss and moved by #8867, eff 4-13-07 (from He-M 426.15); ss by #9285, eff 9-30-08 (from He-M 426.15); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.16); ss by #12154, eff 3-28-17

 

          He-M 426.18  Documentation.  Clinical information and documentation of services as required by
He-M 408 shall be maintained by the CMHP or community mental health provider.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.16); ss by #9285, eff 9-30-08 (from He-M 426.16); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.17); ss by #12154, eff 3-28-17

 

          He-M 426.19  Medicaid Payment for Long-Term Care Certification.

 

          (a)  Except for those medicaid recipients eligible to receive early and periodic screening, diagnosis and treatment (EPSDT) pursuant to He-W 546 or eligible to receive long-term care services in accordance with (b) below, the medicaid payment limit per fiscal year for all community mental health services shall be the limit established by the commissioner with approval of the US Department of Health and Human Services Centers for Medicare and Medicaid Services as an amendment to the Title XIX State Plan in accordance with He-W 520.02 and Section 1902(a) of the Social Security Act.  The fiscal year runs from July 1 to June 30.  Individual service limits shall still apply.

 

          (b)  An individual shall qualify for services in excess of the annual medicaid payment limit if that individual has been certified for long-term care services by:

 

(1)  Determination by the CMHP that the individual is eligible to receive department funded services pursuant to He-M 401; or

 

(2)  Determination by a CMHP that a child through age 17 is eligible for services pursuant to He-M 401 unless the psychiatrist has approved the child to remain until age 21in a children’s program pursuant to He-M 401.

 

          (c)  The department shall recover any medicaid payments in excess of the medicaid payment limit per state fiscal year for a recipient under each of the following circumstances:

 

(1)  The recipient’s record lacks a properly completed eligibility statement which covers long-term care services billed for the period under review;

 

(2) The eligibility period has expired and the redetermination of eligibility has not been completed;

 

(3)  Documentation in the clinical record fails to substantiate that the recipient meets the criteria for certification for long-term care; and

 

(4)  The recipient’s diagnosis does not meet the criteria in He-M 401.

 

          (d)  Certifications made pursuant to (b)(1) above and dated later than the service period being billed for shall be invalid.

 

          (e)  For individuals eligible as adults with severe or severe and persistent mental illness with low service utilization pursuant to He-M 401.07, the commissioner shall establish a limit on the payment for services per state fiscal year. The limit shall be subject to approval by the US Department of Health and Human Services Centers for Medicare and Medicaid Services as an amendment to the Title XIX State Plan in accordance with He-W 520.02 and Section 1902(a) of the Social Security Act. The annual limit shall be waived if the standards established by He-M 426.24 are met.

 

          (f)  Mental health assessment by a non-physician for the purpose of determining long-term care eligibility shall be a covered service when performed by individuals meeting the qualifications in He-M 401.04(b).

 

          (g)  Comprehensive geriatric assessment and treatment planning performed by assessment team for the purpose of determining long-term care eligibility shall be a covered service when performed by individuals meeting the qualifications in He-M 401.04(b).

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.17); ss by #9285, eff 9-30-08 (from He-M 426.17); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-18); renumbered by #12079 (from He-M 426.18); ss by #12154, eff 3-28-17

 

          He-M 426.20  Fair Hearings.  Any medicaid recipient who has been found ineligible for long-term care services by the CMHP or community mental health provider may appeal the adverse decision by requesting a fair hearing in accordance with He-C 200.  Complaints regarding provision of services may be filed in accordance with He-M 309, and He-M 204

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss and moved by #6568, eff 8-22-97 (from He-M 426.20); ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.18); ss by #9285, eff
9-30-08 (from He-M 426.18); ss by #11182, INTERIM, eff
9-29-16, EXPIRES: 3-28-17l; renumbered by #12079 (from He-M 426.19); ss by #12154, eff 3-28-17

 

          He-M 426.21  Revocation of Approval as a Community Mental Health Provider.

 

          (a)  Approval as a community mental health provider shall be revoked, following written notice pursuant to (b)(2) below and opportunity for a hearing pursuant to He-C 200, due to:

 

(1)  Failure of the provider to comply with this rule or any other applicable rule promulgated by the department;

 

(2)  The provider failing to provide information requested by the department and required pursuant to chapter He-M 400 or knowingly giving false or misleading information to the department;

 

(3)  Refusal by the provider to admit any employee of the department authorized to monitor or inspect the provider’s services and programs;

 

(4)  Any reported abuse, neglect, or exploitation of individuals by a provider’s staff if:

 

a.  Such personnel have not been prevented from having contact with individuals as of the reporting date of the alleged violation; and

 

b.  Such abuse, neglect, or exploitation is founded based on a protective investigation performed by the department in accordance with He-E 700 and an administrative hearing held pursuant to He-E 200, if such a hearing is requested;

 

(5)  Revocation of licensure or denial of application for licensure pursuant to RSA 151; or

 

(6)  Revocation of certification pursuant to He-M 1002.

 

          (b)  Revocation of approval shall be in accordance with the following:

 

(1)  Upon determination that a provider meets any of the criteria for revocation listed in (a) above, the commissioner shall revoke the approval of the provider;

 

(2)  Revocation shall only occur following:

 

a.  The provision of 30 days’ written notice by the commissioner to the provider stating the reason(s) for the revocation and, if applicable, the specific rule(s) with which the provider is alleged to not comply; and

 

b.  Opportunity for a hearing on the decision pursuant to He-C 200, if requested by the provider;

 

(3)  The commissioner shall withdraw a notice of revocation if, within the notice period, the provider takes corrective action resulting in the elimination of the reason(s) for revocation; and

 

(4)  Pending corrective action by the provider eliminating the reason(s) for revocation, a provider shall not accept additional individuals if a notice of revocation has been issued concerning a violation which presents potential danger to the health or safety of the individuals being served.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss and moved by #6568, eff 8-22-97 (from He-M 426.21); ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.19); ss by #9285, eff
9-30-08 (from He-M 426.19); ss by #11182, INTERIM, eff
9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.20); ss by #12154, eff 3-28-17

 

          He-M 426.22  Suspension of Approval.

 

          (a)  In the event that a violation poses an immediate and serious threat to the health or safety of the individuals, the commissioner shall suspend a provider’s approval immediately upon issuance of written notice specifying the reasons for the action.

 

          (b)  In the event that the commissioner suspends the approval of a provider, the suspension shall be effective from the date that the violation occurred until such time as the commissioner determines that the provider is in compliance with all applicable rules adopted by the commissioner and no longer poses an immediate and serious threat to the health or safety of the individuals served by the provider.

 

          (c)  At the time that the commissioner suspends the approval of a provider, the commissioner or his or her designee shall schedule a hearing to be held within 10 working days, in accordance with He-C 204.

 

          (d)  A hearing held pursuant to (c) above shall:

 

(1)  Have as its purpose determination of whether the provider in fact posed an immediate and serious threat to the health and safety of its individuals at the time its approval was suspended; and

 

(2)  Afford the provider an opportunity to show that:

 

a.  Since the time that its approval was suspended it has come into compliance with all applicable rules promulgated by the department and no longer poses an immediate and serious threat to the health or safety of its individuals; or

 

b.  It had never been out of compliance or had never posed an immediate and serious threat to the health or safety of its individuals.

 

Source.  (See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98

 

New.  #7088, eff 8-31-99; ss and moved by #8867, eff
4-13-07 (from He-M 426.20); ss by #9285, eff 9-30-08 (from He-M 426.20); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.21); ss by #12154, eff 3-28-17

 

          He-M 426.23  Payment.

 

          (a)  Medicaid payments shall be made for CMHP services rendered to recipients with both psychiatric and intellectual disability diagnoses for services related to the psychiatric diagnosis.  Medical and billing records shall support this classification.  The claim shall indicate the primary diagnosis related to the service rendered.

 

          (b)  Community mental health services shall be paid at rates set by the department based on the audited costs of covered services as determined by units of services provided by all community mental health providers divided by the sum of costs for the individual’s transportation, staff and staff related costs to provide such services incurred by all community mental health providers.

 

          (c)  Claims for medicare-eligible medicaid recipients shall be submitted to medicare for all medicare covered services prior to submitting claims to medicaid.

 

          (d)  Except for claims for people not eligible for medicaid, claims for service shall be submitted to the fiscal agent designated by the department.

 

          (e)  Claims for services necessary to determine the appropriateness of nursing home referral, PASRR, for people who are not eligible for medicaid shall be submitted to:

 

NH Department of Health and Human Services

Behavioral Health

PASRR Office

105 Pleasant Street

Concord, NH  03301

 

Source.  #8867, eff 4-13-07 (from He-M 426.21); ss by #9285, eff 9-30-08 (from He-M 426.21); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.22); ss by #12154, eff 3-28-17

 

          He-M 426.24  Waivers.

 

          (a)  A CMHP or community mental health provider may request a waiver of specific procedures outlined in this part, in writing, from the department.

 

          (b)  A request for a waiver shall include:

 

(1)  A specific reference to the section of the rule for which a waiver is being sought;

 

(2)  A full description of why a waiver is necessary; and

 

(3)  A full explanation of alternative provisions or procedures proposed by the CMHP or community mental health provider.

 

          (c)  No provision or procedure prescribed by statute shall be waived.

 

          (d)  A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the CMHP or community mental health provider meets the objective or intent of the rule and:

 

(1)  Does not negatively impact the health or safety of recipients; and

 

(2)  Does not affect the quality of CMHP or community mental health provider services.

 

          (e)  Upon receipt of approval of a waiver request, the CMHP’s or community mental health provider’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

 

          (f)  Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

 

          (g)  Those waivers which relate to the following shall be effective for the CMHP’s or community mental health provider’s current certification period only:

 

(1)  Fire safety; or

 

(2)  Other issues relative to consumer health, safety or welfare that require periodic reassessment. 

 

          (h)  A CMHP or community mental health provider may request a renewal of a waiver from the department.  Such request shall be made at least 30 days prior to the expiration of a current waiver.

 

Source.  #9285, eff 9-30-08 (from He-M 426.22); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.23); ss by #12154, eff 3-28-17

 


APPENDIX A: INCORPORATION BY REFERENCE INFORMATION

 

Rule

Title

Publisher; How to Obtain; and Cost

He-M 401.02(s)

Diagnostic and Statistical Manual of Mental Disorders, (Fourth Edition, Text Revision) (DSM-IV-TR, 2000)

Available from the publisher, American Psychiatric Publishing (http://www.appi.org/Home), a division of the American Psychiatric Association (APA) (www.psychiatry.org). 

Cost is $121.00.

He-M 402.05(e)(2)

“Guidelines for Environmental Infection Control in Health-Care Facilities” (2003) as updated on August 1, 2014 and published by the Centers for Disease Control and Prevention (CDC)

The document can be obtained at free of charge in pdf format at https://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf.

 

He-M 402.05(e)(7)

“Guidelines for Environmental Infection Control in Health-Care Facilities” (2003) as updated on August 1, 2014 and published by the Centers for Disease Control and Prevention (CDC)

The document can be obtained at free of charge in pdf format at https://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf.

He-M 403.02(t) and He-M 403.02(ab)

Diagnostic and Statistical Manual of Mental Disorders

(DSM-5)

 

He-M 408.02(r) 

Diagnostic and Statistical Manual of Mental Disorders, (Fifth Edition, Text Revision)

(DSM-5)

Available from the publisher, American Psychiatric Publishing (http://www.appi.org/Home), a division of the American Psychiatric Association (APA) (www.psychiatry.org).

Cost is $155.00.

He-M 426.02(k)

American Medical Association 2017 CPT

https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2730008&navAction=push; or for a full text at a Cost: $89.95, published by the American Medical Association, PO Box 930876 Atlanta GA  31193-0876.

 

He-M 426.02(n), and He-M 426.12(i)

Supported Employment Evidence Based Practice Kit (2010)

Available on line free of charge at: http://store.samhsa.gov/product/Supported-Employment-Evidence -Based-Practices-EBP-KIT/SMA08-4365.

He-M 426.02(r), He-M 426.11(i)(2), He-M 426.12(a)(i), (f)(3), (h)(1), (m)(8)d.2., (m)(8)d.4, He-M 426.13(a)(5), (b)(2) and (d)(3)

Illness Management and Recovery Evidence Based Practice Kit (2010)

Available on line free of charge at:

http://store.samhsa.gov/product/Illness-Management-and-Recovery-Evidence-Based-Practices-EBP-KIT /SMA09-4463.

He-M 426.02(z), and (ai), 

Diagnostic and Statistical Manual of Mental Disorders, (Fifth Edition, Text Revision) (DSM-5)

Available from the publisher, American Psychiatric Publishing (http://www.appi.org/Home), a division of the American Psychiatric Association (APA) (www.psychiatry.org).

Cost is $155.00.

He-M 426.16 (a)(1)

“The Assertive Community Treatment Implementation Resource Kit” (Evaluation Edition 2003)

Available free of charge as pdf at http://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345


APPENDIX B: STATUTES IMPLEMENTED

 

RULE

STATE OR FEDERAL STATUES THE RULE IMPLEMENTS

 

 

He-M 401.01

RSA 135-C:3

He-M 401.02

RSA 135-C:3

He-M 401.03

RSA 135-C:12

He-M 401.04 – He-M 401.09

RSA 135-C:13; RSA 135-C:61, II

He-M 401.10 – He-M 401.13

RSA 135-C:19; RSA 135-C:61, VII

He-M 401.14

RSA 135-C:18; RSA 135-C:61, VI

He-M 401.15

RSA 135-C:3;  RSA 135-C:61, XII

 

 

He-M 402

RSA 126-N:3

 

 

He-M 403.01-He-M 403.02

RSA 135-C:10

He-M 403.03

RSA 135-C:7, RSA 135-C:10

He-M 403.04

RSA 135-C:7, 8, 10

He-M 403.05 - He-M 403.16

RSA 135-C:10

 

 

He-M 405.01

RSA 135-C:26, III

He-M 405.02

RSA 135-C:26, III

He-M 405.03

RSA 135-C:26, III; RSA 135-C:26, II; and RSA 126-U

He-M 405.04

RSA 135-C:26, III

He-M 405.05

RSA 135-C:26, III

He-M 405.06

RSA 135-C:31, V; RSA 135-C:48

He-M 405.07

RSA 135-C:33

He-M 405.08

RSA 135-C:17

He-M 405.09

RSA 135-C:49-54

He-M 405.10

RSA 135-C:26, III

He-M 405.11

RSA 135-C:26, III

He-M 405.12

RSA 135-C:26, III

He-M 405.13

RSA 135-C:26, III

He-M 405.14

RSA 135-C:26, III

He-M 405.15

RSA 135-C:26, III

He-M 405.16

RSA 135-C:26, III

He-M 405.17

RSA 541-A:22, IV

 

 

He-M 406

RSA 135-C:5, I

 

 

He-M 408.01 – He-M 408.14

RSA 135-C:5, I(e), RSA 135-C:61, III

 

 

He-M 425.01 – He-M 425.03

RSA 135-C:3

 

 

He-M 426.01, He-M 426.02 intro., (a)-(c), (e)-(s), (u)-(ap), 426.03–426.15 and
426.17-426.24

RSA 135-C:1; 57

He-M 426.01, He-M 426.03-426.11, He-M 426.14-23

RSA 135-C:1; RSA 135-C:57

He-M 426.02 – He-M 426.12 -426.13

RSA 135-C:1; 57

He-M 426.02(d) and (t)

RSA 135-C:1; RSA 135-C:57

He-M 426.16

RSA 135-C:5