N.J. Admin. Code § 10:77-5.6 - General program description

Current through Register Vol. 54, No. 7, April 4, 2022

(a) Intensive in-community mental health rehabilitation services are intensive community-based and family-centered mental health services delivered as a defined set of interventions, within the context of an approved plan of care and are restorative or preventative in nature. These services are geared toward improving or stabilizing the child, youth or young adult's level of functioning within the home and community in order to prevent, decrease or eliminate behaviors or conditions that may lead to or that may place the child, youth or young adult at increased clinical risk, or that may impact on the ability of the child, youth or young adult to function in their home, school or community. These services encompass a variety of mental health rehabilitative services including, but not limited to, group, individual or family therapy, allied behavioral therapies and modalities, clinical consultation, evaluation and counseling.
(b) Intensive in-community services shall be provided either individually or in a group of up to three children/youth or young adults, as appropriate to the needs of the child.
(c) Intensive in-community services shall also include interaction and instruction, provided individually or in a small group setting, to the child, youth or young adult's family and caregiver(s) to enable them to provide the necessary support to the child, youth or young adult to attain the goals of the service plan and sustain the positive behavioral changes and improvement in functionality and quality of life.
1. Intensive in-community services provided in a group setting may be provided to the family member(s) and/or caregiver(s) of up to three children/youth or young adults in one session.
(d) Intensive in-community mental health rehabilitation services may include, but are not limited to, the following interventions:
1. Clinical consultation/evaluation/assessment;
2. Counseling;
3. Group, individual or family therapy;
4. Anger management;
5. Parenting skill development;
6. Stress reduction;
7. Symptom reduction;
8. Problem solving skill development;
9. Adaptive and coping skills; and
10. Psycho-educational instruction related to mental health, including, but not limited to, improved decision-making skills to manage behavior and reduce risk behaviors.
(e) Intensive in-community mental health rehabilitation services shall be goal-oriented and focused, and are intended to support the needs of the child, youth or young adult and his or her family/caregiver to remain in the community. Intensive in-community services are intended to be time-limited interventions that support the child and family in the community while the child and family are connected with office-based practitioner services or as a short term adjunct to office-based practitioner services in order to support the child/family in their current living arrangement.
(f) Intensive in-community mental health rehabilitation services shall be delivered in community-based, clinically appropriate settings that are convenient to the child or youth and his or her family. Intensive in-community mental health rehabilitation services shall be available on a 24-hour basis, seven days per week. These outreach services shall not be provided in an office setting, hospital or Joint Committee on Accreditation of Healthcare Organizations (JCAHO)-accredited residential treatment center, nor should they supplant existing services.
1. For the purposes of this requirement, "providing services in an office setting" describes a concept, whereby the provider is requiring the beneficiary to come to the provider for services rather than the provider rendering services to the child, youth or young adult in their natural environment. Examples are listed below:
i. The family, child, youth, or young adult is not comfortable meeting in their home and asks the provider to meet them at a local community center or church recreation hall. The community center or church agrees to provide a room for such a meeting. This is not considered an office setting, since the provider is meeting the family/beneficiary at the church or recreation center at the family's/beneficiary's request.
ii. Services provided to a child while the child is in a run away shelter and the staff of the runaway shelter center offers the use of an empty office so that the child and the professional providing the behavioral assistance services can have a private conversation. As in the example above, this is not considered "providing services in an office setting," even though the staff and the child were physically in an "office" located in the building. The provider is rendering services to the child in the place where the child is currently residing, that is, the current home of the child.
iii. The provider has access to office space in a community setting, such as a YMCA or a church's community youth center, and children are scheduled to receive services and are required to come to that site to receive the intensive in-community services. This is considered "providing services in an office setting."
2. Services provided in any office of the provider shall not be reimbursed as behavioral health rehabilitation services. These services shall be reimbursed under the applicable Medicaid/NJ FamilyCare provider rules which describe reimbursement for services rendered in the provider's office.
3. Intensive in-community mental health rehabilitation services cannot be provided to a child, youth or young adult who is in a JCAHO-accredited residential treatment center (see N.J.A.C. 10:75).
i. Intensive in-community mental health rehabilitation services can be rendered to a child, youth or young adult who resides in a JCAHO-accredited residential treatment center only while the child is on an approved therapeutic leave from the facility; services cannot be provided on-site.
4. Intensive in-community mental health rehabilitation services cannot normally be provided to children, youth or young adults in other residential mental health rehabilitation facilities, including, but not limited to, group homes, psychiatric community residences for youth and residential child care centers (see N.J.A.C. 10:77) if the residential reimbursement includes these services. However, there may be exceptional circumstances in which these services are clinically required to help support the facility to admit the child into their program. These services are intended to be short-term and must be clinically justified by the provider or the care management entity and prior authorized by the contracted systems administrator.
i. Intensive in-community mental health rehabilitation services can be rendered to a child, youth or young adult who resides in other types of residential mental health rehabilitation facilities while the child is on an approved therapeutic leave from the facility.
(g) Intensive in-community mental health rehabilitation services shall be provided directly by mental health professionals that are licensed, or under the supervision of a licensed clinician.

Notes

N.J. Admin. Code § 10:77-5.6

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