CRISIS STABILIZATION SERVICES Billing and Coverage LIMITATIONS

Sep 3, 2021 | Medical billing basics

CRISIS STABILIZATION SERVICES

Crisis Stabilization services are short-term, outcome-oriented, and of higher intensity than other behavioral interventions that are designed to provide interventions focused on developing effective behavioral management strategies to secure participant and family/caregiver’s health and safety following a crisis. These services may only be delivered in an individual, one-to-one session and are available in the child’s home. The service is short-term designed to achieve community stabilization through psychoeducation, crisis stabilization, and crisis resolution support. The service is of high intensity with the intent to develop effective behavioral strategies that will be maintained and help the child to sustain the behavioral strategies long-term.

Medicaid COVERAGE AND LIMITATIONS

  1. The amount, frequency and duration of this service is based on the participant’s assessed needs and documented in the approved POC.
  2. This service is not subject to Prior Authorization requirements.
  3. Crisis Stabilization services may only be delivered in an individual, one-to-one session and are available in the child/youth’s home.
  4. The maximum number of service hours per day is four hours for up to 40 hours per month. Post authorization request required beyond 40 hours. Additional units of services may be authorized by the DHCFP or designee on post authorization review.

Minimum Expectations to Operate a Crisis Receiving and Stabilization Service Crisis receiving and stabilization services must:

  1. Accept all referrals;
  2. Not require medical clearance prior to admission but rather assessment and support for medical stability while in the program;
  3. Design their services to address mental health and substance use crisis issues;
  4. Employ the capacity to assess physical health needs and deliver care for most minor physical health challenges with an identified pathway in order to transfer the individual
    to more medically staffed services if needed;
  5. Be staffed at all times (24/7/365) with a multidisciplinary team capable of meeting the needs of individuals experiencing all levels of crisis in the community; including:
    a. Psychiatrists or psychiatric nurse practitioners (telehealth may be used)
    b. Nurses
    c. Licensed and/or credentialed clinicians capable of completing assessments in the region; and
    d. Peers with lived experience similar to the experience of the population served.
  6. Offer walk-in and first responder drop-off options;
  7. Be structured in a manner that offers capacity to accept all referrals at least 90% of the time with a no rejection policy for first responders;
  8. Screen for suicide risk and complete comprehensive suicide risk assessments and planning when clinically indicated; and
  9. Screen for violence risk and complete more comprehensive violence risk assessments and planning when clinically indicated.

Best Practices to Operate Crisis Receiving and Stabilization Services

To fully align with best practice guidelines, centers must meet the minimum expectations and:

  1. Function as a 24 hour or less crisis receiving and stabilization facility;
  2. Offer a dedicated first responder drop-off area;
  3. Incorporate some form of intensive support beds into a partner program (could be within the services’ own program or within another provider) to support flow for individuals who need additional support;
  4. Include beds within the real-time regional bed registry system operated by the crisis call center hub to support efficient connection to needed resources; and
  5. Coordinate connection to ongoing care.

Brief Overview of the Crisis Stabilization Service

Crisis stabilization is intended to provide short-term and intensive supportive resources for the youth and his/her family. The intent of this service is to provide an out-of-home crisis stabilization option for the family in order to avoid psychiatric inpatient and institutional treatment of the youth by responding to potential crisis situations. The goal will be to support the youth and family in ways that will address current acute and/or chronic mental health needs and coordinate a successful return to the family setting at the earliest possible time. During the time the crisis stabilization is supporting the youth, there is regular contact with the family to prepare for the youth’s return and his/her ongoing needs as part of the family. It is expected that the youth, family and crisis stabilization provider are integral members of the youth’sindividual treatment team.

Transportation is provided between the youth’s place of residence and other services sites and places in the community, and the cost of transportation isincluded in the rate paid to providers of these services. Medicaid is not claimed for the cost of room and board. Other funding sources reimburse for room and board, iincluding the family or legally responsible party (e.g., OJJ and DCFS).

PROVIDER QUALIFICATIONS

  1. Specialized Foster Care Agency
    a. Pursuant to NRS 424, an application for a license to operate a foster care agency must be in a form prescribed by the Division and submitted to the appropriate licensing authority.
    b. Foster Care Agency providers must be enrolled as a Foster Care Provider Agency through the DHCFP’s fiscal agent and meet all required standards listed in the DHCFP MSM.
    c. Agencies must meet all applicable standards listed in NAC 424 and NRS 424.
  2. Child Welfare Jurisdiction
  3. Meet licensure requirements pursuant to the DHCFP MSM.
  4. Meet all requirements to enroll and maintain status as an approved Medicaid provider, pursuant to the DHCFP MSM, Chapters 100 and 400. NON-COVERED SERVICES

Crisis Stabilization services do not include:

  1. When a youth’s behavior no longer requires immediate and intensive interventions to help stabilize the current situation and prevent hospitalization;
  2. When a youth no longer presents a moderate risk of danger to themselves and others;
  3. When a youth’s behavior becomes manageable and no longer requires stabilization; Crisis stabilization services are not custodial care benefits for individuals with chronic conditions but should result in a change in status;
  4. Custodial care and/or routine supervision: Age and developmentally appropriate custodial mcare and/or routine supervision including monitoring for safety, teaching or supervising hygiene skills, age appropriate social and self-care training, and/or other intrinsic parenting and/or care giver responsibilities;
  5. Maintaining level of functioning: Services provided primarily to maintain a level of functioning in the absence of crisis stabilization goals and objectives, impromptu non-crisis interventions, and routine daily therapeutic milieus;
  6. Case management: Conducting and/or providing assessments, care planning/ coordination, referral and linkage, and monitoring and follow-up;
  7. Habilitative services;
  8. Services provided to individuals with a primary diagnosis of intellectual disabilities and related conditions (unless these conditions co-occur with a mental illness) and which are not focused on rehabilitative mental and/or behavioral health;
  9. Cognitive/intellectual functioning: Recipients with sub-average intellectual functioning who would distinctly not therapeutically benefit from RMH services;
  10. Transportation: Transporting recipients to and from medical and other appointments/services;
  11. Educational, vocational, or academic services: General and advanced private, public and compulsory educational programs; personal education not related to the reduction of mental and/or behavioral health problem, and services intrinsically provided through the IDEA;
  12. Inmates of public institutions: To include detention facilities, forestry camps, training schools, or any other facility operated primarily for the detention of children who are determined to be delinquent;
  13. Room and board: Including housing, food, non-medical transportation, and other miscellaneous expenses, as defined below:

a. Housing expenses include shelter (mortgage payments, rent, maintenance and repairs, and insurance), utilities (gas, electricity, fuel, telephone, and water), and
housing furnishings and equipment (furniture, floor coverings, major appliances, and small appliances);

b. Food expenses include food and nonalcoholic beverages purchased at grocery, convenience and specialty store;

c. Transportation expenses include the net outlay on purchase of new and used vehicles, gasoline and motor oil, maintenance and repairs, and insurance;
Miscellaneous expenses include clothing, personal care items, entertainment, and reading materials;

d. Administrative costs associated with room and board;

  1. Non-medical programs: Intrinsic benefits and/or administrative elements of non- medical programs, such as foster care, therapeutic foster care, child welfare, education, childcare, vocational and prevocational training, housing, parole and probation, and juvenile justice;
  2. Services under this chapter for a recipient who does not have a covered, current ICD diagnosis;
  3. Any type of psychotherapy services;
  4. Respite care;
  5. Recreational activities: Recreational activities not focused on rehabilitative outcomes;
  6. Personal care: Personal care services intrinsic to other social services and not related to RMH goals and objectives

PRIOR AUTHORIZATION

There are no prior authorization requirements for Intensive In-Home services. The service limitations for Intensive In-home services are listed above. There are no prior authorization requirements for Crisis Stabilization services. The service limitations for Crisis Stabilization services are listed above. Additional units of services may be authorized by DHCFP or designee on post authorization review.

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