CALIFORNIA CODE OF REGULATIONS - State of California

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Page 511 TITLE 9. DIVISION 1 — DEPARTMENT OF MENTAL HEALTH § 1810.210 The approval shall provide for the terms and conditions under which the exception is granted, and shall be effected by an amendment to the contract between the mental health plan and the department under this chapter. (d) The department may approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications or the conducting of pilot projects, provided such exceptions are carried out consistent with the mental health plan’s obligations to ensure access, quality of care, and cost effectiveness under federal and state laws and regulations, and the terms of the contract between the department and the mental health plan. A written request and substantiating evidence supporting the request shall be submitted by the mental health plan to the department. If the request is consistent with this subsection, the request may be approved by the department. The approval shall provide for the terms and conditions under which the exception is granted, and may be effected by an amendment to the contract between the mental health plan and the department under this chapter. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5775, 5776, 5777, 5778, 5779 and 14684, Welfare and Institutions Code. Article 2. Definitions, Abbreviations and Program Terms § 1810.201. Acute Psychiatric Inpatient Hospital Services. “Acute Psychiatric Inpatient Hospital Services” means those services provided by a hospital to beneficiaries for whom the facilities, services and equipment described in Section 1810.350 are medically necessary for diagnosis or treatment of a mental disorder in accordance with Section 1820.205. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14132 and 14684, Welfare and Institutions Code. § 1810.202. Administrative Day Service. “Administrative Day Services” means psychiatric inpatient hospital services provided to a beneficiary who has been admitted to the hospital for acute psychiatric inpatient hospital services, and the beneficiary’s stay at the hospital must be continued beyond the beneficiary’s need for acute psychiatric inpatient hospital services due to a temporary lack of residential placement options at appropriate, non–acute treatment facilities. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14132 and 14684, Welfare and Institutions Code. § 1810.203. Adult Residential Treatment Service. “Adult Residential Treatment Service” means rehabilitative services, provided in a non–institutional, residential setting, which provide a therapeutic community including a range of activities and services for beneficiaries who would be at risk of hospitalization or other institutional placement if they were not in the residential treatment program. The service is available 24 hours a day, seven days a week. Service activities may include assessment, plan development, therapy, rehabilitation and collateral. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14021.4 and 14684, Welfare and Institutions Code. § 1810.204. Assessment. “Assessment” means a service activity which may include a clinical analysis of the history and current status of a beneficiary’s mental, emotional, or behavioral disorder; relevant cultural issues and history; diagnosis; and the use of testing procedures. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14021.4 and 14684, Welfare and Institutions Code. § 1810.205. Beneficiary. “Beneficiary” means any person certified as eligible under the Medi–Cal Program according to Title 22, Section 51001. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14000, 14005 and 14684, Welfare and Institutions Code. § 1810.205.1. Border Community. “Border Community” means a community located outside the State of California which is not considered to be out of state for the purpose of excluding coverage by the MHPs because of its proximity to California and historical usage of providers in the community by Medi–Cal beneficiaries. Specific border communities are Ashland, Brookings, Cave Junction, Grants Pass, Jacksonville, Klamath Falls, Lakeview, Medford and Merrill, Oregon; Carson City, Henderson, Incline Village, Las Vegas, Minden, Reno, Sparks, and Zephyr Cove, Nevada; and Bullhead, Kingman, Lake Havasu City, Parker, and Yuma, Arizona. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777 and 14684, Welfare and Institutions Code. § 1810.206. Collateral. “Collateral” means a service activity to a significant support person in a beneficiary’s life with the intent of improving or maintaining the mental health status of the beneficiary. The beneficiary may or may not be present for this service activity. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14021.4 and 14684, Welfare and Institutions Code. § 1810.207. Contract Hospital. “Contract Hospital” means a hospital which has a contract with a specific Mental Health Plan to provide psychiatric inpatient hospital services to beneficiaries. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions Code. § 1810.208. Crisis Residential Treatment Service. “Crisis Residential Treatment Service” means therapeutic or rehabilitative services provided in a non–institutional residential setting which provides a structured program for beneficiaries as an alternative to hospitalization for beneficiaries experiencing an acute psychiatric episode or crisis who do not present medical complications requiring nursing care. The service supports beneficiaries in their efforts to restore, maintain, and apply interpersonal and independent living skills, and to access community support systems. The service is available 24 hours a day, seven days a week. Service activities may include assessment, plan development, therapy, rehabilitation, collateral, and crisis intervention. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14021.4 and 14684, Welfare and Institutions Code. § 1810.209. Crisis Intervention. “Crisis Intervention” means a service, lasting less than 24 hours, to or on behalf of a beneficiary for a condition which requires more timely response than a regularly scheduled visit. Service activities may include but are not limited to assessment, collateral and therapy. Crisis intervention is distinguished from crisis stabilization by being delivered by providers who are not eligible to deliver crisis stabilization or who are eligible, but deliver the service at a site other than a provider site that has been certified by the department or a Mental Health Plan to provide crisis stabilization. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14021.4 and 14684, Welfare and Institutions Code. § 1810.210. Crisis Stabilization. “Crisis Stabilization” means a service lasting less than 24 hours, to
§ 1810.211 CALIFORNIA CODE OF REGULATIONS Page 512 or on behalf of a beneficiary for a condition which requires more timely response than a regularly scheduled visit. Service activities may include but are not limited to assessment, collateral and therapy. Crisis stabilization must be provided on site at a 24 hour health facility or hospital–based outpatient program or at other provider sites which have been certified by the department or a Mental Health Plan to provide crisis stabilization services. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14021.4 and 14684, Welfare and Institutions Code. § 1810.211. Cultural Competence. “Cultural Competence” means a set of congruent practice skills, behaviors, attitudes and policies in a system, agency, or among those persons providing services that enables that system, agency, or those persons providing services to work effectively in cross cultural situations. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions Code. § 1810.212. Day Rehabilitation. “Day Rehabilitation” means a structured program of rehabilitation and therapy to improve, maintain or restore personal independence and functioning, consistent with requirements for learning and development, which provides services to a distinct group of beneficiaries and is available at least three hours and less than twenty–four hours each day the program is open. Service activities may include, but are not limited to, assessment, plan development, therapy, rehabilitation and collateral. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14021.4 and 14684, Welfare and Institutions Code. § 1810.213. Day Treatment Intensive. “Day Treatment Intensive” means a structured, multi–disciplinary program of therapy which may be an alternative to hospitalization, avoid placement in a more restrictive setting, or maintain the beneficiary in a community setting, with services available at least three hours and less than twenty–four hours each day the program is open. Service activities may include, but are not limited to, assessment, plan development, therapy, rehabilitation and collateral. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14021.4 and 14684, Welfare and Institutions Code. § 1810.214. Department. “Department” means the State Department of Mental Health. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5775, 5777, 5778, 14680 and 14684, Welfare and Institutions Code. § 1810.214.1. Disproportionate Share Hospital (DSH). “Disproportionate Share Hospital (DSH)” means a hospital that serves a disproportionate share of low income people as determined annually by the State Department of Health Services in accordance with Welfare and Institutions Code, Section 14105.98. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Section 14105.98, Welfare and Institutions Code, and Title 42, Section 1396r–4, United States Code. § 1810.215. Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Supplemental Specialty Mental Health Services. “EPSDT supplemental specialty mental health services” means those services defined in Title 22, Section 51184, that are provided to correct or ameliorate the diagnoses listed in Section 1830.205, and that are not otherwise covered by this chapter. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14132 and 14684, Welfare and Institutions Code, and Title 42, Section 1396d(r), United States Code. § 1810.216. Emergency Psychiatric Condition. “Emergency Psychiatric Condition” means a condition that meets the criteria in Section 1820.205 when the beneficiary with the condition, due to a mental disorder, is a danger to self or others, or immediately unable to provide for or utilize, food, shelter or clothing, and requires psychiatric inpatient hospital or psychiatric health facility services. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777 and 14684, Welfare and Institutions Code. § 1810.216.1. Fair Hearing. “Fair Hearing” means the State hearing provided to beneficiaries pursuant to Title 22, Sections 50951 and 50953. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 10950–10965 and 14684, Welfare and Institutions Code. § 1810.216.2. Federal Financial Participation (FFP). “Federal Financial Participation (FFP)” means the federal matching funds available for services provided to Medi–Cal beneficiaries under the Medi–Cal program. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Section 5778, Welfare and Institutions Code. § 1810.217. Fee–for–Service/Medi–Cal Hospital. “Fee–for–Service/Medi–Cal Hospital” means a hospital that submits reimbursement claims for Medi–Cal psychiatric inpatient hospital services through the fiscal intermediary. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14680 and 14684, Welfare and Institutions Code. § 1810.218. Fiscal Intermediary. “Fiscal Intermediary” means the entity which has contracted with the State Department of Health Services to perform services for the Medi–Cal Program pursuant to Section 14104.3 of the Welfare and Institutions Code. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 5778, 14104.3 and 14684, Welfare and Institutions Code. § 1810.218.1. Grievance. “Grievance” means a beneficiary’s written complaint or expression of concern filed through the MHP’s grievance process as required by Section 1850.205(e)(1). NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Section 14684, Welfare and Institutions Code. § 1810.218.2. Group Provider. “Group Provider” means an organization that provides specialty mental health services through two or more individual providers. Group providers include entities such as independent practice associations, hospital outpatient departments, health care service plans, and clinics. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777 and 14684, Welfare and Institutions Code. § 1810.219. Hospital. “Hospital” means an institution that meets the requirements of Title 22, Section 51207, and has been certified by the State Department of Health Services as a Medi–Cal provider of inpatient hospital services. Hospital includes general acute care hospitals, acute psychiatric hospitals, and psychiatric health facilities. NOTE: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions Code. § 1810.220. Hospital–Based Ancillary Services. “Hospital–Based Ancillary Services” means services, which include but are not limited to prescription drugs, laboratory services,
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