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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsOctober 2013

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§1905 of the Social Security Act (a)(13), Other diagnostic, screening, preventive, and rehabilitative services
42 CFR §440.130(d), Rehabilitative services
42 CFR §440.60, Medical or other remedial care provided by licensed practitioners
42 CFR §440.225, Optional services
42 CFR §440.20, Outpatient hospital services and rural health clinic services
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
IMPORTANT NOTE: Federal law and regulations use the term “intermediate care facilities for the mentally retarded”. DHSS/DMMA prefers to use the accepted term “individuals with intellectual disability” (ID) instead of “mental retardation.” However, as “intermediate care facilities for the mentally retarded (ICF/MR)” is the term/acronym currently used in all Federal requirements, that term/acronym will be used on applicable amended State plan pages.
6.b. Optometrists Services
6.d. Other Practitioners’ Services
6.d.2. Licensed Behavioral Health Practitioner: A licensed behavioral health practitioner (LBHP) is an individual who is licensed in the State of Delaware to diagnose and treat mental illness or substance abuse acting within the scope of all applicable state laws and their professional license. A LBHP includes individuals licensed to practice independently:
State: DELAWARE
LIMITATIONS ON AMOUNT, DURATION AND SCOPE OF MEDICAL AND REMEDIAL CARE AND SERVICES PROVIDED TO THE CATEGORICALLY NEEDY
Medical or rehabilitation clinics (excluding including Mental Health clinics, which require certification by the Division of Substance Abuse and Mental Health (DSAMH) as part of the Single State Agency for Medicaid) and
other Other laboratory and X-ray services (1905(a)(3), 42 CFR 440.30)
physicians’ Physicians’ services (1905(a)(5), 42 CFR 440.50)
medical Medical care, or any other type of remedial care recognized under State law, furnished by licensed practitioners with the scope of their practice as defined by State law (1905(a)(6), 42 CFR 440.170)
other Other diagnostic screening, preventive and rehabilitative services (1905(a)(13), 42 CFR 440.130)
primary Primary care case management services (1905(a)(19), 42 CFR 440.168).
13d. Rehabilitative Services:
Rehabilitative Services are limited to: 1) community support services for individuals who would benefit from services designed for or associated with mental illness, alcoholism or drug dependence, excluding those services of an educational or vocational nature; and 2) day health and rehabilitation services for individuals who would benefit from services designed for or associated with the treatment of mental retardation or developmental disabilities.
1) Community Support Services
Providers are organizations certified by the Division of Alcoholism, Drug Substance Abuse and Mental Health (Division) in accordance with the Delaware Medical Assistance Program Medicaid Provider Manual for Rehabilitative/Community Support Service Programs.
13d. Rehabilitative Services (Continued)
13d. Rehabilitative Services (Continued)
Comprehensive Medical/Psychosocial Evaluation: A multi-functional assessment of the client conducted by a physician (psychiatrist, internist or family practitioner), and clinicians under the supervision of the physician, to establish the medical necessity of provision of services by the community support service provider and to formulate a treatment plan.
The comprehensive medical/psychosocial evaluation will be conducted with 45 days of admission to the program and at least annually thereafter. It must be documented in the client’s record on forms approved by the Division.
Physician Services: Services provided within the scope of practice of medicine or osteopathy as defined by State law and by or under the personal supervision of an individual licensed under State law to practice medicine or osteopathy.
Emergency Services: Therapy performed in a direct and face-to-face involvement with the client available on a 24-hour basis to respond to a psychiatric or other medical condition which threatens to cause the admission of the client to a hospital, detoxification or other crisis facility. Emergency services are provided by a physician, clinician, or associate clinician or rehabilitative services assistant.
13d. Rehabilitative Services (Continued)
COVERED SERVICES (Continued)
Counseling and Psychotherapy: Counseling is supportive psychotherapy performed as needed in a direct and face-to-face involvement with the client available on a 24-hour basis to listen to, interpret and respond to the client’s expression of her/his physical, emotional and/or cognitive functioning or problems. It is provided within the context of the goals of the program’s clinical intervention as stated in the client’s treatment plan. Its purpose is to help the client achieve and maintain psychiatric and/or drug/alcohol-free stability. Its broader purpose is to help clients improve their physical and emotional health and to cope with and gain control over the symptoms of their illnesses and effects of their disabilities. Counseling is provided by physicians, clinicians or learning and practicing under direct supervision by a credentialed clinician.
Psychiatric Rehabilitative Services: Rehabilitative therapy provided on an individual and small group basis to assist the client to gain or relearn skills needed to live independently and sustain medical/psychiatric stability. Psychiatric rehabilitation is provided primarily in home and community based settings where skills must be practiced. Psychiatric rehabilitative services are provided by a physician, clinician, associate clinician, or assistant clinician or rehabilitative services assistant.
13d. Rehabilitative Services:
1) Community Support Services
COVERED SERVICES - continued
Psychosocial Rehabilitation Center Services: Facility based, group rehabilitative therapy for clients who cannot be adequately served through only individualized home and community based psychiatric rehabilitative services. Psychosocial rehabilitative therapy is provided to assist the client to gain or relearn skills needed to live independently and sustain medical / psychiatric stability. Therapy is provided in 5 4-hour blocks for up to five days per week at a psychosocial rehabilitation center facility. Services are provided by a physician, clinician, associate clinician, or assistant clinician or rehabilitative services assistant.
Residential Rehabilitation Services: Facility-based, 24-hour rehabilitative therapy for clients who cannot be adequately serviced through psychosocial rehabilitative center and/or individualized home and community based psychiatric rehabilitative services. Residential rehabilitation services are provided to assist the client to gain or relearn skills needed to live independently and sustain medical / psychological stability. Residential Rehabilitation Services are provided in a licensed mental health group home or a licensed alcoholism and drug abuse residential treatment program facilities shall be required to comply with all applicable facility licensing requirements. Services are provided by a physician, clinician, associate clinician, or assistant clinician or rehabilitative services assistant. Facilities providing residential rehabilitation services shall not be larger than 16-bed capacity. Room and board costs are not included in the service costs.
13d. Rehabilitative Services
1) Community Support Services
LIMITATIONS - continued
1A. Crisis Intervention (CI) Services are provided to a person who is experiencing a behavior health crisis, designed to interrupt and/or ameliorate a crisis experience including an assessment, immediate crisis resolution, and de-escalation, and referral and linkage to appropriate services to avoid, where possible, more restrictive levels of treatment. The goals of CI are symptom reduction, stabilization, and restoration to a previous level of functioning. All activities must occur within the context of a potential or actual behavioral health crisis. CI is a face-to-face intervention and can occur in a variety of locations, including but not limited to an emergency room or clinic setting, in addition to other community locations where the person lives, works, attends school, and/or socializes.
An individual in crisis may be represented by a family member or other collateral contact who has knowledge of the individual’s capabilities and functioning. Individuals in crisis who require this service may be using substances during the crisis. Substance use should be recognized and addressed in an integrated fashion as it may add to the risk increasing the need for engagement in care. The assessment of risk, mental status, and medical stability must be completed by a certified screener, Licensed Behavioral Health Practitioner (LBHP), advanced practice nurse (APN), nurse practitioner (NP), or physician with experience regarding this specialized mental health service, practicing within the scope of their professional license or certification. The crisis plan developed from this assessment and all services delivered during a crisis must be qualified staff provided under a certified program. Crisis services cannot be denied based upon substance use. The CI specialist must receive regularly scheduled clinical supervision from a person meeting the qualifications of a LBHP, APN, NP, or physician with experience regarding this specialized mental health service. The individual’s chart must reflect resolution of the crisis which marks the end of the current episode. If the individual has another crisis within seven (7) calendar days of a previous episode, it shall be considered part of the previous episode and a new episode will not be allowed.
Provider qualifications: Services are provided by licensed and unlicensed professional staff, who are at least eighteen (18) years of age with a high school or equivalent diploma, according to their areas of competence as determined by degree, required levels of experience as defined by state law and regulations and departmentally approved program guidelines and certifications. All outpatient substance use disorder (SUD) programs are licensed under state law. Licensed practitioners are licensed by Delaware and include, but are not limited to Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors of Mental Health (LPCMH), Licensed Marriage and Family Therapists (LMFTs), nurse practitioners (NPs), advanced practice nurses (APNs), medical doctors (MD and DO) and psychologists. Any staff who is unlicensed and providing addiction services must be credentialed by the Delaware Division of Substance Abuse and Mental Health (DSAMH) and/or the credentialing board and be under the supervision of a qualified health professional (QHP). Unlicensed staff include certified peers, certified alcohol and drug counselor (CADC), internationally certified alcohol and drug counselor (ICADC), certified co-occurring disorders professional (CCDP), internationally certified co-occurring disorders professional (ICCDP), internationally certified co-occurring disorders professional diplomate (ICCDP-D) and licensed chemical dependency professional (LCDP). State regulations require supervision of non-credentialed counselors by QHP meeting the supervisory standards established by DSAMH. A QHP includes the following professionals who are currently registered with their respective Delaware board LCSWs, LPCMH, and LMFTs, APNs, NPs, medical doctors (MD and DO), and psychologists. The QHP provides clinical/administrative oversight and supervision of non-credentialed staff.
Provider qualifications: Services are provided by licensed and unlicensed professional staff, who are at least eighteen (18) years of age with a high school or equivalent diploma, according to their areas of competence as determined by degree, required levels of experience as defined by state law and regulations and departmentally approved program guidelines and certifications. All residential programs are licensed under state law. Licensed practitioners are licensed by Delaware and include, but are not limited to Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors of Mental Health (LPCMH), Licensed Marriage and Family Therapists (LMFTs), nurse practitioners (NPs); advanced practice nurses (APNs), medical doctors (MD and DO) and psychologists. Any staff who is unlicensed and providing addiction services must be credentialed by the Delaware Division of Substance Abuse and Mental Health (DSAMH) and/or the credentialing board and be under the supervision of a qualified health professional (QHP). Unlicensed staff include certified recovery coaches, certified alcohol and drug counselor (CADC), internationally certified alcohol and drug counselor (ICADC), certified co-occurring disorders professional (CCDP), Internationally certified co-occurring disorders professional (ICCDP), Internationally certified co-occurring disorders professional diplomate (ICCDP-D) and licensed chemical dependency professional (LCDP). State regulations require supervision of non-credentialed counselors by QHP meeting the supervisory standards established by DSAMH. A QHP includes the following professionals who are currently registered with their respective Delaware board LCSWs, LPCMH, and LMFTs, APNs, NPs, medical doctors (MD and DO), and psychologists. The QHP provides clinical/administrative oversight and supervision of non-credentialed staff.
The activities included in the service must be intended to achieve identified treatment plan goals or objectives. The treatment plan should be developed in a person-centered manner with the active participation of the individual, family, and providers and be based on the individual’s condition and the standards of practice for the provision of rehabilitative services. The treatment plan should identify the medical or remedial services intended to reduce the identified condition as well as the anticipated outcomes of the individual. The treatment plan must specify the frequency, amount, and duration of services. The treatment plan must be signed by the licensed practitioner or physician responsible for developing the plan with the participant (or authorized representative) also signing to note concurrence with the treatment plan. The development of the treatment plan should address barriers and issues that have contributed to the need for substance use disorder (SUD) treatment. The plan will specify a timeline for reevaluation of the plan that is at least an annual redetermination. The reevaluation should involve the individual, family, and providers and include a reevaluation of plan to determine whether services have contributed to meeting the stated goals. A new treatment plan should be developed if there no measurable reduction of disability or restoration of functional level. The new plan should identify different rehabilitation strategy with revised goals and services.
Except as otherwise noted in the State Plan, the State-developed fee schedule is the same for both governmental and private individual providers and the fee schedule and any annual/periodic adjustments to the fee schedule are published in the Delaware Register of Regulations. The Agency’s fee schedule rate was set as of October 2, 2013 and is effective for services provided on or after that date. All rates are published on the Delaware Medical Assistance Program (DMAP) website at www.dmap.state.de.us/downloads/hcpcs.html.
State: DELAWARE
1) Community Support Service Programs
Except as otherwise noted in the State Plan, the State-developed fee schedule is the same for both governmental and private individual providers and the fee schedule and any annual/periodic adjustments to the fee schedule are published in the Delaware Register of Regulations. The Agency’s fee schedule rate was set as of October 2, 2013 and is effective for services provided on or after that date. All rates are published on the Delaware Medical Assistance Program (DMAP) website at www.dmap.state.de.us/downloads/hcpcs.html.
13. Diagnostic, Screening, Preventive and Rehabilitative Services Other Than Those Described Elsewhere In This Plan. - continued
State DELAWARE
Last Updated: December 31 1969 19:00:00.
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