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(a) The division will reimburse an enrolled provider for an intake assessment, a psychiatric assessment, or psychological testing and evaluation provided to a recipient under 21 years of age if a mental health professional reasonably believes the recipient is an emotionally disturbed child, or a severely emotionally disturbed child.
(b) The division will reimburse an enrolled provider for Medicaid-covered mental health services provided to a Medicaid recipient under 21 years of age, if those services meet the requirements of 7 AAC 43.470 - 7 AAC 43.488, and 7 AAC 43.725 - 7 AAC 43.739.
(c) Subject to the limits set out in 7 AAC 43.727, the division will reimburse a provider for mental health services provided to a recipient under 21 years of age if the
(1) recipient is determined through an intake assessment, a psychiatric assessment, or psychological testing and evaluation to be an emotionally disturbed child; and
(2) intake assessment indicates the recipient needs one or more of the following mental health clinic services:
(A) crisis intervention, as described in 7 AAC 43.738;
(B) family psychotherapy;
(C) group psychotherapy;
(D) individual psychotherapy;
(E) pharmacologic management.
(d) If, at any time during the assessment, evaluation, or treatment of a recipient who is an emotionally disturbed child, an enrolled provider of mental health services determines that the recipient may be a severely emotionally disturbed child, and the recipient is in need of mental health rehabilitation services, that provider shall refer the recipient to a community mental health clinic that provides mental health rehabilitation services in the community.
(e) Subject to the requirements of this section, the division will reimburse a community mental health clinic for the following mental health rehabilitation services under 7 AAC 43.734 provided to a recipient who is a severely emotionally disturbed child at risk of placement in a mental health inpatient or residential facility, group home, foster home, or similar out-of-home placement:
(1) medication administration services, as described in 7 AAC 43.739, if the recipient is receiving at least one other mental health rehabilitation service;
(2) a functional assessment, as described in 7 AAC 43.735;
(3) case management, as described in 7 AAC 43.737;
(4) family skill development services, as described in 7 AAC 43.472;
(5) individual skill development services, as described in 7 AAC 43.736;
(6) group skill development services, as described in 7 AAC 43.474;
(7) day treatment services, as described in 7 AAC 43.476;
(8) recipient support services, as described in 7 AAC 43.478;
(9) the mental health clinic services listed in (c) of this section.
(f) The severely emotionally disturbed child who receives mental health rehabilitative services listed in (e) of this section must be
(1) provided with an intake assessment and a functional assessment;
(2) provided with an EPSDT screening in accordance with 7 AAC 43.452; and
(3) assigned an interdisciplinary team.
(g) The division will reimburse a provider for the services identified in (e) of this section if those services are recommended by the recipient's interdisciplinary team, are included in the recipient's individualized treatment plan and clinical record, as developed under 7 AAC 43.728, and are provided as active treatment. If the services exceed the limits in 7 AAC 43.727, the services must also receive prior authorization by the division to determine whether they are medically necessary, as described in 7 AAC 43.486.
(h) After its initial meeting, a recipient's interdisciplinary team shall meet at least quarterly while the recipient remains in treatment, and conduct a treatment plan review, as developed under 7 AAC 43.728(f) , to review the recipient's individualized treatment plan and the effectiveness of the services being provided under that plan. The interdisciplinary team shall record the results of the review and any changes in the individualized treatment plan in the recipient's clinical record.
(i) The division will reimburse case management services provided by the case manager assigned to the recipient for time spent setting up, traveling to, and attending the interdisciplinary team meeting.
(j) The division will not reimburse a member of an interdisciplinary team, other than a case manager as provided in (i) of this section, for
(1) travel to or from a meeting;
(2) time spent in or preparing for a meeting;
(3) serving as a member of an interdisciplinary team; or
(4) writing or monitoring an individualized treatment plan.
(k) An interdisciplinary team must include, at a minimum,
(1) the recipient;
(2) the recipient's family members, including parents, guardians, siblings, or others similarly involved in providing general oversight of the recipient;
(3) a psychiatrist, psychologist, or mental health professional clinician;
(4) the recipient's mental health provider, if different from the mental health professional clinician;
(5) a staff member of the division of family and youth services in the department, if the recipient is in the state's custody or is under state supervision by the division of family and youth services;
(6) a staff member of the division of juvenile justice in the department, if that division is involved with the care of the recipient;
(7) if the recipient currently resides within an alternative living arrangement, including foster care, residential child care, or an institution, a representative of that facility;
(8) if the recipient is currently unable to succeed in a school, a representative from the recipient's public, private, or home educational system, including a teacher, special education consultant, speech therapist, or other representative involved in the recipient's education; and
(9) the case manager.
(l) All members of the interdisciplinary team shall attend meetings of the team in person or by telephone and be involved in team decisions unless the clinical record documents that
(1) the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipient's well being;
(2) family members, school district employees, or government agency employees refuse to participate after the provider's diligent efforts to encourage participation; or
(3) weather, illness, or another circumstance beyond a member's control prohibits that member from participating.
(m) If a provision of this chapter requires the approval, concurrence, or recommendation of the interdisciplinary team, the interdisciplinary team may issue that approval, concurrence, or recommendation only upon the concurrence of
(1) each team member under (k)(3) of this section;
(2) the recipient or the recipient's representative; and
(3) a majority of the team members other than the members identified in (1) and (2) of this subsection.
(n) The provider shall notify all absent members of the proceedings and decisions of the interdisciplinary team meeting.
(o) In this section, "interdisciplinary team" means a group of individuals listed in (k) of this section who are directly involved in the mental health treatment of a severely emotionally disturbed child, and who develop, implement, monitor, and evaluate an individualized treatment plan designed to improve the quality of the recipient's life.
History: Eff. 8/6/92, Register 123; am 12/31/92, Register 124; am 12/31/94, Register 132; readopt 8/7/96, Register 139; am 1/14/2000, Register 153; am 11/1/2000, Register 156
Authority: AS 47.05.010
Editor's note: 7\n AAC 43.470 originally took effect as emergency regulation 7\n AAC 43.457 as set out in Register 123, October 1992. Before this section was made permanent in Register 124, January 1993, it was revised and renumbered to 7\n AAC 43.470.
Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7\n AAC 43.470 in its entirety, without change, under AS\n 47.05 and AS\n 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.
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Last modified 7/05/2006