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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 21 years of age or older, if the recipient is suspected to be an emotionally disturbed adult, a severely emotionally disturbed adult, or a chronically mentally ill adult.
(b) If, at any time during the assessment, evaluation, or treatment of a recipient who is an emotionally disturbed adult, an enrolled provider of mental health services determines that the recipient may be a severely emotionally disturbed adult or chronically mentally ill adult, and that the recipient is in need of mental health rehabilitation services, the
(1) provider shall refer the recipient to a community mental health clinic that provides mental health rehabilitation services in the community; and
(2) community mental health clinic receiving a referral under this subsection shall conduct a functional assessment and develop an individualized treatment plan for the recipient in accordance with 7 AAC 43.728(c) .
(c) Subject to the requirements of this section, the division will reimburse a community mental health clinic for the following mental health rehabilitation services:
(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) individual skill development services, as described in 7 AAC 43.736;
(5) group skill development services, as described in 7 AAC 43.474;
(6) recipient support services, as described in 7 AAC 43.478;
(7) the clinic services listed in 7 AAC 43.726(a) .
(d) The division will reimburse a provider for a mental health rehabilitation service if
(1) the intake assessment indicates the recipient is a severely emotionally disturbed adult or a chronically mentally ill adult, and the recipient's functional assessment indicates deficits requiring remediation through one or more of the services listed in (c) of this section; and
(2) a physician or a mental health professional clinician recommends the service, and a recommendation for that service is included in the recipient's individualized treatment plan and clinical record, as developed under 7 AAC 43.728.
(e) The division will reimburse a provider for the services identified in (c) of this section if those services are provided as active treatment.
(f) The division will reimburse a community mental health clinic for mental health rehabilitation services if the clinic ensures that the
(1) need for mental health rehabilitation services is identified through an intake assessment conducted by a qualified mental health professional clinician and a functional assessment conducted by a mental health clinical associate;
(2) mental health rehabilitation services are included in the recipient's individualized treatment plan that has been derived from the intake assessment and functional assessment;
(3) mental health rehabilitation services are concurred in by
(A) an interdisciplinary team in accordance with 7 AAC 43.470, if the recipient is a severely emotionally disturbed child; or
(B) a physician or mental health professional clinician, if the recipient is a severely emotionally disturbed adult or a chronically mentally ill adult;
(4) mental health rehabilitation services are provided in combination with other mental health, medical, or social services provided as active treatment that can be reasonably expected to increase the recipient's ability to function within the recipient's home, school, and community; and
(5) staff providing rehabilitation services are mental health professional clinicians or mental health clinical associates, qualified by training or experience to implement mental health rehabilitation services as written in the individualized treatment plan.
(g) The division will reimburse a community mental health clinic for the services listed in (c) of this section and 7 AAC 43.470(e) and provided to qualified recipients if the community mental health clinic
(2) provides services in accordance with a plan that
(A) ensures that all individuals who need mental health rehabilitation services offered through the community mental health clinic have equal access to the services, regardless of an individual's ability to pay;
(B) describes and implements a permanent system of finding and offering services to the majority of individuals who are in need of mental health rehabilitation services in the community mental health clinic's catchment area as defined in the grant award by the division of mental health and developmental disabilities in the department;
(C) assures that the community mental health clinic regularly communicates a description of the mental health rehabilitation services available through the community mental health clinic to all other local, state, and federal agencies that provide, or may provide, services to the individuals described in (A) of this paragraph;
(D) is reviewed and updated annually by the community mental health clinic; and
(E) is submitted and updated in accordance with (h) of this section.
(h) The plan of service required by (g)(2) of this section must be submitted to the division by the community mental health clinic according to the following schedule:
(1) the plan must be submitted within 180 days after the date the grant was awarded;
(2) an annual update of a plan for the succeeding fiscal year must be submitted no later than June 30 of each year.
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 11/1/2000, Register 156
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.734 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.
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Last modified 7/05/2006