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Rule Title: 72-HOUR PRESUMPTIVE ELIGIBILITY FOR ADULT CRISIS STABILIZATION SERVICES: DEFINITIONS
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Department: PUBLIC HEALTH AND HUMAN SERVICES
Chapter: MENTAL HEALTH SERVICES
Subchapter: 72-Hour Presumptive Eligibility for Adult Crisis Stabilization Services
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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37.89.501    72-HOUR PRESUMPTIVE ELIGIBILITY FOR ADULT CRISIS STABILIZATION SERVICES: DEFINITIONS

As used in this subchapter, unless expressly provided otherwise, the following definitions apply:

(1) "Adult" means an individual who is 18 years of age or older.

(2) "Assessment" means a face-to-face interview or observation of an individual by a mental health practitioner to evaluate the individual's mental status or the nature and severity of the individual's mental illness for the purpose of determining which interventions are needed to stabilize the individual.

(3) "Care coordination" means the process of planning and coordinating care and services to meet the individual's mental health service needs. Care coordination includes:

(a) the development and monitoring of the crisis stabilization plan;

(b) identifying available natural and community services and supports for the individual being served;

(c) contact with others as appropriate, for the purpose of supporting;

(d) assisting the individual being served;

(e) service coordination;

(f) referral; and

(g) discharge planning.

(4) "Crisis" means a serious unexpected situation resulting from an individual's apparent mental illness in which the symptoms are of sufficient severity, as determined by a mental health practitioner, to require immediate care to avoid:

(a) jeopardy to the life or health of the individual; or

(b) death or bodily harm to the individual or to others.

(5) "Crisis care manager" means a trained mental health staff member who is responsible for managing the implementation of a crisis stabilization plan until the individual is discharged from crisis stabilization services.

(6) "Crisis management services" means the services listed in ARM 37.89.505, when delivered by an enrolled provider.

(7) "Crisis stabilization" means development and implementation of a short-term intervention to respond to a crisis, for the purposes of reducing the severity of an individual's mental illness symptoms and attempting to prevent admission of the individual to a more restrictive environment.

(8) "Crisis stabilization plan" means an initial, brief, individualized plan that complies with ARM 37.89.505 and is created within 24 hours of an assessment.

(9) "Crisis stabilization provider" means a provider of services that is a legal entity enrolled under ARM 37.89.115 and has executed a provider enrollment addendum approved by the department, or is a hospital.

(10) "Crisis stabilization services" means the services listed in ARM 37.89.521 when delivered by a crisis stabilization provider during an individualized psychiatric emergency intervention, delivered in a safe environment, to:

(a) stabilize a crisis;

(b) improve diagnostic clarity;

(c) find appropriate alternatives to psychiatric hospitalization;

(d) treat those symptoms that can be improved within a brief period of time; and

(e) arrange appropriate follow-up care or to refer an individual to a provider of the appropriate level of care and treatment.

(11) "Day" means a 24 hour period beginning with the first hour that crisis stabilization services are delivered.

(12) "Department" means the Montana Department of Public Health and Human Services.

(13) "Discharge" means the end of reimbursement for crisis stabilization services delivered under this subchapter.

(14) "Eligibility determination" means a decision made by a mental health practitioner that an individual's situation meets the definition of crisis as defined in this rule. This decision establishes presumptive eligibility as defined in (15).

(15) "Medically necessary mental health services" means outpatient and inpatient psychiatric clinical crisis stabilization services delivered to an individual under this subchapter.

(16) "Medically necessary service" means a service that is necessary to assess, diagnose, treat, or prevent the worsening of conditions for an individual who is experiencing a crisis.

(17) "Mental health practitioner" means an individual who is:

(a) a physician licensed under Title 37, chapter 3, MCA;

(b) a professional counselor licensed under Title 37, chapter 23, MCA;

(c) a psychologist licensed under Title 37, chapter 17, MCA;

(d) a social worker licensed under Title 37, chapter 22, MCA;

(e) an advanced practice registered nurse, as provided for in Title 37, chapter 8, MCA, and ARM 24.159.1490 with a clinical specialty in psychiatric mental health nursing; or

(f) a physician assistant licensed under Title 37, chapter 20, MCA, with clinical mental health experience.

(18) "Presumptive eligibility" means a period of up to 72 hours during which time-limited mental health crisis stabilization services delivered to an individual experiencing a crisis will be reimbursed by the department.

History: 53-6-101, 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 2008 MAR p. 1489, Eff. 4/11/08.


 

 
MAR Notices Effective From Effective To History Notes
37-429 4/11/2008 Current History: 53-6-101, 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 2008 MAR p. 1489, Eff. 4/11/08.
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