§ 73425. Special Subacute Psychiatric Program Services -Mentally Disordered.

(a) Mentally disordered subacute psychiatric programs are designed to serve patients who have a chronic psychiatric impairment and whose adaptive functioning is severely impaired. These patients require continuous and intensive supervision and can be expected to benefit from an active subacute psychiatric program effort designed to improve their adaptive functioning to the point of entry into a rehabilitation program. A facility may, but is not required to, provide special subacute psychiatric program services. If the facility meets all of the requirements of this section, it shall be entitled to a supplemental special program rate under the Medi-Cal program (Title 22, California Administrative Code, Section 51335 (k)). Such special program services are those therapeutic services provided to mentally disordered persons having special needs or deficits in one or more of the following general areas: Self-Help Skills, Behavior Adjustment, Interpersonal Relationships, Prevocational Preparation and Prerelease Planning.

(b) To be approved by the Department to furnish such special subacute psychiatric programs to the mentally disordered, a facility shall have:

(1) A minimum initially of 30 patients in the facility who have been certified by the local mental health director as eligible for special subacute psychiatric program services. Eligibility for special subacute psychiatric services shall be redetermined every 30 days by the local mental health director. Patient eligibility for the special subacute psychiatric program shall be limited to a maximum of 90 days. The Department may authorize exceptions to this provision in writing to the local mental health director on an individual patient basis. At any time that the number of eligible patients receiving special program services drops below 27, total program reimbursement shall be terminated unless otherwise agreed to by the Department.

(2) An approved facility plan.

(A) To participate in this program, a facility shall submit to the Department's headquarters review and approval team for approval, an application and a facility plan which meets all the requirements of Section 73425 (c).

(B) When the Department through the headquarters review and approval team determines that the facility plan meets the specified needs of the patient population, it shall provide its written approval of the plan to the facility.

(C) Where the headquarters review and approval team disapproves a facility plan, it shall submit a written report to the facility which specifies components of the plan which need to be improved or corrected. The facility may submit a revised facility plan and a new application to the headquarters review and approval team at any time.

(3) Within 45 days after written approval of the facility plan, by the headquarters review and approval team an on-site visit by the Department to evaluate the appropriateness of the implementation of the facility plan. Upon the recommendation of the on-site visit team, the Department shall certify the facility's Special Subacute Psychiatric Program Services -Mentally Disordered. Eligibility for Medi-Cal reimbursement shall commence on the first day that the on-site visit team determined that full implementation of the approved plan actually occurred; provided, however, that the first day of payment shall not be prior to the actual date of written approval of the plan.

(4) Executed an approved Medi-Cal provider participation agreement.

(5) Maintained compliance with the approved facility plan. Failure to comply with special program requirements of the plan shall cause the termination of eligibility for reimbursement for special program services, unless otherwise excused in writing by the Department.

(c) The following requirements shall be met if the facility is to receive approval for providing special subacute program services to mentally disordered individuals with identified program needs.

(1) A facility plan for providing special subacute psychiatric program services shall be developed and submitted to the Department for approval initially and annually thereafter. The facility plan shall include:

(A) A description of the population group to be served.

(B) Names and number of patients to be served.

(C) An identification of special patient needs and grouping criteria.

(D) A description of the program design to meet the identified patient's needs.

(E) A description of the method and frequency of evaluating patient progress.

(F) Facility program staffing pattern which includes:

1. An organization chart for special program services staff.

2. A description of staffing ratios for program staff.

3. A description of interdisciplinary professional staff by discipline and hours provided per week.

(G) A description of program space provisions.

(H) Description of equipment utilized for program services.

(I) A plan for use of community resources.

(J) Sample patient program days.

(K) In-service training program in effect or planned.

(L) Provisions for accomplishing the following:

1. The facility in conjunction with the local mental health director shall make an initial individual assessment on each patient from which to identify the current level of functioning and program needs of its patients. The assessment shall be standardized on forms approved by the Department.

2. At least every 30 days, the facility in conjunction with the local mental health director shall make a written reassessment of each patient's program needs to evaluate patient progress and reassess program needs.

3. A minimum average of 30 hours of direct group or individual program service for each patient per week.

4. The facility shall have the capability of providing all of the following subacute psychiatric program services. Actual programs shall be provided based on the specific needs identified through the patient assessments.

a. Self-Help Skills Training. This shall include but not be limited to:

(i) Personal care -use of medications

(ii) Money management

(iii) Use of public transportation

(iv) Use of community resources

(v) Behavior control, impulse control

(vi) Frustration tolerance

(vii) Mental health education

(viii) Physical fitness

b. Behavioral Intervention Training. This shall include but not be limited to:

(i) Behavior modification modalities

(ii) Remotivation therapy

(iii) Patient government activities

(iv) Group counseling

(v) Individual counseling

c. Interpersonal Relationships. This shall include but not be limited to:

(i) Social counseling

(ii) Educational and recreational therapy

(iii) Socialization activities such as outings, dances, parties, etc.

d. Prevocational Preparation Services. This shall include but not be limited to:

(i) Homemaking

(ii) Work activity

(iii) Vocational counseling

e. Prerelease Planning.

(i) Out-of-home placement

HISTORY

1. Amendment of subsections (b) and (c) filed 8-19-76 as an emergency; effective upon filing (Register 76, No. 34).

2. Certificate of Compliance filed 12-15-76 (Register 76, No. 51).