1. (1) A provider that meets the respective requirements will be issued one of two types of certificates depending upon the number and type of services delivered by the provider. The criteria listed below will be applied at the time an initial Application for Certification is submitted and during the initial and subsequent site visits after the effective date of this edition of the standards.

   1. (a) Mental Health Services Provider. A provider may be certified as a Mental Health Services provider if it provides one or more (but not all) of the services as listed in 580-2-9-.09 thru 580-2-9-.25 in compliance with the standards. The services for which a provider seeks certification should be listed on the Application for Certification and will be specifically reviewed during the on-site visit. The services that a mental health service provider are certified to provide will be listed in the cover letter mailed with the certificate.

   2. (b) Community Mental Health Center. A provider will be certified as a Community Mental Health Center (CMHC) if the requirements listed below are met. The requirements are designed to assure that any provider certified as a CMHC provides the array of services defined below either directly or through specific arrangement with another agency/individual to a broad array of recipients in an identified service area without regard to age, race, language of preference, sex, and degree of psychiatric disability. The services must be coordinated in a manner that assures access to inpatient and residential care and to community supports for adults with serious mental illness and children and adolescents with severe emotional disturbance.

      1. 1. The provider must provide the following services as defined in Paragraph 2. below directly through its employees:

         1. (i) Emergency Services,
         2. (ii) Outpatient Services,
         3. (iii) Consultation and Education Services, and
         4. (iv) Partial Hospitalization/Intensive Day Treatment/ Rehabilitative Day Program, and
         5. (v) Must provide residential services either directly through its employees or through agreement with other certified providers.

      2. 2. In addition to the specific criteria listed below, the provider must also comply with the applicable sections of the program standards for each program element. For each required program element under the CMHC certificate, the criteria that must be met at the time of initial application and at the time of the first on-site visit and subsequent site visits are specified below. Providers who do not meet all criteria below for each service required to be a Community Mental Health Center (CMHC) at the time of the initial Application for Certification are not eligible to be surveyed as a CMHC. If all the criteria for a CMHC are not met during a site visit, the provider is not eligible for certification as a CMHC. A provider may request certification as a Mental Health Services Provider for those services which do meet the applicable standards.

         1. (i) Emergency Services.

            1. (I) At the time of application:

               1. I. The program description for Emergency Services describes how it will be available 24 hours a day, 7 days a week both by telephone and face-to-face and how consumers are informed about emergency services.

                  1. A. Policies/job descriptions include requirements for Emergency Service staff to be on call 24 hours a day, 7 days a week.

                  2. B. The Emergency Service program description includes the following crisis intervention services for consumers with serious mental illness or severe emotional disturbance.

                     1. (A) Demonstrated capacity to gain access to inpatient psychiatric services.
                     2. (B) Capability to assure that consumers who are in jail can be evaluated and medications, if any, continued unless not permitted by the jail.
                     3. (C) Capacity to ensure that consumers who are deaf/hard of hearing can gain access to linguistically appropriate emergency care.

            2. (II) At the time of the initial and subsequent site visit(s):

               1. I. There is evidence in consumer records and/or other documents that services described in (i) above were provided.
               2. II. In the sole discretion of the DMH, the number of consumers served demonstrates that there is a creditable effort to provide emergency services.

         2. (ii) Outpatient Services.

            1. (I) At the time of application:

               1. I. Outpatient services are listed on the provider’s organizational chart.
               2. II. The Outpatient program description has admission criteria inclusive of all ages, persons with serious mental illness/severe emotional disturbance, and persons discharged from inpatient psychiatric treatment.
               3. III. Specialty services for children and elderly are described.
               4. IV. Policies/job descriptions require staff treating children and elderly to have the required credentials.

               5. V. Specialty services for persons discharged from an inpatient psychiatric setting and for persons with a serious mental illness/severe emotional disturbance must include the following:

                  1. A. Evaluation and medication monitoring by a psychiatrist.
                  2. B. Outreach capability to provide services to consumers in their usual living situation.
                  3. C. Provision of case management services in accordance with the program standards either directly or through an arrangement approved by the Alabama Department of Mental Health.
                  4. D. Screening for admission to state psychiatric hospitals as evidenced by a written agreement with the local 310 Board (if not a 310 Board), relative to coordination of screening petitions for involuntary inpatient commitment for consumers of the CMHC.

                  5. E. Follow-up on all missed appointments for all high-risk consumers including those who:

                     1. (A) Have been discharged from psychiatric inpatient care within the past 12 months.
                     2. (B) Were decompensating at the last visit.
                     3. (C) Are considered potentially harmful to self or others.

            2. (II) At the time of the initial and subsequent site visit(s):

               1. I. A review of a sample of consumer records demonstrates that the services described in the application are provided to consumers.
               2. II. In the sole discretion of the DMH, the number and type of consumers served demonstrates that there is a creditable effort to provide Outpatient specialty services as described in I. through V. above.
               3. III. The staff employed in the Outpatient program meet the credential requirements for both general and specialty services.

         3. (iii) Consultation and Education Services

            1. (I) At the time of application:

               1. I. Application materials describe planned consultation and education activities to include both program and consumer consultation and public education.

            2. (II) At the time of the initial and subsequent site visit(s):

               1. I. Consultation and education activities have been provided and documented as described in the application materials.

         4. (iv) Partial Hospitalization/Day Treatment Services.

            1. (I) At the time of application:

               1. I. There is a program description for either Partial Hospitalization, Intensive Day Treatment, or Rehabilitative Day Program that complies with the respective program standards.
               2. II. The proposed staffing pattern conforms to the applicable standards in the Mental Illness Program Staff section and the respective program standards.
               3. III. The organizational chart includes at least one type of day treatment service.

            2. (II) At the time of the initial and subsequent site visit(s):

               1. I. The schedule of activities and the consumer records document that the program description has been implemented in accordance with the respective certification standards for the service.
               2. II. Staff meet the credential requirements.
               3. III. In the sole discretion of the DMH, the number of consumers served demonstrates that there is a creditable effort to provide Partial Hospitalization/Day Treatment Services.

         5. (v) Residential Services

            1. (I) At the time of application:

               1. I. There must be available either a written program description if residential services are offered directly by the provider or a written agreement with another residential treatment services provider certified under 580-2-9-.18 relative to delivery of residential services.
               2. II. If the provider is applying to deliver residential services directly, the program description and proposed staff must conform to the Residential Services standards.
               3. III. If the provider proposes to offer this service through arrangement with another provider, there must be a written agreement that identifies the services to be provided and the manner in which admission to and follow-up after discharge will be coordinated by the provider.

            2. (II) At the time of the initial and subsequent site visit(s):

               1. I. The consumer records and program documentation validate that the program is operating in accordance with the program description and the Residential Services Standards.
               2. II. There is documentation of the number of the provider’s consumers that have received residential services through the written agreement with another certified residential service provider. The consumer records and any other relevant documents clearly demonstrate coordination of admission and follow-up after discharge from the provider.

               3. III. In the sole discretion of the DMH, the number of consumers served demonstrates that there is a creditable effort to provide residential services.

                  1. (i) At the time of the first site visit, the agency should have:

                     1. (I) Staff capable of providing specialty outpatient services to children, adolescents, adults, and older adults.
                     2. (II) Should be able to demonstrate community outreach efforts designed to promote access from all age groups with particular emphasis on those who are seriously mentally ill or severely emotionally disturbed.
                     3. (III) The number of recipients both total and by service type and the services provided are acceptable for the time period that the agency has been operational and are roughly proportionate to the number of consumers and types of services provided by agencies similarly certified.
                     4. (IV) The provider can demonstrate appropriate response to consumers for whom a petition for involuntary commitment has been issued and/or who have been hospitalized at a state psychiatric hospital.
                  2. (ii) At the end of the first year of operation, the agency must have served at least 100 consumers and the services provided should be proportionate to the average of those agencies that are similarly certified.

                  Because Community Mental Health Centers are expected to offer a broad array of services to a demographically and psychiatrically diverse population, the following additional requirements regarding the overall operation of the agency must be met:

Author: Division of Mental Illness, DMH

Statutory Authority: Code of Ala. 1975, §22-50-11.

History: New Rule: Filed June 14, 2010; effective July 19, 2010.