(b)

1. (1) Complex care home placement for a beneficiary is intended to be temporary and transitional.

2. (2) Each beneficiary living in a complex care home must be diagnosed with an intellectual or developmental disability and a significant co-occurring deficit, which includes without limitation individuals with an intellectual disability and significant:

   1. (A) Behavioral health needs; or
   2. (B) Physical health needs.

3. (3)

   1. (A) A Provider must maintain the beneficiary-to-staff ratio necessary to meet each beneficiary’s needs as provided in their nonclinical treatment plan and PCSP and to ensure beneficiary and direct care staff health, safety, and welfare.
   2. (B) Under no circumstances may there be less than a four-to-one (4:1) beneficiary to staff ratio in a complex care home at any time.

(d)

1. (1) Each provider operating a complex care home must employ or contract with a medical director who is a licensed physician in good standing with the Arkansas State Medical Board.

2. (2) The medical director is responsible for:

   1. (A) Oversight of all medical services performed by the provider for beneficiaries residing in a complex care home;
   2. (B) Oversight of complex care home medical care quality and compliance; and
   3. (C) Ensuring all medical services performed for beneficiaries in a complex care home are provided:

(i) Within each practitioner’s scope of practice under Arkansas law; and

1. (ii) Under such supervision as required by law for practitioners not licensed to practice independently.
2. (3) The medical director must ensure appropriate medical services are accessible twenty-four (24) hours a day, seven (7) days a week for all beneficiaries residing in a complex care home.

3. (4)

   1. (A) A provider operating a complex care home must always have its medical director on-site or on-call during hours of operation.

   2. (B) An on-call medical director must respond:

      1. (i) Within twenty (20) minutes of initial contact; and
      2. (ii) In-person if required by the circumstances.

   3. (C) A provider operating a complex care home must document each after-hours contact with its medical director, including without limitation:

      1. (i) The date and time the medical director was contacted;
      2. (ii) The date and time the medical director responded; and
      3. (iii) The date and time an on-call medical director came on-site when called in due to circumstances.

4. (5) If the medical director is not a licensed psychiatrist, then the medical director must contact the licensed psychiatrist contracted or employed by the provider within twenty-four (24) hours in the following situations:

   1. (A) When antipsychotic or stimulant medications are used in dosages higher than recommended in guidelines published by the Division of Medical Services;
   2. (B) When two (2) or more medications from the same pharmacological class are used; and
   3. (C) When there is a beneficiary clinical deterioration or crisis causing risk of danger to the beneficiary or others.

(e)

1. (1) Each provider operating a complex care home must employ or contract with a licensed psychiatrist certified by one (1) of the specialties of the American Board of Medical Specialties to serve as a consultant to the medical director and other employees, as needed.
2. (2) If the medical director is certified by one (1) of the specialties of the American Board of Medical Specialties, then a provider is not required to retain a second licensed psychiatrist.

(f)

1. (1) Each provider operating a complex care home serving beneficiaries under twenty-one (21) years of age must employ or contract with a board-certified child psychiatrist to serve as a consultant to the medical director and other employees, as needed.
2. (2) If the medical director is a board-certified child psychiatrist, then a provider is not required to retain a second board-certified child psychiatrist.

(g)

1. (1) Each provider operating a complex care home must employ or contract with a full-time clinical director, or functional equivalent, who holds one (1) of the following State of Arkansas licenses or certifications:

   1. (A) Psychologist;
   2. (B) Certified social worker;
   3. (C) Psychological examiner — independent;
   4. (D) Professional counselor;
   5. (E) Marriage and family therapist;

   6. (F) Advanced practice nurse with:

      1. (i) A specialty in psychiatry or mental health; and
      2. (ii) A minimum of two (2) years’ clinical experience post master’s degree; or

   7. (G) Clinical nurse specialist with:

      1. (i) A specialty in psychiatry or mental health; and
      2. (ii) A minimum of two (2) years’ clinical experience post master’s degree.

2. (2) The clinical director is responsible for:

   1. (A) Oversight of all services, professional and paraprofessional, provided to a beneficiary residing in a certified complex care home;
   2. (B) Oversight of complex care home care and service quality and compliance;

   3. (C) Ensuring all services, professional and paraprofessional, performed for beneficiaries in a complex care home are provided:

      1. (i) Within each employee’s or practitioner’s scope of practice under Arkansas law; and
      2. (ii) Under such supervision as required by law for employees and practitioners not licensed to practice independently; and
   4. (D) Ensuring all licensed professionals appropriately supervise the delivery of all services in accordance with the beneficiary’s treatment plan.

(h)

1. (1) A Provider operating a complex care home must assign a multidisciplinary team to each beneficiary residing in the complex care home.

2. (2) The multidisciplinary team is responsible for:

   1. (A) The development of the beneficiary’s treatment plan for those services to be performed by the provider; and
   2. (B) The provider’s delivery of all services included in the beneficiary’s treatment plan.

3. (3)

   1. (A) Each multidisciplinary team must have a designated multidisciplinary team leader.
   2. (B) Each multidisciplinary team leader must be an MHP.
   3. (C) The designated multidisciplinary team leader must have licensure and training applicable to the treatment of the beneficiary as indicated in the beneficiary’s PCSP.

   4. (D) Each multidisciplinary team leader is responsible for:

      1. (i) Overseeing the development of the treatment plan for those services to be performed by the provider;
      2. (ii) Monitoring the provider’s delivery of all services included in the beneficiary’s treatment plan;
      3. (iii) Directly supervising provider employees performing the services included in the beneficiary’s treatment plan; and
      4. (iv) Providing case consultation and in-service training to members of the multidisciplinary team, as needed.
      5. (i)
4. (1) A provider operating a complex care home must establish, implement, and maintain a site-specific crisis response plan at each complex care home location.

5. (2) Each site-specific crisis response plan must include a twenty-four-hour emergency telephone number that provides for a:

   1. (A) Direct access call with an MHP within fifteen (15) minutes of an emergency/crisis;
   2. (B) Face-to-face crisis assessment of a beneficiary within two (2) hours of an emergency/crisis, which may be conducted through telemedicine, unless a different time frame is within clinical standards guidelines and mutually agreed upon by the requesting party and the responding MHP; and
   3. (C) Clinical review by the clinical director within twenty-four (24) hours of the emergency/crisis.

(j) A provider operating a complex care home must:

1. (1) Provide the twenty-four-hour emergency telephone number to all beneficiaries, and, if applicable, the legal guardians of all beneficiaries, residing in the complex care home;
2. (2) Post the twenty-four-hour emergency telephone number on all public entrances to each complex care home location; and
3. (3) Include the twenty-four-hour emergency telephone number on all answering machine greetings.