At a minimum, behavioral health agency staffing shall be sufficient to establish and implement services for each behavioral health agency client, and must include the following:

1. (1)

   1. (A) Chief executive officer/executive director (or functional equivalent) (full-time position or full-time equivalent positions).

   2. (B) The person or persons identified to carry out CEO/ED functions:

      1. (i) Is/are ultimately responsible for applicant/provider organization, staffing, policies and practices, and behavioral health agency service delivery; and

      2. (ii) Must:

         1. (a) (a) Possess a master’s degree in behavioral health care, management, or a related field and experience; and
         2. (b) (b) Meet any additional qualifications required by the provider’s governing body.
   3. (C) Other job-related education, experience, or both, may be substituted for all or part of these requirements upon approval of the provider’s governing body;

2. (2)

   1. (A) Clinical director (or functional equivalent) (full-time position or full-time equivalent positions).

   2. (B) The person or persons identified to carry out clinical director functions must:

      1. (i) Report directly to the CEO/ED;
      2. (ii) Be the Department of Human Services contact for clinical and practice-related issues;
      3. (iii) Be accountable for all clinical services (professional and paraprofessional);
      4. (iv) Be responsible for behavioral health agency care and service quality and compliance;
      5. (v) Assure that all services are provided within each practitioner’s scope of practice under Arkansas law and under such supervision as required by law for practitioners not licensed to practice independently;
      6. (vi) Assure and document in the provider’s official records the direct supervision of MHPs, either personally or through a documented chain of supervision;

      7. (vii)

         1. (a) (a) Assure that licensed mental health professionals directly supervise qualified behavioral health providers.
         2. (b) (b) Direct supervision ratios must not exceed one (1) licensed mental health professional to ten (10) qualified behavioral health providers; and

      8. (viii) Possess independent behavioral health licensure in Arkansas as:

         1. (a) (a) A licensed psychologist;
         2. (b) (b) A licensed certified social worker;
      9. (c) (c) A licensed psychological examiner-independent;

      10. (d) (d) A licensed professional counselor;

          1. (e) (e) A licensed marriage and family therapist; or
          2. (f) (f) An advanced practice nurse or clinical nurse specialist with a:
3. (1) (1) Specialty in psychiatry or mental health; and
4. (2) (2) Minimum of two (2) years clinical experience post master’s degree;

5. (3)

   1. (A) Mental health professionals (independently licensed clinicians, nonindependently licensed clinicians).

   2. (B) MHPs may:

      1. (i) Provide direct behavioral health care;
      2. (ii) Delegate and oversee work assignments of qualified behavioral health providers;
      3. (iii) Delegate and oversee work assignments of certified peer specialists, certified youth support specialists, and certified family support partners;
      4. (iv) Ensure compliance and conformity to the provider’s policies and procedures;
      5. (v) Provide direct supervision of qualified behavioral health providers;
      6. (vi) Provide direct supervision of certified peer specialists, certified youth support specialists, and certified family support partners;
      7. (vii) Provide case consultation and in-service training;
      8. (viii) Observe and evaluate performance of qualified behavioral health providers; and
      9. (ix) Observe and evaluate performance of certified peer specialists, certified youth support specialists, and certified family support partners.

   3. (C) MHP supervision.

      1. (i) Communication between an MHP and the MHP’s supervisor must include each of the following at least every twelve (12) months:

         1. (a) (a) Assessment and referral skills, including the accuracy of assessments;
         2. (b) (b) Appropriateness of treatment or service interventions in relation to the client needs;
      2. (c) (c) Treatment/intervention effectiveness as reflected by the client meeting individual goals;

      3. (d) (d) Issues of ethics, legal aspects of clinical practice, and professional standards;

         1. (e) (e) The provision of feedback that enhances the skills of direct service personnel;
         2. (f) (f) Clinical documentation issues identified through ongoing compliance review;
         3. (g) (g) Cultural competency issues; and
         4. (h) (h) All areas noted as deficient or needing improvement.
      4. (ii) Documented client-specific face-to-face and other necessary communication regarding client care must occur between each MHP’s supervisor and the MHP periodically (no less than every ninety (90) calendar days) in accordance with a schedule maintained in the provider’s official records;

6. (4)

   1. (A) Qualified behavioral health providers (including certified peer support specialists, certified youth support specialists, and certified family support partners):

      1. (i) Are MHP service extenders;
      2. (ii) Supervision must conform to the requirements for MHP supervision (see subdivision (3)(C) of this section) except that all requirements must be met every six (6) months, and one (1) or more licensed healthcare professional or professionals acting within the scope of his or her practice must have a face-to-face contact with each qualified behavioral health provider for the purpose of clinical supervision at least every fourteen (14) days, must have at least twelve (12) such face-to-face contacts every ninety (90) days, and such additional face-to-face contacts as are necessary in response to a client’s unscheduled care needs, response or lack of response to treatment, or change of condition; and

      3. (iii) Must establish that qualified behavioral health provider supervision occurred via individualized written certifications created by a licensed mental health professional and filed in the provider’s official records on a weekly basis, certifying:

         1. (a) (a) That the licensed mental health professional periodically (in accordance with a schedule tailored to the client’s condition and care needs and previously recorded in the provider’s official records) communicated individualized client-specific instructions to the mental health paraprofessional describing the manner and methods for the delivery of paraprofessional services;
         2. (b) (b) That the licensed mental health professional periodically (in accordance with a schedule tailored to the client’s condition and care needs and previously recorded in the provider’s official records, but no less than every thirty (30) days) personally observed the mental health paraprofessional delivering services to a client and that the observations were of sufficient duration to declare whether paraprofessional services complied with the licensed mental health professional’s instructions; and
      4. (c) (c) The date, time, and duration of each supervisory communication with and observation of a qualified behavioral health provider.

   2. (B)

      1. (i) The behavioral health agency is responsible for ensuring qualified behavioral health providers that are not certified as a certified peer support specialist, certified youth support specialist, or certified family support partner successfully complete training in behavioral health services provision from a licensed medical person experienced in the area of behavioral health, a certified behavioral agency, or a facility licensed by the State Board of Education before providing care to Medicaid beneficiaries.
      2. (ii) The qualified behavioral health provider must receive orientation to the behavioral health agency.
      3. (iii) The qualified behavioral health provider training course offered for those individuals not certified as a certified peer support specialist, certified youth support specialist, or certified family support partner must total a minimum of forty (40) classroom hours and must be successfully completed within a maximum time of the first two (2) months of employment by the behavioral health agency.

      4. (iv)

         1. (a) (a) The training curriculum must contain information specific to the population being served, i.e., child and adolescent, adult, dually diagnosed, etc.
         2. (b) (b) The curriculum must include, but is not limited to:
7. (1) (1) Communication skills;
8. (2) (2) Knowledge of behavioral health illnesses;
9. (3) (3) How to be an appropriate role model;
10. (4) (4) Behavior management;
11. (5) (5) Handling emergencies;

12. (6)

    1. (A) (6)(A) Recordkeeping.
    2. (B) (B) Observing beneficiary, reporting or recording observations, time, or employment records;
13. (7) (7) Knowledge of clinical limitations;
14. (8) (8) Knowledge of appropriate relationships with beneficiary;
15. (9) (9) Group interaction;
16. (10) (10) Identification of real issues;
17. (11) (11) Listening techniques;
18. (12) (12) Confidentiality;
19. (13) (13) Knowledge of medications and side effects;
20. (14) (14) Daily living skills;
21. (15) (15) Hospitalization procedures single-point-of-entry;
22. (16) (16) Knowledge of the Supplemental Security Income application process;
23. (17) (17) Knowledge of day treatment models proper placement levels;
24. (18) (18) Awareness of options;
25. (19) (19) Cultural competency;
26. (20) (20) Ethical issues in practice; and

27. (21) (21) Childhood development, if serving the child and adolescent population.

    1. (v) A written examination of the qualified behavioral health providers that are not certified as certified peer support specialists, certified youth support specialists, or certified family support partners knowledge of the forty-hour classroom training curriculum must be successfully completed.

       1. (vi) Evaluation of the qualified behavioral health provider’s ability to perform daily living skills for mental health services must be successfully completed by means of a skills test.

       2. (vii)

          1. (a) (a) The qualified behavioral health provider who successfully completes the training must be awarded a certificate.
          2. (b) (b) This certificate must state the person is qualified to work in an agency under professional supervision as a qualified behavioral health provider.

       3. (viii)

          1. (a) (a) In-service training sessions are required at a minimum of once per twelve-month period after the successful completion of the initial forty-hour classroom training for qualified behavioral health specialists not certified as a certified peer support specialist, certified youth support specialist, or certified family support partner.
          2. (b) (b) The in-service training must total a minimum of eight (8) hours each twelve-month period beginning with the date of certification as a qualified behavioral health provider and each twelve-month period thereafter.
       4. (c) (c) The in-service training may be conducted, in part, in the field.
       5. (d) (d) Documentation of in-service hours will be maintained in the employee’s personnel record and will be available for inspection by regulatory agencies;

28. (5) Corporate compliance officer:

    1. (A) Manages policy, practice standards, and compliance, except compliance that is the responsibility of the medical records librarian;
    2. (B) Reports directly to the CEO/ED (except in circumstances where the compliance officer is required to report directly to a director, the board of directors, or an accrediting or oversight agency);
    3. (C) Has no direct responsibility for billings or collections; and
    4. (D) Is the department and Medicaid contact for department certification, Medicaid enrollment, and compliance;

29. (6)

    1. (A) Medical director.

    2. (B) The medical director:

       1. (i) Oversees behavioral health agency care planning, coordination, and delivery, and specifically:

          1. (a) (a) Diagnoses, treats, and prescribes for behavioral illness;
          2. (b) (b) Is responsible and accountable for all client care, care planning, care coordination, and medication storage;
       2. (c) (c) Assures that physician care is available twenty-four (24) hours a day, seven (7) days a week;

       3. (d) (d) May delegate client care to other physicians, subject to documented oversight and approval; and

          1. (e) (e) Assures that a physician participates in treatment planning and reviews;

       4. (ii)

          1. (a) (a) If not a psychiatrist, a psychiatrist certified by one (1) of the specialties of the American Board of Medical Specialties must serve as a consultant to the medical director and to other staff, both medical and nonmedical.
          2. (b) (b) If the provider serves clients under the age of twenty-one (21), the medical director shall have access to a board certified child psychiatrist, for example, through the Psychiatric Research Institute Child/Adolescent Telephone Consultation Service;
       5. (iii) Medical director services may be acquired by contract;

       6. (iv) If not a psychiatrist, then he or she shall contact a consulting psychiatrist within twenty-four (24) hours in the following situations:

          1. (a) (a) When antipsychotic or stimulant medications are used in dosages higher than recommended in guidelines published by the Division of Medical Services;
          2. (b) (b) When two (2) or more medications from the same pharmacological class are used; and
       7. (c) (c) When there is significant clinical deterioration or crisis with enhanced risk of danger to self or others;
       8. (v) The consulting psychiatrist or psychiatrists shall participate in quarterly quality assurance meetings;

30. (7)

    1. (A) Privacy officer.
    2. (B) The privacy officer develops and implements policies to assure compliance with privacy laws, regulations, and rules.
    3. (C) Applicants/providers may assign privacy responsibilities to the corporate compliance officer, grievance officer, or medical records librarian, but not the CEO/ED;

31. (8)

    1. (A) Quality control manager.
    2. (B) The quality control manager chairs the quality assurance committee and develops and implements quality control and quality improvement activities.
    3. (C) Applicants/providers may assign quality control manager responsibilities to the corporate compliance office or medical records manager, but not the CEO/ED;

32. (9) The grievance officer:

    1. (A) Develops and implements the applicant’s/provider’s employee and client grievance procedures;

    2. (B)

       1. (i) Effectively communicates grievance procedures to staff, contractors, prospective clients, and clients.
       2. (ii) Communications to clients who are legally incapacitated shall include communication to the client’s responsible party; and
    3. (C) Shall not have any duties that may cause him or her to favor or disfavor any grievant;

33. (10) The medical records librarian:

    1. (A) Must be qualified by education, training, and experience to understand and apply:

       1. (i) Medical and behavioral health terminology and usages covering the full range of services offered by the provider;
       2. (ii) Medical records forms and formats;

       3. (iii) Medical records classification systems and references such as:

          1. (a) (a) The American Psychiatric Association’s Diagnostic and Statistical Manual-IV-TR and subsequent editions;
          2. (b) (b) International Classification of Diseases;
       4. (c) (c) Diagnostic Related Groups;

       5. (d) (d) Physician's Desk Reference;

          1. (e) (e) Current Procedural Terminology; and
          2. (f) (f) Medical dictionaries, manuals, textbooks, and glossaries;
       6. (iv) Legal and regulatory requirements of medical records to assure the record is acceptable as a legal document;
       7. (v) Laws and regulations on the confidentiality of medical records (Patient Medical Records Privacy Act, Arkansas Code § 16-46-401 et seq., and the Freedom of Information Act of 1967, Arkansas Code § 25-19-101 et seq.) and the procedures for informed consent for release of information from the record; and
       8. (vi) The interrelationship of record services with the rest of the facility's services; and

    2. (B) Develops and:

       1. (i) Implements the client information system;
       2. (ii) Implements operating methods and procedures covering all medical records functions; and
       3. (iii) Ensures that the medical record is complete, accurate, and compliant; and

34. (11) A licensed psychologist, licensed psychological examiner, or licensed psychological examiner-independent:

    1. (A) Provides psychological evaluations;

    2. (B)

       1. (i) Must have supervision agreements with a doctoral psychologist to provide appropriate supervision or services for any evaluations or procedures that are required under or are outside the psychological examiner’s scope of independent practice.
       2. (ii) Documentation of such agreements and of all required supervision and other practice arrangements must be included in the psychological examiner’s personnel record; and
    3. (C) Services may be acquired by contract.