3414.1 Each CSA shall comply with the certification standards described in § 3413, the service specific standards applicable to core services, and the certification standards set forth in this section, as well as the other certification standards in this chapter.

3414.2 Each CSA shall:

1. (a) Serve as the clinical home for the consumers it enrolls;
2. (b) Be responsible for ensuring that Plans of Care are developed and approved for its enrolled consumers; and
3. (c) Provide clinical management for its enrolled consumers.

3414.3 Each CSA shall satisfy the following minimum staffing requirements:

1. (a) A Chief Executive Officer with professional qualifications and experience who meets the requirements established by the MHRS provider's governing authority. The Chief Executive Officer shall be charged with responsibility for day-to-day management of the CSA, and shall be a full-time employee devoting at least twenty (20) hours a week to administrative and management functions of the CSA;
2. (b) A Medical Director who is a board-eligible psychiatrist, responsible for the quality of medical and psychiatric care provided by the MHRS provider. A child and youth-serving CSA may have a staff or consulting board-eligible child psychiatrist or a staff board-eligible psychiatrist with substantial child and adolescent experience as its Medical Director;
3. (c) A full-time Clinical Director who is an independently licensed qualified practitioner with an appropriate, relevant behavioral health advanced degree, with overall responsibility for oversight of the clinical program of the MHRS provider. The Clinical Director may also serve as the Medical Director if the Clinical Director is a board-eligible psychiatrist;
4. (d) A Controller, Chief Financial Officer, or designated individual responsible for executing or overseeing the financial operations of the MHRS provider. The designated financial officer shall have a Bachelors' Degree plus two (2) years of fiscal experience and may also oversee administrative operations and information services;
5. (e) A medical records administrator responsible for the following:

(1) Ongoing quality control of clinical documentation;

(2) Assuring that clinical records are maintained, completed, and preserved in accordance with the MHRS provider's Clinical Records Policy;

(3) Assuring that information on enrolled consumers is immediately retrievable; and

(4) Establishing a central records index for the MHRS provider.

3414.4 The CSA shall have an annual audit by an independent certified public accountant or a certified public accounting firm in accordance with generally accepted auditing standards. The resulting financial audit report shall be consistent with formats recommended by the American Institute of Public Accountants. The CSA shall submit a copy of the financial audit report to the Department within one hundred and twenty (120) calendar days after the end of the provider's fiscal year.

3414.5 Each CSA shall comply with the following requirements regarding clinical operations:

(a) The CSA shall accommodate consumer preferences and needs with respect to primary staff and team representation.

(b) The consumer and the assigned CSA staff shall be responsible for the development and periodic review of the consumer's Plan of Care and for the coordination the delivery of all MHRS received by the consumer.

(c) The signing independently licensed qualified practitioner shall be primarily responsible for assuring that the Plan of Care assists the consumer in developing self-care skills and achieving recovery.

(d) Each CSA shall establish and adhere to policies and procedures governing its relationship with subcontractors ("Subcontractor Policy") in compliance with Federal and District laws and regulations. The Subcontractor Policy shall address, at a minimum, access to records, clinical responsibility and supervision, legal liability, and insurance and dispute resolution.

(e) Each CSA shall establish and adhere to policies and procedures governing the means by which family education and support will be offered and provided ("Consumer and Family Education Policy"). The Consumer and Family Education Policy shall require, at a minimum, the following:

(1) The CSA shall make family education and support available for all consumer families;

(2) Family education and support shall include general information about mental health and psychiatric illness;

(3) For adult consumers, a provider shall only disclose information about a consumer with the consent of the consumer. In the case of child, the provider shall only disclose information about a consumer with the consent of the parent or guardian in accordance with the CSA's Release of Consumer Information Policy;

(4) The availability of appointments for family members to meet with staff and availability of family support and education groups to be scheduled at times convenient for the family; and

(5) In written materials and face-to-face contacts provide information about available and needed services, as well as how the consumer may access Crisis/Emergency Services. The materials shall be written at the 4th grade reading level and shall be printed in English and either Spanish or the secondary language conducive to facilitating communication with the majority of the CSA's target population.

3414.6 Each CSA shall comply with the following requirements regarding service accessibility:

(a) Each CSA shall operate an on-call system for its enrolled consumers twenty-four (24) hours per day, seven (7) days per week, to respond to urgent, emergency, and routine situations ("CSA On-Call System").

(b) Each CSA shall establish and adhere to policies and procedures governing the operation of its On-Call System ("On-Call System Policy"). The On-Call System Policy shall require the CSA to provide:

(1) Telephone access to an independently licensed qualified practitioner for consumers and their significant others to resolve problems telephonically, when possible;

(2) Timely access to an independently licensed qualified practitioner in order to provide any needed crisis support services, to include face-to-face interventions; and

1. (3) Linkage to Crisis/Emergency Services, including crisis stabilization services and “next day” appointments to assist the consumer to address urgent problems during the next business day.
2. (c) Each CSA shall, at a minimum, offer the core services as specified in § 3417.2. A CSA shall provide at least one (1) core service directly and may provide up to five (5) core services via contract with a sub-provider or subcontractor. A CSA may provide specialty services directly if certified by the Department as a specialty provider.
3. (d) Each CSA shall ensure that its business hours comply with the requirements of § 3413.21 and facilitate each enrolled consumer’s ability to choose an MHRS provider.
4. (e) Each CSA shall provide a consumer presenting with an urgent need with an independently licensed qualified practitioner for an intervention which may include face-to-face contact on the same day that the consumer presents for service.
5. (f) Each potential consumer presenting with a routine need shall be provided an intake appointment by a CSA within seven (7) business days of presentation for service.
6. (g) Each CSA shall have policies and procedures for the provision of outreach services, including means by which these services and individuals will be targeted (“Outreach Policy”). The Outreach Policy shall include procedures for protecting the safety of staff who engage in outreach activities.
7. (h) Each CSA shall educate consumers on EBPs and document consumers’ receipt of this information.3414.7 Each CSA shall comply with the requirements for assessment and referral for Mental Health Supported Employment services and integration of Employment Specialists into the CSA’s treatment team, in accordance with the requirements set forth in 22-A DCMR Chapter 37.3414.8 Each CSA shall make a play area available for children in the waiting room area.3414.9 Each CSA shall be responsible for submitting enrolled consumers’ clinical information to the Department upon request to receive and maintain authorization for medically necessary services.3414.10 The Department shall review and approve each CSA’s Subcontractor Policy,

Consumer and Family Education Policy, On-Call System Policy, Outreach Policy, Quality Improvement Policy, and Evidence-Based Practices Information Policy as part of the certification process.

3414.11 All MHRS providers certified for ACT, CPP, FFT, Multisystemic Therapy (MST), CBI Level II and III, TF-CBT, and TST shall obtain the Department's approval to add teams supported through a Human Care Agreement. Providers shall submit a written request which must include the staffing patterns, including supervisors, training plan and/or dates, staff-to-consumer ratio, and new capacity for the entire team including the new addition.

3414.12 All MHRS providers shall obtain a National Provider Identification (NPI) number for itself and all personnel performing MHRS services through the provider. All providers shall register itself and all personnel performing MHRS services with the Department of Health Care Finance's designated information system prior to billing for services.

SOURCE: Final Rulemaking published at 48 DCR 10297 (November 9, 2001); as amended by Final Rulemaking published at 51 DCR 9308 (October 1, 2004); as amended by Final Rulemaking published at 52 DCR 5682 (June 17, 2005); as amended by Final Rulemaking published at 67 DCR 10674 (September 4, 2020); as amended by Final Rulemaking published at 69 DCR 013495 (November 4, 2022); as amended by Final Rulemaking published at 70 DCR 003050 (March 10, 2023); as corrected by Errata Notice published at 71 DCR 004474 (April 19, 2024).