3424 INTENSIVE DAY TREATMENT

3424.1 IDT is a facility-based, structured, intensive, and coordinated acute treatment program which serves as an alternative to acute inpatient treatment or as a step-down service from inpatient care, and is rendered by an interdisciplinary team to provide stabilization of psychiatric impairments.

3424.2 Daily physician and nursing services are essential components of IDT services.

3424.3 IDT shall:

1. (a) Be time-limited and provided in an ambulatory setting to consumers who are not in danger of self-harm or harming others, but who have behavioral health issues that are incapacitating and interfering with their ability to carry out daily activities;
2. (b) Be provided within a structured program of care which offers individualized, strengths-based, active and timely treatment directed toward alleviating the impairment which caused the admission to IDT;
3. (c) Be an active treatment program that consists of documented mental health interventions that address the individualized needs of the consumer as identified in the Plan of Care;
4. (d) Consist of structured individual and group activities and therapies that are planned and goal-oriented, and provided under active psychiatric supervision;
5. (e) Offer short-term day-programming consisting of therapeutically intensive, acute, and active treatment;
6. (f) Be comprised of services that closely resemble the intensity and comprehensiveness of inpatient services; and
7. (g) Include psychiatric, other medical, nursing, social work, occupational therapy, medication/somatic treatment, care coordination, and psychology services focusing on timely crisis intervention and psychiatric stabilization so that consumers can return to their normal daily lives.

3424.4 Each consumer shall participate in at least five (5) hours of IDT services per day, excluding time for adequate breaks and administrative functions, for the services to be reimbursable.

3424.5 Each consumer shall be directly evaluated by an independently licensed qualified

practitioner as part of the admissions process.

3424.6 Each consumer's care shall be supervised by an independently licensed qualified practitioner who assumes primary responsibility for the consumer's assessment, treatment planning, and treatment services.3424.7 Each consumer shall be assigned to a full-time staff member who assists the consumer and the consumer's family to assess the consumer's needs and progress toward achieving the treatment goals.3424.8 An interdisciplinary treatment team shall meet within one (1) business day of the consumer's admission to develop an initial IDT Plan of Care.3424.9 Each IDT Plan of Care shall be updated every three (3) business days and shall be reviewed by the interdisciplinary treatment team on a weekly basis and upon termination of treatment.3424.10 At least one (1) independently licensed qualified practitioner shall be present on site at all times.3424.11 Each IDT provider shall have policies and procedures included in its Service Specific Policies addressing the provision of IDT (Intensive Day Treatment Organizational Plan) which includes the following:- (a) A description of the particular treatment models utilized, types of intervention practiced, and typical daily curriculum and schedule;

- (b) A description of the staffing pattern including a staffing plan to ensure that the required staff-to-consumer ratios are maintained, and a plan for coverage for unplanned staff absences; and

- (c) A description of how the IDT Plan of Care is modified or adjusted to meet the needs specified in each consumer's Plan of Care.3424.12 The IDT provider shall maintain a minimum staff-to-consumer ratio of one (1) staff for every eight (8) consumers. The IDT provider shall maintain a minimum staffing pattern sufficient to address consumer needs, including adequate physician, nursing, social work, therapy, and psychology services to assure the availability of intensive services.3424.13 Prior authorization by the Department shall be required for IDT services. Initial and any subsequent authorizations shall not exceed seven (7) units at a time.3424.14 IDT shall not be billed on the same day as:

(a) Medication/Somatic Treatment;

(b) Counseling;

(c) Rehabilitation Day Services;

(d) ACT;

(e) TF-CBT;

(f) TREM;

(g) TST;

(h) Psychosocial Rehabilitation Clubhouse; or

(i) Supported Employment services subject to the Supported Employment program standards set forth in 22-A DCMR Chapter 37.

3424.15 IDT shall only be provided at an MHRS provider's service site.

3424.16 The following are qualified practitioners of Intensive Day Treatment (IDT):

(a) Psychiatrists;

(b) Psychologists;

(c) LICSWs;

(d) APRNs;

(e) LISWs;

(f) LPCs;

(g) RNs;

(h) LMFTs;

(i) LGSWs;

(j) LGPCs;

(k) Psychology Associates; and

3424.17 Credentialed staff shall be permitted to provide IDT under the supervision of an independently licensed qualified practitioner.

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 53 DCR 9197 (November 10, 2006); as amended by Final Rulemaking published at 67 DCR 10674 (September 4, 2020); as amended by Final Rulemaking 68 DCR 012400 (November 26, 2021).