Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth

Table of Contents iv

Provider Manual Series

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

4. Program Regulations: Community Behavioral Health Center Services

448.401: Introduction ........................................................................................................... 4-1 448.402: Definitions ............................................................................................................ 4-1 448.403: Eligible Members .................................................................................................. 4-6 448.404: Provider Eligibility ................................................................................................ 4-6 448.405: Provider Enrollment Process ................................................................................. 4-7 448.406: Required Notifications and Reports ....................................................................... 4-7 448.407: Revocation of Enrollment and Sanctions .............................................................. 4-8 448.408: Maximum Allowable Fees….. ............................................................................... 4-9 448.409: Nonreimbursable Services .................................................................................... 4-9 448.410: Site Inspections ...................................................................................................... 4-10 448.411: Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services ...... 4-10 448.412: Scope of Services .................................................................................................. 4-10 448.413: Staff Composition Requirements .......................................................................... 4-16 448.414: Supervision, Training, and Other Staff Requirements .......................................... 4-21 448.415: Qualifications of Professional and Paraprofessional Staff Members Authorized to

Render Billable Community Behavioral Health Center Services .......................... 4-22

448.416: Coordination of Medical Care ............................................................................... 4-25 448.417: Schedule of Operations and Appointments ............................................................ 4-25 448.418: Utilization Review Plan ......................................................................................... 4-26 448.419: Recordkeeping Requirements ................................................................................ 4-27 448.420: Written Policies and Procedures ............................................................................ 4-28 448.421: Administration ....................................................................................................... 4-29 448.422: Outreach ................................................................................................................. 4-30 448.423: Service Limitations ................................................................................................ 4-30

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-1

Provider Manual Series 130 CMR 448.000

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

448.401: Introduction

130 CMR 448.000 establishes requirements for participation of community behavioral health centers in MassHealth. All community behavioral health centers participating in MassHealth must comply with the MassHealth regulations, including but not limited to, 130 CMR 448.000 and 130 CMR 450.000: Administrative and Billing Regulations.

448.402: Definitions

The following terms used in 130 CMR 448.000 have the meanings given in 130 CMR 448.402 unless the context clearly requires a different meaning.

Adult Community Behavioral Health Center (CBHC) Services – CBHC services provided to clients 21 years of age or older as referenced in 130 CMR 448.412(A)(1) through (5).

Adult Community Crisis Stabilization (Adult CCS) – adult CCS is a community-based program that serves as a medically necessary, less-restrictive alternative to inpatient psychiatric hospitalization when clinically appropriate and provides short-term staff-secure, safe, and structured crisis stabilization and treatment services for individuals 18 years of age or older with mental health and substance use disorders. Stabilization and treatment also includes the capacity to provide induction onto and bridging for medication for the treatment of opioid use disorders (MOUD) and withdrawal management for opioid use disorders (OUD) as clinically indicated.

Adult Mobile Crisis Intervention (AMCI) – a community-based behavioral health service available 24/7/365 and providing short-term mobile, on-site, face-to-face crisis assessment, intervention, and stabilization to individuals 21 years of age or older experiencing a behavioral health crisis. Services may be provided in community-based settings outside the CBHC, at the CBHC, or in emergency department sites of services to support stabilization for transition into the community, when necessary. Services may also be provided via telehealth. The purpose is to identify, assess, treat, and stabilize the situation and reduce the immediate risk of danger to the individual or others consistent with the individual’s risk management/safety plan, if any.

Adverse Incident – an occurrence that represents actual or potential serious harm to the well- being of a member, or to others under the care of the community behavioral health center. Adverse incidents may be the result of the actions of a member served, actions of a staff member providing services, or incidents that compromise the health and safety of the member receiving treatment at the center, or the operations of the center.

Behavioral Health Disorder – any disorder pertaining to mental health or substance use as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-2

Provider Manual Series 130 CMR 448.000

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

Case Consultation – intervention, including scheduled audio-only telephonic, audio-video, or in person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

Certified Peer Specialist (CPS) – a person who has been trained by an agency approved by the Department of Mental Health (DMH) who is a self-identified person with lived experience of a mental health disorder and wellness who can effectively share their experiences and serve as a mentor, advocate, or facilitator for a member experiencing a mental health disorder.

Child and Adolescent Needs and Strengths (CANS) – a tool that provides a standardized way to organize information gathered during behavioral health clinical assessments. A Massachusetts version of the tool has been developed and is intended to be used as a treatment decision support tool for behavioral health providers serving MassHealth members under the age of 21.

Communication Protocol – formal descriptions of polices, processes, and procedures that allow two or more providers to exchange information.

Community Behavioral Health Center (CBHC or Center) – an entity that serves as a hub of coordinated and integrated behavioral health disorder treatment for individuals of all ages, including routine and urgent behavioral health outpatient services, mobile crisis services for adults and youth, and community crisis stabilization services for adults and youth.

Couple Therapy – psychotherapeutic services provided to a couple whose primary complaint is the disruption of their marriage, family, or relationship.

Crisis Intervention – an urgent evaluation including assessment of risk, diagnosis, short-term intervention and rendering of a disposition for a member’s presenting crisis, which may include referral to an existing or new behavioral health provider.

Diagnostic Evaluation Services – the examination and determination of a member’s physical, psychological, social, economic, educational, and vocational assets and disabilities for the purpose of designing a treatment plan.

Direct and Continuous Supervision – ongoing supervision provided to unlicensed staff and not independently licensed staff at a frequency of no less than one hour of supervision per week for full-time employees. Supervision time may be pro-rated based on scheduled hours for employees employed less than full-time. Direct and continuous supervision must be delivered by an independently licensed staff member or certified peer supervisor who is employed by the agency.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-3

Provider Manual Series 130 CMR 448.000

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

Enhanced Structured Outpatient Addiction Program (E-SOAP): American Society of Addiction Medicine (ASAM) Level Intensive Outpatient Services – a program that provides short-term, clinically intensive, structured day and/or evening substance use disorder (SUD) services. E- SOAP specifically serves specialty populations including: homeless individuals and people at risk of homelessness, pregnant individuals, and adolescents. E-SOAP services must meet requirements as set forth in 130 CMR 418.000: Substance Use Disorder Treatment Services.

Family Consultation – a scheduled meeting with one or more of the parents, legal guardian, or foster parents of a child who is being treated by clinical staff at the center, when the parents, legal guardian, or foster parents are not clients of the center.

Family Therapy – the psychotherapeutic treatment of more than one member of a family simultaneously in the same visit.

Group Therapy – the application of psychotherapeutic or counseling techniques to a group of persons, most of whom are not related by blood, marriage, or legal guardianship.

Individual Therapy – psychotherapeutic services provided to an individual.

Intensive Outpatient Program (IOP) – a mental health treatment service that provides time- limited, multidisciplinary, multimodal structured treatment in an outpatient setting for individuals requiring a clinical intensity that exceeds outpatient treatment. Services include individual, group, and family therapy as well as case management services.

Massachusetts Prescription Awareness Tool (MassPAT) – a tool used when prescribing opioids to check a patient’s prescription history, required by law in M.G. L. c. 94C Section 24A. Results must be referenced and documented prior to prescribing a Schedule II or III narcotic drug or a benzodiazepine to support safe prescribing and dispensing of medications. MassPAT is a part of the prescription monitoring program through the Department of Public Health.

Medication Visit – a member visit specifically for prescription, review, and monitoring of psychotropic medication by a psychiatrist, psychiatric clinical nurse specialist, Advanced Practice Registered Nurse (APRN), or Physician Assistant, or administration of prescribed intramuscular medication by a physician, nurse, or Physician Assistant.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-4

Provider Manual Series 130 CMR 448.000

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

Mental Health Disorder – any disorder pertaining to mental health as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

Multiple-family Group Therapy – the treatment of more than one family unit, at the same time in the same visit, by one or more authorized staff members. There is more than one family member present per family unit and at least one of the family members per family unit must be an identified patient of the center.

Outreach – mental health and/or substance use disorder treatment services being delivered by a clinical or paraprofessional staff member of the center off the premises of the community behavioral health center, including but not limited to services in members’ homes or other community environments.

Peer Recovery Coach – an individual currently in recovery who has lived experience with substance use and other addictive disorders and/or co-occurring mental health disorders and has been trained to help their peers with a similar experience to gain hope, explore recovery, and achieve life goals. Peer recovery coaches must meet requirements as set forth in 130 CMR 418.000: Substance Use Disorder Treatment Services.

Pharmacotherapy – providing therapeutic treatment with pharmaceutical drugs.

Physician – an individual licensed by the Massachusetts Board of Registration in Medicine in accordance with M.G.L. c. 112, § 2.

Psychological Testing – the use of standardized test instruments to evaluate aspects of an individual’s functioning, including aptitudes, educational achievements, cognitive processes, emotional conflicts, and type and degree of psychopathology, subject to the limitations of 130 CMR 411.000: Psychologist Services.

Quality Management Program – a systematic and ongoing process for monitoring, evaluating, and improving the quality and appropriateness of services provided to members, with focused attention on addressing cultural, ethnic, and language needs.

Recovery Support Navigator – a paraprofessional specialist who receives specialized training in the essentials of substance use disorder and evidence-based techniques such as motivational interviewing, and who supports members in accessing and navigating the substance use disorder treatment system through activities that can include care coordination, case management, and motivational support. Recovery Support Navigators must meet requirements as set forth in 130 CMR 418.000: Substance Use Disorder Treatment Services.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-5

Provider Manual Series 130 CMR 448.000

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

Release of Information (ROI) – a document that allows a patient to authorize and revoke what information they want to release from their patient record, who it can be released to, how long it can be released for, and under what statutes and guidelines it is released.

Structured Outpatient Addiction Program (SOAP): ASAM Level Intensive Outpatient Services – a substance use disorder treatment service that provides short-term, multidisciplinary, clinically intensive structured treatment to address the sub-acute needs of members with substance use disorders and/or co-occurring disorders. These services may be used as a transition service in the continuum of care toward lower intensity outpatient services or accessed directly. SOAP services must meet requirements as set forth in 130 CMR 418.000: Substance Use Disorder Treatment Services.

Substance Use Disorder – any disorder pertaining to substance use as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

Supervised Clinical Experience – a clinician’s experience providing diagnostic and treatment services to individuals, families, and groups of individuals under the direct and continuous supervision of a qualified independently licensed professional as set forth in 130 CMR 448.423, who is employed by the same agency as the supervisee.

Telehealth – the use of synchronous or asynchronous audio, video, electronic media, or other telecommunications technology, including, but not limited to

(1) interactive audio-video technology;

(2) remote patient monitoring devices;

(3) audio-only telephone; and

(4) online adaptive interviews

for the purpose of evaluating, diagnosing, consulting, prescribing, treating, or monitoring of a patient's physical health, oral health, mental health, or substance use disorder condition.

Urgent Behavioral Health Needs – needs characterized by changes in behavior or thinking, role dysfunction, emerging intent of self-injury, or threats to others. Urgent behavioral health needs do not rise to the level of immediate risk of harm to self or others.

Youth CBHC Services – services provided to children and youth younger than 21 years of age as referenced in 130 CMR 448.412(A)(1) through (5).

Youth Community Crisis Stabilization (YCCS) – staff-secure, safe, and structured crisis stabilization and treatment services in a community-based program that provides active treatment that includes restoration of functioning; strengthening the resources and capacities of the youth, family, and other natural supports; and ensuring a timely return to previous living environment to individuals up to and including 18 years of age.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-6

Provider Manual Series 130 CMR 448.000

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

Youth Mobile Crisis Intervention (YMCI) – a community-based behavioral health service available 24/7/365 providing short-term mobile, on-site, face-to-face crisis assessment, intervention, and stabilization to individuals younger than 21 years of age experiencing a behavioral health crisis. Transition-aged youth older than 17 years of age and younger than 21 years of age may be served by adult-trained clinicians with a certified peer specialist instead of a family partner based on an individual’s clinical needs. Services may be provided in community- based settings outside the CBHC, at the CBHC, or in emergency department sites of services to support stabilization for transition into the community. Services may be provided via telehealth. The purpose is to identify, assess, treat, and stabilize the situation and reduce the immediate risk of danger to the youth or others consistent with the youth’s risk management/safety plan, if any.

448.403: Eligible Members

(A) MassHealth Members. MassHealth covers community behavioral health center services only when provided to eligible MassHealth members, subject to the restrictions and limitations described in the MassHealth agency’s regulations. Covered services for each MassHealth coverage type are set forth in 130 CMR 450.105: Coverage Types.

(B) Members of the Emergency Aid to the Elderly, Disabled and Children Program. For information on covered services for recipients of the Emergency Aid to the Elderly, Disabled and Children Program, see 130 CMR 450.106: Emergency Aid to the Elderly, Disabled and Children Program.

(C) For information on verifying member eligibility and coverage type, see 130 CMR 450.107: Eligible Members and the MassHealth Card.

(D) For limitations on mental health disorder and substance use disorder services provided to members enrolled with a MassHealth managed care provider, see 130 CMR 450.105: Coverage Types and 130 CMR 450.124: Behavioral Health Services.

448.404: Provider Eligibility

(A) A center is eligible to participate only if the center is

(1) physically located within the Commonwealth of Massachusetts;

(2) enrolled as a Medicare provider;

(3) enrolled with the MassHealth agency as a billing provider as evidenced by the issuance of a Provider Identification and Service Location (PIDSL) number for the provision of community behavioral health center services;

(4) licensed by DPH as

(a) a clinic with a mental health service designation and a substance use disorder service designation; or

(b) a hospital or hospital satellite that provides outpatient mental health and substance use disorder services;

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-7

Provider Manual Series 130 CMR 448.000

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

(5) certified by the DPH Bureau of Substance Addiction Services through a Certificate of Approval for Substance Use Disorder services for outpatient counseling and outpatient withdrawal management; and

(6) holding a current Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver.

(B) Each center must meet the requirements listed in 130 CMR 448.000 in order to be enrolled by the MassHealth agency.

(C) Payment for services described in 130 CMR 448.000 will be made only to community behavioral health centers participating in MassHealth on the date of service.

448.405: Provider Enrollment Process

(A) A separate, complete application for enrollment as a community behavioral health center must be submitted for each clinic location. The applicant must submit the appropriate provider enrollment application to the MassHealth agency. The MassHealth agency may request additional information or perform a site inspection to evaluate the applicant's compliance with the regulations in 130 CMR 448.000.

(1) Based on the information in the enrollment application, information known to the MassHealth agency about the applicant, and the findings from any site inspection deemed necessary, the MassHealth agency will determine whether the applicant is eligible for enrollment.

(2) The MassHealth agency will notify the applicant of the determination in writing within 60 days of the MassHealth agency receiving a completed application. An application will not be considered complete until the applicant has responded to all MassHealth requests for additional information, and MassHealth has completed any required site inspection.

(B) If the MassHealth agency determines that the applicant is not eligible for enrollment, the notice will contain a statement of the reasons for that determination, including but not limited to incomplete application materials and recommendations for corrective action, if appropriate, so that the applicant may reapply for enrollment once corrective action has been completed.

(C) The enrollment is valid only for the center or centers described in the application and is not transferable to other centers operated at other locations by the applicant. Any additional center established by the applicant at another location must separately apply for enrollment and be enrolled with the MassHealth agency to receive payment.

448.406: Required Notifications and Reports

(A) Annual Report. Each community behavioral health center must submit a completed annual report, on forms furnished by the MassHealth agency, and file them with the MassHealth agency annually. The report must include at minimum

(1) a statement that the program has reviewed and updated as necessary its written policies and procedures during the reporting period. Each program must provide a copy of the

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-8

Provider Manual Series 130 CMR 448.000

Transmittal Letter Date

Community Behavioral Health Center

Manual

CBHC-1 01/01/2023

program’s written policies and procedures as requested by the MassHealth agency; (2) a list of Center Administrative and Clinical Management Staff identified in 130 CMR 448.413(C) that includes the following information: staff name, license number, type of license, and board certification, if applicable, and a list of the clinical supervisor for any clinical staff who are unlicensed or independently licensed; (3) a statement describing the current language capacities, capacity to provide services to specialized populations, and utilization of trauma-informed modalities of the center; (4) written attestation that the center is in compliance with 130 CMR 448.000; and (5) any other information that the MassHealth agency may request.

(B) For each CANS assessment conducted, each center must report data collected during the assessment to the MassHealth agency, in the manner and format specified by the MassHealth agency.

(C) Adverse Incident Reports. Each center must report adverse incidents to the MassHealth agency within 24 hours of discovery of the incident, or, if the incident occurs on a holiday or weekend, on the next business day, in a format specified by the MassHealth agency.

(D) Each center must inform the MassHealth agency within 15 days of any citation or loss of licensure or accreditation issued to the center by another agency, including but not limited to the Department of Public Health, an out of state provider’s relevant state licensing agency, The Joint Commission, or the Commission on Accreditation of Rehabilitation Facilities (CARF), or changes to or loss of Medicare participation and enrollment.

(E) Each center must comply with all reporting requirements that may pertain to the practice, facility, or staffing of the center as directed by the MassHealth agency.