130 C.M.R. 464.412 – Staff Composition Requirements

(A) Minimum Staffing Requirements. Each PACT provider must meet the minimum staffing and staff composition requirements outlined in 130 CMR 464.412 to adequately provide the required scope of services set forth in 130 CMR 464.411. All licensure staffing requirements must be met.
(B) Minimum Staffing Composition. Each PACT provider must have the following minimum staff.
1. (1) Program Director. The program director must have one full-time independent license in nursing, social work, psychiatric rehabilitation, psychology, marriage and family therapy, or mental health counseling, or must be a psychiatrist who meets licensing criteria. The program director must have at least two years of direct experience treating persons with serious mental illness, including at least one year of program management or supervisory experience in a mental health setting. The program director may also function as a practicing clinician on the team. This role is responsible for supervising all PACT team staff, unless that staff is supervised by the team psychiatrist. This role must be supervised by the team psychiatrist.
2. (2) Medical Director. Each PACT provider must employ, whether on staff or by contract, a psychiatrist to serve as medical director of the PACT team. The medical director must be licensed by the Massachusetts Board of Registration in Medicine pursuant to M.G.L c. 112, §§ 2 through 12DD, c. 112 §§ 61 through 65 and 88, and 243 CMR 2.00: Licensing and the Practice of Medicine, and certified by the American Board of Psychiatry and Neurology, the American Osteopathic Board of Neurology and Psychiatry, or board eligible for such certification. The medical director is responsible for supervising all PACT team staff, unless that staff is supervised by the program director. The medical director also supervises the program director.
3. (3) Pharmacological Staff. Each PACT provider must employ, whether on staff or by contract, sufficient staff to support the schedule of operations and provide pharmacological services to members. The pharmacological staff is responsible for meeting regularly with the member, providing pharmacotherapy assessments pursuant to 130 CMR 464.411(F)(7)(b), and medication prescribing, reviewing, and monitoring pursuant to 130 CMR 464.411(F)(7). Pharmacological staff must be qualified as follows.
  1. (a) Psychiatrists must be licensed by the Massachusetts Board of Registration in Medicine pursuant to M.G.L c. 112, §§ 2 through 12DD, c. 112 §§ 61 through 65 and 88, and 243 CMR 2.00: Licensing and the Practice of Medicine, and certified by the American Board of Psychiatry and Neurology, the American Osteopathic Board of Neurology and Psychiatry, or board eligible for such certification.
  2. (b) Advanced practice registered nurses (APRNs) must have a specialty in psychiatric treatment.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-13

Provider Manual Series (130 CMR 464.000)

Transmittal Letter Date

Program of Assertive Community

Treatment Manual

PACT-1 11/1/2025

(c) Psychiatric nurses must be registered nurses with a master’s degree in psychiatric nursing licensed by the Board of Registration in Nursing pursuant to M.G.L. c. 112, § 80B and 244 CMR 4.00: Advanced Practice Registered Nursing.
(d) Psychiatric clinical nurse specialists must be licensed by the Board of Registration in Nursing pursuant to M.G.L. c. 112, § 80B and 244 CMR 4.00: Advanced Practice Registered Nursing.
(e) Physician’s Assistants must be licensed by the Board of Registration of Physician’s Assistants pursuant to M.G.L. c. 112 §9C to 9K and 263 CMR 3.00: Board of Registration of Physician’s Assistants.

(4) Therapeutic Staff. These staff are responsible for the intensive 1:1 therapeutic relationship with the member. The PACT provider must employ, whether on staff or by contract, at least two of the following full-time therapeutic staff:
1. (a) a psychologist licensed by the Massachusetts Board of Registration of Psychologists, and specializing in clinical or counseling psychology, or a closely related specialty, pursuant to M.G.L. c. 112, §§ 118 through 127 and 251 CMR 3.00: Registration of Psychologists;
2. (b) an independent clinical social worker licensed by the Massachusetts Board of Registration of Social Workers pursuant to M.G.L. c 13, §84 and 258 CMR 9.00: Licensure Requirements and Procedures;
3. (c) a licensed mental health counselor licensed by the Board of Registration of Allied Mental Health and Human Services Professions pursuant to M.G.L. c. 112, § 165 and 262 CMR 2.00: Requirements for Licensure as a Mental Health Counselor;
4. (d) a marriage and family therapist licensed by the Board of Registration of Allied Mental Health and Human Services Professions pursuant to M.G.L. c. 112, §§ 163 through 172 and 262 CMR 3.00: Requirements for Licensure as a Marriage and Family Therapist; or
5. (e) other master’s and bachelor’s-level clinicians and staff sufficient to meet the needs of the members served.
(5) Registered Nurse (RN). The PACT provider must employ, whether on staff or by contract, at least one full-time registered nurse licensed by the Board of Registration in Nursing pursuant to M.G.L. c. 112, § 80B and 244 CMR 3.00: Registered Nurse and Licensed Practical Nurse.
(6) Certified Peer Specialists. The program must employ, whether on staff or by contract, at least one full-time certified peer specialist. Certified peer specialists must meet the requirements in all applicable sections of 130 CMR 448.000: Community Behavioral Health Center Services.
(7) Substance Use Disorder Specialist. The PACT provider must employ, whether on staff or by contract, at least one full-time master’s level clinician with experience treating members with substance use disorders.
(8) Employment Specialist. The PACT provider must employ, whether on staff or by contract, at least one employment specialist with experience in rehabilitation counseling or a related field and at least one year of supervised experience in providing individualized job development and supported employment on behalf of persons with mental illness. The PACT provider may employ a single staff member to meet both this requirement and the staffing requirement for a housing resource specialist under 130 CMR 464.412(B)(9).
(9) Housing Resource Specialist. The PACT provider must employ, whether on staff or by contract, at least one housing resource specialist to assist members in finding housing that is safe and affordable through establishing relationships with local housing authorities and housing programs. The PACT provider may employ a single staff member to meet both this requirement and the staffing requirement for an employment specialist under 130 CMR 464.412(B)(8).
(10) Additional Optional Staffing. The PACT provider may employ additional multidisciplinary staff to support the schedule of operations and provide services to members. Staff may include the following.