75-03-44-36. Intensive, community-based mental health care for members of the armed forces and veterans.

1. The certified clinic is responsible for providing directly, or through a designated collaborating organization, intensive and community-based behavioral health care for certain members of the United States armed forces and veterans, particularly armed forces members located fifty miles or more from a military treatment facility and veterans living forty miles or more from a veterans administration hospital, or as otherwise required by federal laws and regulations.

2. The certified clinic shall ask all individuals seeking services whether they have ever served in the United States military.

3. The certified clinic shall offer assistance to individuals affirming current military service in the following manner: a. Active duty service members shall use their servicing military treatment facility. The certified clinic and its designated collaborating organization shall contact the active duty service member's military treatment facility's primary care managers regarding referrals outside the military treatment facility; b. An active duty service member and activated reserve component members who reside more than fifty miles from a veterans administration hospital or military clinic enrolled in TRICARE prime remote shall use the network primary care manager or select any other TRICARE authorized provider as the primary care manager. The primary care manager shall refer an active duty service member or activated reserve component member to specialists for care the primary care manager cannot provide and the primary care manager shall work with the regional managed care support contractor for referrals and authorizations; and

1. c. Members of the selected reserves, not on active duty orders, are eligible for TRICARE reserve select. The certified clinic and its designated collaborating organization shall direct members of the select reserves, not on active duty orders, to schedule an appointment with any TRICARE authorized provider, network or non-network.1. 4. The certified clinic and its designated collaborating organization shall offer assistance to individuals affirming former military service to enroll in veterans health administration services for the delivery of health and behavioral health services. Veterans who decline or are ineligible for veterans health administration services must be served by the certified clinic or its designated collaborating organization, consistent with minimum clinical mental health requirements promulgated by the veterans health administration directive 1160.01, Uniform Mental Health Services in VHA Medical Points of Service, dated April 27, 2023.

2. 5. The certified clinic and its designated collaborating organization shall ensure there is integration or coordination between care for substance use disorders and other mental health conditions for veterans who experience both and integration or coordination between care for behavioral health conditions and other components of health care for all veterans.

3. 6. The certified clinic shall assign a principal behavioral health provider to every veteran seen for behavioral health services. If a veteran is seeing more than one behavioral health provider and is involved in more than one program, the certified clinic shall make clear the identity of the principal behavioral health provider to the veteran and identify the principal behavioral health provider in the veteran's health record. The certified clinic shall identify the principal behavioral health provider on a tracking database for veterans who need case management. The principal behavioral health provider shall: - a. Maintain regular contact with the veteran as clinically indicated if ongoing care is required; - b. Review and reconcile each veteran's psychiatric medication on a regular basis with a psychiatrist or other independent prescriber as permitted by the requirements of veterans health administration directive 1160.01, Uniform Mental Health Services in VHA Medical Points of Service, dated April 27, 2023; - c. Coordinate and develop the veteran's treatment plan. The veteran's treatment plan must incorporate input from the veteran and legal representative, if applicable, and when appropriate, the veteran's family with the veteran's and legal representative's, if applicable, consent; - d. Document and monitor the implementation of the treatment plan, including tracking progress in the care delivered, the outcomes achieved, and the goals attained; - e. Revise the treatment plan when necessary; - f. With the veteran and legal representative, if applicable, and the veteran's family with the veteran's and legal representative's, if applicable, consent communicate about the treatment plan and address any of the veteran's problems or concerns about their care. For veterans who are at high risk of losing decisionmaking capacity, such as those with a diagnosis of schizophrenia or schizoaffective disorder, communications must include discussions regarding future behavioral health care treatment; and - g. Ensure the treatment plan reflects the veteran's goals and preferences for care and that the veteran verbally consents to the treatment plan in accordance with veterans health administration directive 1004.01(3), Informed Consent for Clinical Treatments and Procedures, dated December 12, 2023.

7. If the principal behavioral health provider suspects the veteran lacks the capacity to make a decision about the mental health treatment plan, the principal behavioral health provider shall ensure the veteran's decisionmaking capacity is formally assessed and documented. For veterans who are determined to lack capacity, the principal behavioral health provider shall identify the authorized surrogate and document the authorized surrogate's verbal consent to the treatment plan. The use of supported decisionmaking may also be considered.

8. To satisfy the federal requirements that care for veterans adheres to requirements promulgated by the veteran health administration, the certified clinic, and its designated collaborating organization shall provide behavioral health services that are recovery-oriented.

9. The certified clinic, and its designated collaborating organization shall provide culturally responsive behavioral health care. Any staff of the certified clinic staff and its designated collaborating organization who are not a veteran shall undergo training about military and veterans' culture to be able to understand the experiences and contributions of those who have served their country.

10. The certified clinic shall ensure there is a behavioral health treatment plan for all veterans receiving behavioral health services. The treatment plan must:

a. Include the veteran's diagnosis and document consideration of each type of evidence-based intervention for each diagnosis;

b. Include approaches to monitoring the therapeutic benefits and adverse effects of care, milestones for reevaluation of interventions, and the plan itself;

c. Include, as appropriate, the interventions intended to reduce and manage symptoms, improve functioning, and prevent relapses or recurrences of episodes of illness;

d. Be recovery oriented, attentive to the veteran's values and preferences, and evidence based regarding what constitutes effective and safe treatments; and

e. Be developed with input from the veteran and legal representative, if applicable, and the veteran's family with the veteran's and legal representative's, if applicable, consent. The veteran's verbal consent to the treatment plan is required in accordance with veterans health administration directive 1004.01(3), Informed Consent for Clinical Treatments and Procedures, dated December 12, 2023.

History: Effective April 1, 2026.

General Authority: NDCC 50-06-05.2, 50-06-41.4