ADMINISTRA TIVE/FISCAUCLINICAUPHF POLICY AND PROCEDURES

Transcription

1 ADMINISTRA TIVE/FISCAUCLINICAUPHF POLICY AND PROCEDURES COUNTY OF SANTA BARBARA ALCOHOL, DRUG AND MENTAL HEAL TH SERVICES Section - QUALITY ASSURANCE Effective: 12/ Policy - #54 MEDICAL SERVICE REQUIREMENTS Revised: Assistant Directors Approval ----.J Date Form Ref. Reviewed: Author(s) - POLICY: It is the policy of the Santa Barbara County Mental Health Plan (SBCMHP) to ensure that medical services are provided in a manner which meets the immediate and long term medical needs of the clients served, and which is ln keeping with State and Federal regulatory requirements as well as relevant professional standards of practice. DEFINITIONS: A. SBCMPH uses the following definitions for purposes of ti'~~s Policy and Procedure: 1. Urgent Condition means a situation experienced by a beneficiary that, without timely intervention, is certain to result in an immediate emergency psychiatric condition. [CCR Title 9, Section ] 2. Emergency Psychiatric Condition means a condition that meets the criteria in Section when the beneficiary with the condition, due to a mental disorder, is a danger to self or others, or immediately unable to provide for or utilize, food, shelter or clothing: and requires psychiatric inpatient hospital or psychiatric health facility services. [CCR Title 9, Section ]. 3. Clinician is an individual employed by the MHP or an organizational provider contracted with the MPH who meets one or more of the criteria below: a. Holds a valid California license as an MD, DO, NP, PA, Psychologist, LCSW, or MFT. b. Holds a valid California license as an RN and has earned a Master's degree. c. Holds a valid California registration as an ASW or IMF. d. Holds a valid waiver from DMH to perform the duties of a Psychologist.

2 PROCEDURE: 4. Medical Staff means an individual employed by the MHP or a contracted agency who holds a valid California license as an MD, DO, NP, PA, RN, LVN, or LPT. 5. Psychiatrist means in individual employed by the MHP as a Psychiatrist, or an individual who holds a valid California license as an NP or PA, works under the supervision of an MHP Psychiatrist. A. Client discharged from an inpatient psychiatric facility: 1. Whenever an individual in any of the following categories is discharged from an inpatient psychiatric hospital, an appointment shall be made for that individual to see an ADM HS psychiatrist within 10 business days. a. Medi-Cal beneficiary who is a resident of Santa Barbara County, regardless of Medi-Cal county of responsibility. b. Medi-Cal beneficiary whose Medi-Cal county of responsibility is Santa Barbara and who is discharged within Santa Baroara County or is transported to Santa Barbara County upon discharge c. Indigent client who is a resident of Santa Barbara County d. Other individual with an open admission to an ADMHS program. 2. If a client described above fails to attend a psychiatric appointment, the psychiatrist shall enter a progress note which reflects his/her awareness of the missed appointment, what efforts have been made to gain the client's cooperation and participation, and a plan of action. a. If any program staff are identified as being involved in carrying out the plan of action, the psychiatrist will ensure that such staff are aware of the plan. 3. Responsibility: If a client has an open admission to a County-operated program which includes a psychiatr.ist ~n staff, that program has primary responsibility for arranging psychiatric services for the client. a. If the program to which the client has an open admission is unable to arrange psychiatric services within the period of time indicated above, the program is responsible for making other arrangements. B. Client with an open admission to an ADMHS program who is prescribed psychtatric medication by an ADMHS psychiatrist: 1. Urgent Condition: Any client with an open admission to a County-operated program who is determined by Clinical Staff or Medical Staff to have an urgent condition, or who is determined by Medical Staff to have severe symptoms or impairments which appear to be caused or significantly exacerbated by psychiatric medications prescribed by an ADMHS psychiatrist, shall be seen by a psychiatrist within 72 hours, excluding weekends and holidays. C:\Oocuments and Settingslsatlen\Local Settings\Temp\Oraf\ P&P 54 - Medlcal Service Requirements.doc 2

3 2. Routine Need: All other clients who are referred for psychiatric evaluation and/or services by staff of a County-operated or MHP cohtracted provider shall be seen by a psychiatrist within 60 days of admission to an ADMHS program or referral for psychiatric services, whichever occurs later. 3. On-Going Contact: Any client currently prescribed medications by an ADMHS psychiatrist will receive a scheduled appointment with a psychiatrist no less than once every three months, or will be seen without appointment by a psychiatrist no less than once every three months. 4. Whenever possible, clients who have existing prescriptions from an ADMHS psychiatrist will be seen by, and any prescription changes will be made byl the prescribing psychiatrist. a. If the prescribing psychiatrist is on leave or otherwise unavailable to see a client or determine whether or not to refill a prescription, the program to which the prescribing psychiatrist is responsible for designating an alternate psychiatrist to perform those duties. 5. If a client fails to attend a psychiatric appointment, the psychiatrist shall enter a progress note which reflects his/her awareness of the missed appointment, what efforts have been made to gain the client's cooperation and participation, and a plan of action. a. If staff other than the psychiatrist are identified as being involved in carrying out the plan of action, the psychiatrist will ensure that such staff are aware of the plan. 6. If a client's failure to attend psychiatric appointments results in a gap or more than three months between appointments: a. If the appointment is cancelled, the psychiatrist will be notified as soon as possible, and no later than the end of the day on which the appointment was scheduled. b. For cancelled or missed appointments, the psychiatrist will enter a progress note which reflects his/her awareness of the cancelled or missed appointment, what efforts have been made to gain the client's cooperation and participation, and a plan of action. i. If staff other than the psychiatrist are identified as being involved in carrying out the plan of action, the psychiatrist will ensure that such staff are aware of the plan. c. As part of the plan of action, the client will be offered an opportunity to attend a "makeup" appointment with a psychiatrist within 30 days, on condition that that the client may need to wait until the psychiatrist is able to see the client in addition to previously scheduled appointments. d. At the discretion of the prescribing psychiatrist. a refill for a 30 day supply of medications may be prescribed in order to allow the client to attend an C ~\Oocume nts and Settlngs\sallen\Local Settings\Temp\Draft P&P 54 - Medical Service Requirements.doc 3

4 appointment. If this action is taken, the psychiatrist will document the rationale for the refill. e. If the client cancels or fails to attend the scheduled "makeup" appointment, the same procedure will be followed, except that no additional prescriptions or refills will be made until the client attends a psychiatric appointment. 7. Responsibility: A County-operated program which include~ a psychiatrist on staff has primary responsibility for arranging psychiatric services for a client with an open admission to that program. a. It is preferred that the psychiatrist seen by the client will be on the staff of that program. If that cannot be arranged within the period of time identified above, the program is responsible for making other arrangements. C. Client with an open admission to an ADMHS program who is prescribed psychiatric medication by a physician not employed by ADMHS: 1. Within 60 days after intake to the ADMHS program, the client's Treatment Team, defined as the staff who provide mental health services to the client as well as the Program Manager or Team Supervisor, will review the case and make a recommendation as to whether the client's needs are adequately met by continuing prescription of psychiatric medications by a non-adm HS physician, or if it would be in the best interests of the client to have medications prescribed by an ADMHS psychiatrist. a. At the discretion of the Program Manager or Team Supervisor, an ADMHS psychiatrist may be consulted during the decision-making process. 2. If the Treatment Team recommends that an ADMHS psychiatrist prescribe medjcations, a case review shall be conducted within 60 days. The case review shall include the Program Manager or Team Supervisor, Division Chief for Programs, Medical Director, and a representative of Quality Assurance. The Medical Director may elect to include or contact the prescribing physician. a. The final de.cision as to whether psychiatric medications should continue to be prescribed by a non-admhs physician shall be made by the Medical Director. b. If the Medical Director determines that psychiatric medications should be prescribed by an ADMHS psychiatrist, the Medical Director and Program Manager will assign a psychiatrist to the case and will communicate the decision to the prescribing physician to make arrangement for appropriate transition of care. The Medical Director may delegate this responsibility to the assigned psychiatrist. c. If the Medical Director determines that psychiatric medications may continue to be prescribed by the non-admhs physician, that decision shall be communicated to the Treatment Team by the Program Manager or Team Supervisor. C:\Documents and Settlngs\sallen\Local Settings\Temp\Oraft P&P 54 - Medical Service Requirements.doc 4

5 D. Client with an open admission to an ADMHS program who is not prescribed psychiatric medication: 1. Urgent Condition: Any client with an open admission to a County-operated program who is determined by a Clinician or Licensed Medical Staff to have an urgent condition shall be seen by a psychiatrist within 72 hours, excluding weekends and holidays. 2. Routine Need: All other clients who are referred for psychiatric evaluation and/or services by staff of a County-operated or MHP contracted provider shall be seen by a psychiatrist within 60 days of admission to an ADMHS program or referral for psychiatric services, whichever occurs later. 3..Responsibility: A County-operated program which includes a psychiatrist on staff has primary responsibility for arranging psychiatric services for a client wjth an open admission to that program. a. It is preferred that the psychiatrist seen by the client will be on the staff of that program. If that cannot be arranged within the -period of time identified above, the program is responsible for making other arrangements. E. Client with no open admission to an ADMHS program: 1. These individuals shall be screened and shall receive treatment as provided in whichever of the following Policies and Procedures may apply: P&P 8 (Routine Triage), P&P 9 (Service Triage And Authorization For Urgent And Emergency Conditions), and/or P&P 14 (Authorization For Medi-Cal SpecialtY Mental Health Services - Outpatient). Assistance: Reference: Replaces: C:\Documents and Settings\sallen\Local Settings\Temp\Draft P&P 54 - Medical Service Requirements.doc 5