CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS

Transcription

1 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS TITLE 2. ADMINISTRATION DIVISION 9. JOINT REGULATIONS FOR PUPILS WITH DISABILITIES CHAPTER 1. INTERAGENCY RESPONSIBILITIES FOR PROVIDING SERVICES TO PUPILS WITH DISABILITIES ARTICLE 1. GENERAL PROVISIONS Scope Education Definitions Mental Health Definitions Social Services Definitions. ARTICLE 2. MENTAL HEALTH RELATED SERVICES Local Mental Health and Education Interagency Agreement Referral to Community Mental Health Services for Related Services Assessment to Determine the Need for Mental Health Services Individualized Education Program for Mental Health Services Transfers and Interim Placements. ARTICLE 3. RESIDENTIAL PLACEMENT LEA Identification and Placement of a Seriously Emotionally Disturbed Pupil Case Management for a Pupil with a Disability Who Is Seriously Emotionally Disturbed and Is in a Residential Placement. ARTICLE 4. FINANCIAL PROVISION FOR MENTAL HEALTH SERVICES, SPECIAL EDUCATION AND RESIDENTIAL PLACEMENT Financial Responsibilities. ARTICLE 5. OCCUPATIONAL THERAPY AND PHYSICAL THERAPY California Children s Services (CCS) Medical Therapy Program Definitions Local Interagency Agreements Between CCS and Education Agencies Referral and Assessment Medical Therapy Program Responsibilities Individualized Education Program for Therapy Services Space and Equipment for Occupational Therapy and Physical Therapy. ARTICLE 6. HOME HEALTH AIDE Specialized Home Health Aide. ARTICLE 7. EXCHANGE OF INFORMATION BETWEEN EDUCATION AND SOCIAL SERVICES Community Care Facilities Prior Notification. ARTICLE 8. PROCEDURAL SAFEGUARDS Due Process Hearings Compliance Complaints. ARTICLE 9. INTERAGENCY DISPUTE RESOLUTION Application of Procedures Resolution Procedure. lxiii

2 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS TITLE 5. EDUCATION DIVISION 1. STATE DEPARTMENT OF EDUCATION CHAPTER 3. HANDICAPPED CHILDREN SUBCHAPTER 1. SPECIAL EDUCATION ARTICLE 3.1. INDIVIDUALS WITH EXCEPTIONAL NEEDS Eligibility Criteria Additional Eligibility Criteria for Individuals with Exceptional Needs Age Birth to Four Years and Nine Months. TITLE 9. REHABILITATIVE AND DEVELOPMENTAL SERVICES DIVISION 1. DEPARTMENT OF MENTAL HEALTH CHAPTER 2. CONFLICT OF INTEREST CODE General Provisions. Appendix A Appendix B CHAPTER 3. COMMUNITY MENTAL HEALTH SERVICES UNDER THE SHORT DOYLE ACT ARTICLE 1. APPLICATION Application of Subchapter Section Headings. ARTICLE 2. DEFINITIONS Act Local Director Local Mental Health Service Department May, Shall and Should General Hospital Psychiatric Hospital County Plan. ARTICLE 3. GENERAL PROVISIONS Establishment of Local Services Supervision by Local Director Medical Responsibility Contracts for Service Fee Schedules Auxiliary Personnel Admission Policies Discriminatory Practices Mental Health Advisory Board Composition Mental Health Advisory Board Committee Composition. ARTICLE 3.5. STANDARDS FOR THE CERTIFICATION OF SOCIAL REHABILITATION PROGRAMS Program Standards and Requirements Service Requirements Medical Requirements Treatment/Rehabilitation Plan and Documentation Requirements Admission/Discharge Criteria Client Involvement Requirements Physical Environmental Requirements. lxiv

3 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Staff Characteristics, Qualifications and Duty Requirements Administrative Policies and Procedures Program Certification Review Procedures Waivers and Exceptions. ARTICLE 4. SERVICES SUBJECT TO STATE REIMBURSEMENT Reimbursement Conditions Hour Services Day Services Outpatient Services Emergency Services Outreach Services Diagnostic Services Rehabilitative Services Continuing Care Services Supplemental Residential Care Services Training Research and Evaluation Equipment Expense Remodeling Expense Hour Detoxification Treatment and Evaluation Service. ARTICLE 5. LIMITATIONS ON REIMBURSEMENTS Inpatient Service Other Mental Health Services Non State Reimbursable Charges Reimbursement for Services Funding. ARTICLE 5.5. MAXIMUM ALLOWABLE RATES Application of Article Reimbursement Maximum Allowable Rate Determination and Publication Monitoring Compliance County Augmentation. ARTICLE 6. UTILIZATION REVIEW OF SHORT DOYLE FUNDED ACUTE INPATIENT PSYCHIATRIC SERVICES Review Process Administrative Days Documentation and Reporting Compliance Enforcement. ARTICLE 7. CLAIMS FOR REIMBURSEMENT Forms and Information Approval of Reimbursements. ARTICLE 8. PROFESSIONAL AND TECHNICAL PERSONNEL STANDARDS Director of Local Mental Health Services Acting Director of Local Mental Health Services Medical Program Responsibility Requirements for Professional Personnel Psychiatrist Psychologist Social Worker Marriage, Family and Child Counselor. lxv

4 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS 627. Nurses Licensed Vocational Nurse Psychiatric Technician Mental Health Rehabilitation Specialist Administrative Support Responsibility Other Mental Health Personnel. ARTICLE 9. ACCOUNTING AND RECORDS Financial Records Patient Records Statistical Data. ARTICLE 10. REQUIREMENTS FOR INPATIENT SERVICES Admission Procedures Medical Surgical Services Discharges and Transfers Minimum Staff. ARTICLE 11. REQUIREMENTS FOR OUTPATIENT SERVICES Basic Requirements. ARTICLE 12. REQUIREMENTS FOR PARTIAL HOSPITALIZATION SERVICES Minimum Professional Staff Medical Responsibility. ARTICLE 13. REQUIREMENTS FOR EMERGENCY SERVICES Basic Requirement. ARTICLE 14. PURPOSES, PROCESSES AND REQUIREMENTS OF CONSULTATION, EDUCATION AND INFORMATION SERVICES Purpose of Consultation Services Process of Consultation Services Purpose of Education Services Process of Education Services Purpose of Information Services Process of Information Services Direction and Supervision. ARTICLE 15. REQUIREMENTS FOR DIAGNOSTIC SERVICES Basic Requirements. ARTICLE 16. REQUIREMENTS FOR REHABILITATIVE SERVICES Psychiatric Direction and Supervision Treatment Plan for Patients Minimum Staff. ARTICLE 17. REQUIREMENTS FOR PRECARE AND AFTERCARE SERVICES Referral to Provide Continuity of Care. ARTICLE 18. REQUIREMENTS FOR TRAINING SERVICES Reimbursement for Training Services Minimum Staff. ARTICLE 19. REQUIREMENTS FOR RESEARCH AND EVALUATION SERVICES Standards for Research Personnel Contracting for Services Method of Program Evaluation. lxvi

5 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS 773. Local Mental Health Service Research Committee Research Funds Local Research Trust Fund Application Review Scientific Merit of Research Study Personal Safety and Welfare of Research Subjects Confidential Nature of Information and Records Requirement of Oath of Confidentiality. ARTICLE 20. REQUIREMENTS FOR 72 HOUR DETOXIFICATION, TREATMENT AND EVALUATION SERVICE FOR INEBRIATES ARTICLE 21. INTENSIVE TREATMENT FOR CHRONIC ALCOHOLICS ARTICLE 22. REQUIREMENTS FOR SOCIAL AND REHABILITATION SERVICES CHAPTER 3.5. MENTAL HEALTH REHABILITATION CENTERS ARTICLE 1. APPLICATION Application of Chapter. ARTICLE 2. DEFINITIONS Application of Definitions Meaning of Words Activity Coordinator Alteration Art Therapist Client Client Record Conservator Controlled Drugs Dance Therapist Department Dietitian Director Drug Drug Administration Drug Dispensing Mental Health Rehabilitation Center Director Licensed Mental Health Professional Licensed Nursing Staff Licensed Psychiatric Technician Licensed Vocational Nurse Licensee Local Bank Marriage, Family and Child Counselor Medication Mental Health Rehabilitation Center Mental Health Rehabilitation Specialist Music Therapist Occupational Therapist Pharmacist Physician Program Director Postural Support Psychologist. lxvii

6 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Recreation Therapist Registered Nurse Restraint Seclusion Self Administration of Medication Social Worker Standing Orders Supervision Therapeutic Diet Unit Dose Medication System Standing Orders Supervision Therapeutic Diet Unit Dose Medication System. ARTICLE 3. LICENSE Application Required Application Requirements Application Content Application Process Plan of Operation Requirements Safety, Zoning and Building Clearance Separate Licenses Posting Report of Changes Program Flexibility and Monitoring Conviction of Crime: Standards for Evaluating Rehabilitation Bonds. ARTICLE 4. GENERAL REQUIREMENTS Administration Mental Health Rehabilitation Center Director and Staff Employee Personnel Records Employees Health Examination and Health Records Use of Outside Resources Consumer Information to be Posted Unusual Occurrences Reporting of Communicable Diseases Infectious Diseases Storage and Disposal of Solid Waste Solid Waste Containers Infectious Waste Cleaning, Disinfecting and Sterilizing Soiled Linen Clean Linen Fire and Internal Disasters External Disaster and Mass Casualty Program Admission of Clients Admission Records Clients Records Informed Consent to Medical Treatment Temporary Medical Client Transfer Clients Rights Safeguards for Clients Monies and Valuables Liability for Rent and Return of Rental Advance Abuse and Corporal Punishment Restraint and Seclusion Orders for Restraint and Seclusion. lxviii

7 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Restrictions on Applying Restraints and Utilizing Seclusion Restraint and Seclusion Documentation and Reporting Policies and Procedures Client Capacity Client Rooms Client s Property Storage and Room Furnishings Housekeeping Laundry Clean Linen Soiled Linen General Maintenance Air Filters Storage and Disposal of Solid Waste Solid Waste Containers Infectious Waste Water Supply and Plumbing Lighting and Power System Maintenance Manual Mechanical Systems Space Administrative Policies and Procedures. ARTICLE 5. BASIC SERVICES Services General Medical Director Physician Services General Nursing Service General Nursing Service Administration of Medication and Treatment Nursing Service Director of Nursing Service Nursing Service Staff Dietetic Service General Dietetic Service Therapeutic Diets Dietetic Service Menus Dietetic Service Staff Pharmaceutical Service General Pharmaceutical Service Requirements Pharmaceutical Service Labeling and Storage of Drugs Pharmaceutical Service Stop Orders Pharmaceutical Service Orders for Drugs Pharmaceutical Service Drug Order Processing Pharmaceutical Service Personal Medications Pharmaceutical Service Controlled Drugs Pharmaceutical Service Disposition of Drugs Pharmaceutical Service Unit Dose Medication System Pharmaceutical Service Staff Pharmaceutical Service Equipment and Supplies Pharmaceutical Service Unit Dose Medication System Pharmaceutical Service Staff Pharmaceutical Service Equipment and Supplies. ARTICLE 6. REQUIRED PROGRAMS Program Requirements General Rehabilitation Program Services Rehabilitation Program Admission Requirements Rehabilitation Program Staff Rehabilitation Program Program Director Rehabilitation Program In Service Education. lxix

8 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Rehabilitation Program Individual Service Plan and Documentation Requirements Rehabilitation Program Equipment Activity Program General Activity Program Requirements Activity Program Staff Activity Program Equipment and Supplies Activity Program Staff Activity Program Equipment and Supplies Activity Program Space. ARTICLE 7. PHYSICAL PLANT Fire Safety Alterations to Existing Buildings or New Construction Space Conversion Notice to Department Housekeeping Laundry General Maintenance Air Filters Water Supply and Plumbing Lighting and Power System Mechanical Systems Maintenance Manual Space Rehabilitation Program Space Nursing Service Space Activity Program Space Client Rooms Client s Property Storage and Room Furnishings Client Capacity. ARTICLE 8. CITATIONS AND LICENSE REVOCATION Definitions Filing of Names and Addresses Issuance of Revocation and License Citations Conditions of Revocation of License Appeal of Revocation License Revocation and Citation Review Conference. CHAPTER 4. COMMUNITY MENTAL HEALTH SERVICES UNDER THE LANTERMAN PETRIS SHORT ACT ARTICLE 1. APPLICATION Application of Subchapter Section Headings. ARTICLE 2. DEFINITIONS AND GENERAL PROVISIONS Act Department Shall and May Mental Disorder. ARTICLE 3. FACILITIES Designation by Board of Supervisors Approval of Facilities Approval of Persons or Agencies for Prepetition Screening Professional Person in Charge of a Facility Attending Staff. lxx

9 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS 824. Facilities for Inebriates and Alcoholics Calculation of Evaluation and Treatment Period Exemption Requests Exemption Request Requirements Certification of Exemptions Reapplication for or Revocation of Certification Mental Health Treatment Facility. ARTICLE 4. CONSERVATORSHIP Conservatorship. ARTICLE 5. PATIENTS RIGHTS: CONVULSIVE TREATMENT AND PSYCHOSURGERY General Provision Types of Treatment: Definitions Voluntary and Involuntary Patients: Definitions Facility: Definition Procedures for Insulin Coma and Prefrontal Sonic Treatment Quarterly Reports on Convulsive, Insulin Coma, and Prefrontal Sonic Treatment Application and Requirement Quarterly Reports on Psychosurgery Failure to Submit Quarterly Reports Quarterly Reports to State Informed Consent for Electroconvulsive Treatment Capacity to Consent or Refuse Consent to Recommended Treatment or Surgery Refusal to Consent to Recommended Treatment or Surgery Minors Post Treatment Review Committees Excessive Use of Convulsive Treatment. ARTICLE 5.5. VOLUNTARY PATIENTS RIGHT TO REFUSE ANTIPSYCHOTIC MEDICATIONS Refusal of Antipsychotic Medications Informed Consent to Antipsychotic Medications Maintenance of Records Emergency Withdrawal of Consent Consequence of Refusal Definition of Antipsychotic Medication Reports of Violations. ARTICLE 6. PATIENT RIGHTS: DENIAL FOR GOOD CAUSE Application of Article List of Rights Notification of Rights Definitions Assignment of Patients /Residents Advocate Duties of Patients /Residents Advocate Complaint Procedure Authority for Denial of Rights Denial of Rights in Community Care Facilities Good Cause for Denial of Rights Documentation of Denial of Rights Seclusion and Restraints Restoration of Rights Quarterly Reports to the Director of Health Access to Denial of Rights Information Annual Review. lxxi

10 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS CHAPTER 5. CONDUCT OF RESEARCH AND PATIENT DATA INFORMATION REQUIREMENTS IN FACILITIES PROVIDING SERVICE UNDER DIVISIONS 5, 6, OR 7 OF THE WELFARE AND INSTITUTIONS CODE ARTICLE 1. APPLICATION Application of Chapter Section Headings. ARTICLE 2. DEFINITIONS AND GENERAL PROVISIONS Department Shall and May Facilities. ARTICLE 3. RESEARCH ARTICLE 4. PATIENT DATA INFORMATION CHAPTER 6. JOINT REGULATIONS FOR HANDICAPPED CHILDREN INTERAGENCY RESPONSIBILITIES FOR PROVIDING SERVICES TO HANDICAPPED CHILDREN Joint Regulations for Handicapped Children CHAPTER 7. ACUTE AND NONACUTE LEVELS OF 24 HOUR MENTAL HEALTH CARE PROVIDED BY COUNTY MENTAL HEALTH AGENCIES IN CORRECTIONAL TREATMENT CENTERS Application of Chapter Definitions Mental Health Treatment Program Mental Health Treatment Program General Requirements Mental Health Treatment Program Admission and Discharge Policies Mental Health Treatment Program Multidisciplinary Treatment Team Mental Health Treatment Program Individual Treatment Plan Mental Health Treatment Program Services Acute Mental Health Care Nonacute 24 Hour Mental Health Care Mental Health Treatment Program Staffing Basic Requirements Mental Health Treatment Program Staffing Acute Care Requirements Mental Health Treatment Program Staffing Nonacute Care Requirements Mental Health Treatment Program Space Clinical Restraint, Treatment Restraint, and Clinical Seclusion. CHAPTER 8. RECOVERY HOUSES CHAPTER 9. AUDIT APPEALS OF COMMUNITY MENTAL HEALTH SERVICES UNDER THE SHORT DOYLE ACT ARTICLE 1. DEFINITIONS Policy Definitions. ARTICLE 2. INFORMAL CONFERENCE Time for Filing Request Contents of Request Informal Conference. ARTICLE 3. FILING OF APPEAL Audit Appeal Hearing Time for Filing Appeal Denial of Late Appeal. lxxii

11 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS CHAPTER Form of Appeal Contents of Appeal. ARTICLE 4. FORMAL APPEAL HEARING Disqualification of Hearing Officer Joinder of Successive Appeals Scheduling of Hearings Witnesses and Subpoenas Consolidation of Proceedings Severance of Issues Preparation for Hearing Conduct of Hearing Official and Judicial Notice Department Records Continuance of Hearings; Further Hearing Continuance for Additional Evidence Representation at a Hearing Oral Argument and Briefs Decision. ARTICLE 5. RECOVERY OF OVERPAYMENTS Recovery of Overpayments to Local Mental Health Service Time of Recovery. ARTICLE 6. PAYMENTS Underpayments. ARTICLE 1. MEDI CAL PSYCHIATRIC INPATIENT HOSPITAL SERVICES DEFINITIONS, ABBREVIATIONS AND PROGRAM TERMS Acute Psychiatric Inpatient Hospital Services Administrative Day Service Beneficiary Contract Hospital Culturally Competent Services Department Disproportionate Share Hospital (DSH) Fee for Service/Medi Cal Provider Fiscal Intermediary Hospital Hospital Based Ancillary Services Implementation Plan for Psychiatric Inpatient Hospital Services Medi Cal Managed Care Plan Mental Health Plan Mental Health Plan (MHP) of Beneficiary MHP Payment Authorization Non contract Hospital Point of Authorization Provider Psychiatric Inpatient Hospital Services Receipt or Date of Receipt Routine Services Short Doyle/Medi Cal Provider Submit or Date of Submission Traditional Hospital Provider. ARTICLE 2. ADMINISTRATION lxxiii

12 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Applicability of Laws and Regulations Designation of MHPs Implementation Plan for Psychiatric Inpatient Hospital Services Scope of Reimbursable Services Provider Selection Criteria Contracting for Service Availability State Oversight. ARTICLE 3. FISCAL PROVISIONS Allowable Psychiatric Accommodation Border Communities Located Per Diem Rate Rate Region Risk Reinsurance Small County Small County Reserve Third Party Liability Usual and Customary Charges Utilization Control and Operations Committee Small County Reserve Rate Setting for Psychiatric Inpatient Hospital Services for Negotiated Rate, Fee for Service/Medi Cal Providers Rate Setting for Psychiatric Inpatient Hospital Services for Non negotiated Rate, Fee for Service/Medi Cal Providers Rate Setting for Psychiatric Inpatient Hospital Services for Short Doyle/Medi Cal Providers Rate Reporting Reporting Unexpended Balances. ARTICLE 4. PROVISION OF SERVICES Adverse Decision Continued Stay Services County Medical Services Program Emergency Admission Emergency Psychiatric Condition Licensed Mental Health Professional Planned Admission Prior Authorization Utilization Review Committee Medical Necessity Criteria for Reimbursement of Psychiatric Inpatient Hospital Services Provider Utilization Control MHP Payment Authorization General Provisions MHP Payment Authorization by a Point of Authorization MHP Payment Authorization for Emergency Admissions by a Point of Authorization MHP Payment Authorization by a Utilization Review Committee. ARTICLE 5. PROBLEM RESOLUTION PROCESSES Complaint Resolution Process Denial Fair Hearing Grievance Process Terminated Beneficiary Problem Resolution Processes Fair Hearing and Notice of Action Medical Assistance for Beneficiary Pending Fair Hearing Decision. lxxiv

13 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Provider Appeal Process Services Provider Appeal Process Claims Processing. CHAPTER 11. MEDI CAL SPECIALTY MENTAL HEALTH SERVICES SUBCHAPTER 1. GENERAL PROVISIONS ARTICLE 1. GENERAL General Applicability of Laws and Regulations and Program Flexibility. ARTICLE 2. DEFINITIONS, ABBREVIATIONS AND PROGRAM TERMS Acute Psychiatric Inpatient Hospital Services Administrative Day Service Adult Residential Treatment Service Assessment Beneficiary Border Community Collateral Contract Hospital Crisis Residential Treatment Service Crisis Intervention Crisis Stabilization Cultural Competence Day Rehabilitation Day Treatment Intensive Department Disproportionate Share Hospital (DSH) Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Supplemental Specialty Mental Health Services Emergency Psychiatric Condition Fair Hearing Federal Financial Participation (FFP) Fee for Service/Medi Cal Hospital Fiscal Intermediary Grievance Group Provider Hospital Hospital Based Ancillary Services Implementation Plan Individual Provider Institution for Mental Disease Licensed Mental Health Professional Medi Cal Managed Care Plan Medication Support Services Memorandum of Understanding (MOU) Mental Health Plan (MHP) Mental Health Services MHP of Beneficiary MHP Payment Authorization Non contract Hospital Organizational Provider Plan Development Point of Authorization Prior Authorization Provider Psychiatric Health Facility Psychiatric Health Facility Services. lxxv

14 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Psychiatric Inpatient Hospital Professional Services Psychiatric Inpatient Hospital Services Psychiatric Nursing Facility Services Psychiatrist Services Psychologist Services Receipt or Date of Receipt Rehabilitation Risk Reinsurance Routine Hospital Services Service Activities Short Doyle/Medi Cal Hospital Significant Support Person Small County Small County Reserve Specialty Mental Health Services Submit or Date of Submission Targeted Case Management Therapy Third Party Liability Traditional Hospital Urgent Condition Usual and Customary Charges Waivered/Registered Professional. ARTICLE 3. ADMINISTRATION Designation of MHPs Implementation Plan Contracts Between the Department and the MHP Contract Renewal Contract Termination Allocation of State Funds to MHPs Renegotiation of the Allocation of State Funds to an MHP Small County Reserve Allocation Scope of Covered Specialty Mental Health Services Scope of Covered Psychiatric Inpatient Hospital Services Excluded Services Notification of Beneficiaries Beneficiary Billing MOUs with Medi Cal Managed Care Plans MHP Reporting State Oversight Civil Penalties. ARTICLE 4. STANDARDS Access Standards for Specialty Mental Health Services Cultural and Linguistic Requirements Coordination of Physical and Mental Health Care Hospital Selection Criteria Contracting for Psychiatric Inpatient Hospital Service Availability MHP Individual, Group and Organizational Provider Selection Criteria MHP Individual, Group and Organizational Provider Contracting Requirements Alternative Contracts Between MHPs and Providers MHP Quality Management Programs. SUBCHAPTER 2. MEDI CAL PSYCHIATRIC INPATIENT HOSPITAL SERVICES ARTICLE 1. FISCAL PROVISIONS lxxvi

15 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Definitions Rate Setting for Psychiatric Inpatient Hospital Services for Negotiated Rate, Fee for Service/Medi Cal Hospitals Rate Setting for Psychiatric Inpatient Hospitals for Non negotiated Rate, Fee for Service/Medi Cal Hospitals Rate Setting for Psychiatric Inpatient Hospital Services for Short Doyle/Medi Cal Hospitals. ARTICLE 2. PROVISION OF SERVICES Definitions Medical Necessity Criteria for Reimbursement of Psychiatric Inpatient Hospital Services Hospital Utilization Control MHP Payment Authorization General Provisions MHP Payment Authorization by a Point of Authorization MHP Payment Authorization for Emergency Admissions by a Point of Authorization MHP Payment Authorization by a Utilization Review Committee. SUBCHAPTER 3. SPECIALTY MENTAL HEALTH SERVICES OTHER THAN PSYCHIATRIC INPATIENT HOSPITAL SERVICES General Provisions. ARTICLE 1. FISCAL PROVISIONS Provider Rate Setting Standards and Requirements Psychiatric Nursing Facility Services Rates. ARTICLE 2. PROVISION OF SERVICES Medical Necessity Criteria for MHP Reimbursement of Speciality Mental Health Services Medical Necessity Criteria for MHP Reimbursement for Specialty Mental Health Services for Eligible Beneficiaries Under 21 Years of Age MHP Payment Authorization Authorization of Out of Plan Services Initial Selection and Change of Person Providing Services Psychiatric Inpatient Hospital Professional Services Psychiatric Health Facility Services MHP Payment Authorization for Psychiatric Nursing Facility Services. SUBCHAPTER 4. FEDERAL FINANCIAL PARTICIPATION ARTICLE 1. GENERAL Definitions General Claims Submission Alternative Contract Provider Rates. ARTICLE 2. PSYCHIATRIC INPATIENT HOSPITAL SERVICES General Non Reimbursable Psychiatric Inpatient Hospital Services Lockouts for Psychiatric Inpatient Hospital Services. ARTICLE 3. SPECIALTY MENTAL HEALTH SERVICES OTHER THAN PSYCHIATRIC INPATIENT HOSPITAL SERVICES Psychiatric Nursing Facility Services Crosswalk Between Service Functions and HCPCS Codes Psychiatrist, Psychologist, and EPSDT Supplemental Specialty Mental Health Services. lxxvii

16 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Service Functions Non Reimbursable Services General Claiming for Service Functions General Claiming for Service Functions Based on Minutes of Time Claiming for Service Functions on Half Days or Full Days of Time Claiming for Service Functions Based on Calendar Days Claiming for Service Functions Based on Hours of Time Mental Health Services Contact and Site Requirements Medication Support Services Contact and Site Requirements Day Treatment Intensive Services Contact and Site Requirements Day Rehabilitation Services Contact and Site Requirements Adult Residential Treatment Services Contact and Site Requirements Crisis Residential Treatment Services Contact and Site Requirements Crisis Intervention Contact and Site Requirements Crisis Stabilization Contact and Site Requirements Psychiatric Health Facility Services Contact and Site Requirements Targeted Case Management Contact and Site Requirements Service Function Staffing Requirements General Medication Support Services Staffing Requirements Crisis Stabilization Staffing Requirements Day Treatment Intensive Staffing Requirements Day Rehabilitation Staffing Requirements Adult Residential Treatment Services Staffing Requirements Crisis Residential Treatment Services Staffing Requirements Psychiatric Health Facility Staffing Requirements Lockouts for Day Rehabilitation and Day Treatment Intensive Lockouts for Adult Residential Treatment Services Lockouts for Crisis Residential Treatment Services Lockouts for Crisis Intervention Lockouts for Crisis Stabilization Lockouts for Psychiatric Health Facility Services Lockouts for Medication Support Services Lockouts for Targeted Case Management Services. SUBCHAPTER 5. PROBLEM RESOLUTION PROCESSES Beneficiary Problem Resolution Processes Fair Hearing and Notice of Action Medical Assistance for Beneficiary Pending Fair Hearing Decision Provider Problem Resolution and Appeal Processes Provider Appeal Process Claims Processing Resolution of Disputes Between MHPs Regarding MHP of Beneficiary Resolution of Disputes Between MHPs and Medi Cal Managed Care Plans. CHAPTER 12. MENTAL HEALTH PROGRAM STANDARDS FOR THE COMMUNITY TREATMENT FACILITY ARTICLE 1. GENERAL PROVISIONS Application of Chapter Definitions and Terms. ARTICLE 2. MENTAL HEALTH PROGRAM CERTIFICATION PROCEDURES Application for Mental Health Program Certification Mental Health Program Certification of Separate Premises Application Review Mental Health Program Certification Application for Renewal of Mental Health Program Certification Submission of a New Application. lxxviii

17 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS ARTICLE 3. ADMINISTRATIVE ACTIONS Denial of Application for Mental Health Program Certification Revocation or Suspension of Mental Health Program Certification. ARTICLE 4. OVERSIGHT AND ENFORCEMENT PROVISIONS Department Oversight Inspection by Department Required Reporting Complaints Investigation Authority Notice of Noncompliance Determining Compliance Administrative Review. ARTICLE 5. CONTINUING REQUIREMENTS Facility Requirements Plan of Operation Mental Health Program Director Requirements and Responsibilities Licensed Mental Health Treatment Staffing Required Staff Training Admission Criteria Continuing Stay Criteria Discharge and Release Procedures Habeas Corpus Hearings Mental Health Program Components and Documentation Requirements Psychotropic Medication Control and Monitoring Restraint and Seclusion Discipline Practices. ARTICLE 6. PERSONAL RIGHTS Patient s Rights Notification of Rights Complaint Procedures Denial of Rights Good Cause for Denial of Rights Documentation of Denial of Rights Restoration of Rights Child and Family Involvement and Participation. TITLE 15. CRIME PREVENTION AND CORRECTIONS DIVISION 1. BOARD OF CORRECTIONS CHAPTER 1. BOARD OF CORRECTIONS SUBCHAPTER 4. MINIMUM STANDARDS FOR LOCAL DETENTION FACILITIES ARTICLE 10. MEDICAL/MENTAL HEALTH SERVICES Responsibility for Health Care Services Health Care Services Type IV Facilities Health Service Audits Health Care Staff Qualifications Health Care Staff Procedure Medical/Mental Health Records Health Care Procedures Manual Management of Communicable Diseases in a Custody Setting Medical Receiving Screening Special Mental Disorder Assessment. lxxix

18 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Access to Treatment Mental Heath Services and Transfer to Treatment Facility Individualized Treatment Plans Sick Call Vermin Control Detoxification Treatment Informed Consent Dental Care Pharmaceutical Management Psychotropic Medications Inmate Deaths Suicide Prevention Program First Aid Kit(s) Food Handlers. DIVISION 3. DEPARTMENT OF CORRECTIONS CHAPTER 1. RULES AND REGULATIONS OF THE DIRECTOR OF CORRECTIONS SUBCHAPTER 4. GENERAL INSTITUTION REGULATIONS ARTICLE 9. MENTAL HEALTH SERVICES Availability of Mental Health Services Responsibility Availability of Treatment Right to Refuse Treatment Involuntary Medication Suicide Prevention and Response Mental Health Advisory Board Psychosurgery Aversive Therapy Shock Therapy Inmate/Parolee Placements in Department of Mental Health Hospitals. DIVISION 4. DEPARTMENT OF THE YOUTH AUTHORITY CHAPTER 3. INSTITUTIONS AND CAMPS SERVICES SUBCHAPTER 3. SERVICES TO WARDS ARTICLE 1. MEDICAL AND DENTAL SERVICES Medical and Dental Treatment Treatment Centers Medical and Dental Examination Consent for Medical or Dental Treatment Refusal of Medical or Dental Treatment Compulsory Medical or Dental Treatment Off Site Medical and Dental Treatment. ARTICLE 1.5. MENTAL HEALTH Availability of Mental Health Services Mental Health Records Suicide Prevention, Assessment, and Response Youth Authority Global Assessment of Functioning (YA GAF) Psychotropic Medication Voluntary Psychotropic Medication to Minors Involuntary Psychotropic Medication. lxxx

19 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS TITLE 16. PROFESSIONAL AND VOCATIONAL REGULATIONS DIVISION BOARD OF PSYCHOLOGY ARTICLE 1. GENERAL PROVISIONS Citation and Authority Location of Principal Office Tenses, Gender and Number Definitions Delegation of Functions Filing of Address Display of License Number Declaratory Decisions Emergency Meetings and Additions to Meeting Agendas. ARTICLE 1.5. PSYCHOLOGICAL ASSISTANTS ARTICLE 2. APPLICATIONS Applications Abandonment of Applications Petition for Hearing Appearances Before the Committee Failure to Appear for Examination Withdrawal of Application Failure to Pay Initial License Fee Permit Processing Times. ARTICLE 3. EDUCATION AND EXPERIENCE Human Sexuality Training Human Sexuality Training Required for Licensees Exemption from Human Sexuality Training Requirement Training in Alcoholism/Chemical Dependency Detection and Treatment Child Abuse Assessment Training Requirements Spousal or Partner Abuse Assessment, Detection, and Intervention Training Requirements Comparable Programs Criteria for Approval of Comparable Programs W.A.S.C. Accreditation Criteria for Evaluation of Equivalent Education Effect of Revised Criteria for Evaluation of Equivalent Education Revised Criteria for Evaluation of Education Original Research Dissertation Requirement Defined Foreign Graduates Revised Criteria for Evaluation of Education Effect of Revised Criteria for Evaluation of Experience Supervised Professional Experience Qualifications and Responsibilities of Primary Supervisors Qualifications and Responsibilities of Delegated Supervisors SPE for Trainees Preparing for Practice in Non Mental Health Delivery Services Out of State Experience SPE Log Training in Alcoholism/Chemical Dependency Detection and Treatment Child Abuse Assessment Training Requirements Spousal or Partner Abuse Assessment, Detection, and Intervention Training Requirements. ARTICLE 4. EXAMINATION Examinations Oral Examinations. lxxxi

20 CALIFORNIA CODE OF REGULATIONS TABLE OF CONTENTS Waiver of Examination Under Section Reconsideration of Examinations Inspection of Examinations. ARTICLE 5. PSYCHOLOGICAL ASSISTANTS Citation Registration Withdrawal of Applications Required Training Limited Psychological Functions Statement of Purpose; Supervision Required Supervisor s Responsibility Supervised Professional Experience Employer Employee Business Relationship Continuing Education Annual Reports Notification of Termination Psychological Assistant Renewals Effect of Violation, Psychological Assistant Effect of Violation, Employer. ARTICLE 5.5. PSYCHOLOGICAL CORPORATIONS ARTICLE 6. FEES Psychologist Fees Psychological Assistant Fees Professional Corporation Fees. ARTICLE 7. RESTORATION OF SUSPENDED OR REVOKED LICENSES Requirements for Psychologists on Probation Substantial Relationship Criteria Rehabilitation Criteria for Denials and Reinstatements Rehabilitation Criteria for Suspensions or Revocations. ARTICLE 8. RULES OF PROFESSIONAL CONDUCT Competence Interpersonal Relations Misrepresentation Test Security Professional Identification Advertising Child Abuse Reporting Requirements Effect of Violation Competence Interpersonal Relations Misrepresentation Confidentiality Test Security Professional Identification Employment of Psychological Assistant Unprofessional Conduct Advertising Disciplinary Guidelines Citation Professional Relationships and Responsibilities Not Affected Office for Filing Application Approval and Issuance of Certificates. lxxxii