annex a 4/30/2010 draft titile 55. public welfare part vii ... · psychiatric rehabilitation...
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Annex A 4/30/2010 Draft
TITILE 55. PUBLIC WELFARE
PART VII. MENTAL HEALTH MANUAL
Subpart D. NONRESIDENTIAL AGENCIES/FACILITIES/SERVICES
CHAPTER XYZ. PSYCHIATRIC REHABILITATION SERVICES
GENERAL PROVISIONS § 1. Purpose.
§ 2. Scope.
§ 3. Definitions.
§ 4. Psychiatric rehabilitation principles and practices.
§ 5. Access to facility and records.
GENERAL REQUIREMENTS
§ 10. Organizational structure.
§ 11. Licensing and inspections.
§ 12. Provider records.
§ 13. Physical site requirements.
§ 14. Service description.
§ 15. Coordination of care.
§ 16. Confidentiality.
INDIVIDUAL RECORD
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§ 20. Content of individual record.
§ 21. Record security, retention and disposal.
§ 22. Access to individual record.
ADMISSION, CONTINUED STAY AND DISCHARGE CRITERIA
§ 30. Admission criteria.
§ 31. Continued stay criteria.
§ 32. Discharge criteria.
RIGHTS
§ 40. Statement of Rights.
§ 41. Individual participation and freedom of choice.
§ 42. Non discrimination.
§ 43. Complaint, grievance and appeal procedures.
STAFFING
§ 50. General staffing patterns.
§ 51. Individual services.
§ 52. Group services.
§ 53. Clubhouse services.
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§ 54. Staff qualifications.
§ 55. Supervision.
§ 56. Staff training requirements.
§ 57. Criminal history background checks.
SERVICE PLANNING AND DELIVERY
§ 60. Assessment.
§ 61. Individual rehabilitation plan.
§ 62. Documentation of progress..
§ 63. Vocational, educational and social services.
DISCHARGE
§ 70. Discharge.
§ 71. Discharge summary.
QUALITY IMPROVEMENT
§ 80. Quality improvement requirements.
WAIVER OF STANDARDS
§ 90. Requests for waivers.
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GENERAL PROVISIONS
§ 1. Purpose.
The purpose of this chapter is to establish requirements for the licensing and
provision of psychiatric rehabilitation services (PRS).
§ 2. Scope.
(a) The requirements are applicable to providers licensed to provide PRS
by the Department.
(b) The requirements are applicable to psychiatric rehabilitation providers
in HealthChoices, fee-for-service and county mental health funded
programs.
§ 3. Definitions.
Best practices - Service delivery practices based directly on PRS principles that
are generally recognized by the psychiatric rehabilitation profession and are
documented in the professional literature.
Clubhouse - A psychiatric rehabilitation program that is accredited by the
International Center for Clubhouse Development (ICCD).
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Community support principles - The set of accepted principles for delivery of
community mental health services developed by OMHSAS and recognized by
the Community Support Program of Pennsylvania.
Coordination of care - Direct contact with other behavioral health, physical health
or human service providers and with formal and natural supports, to assure
continuity in service planning between service providers.
County MH/MR Administrator - The Mental Health/Mental Retardation
Administrator who has jurisdiction in the geographic area.
CPRP - Certified Psychiatric Rehabilitation Practitioner - A person who has
completed the required education, experience and testing, and who is currently
certified as a CPRP by the United States Psychiatric Rehabilitation Association
(USPRA).
CPS - Certified Peer Support Specialist - A person who has successfully
completed OMHSAS approved training in peer support services and is currently
certified as a CPS.
Culturally competent - The ability to provide services in a manner that shows
awareness of and is responsive to the beliefs, interpersonal styles, attitudes,
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language, and behavior of individuals and families who are referred for or
receiving services.
Department - The Department of Public Welfare.
Discharge - Discontinuation of a Medical Assistance funded PRS that occurs
when discharge criteria are met. In the case of Clubhouse, membership is
lifetime, distinct from discharge.
EBP - Evidence based practices - Service delivery practices identified,
recognized, and verified by research and empirical data to be effective in
producing positive outcomes and supporting recovery.
Face- to-face - Contact between two or more people that occurs at the same
location, in person.
Facility - The premises that have been licensed as a service site by the
Department.
Fee-for-service - A Medical Assistance payment methodology.
Formal supports - Agencies, organizations or persons who provide assistance or
resources to others within the context of an official role.
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FTE – Full-time Equivalent - 37.5 hours per calendar week of staff time.
Functional impairment - The loss or abnormality of the ability to perform
necessary tasks and roles.
GED - Graduate Equivalency Diploma.
Individual - A person who uses PRS.
Individual record - The organized collection of documents in paper or electronic
format that chronicles eligibility for, receipt of and response to PRS.
IRP - Individual rehabilitation plan - A document that describes the current
service needs based on the assessment of the individual, and identifies the
individual’s goals, interventions to be provided, the location, intensity and
duration of services, and the staff who will provide the service.
Licensed practitioner of the healing arts - Those professional staff currently
recognized by the Department as qualified to recommend PRS.
MA - Medical Assistance.
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MCO -Managed care organization - An entity which manages the purchase and
provision of physical or behavioral health services under the HealthChoices
program.
Mental health direct services - Working directly with individuals to provide mental
health services.
Natural supports - Persons or organizations that are selected by an individual to
provide validation, assistance or resources in the context of a personal or
nonofficial role.
OSHA - Occupational Safety and Health Administration.
Outcome - The observable and measurable result of rehabilitation services.
Provider - An agency or organization licensed by the department to deliver PRS.
PRS - Psychiatric rehabilitation services - Recovery oriented services and
methodologies offered individually or in groups in community settings or
designated facilities which reflect the fundamental principles of recovery and are
predicated upon, and consistent with, the principles, values and practice
standards of the United States Psychiatric Rehabilitation Association (USPRA).
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PRS Statement of Rights - A Department publication that lists rights for
individuals who participate in PRS.
Psychiatric Rehabilitation Principles - A list of core values inherent in psychiatric
rehabilitation as defined by United States Psychiatric Rehabilitation Association
(USPRA).
QI - Quality improvement.
Quality improvement plan - A document outlining the ongoing formal process to
assure optimal care and maximize service benefits.
USPRA - United States Psychiatric Rehabilitation Association -The nationally
recognized organization of people providing PRS.
Visit - Participation in PRS on one calendar day.
§ .4. Psychiatric rehabilitation principles and practices.
(a) PRS providers shall assist individuals 18 years or older who have a
functional impairment resulting from mental illness to develop,
enhance, and retain skills and competencies in living, learning,
working, and socializing so that individuals can live in the environment
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of choice and participate in the community. PRS Providers shall offer
services in the following three aspects:
1. Engagement - developing relationship and trust, mutual
assessment of needs, goal setting and plan development.
2. Plan implementation - identifying needed and preferred skills and
supports, developing and managing supports and resources as
needed to produce the outcomes consistent with individual
preferences as identified in the IRP.
3. Goal attainment and retention - identifying, practicing, and
supporting skills development.
(b) PRS staff shall employ the following practices:
1. Creating a culturally competent, recovery oriented PRS
environment consistent with the values and practice standards of
the United States Psychiatric Rehabilitation Association (USPRA).
2. Engaging individuals in PRS.
3. Assessing individual strengths, interests and preferences for
rehabilitation services with the individual.
4. Developing strategies to assist the individual in identifying,
achieving and maintaining valued roles.
5. Developing rehabilitation plans with the individual.
6. Helping the individual increase awareness of community resources
and identify preferred options for the rehabilitation process.
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7. Educating the individual about mental illness, wellness and living in
recovery.
8. Providing direct or indirect skills development.
9. Assisting the individual in identifying, developing and utilizing
natural supports.
10. Advocating for the individual as needed.
11. Reaching out and reengaging individuals.
(c) PRS may occur concurrently with clinical treatment and may begin
following diagnosis.
(d) The PRS provider shall collaborate and coordinate with other services
with the consent of the individual.
(e) The PRS provider shall follow best practices or EBP.
(f) The PRS provider shall demonstrate fidelity to the specific PRS
approach identified in the service description.
(g) PRS may be offered in a facility or in the community, or in a
combination of the two, consistent with an approved service
description.
(h) The Department reserves the right to approve or deny service
descriptions and approaches that do not meet Department
requirements.
§ 5. Access to facility and records.
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(a) The PRS provider shall make available to the Department and its
authorized agents full access to the facility or agency and its records
during announced and unannounced inspections.
(b) The PRS provider shall make an opportunity available for authorized
agents of the Department to privately interview individuals and staff.
GENERAL REQUIREMENTS
§ 10. Organizational structure.
The legal entity seeking licensure as a PRS provider has responsibility for the
operation of the service. The governing board of the legal entity shall:
(a) Develop a PRS advisory structure that includes participation by
individuals and families who utilize mental health services.
(b) Document that the members of the PRS advisory structure have been
provided with an overview of psychiatric rehabilitation principles.
(c) Identify the PRS separately from other services offered, naming a
director and staff.
(d) Describe the structure of the PRS in the service description.
(e) PRS providers identified as a Clubhouse must be certified by the
International Committee for Clubhouse Certification (ICCD) within 3
years of licensing.
§ 11. Licensing and inspections.
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The requirements in Chapter 20 (relating to licensure or approval of facilities and
agencies) apply to PRS providers.
§ 12. Provider records.
Provider shall maintain records that contain copies of the following:
(a) Required inspection reports, certifications or licenses issued by state
and local agencies.
(b) The PRS Statement of Rights.
(c) Documentation of civil rights compliance.
(d) Detailed service description.
(e) PRS provider policies and procedures that address:
1. The implementation of the service based upon the service
description.
2. Non discrimination.
3. Compliance with other applicable state and federal regulations,
including the Americans with Disabilities Act (ADA) and the Health
Insurance Portability Accountability Act (HIPAA).
4. Engagement and outreach to individuals to maintain participation in
the IRP.
5. Complaint, grievance and appeal.
6. Crisis response.
7. Disaster preparedness.
(f) Human resources policies and procedures that address:
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1. Job descriptions for positions.
2. Criminal history background check requirements and protocol.
3. Policies regarding transportation of individuals.
4. Evidence of staff credentials or qualifications.
5. Records of orientation and training, including annual training plan
for staff.
6. Staff work schedules and time sheets.
(g) PRS daily schedules.
(h) A schedule of allowable fees or charges.
(i) A copy of contracts or letters of agreement with external funding
sources including MCOs or County MH/MR Administrators.
(j) Letters of agreement with mental health services and community
agencies.
(k) QI documents:
1. Data gathering tools.
2. Evaluation reports and summaries.
(l) Infection control procedures that document compliance with
Occupational Safety and Health Administration (OSHA).
(m) Evidence that the PRS follows Community Support Principles.
§ 13. Physical site requirements.
The PRS provider shall make available:
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(a) An approved physical site for record keeping and other administrative
functions of the PRS regardless of where services are provided.
(b) Space for the PRS distinct from other services offered simultaneously.
(c) A site that is accessible to the service population.
(d) Space, equipment and supplies that are well maintained and sufficient
to deliver the services as proposed in the service description.
(e) Private interview space.
(f) Protocols that meet applicable federal, state and local requirements for
fire, safety and health, including protocols for:
1. Sanitation.
2. Fire drills.
§ 14. Service description.
(a) Prior to the initial licensing visit, and when changes occur, the PRS
provider shall submit to the OMHSAS regional field office a service
description that includes a description of the following:
1. The governing body, advisory structure and an agency table of
organization.
2. The philosophy of the PRS provider, incorporating psychiatric
rehabilitation principles.
3. The population to be served, including the following:
i. Anticipated daily attendance
ii. Age range
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iii. Diagnostic groups
iv. Plans to identify and accommodate special populations.
v. Plans to identify and accommodate culturally diverse
populations.
4. The approaches of PRS offered including EBPs utilized.
5. The location of services, whether in a facility or in the community,
or a combination of both.
6. Expected outcomes.
7. Staffing:
(i) Staffing patterns.
(ii) Staff to individual ratios.
(iii) Staff qualifications.
(iv) Staff supervision plans.
(v) Staff training protocols
(g) Service delivery patterns, including frequency, intensity and duration of
services.
(h) Days and hours of PRS operation.
(i) Geographic limits of PRS operation.
(j) The physical site, including copies of all applicable licenses and
certificates.
(k) The process for development of the IRP with the individual, including
time frames.
(l) The referral process.
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(m)Methods by which the PRS staff and individual will collaborate to
identify community resources and establish linkages.
(n) The process for developing and implementing the QI plan.
(o) The procedure for resolving complaints and grievances.
§ 15. Coordination of care.
The PRS provider shall have written agreements with other service providers,
including:
(a) The County MH/MR program.
(b) Psychiatric inpatient facilities.
(c) Partial hospitalization programs.
(d) Psychiatric clinics.
(e) Housing and residential programs.
(f) Drug and alcohol programs.
(g) Vocational, educational and social programs.
§ 16. Confidentiality.
Information about individuals who are receiving PRS must be protected in
compliance with the Mental Health Procedures Act §§ 5100.31 – 5100.39 and
with other applicable Federal and State regulations.
INDIVIDUAL RECORD
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§ 20. Content of individual record.
The PRS provider shall develop and maintain a unique record for the individual
served containing the following:
(a) Identifying information.
(b) Eligibility for PRS, including diagnosis and exception documentation.
(c) Referral source and reason for referral.
(d) A signed:
1. Consent to receive services.
2. Consent to release information.
3. Statement that the individual has received and had an opportunity
to discuss the oral and written versions of the PRS Statement of
Rights.
4. Statement that the individual has been given verbal and written
notification of freedom of choice.
(e) The assessment and updates.
(f) The IRP and updates.
(g) Staff documentation of progress.
(h) Staff documentation of coordination with other services and supports.
(i) Discharge summary.
§ 21. Record security, retention and disposal.
The PRS provider shall comply with §§ 1101.51(e).for record keeping. The
record must be:
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(a) Kept in a permanent, secure and protected location.
(b) Maintained for 4 years.
(c) Destroyed in a manner that protects confidentiality.
§ 22. Access to individual record.
(a) The individual may access records according to §5100.33.
(b) The individual may write, review and sign daily entries in the individual
record.
ADMISSION, CONTINUED STAY AND DISCHARGE CRITERIA
§ 30. Admission criteria.
(a) To be eligible for PRS the individual shall:
1. Be a member of the adult priority group as defined by the
Department.
2. Have a written recommendation for PRS by a physician or licensed
practitioner of the healing arts acting within the scope of
professional practice.
3. As a result of the mental illness, have a moderate to severe
functional impairment that interferes with or limits performance in at
least one of the following domains:
(i) Living.
(ii) Learning.
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(iii) Working.
(iv) Socializing.
4. Choose to participate in the PRS program.
(b) The PRS provider shall document the functional impairment as
determined by an assessment.
(c) When an individual is not a member of the adult priority group, a
request for eligibility for PRS services must be submitted to the MCO
for MA HealthChoices funded individuals or to the county
administrator for county funded individuals, or to the Department in
MA Fee-for-Service. The request must identify the reason that
psychiatric rehabilitation will be beneficial to the individual.
§ 31. Continued stay criteria.
When the individual chooses additional participation in the PRS, the PRS
provider shall determine eligibility for continued stay by an assessment that
indicates one or more of the following:
(a) As a result of the mental illness, there are functional impairments and
skill deficits which are addressed in the IRP.
(b) The withdrawal of services could result in loss of rehabilitation gains or
goals attained by the individual.
§ 32. Discharge criteria.
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When the PRS provider documents one of the following criteria, discharge may
occur. The individual:
(a) Has achieved rehabilitation goals and sustained them as designated in
the IRP.
(b) Has gained maximum rehabilitative benefit from PRS.
(c) Will not lose rehabilitation gains or goals as a result of withdrawal of
services.
(d) Voluntarily terminates from the PRS.
RIGHTS
§ 40. Statement of Rights.
(a) The following PRS Statement of Rights applies to the individual
participating in PRS:
PRS Statement of Rights
1. You have the right to be treated with dignity and respect and to be free
from physical and mental harm.
2. You have the right to receive PRS in a culturally respectful and
nondiscriminatory environment.
3. You have the right to receive PRS in the least restrictive setting that
fosters your recovery and promotes growth.
4. You have the right to access competent, timely and quality services to
assist with fulfillment of personal goals.
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5. You have the right to express goals which are individualized and reflect
informed choices concerning selection, direction or termination of
services and service plans.
6. You have the right to choose services which are based on individual
need, choice and acceptance and not dependent on compliance or
participation with any other treatment or rehabilitation services.
7. You have the right to keep and use personal possessions in a manner
that is reasonable to the service and location. Any necessary
limitations must be clearly communicated and defined, universally
applied, and documented.
8. You have the right to offer opinions and beliefs and to express
complaints related to services and your Individual Rehabilitation Plan
(IRP) and to have those complaints heard in a fair manner.
9. You have the right to appeal service decisions.
10. You have the right to have the assistance of a personally chosen
representative or advocate in expressing complaints or grievances.
11. You have the right to be able to contribute to; have access to; and
control over release of your records.
12. You have the right to have information and records concerning your
services treated in a confidential manner, as required by HIPAA.
(b) The PRS provider shall make service decisions in compliance with
individual civil rights.
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(c) The PRS provider shall develop and implement a written procedure for
assuring rights.
(d) Notify individuals of rights verbally and in writing, with a signed
acknowledgement in the individual record.
(e) Post the PRS Statement of Rights
§ 41. Individual participation and freedom of choice.
(a) The PRS provider shall adhere to freedom of choice requirements that
govern service delivery in the MA Program.
(b) The PRS provider shall document evidence in the individual record that
the PRS provider supplied verbal and written information to the
individual on the freedom of choice principles listed below:
1. The PRS provider shall not require participation in other services as
a condition of participation in PRS.
2. The individual shall have a choice in the selection of available
providers for PRS and other services, and be provided information
needed to access alternative providers.
§ 42. Nondiscrimination.
The PRS Provider shall not discriminate against individuals or staff on the basis
of age, race, sex, religion, ethnic origin, economic status, sexual orientation or
gender identity or expression, or persons with disabilities as described in the
Americans with Disabilities Act and other State and Federal regulations.
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§ 43. Complaint, grievance and appeal procedures.
(a) The PRS provider shall give verbal and written notice to the individual,
explaining complaint and grievance procedures.
(b) The PRS provider shall offer assistance to the individual as needed to
follow the procedures.
(c) The individual has the right to appeal service decisions.
STAFFING
§ 50. General staffing patterns.
(a) PRS may occur in a variety of locations, including facility and
community locations, consistent with the service description.
(b) The intensity of services may range from individual services to group
services.
(c) The intensity of services and the choice of service locations must be
determined by the IRP of the individual.
(d) The PRS provider shall employ a director and a specialist for the PRS.
(e) When services are delivered in a facility, the PRS provider shall have
an overall complement of one full time equivalent (FTE) staff for every
ten individuals (1:10), based upon average daily attendance.
(f) The PRS provider shall schedule a specialist or worker to be present at
all times.
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(g) The PRS provider shall develop a schedule that includes a plan to
maintain staffing requirements during:
1. Staff absences.
2. Deployment of staff for community services.
(h) The PRS provider shall document staffing by maintaining work
schedules, time records and daily utilization data
(i) When the PRS is approved to operate at more than one location, the
PRS director shall be present at approved PRS locations an average
of 7.5 hours per week per calendar month.
(j) A minimum of 25% of the FTE staff complement shall meet specialist
criteria within 1 year of initial licensing.
(k) A minimum of 25% of the FTE staff complement shall have Certified
Psychiatric Rehabilitation Practitioner (CPRP) status within 2 years of
initial licensing.
(l) A PRS assistant may work independently in community PRS only
when the assistant is also a CPRP.
(m)Trained staff shall be available, or other accommodations made, to
address the language needs of participants, including American Sign
Language and Braille.
§ 51. Individual services.
Individual PRS may be offered in a facility or in the community on a one staff to
one individual (1:1) ratio.
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§ 52. Group services.
(a) Group PRS may be offered in a facility or in the community.
(b) When group services are provided in a facility, group size may vary as
long as the one staff to ten individuals (1:10) ratio for the overall
service is met.
(c) When services are delivered in the community, one staff may serve a
group of two to five individuals.
1. Individuals participating in group services shall be working on
similar goals, as identified in the IRPs.
2. Individuals participating in group services shall be informed in
advance of other participants and shall consent to participate in the
group activity in a public community location.
3. Community group participation shall not be required and individual
preference for one to one (1:1) services must be honored, per
freedom of choice requirements.
4. The PRS provider shall consider individual preferences of
participants and shall inform group members of:
(ii) The location where the group is to meet.
(iii) The purpose of the community outing.
(iv) The roles of individuals and PRS staff.
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(h) The PRS provider shall design group community services as
experiential rather than verbal, to protect confidentiality in public
locations.
(i) The PRS provider shall arrange for group discussion of the experience
before and after the community outings to occur in the privacy of the
facility.
(j) Community PRS groups with more than five individual participants are
not billable.
§ 53. Clubhouse services.
(a) When the PRS provider indicates a service plan utilizing the clubhouse
approach, the PRS provider shall offer a facility for service delivery.
(b) The PRS provider may also deliver clubhouse services in the
community consistent with IRPs.
§ 54. Staff qualifications.
(a) The PRS director shall have one of the following:
1. A bachelor’s degree and CPRP certification.
2. A bachelor’s degree and at least 3 years work experience in mental
health direct care, 2 years of which must be work experience in
PRS. CPRP certification must be attained within 2 years of hire.
(b) A psychiatric rehabilitation specialist shall have one of the following:
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1. A bachelor’s degree and 2 years work experience in mental health
direct services, 1 year of which must be work experience in PRS.
CPRP certification must be attained within 2 years of hire.
2. CPRP status.
(c) A psychiatric rehabilitation worker shall have one of the following:
1. A bachelor’s degree.
2. An associate’s degree and 1 year work experience in mental health
direct services.
3. A CPS certificate and 1 additional year paid or volunteer work
experience in mental health direct services.
4. A high school diploma or graduate equivalency diploma (GED) and
2 years work experience in human services which must include 1
year of mental health direct services experience.
(d) A psychiatric rehabilitation assistant shall have a high school diploma
or GED and experience in human services.
§ 55. Supervision.
(a) The PRS director shall provide supervision of individual staff.
(b) The PRS specialist may perform supervisory functions as delegated by
the director, consistent with approved job descriptions for the two
positions.
(c) Supervision must occur no less than two times per calendar month,
utilizing the following methods:
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1. Monitoring active PRS delivery.
2. Individual case reviews.
3. Staff meetings.
4. Individual face to face staff supervisory sessions.
(c) PRS staff must be evaluated annually.
§ 56. Staff training requirements.
The PRS provider shall implement a staff training plan that ensures initial and
ongoing training in PRS practices.
(a) Orientation of new PRS staff prior to working independently must
include training on the specific model or approach and supervised
experience.
(b) All direct service staff employed in a PRS are required to complete a
12 hour psychiatric rehabilitation orientation course approved by the
Department no later than 1 year after hire. This course counts
towards the annual training requirement for the year in which it is
completed.
(c) All direct service staff employed in PRS are required to complete 18
hours of training per year with 12 hours specifically focused on
psychiatric rehabilitation or recovery practices or both.
(d) Training must have learning objectives.
(e) Documentation of training hours must be maintained in the provider
records.
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§ 57. Criminal history background checks.
(a) The PRS Provider shall complete criminal history background checks
for staff that will have direct contact with individual participants.
(b) The PRS Provider shall develop and consistently implement written
policies and procedures relevant to the service description regarding
personnel decisions based on the outcome of the criminal history
background checks.
SERVICE PLANNING AND DELIVERY
§ 60. Assessment.
(a) The PRS provider shall complete an assessment of functioning in the
living, learning, working and socializing domains.
(b) The assessment must include a determination of eligibility and is the
basis for the development of the IRP.
(c) The assessment must be completed in collaboration with the individual
and must:
1. Include strengths and needs.
2. Identify existing and needed natural and formal supports, including
other health care providers and social service agencies.
3. Identify the specific skills, supports and resources the individual
needs and prefers to accomplish stated goals.
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4. Identify cultural needs and preferences.
5. Be signed by the individual and staff.
6. Be updated annually and when one of the following occurs. The
individual:
(i) Requests an update.
(ii) Completes a goal or objective.
(iii) Is not progressing on stated goals.
§ 61. Individual rehabilitation plan.
(a) The PRS staff and the individual shall jointly develop the IRP,
consistent with the assessment.
(b) The IRP must include:
1. Rehabilitation goals and objectives designed to achieve
measurable outcomes.
2. Interventions to be provided, including skills development and
resource acquisition.
3. Responsibilities of the individual and the staff.
4. Action steps and timeframes.
5. Expected frequency and duration of participation in the PRS.
6. Intended service locations.
7. Dated signatures of the individual, the staff and the PRS director.
(c) The PRS provider shall complete the IRP within the first 20 visits, but
no more than 60 calendar days after the initial contact.
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(d) The PRS provider shall document a joint review of the IRP in the 90
day comprehensive summary, with updated signatures of the
individual and staff on the existing IRP.
(e) The PRS provider shall revise the IRP annually, and when:
1. The overall rehabilitation goal is completed.
2. An objective is completed.
3. No significant progress is made.
4. The individual requests changes.
§ 62. Documentation of progress.
The PRS provider shall include the following documentation of services and
progress in the record of the individual served:
(a) A daily entry that addresses services provided and the activities for the
day which must:
1. Indicate the date, time, duration, location, and type of intervention.
2. Document services provided in the context of the goal, regardless
of whether or not a billable service was provided.
3. Document the individual response to service.
4. Include the signature of the individual, or document the reason if
the individual does not sign.
5. Be signed and dated by the PRS staff.
(b) A comprehensive summary of the individual’s progress, which must be
completed every 90 days. The summary must:
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1. Include a description of the services in the context of the goals
identified in the IRP.
2. Document the participation and response to service.
3. Summarize the progress or lack of progress towards goals in the
IRP.
4. Summarize the need for revision and changes made to the IRP.
5. Include the signature of the individual, or document the reason if
the individual does not sign.
6. Be signed and dated by the PRS staff.
§ 63. Vocational, educational and social services.
The PRS provider may offer the following services which are not currently MA
billable:
(a) Vocational activities or training such as job development, placement
and coaching that prepare an individual for a specific job.
(b) Educational services including GED programs or educational programs
that prepare individuals for a particular trade.
(c) Social activities that are not related to specific individual PRS goals.
DISCHARGE
§ 70. Discharge.
(a) The PRS provider shall discuss discharge with the individual.
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1. The decision to discharge must be a joint decision between the
individual and the PRS.
2. When the decision to discharge is not mutual, the PRS provider
shall document the reason.
3. When the decision to discharge is reached, the PRS provider shall
offer the individual the opportunity to participate in future services.
4. When the individual ends participation in the PRS, the PRS
provider shall plan and document next steps with the individual,
including recommended services and referrals.
5. When it is necessary to discharge an individual from PRS due to
the individual’s disengagement, prior to discharge the PRS provider
shall document:
(i) Attempts to reengage the individual.
(ii) The circumstances and rationale for discharge.
6. When an individual has a recurring or new need for PRS and meets
admission criteria, the PRS provider shall reconsider the individual
for readmission without regard to previous participation.
§ 71. Discharge summary.
(a) When services are concluded, the PRS provider shall complete a
dated and signed discharge summary that must include a brief
description of:
1. Services provided.
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2. Participation.
3. Progress.
4. The reason for discharge.
5. Referrals for future services.
(b) The PRS provider shall document that the discharge summary is:
1. Reviewed and signed by the PRS director.
2. Completed no more than 30 days after the date of discharge.
3. Offered to the individual for review, signature and the opportunity to
comment.
QUALITY IMPROVEMENT
§ 80. Quality improvement requirements.
The PRS provider shall establish and implement a written QI plan addressing the
delivery of PRS that:
(a) Provides for an annual review of the quality, timeliness and
appropriateness of services, including:
1. Outcomes for individuals in PRS.
2. Individual record audits.
3. Individual satisfaction.
4. Use of exceptions to admission and continued stay criteria.
5. Evaluation of fidelity to the service description.
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(b) Identifies reviewers, frequency and types of audits and methodology
for establishing sample size.
(c) Documents that individuals served participate in QI plan development
and follow up.
(d) Results in an annual comprehensive summary that:
1. Reports on actions planned to address QI findings.
2. Is available to all stakeholders.
WAIVER OF STANDARDS
§ 90. Requests for waivers.
(a) The PRS provider may submit a written request to the Department for
a waiver of a specific requirement contained in this chapter.
(b) The Department reserves the right to grant or deny waivers of specific
requirements contained in this chapter.
(c) Waivers will be considered only in exceptional circumstances.
(d) A waiver will be granted only when the health and safety of the
individuals and the quality of services are not adversely affected.
(e) The Department reserves the right to revoke a waiver if the conditions
required by the waiver are not met.
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PRS STATEMENT OF RIGHTS
All licensed Psychiatric Rehabilitation Services shall adhere to §§ 5100.51 -
5100.56. The following PRS Statement of Rights applies to the individual
participating in PRS:
1. You have the right to be treated with dignity and respect and to be free from
physical and mental harm.
2. You have the right to receive PRS in a culturally respectful and
nondiscriminatory environment.
3. You have the right to receive PRS in the least restrictive setting that fosters
your recovery and promotes growth.
4. You have the right to access competent, timely and quality services to assist
with fulfillment of personal goals.
5. You have the right to express goals which are individualized and reflect
informed choices concerning selection, direction or termination of services and
service plans.
6. You have the right to choose services which are based on individual need,
choice and acceptance and not dependent on compliance or participation with any
other treatment or rehabilitation services.
7. You have the right to keep and use personal possessions in a manner that is
reasonable to the service and location. Any necessary limitations must be clearly
communicated and defined, universally applied, and documented.
8. You have the right to offer opinions and beliefs and to express complaints
related to services and your Individual Rehabilitation Plan (IRP) and to have those
complaints heard in a fair manner.
9. You have the right to appeal service decisions.
10. You have the right to have the assistance of a personally chosen
representative or advocate in expressing complaints or grievances.
11. You have the right to be able to contribute to; have access to; and control over
release of your records.
12. You have the right to have information and records concerning your services
treated in a confidential manner, as required by HIPAA.