Ariz. Admin. Code § 9-21-301

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-21-301 - General Provisions

A. Responsibilities of the regional authority, clinical team, and case manager.

1. The regional authority is responsible for providing, purchasing, or arranging for all services identified in ISPs.

a. The regional authority shall perform all intake and case management for its region. The regional authority may contract with a mental health agency to perform intake or case management but only with the written approval of the Administration, which may be given in its sole discretion.

b. Other services may be provided directly by programs operated by the Administration or by the regional authority through contracts with service providers, or through arrangements with other agencies or generic providers.

2. The regional authority and the clinical team shall work diligently to ensure equal access to generic services for its clients in order to integrate the client into the mainstream of society.

3. The initial clinical team shall work to meet the individual's needs from the date of application or referral for services until such time as eligibility is established and an ISP is developed.

4. The assigned clinical team shall be primarily responsible for providing continuous treatment, outreach and support to a client, for identifying appropriate behavioral health services or community services, and for developing, implementing and monitoring ISPs for clients.

5. The case manager, in conjunction with the clinical team, shall:

a. Locate services identified in the ISP;

b. Confirm the selection of service providers and include the names of such providers in the ISP;

c. Obtain a written client service agreement from each provider;

d. Be responsible for ensuring that services are actually delivered in accordance with the ISP; and

e. Monitor the delivery of services rendered to clients. Monitoring shall consider, at a minimum, the consistency of the services with the goals and objectives of the ISP.

6. The case manager shall also be responsible to:

a. Initiate and maintain close contact with clients and service providers;

b. Provide support and assistance to a client, with the client's permission and consistent with the client's individual needs;

c. Ensure that each service provider participates in the development of the ISP for each client of the service provider;

d. Ensure that each inpatient facility, according to R9-21-312, develops an ITDP that is integrated in and consistent with the ISP;

e. Assess progress toward, and identify impediments to, the achievement of the client's goals and objectives identified in the ISP;

f. Promote client involvement in the development, review, and implementation of the ISP;

g. Attempt to resolve problems and disagreements with respect to any component of the ISP;

h. Assist in resolving emergencies concerning the implementation of the ISP;

i. Attend all periodic reviews of the ISP and ITDP meetings;

j. Assist in the exploration of less restrictive alternatives to hospitalization or involuntary commitment; and

k. Otherwise coordinate services provided to the client.

7. If a case manager is assigned to a client who, at any time, is admitted to an inpatient facility, the case manager shall ensure the development, modification or revision of a client's ISP and the integration of the ITDP according to this Article.

a. The inpatient facility clinician responsible for coordinating the ITDP shall immediately notify the client's case manager of the time of the admission and ensure that all treatment and discharge planning includes the case manager.

b. The case manager shall be provided notice of all treatment and discharge meetings, shall participate as a full member of the inpatient facility treatment team in such meetings, shall receive periodic and other reports concerning the client's treatment, and shall be responsible for identifying and securing appropriate community services to facilitate the client's discharge.

c. If no case manager has been assigned, the inpatient facility clinician primarily responsible for the client's inpa-tient care shall, within three days of admission, make a referral to the appropriate regional authority for the appointment of a case manager.

d. Delays in the assignment of a case manager or in the development or modification of an ISP or ITDP shall not be construed to prevent the clinically appropriate discharge of a client from an inpatient facility.

e. Inpatient facilities shall establish a mechanism for the credentialing of case managers and other members of the clinical team in order that they may participate in ITDP meetings.

B. Client participation in service planning.

1. It is the responsibility of the regional authority and its service providers to engage in service planning, including the provision of assessments, case management, ISPs, ITDPs, and service referrals, according to the provisions of these rules for the benefit of clients requesting, receiving or referred for behavioral health services or community services. Clients and the clients' guardians may refuse to participate in or to receive any service planning. In the event of such refusal, service planning shall not be provided unless:

a. There is an emergency in which a qualified clinician determines that immediate intervention is necessary to prevent serious harm to the client or others; or

b. The client is subject to court-ordered evaluation or treatment.

2. A client's refusal to accept a particular service, including case management services, or a particular mode or course of treatment, shall not be grounds for refusing a client's access to other services that the client accepts.

3. A physical examination shall not be conducted over a client's refusal unless the examination is consented to by the client's guardian, or the examination is otherwise required by court order.

4. A decision to provide services, including assessment, service planning, and case management services, to a client who is refusing such services, or a decision not to provide such services to such an individual, may be appealed according to the provisions of R9-21-401. This subsection does not limit the rights of a client to accept, reject, or appeal particular results of the service planning process as identified in other applicable provisions of these rules.

C. Clients with special needs.

1. Whenever, according to an assessment or in the development or review of any plan prepared under this Article, it is determined that a client is a client who needs special assistance or a client who needs counsel or advice in making treatment decisions or in enforcing the client's rights, the case manager shall:

a. Notify the regional authority, the Office of Human Rights, and the appropriate human rights committee of the client's need so that the client can be provided special assistance from the human rights advocate or special review by the human rights committee; and

b. If the client does not have a guardian, identify a friend, relative, or other person who is willing to serve as a designated representative of the client.

2. The clinical team shall make arrangements to have qualified interpreters or other reasonable accommodations, including qualified interpreters for the deaf, present at any assessment, meeting, service delivery, notice, review, or grievance for clients who cannot converse adequately in spoken English.

3. Clients who are incarcerated in jails shall receive ISPs in accordance with R9-21-307. If legitimate security requirements of any jail in which a client is incarcerated require a reasonable modification of a specific procedure set forth in this rule, the clinical team may modify the method for preparing the ISP only to the extent necessary to accommodate the legitimate security concerns.

a. No modification may unreasonably restrict the client's right to participate in the ISP process;

b. No modification may alter the standards for developing an ISP, the client's right to obtain services identified in the ISP, as provided in this Article, or the client's right to appeal any aspect of treatment planning according to R9-21-401, including the decision to modify the process for security reasons.

D. Notices to the individual.

1. Any individual or mental health agency required to give notice to an individual of any documents, including eligibility determinations, assessment reports, ISPs, and ITDPs according to this rule shall do so by:

a. Providing a copy of the document to the individual;

b. Providing copies to any designated representative and guardian;

c. Personally explaining to the individual and designated representative and/or guardian any right to accept, reject, or appeal the contents of the document and the procedures for doing so under this Article.

2. Individuals requesting or receiving behavioral health services or community services shall be informed:

a. Of the right to request an assessment;

b. Of the right to have a designated representative assist the client at any stage of the service planning process;

c. Of the right to participate in the development of any plan prepared under this Article, including the right to attend all planning meetings;

d. Of the right to appeal any portion of any assessment, plan, or modification to an assessment or plan, according to R9-21-401;

e. Of the Administration's authority to require necessary and relevant information about the individual's needs, income, and resources;

f. Of the availability of assistance from the regional authority in obtaining information necessary to determine the need for behavioral health services or community services;

g. Of the Administration's or mental health agency's authority to charge for services and assessments;

h. That if the individual declines the services of a case manager or an ISP, the individual has the right to apply for services at a subsequent time; and

i. That if the individual declines any particular service or treatment modality, it will not jeopardize other accepted services.

E. Extensions of time.

1. The time to initiate or complete eligibility determinations, assessments, ISPs, and other actions according to this Chapter may be extended if:

a. There is substantial difficulty in scheduling a meeting at which all necessary participants can attend;

b. The client fails to keep an appointment for assessment, evaluation, or any other necessary meeting;

c. The client is capable of but temporarily refuses to cooperate in the preparation of the plan or completion of an assessment or evaluation;

d. The client or the client's guardian and/or designated representative requests an extension of time or

e. Additional documentation has been requested but has not yet been received.

2. An extension under this rule shall not exceed the number of days incurred by the delay and in no event may exceed 20 days, unless the whereabouts of the client are unknown.

3. For an SMI eligibility determination, an extension of time shall only apply if an applicant agrees to the extension.

F. Meeting attendance through telecommunications link. Attendance by any person at any meeting that is required or recommended according to this Article may be accomplished through a telecommunications link that is contemporaneous with the meeting.

Ariz. Admin. Code § R9-21-301

Adopted under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective October 7, 1992; received in the Office of the Secretary of State October 14, 1992 (Supp. 92-4). Amended under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, §61, effective September 30, 1993 (Supp. 93-3). Amended by exempt rulemaking at 9 A.A.R. 3296, effective June 30, 2003 (Supp. 03-2). Amended by final rulemaking at 22 A.A.R. 2019, effective 7/12/2016.