D.C. Mun. Regs. tit. 22, r. 22-A3436

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-A3436 - INTENSIVE CARE COORDINATION

3436.1

ICC is a comprehensive, holistic, child/youth, and family-driven approach to case management for children and youth experiencing behavioral health challenges. ICC services shall be delivered according to the National Wraparound Initiative (NWI) High Fidelity Wraparound model. ICC services shall be provided to fidelity to the NWI model. Each ICC provider shall maintain a passing fidelity score using the Wraparound Fidelity Index.

3436.2

ICC services shall be delivered through a Wraparound Team Meeting (WTM) process. ICC shall support the child/youth and their family in defining a family vision and goals and in developing creative and individualized services and supports to help the family achieve their goals and vision. The Wraparound Team shall work directly with the child/youth and their family (including biological, kin, foster, adoptive, and fictive) to develop, implement, track, and adapt a family- driven and child/youth-guided individualized plan of care (IPC) that identifies goals and the appropriate strategies to reach the goals.

3436.3

ICC services shall be customized to each child/youth and their family and responsive to the family's strengths, using a combination of formal and informal supports. ICC services shall involve the coordination, to the extent consistent with applicable law, of a broad range of services and supports across multiple systems, including the behavioral health system, the child welfare system, and the juvenile justice system.

3436.4

ICC services may include the coordination of Medicaid-reimbursable services such as MHRS, SUD Treatment and Recovery Services, Crisis Services, peer supports, social services, and educational services; and non-Medicaid reimbursable services paid through a child/youth's flexible funding allotment.

3436.5

ICC service components shall include:

(a) A comprehensive assessment;

(b) Child/youth and family-driven identification of appropriate members for the Wraparound Team;

(c) Development of the IPC in collaboration with the child/youth, family, and collateral contacts;

(d) Development of a Crisis Safety Plan;

(e) Regular contact between the care coordinator and the family, the child/youth (where appropriate) and other relevant persons in the child/youth's life;

(f) Facilitation of WTM at least monthly;

(g) Face to face contact with the child/youth and family, and the ICC Care Coordinator, weekly;

(h) Referrals to other appropriate behavioral health services and supports including housing;

(i) Identification and development of natural supports, such as family and friends;

(j) Assistance with navigation of other services, including social services, medical services, and educational services;

(k) Family engagement and orientation, including family education and advocacy services and support; and

(l) Monitoring, reviewing, and updating the IPC to reflect the changing needs of the child/youth and family.

3436.6

ICC providers shall be community-based, culturally and linguistically competent and able to meet the changing needs of a child/youth and their family.

3436.7

Children/youth eligible to receive ICC services shall:

(a) Be under age twenty-two (22);

(b) Exhibit significant functional impairment across life domains as reflected in the Department-designated standardized assessment tool; and

(c) Exhibit at least one (1) of the following criteria:

(1) Be at risk of placement outside of their home to include foster care, shelter care through the juvenile justice system, or a Psychiatric Residential Treatment Facility due to behavioral health needs as assessed by an independently licensed behavioral health practitioner or a school psychologist. In evaluating risk of being placed outside of home, the assessment shall evaluate the child/youth's impairment in the following areas:

(i) Self-Care - Basic hygiene, grooming or nutritional needs which are consistent with the maintenance of general health and wellness;

(ii) Community Functioning - Behaviors observed in the community related to personal judgement abilities and decision-making skills;

(iii) Social Relationships - The ability to maintain positive and effective relationship with peers and adults;

(iv) Family Functioning - The ability to maintain positive, healthy relationships with family members; or

(v) School/Vocational/Work Functioning - The ability to function in the school or vocational setting. Impairment may be evidenced by poor school attendance, decline in productivity or maladaptive behavior in the school/vocational/work setting.

(2) Be returning from a placement outside-of-home;

(3) Receiving services or supports from two (2) or more District government agencies; or

(4) Have had three (3) or more behavioral health hospitalizations within a six (6) month period.

3436.8

The ICC provider shall convene a Wraparound Team, which shall consist of, at a minimum, the following members:

(a) The child/youth;

(b) The ICC care coordinator;

(c) The child/youth's family, including fictive kin;

(d) Any interested person the family wishes to include as a member of the team, which may include clergy members, family friends, and other informal support resources;

(e) The child/youth's medical, behavioral, and community-based providers;

(f) A clinical staff member who is directly involved in the treatment of the child/youth for whom the IPC is being developed, if desired by the family;

(g) Representation from outside agencies with which the child/youth is involved, including current providers of services, parole/probation officers, or educators that the child/youth and their family agree to include; and

(h) The Child and Family Services Agency (CFSA) social worker assigned to the child/youth, if the child/youth is receiving services from CFSA.

3436.9

Each ICC team shall be staffed by an ICC care coordinator and an ICC supervisor.

3436.10

The ICC provider shall assign an ICC care coordinator to a child/youth within seventy-two (72) hours of receipt of an approved referral for ICC services from the Department or its authorized designee.

3436.11

Within fourteen (14) calendar days of the child/youth's referral to ICC services, the ICC care coordinator shall complete a comprehensive family narrative inclusive of family strengths.

3436.12

The ICC provider shall complete a comprehensive assessment for the child/youth at the initiation of ICC services and reassess the child/youth at least annually. The assessment shall include a comprehensive history for the child/youth with information from relevant third-party sources as appropriate. The assessment shall determine the child/youth's need for linkages to medical, educational, or social services.

3436.13

Within thirty (30) calendar days of the child/youth's referral to ICC services, the ICC care coordinator shall convene an initial WTM and complete an IPC. The IPC shall be based on findings of the comprehensive assessment and integrate individualized set of community services and natural supports to be wrapped around the child/youth and their family to achieve the desired outcomes. The Wraparound Team shall review and update the IPC during each monthly WTM, following any comprehensive assessment, and following any crisis, to ensure that it remains appropriate to meet the family's goals and that services are furnished in accordance with the IPC. The IPC shall include a list of the child/youth's goals and the medical, educational, and social services actions and referrals needed to achieve them.

3436.14

The ICC care coordinator will identify and actively assist the child/youth and family to obtain and monitor the delivery of available services to support the goals established in the child/youth's IPC, including medical, educational, social, therapeutic, or other services. The ICC care coordinator will collaborate with the other service providers and agencies (if involved) on the behalf of the child/youth and family to facilitate service delivery.

3436.15

The ICC care coordinator shall meet at least weekly with the child/youth and their family to discuss progress towards the goals established in the IPC.

3436.16

The ICC provider shall work with the child/youth and family to develop an individualized Crisis Safety Plan for each child/youth within fourteen (14) calendar days of the child/youth's initiation of ICC services, which may include utilization of twenty-four (24) hour Crisis Services through the Child Adolescent Mobile Psychiatric Services Crisis Team. The ICC provider shall respond twenty-four (24) hours a day seven (7) days a week to crises for child/youth and their family, including assisting in implementing the child/youth's Crisis Safety Plan during a crisis.

3436.17

Each child/youth receiving ICC services may receive up to a one thousand dollar ($1,000.00) flexible funding allotment per calendar year as needed for non- Medicaid reimbursable services and supports that are included in their treatment plan. The ICC provider shall manage these funds to ensure they are used only to support individualized needs identified and delineated in the child/youth's IPC.

3436.18

ICC shall be provided in natural settings including the child/youth's home, school, community, the ICC provider site, or in any out of home placement where the child/youth is currently placed and pending discharge. The ICC provider shall accommodate WTM at times that are reasonably convenient for the child/youth and their family.

3436.19

The ICC provider shall discharge the child/youth from ICC services when:

(a) ICC services are no longer indicated for the child/youth pursuant to the District-approved functional assessment tool;

(b) The child/youth's clinical presentation indicates that ICC services are no longer appropriate; or

(c) The child/youth or their family refuses to continue with ICC.

3436.20

The Wraparound Team shall begin transition planning from the start of enrollment in ICC. Within sixty (60) calendar days prior to a discharge, the Wraparound Team shall update the transition plan to ensure it aligns with the current IPC, the child/youth and family's goals and preferences, and the availability of culturally responsive and appropriate community-based services for the child/youth and their family to support continued progress and/or maintenance. Transition services may include services and support already in place while involved in ICC.

3436.21

The ICC supervisor shall:

(a) Provide clinical and administrative oversight to the ICC team; and

(b) Ensure that ICC services are delivered according to NWI fidelity standards and the ten (10) NWI Principles of Wraparound, available from https://nwi.pdx.edu/NWI-book/Chapters/Bruns-2.1-(10-principles-of-wrap).pdf.

3436.22

The ICC care coordinator shall ensure that the plan of care reflects the decisions of the Wraparound Team and detail tasks to complete to ensure that the child/youth and their family receive the supports identified in the IPC. The ICC care coordinator shall have a maximum case load of ten (10) children/youth at any time.

3436.23

ICC care coordinators shall:

(a) Possess a Bachelor of Arts or a Bachelor of Science degree in social work, psychology or related field and have a minimum of three (3) years of experience in a human services profession; or

(b) Have at least four (4) years of employment in a human services profession.

3436.24

ICC supervisors shall:

(a) Possess a master's degree in social work, psychology, or other related profession;

(b) Be an independently licensed behavioral health practitioner;

(c) Have at least five (5) years of experience in case management;

(d) Have at least two (2) years of supervisory experience; and

(e) Have a supervisory certification from the National Wraparound Implementation Center (NWIC) or be enrolled and completing the certification process while employed as an ICC supervisor.

3436.25

ICC providers shall ensure that all ICC care coordinators and ICC supervisors meet all training requirements established by the Department in this chapter and are certified by NWIC, and shall not utilize an ICC care coordinator or ICC supervisor who does not meet those requirements or does not maintain that certification.

3436.26

ICC providers shall not deliver services before receiving prior authorization from the applicable payor.

3436.27

ICC services may include contacts with individuals other than the child/youth that are directly related to at least one (1) of the following:

(a) Identifying the child/youth's needs and care to help the child/youth access services;

(b) Providing the ICC case coordinator or ICC supervisor with feedback; or

(c) Alerting the ICC case coordinator or ICC supervisor to changes in the child/youth's needs.

3436.28

ICC providers shall maintain case records that document the following for all children/youth receiving ICC services:

(a) The name of the child/youth receiving ICC services;

(b) The dates that the child/youth received ICC services;

(c) The name of the person(s) providing ICC services;

(d) The nature, content, units of the case management services received and whether goals specified in the care plan have been achieved;

(e) Whether the child/youth and family has declined services in the care plan;

(f) The need for, and occurrences of, coordination with other case managers;

(g) A timeline for obtaining needed services; and

(h) A timeline for reevaluation of the plan.

3436.29

ICC providers shall submit all data to the Department in the form and format required by the ITE Provider Extract Companion Guide, which outlines the instructions for network providers to submit BHSD (available at https://dbh.dc.gov/).

3436.30

ICC providers whose services are reimbursable under Medicaid shall be reimbursed at a per member per month rate established by the DHCF on the Medicaid Fee Schedule (available at https://dbh.dc.gov/).

D.C. Mun. Regs. tit. 22, r. 22-A3436

Final Rulemaking published at 71 DCR 14542 (11/29/2024)