C.M.R. 14, 193, ch. 6, OUTPATIENT SERVICE STANDARDS
These standards, in addition to the core standards, are applied to agencies providing outpatient services.
Access
OP.1 The agency has policies and procedures governing the establishment of a waiting list, that minimally includes the following: prioritizing clients, selecting clients from the waiting list, and referring clients to other providers.
Assessment
OP.2 A comprehensive assessment is conducted by an individual chosen or agreed to by the client, with the client's participation, within 30 days of the client agreeing to initiate services.
OP. 2. A. The comprehensive assessment minimally addresses the following:
OP. 2. A.1 the client's strengths and weaknesses;
OP. 2. A.2 the client's perception of his or her needs;
OP. 2. A.3 the family/guardian's input and perception of the client's needs when appropriate, and with the client's consent;
OP. 2. A.4 a personal, family, and social history;
OP. 2. A.5 the client's emotional, psychiatric, and psychological strengths and needs;
OP. 2. A.6 a physical health status and history, including current prescription and over-the-counter medication use;
OP. 2. A.7 past and current drug/alcohol use;
OP. 2. A.8 a developmental history;
OP. 2. A.9 possible sources of assistance and support in meeting the needs expressed by the client or legally responsible party, including state and federal entitlement programs;
OP. 2. A.10 physical and environmental barriers that may impede the client and family's ability to obtain services;
OP. 2. A.11 history of physical and/or sexual abuse;
OP. 2. A.12 the vocational, educational, social, living, leisure/recreation and medical domains;
OP. 2. A.13 potential need for crisis intervention services
OP. 2. A.14 housing and financial needs,
OP. 2. A.15 status of the Individualized Support Plan; and
OP. 2. A.16 the signature of the person who performed the assessment,
Interpretive Guideline for OP.2.A.1 thru OP.2.A.13
The Division of Licensing recognizes that in some cases not all of the information requested in these standards will be able to be obtained. The Division also recognizes that the level of detail required will vary given a variety of factors (the client's level of cooperation, the integrity of the information sources, the length of services or treatment, the condition being addressed, the practitioner's training, etc.). Although the Division will attempt to be sensitive to these factors and flexible in surveying this area, the agency should assure that assessments that do not address all these standards have accompanying documentation that justifies abbreviated or absent information.
OP. 2. B. The agency will establish policies and procedures establishing criteria for the performance of the following assessments:
OP. 2. B.1 a nutritional assessment;
OP. 2. B.2 a cognitive functioning assessment;
Interpretive Guideline for OP.2.B.2
The client's cognitive functioning assessment should include assessment of the following functions: problem solving, decision making, organization, self-direction, system negotiation skills, concentration, and abstract reasoning. For individuals over 60 years of age, this assessment should also include memory, language, orientation, and visuo-spatial abilities.
OP. 2. B.3 an assessment of the client's capacity;
OP. 2. B.4 a neurological assessment.
Interpretive Guideline for OP.2.B thru OP.2.B.4
These assessments do not necessarily have to be performed in the agency or by agency staff. The intent of these standards are to assure that the agency has mechanisms by which to evaluate the need for these assessments and to perform or refer for assessment those clients whose symptomatology suggests the need for these assessment.
OP. 2. C The assessment(s) shall be obtained from the client, legally responsible party, community service agencies, and to the extent possible, from other individuals in the community as authorized by the client or legally responsible party.
OP. 2. C.1. In instances in which the client receives community support services and/or has an Individualized Support Plan, the agency will, subject to the client's consent, attempt to coordinate the assessment and subsequent service planning with the community support provider.
OP. 2. C.1.a. Services provided to these clients will be consistent with the targets and objectives of the Individualized Support Plan.
OP. 2. C.1.b. Services provided to these clients will be delivered pursuant to a service agreement negotiated with the community support worker.
OP. 2. D The client record contains a summary evaluation of the data collected in the comprehensive assessment.
OP.3 The agency has a documented policy and procedure on updating assessments that assures that assessments are current and in no case exceed annual updates.
Service Planning
OP.4 There is documented evidence that the service planning and revision process involves the client, legally responsible party, and other representatives and professionals whom the client identifies.
OP.5 A comprehensive service plan is developed for each client, with the client's consent, and within 30 days of initiation of service.
Interpretive Guideline for OP.4
The client and legally designated guardian shall be fully and actively involved in the development or revision of the service plan, if possible. It the client consents, the client's designated representative e, family members or significant others shall be included in the development and revision of the service plan, unless contraindicated. When these individuals do not attend, their absence is noted. Each agency shall document good faith efforts, including at least 3 days notice of any service planning meeting, to involve guardians, representatives or legally responsible parents.
OP. 5. A.. The comprehensive service plan minimally contains the following:
OP. 5. A.1 problem statements;
OP. 5. A.2 short- and long-range goals based upon client needs with a projection of when such goals will be attained;
OP. 5. A.3 objectives stated in terms which allow objective measurement of progress;
OP. 5. A.4 multidisciplinary input and specification of treatment responsibilities;
OP. 5. A..5 client input and signature;
OP. 5.A. 6 signatures of all people participating in the development of the plan;
OP. 5. A.7 the methods and frequency of treatment, rehabilitation, support;
OP5.A.8 a description of any physical handicap and any accommodations necessary to provide the same or equal services and benefits as those afforded non-disabled individuals; and
OP. 5. A..9 criteria for discharge.
OP. 5. B Justification for not addressing problems identified in the assessments is documented in the client record.
Interpretive Guideline for OP.5.B
The intent of this standard is to assure that the clinical staff considers all of the client's identified problems in formulating the service plan. problems that are not reflected on the service plan should have accompanying documentation identifying the rationale for not addressing the problems at this time. This documentation can take many forms including progress notes service plan narratives, etc.
OP. 5. C For those clients with ISP's and service agreements to the extent that the ISP and service agreement meet all requirements of a service plan, and are completed by a person qualified to provide outpatient services, EL service plan will not be required.
0P.6 The service plan is designed so that the client's progress towards service plan goals can be monitored and evaluated.
Interpretive Guideline for OP.6
Service plans should have measurable goals and some means for reflecting when, or to what degree, a goal has been attained. The organization should also have mechanisms that document monitoring and evaluation of client goals, e.g., quality assessment, treatment plan review documents.
OP.7 The service plan is reviewed at major decision points in each client's treatment course, upon client request, and no less frequently than every 90 days.
Interpretive Guideline for OP.7
Major decision points may include, but are not necessarily limited to the following: when there is a change in the client's condition, when a service appears not to benefit the client, when the client is under- or over- utilizing services.
OP.8 Unmet service needs are documented in the service plan.
OP.9 The agency has a policy and procedure for providing clients with a copy of their service plan within one week following its formulation, review or revision and notification of client recourse should they disagree with any aspect of the plan.
Interpretive Guideline for OP.8
If at the time of the service planning meeting, team members know on the basis of reliable information that the needed services are unavailable, they shall note them as "unmet service needs" on the service plan and develop an interim plan based upon available services that meet, as nearly as possible, the actual needs of the client. The organization should also document notification of the organization's leadership and the Commissioner regarding the unavailability of service that is causing the unmet service need.
OP. 9. A. The agency will not fail to provide a copy of the client's service plan and/or notify them of recourse should they disagree.
Discharge Planning
OP.10. Each client record contains documentation of current discharge or termination planning.
OP.11. The agency has discharge planning policies and procedures.
OP. 11. A The agency has a policy and procedure for determining when a client is considered "inactive".
OP. 11. A.1 The inactive status policy and procedure notes what documentation is kept on the client during inactive status.
OP. 11. A.2 The inactive status policy and procedure notes the duration of inactive status before the case is considered closed.
OP.12 A discharge summary is entered in the client record within 15 days of discharge or on the 90th day of inactive status and includes the client's course of treatment and ongoing needs at discharge.
OP. 12. A Each discharge summary minimally addresses, but need not be limited to the following:
OP.12. A..1 the reasons for termination of service;
OP. 12. A. 2 the final assessment, including general observations and significant findings of the client's condition initially, while services were being provided and at discharge;
OP. 12. A.3 the course and progress of the client with regard to each identified problem; and
OP. 12. A.4 the recommendations and arrangements for further continued service needs.
Interpretive Guideline for OP.12
For clients on inactive status, a discharge summary should be completed no later that 90 days following placement on inactive status or earlier given the following conditions:
1. another agency submits a request for the client's discharge summary prior to the 90th day of inactive status;
2. agency policy requires that discharge summary be completed earlier than the 90th day of inactive status; and
3. practitioners who are leaving agency employment must complete discharge summaries on all of their inactive status clients regardless of time frame.
OP.13 The agency has policies and procedures that specify under what conditions services may be discontinued or interrupted which minimally include how and when the client is notified.
OP. 13. A. For agencies serving DMHMR class members, the agency shall first obtain prior written approval for discontinuing or interrupting services from the Department.
OP. 13. B For agencies serving DMHMR class members, the agency shall give thirty days advance written notice to the client and the client's guardian. If the client poses a threat of imminent harm to persons employed or served by the agency, the agency shall give notice that is reasonable under the Circumstances.
OP. 13. C For agencies serving DMHMR class members, the agency shall give such notice as may be required by law or regulation.
OP. 13. D For agencies serving DMHMR class members, the agency shall assist the client in obtaining the services from another agency.
OP. 13. E For agencies serving DMHMR class members, the agency shall provide documented evidence in the client record of compliance with these standards, through letters, progress notes, phone logs, and/or facsimile.
OP.14 Applicants, who are not eligible for services, will be referred to appropriate services, if required, available and desired.
OP. 14. A. The agency has a policy and procedure on referral and/or transfers of individuals deemed inappropriate for services offered by the agency that minimally includes communicating the rationale for the referral/transfer to the applicant and providing them with a list of alternative service providers and advocacy services.
OP. 14. B. The agency provides and documents other assistance as required to assist the individual to obtain/access the services to which they are referring him/her.
Health
OP.15 If food services are provided, the facilities for the preparation and serving of food shall be inspected and approved by the Department of Human Services.
OP. 15. A.. If food is either prepared or served at the facility, then the agency shall either a DHS Eating Establishment license or show written evidence from DHS indicating that they need no such license.
OP. 15. B. When the agency requires a DHS license, the agency's Eating Establishment license is current.
OP.16 The agency shall have methods for obtaining on- or off-site medical services for all clients.
OP. 16. A. The agency defines in policy and procedure those medical services delivered on-site. For those medical services not provided on-site, letters of agreement and/or procedures for accessing medical service provider(s) are in effect.
C.M.R. 14, 193, ch. 6, OUTPATIENT SERVICE STANDARDS