Currentharvard pilgrim health carePolicy N/A

Adult Community Based Mobile Crisis Intervention Amci Performance Specifications

Defines service, staffing, process, documentation, quality, disposition, and community linkage requirements for AMCI programs serving adults (21+) under specified Tufts Health Plan and Tufts Health Public Plans products, including Senior Care Options, Tufts Health Together, and Tufts Health One Care.

Policy Summary

Payerharvard pilgrim health care

PolicyAdult Community Based Mobile Crisis Intervention Amci Performance Specifications

Policy CodePolicy N/A

Change TypeRevised / Added (document history)

Effective DateN/A

Next Review DateN/A

Key ActionComplete and electronically submit an AMCI encounter form for every intervention and link subsequent encounters to the full encounter by unique encounter ID and submit to MBHP within established timeframes.

SourceLink

POLICY UPDATE CHANGES

Tufts Health One Care name change noted in January 2024.

Policy created January 2023.

24/7/365Required Availability

21+Eligible Age

72 hrsPost-stabilization Max

60 minAssessment Start

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This policy covers Adult Community-Based Mobile Crisis Intervention (AMCI) for adults 21+ experiencing behavioral health crises, delivered 24 hours per day, 7 days per week, 365 days per year. Coverage is covered with criteria when program and clinical criteria are met.

AMCI provides rapid community-based crisis assessment, intervention, stabilization, and short-term post-stabilization follow-up of up to 72 hours when inpatient or other 24-hour care is not required. Services include mobile response, CBHC-based care, telehealth as appropriate, and ED-based services when necessary.

AMCI must be accessible via self-referral or referral from any source (including the statewide 24/7 Behavioral Health Help Line) and begin crisis assessment within 60 minutes of the Member's time of readiness. Quick facts: Required Availability: 24/7/365; Eligible Age: 21+; Post-stabilization Maximum: 72 hours; Assessment Start Timeframe: 60 minutes.

Key thresholds

Post-stabilization duration<= 72 hours (3 days)

Crisis assessment start timeWithin 60 minutes of time of readiness

Referral proximity - closestIn-network within 30 miles

Referral proximity - moderateIn-network within 60 miles

Medical-Necessity & Service Criteria

Eligibility / Access

AMCI services are available when ALL of the following are met:

ALL of the following

Member is an adult aged 21 years or older
Member is experiencing a behavioral health crisis (mental health, substance use disorder, co-occurring conditions, or behavioral health and medical conditions)
AMCI is accessible to Member via self-referral or referral from any individual or resource (24/7 Behavioral Health Help Line, family, providers, law enforcement, courts, etc.)

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Core Service Requirements (Medically Necessary Coverage Conditions)

Covered when ALL of the following service components are provided:

ALL of the following

Provision of behavioral health crisis assessment, intervention, stabilization, and post-stabilization services
Services available 24 hours per day, 7 days per week, 365 days per year
Services delivered in community, CBHC site, via telehealth when appropriate, or in ED when necessary
Complete assessment includes diagnostic interview, full mental status exam, history of substance use, overdose, Naloxone administration, level of care recommendations, and reason for rule-out of less restrictive alternatives
Up to 72 hours (3 days) of daily post-stabilization follow-up to link Member to supports and confirm transition to aftercare when inpatient/24-hour level of care not required

Staffing and Competency Requirements

AMCI meets ALL of the following staffing criteria:

ALL of the following

Multidisciplinary team including physicians, nurses, behavioral health clinicians, certified peer specialists (CPSs), and recovery coaches
Two-person multidisciplinary team for mobile response and CBHC visits
Medical Director: board-certified or board-eligible psychiatrist responsible for clinical oversight, DEA waiver to prescribe buprenorphine, experience treating SUD, availability for consultation
Prescriber requirements: At least one psychiatrist or APRN responsible for urgent psychopharmacology and MOUD induction/bridging; at least one psychiatrist/APRN should be X-waivered

Process and Documentation Requirements

AMCI must follow ALL of the following process specifications:

ALL of the following

Initial telephonic access via statewide 24/7 Behavioral Health Help Line or direct CBHC/AMCI contact
Separate entrance from co-located CBHC with capacity to accept law enforcement and emergency vehicles
Begin crisis assessment within 60 minutes of time of readiness; readiness defined as medically stable, awake, and sufficiently clear from substanceswithin 60 minutes of time of readiness
If Member unable to participate, gather collateral information

Disposition and Bed Search / Escalation

When ALL of the following apply for Members needing 24-hour care:

ALL of the following

Bed search: AMCI conducts bed search and transmits referrals through secure systems
Referral proximity thresholds: Follow guidelines for referral proximity: closest (in-network within 30 miles), moderate (in-network within 60 miles), extended (all in-network facilities)closest: 30 miles; moderate: 60 miles
EPIA/Internal Escalation: If unable to access 24-hour placement, follow Expedited Psychiatric Inpatient Admissions (EPIA) protocol and activate Internal Escalation Protocol after first 24 hours awaiting placement in EDafter first 24 hours

Post-Stabilization Follow-up

AMCI provides ALL of the following during post-stabilization (up to 72 hours):

ALL of the following

Aftercare/safety plan: Create person-centered aftercare and safety plan addressing goals and next steps
Referrals to aftercare/CBHC: Identify and refer Member to clinically indicated behavioral health services or ensure transition to CBHC for longer-term outpatient treatment
Support contacts: Provide contact information for natural and professional supports
Alternatives to ED: Inform Member of availability of community-based and mobile crisis services as alternatives to ED

Coverage of Uninsured and Multiple Payers

AMCI must provide services to ALL of the following categories:

Covered payer groups

Uninsured individuals
MassHealth-contracted MCEs (including MBHP)
MassHealth fee-for-service
Medicare-only
Commercial payers based on coverage of services

Provider Actions & Operational Requirements

Documentation Required

Complete encounter form and subsequent follow-ups

Complete and electronically submit an AMCI encounter form for every intervention. For each additional day of an intervention, complete and electronically submit the abbreviated subsequent AMCI follow-up encounter form(s). Link all subsequent encounters to the full encounter using the unique encounter ID and ensure encounter forms are electronically submitted to MBHP within the timeframe established by MBHP.

Documentation Required

Comprehensive assessment documentation

Document each crisis assessment, intervention, and stabilization episode using the AMCI Comprehensive Assessment tool. Required elements include: member name and identifying information, date/time of request and start time, location, presenting problem, mental status exam, involvement of others/agencies, actions taken, clinical assessment and diagnostic formulation (including history of substance use, overdose, and whether Naloxone was administered), level of care recommendations (including SUD needs), reason for rule-out of less restrictive alternatives, target problems, short-term treatment planning, written disposition plan, time of disposition, signature/title of staff, and name/title of the independently licensed supervisor reviewing the disposition. Ensure supervisory review of all documentation with feedback and quality monitoring.

Prior Authorization

Follow authorization protocols when bed obtained

When a bed for inpatient or other 24-hour care is obtained for a Member, follow the authorization protocols as instructed by the respective MCE.

Billing Rule

Boarding reporting

Complete the boarding form on MABHA (or other required database) for individuals awaiting an acute level of care who have Medicare/Medicaid, Health Safety Net, or MassHealth Fee for Service coverage. Ensure accurate reporting and updating on MABHA and follow procedures for removal when the Member is no longer waiting for placement.

Denial Risk

Timely assessment risk

Begin the crisis assessment within 60 minutes of the time of readiness (member medically stable, awake, and sufficiently clear from substances). Failure to begin assessment within this 60-minute timeframe may represent noncompliance with performance specifications and risk contractual or quality findings.

Documentation Required

Post-stabilization opt-out documentation

If a Member declines post-stabilization services (post-stabilization is an opt-out service provided for up to 72 hours), document the Member's declination clearly in the Member's medical record.

Coding & Administrative Systems

Administrative / Reporting Systems referencedmixed

MABHA

Database/system for boarding forms and reporting (name referenced)

Background

AMCI is a community-based program whose mission is to respond rapidly to adult behavioral health crises, assess needs, intervene, stabilize, and connect Members to ongoing supports to promote recovery and safety and to divert care from inpatient settings and emergency departments when clinically appropriate.

Services are delivered by multidisciplinary teams (physicians, nurses, behavioral health clinicians, certified peer specialists, and recovery coaches) through co-located Community Behavioral Health Centers (CBHCs) and mobile response units, and include crisis assessment, short-term crisis counseling, urgent psychopharmacology and MOUD induction/bridging, medical screening, transportation arrangements, and referrals to community-based treatment and diversionary services.

AMCI emphasizes linkages to community resources and maintains directories and relationships with outpatient, recovery-oriented, and diversionary programs to ensure expedited access to aftercare and minimize re-escalation of crises.

Scope and review dates

ScopeAMCI requirements for adults 21+ across specified Tufts Health Plan and Public Plans products

SubjectAdult Community-Based Mobile Crisis Intervention (AMCI) performance specifications

StatusCURRENT

Last review2024-01

Effective(not specified)

Definitions

AMCI: Adult Community-Based Mobile Crisis Intervention providing crisis and behavioral health assessment, intervention, stabilization, and post-stabilization services for adults 21+ with 24/7/365 availability.

CBHC: Community Behavioral Health Center — the co-located site where AMCI services may be provided and which coordinates with AMCI for assessment, urgent psychopharmacology, and referrals.

Post-stabilization: Aftercare services and supports provided within the 72-hour period following a behavioral health crisis encounter; these services are opt-out and must be documented if declined by the Member.

Time of readiness: The point at which the Member is medically stable, awake, and sufficiently cleared from substances to participate in the evaluation; crisis assessment must begin within 60 minutes of this time.

Revision History

January 2023added

Policy created January 2023

January 2024revised

Tufts Health One Care name change noted in January 2024

Policy Summary

Payerharvard pilgrim health care

PolicyAdult Community Based Mobile Crisis Intervention Amci Performance Specifications

Policy CodePolicy N/A

Change TypeRevised / Added (document history)

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Post-stabilization is opt-out; if Member declines, declination must be documented

AMCI provides access to MOUD induction/bridge and urgent psychopharmacology, including induction/bridging for opioid use disorder and psychiatric medications

AMCI provides medical screening to identify acute medical conditions requiring emergency treatment and arranges transportation as clinically appropriate

AMCI conducts triage and begins crisis assessment within 60 minutes of time of readinesswithin 60 minutes of time of readiness

Documentation requirements for each encounter using AMCI Comprehensive Assessment tool and electronic submission of encounter forms to MBHP within established timeframes

Clinical Program Director: full-time independently licensed clinician sharing oversight responsibilities and primary accountability to CBHC

Supervision: Independently licensed clinical supervisors and clinicians providing supervision and direct crisis services; designated shift supervisor each shift

Triage clinician (master's- or doctoral-level) answering all incoming calls

Master's/Bachelor's clinicians: Master's- and bachelor's-level clinicians fulfilling described roles; encouraged to credential bachelor's-level as CPS/recovery coaches

Medical screening staff: Appropriate staff (e.g., LPN, EMT) to conduct medical screening and monitoring

CPS staffing: Certified Peer Specialists: one or more CPSs required; a CPS team must include at least one FTE recovery-focused peer support for SUD; 12-month grace period to reach full CPS staffing levels

Clerical/security: Clerical and security staff with training in de-escalation and behavioral support/management

Training: All staff receive standardized training, supervision, trauma-informed care, de-escalation, harm reduction, and population-specific competencies (listed populations)

Ask about existing crisis prevention/safety plans and access any on file

Encounter documentation: Each encounter documented with specified elements (member identifiers, times, location, presenting problem, mental status exam, involvement of others/agencies, action taken, assessment including substance use history and Naloxone info, level of care recommendations, reason for rule-out, target problems, short-term treatment planning, disposition plan, time of disposition, signatures and supervisory review)

Supervisory review: Ensure supervisory review of all documentation with feedback and quality monitoring

Medical screening procedures: Follow written procedures for assessing medical needs and determining need for medical evaluation or hospital admission

Collaboration: Collaborate with 911, 988, and 24/7 Help Line to accept direct transfers and have protocols to receive referrals

MassHealth coverage protocols: Develop protocols to apply for MassHealth coverage for individuals awaiting placement, including Hospital Presumptive Eligibility if applicable

MABHA boarding form: Complete boarding form on MABHA (or required database) for individuals awaiting acute care with specified insurance (Medicare/Medicaid; Health Safety Network; MassHealth Fee for Service) and update reporting

Authorization follow-up: When bed obtained, follow authorization protocols as instructed by respective MCE

Outreach frequency: Outreach at least once via telephone or electronic media to confirm linkage to aftercare; if unable to access supports, address barriers and assist with reschedulingat least once

Documentation of outcomes: Document outcome of post-stabilization intervention in Member's medical record

OpenPayer

Adult Community Based Mobile Crisis Intervention Amci Performance Specifications

Coverage Summary

Medical-Necessity & Service Criteria

Provider Actions & Operational Requirements

Coding & Administrative Systems

Background

Definitions

Revision History