Mode & Service Function Information

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Mode & Service FunctionInformation20

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSS/D Mode 05 S/D Mode 10 S/D Mode 15 24-Hour ServicesDay ServicesOutpatient ServicesS/D Mode ofServiceSD/MC Mode 05 SD/MC Mode 07 Residential/PHFGeneral HospitalSD/MC Mode 08 Psych Hospital: Age 21SD/MC Mode 09 Psych Hospital: Age 64SD/MC Mode 12 SD/MC Mode 18 Hospital OutpatientNon-Hospital OutpatientService FunctionSD/MC Mode ofService0505050505050505050505050510-18 Hospital Inpatient19 Hosp. IP Admin Day36-3940-4950-5960-6465-7980-8485-8990-94IMD with PatchAdult Crisis ResidentialJail InpatientResidential OtherAdult ResidentialSemi Supervised LivingIndependent LivingMH Rehab Centers08 0908 0905Not Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal Eligible05Not Medi-Cal EligibleNot Medi-Cal Eligible05Not Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal 1-8485-8991-9495-99Crisis Stabilization ERCrisis Stab. Urgent CareVocationalSocializationSNF AugmentationDay TX Intensive ½ DayDay TX Intensive Full DayDay Rehabilitation ½ DayDay Rehabilitation Full Day12 1812 18Not Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal Eligible12 1812 1812 1812 1815151515151501-0910-1930-57,5860-6970-79Case Management/BrokerageMental Health Services (MHS)59 MHSTBSMedication SupportCrisis Intervention20-29 PHF30-34 SNF Intensive35 IMD Basic - No Patch210707121212121212181818181818

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSS/D Mode ofServiceSD/MC Mode ofServiceService Function20 – 4200 AdministrationNot Medi-Cal Eligible454510-19 Mental Health Promotion20-29 Community Client ServicesNot Medi-Cal EligibleNot Medi-Cal 14-1617-1921-2324-2627-2931-3435-39Medi-Cal OutreachMedi-Cal Eligibility IntakeMedi-Cal Contract Admin.Crisis ReferralMHS Contract Admin.Discounted MH OutreachSPMP Case ManagementSPMP Program PlanningSPMP MAA TrainingNon-SPMP Case ManagementNon-SPMP Program PlanningNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal hip InvestigationConservatorship AdministrationLife Support/Board & CareCase Management SupportClient Housing SupportExpendituresClient Housing OperatingExpendituresClient flexible Support ExpendituresNon-Medi-Cal Capital AssetsOther Non-Medi-Cal Client supportExpendituresNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal Eligible60606060607172757822Not Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal EligibleNot Medi-Cal Eligible

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSDEFINITION OF MODE OF SERVICEA mode of service identifies the different kinds of services or activities provided to clients in thelocal mental health program.Cost Reports and CSI (Client and Service Information System) Modes of Service are used forCost Reports and Settlement and CSI.SD/MC Modes of Service are used for Billing.DEFINITION OF SERVICE FUNCTIONSService functions are the most specific level of reporting under modes of service. The numericcodes for service functions are usually expressed as ranges. This feature allows local programsthe option of collecting cost and service data at an even more specific level. Not all modes ofservice have service functions.SPECIFIC MODES AND SERVICE FUNCTIONSMODE 05: 24-Hour Mode of ServiceServices designed to provide a therapeutic environment of care and treatment within a residentialsetting. Depending on the severity of mental disorder, and the need for related medical care,treatment would be provided in one of a variety of settings.The following SD/MC Modes are included in Cost Reports and CSI Mode 05:05 – Psychiatric Health Facility, Adult Crisis Residential, or Adult Residential07 – Inpatient Hospital Services of an acute care general hospital08 – Psychiatric Hospital Services for individuals under 2109 - Psychiatric Hospital Services for individuals age 65 and olderUSE THE FOLLOWING SERVICE FUNCTIONS FOR MODE 05:Service Functions 10-18: Hospital InpatientService Functions 10-18: Hospital InpatientServices provided in an acute psychiatric hospital or a distinct acute psychiatric part of ageneral hospital that is approved by the Department of Health Services to providepsychiatric services. Those services are medically necessary for diagnosis or treatment ofa mental disorder in accordance with Section 1820.205.MODE 05: Service Functions (continued)Revised August 200623Provider File DefinitionsModes and Service Functions

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSService Function 19: Hospital Inpatient Administrative Days"Administrative Day Services" means psychiatric inpatient hospital services provided to abeneficiary who has been admitted to the hospital for acute psychiatric inpatient hospitalservices, and the beneficiary's stay at the hospital must be continued beyond thebeneficiary's need for acute psychiatric inpatient hospital services due to a temporary lackof residential placement options at nonacute residential treatment facilities that meet theneeds of the beneficiary. (CCR, Title 9, Section 1810.202)Service Functions 20-29: Psychiatric Health Facility (PHF)“Psychiatric Health Facility” means a facility licensed by the Department under theprovisions of California Code of Regulations, Title 22, Chapter 9, Division 5, beginningwith Section 77001. For the purposes of this Chapter, psychiatric health facilities thathave been certified by the State Department of Health Services as Medi-Cal providers ofinpatient hospital services will be governed by the provisions applicable to hospitals andpsychiatric inpatient hospital services, except when specifically indicated in context.(CCR, Title 9, Section 1810.236)“Psychiatric Health Facility Services” means therapeutic and/or rehabilitative servicesprovided in a psychiatric health facility, other than a psychiatric health facility that hasbeen certified by the State Department of Health Services as a Medi-Cal provider ofinpatient hospital services, on an inpatient basis to beneficiaries who need acute care,which is care that meets the criteria of California Code of Regulations, Title 9, Section1820.205, and whose physical health needs can be met in an affiliated general acute carehospital or in outpatient settings. (CCR, Title 9, Section 1810.237)Service Functions 30-34:Intensive Skilled Nursing Facility (SNF)A licensed skilled nursing facility which is funded and staffed to provideintensive psychiatric care and meets Title 9 staffing standards for inpatient services.Service Function 35:Institute for Mental Disease (IMD) Basic – No PatchFor this service function an IMD is a SNF where more than 50% of thepatients are diagnosed with a mental disorder. The federal governmenthas designated these facilities as IMDs.Service Functions 36-39: IMD With PatchOrganized therapeutic activities that augment and are integratedinto an existing skilled nursing facility.Revised August 200624

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSMode 05: Service functions (continued)Service Functions 40-49: Adult Crisis Residential“Crisis Residential Treatment Service” means therapeutic or rehabilitative servicesprovided in a non-institutional residential setting which provides a structured program asan alternative to hospitalization for beneficiaries experiencing an acute psychiatricepisode or crisis who do not have medical complications requiring nursing care. Theservice includes a range of activities and services that support beneficiaries in theirefforts to restore, maintain, and apply interpersonal and independent living skills, and toaccess community support systems. The service is available 24 hours a day, seven days aweek. Service activities may include but are not limited to assessment, plan development,therapy, rehabilitation, collateral, and crisis intervention. (CCR, Title 9, Section1810.208)Service Functions 50-59: Jail InpatientA distinct unit within an adult or juvenile detention facility which isstaffed to provide intensive psychiatric treatment of inmates.Service Functions 60-64: Residential OtherThis service function includes children’s residential programs, formerSB 155 programs, former Community Care Facility (CCF) augmentation,and other residential programs that are not Medi-Cal certified or defined elsewhere.Service Functions 65-79: Adult Residential“Adult Residential Treatment Service” means rehabilitative services, provided in a noninstitutional, residential setting, for beneficiaries who would be at risk of hospitalizationor other institutional placement if they were not in the residential treatment program. Theservice includes a range of activities and services that support beneficiaries in theirefforts to restore, maintain and apply interpersonal and independent living skills and toaccess community support systems. The service is available 24 hours a day, seven days aweek. Service activities may include but are not limited to assessment, plan development,therapy, rehabilitation and collateral. (CCR, Title 9, Section 1810.203)Service Functions 80-84: Semi-Supervised LivingA program of structured living arrangements for persons who do not need intensivesupport but who, without some support and structure, may returnto a condition requiring hospitalization. Housing units, which are to be sharedby three to five persons, shall function as independent households with staff support incase of emergency as well as for regular assessments and assistance with he problems ofdaily living. This program may be a transition to independent living. Services mayinclude provision of a rent subsidy.Revised August 200625Provider File DefinitionsModes and Service Functions

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSMode 05: Service Functions (continued)Service Functions 85-89: Independent LivingThis program is for persons who need minimum support in order to livein the community. Clients may require rent subsidy and other assistance.Service Functions 90-94:Mental Health Rehabilitation CenterThis is a 24-hour program, licensed by the State Department of Mental Health, whichprovides intensive support and rehabilitation services designed to assist persons 18 yearsor older, with mental disorders who would have been placedn a state hospital or another mental health facility to develop the skills to become selfsufficient and capable of increasing levels of independent functioning.MODE 10: Day Mode of ServiceServices that provide a range of therapeutic and rehabilitative programs as an alternative toinpatient care.The following SD/MC Mode is included in Cost Reports and CSI Mode 10:12 – Outpatient Hospital Services18 – Non-Residential Rehabilitative TreatmentUSE THE FOLLOWING SERVICE FUNCTIONS FOR MODE 10:Service Functions 20-24:Crisis Stabilization - Emergency Room“Crisis Stabilization” means a service lasting less than 24 hours, to or on behalf of abeneficiary for a condition that requires more timely response than a regularly scheduledvisit. Service activities include but are not limited to one or more of the following:assessment, collateral and therapy. Crisis stabilization is distinguished from crisisintervention by being delivered by providers who do meet the crisis stabilization contact,site, and staffing requirements described in CCR, Title 9, Sections 1840.338 and1840.348. (CCR, Title 9, Section 1810.210) Crisis Stabilization shall be provided on siteat a licensed 24-hour health care facility or hospital based outpatient program or aprovider site certified by the Department or an MHP to perform crisis stabilization(CCR, Title 9, Section 1840.338 (a)). The maximum allowance provided in CCR, Title22, Section 51516, for “crisis stabilization-emergency room” shall apply when the serviceis provided in a 24-hour facility, including a hospital outpatient department. (CCR, Title9, Section 1840.105(a)(4))Revised August 200626Provider File DefinitionsModes and Service Functions

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSMode 10: Service Functions (continued)Service Functions 25-29: Crisis Stabilization - Urgent Care“Crisis Stabilization” means a service lasting less than 24 hours, to or on behalf of abeneficiary for a condition that requires more timely response than a regularlyscheduled visit. Service activities include but are not limited to one or more of thefollowing: assessment, collateral and therapy. Crisis stabilization is distinguishedfrom crisis intervention by being delivered by providers who do meet the crisisstabilization contact, site, and staffing requirements described in CCR, Title 9,Sections 1840.338 and 1840.348. (CCR, Title 9, Section 1810.210). CrisisStabilization shall be provided on site at a licensed 24-hour health care facility orhospital based outpatient program or a provider site certified by the Department or anMHP to perform crisis stabilization (CCR, Title 9, Section 1840.338 (a)). Themaximum allowance for “crisis stabilization-urgent care” shall apply when theservice is provided in any other appropriate site.(CCR, Title 9, Section1840.105(a)(4)).Service Functions 30-39: Vocational ServicesServices designed to encourage and facilitate client motivation and focus uponrealistic and attainable vocational goals. To the extent possible, the intent is tomaximize client involvement in skill seeking and skill enhancement, with an ultimategoal of self-support.Service Functions 40-49: Socialization ServicesServices designed to provide activities for persons who require structured support andthe opportunity to develop the skills necessary to move toward more independentfunctioning.Service Functions 60-69: SNF AugmentationOrganized therapeutic activities that augment and are integrated into anexisting skilled nursing facility.Service Functions 81-84: Day Treatment Intensive - 1/2 DayService Functions 85-89: Day Treatment Intensive - Full Day“Day Treatment Intensive“ means a structured, multi-disciplinary program of therapywhich may be an alternative to hospitalization, avoid placement in a more restrictivesetting, or maintain the individual in a community setting, which provides services toa distinct group of individuals. Services are available at least three hours and less than24 hours each day the program is open. Service activities may include, but are notlimited to, assessment, plan development, therapy, rehabilitation and collateral.(CCR,Title9,Section1810.213)Revised August 200627

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSMode 10: Service Functions (continued)Service Functions 91-94: Day Rehabilitation - 1/2 DayService Functions 95-99: Day Rehabilitation - Full Day“Day Rehabilitation” meansa structured program of rehabilitation and therapy to improve,maintain or restore personal independence and functioning, consistent with requirementsfor learning and development, which provides services to a distinct group of individuals.Services are available at least three hours and less than 24 hours each day the program isopen. Service activities may include, but are not limited to, assessment, plandevelopment, therapy, rehabilitation and collateral. (CCR, Title 9, Section 1810.212)MODE 15: Outpatient Mode of ServiceServices designed to provide short-term or sustained therapeutic intervention for clientsexperiencing acute and/or ongoing psychiatric distress.USE THE FOLLOWING SERVICE FUNCTIONS FOR MODE 15:Service Functions 01-09: Case Management/BrokerageCase Management/Brokerage means services that assist a beneficiary to access neededmedical, educational, social, prevocational, vocational, rehabilitative, or other communityservices. The service activities may include, but are not limited to, communication,coordination, and referral; monitoring service delivery to ensure beneficiary access toservice and the service delivery system; monitoring of the beneficiary’s progress;placement services; and plan development. (CCR, Title 9, Section 1810.249)Service Functions 10-18, 30-38, 40-48, 50-57: Mental HealthServices“Mental Health Services” means individual or group therapies and interventions that aredesigned to provide reduction of mental disability and restoration, improvement ormaintenance of functioning consistent with the goals of learning, development,independent living and enhanced self-sufficiency and that are not provided as acomponent of adult residential services, crisis residential treatment services, crisisintervention, crisis stabilization, day rehabilitation, or day treatment intensive. Serviceactivities may include but are not limited to assessment, plan development, therapy,rehabilitation and collateral.(CCR, Title 9, Section 1810.227)Service Function 58: Therapeutic Behavioral Services (TBS)“Therapeutic Behavioral Services” (TBS) are one-to-one therapeutic contacts for aspecified short-term period of time between a mental health provider and a child or youthwith serious emotional disturbances (SED). TBS is designed to maintain the child/youth’sresidential placement at the lowest appropriate level by resolving target behaviors andRevised August 200628Provider File DefinitionsModes and Service Functions

PROVIDER FILE DEFINITIONSMODES AND SERVICE FUNCTIONSService Function 58: TBS (continued)achieving short-term treatment goals. TBS is available to full-scope Medi-Calbeneficiaries under 21 years of age who meet MHP medical necessity criteria(children/youth with SED), are members of the certified class and meet the criteria forneeding these services. A contact is considered therapeutic if it is intended to provide thechild/youth with skills to effectively manage the behaviors or symptoms that are barriersto achieving residence in the lowest possible level.The person providing TBS must be available on-site to provide individualized one-toone, face-to-face behavioral assistance and one-to-one interventions to accomplishoutcomes specified in the written treatment plan. The critical distinction between TBSand other rehabilitative mental health services is that a significant component of thisservice activity is having one provider on-site and immediately available to intervene fora specified period of time. The expectation is that the mental health provider would bewith the child/youth for a designated time period specified in the treatment plan and thatthe entire time spent with the child/youth would be reimbursable. These designated timeperiods may vary in length and may be up to 24 hours a day, depending upon the needs ofthe child/youth. (See DMH Letter No.: 99-03)Service Functions 19, 39, 49, 59:Mental Health Services – Professional Inpatient VisitThese services are the same as Mental Health Services except theservices are provided in a non-SD/MC inpatient setting by professional(former non-SD/MC Fee-For-Service) staff.Service Functions 60-68: Medication Support Services“Medication Support Services” means those services that include prescribing,administering, dispensing and monitoring of psychiatric medications or biologicals thatare necessary to alleviate the symptoms of mental illness. Service activities may includebut are not limited to evaluation of the need for medication; evaluation of clinicaleffectiveness and side effects; the obtaining of informed consent; instruction in the use,risks and benefits of and alternatives for medication; and collateral and plan developmentrelated to the delivery of the service and/or assessment of the beneficiary. (CCR, Title 9,Section 1810.225)Service Function 69:Medication Support – Professional Inpatient VisitThese services are the same as Medication Support except the servicesare provided in a non-SD/MC inpatient setting by professional(former non-SD/MC Fee-For-Service) staff.Revised August 200629Provider File DefinitionsModes and Service Functions

55 11-13 Crisis Referral Not Medi-Cal Eligible 55 14-16 MHS Contract Admin. Not Medi-Cal Eligible 55 17-19 Discounted MH Outreach Not Medi-Cal Eligible 55 21-23 SPMP Case Management Not Medi-Cal Eligible 55 24-26 SPMP Program Planning Not Medi-Cal Eligible 55

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