DEPARTMENT OF HEALTH
AND SOCIAL SERVICES
DIVISION OF
MENTAL HEALTH
AND
DEVELOPMENTAL DISABILITIES
7 AAC 71
COMMUNITY MENTAL HEALTH SERVICES
As amended
through March 16, 2001
CHAPTER 71. COMMUNITY MENTAL HEALTH
SERVICES.
Article
1. Scope (7 AAC 71.010)
2. Contracts for Services (7 AAC 71.020 -
7 AAC 71.045)
3. Standards for Operation of a Community
Mental
(7 AAC 71.100
- 7 AAC 71.165)
4. Client Rights (7 AAC 71.200 - 7 AAC
71.300)
5. Management Information System for
Mental Health Programs
(7 AAC 71.400
- 7 AAC 71.449)
6. General Provisions (7 AAC 71.990)
ARTICLE 1. SCOPE.
Section
10. Applicability
7 AAC
71.010. APPLICABILITY. (a) 7 AAC 71 applies to a community
mental health center receiving financial assistance under AS 47.30.520 -
47.30.620, the Community Mental
Health Services Act.
(b) A nonprofit
corporation or political subdivision that receives financial assistance under
AS 47.30.520 - 47.30.620 and subcontracts with agencies or individuals to
deliver mental health services must ensure that the agencies actually
delivering the services comply with 7 AAC 71.
(Eff.
Authority: AS 47.30.530 AS 47.30.540
ARTICLE
2. CONTRACTS FOR SERVICES.
Section
20. Application process
25. Geographic planning areas
30. Governing boards and advisory boards
35. Execution of contract
40. Coordination and non-duplication of
services
45. Capital expenditures
7 AAC 71.020. APPLICATION
PROCESS. (a) Application for financial assistance under AS 47.30.520
- 47.30.620 must be made on a form provided by the division.
(b) The division
will, in its discretion, assist an applicant in preparing the application and
in complying with the requirements of 7 AAC 71. (Eff.
Authority: AS 47.30.530
7 AAC 71.025.
GEOGRAPHIC PLANNING AREAS.
(a) The division will maintain a list of geographic planning areas and
the communities within each of those areas. A community mental health center
receiving financial assistance or an applicant for financial assistance under
AS 47.30.520 - 47.30.620 within a geographic planning area shall serve the
entire area. Centers or applicants that are unable to provide services to the
entire geographical planning area must submit to the division their reasons for
proposing to serve only part of the geographical planning area. The division
must review and approve these reasons prior to awarding financial assistance.
(b)
Organizations applying for financial assistance under AS 47.30.520 - 47.30.620
shall, whenever possible, propose to provide services throughout an entire
geographic planning area. If two or more organizations are each proposing to
serve only a part of the planning area, the division, upon receipt of the
organizations' letters of intent under 7 AAC 78.060, will notify each applicant
of the intent of other applicants to serve a part of the same planning area.
The affected applicants shall either develop a single areawide services
application or document attempts to do so.
(c) An applicant
shall submit a separate application for each geographic planning area for which
financial assistance is sought. (Eff.
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.030.
GOVERNING BOARDS AND ADVISORY BOARDS. (a) A
community mental health center receiving financial assistance under AS
47.30.520 - 47.30.620 must be governed by a board selected in accordance with
the following criteria, except as provided for in (b) of this section:
(1) A governing board must be composed of at least five members
who reside in the area served by the mental health center.
(2) A majority of the board members may not be providers of direct
health care services or have been providers of direct health care services for
the 12 months before appointment. No more than two members or 40 percent of the
membership, whichever is greater, may be providers of direct health care
services.
(3) As much as practicable, a governing board must be
representative of the geographic planning area, including representatives of the
(A)
major racial and linguistic groups; and
(B)
various economic groups.
(4) A
representative of a particular subgroup or class of members need not be an
actual member of the subgroup or class if the representative is designated by
an organization composed primarily of
members of the subgroup or class.
(5) No employee
of a grantee may be a member of the grantee's governing board.
(b) A native
corporation, municipality, or other nonprofit entity that receives financial
assistance under AS 47.30.520 - 47.30.620 which has an existing governing board
must
(1)
appoint and be advised by an advisory board; or
(2) if services
are offered by a subcontractor, the subcontractor must either have its own
board as specified in (a) of this section or be directed by the contractor's
advisory board.
(c) Each
advisory board must meet the requirements of representation in (a) of this
section. An advisory board must participate in program planning, development
and evaluation, and must advise the governing board with respect to policy,
administration procedures, and other areas of community mental health.
(d) A governing
board must select a program director or subcontractor. If an advisory board is
required by (b) of this section, the selection and discharge of a project
director is subject to the approval of the advisory board. (Eff.
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.035.
EXECUTION OF CONTRACT. (a) The division will distribute
financial assistance under AS 47.30.520 - 47.30.620 to a local community entity
whose application is approved under 7 AAC 71.110 only after the community
entity enters into a written contract with the department.
(b) The contract
must contain a written provision assuring that money made available under AS 47.30.520
- 47.30.620 will not supplant existing local funding support of community
mental health services.
(c) If the
contractor is, or is affiliated with, a political subdivision of the state, the
contract must provide that local support of community mental health services
will be continued at a level at least equal to that of the previous grant year.
(Eff.
Authority: AS 47.30.520 AS 47.30.540 AS
47.30.560
AS 47.30.530 AS 47.30.550 AS 47.30.570
7 AAC 71.040.
COORDINATION AND NON-DUPLICATION OF SERVICES. An
applicant or contractor receiving financial assistance under AS 47.30.520 -
47.30.620 must work with other programs or entities in its service area
providing the same category or scope of services to assure that service delivery
is coordinated with other programs in order to minimize
duplication of services and best meet the
needs of the service area population. An applicant must document these attempts
in the application for financial assistance. (Eff.
Authority: AS 47.30.530 AS 47.30.570
7 AAC 71.045.
CAPITAL EXPENDITURES. Capital expenditures by
contractors may not be paid, in whole or in part, by financial assistance
provided under AS 47.30.520 - 47.30.620. (Eff.
Authority: AS 47.30.530 AS 47.30.570
ARTICLE
3. STANDARDS FOR OPERATION OF A
COMMUNITY
MENTAL
Section
100. Organization and administration
105. Policy and procedures manual
110. Fiscal administration
115. Personnel administration
120. Program evaluation
125. Quality assurance
130. Plan of services
135. Types of services and populations to
be served
140. Availability and accessibility of
services
145. Coordination and continuity of
services
155. Client records
160. Records retention
165. Waiver of requirements
7 AAC 71.100.
ORGANIZATION AND ADMINISTRATION. A community
mental health center must provide the division with
(1) a table of organization that identifies and describes all
operating units of the program, defines the roles and responsibilities of all
center staff, delineates the interrelationship of the governing body, advisory
board, program director, and all center administrative and service staff, and
that is reviewed and updated annually; and
(2) the name, address, and telephone number of the individual or
entity ultimately responsible for operation of the center and the name and
address of each member of its governing and advisory boards. (Eff.
Authority: AS 47.30.530
7 AAC 71.105.
POLICY AND PROCEDURES MANUAL. (a) A center
must have a policy and procedures manual that is approved by the governing
board. It must be reviewed annually and revised as necessary.
(b) Provisions
in the policy and procedures manual must be consistent internally and with applicable
department and division policies and procedures.
(c) Written
policies and procedures must be maintained in the following areas:
(1) fiscal
administration, including provisions required under 7 AAC 71.110;
(2) personnel
administration, including provisions required under 7 AAC 71.115;
(3) evaluation
and research procedures, including provisions of 7 AAC 71.120;
(4) quality
assurance and utilization review procedures, including provisions of 7 AAC
71.125;
(5) provisions
for service delivery to the physically handicapped, including provisions of 7
AAC 71.135;
(6) procedures
for serving major language and cultural population subgroups, including
provisions of 7 AAC 71.135;
(7) procedures
for 24-hour availability of services according to 7 AAC 71.135;
(8) procedure to
ensure coordination and continuity of services to clients, including provisions
of 7 AAC 71.140;
(9) procedures
for ensuring privacy in facilities, including provisions of 7 AAC 71.150;
(10) client
records, including provisions required under 7 AAC 71.155 - 7 AAC 71.160;
(11) rights of
clients, including provisions of 7 AAC 71.200 - 7 AAC 71.220; and
(12) a plan for
management of pharmaceuticals stored in the center. (Eff.
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.110.
FISCAL ADMINISTRATION.
To maximize revenues and to ensure proper fiscal management, a center
must
(1) prepare and
maintain a formal budget;
(2) maintain
fiscal records and provide to the division fiscal reports at least quarterly on
forms provided by the division;
(3) provide for
an audit at least once every two years;
(4) develop a
sliding fee scale based on an analysis of reasonable ability to pay; and
(5) establish
procedures within the limits set by 7 AAC 71.140(g) to maximize collection of fees from service recipients
and third-party insurers. (Eff.
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.115.
PERSONNEL ADMINISTRATION. (a) A center must have written
and functioning policies and procedures to ensure consistency in personnel
administration and staff competency in carrying out assigned tasks. These
policies and procedures must include
(1) job
descriptions for paid and volunteer staff members, including for each position
(A)
a description of the duties, specific tasks and responsibilities;
(B)
the salary range;
(C)
a statement of minimum qualifications describing necessary training,
experience, and other qualifications such as licensure; and
(D)
the position title of the immediate supervisor of the position;
(2)
provision for yearly written evaluations of all staff;
(3)
procedures for recruitment and screening of job applicants;
(4) a
description of the center's salary structure, including salary ranges and the
method of determining salary increases; and
(5) a
requirement that tasks which are restricted by law to specific disciplines will
be performed only by qualified individuals.
(b) Changes in
or exceptions to written job descriptions which materially alter the scope of
the program are subject to prior approval of the division.
(c) A written
job description for a program director is subject to approval by the division.
A program director must be an experienced mental health professional with at
least a Master's degree in a mental health field.
(d) A center
must develop a staff training plan and provide or arrange for supervised
practical experience, education, or training to increase the skill level of
center staff. This staff training must include a least 30 hours of instruction
each year. The training may be offered in the form of formalized education,
case supervision, staff conferences, or other appropriate
educational activities in the area of
mental health and mental health administration. (Eff. 9/1/82, Register 83)
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.120.
PROGRAM EVALUATION. (a) A center must develop
procedures necessary to evaluate the program and must conduct an evaluation
annually.
(b) The
evaluation must include
(1) information
about demographic characteristics and diagnostic categories of clients served;
(2) computation
of the time spent in each program area such as administration, direct client
services, and consultation;
(3) assessment
of community and client reaction to services, which may include questionnaires,
surveys, or board reports; and
(4) the center's
evaluation of the degree of achievement of the annual plan.
(Eff. 9/1/82, Register 83)
Authority: AS 47.30.530
7 AAC 71.125.
QUALITY ASSURANCE. (a) A center must have systematic
procedures for the review of the quality of care and the use of services and
facilities.
(b) There must
be a written description of current quality assurance procedures that is
reviewed and revised annually.
(c) At least two
utilization reviews must be completed each year as described in 7 AAC
71.155(g). (Eff. 9/1/82, Register 83)
Authority: AS 47.30.530
7 AAC 71.130.
PLAN OF SERVICES. A center must have a written plan
of services which
(1) the center
staff reviews annually and revises as necessary to reflect changing community
needs;
(2) includes the
center's annual goals, the steps and resources necessary to implement the
goals;
(3) includes a
review of compliance with or reasons for exceptions to relevant regional and
state planning documents; and
(4) includes a
five-year plan for development and delivery of mental health services to the
service area. (Eff. 9/1/82, Register 83)
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.135.
TYPES OF SERVICES AND POPULATIONS TO BE SERVED.
(a) A center must serve, to the extent that mental health services are not
available to them from other providers, the following populations in
prioritized order:
(1) acutely
disturbed persons;
(2) chronically,
severely disturbed persons;
(3) children and
adolescents;
(4) other
persons or agencies requiring direct mental health intervention; and
(5) other
persons or agencies requiring nondirect mental health services such as
consultation or education.
(b) A center
must provide the following services to the above listed populations in
prioritized order:
(1)
evaluation services, including
(A)
diagnosis using the DSM-III classification; and
(B)
evaluations for persons being considered for involuntary commitment under AS
47.30.700 - 47.30.915; this service is to include both court-ordered
screening investigations and evaluations
for commitment, if the necessary facilities and personnel are available; and
(2) treatment
services, both voluntary and involuntary, which emphasize a brief therapy and
crisis intervention model, including
(A)
24-hour inpatient psychiatric treatment for both voluntary and involuntary
patients as close to the patient's home as possible; for involuntary patients,
this service must include a written cooperative agreement with the Alaska
Psychiatric Institute or other state-designated inpatient psychiatric facility;
and
(B) outpatient
care, including
(i)
24-hour direct emergency services for crisis intervention;
(ii)
individual counseling/psychotherapy;
(iii)
group counseling/psychotherapy;
(iv)
case management and supportive care for chronic patients;
(v)
referral services to other agencies; and
(vi)
consultation and education services.
(3)
The services required by (b) of this section may be provided either
(A)
directly by the center; or
(B)
by another provider through a contract with the center.
(Eff.
9/1/82, Register 83)
Authority: AS 47.30.530 AS 47.30.540
Editor's Notes
- A copy of the DSM-III, Diagnostic and Statistical Manual of Mental Disorders
, mentioned in (b)(1)(A) of this section, may be reviewed at a regional office
of the division.
7 AAC 71.140.
AVAILABILITY AND ACCESSIBILITY OF SERVICES. (a) A
center must make services available at times and locations which enable service
area residents to use services.
(b) A center
must
(1) have written
procedures indicating how residents will have access to 24-hour mental health
emergency services;
(2) provide
regular services on evenings and weekends if the need for such services is
determined by the local governing board; and
(3) include in
its yearly plan provisions for serving those persons who cannot come to the
center.
(c) Methods of
obtaining services must be made known to other human services agencies and to
area residents.
(d) Center
services must be listed in the public telephone directory.
(e) If center
services are not accessible to physically handicapped individuals, alternative
means for these individuals to receive services must be included in the yearly
plan.
(f) A center
must establish procedures to make services available to clients in the
languages of the major subgroups within the service area.
(g) A center may
not deny services to any person because of inability to pay. (Eff. 9/1/82,
Register 83)
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.145.
COORDINATION AND CONTINUITY OF SERVICES. (a) A center
must
(1) have written
procedures to ensure coordination and continuity of services to clients;
(2) document
coordination of services within the center and between community agencies and
the center through such mechanisms as referral agreements and case conferences;
(3) identify,
initiate, and document working relationships with all in-patient facilities
servicing the service area, to ensure that area residents have access to
follow-up services; and
(4) document
procedures for case management.
(b) To ensure coordination and continuity of services under (a) of this
section, the center must enter into a written agreement with each
(1) evaluation or treatment facility designated under
7 AAC 72 that refers patients to the center after discharge; and
(2) state-operated hospital that refers patients to
the center after discharge.
(c) An agreement under (b) of this section must state that the center
will, after being notified by the facility or hospital of a patient’s
discharge, schedule an appointment at the center with the patient for
(1) clinical services within one week after the
patient’s discharge; and
(2) medication management services before depletion
of any psychotropic medication dispensed or prescribed to the patient upon
discharge, and that, whenever possible, medication management services are to
include a psychiatric evaluation.
(d) If a single-point-of-entry psychiatric emergency facility is located in the area served by a center, the center shall, at a minimum, have in place with that facility a memorandum of understanding that includes terms identical to those required under (c) of this section.
(Eff. 9/1/82, Register 83; am 3/16/2001, Register 157)
Authority: AS 47.30.530 AS
47.30.660
AS 47.30.540 AS 47.31.090
7 AAC 71.150.
CENTER FACILITY. A center must
(1) provide
space for confidential interviews; and
(2) comply with
applicable state and local fire, health and safety ordinances, regulations, and
statutes. (Eff. 9/1/82, Register 83)
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.155.
CLIENT RECORDS. (a) A center must maintain an organized
record system which contains client information including all information
required on the admission and discharge forms provided by the division.
(b) A client
record must contain documentation of the initial and continued assessment of
the client including
(1) a
description and evaluation of the present problem as seen by the client;
(2) a mental
status assessment;
(3) health status
and current medication;
(4)
developmental, social, and referral information; and
(5) a diagnostic
formulation of the client's problems.
(c) A client
record must contain an identifiable, current treatment plan which includes
(1)
the goals of the service provided by the center;
(2)
a description of the services to be provided and the frequency and estimated
duration of these services; and
(3)
copies of referrals to other individuals or agencies to meet these service
goals when referrals are necessary.
(d) A client
record must contain descriptive progress notes including all diagnostic and
treatment services rendered and their results.
(e) A client
record must be dated and signed by the person completing it.
(f) A client
record must contain a closing summary at termination of service which must
include the reason for termination, a summary of the course and results of
treatment, and any follow-up plans or referral information.
(g) A center
must provide for at least semi-annual utilization review of client records to
determine that the records contain sufficient documentation to meet the
requirements of this section.
(h) A center
must submit information to the division under 7 AAC 71.400 - 7 AAC 71.449.
(Eff. 9/1/82, Register 83; am 11/29/97, Register 144)
Authority: AS 47.30.530 AS 47.30.540
7 AAC 71.160.
RECORDS RETENTION. (a) Administrative records of a
center must be retained in accordance with department grant regulation 7 AAC
78.250 .
(b) Client
records of the center must be retained for seven years following the discharge
of the client. However, the records of a client under 19 years of age must be
kept until at least two years after the client reaches age 19 or until seven
years after the discharge of the client, whichever is later. (Eff. 9/1/82,
Register 83)
Authority:
AS 18.20.085 AS 47.30.530 AS
47.30.540
7 AAC 71.165.
WAIVER OF REQUIREMENTS. (a) The commissioner of the
department will, in his discretion, waive a requirement of 7 AAC 71.100 - 7 AAC
71.165 , if a center establishes an alternative method of satisfying the
requirement.
(b) Application
for waiver must be made in writing to the department and must include
(1) a statement
of the requirement for which a waiver is requested;
(2) an
explanation of the reasons why the requirement cannot be satisfied; and
(3) a
description of the alternative method proposed to satisfy the requirement for
which the waiver is requested.
(c) The
department will answer all requests for waivers in writing. (Eff. 9/1/82,
Register 83)
Authority: AS 47.30.530
ARTICLE
4. CLIENT RIGHTS.
Section
200. Legal rights
205. Informed consent
210. Bill of client rights
215. Confidentiality
220. Grievance procedures
300. Definitions
7 AAC 71.200.
LEGAL RIGHTS. A person receiving treatment at a community
mental health center which receives financial assistance under AS 47.30.520 -
47.30.620 has the same
legal
rights and responsibilities guaranteed to all persons by the Constitution and
statutes of the United States and the State of Alaska. (Eff. 9/1/82, Register
83)
Authority: AS 47.30.530 AS 47.30.590
7 AAC 71.205.
INFORMED CONSENT. (a) A center must obtain written,
informed consent from a client for
(1) experimental
treatments;
(2) nonstandard
treatment; and
(3)
participation in education or demonstration programs such as the use of
audio-visual equipment and one-way mirrors.
(b) All
experimental or nonstandard treatment procedures must be documented in the
client's record. (Eff. 9/1/82, Register 83)
Authority: AS 47.30.530 AS 47.30.590
7 AAC 71.210.
BILL OF CLIENT RIGHTS. (a) A center must prepare a
"bill of client's rights," including all rights in this section,
which must be prominently posted in places of treatment.
(b) The
"bill of client's rights" must contain the following information:
(1) a client is
entitled to participate in formulating, evaluating, and periodically reviewing
his or her individualized written treatment plan, including requesting specific
forms of therapy, being informed why requested forms of therapy are not made
available, refusing specific forms of therapy that are offered, and being
informed of treatment prognosis;
(2) a client has
the right to review with a staff member, at a reasonable time, the client's
treatment record; however, information confidential to other individuals may
not be reviewed by the client;
(3) a client
will be informed by the prescribing physician of the name, purpose, and
possible side effects of medication prescribed as part of the client's
treatment plan at the center;
(4) a client may
request a copy of the treatment summary which should include follow-up plans;
(5) a client has
a right to confidential treatment of all information pertaining to the client
and the right of prior written approval for the release of identifiable information.
(Eff. 9/1/82, Register 83)
Authority: AS 47.30.530 AS 47.30.590
7 AAC 71.215.
CONFIDENTIALITY. (a) All records and information
about a client must be kept confidential by the center except as provided in
(b) of this section unless the center
obtains
an authorization for release of information from the patient or a legally
designated representative of the patient.
(b) Information
regarding a client may be released without consent only to
(1) a person
authorized by court order;
(2) a designated
hospital to which a client is involuntarily committed;
(3) direct
service health or mental health personnel if a medical or psychological
emergency arises;
(4) mental
health professionals designated by the division to conduct program analysis or
on-site reviews;
(5)
center-authorized researches, if provision is made to preserve anonymity in the
reported results;
(6) insurance,
medical assistance, or other programs to the extent necessary for a client to
make a claim, or for a claim to be made on behalf of a client;