provisions governing the coverage and reimbursement of Multi-Systemic Therapy (MST) for youth with serious emotional/behavioral disturbances who are at risk of out-of-home placement or returning home from out-of-home placement as a result of the emotional/behavioral disturbance. The MST model is based on empirical data and evidence-based interventions that target specific behaviors with individualized behavioral interventions (Louisiana Register, Volume 34, Number 7). The department now proposes to amend the July 1, 2008 Emergency Rule to further clarify recipient qualifications for MST (Louisiana Register, Volume 34, Number 10).
This action is being taken to avoid imminent peril to the health and welfare of youth who are in critical need of this service.
Effective October 20, 2008, the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing adopts provisions governing the coverage and reimbursement of Multi-Systemic Therapy.
PUBLIC HEALTH—MEDICAL ASSISTANCE
Part XV. Services for Special Populations
Subpart 17. Multi-Systemic Therapy
Chapter 251.General Provisions
A.Effective July 1, 2008, the Medicaid Program shall provide for the coverage and reimbursement of Multi-Systemic Therapy (MST) for youth. MST provides an intensive home/family and community-based treatment for youth who are at risk of out-of-home placement or who are returning home from placement which resulted from serious emotional/behavioral disturbance.
B.The MST model is based on empirical data and evidence-based interventions that target specific behaviors with individualized behavioral interventions.
C.Services are provided through a team approach to individuals and their families. The intent of the team approach is to:
1.promote the family’s capacity to monitor and manage the youth’s behavior;
2.involve families and other systems, such as schools, probation officers, extended families and community connections;
3.provide access to a variety of interventions 24 hours per day, seven days per week by staff that will maintain contact and intervene as one organizational unit; and
4.include structured face-to-face therapeutic interventions to provide support and guidance in all areas of functional domains (adaptive, communication, psychosocial, problem solving, behavior management, etc.).
D.A psychiatric, psychological or psychosocial evaluation completed by a licensed psychiatrist, psychologist or licensed clinical social worker no more than 12 months prior to the admission to MST services shall be on file to document medical necessity for MST services.
E.All MST services must be provided to, or directed exclusively toward the treatment of the Medicaid eligible youth.
F.Medicaid coverage of MST services is contingent upon appropriation of funding by the Louisiana Legislature.
AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.
HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 35:
A.Admission Criteria. In order to receive MST services, the recipient must be a youth from 11 through 17 years of age with serious emotional/behavioral disturbances and meet the following criteria. The youth is:
1.capable of participating in this therapy;
2.involved in, or at serious risk of involvement with the juvenile justice system; and
3.at risk of out-of-home placement as a result of one or more of the following behaviors, or returning from out-of-home placement where one or more of these behaviors was the focus of treatment:
b.aggressive/violent behavior; or
c.substance abusing behavior.
B.MST services may not be clinically appropriate for individuals who meet the following conditions:
1.youth who meet criteria for out-of-home placement due to suicidal, homicidal or psychotic behavior;
2.youth living independently, or youth for whom a primary caregiver cannot be identified despite extensive efforts to locate all extended family, adult friends and other potential surrogate caregivers;
3.the referral problem is limited to serious sexual misbehavior; or
4.youth has a primary diagnosis of an autism spectrum disorder.
C.Continuing Treatment Criteria. Individuals must meet all of the following criteria for continuing treatment through MST:
1.treatment does not require a more intensive level of care;
2.the treatment plan has been developed, implemented, and updated based on the youth’s clinical condition and response to treatment, as well as the strengths of the family, with realistic goals and objectives clearly stated;
3.progress is clearly evident in objective terms, but goals of treatment have not yet been achieved, or adjustments in the treatment plan to address the lack of progress are evident; and
4.the family is actively involved in treatment, or there are active, persistent efforts being made which are expected to lead to engagement in treatment.
D.Discharge Criteria. Individuals who meet one or more of the following criteria no longer meet medical necessity criteria for MST and shall be discharged from MST treatment:
1.the recipient’s treatment plan goals and objectives have been substantially met;
2.the recipient meets criteria for higher or lower level of treatment, care or services;
3.the recipient, family, guardian and/or custodian are not engaging in treatment or not following program rules and regulations despite attempts to address barriers to treatment;
Louisiana Register Vol. 34, No. 10 October 20, 2008