Section 320. Therapeutic consultation

A. Service description.

1. Therapeutic consultation is available through the CMH Waiver for Virginia-licensed or certified practitioners in psychology, social work, occupational therapy, therapeutic recreation, rehabilitation, speech/language therapy, professional counseling, marriage and family therapy, medicine, psychiatric clinical nurse specialists, and psychiatric nurse practitioners. Behavioral consultation performed by these individuals may also be a covered waiver service. These services may be provided, based on the client's ISP, for those clients for whom specialized consultation is clinically necessary to enable their utilization of waiver services.

2. Therapeutic consultation provides expertise, training and technical assistance for any of the specialty providers listed above to assist family members, caregivers, and other service providers in supporting the client. The specialty areas are (i) psychology, (ii) behavioral consultation, (iii) therapeutic recreation, (iv) speech and language pathology, and (v) occupational therapy. The need for any of these services is based on the client's ISP and provided to those clients for whom specialized consultation is clinically necessary and who have additional challenges restricting their ability to function in the community. Therapeutic consultation services may be provided in the client's home, and in appropriate community settings and are intended to facilitate implementation of the individual's and family/caregiver's desired outcomes as identified in his ISP.

3. Therapeutic consultation services may be provided in in-home residential or treatment support settings or in office settings in conjunction with another service. Behavioral consultation may be offered in the absence of any other waiver service when the consultation provided to informal caregivers is determined to be necessary to prevent institutionalization. Therapeutic consultation service providers are reimbursed according to the amount and type of service authorized in the ISP based on an hourly fee-for-service rate.

B. Criteria. In order to qualify for these services, the client shall have a demonstrated need for consultation in any of these services. Documented need must indicate that the ISP cannot be implemented effectively and efficiently without such consultation from this service.

1. The client's therapeutic consultation supporting documentation must clearly reflect the client's needs, as documented in the assessment, for specialized consultation provided to family/caregivers and providers in order to implement the ISP effectively.

2. Therapeutic consultation services may not include direct therapy provided to waiver clients or monitoring activities, and may not duplicate the activities of other services that are available to the client through the State Plan for Medical Assistance.

C. Service units and service limitations. The unit of service shall equal one hour. The services must be explicitly detailed in the ISP or supporting documentation. Travel time, written preparation, and telephone communication are not billable as separate items. Therapeutic consultation may not be billed solely for purposes of monitoring.

D. Provider requirements. In addition to meeting the general conditions and requirements for home and community-based participating providers as specified in 12VAC30-135-120 and 12VAC30-135-160, professionals rendering therapeutic consultation services, including behavioral consultation services, shall meet all applicable state or national licensure, endorsement or certification requirements. Behavioral consultation may be performed by professionals based on the professionals' work experience, education, and demonstrated knowledge, skills, and abilities.

The following documentation is required for therapeutic consultation:

1. ISP, that contains at a minimum, the following elements:

a. Identifying information: client's name and Medicaid number; provider name and provider number; responsible person and telephone number; effective dates for supporting documentation; and semi-annual review dates, if applicable;

b. Targeted objectives, time frames, and expected outcomes;

c. Specific consultation activities; and

d. The expected outcomes.

2. A written support plan detailing the recommended interventions or support strategies for providers and family/caregivers to use to better support the client in the service.

3. Ongoing documentation of consultative services rendered in the form of contact-by-contact or monthly notes that identify each contact. All monthly, quarterly, semi-annual and annual notes must include:

a. Specific details of the activities conducted;

b. Dates, locations, and times of service delivery;

c. Supporting documentation objectives addressed;

d. Services delivered as planned or modified;

e. Effectiveness of the strategies and client's and family/caregiver's satisfaction with service;

f. Client status; and

g. Consultation outcomes and effectiveness of support plan.

4. If consultation services extend less than three months, the provider must forward monthly contact notes or a summary of them to the case manager.

5. If the consultation services extend three months or longer, written quarterly reviews must be completed by the service provider and are to be forwarded to the case manager. Any changes to the ISP must be reviewed with the client and family/caregiver.

6. Semi-annual reviews are required by the service provider if consultation extends three months or longer and are to be forwarded to the case manager.

7. If the consultation service extends beyond one year, the ISP must be reviewed by the provider with the client and family/caregiver and the case manager. The written review must be submitted to the case manager, at least annually, or more often as needed.

8. A written support plan, detailing the interventions and strategies for staff, family, or caregivers to use to better support the client in the service.

9. A final disposition summary must be forwarded to the case manager within 30 days following the end of this service and must include:

a. Strategies utilized;

b. Objectives met;

c. Unresolved issues; and

d. Consultant recommendations.

Historical Notes

Derived from Volume 24, Issue 02, eff. December 1, 2007.

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.