Community Provider Responsibilities

​​​​Outpatient providers, both basic and enhanced, serve as the first line of assistance when a member has a behavioral health crisis. Managing a behavioral health crisis occurs in a number of ways:

  1. Crisis Planning: Development of an enhanced crisis plan for those at an increased risk of a behavioral health crisis and for anyone with a Person Centered Plan (PCP). A crisis plan includes numbers to call, resources, and instructions for providers on how to deescalate the crisis. Generally, a crisis plan should not include going to an Emergency Room or calling 911 first, unless the crisis includes bodily risk and injury. Crisis plans should also include processes to ensure up-to-date physical and behavioral health information is available to whoever is managing the crisis. Crisis plans should be reviewed and updated yearly, and at every instance of a crisis event. The goals of a crisis plan should be safety, de-escalation and minimization of the use of inappropriate levels of care or resources to manage a crisis.

  2. Referral to other resources/services: Referral to a higher level of care may be indicated for those experiencing repeated crises. Outpatient providers should be reviewing member's cases when each crisis event occurs, to ensure the member is receiving the correct level of care.

  3. Provider as First Responder

    Outpatient providers play the role of first responders in a behavioral health crisis. Providers should have systems in place that allow them the capacity to manage a member's crisis.

    1. Generally, providers of basic outpatient services are expected to handle the initial management of a crisis by telephone, helping to direct the member to appropriate services, which may include an emergent appointment at the provider's office assuming this can be safely done. All providers of behavioral health services are expected to have 24/7/365 availability of telephonic crisis assistance. Crisis calls are to be returned in no more than 15 minutes. Providers of basic services may also use Mobile Crisis Management (MCM) to assist in the management of a crisis. Providers should refrain from giving members the instruction to call 911 or go to an Emergency Room unless the specific clinical information from the case warrants such attention. CPT crisis codes can be billed for time spent with patients in a crisis assuming a face-to-face component has occurred.

    2. Providers of Assertive Community Treatment Teams (ACTT), Intensive In-Home (IIH), Community Support Team (CST), Substance Abuse Residential, Substance Abuse Detoxification, Multi-Systemic Therapy (MST), Inpatient and Psychiatric Residential Treatment Facility (PRTF) services are expected to be the in-person first responder 24/7/365 to those currently receiving those services.

    3. In-person response is to be within two hours of the crisis call.

  4. Coordination of Care and Information Sharing: Outpatient providers are to inform and direct the connection of members to other crisis system services, such as admission to a facility or use of Mobile Crisis Management.

    1. Providers should work to secure the placement of members who require admission by calling appropriate facilities and providing the information needed to obtain admission. This time is considered in the rates for CPT crisis codes for those in basic services and enhanced service rates for those receiving enhanced services.

    2. Providers should also have a way to communicate necessary medical and behavioral health information to those serving the member in crisis. Recent assessments, interim histories, and up-to-date diagnoses and medications should be available 24/7/365 and should be made available to any other providers assisting in the crisis management.  In emergency situations signed consents are not required for communication between providers for the purposes of crisis management and coordination of care.