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UNOFFICIAL 1737-61 Services can be provided to individuals in their home, work or other community settings. ACT services are provided by agencies whose staffs include one or more licensed qualified mental health professionals. If the services are provided by staff other than a licensed qualified mental health professional, the staff shall be supervised by a licensed qualified mental health professional. Provider qualifications to provide these services are ensured by provider compliance with requirements and standards of a national accreditation organization. Case management is an integral part of this service and reimbursement for case management as a separate service is not allowed. If biopsychosocial rehabilitation is part of the individual’s plan of care under intensive case management, reimbursement for biopyschosocial rehabilitation as a separate service is not allowed. (b) Community mental health rehabilitative services are available to individuals eligible for medical assistance and who are medically determined to need mental health, drug abuse, or alcohol services or all three. These services must be recommended by a licensed physician, licensed psychologist, advanced practice registered nurse or a licensed clinical social worker in behavioral health to promote the maximum reduction or restoration, or both, of a recipient to their best possible functional level relevant to their diagnosis of mental illness, abuse of drugs or alcohol. (c) Individuals who are mentally retarded (MR) or developmentally disabled are not eligible for these services, including mentally retarded and developmentally disabled individuals who are in Home and Community Based Waiver programs. (d) Community mental health rehabilitative services shall be provided by the agencies certified by the department of Health, adult mental health division and child and adolescent mental health division.

(e) The covered services are available only to Medicaid eligible recipients with a written plan of care developed with the participation of a licensed psychiatrist or psychologist. Services must be medically necessary.