DEPARTMENT OF HEALTH AND HUMAN SERVICES
BEHAVIORAL AND PHYSICAL HEALTH AND AGING SERVICES ADMINISTRATION
CRISIS STABILIZATION UNIT CERTIFICATION
Filed with the secretary of state on
These rules become effective immediately after filing with the secretary of state unless adopted under section 33, 44, or 45a(9) of the administrative procedures act of 1969, 1969 PA 306, MCL 24.233, 24.244, or 24.245a. Rules adopted under these sections become effective 7 days after filing with the secretary of state.
R 330.151, R 330.152, R 330.153, R 330.154, R 330.155, R 330.156, R 330.157, R 330.158,
R 330.159, R 330.160, R 330.161, R 330.162, R 330.163, R 330.164, R 330.165, R 330.166,
R 330.167, R 330.168, R 330.169, R 330.170, R 330.171, R 330.172, R 330.173, R 330.174,
R 330.175, R 330.176, R 330.177, R 330.178, R 330.179, R 330.180, R 330.181, R 330.182,
R 330.183, R 330.184, R 330.185, R 330.186, R 330.187, R 330.188, R 330.189, R 330.190,
R 330.191, R 330.192, R 330.193, R 330.194, R 330.195, R 330.196, R 330.197, R 330.198,
and R 330.199 are added to the Michigan Administrative Code, as follows:
R 330.151 Definitions.
Rule 1. (1) As used in these rules:
(a) “Admission” means acceptance of an individual by the CSU for assessment or stabilization services.
(b) “Admission triage screening” means a brief nursing examination to identify immediate physical health needs of the individual and a brief screening of the level of acuity of their behavioral health status.
(c) “Adult” means an individual 18 years of age or older.
(d) “Ambulatory care” means the level of care typically provided in an outpatient medical clinic.
(e) “AOT” means assisted outpatient treatment as used in the mental health code, 1974 PA 258, MCL 330.1100 to 330.2106.
(f) “ASAM” means the comprehensive set of standards and decision rules established by the American society of addiction medicine that use a holistic, person-centered approach to determining the appropriate level of care and developing treatment plans for individuals with addiction and co-occurring conditions.
(g) “Assistive personnel” mean individuals who provide direct care and oversight to individuals receiving services in the CSU including, but not limited to, vital signs, safety observations, and other duties as assigned. Assistive personnel may be referred to as any of the following:
(i) Psychiatric attendants.
(ii) Certified nursing assistants.
(iii) Behavioral health assistants.
(iv) Healthcare technicians.
(v) Social service technicians.
(vi) Any other recognized industry terms.
(h) “Behavioral health crisis” means a crisis, as defined by these rules, involving emotional health, mental health, or substance use disorder or addictive issues, or any combination of such needs for all individuals including individuals with serious emotional disorders, mental illness, substance use disorders, intellectual and other developmental disabilities, cognitive challenges, or a combination of any of these, regardless of whether or not they have underlying diagnoses.
(i) “Certification” means the formal approval of a CSU by the department pursuant to section 971 of the mental health code, 1974 PA 258, MCL 330.1971, and in accordance with these rules.
(j) “Chemical restraint” means a medication that is used as a restriction to manage the behavior of an individual receiving services or restrict the individual’s freedom of movement and is not a standard treatment or dosage for the individual’s condition.
(k) “Chief administrative officer” means the individual designated by a governing authority to implement the governing authority’s direction within the CSU.
(l) “CMHSP” means community mental health services program.
(m) “Crisis” means an episode of acute emotional, behavioral, or social dysfunction, as defined by the individual, the individual’s representative, family, or a behavioral health professional. An episode is considered a crisis when at least 1 of the following applies:
(i) The individual or caregiver has identified a crisis and reports that their capacity to manage the crisis is limited at the time they are requesting assistance.
(ii) The individual can reasonably be expected within the near future to physically injure themself or another individual, either intentionally or unintentionally.
(iii) The individual exhibits risk behaviors, behavioral or emotional symptoms, or any behaviors or symptoms that are impacting their overall functioning, health, or well-being, including a current functional impairment that is a clearly observable change compared with previous functioning.
(iv) The individual requires immediate intervention in order to be maintained in their home or present living arrangement or to avoid psychiatric hospitalization or other out of home placement.
(n) “Crisis continuum of care” means an organized network of services that work collaboratively to provide a continuum of behavioral health crisis services for people in that community, including, but not limited to, the following:
(i) CMHSPs.
(ii) PIHPs.
(iii) Hospitals.
(iv) Emergency departments.
(v) Law enforcement.
(vi) Mobile crisis teams.
(vii) Call centers.
(viii) Community behavioral health services providers.
(vix) Urgent care settings.
(o) “Crisis residential facility” means a program that serves individuals experiencing a mental health emergency in a community-based setting, characterized by a home-like environment, blended psychosocial model of care, multi-day length of stay and treatment milieu that emphasizes autonomy and accountability.
(p) “CRM” means the customer relations management system used by the department.
(q) “CSU” means crisis stabilization unit.
(r) “CSU best practice and policy handbook” means a handbook developed through the CSU community of practice pilot containing requirements related to items such as required training and data reports, as well as recommended best practices for CSU policies and procedures.
(s) “Department” means the department of health and human services.
(t) “Emergency involuntary medication” means medication, particularly acute intramuscular injections, used in an emergency in which the individual receiving services does not consent to treatment and medication is determined to be medically necessary to treat the underlying condition of the individual.
(u) “Individual receiving services” means an individual admitted to a CSU to receive services. An individual receiving services may also be referred to as a recipient.
(v) “Initial certification” means the first certification awarded to an applicant and effective for 1 year.
(w) “Involuntary services” means those services provided to an individual with mental illness who is held or court-ordered to receive treatment under chapter 4 of the mental health code, 1974 PA 258, MCL 330.1400 to 330.1490.
(x) “LEP” or “individuals with limited English proficiency” means individuals who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English.
(y) “LGBTQ+” means lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and others.
(z) “Liable third party” means any health insurance plan or carrier such as individual, group, employer-related, self-insured, or self-funded; commercial carrier; automobile insurance; worker's compensation; or program such as Medicaid or Medicare that has liability for all or part of the covered benefit of an individual receiving services.
(aa) “Medical personnel” means a physician, physician’s assistant, nurse practitioner, or a registered nurse.
(bb) “Medical practitioner” means a physician, physician’s assistant, or a nurse practitioner.
(cc) “NGRI” means not guilty by reason of insanity.
(dd) “NP” or “nurse practitioner” means a registered professional nurse licensed under part 172 of the public health code, 1978 PA 368, MCL 333.17201 to 333.17242, who has been granted specialty certification by the Michigan board of nursing.
(ee) “Nursing administrator” means a registered nurse who provides direction for the nursing services provided at a CSU.
(ff) “OUD” means opioid use disorder.
(gg) “Peer recovery coach” means an individual in a journey of recovery from substance use, co-occurring disorders, non-substance addictive disorders, or any of these, and who identifies with an individual being served by the CSU based on a shared background and lived experience, complies with the programmatic, funding, and supervision requirements of the CMS, and is certified by the department.
(hh) “Peer support specialist” means an individual with a strong personal knowledge of what it is like to have first-hand lived experience with a mental health condition that has caused a substantial life disruption; complies with the programmatic, funding, and supervision requirements of the CMS; and is certified by the department. For purposes of this definition, a substantial life disruption includes experiencing some or all of the following:
(i) Homelessness.
(ii) Mental health crises.
(iii) Trauma.
(iv) Lack of employment.
(v) Criminal justice involvement.
(vi) Discrimination.
(vii) Stigma or prejudice intensified by mental health challenges.
(viii) Receiving public benefits due to poverty.
(ii) “Physical management” means a technique used by staff as an emergency intervention to restrict the movement of an individual receiving services by direct physical contact to prevent the individual from harming themself or others.
(jj) “PIHP” means prepaid inpatient health plan.
(kk) “Recovery principles” means a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
(ll) “Renewal certification” means any subsequently awarded certification that is effective for 1 year, except in cases when the CSU is accredited as required by section 975 of the mental health code, 1974 PA 258, MCL 330.1975. For a CSU that has achieved accreditation as described in section 971 of the mental health code, 1974 PA 258, MCL 330.1971, the renewal certification is effective for 3 years.
(mm) “Target population” means all individuals, aged 18 or older, presenting with a behavioral health crisis, including, but not limited to, individuals who may or may not have been diagnosed with serious mental illness, serious emotional disturbance, an intellectual or developmental disability including autism spectrum disorder, substance use disorders, or co-occurring disorders including more than 1 of the above categories.
(nn) “Therapeutic de-escalation” means an intervention where the individual receiving services is placed in a room and accompanied by staff who therapeutically engage the individual in behavioral de-escalation techniques and debriefing as to the cause and future prevention of the target behavior.
(oo) “Time out” means a voluntary response to the therapeutic suggestion to an individual receiving services to remove themself from a stressful situation in order to prevent a potentially hazardous outcome.
(pp) “Urgent care provider” means a walk-in clinic that treats minor behavioral health concerns either in person or via telehealth and does not provide crisis services under chapter 9A of the mental health code, 1974 PA 258, MCL 330.1971 to 330.1979.
(qq) “Warm hand-off” means a transfer of care between 2 members of the healthcare team from different entities, where the handoff occurs with the direct involvement of the individual receiving services and family. This transparent handoff of care allows individuals receiving services and their families to hear what is said and engages individuals and their families in communication, giving them the opportunity to clarify or correct information or ask questions about their care.
(2) A term defined in the mental health code, 1974 PA 258, MCL 330.1100 to 330.2106, and the public health code, 1978 PA 368, MCL 333.1101 to 333.25211 has the same meaning when used in these rules.
PART 1: STATE AGENCY REQUIREMENTS CERTIFICATION
R 330.152 Certification required; eligible entities.
Rule 2. (1) A person, corporation, or other entity shall not advertise, operate, or hold itself out as a CSU as defined in these rules unless designated as a CSU by the department.
(2) Certification must not be issued unless the applicant complies with these rules.
(3) The following entities are eligible to establish a CSU:
(a) CMHSP preadmission screening units operated contractually or directly.
(b) Psychiatric hospitals.
(c) General hospitals.
(4) General hospitals must have 24-hour access to a preadmission screening unit for crisis services and establish a contract with a CMHSP and a PIHP for services provided to individuals using public behavioral health funds.
(5) A CSU operated by a hospital must do all of the following:
(a) Operate within an area that is separate and distinct from the hospital's emergency department.
(b) Have a separate entrance and intake area and process from the hospital’s general receiving entrance or emergency department receiving or intake area.
(c) Be marked by signage that clearly delineates that the CSU is a separate service and is not a hospital. A CSU is prohibited from holding itself out as a hospital or from billing for hospital or inpatient services.
R 330.153 Application; submission requirements; review process and timelines;
recertification; denial.
Rule 3. (1) An applicant must obtain certification before admitting individuals.
(2) An application for initial certification or a renewal of certification to provide CSU services must be submitted through the CRM made available by the department.
(3) Each location of a CSU must be separately certified.
(4) An application for certification shall not be acted upon by the department until the application is determined complete with all required attachments.
(5) The applicant must submit all the following information to the department no later than 90 calendar days before the projected opening date of the CSU:
(a) The name and proposed location of the CSU.
(b) A statement of whether the CSU is to be located on property owned or leased by the applicant entity. If the CSU is located in a leased facility, a copy of the lease showing the rights and responsibilities of the parties and exclusive rights of possession of the leased premises.
(c) A statement that the CSU is to be operated as a profit, nonprofit, or government entity.
(d) Documentation of business registration as required by this state.
(e) Documentation that the applicant entity is 1 of the following:
(i) A sole proprietorship.
(ii) A corporation and the name and title of each corporate officer.
(iii) A partnership and the name of each partner.
(iv) A limited liability partnership and the name of each partner.
(v) A limited liability company and the name of the designated manager. If no manager is designated, the names of any 2 members of the limited liability company.
(vi) A governmental agency and the name and title of the individual in charge of the governmental agency.
(f) Whether the owner, any person with 5% or more business interest in the applicant entity, the medical director, or the administrator has had a license to operate a healthcare institution.
(g) In the event of a healthcare professional license or certification being denied, revoked, or suspended, all of the following:
(i) The reason for the denial, suspension, or revocation.
(ii) The date of the denial, suspension, or revocation.
(iii) The name and address of the licensing agency that denied, suspended, or revoked the license.
(h) Proof of insurance as required by the department.
(i) A description of the program's geographic service area.
R 330.154 Services to be provided; treatment approach; activities support services.
Rule 4. The following facility services must be submitted no later than 90 calendar days before the projected opening date of the CSU:
(a) A description of the CSU’s mental health and substance use disorder crisis services that includes all of the following:
(i) Assessment.
(ii) Crisis stabilization treatment that encompasses a biopsychosocial approach, including stabilization activities.
(iii) Medication treatment.
(iv) Non-pharmacological biological crisis-oriented therapy.
(iii) Outreach and referral services.
(iv) Discharge planning.
(v) Follow up.
(vi) Coordination with community services, including:
(A) Whether the services are to be provided directly or through written agreement with other providers of services.
(B) Evidence that services are provided from a person-centered perspective and incorporate recovery principles.
(b) A statement of treatment approach/milieu/philosophy that fosters a respectful, prosocial environment and a culture of safety for individuals receiving services and staff.
(c) Proposed activities that support stabilization interventions and prosocial behavior.
R 330.155 Additional requirements; staffing; qualifications of staff.
Rule 5. The following staff information must be submitted no later than 90 calendar days before the projected opening date of the CSU:
(a) An organizational chart depicting the governance of the program.
(b) The name and qualifications of the chief administrative officer and the medical director of the CSU or proposed CSU.
(d) An onboarding plan tailored to each staffing position as required by R 330.188.
R 330.156 Additional requirements; facility requirements; architectural plan; space and
bedroom availability; privacy and safety; maximum number of admissions; contingency plan
for high demand or overcrowding; certificate of occupancy.
Rule 6. The following facility information must be submitted no later than 90 calendar days before the projected opening date of the CSU:
(a) An architectural plan, including specific floor plans with dimensions and space and room function designations that show both of the following:
(i) The proposed number of recliners or private treatment spaces and a rational for that number.
(ii) The proposed number of single-occupancy bedrooms and a rational for that number.
(b) A floor plan that demonstrates compliance with all the following:
(i) Models a trauma-informed environment.
(ii) Provides privacy for the individuals receiving services.
(iii) Provides safety for the individuals receiving services, visitors, and staff.
(c) A copy of a fire safety inspection report indicating approval by the local fire authority or other applicable authority having jurisdiction where the CSU is based that is dated no earlier than 1 year before the projected opening date of the CSU.
(d) The maximum number or individuals admitted at any 1 time, and a justification for that number.
(e) A contingency plan developed in collaboration with local hospitals, emergency medical services, and law enforcement for when new admissions must be deferred during periods of high demand and overcrowding.
(f) A certificate of occupancy.
R 330.157 Admission and discharge criteria; procedures; agreements, affiliations; accreditation.
Rule 7. (1) The following facility information must be submitted no later than 90 calendar days before the projected opening date of the CSU:
(a) A program description signed by the medical director that incorporates admission and discharge criteria and procedures consistent with these rules, including both of the following:
(i) Utilization of a department-approved standardized medical clearance protocol as described in R 330.166.
(ii) Discharge criteria with guidelines for discharge planning and coordination with community services for individuals in need of post-emergency treatment or services.
(b) Written agreements or affiliations with the host or other hospitals, as appropriate, to receive and admit individuals who have been referred by the CSU for physical healthcare needs that are beyond the scope of the CSU and require inpatient treatment.
(c) Documentation of accreditation, provisional accreditation, or a plan to demonstrate compliance with the requirements of R 330.163.
(d) Copies of written documents and agreements with any of the following:
(i) Local behavioral health and substance use disorder systems and providers.
(ii) Local educational centers.
(iii) Social services.
(iv) Local aging and older adult services providers.
(v) State and local law enforcement, 911 Dispatch, emergency medical services, ambulance services, and any other similar service providers.
(2) The facility information required in subrule (1) of this rule must include, but is not limited to, the following:
(a) Letters of support demonstrating community engagement and integration of services.
(b) Letters of agreement describing the applicant’s linkages with behavioral health and substance use disorders systems and providers. The documentation may include, but is not limited to, the following:
(i) Formal agreements.
(ii) Letters of support.
(iii) Minutes from meetings.
(iv) Reports of outreach efforts demonstrating community engagement and integration of services with other relevant community partners.
R 330.158 Additional requirements; budget, funding; revenue; licensing; any other information
required.
Rule 8. (1) The following facility information must be submitted no later than 90 calendar days before the projected opening date of the CSU:
(a) A working budget showing projected revenue and expenses for the first year of operation, including a revenue plan and documentation of working capital, including both of the following:
(i) Funds or a line of credit sufficient to cover at least 90 days of operating expenses if the applicant is a corporation, unincorporated organization or association, sole proprietor, or partnership.
(ii) Appropriate revenue if the applicant is a state or local governmental agency, authority, board, or commission.
(b) Copies of all required licensing for services and programs to be provided by the CSU, including, as appropriate, substance use treatment, pharmacy, and laboratory.
(2) In addition to all of the required information under R 330.155, R 330.156, and this rule, the department may request any other information needed to determine certification requirements.
R 330.159 Onsite reviews; initial certification; renewal.
Rule 9. (1) The department may conduct announced and unannounced onsite reviews of all facilities and services to determine compliance with the certification requirements and any statutes, rules, and regulations to operate CSUs before an initial or renewal certification being granted, or when a complaint has been received.
(2) When a determination has been made that the applicant complies with all applicable rules and regulations, and any variances granted under R 330.160, the department shall certify the applicant. The initial certification is valid for the first year of operation.
(3) Before the expiration of the initial certification, the department shall conduct a review of the CSU for compliance with all applicable rules and regulations.
(4) In order to receive and retain certification, the CSU shall do the following:
(a) Cooperate with the department during any review, evaluation, or inspection of the facility or program.
(b) Allow an authorized department representative to enter upon request and inspect all of the premises to determine compliance with policy and certification to operate as a CSU.
(c) Upon request from the department, make available all documents, files, reports, individual receiving services records, accounting records, or other materials required by or requested by the department, with the exception of protected peer review documentation, in the course of visitation, audit, inspection, or investigation.
(d) Undertake changes in the operation of the CSU as required by the department.
(5) It is the responsibility of the CSU to complete and submit a renewal application for certification through the CRM at least 90 calendar days, but starting within no more than 180 days, before the expiration date of the current certification.
(6) If the CSU fails to submit the completed renewal application, the department shall provide notice by certified mail advising that unless the renewal application and departmental review is satisfactorily completed, the CSU is operating without certification and is subject to sanctions.
(7) Pursuant to a satisfactory review, the department shall renew the certification.
Renewal certifications are valid for 1 year for CSUs that have not received accreditation as described in R 330.163.
(8) Following accreditation of the CSU under R 330.163, a renewal certification is valid for 3 years.
(9) The CSU shall frame and prominently and conspicuously display its certificate in a public area of the premises that is readily visible to individuals receiving services, employees, and visitors and make a copy available upon request.
(10) A CSU certificate must not be altered.
(11) Certification is not transferrable to another CSU for the purpose of facilitating a change in location or a change in the governing body or owner.
(12) The CSU shall be certified for a specific capacity.
(13) The CSU shall notify the department in writing at least 30 days before changing any of the following:
(a) The CSU’s name.
(b) The telephone number or other contact information for the CSU.
(c) The chief administrative officer or medical director.
(14) The CSU shall notify the department in writing at least 30 days of its permanent closing of the facility.
(15) The CSU shall notify the department in writing at least 30 days before and shall obtain approval from the department before implementing any of the following changes:
(a) Any construction, renovation, or modification of the CSU buildings or leased space.
(b) Location of the CSU.
(c) The total capacity of the CSU.
(d) Ownership of the CSU.
(e) Significant changes in the services provided by the program.
(f) Termination of the program or services in the program.
R 330.160 Variance.
Rule 10. (1) Upon written request of an applicant or certified CSU, the department may grant a variance from a certification standard or requirement if there is clear and convincing evidence that the alternative to the rule complies with the intent of the standard or requirement from which a variance is sought, and the variance does not impact the health, safety, or welfare of individuals or the quality of care.
(2) The department shall enter its decision, including the qualification under which the variance is granted, in the records of the department and send a signed copy to the applicant or certified CSU.
(3) The variance may remain in effect for as long as the CSU continues to comply with the intent of the rule or may be time limited by the department.
R 330.161 Denial, suspension, revocation of certification; sanctions; corrective action plan.
Rule 11. The department may deny, suspend, or revoke certification; sanction; or require a corrective action plan for, but not limited to, the following reasons:
(a) Federal Medicare or state Medicaid sanctions or penalties.
(b) Eviction involving any property or space used as a CSU.
(c) Unresolved state Medicaid or federal Medicare audit.
(d) Denial, suspension, or revocation of a license or certification of a healthcare or behavioral healthcare facility in any state, with substantially the same owners, whether the ownership was direct or indirect, or with substantially the same principals, directors, officers, or managers.
(e) Violation of any local, state, or federal rule, regulation, or law.
(f) Loss of required accreditation.
(g) Violation of any of the standards or requirements of these rules.
(h) An unsatisfactory site review or complaint investigation that was not successfully remediated.
R 330.162 Administrative hearing; return of certification; ceasing CSU services.
Rule 12. (1) Before an order is entered denying a certification application or suspending or revoking a certification previously granted, the applicant or certified CSU shall have an opportunity for a hearing. A hearing under this section is subject to the provisions governing a contested case under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328.
(2) A certificate must be returned to the department immediately after the notification date when a certified CSU ceases to operate, is moved to another location, changes ownership, or the certification is suspended or revoked.
(3) If the CSU receives notice from the department that the certification is no longer valid, the CSU is no longer authorized to provide the services of a CSU as defined by section 971 of the mental health code, 1974 PA 258, MCL 330.1971, and these rules and shall cease to do so.
R 330.163 Accreditation.
Rule 13. A CSU shall obtain and maintain behavioral healthcare accreditation from 1 of the following accreditation bodies within 3 years after initial certification:
(a) The Joint Commission.
(b) The Commission on Accreditation of Rehabilitation Facilities International.
(c) Accreditation from an organization with similar standards as the organizations described in subdivisions (a) and (b) of this rule that is approved by the department director.
PART 2: CERTIFIED CRISIS STABILIZATION UNIT REQUIREMENTS
R 330.164 Recipient rights.
Rule 14. (1) An individual receiving services in a CSU is a recipient of behavioral health services and is afforded all rights afforded to a recipient of behavioral health services under chapter 7 of the mental health code, 1974 PA 258, MCL 330.1700 to 330.1758.
(2) A CSU operated by a preadmission screening unit, a licensed psychiatric hospital, or a general hospital shall utilize the recipient rights system of the local community mental health services program for all Medicaid and non-Medicaid individuals to ensure compliance with chapters 7 and 7a of the mental health code, 1974 PA 258, MCL 330.1700 to 330.1758 and MCL 330.1772 to 330.1788, regardless of payor. A CSU shall ensure that all individuals receiving services are provided with a summary of their rights upon admission and that information on how to file a complaint and contact the rights office is posted on the unit.
(3) A CSU shall ensure that all employees and contract providers are trained through state-approved training in recipient rights within 30 days after the start of employment.
(4) A CSU shall ensure that individuals are protected from rights violations while they are receiving services from a contracted provider and that all individuals and staff are protected from retaliation and harassment resulting from recipient rights activities.
(5) A CSU shall comply with policies and procedures related to recipient rights under section 752 of the mental health code, 1974 PA 258, MCL 330.1752, and of the local CMHSP, except those related to the use of physical management and restraint.
SUBPART A: CLINICAL OPERATIONS
GENERAL OPERATIONS
R 330.165 Prohibitions in operating other than a CSU; CSU required services; compliance with
laws and rules; consent.
Rule 15. (1) A CSU shall be separately certified as a CSU.
(2) A CSU shall not be operated as a holding facility for inpatient hospitalization or crisis residential facilities.
(3) A CSU cannot simultaneously operate as a crisis residential facility, any form of respite facility, or an urgent care provider. This rule must not be construed to prevent co-location of a CSU with other facilities or shared staffing arrangements.
(4) A CSU shall provide all of the following:
(a) Assessment.
(b) Crisis intervention planning.
(c) Stabilization treatment.
(d) Discharge planning.
(e) Follow-up care.
(5) The requirements of subrule (4) of this rule must be achieved from a person-centered perspective, encouraging and including the participation of the individual, and their family and support persons, incorporating recovery principles and providing care in the least restrictive manner possible.
(6) Individuals with co-occurring mental health and substance use disorders shall receive integrated interventions for their individual needs and conditions.
(7) The CSU, throughout its stabilization care of the individual, shall consider all of the following whenever possible to promote the development of a strong social support network:
(a) An individual’s family situation.
(b) Financial security.
(c) Housing.
(d) Food stability.
(e) Social service status and their impact on the individual’s behavioral health stability.
(8) The CSU shall seek to integrate applicable formal and informal social supports in the assessment, planning, and discharge process.
(9) A CSU shall comply with federal law, the mental health code, 1974 PA 258, MCL 330.1001 to 330.2106, and related department administrative rules regarding informed consent and confidentiality. Where conflicts exist, the CSU shall comply with the requirement that is most protective of the individual’s rights to consent and confidentiality.
(10) Consent must be obtained from the individual or, if applicable, the individual’s individual representative, before or at the time of admission. Consent is not required in either of the following situations:
(a) The individual is adjudicated as a person requiring treatment as defined by section 401 of the mental health code, 1974 PA 258, MCL 330.1401.
(b) The individual is being detained for examination as defined by section 435 of the mental health code, 1974 PA 258, MCL 330.1435.
(11) With the consent of the individual receiving services or their individual representative, all of the following actions must occur during each presentation of the individual at the CSU:
(a) Family and support persons shall be given the opportunity and encouraged to participate in the assessment, stabilization, crisis intervention planning, discharge planning, and follow-up services, either virtually or in person. This process must include education about the individual’s behavioral health crisis and suggestions on how to best support the individual. If participation is not clinically indicated, then it must be clearly documented in the record.
(b) Reasonable attempts to contact family members and support persons for their participation. The results of these attempts must be documented in the individual’s medical record.
(c) If the individual receiving services is already receiving behavioral health services in the community , those community behavioral health providers shall be involved, to the maximum extent possible, in the assessment, stabilization treatment, and discharge processes.
(d) Involvement with social service providers, if applicable, in the discharge and follow-up processes regarding the following information about the individual:
(i) Financial security.
(ii) Housing.
(iii) Food stability.
(iv) Social service status.
(12) If the individual chooses either not to participate or not to have family, support persons, or social service providers involved, a clear explanation of the refusal must be documented in the individual receiving services’ medical record. If the individual receiving services does not initially provide consent, unless there is a documented clinical reason not to repeat attempts must be made and documented.
R 330.166 Access to CSU; admission.
(3) A CSU shall be able to provide services for individuals experiencing a behavioral health crisis, whether or not the individual may have also been diagnosed with any of the following:
(a) Serious mental illness.
(b) Substance use disorders.
(c) Co-occurring mental health and substance use disorders.
(d) An intellectual or developmental disability, including, but not limited to, autism spectrum disorder.
(a) Provide emergency receiving and evaluation functions on a limited basis.
(b) Provide ambulatory and integrated care to address minor physical health issues.
(c) Coordinate and transfer an individual to the next level of care when necessary.
(5) Unless operating under a hold or deferment issued under R 330.166, a CSU shall not refuse to accept for admission triage screening any individual who presents or is referred to the CSU for evaluation or stabilization, including, but not limited to, any of the following:
(a) Individuals who walk in.
(b) Individuals dropped off by law enforcement.
(c) Individuals dropped off by mobile crisis teams.
(d) Individuals brought in for court-ordered evaluation and treatment.
(6) A CSU shall accept all payors and shall not refuse to admit an individual solely on the basis of any of the following:
(a) Insurance or lack of insurance.
(b) The individual being on a law enforcement hold or living in the community on parole.
(c) Probation or any court-related commitment.
(d) The individual is currently in any of the following statuses:
(i) Being followed by the NGRI committee of the center for forensic psychiatry.
(ii) Adjudicated NGRI.
(iii) In a juvenile justice or correctional custody.
(iv) Placed on the sex offender registry.
(v) Issues involving citizenship status.
(7) Admission to the CSU must be equitably available to all populations. The CSU shall not discriminate on the basis of race, color, religion, national origin, ancestry, age, gender, sexual orientation, height, weight, marital status, or physical or mental disability.
(8) The medical director of the CSU or their designee may place a hold on or defer all new admissions to the CSU for capacity or other extenuating circumstances if a conclusion is reached that the ability of the CSU to deliver quality service would be jeopardized based on the following requirements:
(a) If the CSU holds or defers new admissions, the department shall be notified at the time the decision is made, and the notification must include duration of the deferred admissions and the rationale for this decision. The CSU shall also confirm with the department when the hold is lifted.
(b) A CSU shall develop and maintain a contingency plan with other local affiliated hospitals, emergency medical services, and law enforcement for when new admissions must be deferred during periods of high demand and overcrowding.
(9) A pattern of refusals or deferred admissions may result in a site visit and a review of the certification of the CSU by the department.
(12) If an individual’s physical health needs do not exceed the capability of the CSU, the individual must be accepted for admission, except for individuals meeting the criteria of R 330.166.
(13) The admission triage screening must include use of a department-approved standardized medical clearance protocol as defined in the CSU best practice and policy handbook.
(14) If the admission triage screening results in a determination that the individual’s needs are not emergent and can be met through a less intense level of care, the CSU shall initiate the process to refer or transfer the individual to the clinically indicated level of care. A warm handoff or follow-up, commensurate with need, must be provided.
(16) If the admission triage screening or a subsequent assessment or exam results in a determination that the individual’s needs will likely not be stabilized within 72 hours or the individual needs a higher level of care such as a crisis residential or psychiatric hospitalization, the CSU shall immediately initiate the process to refer or transfer the individual to the clinically indicated level of care, including transportation, if required. Stabilization interventions and follow-up care must be provided until the individual is actively engaged in that level of care.
(17) A CSU shall maintain documentation of the rationale for transfers or referrals and the follow-up care.
(18) When an individual is brought to CSU by law enforcement, the CSU transfer must take place within 15 minutes of arrival.
R 330.167 Assessment and plan.
Rule 17. (1) A CSU shall have a comprehensive intake process, approved by the department, that ensures prompt treatment of all individuals presenting at the CSU. The process must include, at a minimum, the following components and comply with the associated timeframes:
(a) A behavioral health assessment, a crisis stabilization plan, and stabilization services, each initiated by a mental health professional within no more than 1 hour after the individual’s arrival on-site, unless there are documented medical reasons why they cannot be initiated within this timeframe or why they may not be indicated.
(b) Both the behavioral health assessment and crisis stabilization plan must focus on immediate stabilization needs from the individual’s admission to the CSU through to and including discharge, follow-up care, and connection with a community treatment provider. The stabilization approach must not only impact immediate needs but must identify root causes and start to address long-term needs.
(c) A psychiatric assessment that includes a medical history and exam by a medical practitioner initiated within 3 hours after the individual’s arrival on-site unless there are documented medical reasons why they cannot be initiated within this timeframe or why they may not be indicated.
(d) A medical exam must identify conditions that may affect the individual’s current status, including a review of symptoms focused on conditions, such as a history of trauma and withdrawal status, that may present with psychiatric symptoms or cause cognitive impairment.
(e) The medical exam and history may be initiated by an RN as long as the findings are made available to the medical practitioner within the 3-hour timeframe.
(f) If a medical exam was conducted by a medical practitioner before admission, the CSU medical practitioner shall incorporate those findings, determine what additional medical assessment is necessary and document the rationale.
(2) The following components must be assessed and included in the assessment and documented in the medical record of the individual receiving services:
(a) Chief complaint.
(b) Mental status exam, including, but not limited to, the following:
(i) Signs and symptoms of mental illness.
(ii)Thoughts of self-harm.
(iii) Suicidal ideation.
(iv) Homicidal or violent ideation.
(c) Medical history.
(d) Current providers of behavioral and physical health.
(e) Current medications.
(f) Psychiatric history, including, but not limited to, previous behavioral health crises.
(g) Substance use history.
(h) Legal history pertinent to crisis, including, but not limited to, any of the following:
(i) Custody.
(ii) Guardianship.
(iii) Pending litigation.
(iv) Court-ordered treatment status.
(v) Parole or probation status.
(i) Social history including information pertinent to the crisis, including, but not limited to, family and social supports, and recent and relevant history of trauma or neglect.
(j) Current environmental status, including both strengths and gaps that impact the individual’s immediate crisis and behavioral health status.
(k) Economic status, including financial security, housing situation, and food stability, that includes both strengths and gaps that impact the individual’s immediate crisis and behavioral health status.
(l) Social service status, including both strengths and gaps that impact the individual’s immediate crisis and behavioral health status.
(m) Presence of any advance directives, including a psychiatric advanced directive or medical power of attorney, from the individual receiving services or their individual representative, if applicable.
(3) The crisis stabilization plan must be based on the components of the behavioral health assessment, provide recommendations for services to address behavioral health and physical needs of the individual receiving services specific to the acute crisis, and guide stabilization treatment during admission and discharge planning.
(4) The crisis stabilization plan must address all the following:
(a) Immediate and long-term stabilization needs.
(b) Discharge planning, with a discharge date, if 1 has been determined, including, to the maximum extent possible and with the consent of the individual receiving services or their individual representative, linkage of the individual and their family and support persons to community resources, including a warm handoff and specific follow-up measures to ensure that the individual is actively engaged in treatment following discharge.
(c) How to maximize the safety of the individual receiving services, other individuals receiving services, CSU staff, and visitors.
(d) Agreement to and implementation of the plan consistent with R 330.7199 and section 712 of the mental health code, 1974 PA 258, MCL 330.1712.
(e) Specific stabilization treatment and level of care to address the acute crisis and meet the individual receiving services’ assessed and anticipated needs after discharge. If the need for hospitalization appears inevitable, then hospital referrals must begin as soon as possible.
(f) The role of the individual’s family situation, financial security, housing, food stability, and social service status in contributing both positively and negatively to the individual’s behavioral health stability.
(g) If no family or support persons are identified, a plan for addressing gaps or needs in an individual’s community and social support networks.
(5) The crisis stabilization plan must be updated when the condition or needs of the individual receiving services change, and it must be reviewed frequently to assess the need for the individual’s continued stay in the CSU.
(6) The psychiatric assessment, the behavioral health assessment, and the crisis stabilization plan must be documented in the medical record of the individual receiving services within 24 hours after admission. Documentation requires the time, date, and signature of staff completing the assessment or plan.
(7) Nursing and observation notes must be completed at least once per shift. Medical practitioner notes must be updated daily.
(8) Decisions about remaining in the CSU or being transferred to alternative levels of care shall only be made by a medical practitioner, considering the behavioral health assessment and the crisis stabilization plan.
R 330.168 Crisis stabilization services; risk of harm and intervention.
Rule 18. (1) A CSU must have the capability to provide or arrange for the following crisis intervention and stabilization of the individual:
(a) Individual crisis interventions addressing mental health or substance use disorder or social needs.
(b) Family stabilization services.
(c) ASAM 3.7 withdrawal management.
(d) Psychopharmacological treatment.
(e) Care coordination and consultation for other conditions impacting the crisis such as autism spectrum disorder or dietary needs.
(f) Coping or recovery skills training.
(g) Personal care for people with disabilities.
(h) Peer support and peer recovery coach services.
(i) Care coordination.
(j) Interpretation services.
(k) Transportation services, ensuring wheelchair accessibility when needed.
(l) Additional services as the CSU determines applicable.
(a) Include protocols for identifying and managing individuals at high risk of harm to self or others.
(b) Emphasize person-centered, prosocial approaches to interventions that support a culture of recovery.
(c) Protect the health and safety of the individual receiving services and others at all times.
(d) Specify the methods for documenting the use of the interventions.
(3) The following must be included in the individual receiving services’ medical record:
(a) An individual assessed to be potentially suicidal or violent who is on a higher level of monitoring and observation.
(c) A registered nurse or other certified clinician may initiate increased monitoring and other suicide or violence prevention interventions before obtaining a medical practitioner’s order, but in all instances must obtain an order within 1 hour of initiating the intervention.
(d) Both the initiation of increased monitoring and the determination of when such monitoring levels may be decreased
R 330.169 Assisted outpatient treatment.
Rule 19. (1) A CSU shall have protocols to assess whether there is a valid court order for AOT for any individual served.
(2) Assessment of and provision of services to an individual on AOT must incorporate communication with the individual’s AOT coordinator or case manager or designee.
(3) A CSU shall have protocols that demonstrate that AOT is not an authorization for non-emergency, involuntary administration of medication.
(4) A CSU shall have protocols for all of the following:
(a) Initiating AOT petitions.
(b) Completing petitions through certification if needed.
(c) Working with AOT programs with their service area, including to plan for any needs for testimony required.
R 330.170 Withdrawal management; initiation of substance use disorder treatment.
Rule 20. (1) A CSU shall have the capability and be licensed or have contractual authority from the PIHP to provide substance use disorder assessment, crisis stabilization treatment, and provide or make available ASAM 3.7 medically monitored residential withdrawal management as defined in the Medicaid specialty supports and services program FY 20, Treatment Policy No. 13, withdrawal management continuum of services, for 24 hours a day, 7 days a week, and 365 days a year.
(2) Residential withdrawal management services provided by the CSU must not exceed ASAM 3.7 services.
(3) A CSU shall have policies and procedures for identifying and providing a planned treatment regimen of 24-hour, professionally driven evaluation, care, and stabilization treatment for individuals who have substance use issues or meet the diagnostic criteria for a substance use disorder.
(4) A CSU shall offer a naloxone kit to, at a minimum, all individuals with a history of opioid use or who are otherwise determined to be at risk for an overdose who are being discharged into the community. The offer must be documented in the medical record of the individual receiving services.
(6) A CSU shall have the capability to initiate treatment of OUD and either of the following:
(a) If clinically indicated and acceptable to the individual, a CSU medical practitioner shall provide treatment for OUD and provide access to buprenorphine.
(b) If a medical practitioner at the CSU determines that prescribing medication for OUD is not clinically indicated or feasible, or the individual receiving services declines the intervention, the individual with OUD shall be offered withdrawal interventions at the CSU, and if indicated for the individual, a written referral for further withdrawal management services or opioid treatment before the individual is discharged from the CSU. Follow-up care must be provided until the individual is actively engaged in treatment.
(7) Refusal of follow-up services must be documented.
R 330.171 Restraint and seclusion.
Rule 21. (1) A CSU is prohibited from using seclusion. CSUs, as locked units, are not considered seclusion, as the individual is not alone on the unit. Seclusion does not include the use of a time out or therapeutic de-escalation.
(2) A CSU is prohibited from using chemical restraint. Emergency involuntary medications are allowed, as defined and used according to these rules. The use of emergency involuntary medications must comply with R 330.7158.
(3) Least restrictive interventions must be utilized if possible and physical management and restraint must only be used as a last resort after consideration of the risk of trauma and iatrogenic harm.
(4) All staff shall have training in non-physical de-escalation interventions and be able to demonstrate the competencies and have the ability to participate in de-escalation. De-escalation skills must be a consideration in hiring and supervisory support. Participation in de-escalation training must be required of all staff as part of professional development and annual training requirements.
(5) Use of
physical management and restraint must comply with section 740 of the mental
health code, 1947 PA 258, MCL 330.1740, and associated administrative rules.
(6) Data on the use of physical management and restraint must be tracked for continuous improvement.
(7) A CSU shall develop policies and procedures for the use of physical management and restraint that must be consistent with the mental health code, these administrative rules, and contain, at a minimum, the following additional elements:
(a) Documentation of all of the following must be included in the medical record of the individual receiving services:
(i) Physical management or restraint.
(ii) Rationale.
(iii) Efforts at de-escalation and a description of less restrictive alternatives that were attempted before the use of physical management or restraint.
(c) Debriefing with both staff and the individual receiving services after an episode of physical management or restraint. Information collected during the debriefing must be used to develop strategies for prevention of physical management and restraint in the future.
R 330.172 Medication administration.
Rule 22. (1) Medications must be ordered and administered in compliance with R 330.7158.
(3) All prescribing medical practitioners working in the CSU shall obtain licensure and meet the requirements related to prescribing and dispensing pharmaceuticals or controlled substances as required by chapter 7 of the mental health code, 1974 PA 258, MCL 330.1700 to 330.1758, article 7 of the public health code, 1978 PA 368, MCL 333.7101 to 333.7545, and the Controlled Substances Act, 21 USC 801 to 904.
(4) Every order given verbally or over the phone must be received by an RN or LPN, must be recorded immediately with the ordering prescriber’s name, and signed by a physician or authorized prescriber within 24 hours. The order must be documented in the medical file of the individual receiving services along with a notation of the time and date of the order, how the original order was communicated, and why the order was delivered verbally.
(5) A CSU shall perform all the following regarding medication:
(a) Be able to administer routine medications as soon as possible and no later than 24 hours after order. Medications that are considered time-sensitive shall be started as soon as possible and no later than 4 hours after order.
(b) Document and report as part of its performance indicators when the time standards were not met and the reason.
(c) Have a current drug reference guide and current toxicology reference guide available for use by staff at all times.
(d) Demonstrate
protocols to maintain emergency medications on-site, as determined by the department.
(e) Maintain a drug formulary that is no more restrictive than the Medicaid formulary and is updated at least every 12 months.
(6) A CSU shall have policies and procedures for medication management in all the following areas:
(a) Adherence to federal and state laws, rules, and regulations.
(b) Direct the management of all of the following:
(i) Medication ordering.
(ii) Procurement.
(iii) Prescribing.
(iv) Transcribing.
(v) Dispensing.
(vi) Administration.
(vii) Documentation.
(viii) Wasting or disposal and security.
(ix) Management of controlled substances, floor stock, and physician sample medications.
(7) Medication management policies and procedures must include, at a minimum, all the following:
(a) Specifications for which staff positions may order and administer medication and procedures for verification of credentialing the authorization.
(b) Procedures to ensure that the medication regime of an individual receiving services is reviewed by a medical practitioner to ensure the medication regimen meets the individual’s needs.
(c) Procedures for reviewing and handling medications brought in at admission.
(d) Procedures to ensure medication is administered in compliance with a medical order.
(e) Procedures for documenting medication administration and assistance in the self-administration of medication.
(f) Procedures for assisting an individual receiving services in obtaining medication.
(g) Procedures for ensuring privacy for medication administration.
(h) Specifications for which medications and medication classifications are required to be stopped automatically after a specific time-period unless the ordering medical practitioner specifically orders otherwise.
(i) Procedures to identify, track, and correct deviations in all of the following:
(i) Medication prescribing.
(ii) Transcribing.
(iii) Dispensing.
(iv) Administration.
(v) Documentation.
(vi) Drug security of ordering or procurement of medication.
(j) Procedures to follow when drug reactions and other emergencies related to the use of medications occur, including the following:
(ii) The emergency medical care that may be initiated by a registered nurse to alleviate a life-threatening situation.
(iii) A process for review of a medication administration error or an adverse reaction to medicine through the CSU’s quality management program.
(8) A CSU shall have a policy specifying indications and procedures for prioritizing engagement of the individual receiving services in voluntary acceptance of medication first, as well as policies and procedures for emergency and non-emergency involuntary medication administration that includes, at a minimum, all the following:
(a) Involuntary administration of medication in a non-emergency is not authorized for individuals receiving services subject to AOT orders but may be administered for individuals whose individual representative has approved medication administration. Consideration for inpatient admission may be indicated for individuals who are under AOT orders who decline medication administration.
(b) Emergency involuntary medications must be used solely for the purposes of providing medically appropriate stabilization and treatment and protecting the immediate safety of the individual receiving services and other individuals after less intrusive alternatives have been exhausted and must not be used as punishment, for the convenience of staff, or as chemical restraint to control or coerce behavior.
(c) Data regarding the frequency of administration of emergency involuntary medication must be tracked and CSUs shall strive to engage individuals receiving services in voluntary treatments and minimize the use of this type of medication administration.
(d) Coercion of an individual receiving services to consent to medication is not authorized and does not circumvent the required policies related to reduced use of emergency involuntary medication and tracking of related data.
(9) If medication is stored at the CSU, the CSU shall ensure all the following:
(a) Medication is stored in a separate locked room, closet, or self-contained unit used only for medication storage, with additional provisions for controlled substances as specified in article 7 of the public health code, 1978 PA 368, MCL 333.7101 to 333.7545, and applicable administrative rules.
(b) Medication is stored according to the instructions on the medication container.
(c) Medication management policies and procedures include, at a minimum, all the following:
(i) Establishing what medications are stored on-site and at what quantities.
(ii) Receiving, storing, inventorying, tracking, dispensing, and destroying or discarding medication, including expired medication.
(iii) Discarding or returning prepackaged and sample medication to the manufacturer at the manufacture’s request.
(iv) Addressing a medication recall, including notification of individuals receiving services who received recalled medication.
(v) Storing, inventorying, and dispensing controlled substances.
R 330.173 Discharge.
(a) The individual no longer needs crisis stabilization.
(b) A referral to outpatient services for aftercare treatment.
(c) A referral to a partial hospitalization program.
(d) A referral to a residential treatment center, including crisis residential services.
(e) A referral to an inpatient bed.
(f) An order for involuntary treatment of the individual.
(2) An individual receiving services shall be discharged from a CSU when the individual’s treatment needs are not consistent with the services that the CSU is authorized or able to provide, including when the individual is being transferred or discharged under R 330.166.
(3) A CSU shall ensure that there is a documented discharge order by a medical practitioner or other staff member authorized by policy and procedure to authorize discharge before an individual receiving services is discharged unless the individual leaves the CSU against a medical practitioner’s or mental health professional’s advice and it is determined that a petition to hold the individual under sections 434 to 439 of the mental health code, 1974 PA 258, MCL 330.1434 to 330.1439, is not clinically indicated.
(4) A discharge summary must be prepared that includes all of the following:
(a) The presenting issue of the individual receiving services and other physical and behavioral health issues identified in the behavioral health assessment or crisis stabilization plan.
(b) A summary of the treatment services provided to the individual.
(c) The individual’s progress in meeting treatment goals.
(d) The name, dosage, and frequency of each medication ordered for or provided to the individual by a medical practitioner at the CSU at the time of discharge.
(e) A description of the disposition of the possessions, funds, or medications brought to the CSU by the individual.
(f) The individual receiving services, their individual representative, and any facility to which the individual is transferred must receive a copy of the crisis stabilization plan and discharge summary.
(g) A copy of the discharge summary must be placed in the medical record of the individual receiving services within 24 hours after discharge.
(h) At the time of discharge, an individual receiving services shall receive a referral for treatment or ancillary services that the individual may need after discharge and a warm hand-off must be arranged in collaboration with the individual.
(i) If a warm hand-off is not possible, reasonable attempts made to achieve the warm hand-off must be documented in the medical record of the individual receiving services.
(6) Activities of engagement must be documented in the medical record of the individual receiving services.
(7) If care is not established with a community provider, documentation of the efforts by the staff person to establish the connection and the reason care was not established must be documented.
(a) Coordination, including a warm hand-off, with the individual’s existing primary care and behavioral health care providers to ensure the individual has access to the medication.
(b) Developing policies and funding to facilitate the individual receiving a minimum of a 1-week supply of medication upon discharge.
(c) Providing the individual with a prescription for the medication, if the individual does not already have one, that covers the period of time until the next scheduled medication visit. The CSU shall provide follow-up assistance in having the prescription filled or refilled and document follow-up contact with the individual to confirm they have obtained the medication.
(9) No family member or support person shall be required to agree to the discharge of the individual receiving services. A notation must be made in the individual’s medical record if a family member or support person objects to the discharge plan or any part of it.
R 330.174 Readmission.
Rule 24. Individuals can be readmitted to the CSU after discharge at any time, except for circumstances that immediately follow discharge in which the medical practitioner determines that readmission is not indicated.
R 330.175 Pharmacy services.
Rule 25. (1) A CSU shall have a formal, documented arrangement with a pharmacy for pharmacy services that are not available on the premises and for provision of medications post-discharge, as required.
(2) If pharmaceutical services are provided on the premises, all the following are required:
(a) All pharmacy operations or services within the CSU must be licensed and under the direct supervision of a registered pharmacist or provided by contract with a licensed pharmacy operated by a registered pharmacist.
(b) Pharmaceutical services must comply with article 7of the public health code, 1978 PA 368, MCL 333.7101 to 333.7545, and applicable administrative rules.
(c) The CSU shall have policies and procedures to address medication substitution.
(d) A copy of the pharmacy license must be provided to the department upon request.
R 330.176 Laboratory services.
Rule 26. (1) A CSU shall ensure the capability to perform necessary laboratory work and other diagnostic procedures that are commonly required to treat individuals experiencing serious behavioral health crisis as ordered by the physician.
(2) Laboratory services must be made available 24 hours a day, 7 days a week, and 365 days a year.
(3) Laboratory services may be provided either directly by the CSU or through a contractual relationship and must be certified and operate as required by the Clinical Laboratory Improvement Amendments of 1988, 42 USC 263a.
R 330.177 Transportation.
Rule 27. (1) The CSU shall provide or ensure necessary voluntary transportation for transfer of care or discharge, and in rare circumstances, to outside appointments, to ensure the individual’s access and safe passage to the appropriate destination, community-based services, or both.
(2) Transportation required to seek treatment for a medical emergency must be delegated to 911 or a licensed local emergency medical transportation provider.
SUBPART B: PHYSICAL PLANT AND NON-CLINICAL OPERATIONS REQUIREMENTS
PHYSICAL PLANT REQUIREMENTS
R 330.178 Variances.
Rule 28. Requests
for variances for any of these standards for CSUs operating within existing
structures are considered part of the certification process.
R 330.179. Physical plant requirements.
Rule 29. (1) All CSUs shall be locked facilities.
(2) A CSU’s physical plant must include, at a minimum, the following areas:
(a) Entrance and intake areas, including the following:
(i) A drop-off area for law enforcement that preserves the privacy of the individual being brought to the CSU, facilitates a rapid transfer from law enforcement to the CSU, and protects other individuals from being triggered by the presence of law enforcement.
(ii) A screening area, which must be a separate, locked room adjacent to the waiting area where a screening for contraband may be conducted.
(b) Waiting room or rooms, including the following:
(i) Adequate space and seating to accommodate the anticipated number of individuals receiving services and visitors, including family members and support persons who remain on-site when not engaged in assessment, treatment, or discharge planning.
(ii) Visual access into the room by staff.
(c) Medical examination room.
(d) Area for observation, evaluation, and stabilization of individuals receiving services that is distinct from the waiting area, including the following:
(i) A multiple-individual observation area.
(ii) Individual observation, behavioral health treatment, or consultation rooms.
(iii) Single occupancy sleeping rooms for individuals receiving services. Sleeping rooms must have at least 80 square feet of floor space.
(e) Space for therapeutic stabilization activities.
(f) Rooms with adequate and comfortable space for meeting with family members, support persons, and community providers.
(g) Flexible spaces available for quiet activities, sensory activities, and engagement with others.
(h) Restraint room.
(i) Areas to address nourishment needs of individuals receiving treatment and visitors.
(j) Toileting and hygiene, including at least 1 gender-neutral common bathroom for individuals receiving services, and a minimum ratio of 1 shower per 8 beds and 1 toilet and lavatory per 6 beds or recliners.
(k) Secured storage space for personal possessions of individuals receiving services.
(3) No individual waiting for or receiving services may be placed in a hallway or other area not designated as waiting, treatment, consultation, or observation areas on the floor plan submitted with the application.
(4) A living room, dining room, hallway, basement, or other room not ordinarily used for observation, treatment, or sleeping must not be used for sleeping purposes by individuals receiving services, visitors, or staff.
R 330.180 Design, construction, and environmental standards.
Rule 30. (1) A CSU’s physical plant must be designed in a manner that includes all the following:
(a) Addresses the needs of individuals who will only stay a few hours, as well as those who may stay up to 72 hours on a voluntary or involuntary basis.
(b) Provides a welcoming, non-institutional, low-sensory stimulating environment that supports calming and de-escalation.
(c) Ensures the safety of individuals receiving services, visitors, and staff.
(2) Design and construction of the CSU must be consistent and comply with the following:
(a) The department adopts by reference the Michigan Outpatient Facilities Design Code 2018 https://up.codes/viewer/michigan/fgi-outpatient-facilities-2018/.
(b) Any additional physical plant or area-specific requirements contained in these rules.
(c) CMS requirements necessary to ensure continued receipt of federal reimbursement for care and services.
(d) Applicable codes as required by the local authority having jurisdiction over the CSU.
(4) Where conflicts exist, the CSU shall comply with the requirement that is most protective of the individual’s health and safety.
Rule 31. (1) A CSU shall have at least 1 designated room for use for restraint for every 16 potential individuals receiving services.
(2) Designated restraint rooms must be away from the common area and provide staff full visual access to the individual receiving services.
(3) The restraint room must have all of the following:
(a) A commercially designed bed for use with restraints that is secured to the floor and without sharp edges. The surface of the bed must be impermeable to resist penetration by body fluids.
(b) The walls, flooring, and door to the room must be free of sharp edges or corners, strongly constructed to withstand repeated physical assaults and contain only anti-ligature fixtures and hardware.
(c) The floors and walls must be coated with an impermeable finish up to a minimum height of 3 feet to resist penetration of body fluids.
(d) The room must be a minimum of 100 square feet. The ceiling height must be at least 9 feet.
(e) The door to the room must be designed to allow for outward swinging egress.
(f) The bed placement in the room must provide adequate space for staff to apply restraints and must not allow individuals receiving services to access the lights, smoke detectors, or other items that may be in the ceiling of the room.
(g) Where the interior of a room is padded with combustible materials, the floors, walls, ceiling, and all openings must be protected with not less than 1-hour rated construction.
R 330.182 Environment; maintenance.
Rule 32. (1) A CSU shall maintain the environmental temperature between 65 and 82 degrees Fahrenheit.
(2) The plumbing system must supply hot water at all times to meet the needs of each individual receiving services and the functional needs of the various service areas. There must be no cross-connections.
(3) Hot water temperatures at fixture outlets must be regulated and provide tempered water in the range of 105 to 110 degrees Fahrenheit.
(4) If water is not from a municipal source or a source regulated by the local health department, the CSU must test the drinking water as follows:
(a) A minimum of once every 12 months for total coliform bacteria and fecal coliform or Escherichia coli bacteria.
(b) A minimum of every 3 years for arsenic, copper, lead, and other contaminants as recommended by the local health department.
(c) Documentation of testing must be retained until the completion and receipt of results for the subsequent test.
(5) All garbage and rubbish containing food wastes must be kept in leakproof, nonabsorbent containers that must be kept covered with tight-fitting lids and removed from the premises at least weekly.
(6) If pets or support animals are allowed in the CSU, they must be all the following:
(a) Managed to limit exposure to other individuals receiving services or staff, especially those with allergy concerns.
(b) Controlled to prevent endangering or impacting others and to maintain sanitation.
(c) Licensed consistent with local ordinances.
(d) A dog or cat must be vaccinated against rabies.
(7) A CSU shall maintain medical safety equipment to include an automated external defibrillator and all other necessary medical safety supplies.
(8) Equipment used at the CSU must be all the following:
(a) Maintained in working order.
(b) Tested, calibrated, and used according to the manufacturer’s recommendations or, if there are no manufacturer’s recommendations, as specified in policies and procedures.
(c) Documentation of equipment testing, calibration, and repair is maintained until completion of the subsequent testing, calibration, or repair.
Rule 33. (1) A CSU shall make available to individuals requiring services, visitors, and staff masks and personal protective equipment.
(2) A CSU shall develop and implement policies and procedures for infection control and prevention that include the following:
(a) Standard precautions are defined, and personal protective equipment is used when handling blood, body substances, excretions, and secretions.
(b) Proper hand washing techniques.
(c) Proper disposal of biohazards, including the following:
(i) Potentially infected waste and spills management.
(ii) Needles, lancets, scissors, tweezers, and other sharp instruments.
(d) Prevention and treatment of needle stick or sharp injuries.
(e) The management of common illness likely to be emergent in the CSU service setting, including, but not limited to, the following:
(i) Methicillin-Resistant Staphylococcus Aureus.
(ii) Colds and influenza.
(iii) Gastrointestinal viruses.
(iv) Pediculosis.
(v) Tinea pedis.
(f) Specific procedures to manage infectious diseases including, but not limited to, the following:
(i) Tuberculosis.
(ii) Hepatitis B.
(iii) Human Immunodeficiency Virus.
(iv) Acquired Immune Deficiency Syndrome.
(g) Handling and maintenance of equipment.
(h) Annual review of the CSU’s infection control risk assessment for effectiveness, and revision, if necessary.
(i) Procedures to ensure that bed linens and towels are washed, stored, and transported in a manner that prevents the spread of infection.
(j) Staff training in, and adherence to, infection control practices.
(3) In relation to individuals receiving services who are carriers of an infectious illness, the transfer and the release of confidential information to select unit medical and direct care staff is on a need-to-know basis.
R 330.184 Food service.
Rule 34. (1) A CSU shall provide a minimum of 3 regular nutritious meals daily to individuals receiving services. Not more than 14 hours shall elapse between the evening and morning meal.
(2) Nutritious snacks must be available upon request for individuals receiving services unless there are medical orders justifying restrictions.
(3) Under no circumstances may food be withheld for disciplinary reasons, nor may food be used as a form of reward.
(4) For food and nutrition services, including preparation, storage, and service, the department adopts by reference the Michigan modified food code, https://www.michigan.gov/-/media/Project/Websites/mdard/documents/food-dairy/laws/mi_modified_2009_food_code.pdf?rev=f69c9a99cc3248bf953c37e782e6e1f7, which the CSU must comply with, and must be licensed and inspected as required by the local health department.
(6) Foods, drinks, and condiments must be dated when opened and discarded when expired.
R 330.185 Additional requirements.
Rule 35. (1) A CSU shall ensure a telephone is available and accessible to individuals receiving services, and that individuals have access to communicate with others as required by section 726 of the mental health code, 1974 PA 258, MCL 330.1726.
(2) A CSU shall have readily available, convenient access to laundry facilities for the purposes of laundering clothing of individuals receiving services and CSU linens.
(3) A CSU shall ensure reasonable access to meals and snacks for family members or support persons who are staying with the individual receiving services. This may include food for purchase on-site or accessible proximity to external food service providers.
(4) A CSU shall comply with all federal, state, and local fire safety laws and codes.
(5) A CSU shall have fire inspections conducted according to the timeframe established by the local fire department or the state fire marshal, make any repairs or corrections stated on the fire inspection report, and maintain documentation of a current fire inspection.
(6) A CSU shall have an evacuation plan or written procedures in case of fire, medical emergency, severe weather emergency, and encounters of aggressive individuals or individuals with weapons. Individuals receiving services who may require special assistance must be identified in the written procedure.
(7) There must be protocols for and documentation of safety drills, including fire drills, severe weather drills, and encounters of aggressive individuals or individuals with weapons.
(8) A CSU shall ensure that all staff, individuals receiving services, and visitors are familiar, to the best of their ability, with the evacuation plan and emergency procedures.
(9) A CSU shall, if necessary, ensure emergency transportation of individuals receiving services through the use of an ambulance service during an emergency or evacuation.
The evacuation plan and emergency procedures must be prominently posted in the CSU.
(10) A CSU shall post all health, safety, recipient rights, and public notices as required by the department and state and federal governments.
(11) A CSU shall accommodate limited English proficiency and ensure that services are accessible for all individuals with visual and hearing impairments.
SUBPART C: STAFFING AND PERSONAL MANAGEMENT
R 330.186 Staffing assessment; required personnel.
Rule 36. (1) A CSU shall have sufficient staff to conduct all the functions of the CSU 24 hours a day, 7 days a week, and 365 days a year, including staff who ensure the safety and security of the individual receiving services, visitors, and staff.
(2) Staff may only operate within their licensed or certified scope of practice. Nothing in these rules shall be construed to authorize a staff member to operate outside of that scope.
(3) Before submitting an application for initial or renewal of certification, the applicant CSU shall conduct an assessment of services offered by the program and identify staffing levels.
(4) The assessment must be based on recommended staffing practices as outlined in the CSU best practice and policy handbook and be consistent with the supervision requirements applicable to psychiatric hospitals.
(5) The assessment must provide all the following:
(a) Identification of the population to be served and the services offered by the program.
(b) The number and level of staff required to provide those services.
(c) The licensing and credentialing requirements for the staff identified.
(6) The assessment must have a component that addresses milieu management and security.
(7) The assessment must have a component that addresses diversity, equity, and inclusion, including efforts to have staff demographics resemble those of the individuals served, and the cultural competencies of staff with respect to the demographics of the service area.
(8) The assessment must be completed and documented by the applicant or certified CSU annually or when there is a change in services or the needs of the individuals served by the CSU, whichever is sooner.
(9) The assessment serves as the foundation for the staffing plan that is submitted for approval by the department as part of the certification process.
(10) A CSU shall have the following minimum staff positions at staffing levels identified through the staffing assessment:
(a) Medical director who is a psychiatrist and serves as the chief medical officer of the CSU and has overall responsibility for treatment of individuals receiving services within a CSU and supervisory responsibility over all medical practitioners at the CSU.
(b) Chief administrative officer.
(c) Nursing administrator.
(d) Registered nurse.
(e) Clinic supervisor with responsibility for non-medical interactions with individuals receiving services.
(f) Peer specialists and peer recovery coaches, scheduled to allow for all individuals receiving services to have access, at a minimum, during waking hours.
(g) Staff must be trained or licensed or credentialed, or both, to do all of the following:
(i) Assess the needs of individuals receiving services as individuals and within the context of their self-identified family and community.
(ii) Carry out behavioral health stabilization services and supports including the following:
(A) Therapeutic interventions.
(B) Discharge planning and facilitating linkages to the community and natural supports.
(C) Monitoring safety and providing milieu management.
(h) Assistive personnel to engage individuals receiving services and foster recovery goals.
(i) Uniformed security personnel who are required to do the following:
(A) Shall be limited to building entrance and perimeter security.
(B) Shall not be assigned to have a regular or direct presence in treatment areas for individuals receiving services.
(C) Shall not serve as a greeter or receptionist at the CSU.
(D) Shall follow confidentiality rules similar to healthcare personnel.
(E) Shall have protocols for calling in back-up or additional personnel when necessary.
(a) One registered nurse must be on duty and on-site 24 hours a day, 7 days a week, and 365 days a year.
(b) A minimum of 1 staff individual trained in each of the following must be on duty and on-site 24 hours a day, 7 days a week, and 365 days a year:
(i) Basic cardiac life support.
(ii) Use of an automated external defibrillator equipment.
(iii) Naloxone administration.
(c) A psychiatrist who is available on site or on call 24 hours a day, 7 days a week, and 365 days a year.
(d) A medical practitioner who is authorized by the mental health code, 1974 PA 258, MCL 330.1001 to MCL 330.2106, to order restraint who is available onsite or on-call and available to respond by phone within 30 minutes or, if required, to arrive on-site within 2 hours.
(e) The ratio of combined nursing staff, clinical staff, and assistive personnel to individuals receiving services must be at least 1:4, however, at no time may there be less than 3 staff persons on-site.
(12) The CSU shall consider the acuity levels and clinical and safety needs of individuals being served at the time and adjust staffing levels based on those needs, with special attention to the required levels of observation and support for high-risk individuals.
(13) The CSU staffing plan must adequately ensure staffing needed for provision of minor medical care as defined in the CSU best practice and policy handbook in order to meet timeliness of care standards, reduce medical adverse events, and minimize transfers to emergency departments.
(14) On-site staffing levels shall be adequate to allow for individuals to be engaged with and able to view individuals receiving services 24 hours a day, 7 days a week, and 365 days a year according to safety monitoring policies and to address fire code requirements for safe evacuation.
(15) A CSU's staffing must meet the requirements of R 325.1388.
R 330.187 Peer specialists; peer recovery coaches.
Rule 37. (1) Peer specialists and peer recovery coaches shall be certified within the first 90 days of employment.
(2) Peer specialists and peer recovery coaches shall be maximized throughout the stabilization process for individuals receiving services, including from the first point of contact through to discharge, where the peer specialists and peer recovery coaches participate as a member of the stabilization team, and continuing active engagement until the individual is actively engaged in community treatment services.
(3) The CSU shall create a policy that defines the role of a peer specialist or peer recovery coach, or both, within CSU services in order to ensure that the peer impact is maximized in guiding individuals receiving services in their path to recovery. This policy must address efforts to prevent peer drift and ensure peers maintain a supportive role in healing.
(4) Peer specialists and peer recovery coaches may not participate in the application of the restraints, though they shall be engaged in the de-escalation process through verbal de-escalation, partnering, and supporting other individuals receiving services.
(5) Peer specialists and peer recovery coaches shall engage with the individual receiving services following discontinuance of the restraint order to debrief and assist in updating the safety plan.
R 330.188 Staff qualifications; competencies, training.
Rule 38. (1) A CSU shall have all of the following staff requirements in order to serve its population:
(a) Staff with qualifications, skills, and knowledge needed to serve the CSU’s target population and the diverse subgroups within its service area, including, but not limited to, cultural, racial, tribal nations, and LGBTQ+.
(b) Written job descriptions describing the specific qualifications, competencies, and knowledge required for each staff position to provide the expected physical health services and behavioral health services listed in the job description.
(c) An onboarding plan for each position that is specifically tailored to that position. This plan must outline the time frames for training and orientation activities from before providing services to the first 60 days of employment, at which time all onboarding and orientation activities must be complete.
(d) A staff development plan tailored to each position and containing annually required training. The plan must be customizable by each staff person’s strengths and growth areas. This plan must also contain annually required training.
(e) Establish and implement a core list of training topic areas for all staff in accordance with requirements by the department in the Medicaid provider manual and the CSU best practice and policy handbook, and which include the core competencies outlined in the certified crisis professional training or equivalent.
(2) Staff development and training for personnel must be designed to meet needs of all populations and diverse subgroups within the CSU’s geographic region, and include training related to diversity, equity, inclusion, and cultural competency.
(3) The department, with input from stakeholders, shall develop and keep current a list of required trainings contained within the CSU best practice and policy handbook, ensuring at least 6 months advanced notice before requiring any changes to the training requirements.
(4) A CSU shall have a written job description for each staff position that identifies all of the following:
(a) Job title.
(b) Tasks and responsibilities.
(c) Education and experience requirements.
(d) Skills, knowledge, and training requirements.
(e) Licensure or credentialing required, as applicable.
(f) Any supervisory roles and responsibilities for other staff members, including of individuals with a limited or temporary license.
(6) A CSU shall ensure that all functions performed by staff whose practice is regulated or licensed by this state are within the scope allowed by the laws of this state and professional practice acts.
(7) A CSU shall have procedures for verifying licenses, credentials, experience, and competence of staff.
(8) A CSU shall comply with all applicable laws, rules, and regulations governing criminal history records checks.
(9) A CSU shall ensure that all persons providing services comply with all applicable laws, rules, and regulations regarding professional or nonprofessional licenses, certifications, and qualifications to provide services within the CSU.
(10) Personnel policies, procedures, and job descriptions must be reviewed and documented annually and updated, as necessary.
R 330.189 Personnel records.
Rule 39. (1) A CSU shall maintain personnel records for each staff member that includes the following:
(a) The individual’s name, date of birth, and contact telephone number.
(b) The individual’s starting date of employment or volunteer service and, if applicable, the ending date.
(c) Documentation of all of the following:
(i) The staff member’s qualifications, including competencies and knowledge applicable to the employee’s job duties.
(ii) The staff member’s education and experience applicable to the employee’s job duties.
(iii) The staff member’s completed onboarding orientation and training as described in R 330.188.
(iv) The staff member’s current license or certification, if applicable.
(v) The staff member’s compliance with training requirements.
(vi) Evidence of freedom from infectious tuberculosis.
(vii) A valid driver’s license if the staff person will be providing transportation.
(2) A CSU shall maintain personnel records throughout an individual’s period of providing services in or for the CSU for at least 7 years after the last date the individual provided those services.
(3) The department shall have access to personnel records of a CSU upon request to ensure adherence to these certification standards.
R 330.190 Required policies and procedures.
Rule 40. (1) A CSU shall have policies and procedures that are established, documented, and implemented that, at a minimum, do the following:
(a) Ensure compliance with the PIHP contractual requirements to provide residential withdrawal management programs no higher than level ASAM 3.7.
(b) Ensure compliance with the Michigan modified food code.
(c) Ensure compliance with applicable federal, state, and local building, fire, safety, and sanitation codes.
(2) A CSU shall comply with all federal and district laws and regulations, including, but not limited to, the following in order to prevent inappropriate referrals between entities of common ownership:
(a) False Claims Act, 31 USC 3729 to 3733.
(b) Anti-Kickback Statute, 42 USC 1320a to 7b.
(c) Physician Self-Referral Law, 42 USC 1395nn.
(d) Exclusion Statute, 42 USC 1320a-7.
(3) A CSU shall have policies and procedures codifying and operationalizing all requirements as outlined in the CSU certification standards and addressed in the department’s CSU best practice and policy handbook, including, at a minimum, the following:
(a) Admission.
(b) Discharge planning, including protocols to be followed for referrals and transfer of care to the following:
(i) Outpatient.
(ii) Partial hospitalization.
(iii) Residential services.
(iv) Inpatient services.
(v) Recovery supports.
(vi) Other community resources.
(c) Provision of services and treatments of the CSU, including the following:
(i) The promotion and encouragement of the involvement in care of family members and support persons through assessment, stabilization, treatment, discharge planning, and follow up.
(ii) Treatment flow, including assessment and application of mental health crisis protocol or substance use disorder protocols.
(iii) Involvement of community resources, especially current behavioral health service providers during assessment, care, discharge planning, and follow-up.
(iv) Transportation, including protocols to ensure that individuals providing transportation have a valid driving license, a safe driving record, and required insurance.
(d) Orders for care and observation of individuals receiving services, including precautions for fall risk, violence, elopement, and self-harm.
(e) Physical care needs including food, clothing, and hygiene.
(f) Safety of individuals receiving services, staff, and visitors, including the following:
(i) The role of all personnel in practicing de-escalation and promoting a trauma-informed environment.
(ii) Control of potentially injurious contraband items, including a screening of individuals and their belongings for contraband upon arrival at the CSU.
(iii) Removal of ligature risks.
(iv) Promotion of a prosocial environment where respect and dignity of others is a primary mission of the program.
(v) Escalation of concerns, including, but not limited to, safety and behavioral issues.
(vi) Emergency preparedness for fire, medical emergency, severe weather emergency, and encounters of aggressive individuals, or individuals with weapons.
(vii) Control and disposal of items, including, but not limited to, any of the following:
(A) Flammables.
(B) Toxins.
(C) Ropes.
(D) Wire clothes hangers.
(E) Scissors.
(F) Luggage straps.
(G) Belts.
(H) Knives.
(I) Shoestrings.
(J) Housekeeping supplies and chemicals.
(K) Nursing and medical supplies.
(L) Needles and other sharps.
(M) Breakable items.
(g) Rights and privacy of individuals receiving services, including the following:
(i) Procedures to prevent unauthorized access to medical records of individuals receiving services.
(ii) Procedures to safeguard the personal possessions and money of individuals receiving services.
(iii) Procedures to accurately account for and return possessions and money to the individual receiving services upon discharge.
(h) Staffing.
(i) Continuity of operations in circumstances of severe weather, facility disruption, or unexpected staff shortage.
(j) Complaint processes.
(k) Quality management.
(l) Record keeping.
(m) Billing.
(n) Telehealth, including when the use of telehealth is appropriate and when in-person care is required.
(o) Diversity, equity, and inclusion, including all the following:
(i) Policies to ensure that staff demographics and cultural competencies are appropriate for the geographic service area of the CSU.
(ii) Procedures for supporting individuals with limited English proficiency, as well as individuals with visual or hearing impairments, or both.
(iii) Procedures for supporting individuals with intellectual or developmental disabilities, or both.
(iv) Procedures for supporting those who identify with the LGBTQ+ communities.
(p) A CSU shall follow a written regular review schedule of policies and procedures where each policy and procedure is reviewed no less than every 3 years, and more frequently as necessary.
(q) Reviews must be documented through date and signature on the policy and procedure or by meeting minutes that list the specific policies and procedures reviewed.
(r) Policies and procedures must be available to all personnel members, employees, volunteers, and interns or students.
(s) Policies and procedures required by these rules must be provided to the department within 2 hours after a department request, or as soon as possible pending staff availability and as agreed to by the department.
R 330.191 Administrative and medical records of individuals receiving services.
Rule 41. (1) A CSU shall maintain an electronic medical record for each individual receiving services, in accordance with the mental health code, 1974 PA 258, MCL 330.1001 to MCL 330.2106, and Medicaid requirements.
(2) The electronic records system must comply with all relevant confidentiality standards, including 42 CFR Part 2.
(3) The date and time stamps in a medical record must be recorded by the computer’s internal clock.
(a) Individual-identifying information and available psychiatric medical and relevant social history, including the individual’s residential situation and the details of the circumstances leading to the individual’s presentation at the CSU.
(b) The name of the person or persons who have referred or brought the individual to the CSU.
(c) In the case of individuals brought to the CSU by law enforcement officers, the name of the officer and information provided by the officer at the time of drop off.
(d) A copy of the admission assessment and outcome of the assessment, including the date, time, name, and credentials of the professional conducting the assessment.
(e) Any additional assessments including, but not limited to, psychiatric, nursing, and social worker or counselor assessment.
(f) Legal status documents for admission and continued stay in the CSU.
(g) Attempts to involve the individual, their individual representative, and family and support persons in assessment, crisis stabilization planning, interventions, treatments, and discharge planning, and the results of those attempts.
(h) A copy of the crisis stabilization plan.
(i) Any order given by a medical practitioner, accompanied by documentation of the rationale for changes to the care plan and response to care.
(j) Documentation of implementation of crisis stabilization interventions and treatment, the name and title of the professional or other staff providing the service, and the response of the individual receiving services.
(k) Evidence of progress toward stabilization and recovery, or lack thereof.
(l) Documentation of medical testing, if any, medical findings, medical care needs, or interventions provided.
(m) Nursing staff documentation as to the status of the individual receiving services at least once per shift.
(n) Documentation of events or incidents that affect care and treatment, including the response of the individual receiving services.
(o) Documentation of integrating care with community resources, as applicable.
(p) Documentation relevant to physical management and restraint, consistent with R 330.7243.
(q) Record of implementation of emergency safety interventions of last resort, including physical management and restraint, if implemented.
(r) Name and title of staff providing care and treatment.
(s) Discharge notes and aftercare plans, including the status of the individual receiving services at discharge, ongoing needs, aftercare plan, and the date, time, and method of discharge.
(t) Documentation of follow-up services.
(u) Emergency contact information including, but not limited to, the individual’s representative, if applicable.
(v) Consent forms as required and applicable.
(w) Within 24 hours after discharge from a program or transfer to another program, a discharge summary.
(x) Documentation of the distribution of the discharge summary according to R 330.173.
R 330.192 Record maintenance and storage.
Rule 42. (1) Medical records of individuals receiving services must be preserved and be readily available to ensure necessary and immediate access by staff authorized to deliver needed care and services.
(2) Medical records of individuals receiving services must be secured to ensure confidentiality and protection from access by unauthorized persons in accordance with federal laws and the laws of this state.
(3) Medical records of individuals receiving services that contain healthcare treatment and services must be maintained for at least 7 years after the date of service and in accordance with the medical records access act, 2004 PA 47, MCL 333.26261 to 333.26271.
(4) A program shall maintain, at a minimum, the following administrative records:
(a) Daily census records that identify the specific number of individuals receiving services and referral sources.
(b) Incident records, including all instances of accidents, injuries, or deaths.
(c) Administrative records must be maintained in accordance with the department’s records and retention policy.
R 330.193 Reporting of critical incidents and sentinel events.
Rule 43. (1) A CSU shall respond to and report all critical incidents, sentinel events, or adverse outcomes experienced by individuals receiving services or others consistent with the department’s requirements for prepaid inpatient health plans.
(2) All new staff shall receive training that must include, at a minimum, the definition of incidents, reporting procedures, an overview of the review process, and the role of risk management.
(3) Refresher incident reporting training must be conducted at least annually for all staff and evidence of the training must be recorded in the staff personnel file.
(4) A CSU shall have internal mechanisms to document, investigate, and take appropriate action for complaints and incidents that are not required to be reported to the department and the office of recipient rights of the local CMHSP.
R 330.194 Quality improvement; data reporting.
Rule 44. (1) A CSU shall comply with all quality improvement and data reporting requirements as developed and updated by the department, to include, at a minimum, the following:
(a) All critical incidents.
(b) Sentinel events.
(c) Instances of physical management not resulting in injury and all instances of restraint.
(2) Metrics of timeliness of care, medical adverse events, and emergency department transfers must be maintained by the CSU and utilized for continuous quality improvement with the goal of maximizing positive medical outcomes.
(3) A CSU shall collect data on all payor types and submit it through the department’s designated data collection system.
(4) A CSU shall provide near real time information on capacity in the department-designated psychiatric bed registry.
SUBPART E: PARTNERSHIPS AND COLLABORATION
R 330.195 Formal agreements for services; referral mechanisms; collaborative relationships.
Rule 45. (1) A CSU shall be formally established as a preadmission screening unit by the local CMHSP.
(2) A CSU shall have a formal agreement with area CMHSPs and PIHPs for services provided to individuals utilizing public behavioral health funds, including all of the following:
(a) Outreach and enrollment for eligible health coverage.
(b) Payment for SUD services required to be provided by these rules.
(c) Annual rate setting.
(d) Proper communication with payers.
(e) Methods for resolving billing disputes between providers and payers.
(3) A CSU shall have documented agreements and referral mechanisms for psychiatric disorders, substance use disorders, and physical healthcare needs that are beyond the scope of the CSU and require inpatient treatment.
(4) A CSU shall have documented collaborative relationships with other major participants in the local crisis continuum of care, including the following:
(a) Law enforcement agencies.
(b) Emergency departments.
(c) Michigan crisis and access line and other regional 988 entities.
(d) Mobile crisis services.
(e) Emergency medical services.
(f) 911 dispatch.
(5) The collaborative relationship must be evidenced by any of the following that reflect the parties’ expectations, roles, and responsibilities:
(a) Contracts.
(b) Memorandums of agreement.
(c) Memorandums of understanding.
(d) Written communication between parties, including other means such as meeting minutes.
(6) A CSU shall proactively identify transportation resources and develop memorandums of understanding with community partners to provide transportation to and from CSUs for individuals receiving services and their families.
SUBPART F: FINANCIAL REQUIREMENTS
R 330.196 Reimbursement for services.
Rule 46. (1) A CSU shall identify and seek reimbursement from all other liable third parties.
(2) A CSU shall have a designated staff person available on-site or by phone to assist the individual receiving services and family members in identifying sources of, and applying for, financial assistance, including, but not limited to, insurance, to minimize the financial burden of paying for crisis services.
(3) A CSU shall have the capability to bill Medicaid for payments and comply with all Medicaid eligibility requirements for payment for services at the CSU.
(4) A CSU may charge responsible parties for that portion of the financial liability that is not met by insurance coverage. Subject to section 814 of the mental health code, 1974 PA 258, MCL 330.1814, the amount of the charge must be the least of the following amounts:
(a) The responsible party’s ability as determined in accordance with the requirements of the federal sliding fee discount program under 42 USC 254g and related guidance. Eligibility for the sliding fee discount program must be based solely on family size and income in accordance with the most current federal poverty guidelines published annually in the Federal Register by the United States Department of Health and Human Services under its authority to revise the poverty line under 42 USC 9902, as determined under section 818 of the mental health code, 1974 PA 258, MCL 330.1818.
(b) Cost of services as defined in section 800 of the mental health code, 1974 PA 258, MCL 330.1800.
(c) The amount of coinsurance and deductible in accordance with the terms of participation with a payer or payer group.
(5) A CSU shall waive payment of that part of a charge determined under subrule (4) in this rule that exceeds financial liability. A CSU shall not impose charges in excess of ability to pay.
PART 3: COMPLAINT FILED WITH PROGRAM, INVESTIGATION
R 330.197 Complaint procedure; investigation; timeframes; prohibitions.
Rule 47. (1) A CSU shall conspicuously post a description provided by the department of complaint procedures established by these rules and the name, address, and telephone number of an individual authorized by the department to receive complaints.
(2) A person who believes that a CSU has violated any requirements of the public health code, 1978 PA 368, MCL 333.1101 to 333.25211, the mental health code, 1974 PA 258, MCL 330.1001 to MCL 330.2106, including, but not limited to, recipient rights, state or federal law, or these rules may request an investigation of the CSU. The request must be submitted to the department in writing, or the department shall assist the individual in transferring an oral complaint to writing within 7 days after the oral request is made. Any request for investigation related to an apparent or suspected violation of the rights of the individual receiving services must also be forwarded to the office of recipient rights of the local CMHSP.
(3) If the nature of the complaint necessitates an on-site inspection, the substance of the complaint must be provided to the CSU no earlier than at the commencement of the on-site inspection.
(4) Disclosure of the name of the complainant or an individual receiving services named in the complaint, a copy of the complaint, the written determination, a copy of the written determination or a record published, released, or otherwise disclosed by the department or the CSU, is not allowed unless 1 of the following applies:
(a) For a complaint related to the apparent or suspected violation of recipient rights, the disclosure must comply with chapter 7 of the mental health code, 1974 PA 258, MCL 330.1700 to 330.1758, and applicable administrative rules.
(b) For a complaint not related to an apparent or suspected violation of recipient rights of the complainant or individual named in the complaint, disclosure may occur under any of the following:
(i) The complainant or individual named in the complaint consents in writing to the disclosure.
(ii) The investigation results in an administrative hearing or a judicial proceeding.
(iii) The disclosure is considered essential to the investigation by the department and the complainant has been given the opportunity to withdraw the complaint before disclosure.
(5) Upon receipt of a complaint, the department shall determine, based on the allegations presented, whether requirements of any of the following have been, or are in danger of being, violated:
(a) The public health code, 1978 PA 368, MCL 333.1101 to 333.25211.
(b) The mental health code, 1974 PA 258, MCL 330.1001 to MCL 330.2106.
(c) Federal laws or the laws of this state.
(d) The Michigan Administrative Code.
(6) Information or records shared under these subrules must not be released by the department unless otherwise allowed by these rules, the mental health code, 1974 PA 258, MCL 330.1001 to MCL 330.2106, or other applicable state or federal law.
(7) Complaint investigations may include, but are not limited to, any of the following, which may occur in person, on-site, or via videoconference or phone:
(a) Observation of the operation of the program.
(b) Assessment and copying of relevant records, including recipient records, videos, and other documents or data collected and maintained either on paper or electronically by the CSU.
(c) A CSU shall not alter or destroy a record that may be relevant to the investigation once the CSU becomes aware that a complaint has or may be filed. Recipient records that are subject to updating must include an electronic date and time stamp of the update.
(d) Collection of other information, including otherwise privileged or confidential information, from any individual who may have information bearing on a CSU’s compliance or ability to comply with the requirements for certification.
(8) The department shall investigate the complaint according to the urgency determined by the department, but commencement of the investigation cannot be more than 15 days after receipt of the written complaint by the department.
R 330.198 Suspension of certification pending hearing; notice to complainant;
administrative review; reopening investigation.
Rule 48. (1) The department may take immediate action against a CSU and suspend a certification for 10 days pending a hearing, after an investigation finds that there is an immediate threat to the health or safety of the individual receiving services or employees of a CSU.
(2) The department shall inform the complainant of its findings.
(3) Within 90 days after the receipt of a complaint, the department shall provide the complainant a copy, if any, of the written determination or a status report indicating when the written determination may be expected. The final written determination must include a copy of the original complaint.
(4) The complainant may request additional copies of the documents listed in R 330.197 to R 330.199 and must reimburse the department for the copies under the freedom of information act, 1976 PA 442, MCL 15.231 to 15.246.
(5) The department shall inform the CSU of the department's findings at the same time that the department informs the complainant.
(6) A written determination concerning a complaint must be available for public inspection.
(7) A complainant who is dissatisfied with the determination or investigation may request an administrative review by the department, separate from the process of recipient rights appeals in the mental health code, 1974 PA 258, MCL 330.1001 to MCL 330.2106.
(8) The complainant shall file a request in writing to the department director, or the director's designee, within 30 days after receipt of the written notice of the department’s decision.
(9) The administrative review must be conducted based on pertinent documentation or a verifiable statement submitted in writing by the complainant.
(10) The department shall send the results of the administrative review to the complainant. If the administrative review results in reconsideration of a complaint against the CSU, the department must reopen the complaint investigation.
R 330.199 Revocation, denial to renew; timeframes notice of intent; administrative review.
Rule 49. (1) When the department determines that a CSU has committed an act or engaged in conduct or practices that warrants the revocation of certification or the denial to renew certification, the department shall issue a notice of intent that includes all of the following:
(a) The reason or reasons for the revocation of certification or the denial to renew certification.
(b) The date, time, and location for a compliance conference. The compliance conference must take place at least 45 days after the date of the notice of intent.
(c) Guidance to the CSU that a written appeal of the notice of intent must be submitted to the department within 30 days after the date of the notice of intent for the compliance conference to occur.
(2) If a CSU does not submit a written appeal of the notice of intent within 30 days after the date of notice of intent, the department may revoke or not renew certification. This action on certification must be final and is not subject to administrative appeal.
(3) If a CSU submits a timely appeal of the notice of intent, the department shall hold the compliance conference as indicated in the notice of intent. The CSU shall be afforded an opportunity to show compliance with all lawful requirements for certification.
(4) Instead of suspending or revoking the certification where there are serious concerns with compliance with certification requirements that do not create an immediate threat to the health or safety of individuals receiving services or employees of a CSU, the department may schedule the CSU for a probation period of no less than 30 days if the CSU is found in noncompliance and requires corrective action.
(5) A party aggrieved by the decision of the department following administrative review may seek judicial review in accordance with chapter 6 of the administrative procedures act of 1969, 1969 PA 306, MCL 24.301 to 24.306.