This section provides an overview of mental restoration services and policy on
Mental restoration services are
*Based on CFR Section 361.5 (b)(40)(i)
*Mental restoration services are purchased only when comparable benefits, such as community-based behavioral health and developmental disability services centers or indigent care services, are not available to provide them.*
*Based on CFR Section 361.48(e)
If a licensed psychologist or psychiatrist recommends or prescribes mental restoration services, you may purchase them from
Note: Mental restoration services provided by an intern who is working under the supervision of a licensed provider are purchased at the supervising licensed provider's payment rate.
Mental restoration services are limited to the purchase of psychotherapy and outpatient psychiatric treatment.
Sessions with qualified providers are limited to
Visits to a psychiatrist for medication monitoring only are not subject to these limitations, but are subject to limitations on outpatient treatment (see Chapter 6: Physical Restoration Services, 6.4.24 Outpatient Services).
DRS does not pay for inpatient psychiatric treatment.
A "no-show" occurs when a DRS consumer:
If a no-show occurs and if the provider chooses to bill DARS for the no-show, the acceptable fee is limited to 50 percent of the payment allowed by the Maximum Affordable Payment Schedule (MAPS) for the codes authorized on the service authorization.
DRS accepts for consideration only the no-show billings received from a psychiatrist, social worker, licensed professional counselor, or psychologist. No-show occurrences for other disciplines, specialties, and contractors are not subject to or eligible for no-show payments, as described in the above policy.
Applied Behavior Analysis (ABA) is used to address problem behavior that is an impediment to employment. ABA is typically used with consumers who have autism spectrum disorder, or cognitive or developmental disorders. ABA includes evaluating the problem behavior, identifying the cause, and developing a treatment plan to increase desired behaviors and decrease problem behaviors. ABA is not always indicated for autism. See guidance When to Purchase ABA Services.
To determine whether ABA is an appropriate intervention for your consumer, consider the following:
Purchase ABA services based on the provider's scope of practice, as defined below:
A Board Certified Behavior Analyst (BCBAŽ)—Master's level provider
A Board Certified Assistant Behavior Analyst (BCaBAŽ)—Bachelor's level provider implements the intervention plan under the supervision of a BCBA-D or BCBA. A graduate student in a behavior analysis program implements the intervention plan under the supervision of a BCBA-D or BCBA.
Fees for assessment and social skills support training and behavior intervention and are as follows.
|Assessment and Individual||Group|
|BCBA-D||$125 per hour||$50 per hour|
|BCBA||$75 per hour||$30 per hour|
|BCaBA or graduate student||$50 per hour||$15 per hour|
For DRS, ABA consists of two primary services:
Social skills support is for consumers who need to learn or practice social skills necessary for employment that go beyond the scope of PSAT. These consumers have social or communication deficits, but do not necessarily have problem behaviors. ABA is not always indicated for autism. See guidance When to Purchase ABA Services.
The assessment should be not exceed 4 hours. A report summarizing the assessment may include
Social skills support training may be individual or group training, or a combination of individual and group training, as recommended by the social skills assessment and recommendations. Social skills support training may not exceed 30 hours. It is conducted in the work environment but can be initiated in a therapeutic setting and then transferred to the work environment.
The final social skills support training report must include
Purchase behavior intervention services for consumers whose behaviors create an impediment to employment. ABA is not always indicated for autism. See guidance When to Purchase ABA Services.
The functional behavior assessment (FBA) analyzes a consumer's behavior in a particular environment (such as the workplace) to determine what factors are causing problem behaviors. An FBA typically takes a minimum of four hours, and is limited to a maximum of eight hours.
The FBA report summarizes data collected and provides information to assist in VR planning such as
Meet with the behavior analyst and consumer to discuss the FBA results and recommendations. If the FBA recommendations can be applied in the work setting to address the consumer's problem behaviors, intervention with the consumer may not be necessary. If intervention is necessary, arrange for a behavior intervention plan.
In the behavior intervention plan (BIP), the behavior analyst summarizes FBA findings and describes
Development of the BIP should not exceed four hours. Intervention may vary from two to ten or more hours a week, but should not exceed 30 hours.
If an intervention is not effective within the time frame recommended in the BIP, discuss with the behavior analyst whether a new FBA and BIP would be appropriate. The approval of the area manager is required for a new FBA and BIP.
A maximum of 30 hours of intervention may be provided
The intervention is conducted in the work environment. If necessary to meet the consumer's needs, intervention can begin in a nonwork environment but then must be transferred to the work setting.
A written progress report, signed by the BCBA or BCBA-D is required for payment for any assessment or intervention.
During social skills support or behavior intervention, a progress report documenting the number of hours of intervention and progress toward the planned goals must be submitted at least monthly to the counselor before payment is made.
This report must contain
The progress report must be signed by the person doing the direct intervention and, if the service is being provided by a BCaBA or graduate student, by the supervising BCBA or BCBA-D.
The Wellness Recovery Action Plan (WRAP) program is for adults with a severe mental health disability. The program's primary goal is to help consumers identify and learn to use wellness tools (coping strategies and resources) when they experience triggers or early warning signs that their mental health is worsening or when things are breaking down.
Adult with severe mental illness
An adult with severe mental illness is a person who
Wellness Recovery Action Plan (WRAP)
The WRAP program is for adults who have severe mental illness and who want to learn strategies to monitor, reduce, or eliminate uncomfortable or dangerous physical symptoms, emotions, and feelings. A participant writes a comprehensive plan to help manage his or her own illness. For specific topics in the WRAP plan, see the Wellness Recovery Action Plan section descriptions.
WRAP services can be delivered either individually or in a group setting. In group settings, the ratio between WRAP facilitators and consumers cannot be greater than one WRAP facilitator to eight consumers.
WRAP facilitators who work with consumers must follow the Copeland Center's values and ethics, process, and concepts. Facilitators must use the evidence-based model recognized by the Substance Abuse and Mental Health Services Administration. Facilitators follow the WRAP Facilitator's Training Manual and use the PowerPoint presentation slides and CD found in the training manual during presentations. The three-day WRAP curriculum may be approved in consultation with the counselor.
A consumer who can benefit most from a WRAP will learn how to use wellness tools to manage his or her disability. This is a consumer who
The consumer will learn how to use wellness tools to move forward in recovery by developing natural supports, coping skills, and self-management skills.
The consumer must be experiencing difficulties in, or lack useful life experience in, one or more of the following areas:
The WRAP benchmark is achieved when the consumer has
The fee for successful achievement of the WRAP benchmark is $500.00. The benchmark fee can be paid only one time per consumer.
A WRAP facilitator must
The prerequisites for the WRAP facilitator certification can be met by taking the Mental Health Recovery Correspondence Course. See the Copeland Center website.
Autism Spectrum Disorder: ASD is characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors and hyper or hypo reactivity to sensory input as defined by the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).
Admission Review Dismissal (ARD) committee: A required group of individuals that is formed when a student is admitted into Special Education Services. This committee must consist of the student, his or her guardian, a school administrator, a special education representative, and a regular education representative. This committee creates the student's Individualized Education Program (IEP).
Applied Behavior Analysis (ABA): ABA is the science of applying experimentally derived principles of behavior to improve socially significant behavior. ABA takes what is known about human behavior and uses it to develop and apply strategies that are intended to bring about real-world, meaningful change in the individual's behavior (Applied). In ABA, behaviors are defined in observable and measurable terms in order to assess behavior changes over time (Behavior). These behaviors are then analyzed within a real world environment to identify factors that are influencing the behavior and assess how these factors and or the behaviors can be modified (Analysis).
Barrier: A barrier is a behavior that is preventing the consumer from obtaining or maintaining employment.
Diagnostic and Statistical Manual of Mental Disorders (DSM): The DSM is the standard classification of mental disorders used by mental health professionals in the United States. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the current edition.
Direct Services: Time spent in person with the consumer
Indirect Services: Time spent providing services other than in-person support
Individualized Education Program: A school's written statement of services for a student with a disability is called an Individualized Education Program (IEP). Refer to Chapter 10: Transition Services, 10.1 Key Terms.
Targeted: Refers to barriers that are specific and that can be reduced within a relatively short period of time.
Autism Spectrum Disorder (ASD) supports are intended to address and reduce targeted barriers to employment for consumers who have been diagnosed with ASD or who have characteristics of ASD. These supports are the middle ground between clinical intervention and job coaching. They are used when the consumer needs help addressing barriers but the support does not require clinical intervention and/or is outside the role of a job coach. For more information, refer to the Examples of Possible Barriers guidance document.
Consumers must meet all of the following conditions in order to be an appropriate referral for ASD supports:
Note: The counselor must document that the consumer meets the above conditions in a ReHabWorks case note. The counselor must also document that the consumer meets one of the following conditions:
ASD Supports is a service that can be:
For additional information about ASD Supports, refer to the following guidance documents:
In order to be linked in ReHabWorks as a provider of ASD Supports, the provider must show proof of one of the following credentials:
ASD Supports can be provided individually or in a group setting
The direct individual and indirect individual service fee is $37.50 per hour.
The direct group service fee is $18.75 per hour.
The number of hours of service for ASD Supports may not exceed 120 hours per consumer per lifetime. This includes up to two hours per month of indirect service time.
The number of hours allowed to complete the DARS1880, ASD Supports Plan, may not exceed five hours per consumer per lifetime. These hours are in addition to the 120 hours of service for ASD Supports.
After it is determined that ASD Supports are the appropriate services, the DARS1879, ASD Supports Referral, should be submitted to the provider. You must document in a ReHabWorks case note that the form was completed and submitted to the provider. Maintain a copy of the form in the case file.
After the referral has been accepted by the provider and the initial consultation with the counselor has taken place, the provider makes his or her initial contact and assessment of the consumer's needs. The provider must submit the DARS1880, ASD Supports Plan. This includes:
Payment to the provider will be issued when the report and invoice have been received and approved by the counselor. The hours billed for creation of the plan may not exceed five hours.
The DARS1881, ASD Supports Time Log and Progress Report, must be completed to document each hour that is billed. The report must be submitted each time an invoice is submitted. With the information that is documented in the DARS1881, the counselor must be able to evaluate the progress that is being made and all issues that need to be addressed.