performance-contract-Addendum-III

Core Services Taxonomy 7.3
Effective July 1, 2014 for FY 2015 and
Subsequent Fiscal Years Until Superseded.
June 30, 2014
Core Services Taxonomy 7.3

06-30-2014
Table of Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Types of Community Services Boards (CSBs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Core Services Definitions: Categories and Subcategories of Services. . . . . . . . . . . . . . . . . . . . . . . . 5
Emergency and Ancillary Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Ancillary Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Consumer-Run Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Services Available at Admission to a Program Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Inpatient Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Outpatient Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Case Management Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Day Support Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Employment Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Residential Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Prevention Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Infant and Toddler Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Community Consumer Submission (CCS) Consumer Designation Codes . . . . . . . . . . . . . . . . . . . . 16
Core Services Category and Subcategory Matrix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Core Services Definitions: Units of Service, Static Capacities, Individuals Receiving Services . . 21
Inpatient Core Service and State Facility Cost Centers Crosswalk . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Performance Contract Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Appendix A: Diagnostic Checklists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Serious Mental Illness Criteria Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Serious Emotional Disturbance Criteria Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
At-Risk for Serious Emotional Disturbance Criteria Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Appendix B: Core Services Taxonomy and Medicaid ID HCB Waiver Service Crosswalk. . . . . . . 34
. . Appendix C: Retired Core Services Service Codes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Appendix D: Reserved for Future Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Appendix E: Regional Program Operating Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Appendix F: Regional Program Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Appendix G: Core Services Work Group Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Appendix H: REACH Services Crosswalk and Reporting Requirements . . . . . . . . . . . . . . . . . . . . 53
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Introduction
The idea of core services emerged from the General Assembly’s Commission on Mental
Health and Mental Retardation, chaired by Richard M. Bagley, in 1980. The first list of core
services, developed in response to a Commission recommendation, contained five categories of
services: emergency, inpatient, outpatient and day support, residential, and prevention and early
intervention. The State Board of Behavioral Health and Developmental Services (State Board)
approved the original core services definitions in 1981. The General Assembly accepted general
definitions of these services and amended § 37.1-194 of the Code of Virginia in 1984 to list the
services, requiring the provision of only emergency services. In 1998, the legislature required the
provision of case management services, subject to the availability of funds appropriated for them.
The initial description of core services established a useful conceptual framework for
Virginia’s network of community services board (CSB) and state hospital and training center (state
facility) services. However, this description was too general and not sufficiently quantifiable for
meaningful data collection and analysis. The initiation of performance contracting in Fiscal Year
(FY) 1985 revealed the need for detailed, consistent, and measurable information about services and
individuals receiving services. Experience with the first round of contracts reinforced the need for
core services definitions that were sufficiently differentiated to reflect the variety of programs and
services and yet were general enough to encompass the broad diversity of service modalities and the
need for basic, quantified data about services, collected and reported uniformly.
The Virginia Department of Behavioral Health and Developmental Services (Department) and
the Virginia Association of Community Services Boards (VACSB) developed the first core services
taxonomy, a classification and definition of services, in 1985 to address these needs. The original
version of the taxonomy was used with the FY 1986 and 1987 community services performance
contracts. State Board Policy 1021 (SYS) 87-9 on core services, adopted in 1987, states that the
current version of the taxonomy shall be used to classify, describe, and measure the services
delivered directly or through contracts with other providers by all CSBs and state facilities. The
Department and the VACSB have revised the core services taxonomy seven times since 1985.
Core Services Taxonomy 7, used in FY 2006 and 2007, added a new core services category,
limited services, separated outpatient and case management services into two categories to provide
more visibility for case management services, and split day support services into day support
services and employment services to reflect the clear differences between them. The limited
services category allowed CSBs to capture less information about services that are typically low
intensity, infrequent, or short-term (e.g., less than 30 days or four to eight sessions in duration)
services. As a result, Taxonomy 7 had nine categories of core services: emergency, inpatient,
outpatient, case management, day support, employment, residential, prevention and early
intervention, and limited services.
Core Services Taxonomy 7.1, used in FY 2008 and 2009, incorporated changes in the
Community Consumer Submission 3 (CCS 3), the new admission and discharge paradigm, and new
system transformation initiative services. It reordered core services categories to reflect the new
paradigm. Some services were grouped under services available outside of a program area
(SAOPA), but most were under services available at admission to a program area. It added a tenth
core services category, consumer-run services, and two subcategories, ambulatory crisis
stabilization services and residential crisis stabilization services, and separated prevention and
infant and toddler intervention into separate categories.
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Core Services Taxonomy 7.2, used in FY 2010 through FY 2014, incorporated two new
concepts: service subtype, used only for emergency and case management services, and service
location to provide more specific information about core services; these changes are reflected in the
CCS. It replaced consumer with individual or individual receiving services unless the context
requires the use of consumer (e.g., the CCS). It retained infant and toddler services for descriptive
purposes only. Information about these services is collected through a separate information system
instead of the CCS, and the services are funded through a separate contract. Taxonomy 7.2 added
two appendices on regional programs that were previously in the performance contract. It replaced
SAOPA with emergency services and ancillary services. Finally, mental health or substance use
disorder or intellectual disability were used to refer to a condition experienced by an individual,
while mental health, substance abuse, or developmental services referred respectively to the
services that address these conditions.
Core Services Taxonomy 7.3, effective for FY 2015 and subsequent years, incorporates all
revisions of Taxonomy 7.2 issued since July 1, 2009. It adds a new outpatient services subcategory
for intensive outpatient and clarifies that consumer designation code 920 includes all individuals
receiving intellectual disability home and community-based Medicaid waiver services.
Taxonomy categories and subcategories are inclusive rather than narrowly exclusive; they are
not meant to capture every detail about everything a CSB or state facility does. Categories and
subcategories allow meaningful and accurate descriptions and measurements of service delivery
activities; this can help produce valid and informative analyses and comparisons of CSBs, state
facilities, and regions. Given the diversity and variety of Virginia’s localities and the mix and
availability of resources and services from other public and private providers, each CSB may not
need to provide every subcategory in the taxonomy. The categories and subcategories do not create
additional mandates for CSBs; only emergency and case management services are now required.
The relationship of taxonomy core services categories and subcategories to the more
traditional community services organizational structure is represented below.
Community Services Board or Behavioral Health Authority (CSB)
Program Area (all mental health, developmental, or substance abuse services)
Core Service Category (e.g., residential services)
Core Service Subcategory (e.g., intensive residential services)
Service Subtype (for emergency and case management services) and
Service Location (for all services)
Services in a Subcategory (e.g.in-home respite in supportive residential)
Individual Program (e.g., a particular group home)
Discrete Service Activity (e.g., meal preparation)
The numbers after some core services categories and all core service subcategories in the
definitions section and the matrix are the Community Automated Reporting System (CARS) and
CCS codes for those services. Core services categories with subcategories, such as inpatient
services, do not have codes because they have subcategories with codes. However, core services
categories with no subcategories, such as emergency services, do have codes. Services that have
moved to different categories, such as individual supported employment moving from the day
support services to the employment services category, retain the same code numbers that they had
in Taxonomy 7 and the original CCS for historical data base continuity purposes. The CARS and
CCS do not include details of the bottom three levels (services in a subcategory, individual program
and discrete service activity) above.
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Types of Community Services Boards (CSBs)
A particularly meaningful classification of CSBs is the relationship between the CSB and its
local government or governments. While CSBs are agents of the local governments that established
them, most CSBs are not city or county government departments. Section 37.2-100 of the Code of
Virginia defines three types of CSBs, and Chapter 6 of Title 37.2 authorizes behavioral health
authorities (BHAs) to provide community services. Throughout the taxonomy, community services
board or CSB refers to all of the following organizations.
Administrative policy CSB or administrative policy board means the public body organized
in accordance with the provisions of Chapter 5 (§ 37.2-500 et seq.) that is appointed by and
accountable to the governing body of each city and county that established it to set policy for and
administer the provision of mental health, developmental, and substance abuse services. The
administrative policy CSB or administrative board denotes the board, the members of which are
appointed pursuant to § 37.2-501 with the powers and duties enumerated in subsection A of § 37.2-
504 and § 37.2-505. An administrative policy CSB includes the organization that provides mental
health, developmental, and substance abuse services through local government staff or contracts
with other organizations and providers, unless the context indicates otherwise. An administrative
policy CSB does not employ its staff. There are 11 administrative policy CSBs; nine are city or
county government departments; two are not, but use local government staff to provide services.
Behavioral health authority (BHA) or authority means a public body and a body corporate
organized in accordance with the provisions of Chapter 6 (§ 37.2-600 et seq.) that is appointed by
and accountable to the governing body of the city or county that established it for the provision of
mental health, developmental, and substance abuse services. BHA or authority also includes the
organization that provides these services through its own staff or through contracts with other
organizations and providers, unless the context indicates otherwise. Chapter 6 authorizes
Chesterfield County and the cities of Richmond and Virginia Beach to establish a BHA; only
Richmond has done so. In many ways, a BHA most closely resembles an operating CSB, but it has
several powers or duties in § 37.2-605 of the Code of Virginia that are not given to CSBs.
Operating CSB or operating board means the public body organized in accordance with the
provisions of Chapter 5 (§ 37.2-500 et seq.) that is appointed by and accountable to the governing
body of each city and county that established it for the direct provision of mental health,
developmental, and substance abuse services. The operating CSB or operating board denotes the
board, the members of which are appointed pursuant to § 37.2-501 with the powers and duties
enumerated in subsection A of § 37.2-504 and § 37.2-505. Operating CSB or operating board also
includes the organization that provides such services, through its own staff or through contracts with
other organizations and providers, unless the context indicates otherwise. The 27 operating CSBs
employ their own staff and are not city or county government departments.
Policy-Advisory CSB or policy-advisory board means the public body organized in
accordance with the provisions of Chapter 5 that is appointed by and accountable to the governing
body of each city and county that established it to provide advice on policy matters to the local
government department that provides mental health, developmental, and substance abuse services
directly or through contracts with other organizations and providers pursuant to subsection A of §
37.2-504 and § 37.2-505. The policy-advisory CSB or policy-advisory board denotes the board, the
members of which are appointed pursuant to § 37.2-501 with the powers and duties enumerated in
subsection B of § 37.2-504. The CSB has no operational powers or duties; it is an advisory board to
a local government department. There is one local government department with a policy-advisory
CSB, the Portsmouth Department of Behavioral Healthcare Services.
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Core Services Definitions: Categories and Subcategories of Services
Emergency and Ancillary Services (400): If a CSB determines that it can serve a person who is
seeking or has been referred for services, the CSB opens a case for the person. Persons needing
these services may access them without being admitted to a program area (all mental health,
developmental, or substance abuse services). However, individuals who have been admitted to a
program area may still access the following services if they need them. These services do not
require collecting as many CCS data elements or as much individual service record information as
admission to a program area does. If a person receives any of the following services and is
subsequently admitted to a program area, the additional CCS program area admission data elements
must be collected. The 400 is a pseudo program area code for CCS service file purposes, since this
group of services is not a program area. If individuals receive any of the following services after
they are admitted to a program area, these services still must be coded with the 400 code, rather
than the program area code (100, 200, or 300) to which they have been admitted.
Emergency Services (100) are unscheduled and sometimes scheduled crisis intervention,
stabilization, and referral assistance provided over the telephone or face-to-face, if indicated, 24
hours per day and seven days per week to people seeking such services for themselves or
others. Services also may include walk-ins, home visits, and jail interventions. Emergency
services include preadmission screening activities associated with admission to a state hospital
or training center or other activities associated with the judicial admission process. This
category also includes Medicaid crisis intervention and short-term crisis counseling and
intellectual disability home and community-based (ID HCB) waiver crisis stabilization and
personal emergency response system services. Persons receiving critical incident stress
debriefing services are not counted as individuals receiving services, and service units are
identified and collected through the z-consumer function in the CCS.
Service Subtype is a specific activity associated with a particular core service category or
subcategory for which a service.txt file is submitted in the CCS. Currently, service subtypes are
defined only for emergency services and case management services. The emergency services
subtype is collected at every emergency services encounter and reported in the service file;
every emergency service encounter is coded with one of these six subtypes in the CCS.
a. Crisis Intervention is provided in response to an acute crisis episode. This includes
counseling, short term crisis counseling, triage, or disposition determination and all
emergency services not included in the following service subtypes.
b. Crisis Intervention Provided Under an Emergency Custody Order is clinical
intervention and evaluation provided by a certified preadmission screening evaluator in
response to an emergency custody order (ECO) issued by a magistrate.
c. Crisis Intervention Provided Under Law Enforcement Custody (paperless ECO) is
clinical intervention and evaluation provided by a certified preadmission screening evaluator
to an individual under the custody of a law enforcement officer without an ECO issued by a
magistrate.
d. Independent Examination is an examination provided by an independent examiner who
satisfies the requirements in and who conducts the examination in accordance with § 37.2-
815 of the Code of Virginia in preparation for a civil commitment hearing.
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e. Commitment Hearing is attendance of a certified preadmission screening evaluator at a
civil commitment or recommitment hearing conducted pursuant to § 37.2-817.
f. MOT Review Hearing is attendance at a review hearing conducted pursuant to §§ 37.2-
817.1 through 37.2-817.4 for a person under a mandatory outpatient treatment (MOT) order.
Ancillary Services consist of the following activities that typically are short term (less than 30
days or four to eight sessions in duration), infrequent, or low-intensity services.
a. Motivational Treatment Services (318) are generally provided to individuals on an hourly
basis, once per week, through individual or group counseling in a clinic. These services are
structured to help individuals resolve their ambivalence about changing problematic
behaviors by using a repertoire of data gathering and feedback techniques. Motivational
treatment services are not a part of another service; they stand alone. Their singular focus
on increasing the individual’s motivation to change problematic behaviors, rather than on
changing the behavior itself, distinguishes motivational treatment services from outpatient
services. A course of motivational treatment may involve a single session, but more
typically four to eight sessions; and it may be repeated, if necessary, as long as repetition is
clinically indicated. Prior to placement in motivational treatment, the individual’s level of
readiness for change is usually assessed, based on clinical judgment, typically supported by
standardized instruments. An assessment may follow a course of motivational treatment to
ascertain any changes in the individual’s readiness for change. Psycho-educational services
are included in this subcategory.
b. Consumer Monitoring Services (390) are provided to individuals who have not been
admitted to a program area but have had cases opened by the CSB. For example, this
includes individuals with opened cases whom the CSB places on waiting lists for other
services, for example, Medicaid ID wavier services. Individuals receive no interventions or
face-to-face contact, but they receive consumer monitoring services that typically consist of
service coordination or intermittent emergency contacts. Other examples of consumer
monitoring services include individuals who receive only outreach services, such as
outreach contacts through projects for assistance in transition from homelessness (PATH),
individuals in waiting list groups, and outreach by peers to individuals who are in need of
services or have been referred for services.
c. Assessment and Evaluation Services (720) include court-ordered or psychological
evaluations; initial assessments for screening, triage, and referral for individuals who
probably will not continue in services; and initial evaluations or assessments that result in
placement on waiting lists without receiving other services. An abbreviated individualized
services plan and services record may be required.
d. Early Intervention Services (620) are intended to improve functioning or change behavior
in individuals who have been identified as beginning to experience problems, symptoms, or
behaviors that, without intervention, are likely to result in the need for treatment. Outpatient
service activities should not be included here merely to avoid record keeping or licensing
requirements since this is not clinically appropriate and could expose the CSB to increased
liability. Services are generally targeted to identified individuals or groups and include case
consultation, groups for adolescents who have been suspended for use of alcohol or tobacco,
and programs for children or adults exhibiting behavior changes following loss such as
divorce, death of a loved one, and job loss. School-based interventions should be included
in prevention, early intervention, or outpatient services, as appropriate.
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Consumer-Run Services (730) are self-help programs designed, governed, and led by and for
people in recovery. Consumer-run services employ peers as staff and volunteers and are often
open on weekends and evenings beyond the usual hours traditional services operate. Services
are usually open door or drop in, with no required applications, waiting times, or appointments.
Services include networking, advocacy, and mutual support groups; drop-in centers; supported
housing; hospital liaison; recreation and social activities; arts and crafts and exercise groups;
peer counseling, mentorship, and one-on-one consultations; information and referrals; and
knowledge and skill-building classes such as employment training, computer training, and other
seminars and workshops. Consumer-run centers also may offer the use of washers and dryers,
showers, telephones for business calls, mailboxes, and lending libraries. Because of their
nature, no information is collected in the CCS about consumer-run services or the individuals
participating in them. Instead, the number of persons participating in consumer-run services is
reported in the CARS management report. However, core services provided by peers are
included and reported where they are delivered, e.g., in outpatient, rehabilitation, or residential
services, rather than in consumer-run services; see Appendix G for more information.
Services Available at Admission to a Program Area: If an individual needs other services
beyond emergency or ancillary services, the CSB admits the individual to a program area: all
mental health (100), developmental (200), or substance abuse (300) services. Depending on his or
her needs, the individual may be admitted to two or even three program areas. An individual may
be admitted directly to a program area, bypassing case opening, but CCS data elements collected at
case opening must still be obtained. Even after admission to a program area, an individual may still
receive emergency or ancillary services if he or she needs them.
Inpatient Services deliver services on a 24-hour-per-day basis in a hospital or training center.
a. Medical/Surgical Care provides acute medical treatment or surgical services in state
facilities. These services include medical detoxification, orthopedics, oral surgery, urology,
care for pneumonia, post-operative care, ophthalmology, ear, nose and throat care, and other
intensive medical services.
b. Skilled Nursing Services deliver medical care, nursing services, and other ancillary care for
individuals with mental disabilities who are in state facilities and require nursing as well as
other care. Skilled nursing services are most often required by individuals who are acutely
ill or have significant intellectual disability and by older adults with mental health disorders
who suffer from chronic physical illnesses and loss of mobility. Services are provided by
professional nurses, licensed practical nurses, and qualified paramedical personnel under the
general direction and supervision of a physician.
c. Intermediate Care Facility for Individuals with Intellectual Disability (ICF/ID) Services
are provided in state training centers for individuals with intellectual disability who require
active habilitative and training services, including respite and emergency care, but not the
degree of care and treatment provided in a hospital or skilled nursing home.
d. Intermediate Care Facility/Geriatric Services are provided in state geriatric facilities by
interdisciplinary teams to individuals who are 65 years of age and older. Services include
psychiatric treatment, medical treatment, personal care, and therapeutic programs
appropriate to the facility and to the individual’s needs.
e. Acute Psychiatric or Substance Abuse Inpatient Services (250) provide intensive shortterm psychiatric treatment in state hospitals or intensive short-term psychiatric treatment,
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including services to individuals with intellectual disability, or substance abuse treatment,
except medical detoxification, in local hospitals. Services include intensive stabilization,
evaluation, psychotropic medications, psychiatric and psychological services, and other
supportive therapies provided in a highly structured and supervised setting.
f. Community-Based Substance Abuse Medical Detoxification Inpatient Services (260) use
medication under the supervision of medical personnel in local hospitals to systematically
eliminate or reduce the effects of alcohol or other drugs in the body.
g. Extended Rehabilitation Services offer intermediate or long-term treatment in a state
hospital for individuals with severe psychiatric impairments, emotional disturbances, or
multiple disabilities (e.g., individuals with mental health disorders who also are deaf).
Services include rehabilitation training, skills building, and behavioral management for
people who are beyond the crisis stabilization and acute treatment stages.
Outpatient Services provide clinical treatment services, generally in sessions of less than three
consecutive hours, to individuals and groups.
a. Outpatient Services (310) are generally provided to individuals on an hourly schedule, on
an individual, group, or family basis, and usually in a clinic or similar facility or in another
location, including a jail or juvenile detention center. Outpatient services may include
diagnosis and evaluation, screening and intake, counseling, psychotherapy, behavior
management, psychological testing and assessment, laboratory and other ancillary services,
medical services, and medication services. Medical services include the provision of
psychiatric, medical, psychiatric nursing, and medical nursing services by licensed
psychiatrists, physicians, and nurses and the cost of medications purchased by the CSB and
provided to individuals. Medication services include prescribing and dispensing
medications, medication management, and pharmacy services. Medication only visits are
provided to individuals who receive only medication monitoring on a periodic (monthly or
quarterly) basis from a psychiatrist, other physician, psychiatric nurse, or physician’s
assistant. These visits are included in outpatient services. The Department has identified a
minimum set of information for licensing purposes that would be needed to constitute an
individualized services plan (ISP) for individuals receiving only medication visits.
Outpatient services also include intensive in-home services that are time-limited, usually
between two and six months, family preservation interventions for children and adolescents
with or at risk of serious emotional disturbance, including such individuals who also have a
diagnosis of intellectual disability. In-home services are provided typically but not solely in
the residence of an individual who is at risk of being moved into or is being transitioned to
home from an out-of-home placement. The services provide crisis treatment; individual and
family counseling; life, parenting, and communication skills; case management activities
and coordination with other required services; and 24 hour per day emergency response.
Outpatient services also include jail-based habilitation services that involve daily group
counseling, individual therapy, psycho-educational services, 12 step meetings, discharge
planning, and pre-employment and community preparation services.
Finally, outpatient services also include Medicaid ID HCB waiver skilled nursing services
and therapeutic consultation services. Probation and parole and community corrections day
reporting centers also are included in outpatient services, rather than in ancillary services.
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b. Intensive Outpatient Services (313) provide substance abuse treatment in a concentrated
manner for two or more consecutive hours per day to groups of individuals in nonresidential
settings multiple times per week. This service is provided over a period of time for
individuals requiring more intensive services than outpatient services can provide. Intensive
substance abuse outpatient services include multiple group therapy sessions during the
week, individual and family therapy, individual monitoring, and case management.
c. Medication Assisted Treatment (335) combines outpatient treatment with administering or
dispensing synthetic narcotics, such as methadone or buprenorphine (suboxone), approved
by the federal Food and Drug Administration for the purpose of replacing the use of and
reducing the craving for opioid substances, such as heroin or other narcotic drugs.
d. Assertive Community Treatment (350) consists of two modalities: intensive community
treatment (ICT) and program of assertive community treatment (PACT). Individuals served
by either modality have severe symptoms and impairments that are not effectively remedied
by available treatments or, because of reasons related to their mental health disorders, resist
or avoid involvement with mental health services. This could include individuals with
severe and persistent mental illnesses who also have co-occurring diagnoses of intellectual
disability. Assertive community treatment provides an array of services on a 24-hour per
day basis to these individuals in their natural environments to help them achieve and
maintain effective levels of functioning and participation in their communities. Services
may include case management, supportive counseling, symptom management, medication
administration and compliance monitoring, crisis intervention, developing individualized
community supports, psychiatric assessment and other services, and teaching daily living,
life, social, and communication skills.
ICT is provided by a self-contained, interdisciplinary team of at least five full-time
equivalent clinical staff, a program assistant, and a psychiatrist. This team (1) assumes
responsibility for directly providing needed treatment, rehabilitation, and support services to
identified individuals with severe and persistent mental illnesses, (2) minimally refers
individuals to outside service providers, (3) provides services on a long-term care basis with
continuity of caregivers over time, (4) delivers 75 percent or more of the services outside of
the program’s offices, and (5) emphasizes outreach, relationship building, and
individualization of services. PACT is provided by a self-contained, inter-disciplinary team
of at least 10 full-time equivalent clinical staff, a program assistant, and a psychiatrist, and
this team meets the five criteria contained in the definition of ICT.
Case Management Services (320) assist individuals and their family members to access
needed services that are responsive to the individual’s needs. Services include: identifying and
reaching out to individuals in need of services, assessing needs and planning services, linking
the individual to services and supports, assisting the individual directly to locate, develop, or
obtain needed services and resources, coordinating services with other providers, enhancing
community integration, making collateral contacts, monitoring service delivery, and advocating
for individuals in response to their changing needs.
Service Subtype is a specific activity associated with a particular core service category or
subcategory for which a service.txt file is submitted in the CCS. Currently, service subtypes are
defined only for emergency and case management services. The case management services
subtype is collected at every developmental case management services encounter and reported
in the service file with one of the two subtypes in the CCS. CSBs may report these service
subtypes for mental health or substance abuse case management services, but this is optional.
Core Services Taxonomy 7.3
06-30-2014
a. Face-to-Face Case Management Services: These are case management services received
by an individual and provided by a case manager during a face-to-face encounter in a case
management service licensed by the Department. Examples of service hour activities
applicable to face-to-face case management services include case management, individual
present and discharge planning, individual present. All other case management services
must be reported using non-face-to-face case management.
b. Non-Face-to-Face Case Management Services: These are all other case management
services provided to or on behalf of an individual by a case manager in a case management
service licensed by the Department. This includes telephone contacts with the individual,
any contacts (face-to-face or otherwise) with the individual’s family members or authorized
representative, or any contacts (face-to-face or otherwise) about the individual with other
CSB staff or programs or other providers or agencies. Examples of service hour activities
applicable to non-face-to-face case management services include:
● case management, individual not present; ● individual-related staff travel; and
● phone consultation with individual; ● discharge planning, individual not present.
● report writing re: individual;
Day Support Services provide structured programs of treatment, activity, or training services,
generally in clusters of two or more continuous hours per day, to groups or individuals in nonresidential settings.
a. Day Treatment or Partial Hospitalization (410) is a treatment program that includes the
major diagnostic, medical, psychiatric, psychosocial, and prevocational and educational
treatment modalities designed for adults with serious mental health, substance use, or cooccurring disorders who require coordinated, intensive, comprehensive, and multidisciplinary treatment that is provided several hours per day for multiple days each week
and is not provided in outpatient services.
This subcategory also includes therapeutic day treatment for children and adolescents, a
treatment program that serves children and adolescents (birth through age 17) with serious
emotional disturbances or substance use or co-occurring disorders or children (birth through
age 7) at risk of serious emotional disturbance in order to combine psychotherapeutic
interventions with education and mental health or substance abuse treatment. Services
include: evaluation, medication education and management, opportunities to learn and use
daily living skills and to enhance social and interpersonal skills, and individual, group, and
family counseling.
b. Ambulatory Crisis Stabilization Services (420) provide direct care and treatment to nonhospitalized individuals experiencing an acute crisis related to mental health, substance use,
or co-occurring disorders that may jeopardize their current community living situation. The
goals are to avert hospitalization or re-hospitalization, provide normative environments with
a high assurance of safety and security for crisis intervention, stabilize individuals in crisis,
and mobilize the resources of the community support system, family members, and others
for ongoing rehabilitation and recovery. Ambulatory crisis stabilization services may be
provided in an individual’s home or in a community-based program licensed by the
Department. These services are planned for and provide services for up to 23 hours per day.
Services that are integral to and provided in ambulatory crisis stabilization programs, such
as outpatient or case management services, should not be reported separately in those core
services since they are included in the ambulatory crisis stabilization day support hours.
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c. Rehabilitation or Habilitation (425) consists of training services in two modalities.
Psychosocial rehabilitation provides assessment, medication education, opportunities to
learn and use independent living skills and to enhance social and interpersonal skills, family
support and education, vocational and educational opportunities, and advocacy to
individuals with mental health, substance use, or co-occurring disorders in a supportive
community environment focusing on normalization. It emphasizes strengthening the
individual’s abilities to deal with everyday life rather than focusing on treating pathological
conditions.
Habilitation provides planned combinations of individualized activities, supports, training,
supervision, and transportation to individuals with intellectual disability to improve their
condition or maintain an optimal level of functioning. Specific components of this service
develop or enhance the following skills: self-care and hygiene, eating, toileting, task
learning, community resource utilization, environmental and behavioral skills, medication
management, and transportation. Habilitation also includes Medicaid ID HCB waiver day
support (center-based and non-center- based) and prevocational services.
Employment Services provide work and support services to groups or individuals in nonresidential settings.
a. Sheltered Employment (430) programs provide work in a non-integrated setting that is
compensated in accordance with the Fair Labor Standards Act for individuals with
disabilities who are not ready, are unable, or choose not to enter into competitive
employment in an integrated setting. This service includes the development of social,
personal, and work-related skills based on an individualized services plan.
b. Group Supported Employment (465) provides work to small groups of three to eight
individuals at job sites in the community or at dispersed sites within an integrated setting.
Integrated setting means opportunities exist for individuals receiving services in the
immediate work setting to have regular contact with non-disabled persons who are not
providing support services. The employer or the vendor of supported employment services
employs the individuals. An employment specialist, who may be employed by the employer
or the vendor, provides ongoing support services. Support services are provided in
accordance with the individual’s written rehabilitation plan. Models include mobile and
stationary crews, enclaves, and small businesses. Group supported employment includes
Medicaid ID HCB waiver supported employment – group model.
c. Individual Supported Employment (460) provides paid employment to an individual placed
in an integrated work setting in the community. The employer employs the individual. Ongoing support services that may include transportation, job-site training, counseling,
advocacy, and any other supports needed to achieve and to maintain the individual in the
supported placement are provided by an employment specialist, co-workers of the supported
employee, or other qualified individuals. Support services are provided in accordance with
the individual’s written rehabilitation plan. Individual supported employment includes
Medicaid ID HCB waiver supported employment – individual model.
Residential Services provide overnight care with an intensive treatment or training program in
a setting other than a hospital or training center, overnight care with supervised living, or other
supportive residential services.
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a. Highly Intensive Residential Services (501) provide overnight care with intensive treatment
or training services. These services include:
Mental Health Residential Treatment Centers such as short term intermediate care,
residential alternatives to hospitalization such as community gero-psychiatric residential
services1
, and residential services for individuals with co-occurring diagnoses (e.g., mental
health and substance use disorders, intellectual disability and mental health disorders) where
intensive treatment rather than just supervision occurs;
Community Intermediate Care Facilities for Individuals With Intellectual Disability
(ICF/ID) that provide care to individuals who have intellectual disability and need more
intensive training and supervision than may be available in an assisted living facility or
group home, comply with Title XIX of the Social Security Act standards and federal
certification requirements, provide health and habilitation services, and provide active
treatment to individuals receiving services toward the achievement of a more independent
level of functioning or an improved quality of life; and
Substance Abuse Medically Managed Withdrawal Services that provide detoxification
services with physician services available when required to eliminate or reduce the effects of
alcohol or other drugs in the individual’s body and that normally last up to seven days, but
this does not include medical detoxification services provided in community-based substance abuse medical detoxification inpatient services (260) or social detoxification services.
b. Residential Crisis Stabilization Services (510) provide direct care and treatment to nonhospitalized individuals experiencing an acute crisis related to mental health, substance use,
or co-occurring disorders that may jeopardize their current community living situation. The
goals are to avert hospitalization or re-hospitalization, provide normative environments with
a high assurance of safety and security for crisis intervention; stabilize individuals in crisis,
and mobilize the resources of the community support system, family members, and others
for ongoing rehabilitation and recovery. Residential crisis stabilization services are
provided in a community-based program licensed by the Department. These services are
planned for and provide overnight care; the service unit is a bed day. Services that are
integral to and provided in residential crisis stabilization programs, such as outpatient and
case management services, should not be reported separately in those core services since
they are included in the bed day.
c. Intensive Residential Services (521) provide overnight care with treatment or training that
is less intense than highly intensive residential services. It includes the following services
and Medicaid ID HCB waiver congregate residential support services.
Group homes or halfway houses provide identified beds and 24 hour supervision for
individuals who require training and assistance in basic daily living functions such as meal
preparation, personal hygiene, transportation, recreation, laundry, and budgeting. The
expected length of stay normally exceeds 30 days.

1 Community gero-psychiatric residential services that provide 24-hour non-acute care with
treatment in a setting that offers less intensive services than a hospital, but more intensive
mental health services than a nursing home or group home. Individuals with mental health
disorders, behavioral problems, and concomitant health problems, usually age 65 and older,
who are appropriately treated in a geriatric setting, receive intensive supervision, psychiatric
care, behavioral treatment planning, nursing, and other health-related services.
Core Services Taxonomy 7.3

06-30-2014
Primary care offers substance abuse rehabilitation services that normally last no more than
30 days. Services include intensive stabilization, daily group therapy and psychoeducational services, consumer monitoring, case management, individual and family
therapy, and discharge planning.
Intermediate rehabilitation is a substance abuse psychosocial therapeutic milieu with an
expected length of stay up to 90 days. Services include supportive group therapy, psychoeducation, consumer monitoring, case management, individual and family therapy,
employment services, and community preparation services.
Long-term habilitation is a substance abuse psychosocial therapeutic milieu with an
expected length of stay of 90 or more days that provides a highly structured environment
where residents, under staff supervision, are responsible for daily operations of the facility.
Services include intensive daily group and individual therapy, family counseling, and
psycho-education. Daily living skills and employment opportunities are integral
components of the treatment program. Jail-based habilitation services, previously reported
here, should be reported in outpatient services (310).
d. Supervised Residential Services (551) offer overnight care with supervision and services.
This subcategory includes the following services and Medicaid ID HCB waiver congregate
residential support services.
Supervised apartments are directly-operated or contracted, licensed residential programs
that place and provide services to individuals in apartments or other residential settings. The
expected length of stay normally exceeds 30 days.
Domiciliary care provides food, shelter, and assistance in routine daily living but not
treatment or training in facilities of five or more beds. This is primarily a long-term setting
with an expected length of stay exceeding 30 days. Domiciliary care is less intensive than a
group home or supervised apartment; an example would be a licensed assisted living facility
(ALF) operated, funded, or contracted by a CSB.
Emergency shelter or residential respite programs provide identified beds, supported or
controlled by a CSB, in a variety of settings reserved for short term stays, usually several
days to no more than 21 consecutive days.
Sponsored placements place individuals in residential settings and provide substantial
amounts of financial, programmatic, or service support. Examples include individualized
therapeutic homes, specialized foster care, family sponsor homes, and residential services
contracts for specified individuals. The focus is on individual residential placements with
expected lengths of stay exceeding 30 days rather than on organizations with structured staff
support and set numbers of beds.
e. Supportive Residential Services (581) are unstructured services that support individuals in
their own housing arrangements. These services normally do not involve overnight care
delivered by a program. However, due to the flexible nature of these services, overnight
care may be provided on an hourly basis. It includes the following services and Medicaid
ID HCB waiver supported living/in-home supports, respite (agency and consumer-directed)
services, companion services (agency and consumer-directed), and personal assistance
services (agency and consumer-directed).
In-Home respite provides care in the homes of individuals with mental disabilities or in a
setting other than that described in residential respite services above. This care may last
Core Services Taxonomy 7.3
06-30-2014
from several hours to several days and allows the family member care giver to be absent
from the home.
Supported living arrangements are residential alternatives that are not included in other
types of residential services. These alternatives assist individuals to locate or maintain
residential settings where access to beds is not controlled by a CSB and may provide
program staff, follow along, or assistance to these individuals. The focus may be on
assisting an individual to maintain an independent residential arrangement. Examples
include homemaker services, public-private partnerships, and non-CSB subsidized
apartments (e.g., HUD certificates).
Housing subsidies provide cash payments only, with no services or staff support, to enable
individuals to live in housing that would otherwise not be accessible to them. These cash
subsidies may be used for rent, utility payments, deposits, furniture, and other similar
payments required to initiate or maintain housing arrangements for individuals. This is used
only for specific allocations of funds from the Department earmarked for housing subsidies.
Numbers of individuals receiving services and expense information should be included in
supportive residential services in performance contract reports. Information associated with
other housing subsidies should be included in the services of which they are a part.
Prevention Services (610) are designed to prevent mental health or substance use disorders.
Activities that are really outpatient services should not be included in prevention services to
avoid record keeping or licensing requirements, since this exposes the CSB to increased
liability, is not clinically appropriate, and violates the regulatory requirements of the federal
Substance Abuse Prevention and Treatment block grant. Prevention services promote mental
health through individual, community, and population-level change strategies. Prevention
services are identified through the implementation of the Strategic Prevention Framework, an
evidenced-based and community-based needs assessment-focused planning model. This model
involves data-driven needs assessment, planning and evaluation, capacity building, and
implementation of evidenced-based programs, strategies, and practices. Overlaying all these
components are cultural competence and sustainability of effective outcomes. To achieve
community level strategies, CSBs must be a part of a community coalition. Emphasis is on
enhancement of protective factors and reduction of risk factors in individuals and the
community. Information on substance abuse prevention services is collected and reported
separately through the Department’s contracted prevention services information system, instead
of being included in the CCS. The following six strategies comprise prevention services.
Information Dissemination provides awareness and knowledge of the nature and extent of
mental health and substance use disorders and intellectual disability. It also provides awareness
and knowledge of available prevention programs and services. Examples of information
dissemination include media campaigns, public service announcements, informational
brochures and materials, community awareness events, and participation on radio or TV talk
shows. Information dissemination is characterized by one-way communication from the source
to the audience.
Prevention Education aims to affect critical life and social skills, including general competency
building, specific coping skills training, support system interventions, strengthening caregivers,
and decision-making skills training. Prevention education is characterized by two-way
communication with close interaction between the facilitator or educator and program
Core Services Taxonomy 7.3
06-30-2014
participants. Examples of prevention education include children of alcoholics groups and
parenting classes.
Alternatives provide for the participation of specific populations in activities that are
constructive, promote healthy choices, and provide opportunities for skill building. Examples
of prevention alternatives include leadership development, community service projects, alcohol,
tobacco, and other drug free activities, and youth centers.
Problem Identification and Referral aims at the identification of those individuals who are most
at risk of developing problematic behaviors in order to assess if their behaviors can be changed
though prevention education. Examples include student and employee assistance programs.
Community-Based Process aims at enhancing the ability of the community to provide
prevention and treatment services more effectively. Activities include organizing, planning,
enhancing efficiency and effectiveness of service implementation, interagency collaboration,
coalition building, and networking. Examples include community and volunteer training,
multi-agency coordination and collaboration, accessing services and funding, and community
team-building.
Environmental Prevention Activities establish or change written and unwritten community
standards, codes, and attitudes, thereby influencing the development of healthy living
conditions. Examples include modifying advertising practices and promoting the establishment
and review of alcohol, tobacco, and other drug use policies.
Infant and Toddler Intervention Services (625) provides family-centered, community-based
early intervention services designed to meet the developmental needs of infants and toddlers
and the needs of their families as these needs relate to enhancing the child’s development.
These services prevent or reduce the potential for developmental delays in infants and toddlers
and increase the capacity of families to meet the needs of their at-risk infants and toddlers.
Infant and toddler intervention is delivered through a comprehensive, coordinated, interagency,
and multidisciplinary services system. Infant and toddler intervention includes:
a. assistive technology, j. special instruction,
b. audiology, k. psychological services,
c. family training, counseling, and home visits, l. service coordination,
d. health services, m. social work services,
e. nursing services, n. speech-language pathology,
f. nutrition services, o. transportation services, and
g. occupational therapy, p. vision services.
h. physical therapy,
i. medical services (for diagnostic or evaluation purposes only),
The identified individual receiving services is the infant or toddler. Information about infant
and toddler intervention services, including funds, expenditures, costs, service units, and the
individuals receiving them is collected and reported to the Department through a separate
contract and automated information system, rather than through CARS reports and the CCS.
Consequently, this service is not included in the Core Services Category and Subcategory
Matrix in the taxonomy. This infant and toddler intervention services definition is included in
the taxonomy for information and reference purposes.
Core Services Taxonomy 7.3
06-30-2014
Community Consumer Submission (CCS) Consumer Designation Codes
The CCS consumer designation codes for specialized initiatives or projects (consumer
designation codes for short) identify individuals who are served in certain specific initiatives or
projects; these codes are not service codes per se, like 310 is the core services code for Outpatient
Services, instead, these codes reflect a particular status of those individuals. Consumer designation
codes may encompass more than special projects or initiatives.
The component services of these projects or initiatives are included in the appropriate core
services and numbers of individuals in these initiatives are counted in the CCS in the following
manner. When an individual receives services in any of the following initiatives, the consumer
designation code for the initiative will be entered in the type of care file for the individual. Units of
service for these initiatives will be recorded and accumulated in the applicable core services
associated with the initiative, such as outpatient, case management, day treatment or partial
hospitalization, rehabilitation or habilitation, or various residential services.
905 – Mental Health Mandatory Outpatient Treatment (MOT) Orders
910 – Discharge Assistance Program (DAP)
915 – Mental Health Child and Adolescent Services Initiative,
916 – Mental Health Services for Children and Adolescents in Juvenile Detention Centers
918 – Program of Assertive Community Treatment (PACT),
919 – Projects for Assistance in Transition from Homelessness (PATH), and
920 – Medicaid Intellectual Disability (ID) Home and Community-Based Waiver Services.
933 – Substance Abuse Medication Assisted Treatment
935 – Substance Abuse Recovery Support Services
Additional CCS consumer designation codes may be used to identify individuals involved in
special projects and to gather information about those individuals and the services associated with
those projects. The Department and the VACSB Data Management Committee will designate and
approve additional consumer designation codes for such purposes.
Descriptions of Some Consumer Designation Codes
Consumer Designation Code 905 – Mental Health Mandatory Outpatient Treatment (MOT)
Orders is used only for individuals for whom a judge or special justice has issued a mandatory
outpatient treatment order pursuant to § 37.2-817.D of the Code of Virginia and for whom the CSB
has developed an initial mandatory outpatient treatment plan pursuant to § 37.2-817.F and a
comprehensive mandatory outpatient treatment plan pursuant to § 37.2-817.G. Individuals
receiving services from the CSB as a result of any other court orders (e.g., court-ordered
evaluations, forensic evaluations, or competency restoration services) shall not be assigned this
consumer designation code. If an individual who is the subject of an MOT order will be receiving
mental health services under that order from or through the CSB and has not been admitted to the
mental health services program area (100) previously, the individual must be admitted to that
program area, with two CCS TypeOfCare records submitted in the next monthly CCS extract file
submission: first, one record for the admission, and second, one record for the 905 consumer
designation code. The ServiceFromDate on the second record must be the date of the MOT order
and must be the same or a later date than the ServiceFromDate on the TypeOfCare record for the
admission to the mental health services program area. When the MOT order expires or is rescinded,
the date of that expiration or rescission must be entered as the ServiceThroughDate on a
TypeOfCare record to end the MOT consumer designation code.
Core Services Taxonomy 7.3
06-30-2014
If an individual who is the subject of an MOT order will not be receiving mental health services
under that order from or through the CSB, for example, the individual will receive services from
non-contracted private providers and the CSB will only be monitoring the individual’s compliance
with the comprehensive MOT plan, then admission to the mental health services program area (100)
is not necessary. The CSB’s monitoring of compliance with the MOT plan should be recorded as
consumer monitoring services (390), an ancillary service, and, if the CSB did not perform the
preadmission screening or provide emergency services to the individual, the CSB still must open a
case on the individual, collecting the applicable CCS 3 data elements associated with case opening.
A TypeOfCare record for the initiation of the MOT must still be submitted by the CSB to start the
MOT consumer designation code. When the MOT order expires or is rescinded, the date of that
expiration or rescission must be entered as the ServiceThroughDate on a TypeOfCare record to end
the MOT consumer designation code.
The duration of the MOT order is specified in the order, per § 37.2-817.E of the Code of Virginia.
The clerk of the court must provide a copy of the order, per § 37.2-817.I, to the person who is the
subject of the order and to the CSB that is required to monitor the individual’s compliance with the
MOT plan pursuant to § 37.2-817.1. Sections 37.2-817.3 and 37.2-817.4 contain provisions for the
rescission or continuation of MOT orders.
Consumer Designation Code 910 – Discharge Assistance Program (DAP) is used for individuals
receiving services supported with mental health state DAP funds. Since the state hospital discharge
date and related DAP TypeOfCareFromDate may precede the TypeOfCareFromDate for admission
to the mental health services program area, the individual does not have to be admitted to the mental
health services program area (100) before being given a 910 consumer designation code.
Consumer Designation Code 915 – Mental Health Child and Adolescent Services Initiative is
used for children and adolescents with serious emotional disturbance (SED) or related disorders
who are not mandated to receive services funded through the Comprehensive Services Act.
Initiative services are funded with restricted mental health state funds that are used exclusively for
this purpose. Related disorders are not defined in the Appropriations Act, but the term allows
sufficient flexibility to serve children with mental health or co-occurring mental health and
substance use disorders who may not fit the definition of SED but may need services that can only
be provided with these Initiative funds.
Consumer Designation Code 916 – Mental Health Services for Children and Adolescents in
Juvenile Detention Centers is used for children and adolescents in juvenile detention centers
receiving CSB services that are funded with restricted mental health state funds identified for this
purpose. The use of this consumer designation code will eliminate the separate paper reporting
mechanism for these services by CSBs maintained by the Department’s Office of Child and Family
Services. A CSB’s primary role in a juvenile detention center is providing short-term services to
juveniles with mental health disorders or co-occurring mental health and substance use disorders
who are incarcerated in the center. As part of this role, a CSB also consults with juvenile detention
center staff on the needs and treatment of these juveniles. Since the juveniles have been court
ordered to the center, they are under the jurisdiction of the center for care. A CSB provides
consultation and behavioral health services in support of the center’s care of these juveniles. If the
CSB provides consultation to the center’s staff about groups of children, rather than about specific
individuals, the CSB should report the service hours using the z-consumer function in the CCS.
Core Services Taxonomy 7.3
06-30-2014
A CSB typically provides the following core services to most of the juveniles it serves in juvenile
detention centers: emergency, consumer monitoring, assessment and evaluation, or early
intervention services. Since these services are being provided in a consultative mode within the
juvenile detention center and the CSB will not have an ongoing clinical relationship with most of
these juveniles once they are released, CSB staff should enter information about these services in
the juvenile’s record at the detention center, rather than initiating an individualized services plan
(ISP) or service record at the CSB. Less frequently, a CSB may provide outpatient services to
juveniles whose needs and lengths of stay warrant them and case management services for juveniles
who are near discharge to their home CSBs. These services are typically more intensive and of
longer duration, and staff must initiate ISPs at the CSB for juveniles receiving them. Except for
outpatient and case management services, the other services that can be provided are emergency or
ancillary services and, therefore, require limited CCS 3 data to be collected. However, if it provides
outpatient or case management services, a CSB must admit the juvenile to the mental health
services program area with a Type Of Care record prior to assigning a 916 consumer designation
code, according to instructions in the CCS 3 Extract Specifications. The CSB must collect a full
data set consistent with the CCS 3 requirements, as well as conform to the licensing requirements
for the provision of those services.
A CSB must assign a 916 consumer designation code to each juvenile served in a juvenile detention
center when his or her case is opened for CCS 3 purposes, so the services that he or she receives
while in the juvenile detention center and upon discharge from it can be identified with this
initiative. Normally, an individual must be admitted to a program area in order to assign a
consumer designation code. However, an exception exists in the CCS 3 Extract Specifications for
juveniles who receive only emergency or ancillary services; the CSB can submit a TypeOfCare
record to assign the 916 consumer designation code without an admission to a program area. Refer
to the Revised Guidance for CSB Services in Juvenile Detention Centers, March 3, 2008, for further
information about collecting and reporting information about these services.
Consumer Designation Code 920 – Medicaid ID Home and Community-Based (HCB) Waiver
Services is used only for individuals who have been admitted to the developmental services
program area (200) and are receiving any Medicaid ID HCB waiver services from a CSB, directly
or through CSB contracts with other agencies or individuals where the CSB remains the provider
for DMAS purposes, or from any other provider of Medicaid ID HCB waiver services. Admission
to the developmental services program area (200) is a prerequisite for assigning this consumer
designation code. Assigning the 920 consumer designation code to individuals who do not receive
Medicaid ID HCB waiver services from the CSB should not be a problem since the CSB provides
case management services, a non-waiver service, to all individuals receiving Medicaid ID HCB
waiver services, even if the CSB does not provide those waiver services.
Consumer Designation Code 933 – Substance Abuse Medication Assisted Treatment is used
only for individuals who have been admitted to the substance abuse services program area (300) and
are receiving buprenorphine (suboxone) that is provided by the CSB or prescribed by a private
physician who has a formal agreement with the CSB to provide medical oversight for medication
assisted treatment to individuals for whom the CSB is providing support services, including
counseling and case management. Medication assisted treatment is reported in outpatient services.
Admission to the substance abuse services program area (300) is a prerequisite for assigning this
consumer designation code.
Core Services Taxonomy 7.3
06-30-2014
Consumer Designation Code 935 – Substance Abuse Recovery Support Services is used only
for individuals receiving recovery support at a program funded specifically for this purpose by the
Department. Because of the mix of services (some emergency or ancillary services) that individuals
will receive, admission to the substance abuse services program area (300) is not a prerequisite for
assigning this consumer designation code.
Recovery support services are designed and delivered by peers in recovery and in coordination with
clinical staff. However, recovery support services are designed and provided primarily by
individuals in recovery; although supportive of formal treatment, recovery support services are not
intended to replace treatment services in the commonly understood clinical sense of that term.
Recovery support services include:
emotional support that offers demonstrations of empathy, caring, and concern that bolster one’s
self-esteem and confidence and include peer mentoring, peer coaching, and peer-led support
groups;
informational support that involves assistance with knowledge, information, and skills and
includes peer-led life skills training, job skills training, citizenship restoration, educational
assistance, and health and wellness information;
instrumental support that provides concrete assistance in helping others do things or get things
done, especially stressful or unpleasant tasks, and includes connecting people to treatment
services, providing transportation to get to support groups, child care, clothing closets, and filling
our applications or helping people obtain entitlements; and
affiliational support that offers the opportunity to establish positive social connections with
other recovering people.
CSB services associated with recovery support include emergency, motivational treatment, and
assessment and evaluation services in addition to needed substance abuse services.
Core Services Category and Subcategory Matrix
Emergency and Ancillary Services
Unit of Service Capacity
Emergency Services (100) Service Hour NA
Ancillary Services
a. Motivational Treatment Services (318) Service Hour NA
b. Consumer Monitoring Services (390) Service Hour NA
c. Assessment and Evaluation Services (720) Service Hour NA
d. Early Intervention Services (620) Service Hour NA
Consumer-Run Services (730) NA NA
Core Services Taxonomy 7.3
06-30-2014
Core Services Category and Subcategory Matrix
Services Available at Admission to a Program Area
MH DV SA Unit of Service Capacity
Inpatient Services
a. Medical/Surgical Care (State Facility) x x NA Bed Day Bed
b. Skilled Nursing Services (State Facility) x x NA Bed Day Bed
c. ICF/ID Services (State Facility) NA x NA Bed Day Bed
d. ICF/Geriatric Services (State Facility) x x NA Bed Day Bed
e. Acute Psychiatric or Substance Abuse
Inpatient Services (250) x NA x Bed Day Bed
f. Community-Based Substance Abuse Medical
Detoxification Inpatient Services (260) NA NA x Bed Day Bed
g. Extended RehabilitationServices (St. Facility) x NA NA Bed Day Bed
Outpatient Services
a. Outpatient Services (310) x x x Service Hour NA
b. Intensive Outpatient (313) NA NA x Service Hour NA
c. Medication Assisted Treatment (335) NA NA x Service Hour NA
d. Assertive Community Treatment (350) x NA NA Service Hour NA
Case Management Services (320) x x x Service Hour NA
Day Support Services
a. Day Treatment or Partial Hospitalization (410) x NA x Day Support Hour Slot
b. Ambulatory Crisis Stabilization Services (420) x x x Day Support Hour Slot
c. Rehabilitation (MH, SA) or Habilitation (425) x x x Day Support Hour Slot
Employment Services
a. Sheltered Employment (430) x x x Day of Service Slot
b. Group Supported Employment (465) x x x Day of Service Slot
c. Individual Supported Employment (460) x x x Service Hour NA
Residential Services
a. Highly Intensive Residential Services (501) x x x Bed Day Bed
b. Residential Crisis Stabilization Services (510) x x x Bed Day Bed
c. Intensive Residential Services (521) x x x Bed Day Bed
d. Supervised Residential Services (551) x x x Bed Day Bed
e. Supportive Residential Services (581) x x x Service Hour NA
Prevention Services (610) x x x Service Hour NA
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Core Services Definitions: Units of Service
There are four kinds of service units in this core services taxonomy: service hours, bed days, day
support hours, and days of service. These units are related to different kinds of core services and
are used to measure and report delivery of those services. The unit of service for each core service
category or subcategory is shown in the Core Services Category and Subcategory Matrix on the
preceding pages. Units of service are collected and reported in the Community Consumer
Submission (CCS) for all services provided by CSBs directly or through contracts with other
providers.
Service Hours
A service hour is a continuous period measured in fractions or multiples of an hour during
which an individual or a family member, authorized representative, care giver, health care
provider, or significant other through in-person or electronic (audio and video or telephonic)
contact on behalf of the individual receiving services or a group of individuals participates in or
benefits from the receipt of services. This definition also includes significant electronic contact
with the individual receiving services and activities that are reimbursable by third party payers.
The following table, developed by the Department and the VACSB Data Management
Committee, contains examples of activities received during service hour services directly by or
on behalf of individuals or groups of individuals.
Examples of Service Hour Activities
Individual, group, family, or marital, counseling or Phone consultation with individual
therapy Follow up and outreach
Psychological testing and evaluations Social security disability evaluation
Medication visit or physician visit Case management, individual present
Crisis intervention Case management, individual not present
Intake, psychiatric, forensic, court, and jail evaluations Peer self help or support
Emergency telephone contacts with individual Individual or group training
Preadmission screening evaluations Job development for individuals
Independent examinations Report writing re: individual
Commitment and MOT hearings Individual-related staff travel
Attending court with the individual Activity or recreation therapy
Discharge planning, individual present Education of individuals
Discharge planning, individual not present Early intervention activities
Service hours measure the amounts of services received by or on behalf of individuals or groups
of individuals. For example, if nine individuals received one hour of group therapy, one service
hour of outpatient services would be reported for each individual in a service.txt record in the
CCS. Service hours are reported in the CCS service file only for the following core services:
● Emergency services, ● Intensive outpatient services,
● Motivational treatment services, ● Medication assisted treatment,
● Consumer monitoring services, ● Assertive community treatment,
● Assessment and evaluation services, ● Case management services,
● Early intervention services, ● Individual supported employment, and
● Outpatient services, ● Supportive residential services.
Mental health and developmental prevention services are discussed on the next page.
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Z-Consumers: Service hours that are not received by or associated directly with individuals or
groups of individuals also are collected and reported for the core services listed at the bottom of
the previous page through the CCS using the z-consumer (unidentified individual receiving
services) function (NC Service file). In addition, mental health and developmental prevention
services are collected and reported using the z-consumer function, since individuals receiving
services are not counted for prevention services. All information about Substance Abuse
Prevention Services is collected and reported through the KIT Prevention System. Examples of
z-consumer activities are listed below.
Examples of Z-Consumer Activities for Service Hours
Case-specific clinical supervision Employee, student, or peer assistance
Record charting Staff preparation for individual, group, family,
Case consultation or marital counseling or therapy
Treatment planning conference Healthy pregnancies and fetal alcohol syndrome
Phone Calls in emergency services education
Participation in FAPT Child abuse and neglect prevention and
Coordination of multidisciplinary teams positive parenting programs
Consultation to service providers Neighborhood-based high risk youth programs
Application for admission to facility Competency building programs
Preparing for workshops and training Skill-building group training
Service hours received by groups of identifiable individuals (e.g., individuals participating in
group outpatient services) must not be reported using the z-consumer function (NC service file);
they must be reported in the service file as service hours received by each individual
participating in the group. Similarly, service hours directly associated with individuals, such as
case management without the individual present, discharge planning without the individual
present, phone consultation with the individual, or report writing re: individual, must not be
reported using the z-consumer function. Finally, units of service for core services measured
with bed days, days of service, or day support hours must not be reported in the CCS using the
z-consumer function (NC service file).
Bed Days
A bed day involves an overnight stay by an individual in a residential or inpatient program,
facility, or service. Given the unique nature of residential SA medically managed withdrawal
services, CSBs may count partial bed days for this service. If an individual is in this program
for up to six hours, this would equal ¼ bed day, six to 12 hours would equal ½ bed day, 12 to
18 hours would equal ¾ bed day, and 18 to 24 hours would equal one bed day.
Day Support Hours
Many day support services provided to groups of individuals are offered in sessions of two or
more consecutive hours. However, Medicaid billing units for State Plan Option and ID waiver
services vary by service. Therefore, counting service units by the smallest reasonable unit, a
day support hour, is desirable and useful. Medicaid service units, if different from taxonomy
units of service, need to be converted to taxonomy units for Medicaid services included in the
CCS. The day support hour is the unit of service for day treatment or partial hospitalization,
ambulatory crisis stabilization, and rehabilitation or habilitation and measures hours received by
individuals in those services.
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This unit allows the collection of more accurate information about services and will facilitate
billing various payors that measure service units differently. At a minimum, day support
programs that deliver services on a group basis must provide at least two consecutive hours in
a session to be considered a day support program.
Days of Service
Two employment services provided to groups of individuals are offered in sessions of three or
more consecutive hours. Day of service is the unit of service for sheltered employment and
group supported employment. A day of service equals five or more hours of service received
by an individual. If a session lasts three or more but less than five hours, it should be counted
as a half day. Since the unit of service is a day, fractional units should be aggregated to whole
days in the CCS. Also, Medicaid service units, if different from taxonomy units, need to be
converted to taxonomy units for Medicaid services included in the CCS.
Core Services Definitions: Static Capacities
Static capacities are reported through performance contract reports in the Community Automated
Reporting System (CARS) for those services shown in the Core Services Category and Subcategory
Matrix with a static capacity that are provided by CSBs directly or through contracts with other
providers.
Number of Beds
The number of beds is the total number of beds for which the facility or program is licensed and
staffed or the number of beds contracted for during the performance contract period. If the CSB
contracts for bed days without specifying a number of beds, convert the bed days to a static
capacity by dividing the bed days by the days in the term of the CSB’s contract (e.g., 365 for an
annual contract, 183 for a new, half-year contract). If the CSB contracts for the placement of a
specified number of individuals, convert this to the number of beds by multiplying the number
of individuals by their average length of stay in the program and then dividing the result by the
number of days in the term of the CSB’s contract.
Number of Slots
Number of slots means the maximum number of individuals who could be served during a day
or a half-day session in most day support programs. It is the number of slots for which the
program or service is staffed. For example, in psychosocial rehabilitation programs, the
number of slots is not the total number of members in the whole program; it is the number of
members who can be served by the program at the same time during a session. If the CSB
contracts for days of service without specifying a number of slots, convert the days of service to
a static capacity by dividing the days of service by the days in the term of the CSB’s contract
(e.g., 248 for an annual contract based on 365 days minus 105 weekend and 12 holiday days).
If the CSB contracts for the placement of a specified number of individuals, convert this to days
of service by multiplying the number of individuals by the average units of service they receive
and then convert the resulting days of service to slots, per the preceding example. If the CSB
contracts for day support hours without specifying a number of slots, convert the hours to a
static capacity by dividing the day support hours by the number of hours the program is open
daily and dividing the result by the number of days the program is open during the CSB’s
contract period.
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Core Services Definitions: Individuals Receiving Services
Section 37.2-100 of the Code of Virginia defines an individual receiving services as a current direct
recipient of public or private mental health, developmental, or substance abuse treatment or
habilitation services. The term individual or individual receiving services will always be those
individuals who have been admitted to a program area or for whom a CSB has opened a case and
who have received valid services during a reporting period or the contract period. However,
persons participating in prevention services are not counted as individuals receiving services.
If a CSB has opened a case for an individual or admitted an individual to a program area, but the
individual has not received any valid services during the reporting period or the contract period, the
CSB must not report that individual as a consumer in the CCS. Information about all individuals
receiving valid services from CSBs through directly operated services or contracts with other
providers must be collected and reported through the CCS.
Inpatient Core Service and State Facility Cost Centers Crosswalk
The following table crosswalks the inpatient services in the core services taxonomy (4.a through g)
with the state facility cost centers and codes.
Core Service and State Facility Cost Accounting Crosswalk
Inpatient Services (Core Service)
State Facility Cost Center Code
a. Medical/Surgical
Acute Medical/Surgical (Certified) 411
b. Skilled Nursing
Skilled Nursing – ID (Certified) 421
Skilled Nursing – General (Certified) 423
c. Intermediate Care Facility/Intellectual Disability (ID)
ICF/ID Certified (General) 529
d. Intermediate Care Facility/Geriatric
ICF (Certified) 441
Chronic Disease (Certified) 443
e. Acute Intensive Psychiatric
Acute Admissions (Certified) 457
g. Extended Rehabilitation
Community Preparation/Psychosocial 481
Long Term Rehabilitation 482
Child and Adolescent Services (General) 487
Clinical Evaluation 488
Forensic Medium Security 490
Forensic Maximum Security 491
Forensic Intermediate Security 493
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Performance Contract Definitions
Administrative Expenses means the expenses incurred by the CSB for its administrative functions.
Administrative expenses are incurred for common or joint activities that cannot be identified readily
with a particular organizational activity or cost objective. Expenses may include overall leadership
and supervision of the CSB organization (e.g., expenses for the executive director, deputy director
or director of administration, and support staff), financial management, accounting, reimbursement,
procurement, human resources management, information technology services, policy development,
strategic planning, resource development and acquisition, quality improvement, risk management,
intergovernmental relations, board member support, and media relations.
Administrative functions and expenses may be centralized or included in programs and services,
depending on the CSB’s organizational structure. However, in either alternative, administrative and
management expenses must be identified and allocated on a basis that is auditable and satisfies
generally accepted accounting principles among service costs across the three program areas and
emergency and ancillary services on financial and service forms in the performance contract and
reports, and administrative costs must be displayed separately on the Consolidated Budget form
(page AF-1) in the performance contract and reports. CSB administrative and management
expenses shall be reasonable and subject to review by the Department.
Admission means the process by which a CSB accepts a person for services in one or more
program areas (all mental health, developmental, or substance abuse services). If a person is only
interviewed regarding services or triaged and referred to another provider or system of care, that
activity does not constitute an admission. The staff time involved in that activity should be
recorded in the core service category or subcategory (e.g., emergency or outpatient services) where
the activity occurred as a z-consumer, a service with no associated individual receiving services, for
Community Consumer Submission (CCS) purposes. Admission is to a program area, not to a
specific program or service. A clinical record is opened on all persons seen face-to-face for an
assessment. Individuals who will be receiving services through a CSB-contracted program or
service are admitted to a program area, based upon a face-to-face clinical assessment. In order for a
person to be admitted to a program area, all of the following actions are necessary:
an initial contact has been made,
a clinical screening or initial assessment was conducted,
a unique identifier for the individual was assigned or retrieved from the management information
system if the person has been admitted for a previous episode of care, and
the person is scheduled to receive services in a directly-operated or contractual service in the
program area.
Admission is to a program area. An individual is not admitted to a program area for emergency
services or ancillary (motivational treatment, consumer monitoring, assessment and evaluation, or
early intervention) services; the CSB opens a case for that individual. The CCS requires collection
of an abbreviated set of data elements, rather than a full set, for these services. However, all of the
CCS data elements that were not collected then must be collected if an individual subsequently is
admitted to a program area. It is possible that an individual may be admitted to more than one
program area concurrently. A case is not opened for an individual participating in consumer-run
services. CSBs providing consumer-run services directly or contractually must report the number
of individuals participating in those services separately in the CARS management report.
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Case Management CSB means the CSB that serves the area in which the individual receiving
services lives. The case management CSB is responsible for case management, liaison with the
state facility when a person is admitted to it, and discharge planning. Any change in case
management CSB for an individual shall be implemented in accordance with the current Discharge
Planning Protocols to ensure a smooth transition for the individual and the CSB. Case management
CSB also means the CSB to which bed day utilization is assigned, beginning on the day of
admission, for an episode of care and treatment when an individual is admitted to a state facility.
Case Opening means the process by which the CSB opens a case for a person. The CSB has
determined that it can serve the person who has sought or been referred to it for services. This does
not constitute an admission to a program area. When the CSB opens a case for a person, he or she
can access the following services without being admitted to a program area: emergency services or
ancillary (motivational treatment, consumer monitoring, assessment and evaluation, and early
intervention) services. The CSB collects only minimal CCS data elements at case opening. If the
person needs other services, he or she is admitted to a program area. A person can be admitted
directly to a program area without going through case opening; however, CCS data and other
information collected at case opening must still be collected and reported.
Case Closing means the process by which the CSB closes a case for an individual who received
services.
Cognitive Delay means a child is at least three but less than six years old and has a confirmed
cognitive developmental delay. Documentation of a confirmed cognitive developmental delay must
be from a multidisciplinary team of trained personnel, using a variety of valid assessment
instruments. A confirmed delay will be noted on the test with a score that is at least 25 percent
below the child’s chronological age in one or more areas of cognitive development. A
developmental delay is defined as a significant delay in one of the following developmental areas:
cognitive ability, motor skills, social/adaptive behavior, perceptual skills, or communication skills.
A multidisciplinary team of trained personnel will measure developmental delay (25 percent below
the child’s chronological age) by a using a variety of valid assessment instruments. The most
frequently used instruments in Virginia’s local school systems are the Battelle Developmental
Inventory, Learning Accomplishments Profile – Diagnostic Edition (LAP-D), the Early Learning
Accomplishment Profile (ELAP), and the Hawaiian Early Learning Profile (HELP). For infants and
toddlers born prematurely (gestation period of less than 37 weeks), the child’s actual adjusted age is
used to determine his or her developmental status. Chronological age is used once the child is 18
months old.
Co-Occurring Disorders means individuals are diagnosed with more than one, and often several,
of the following disorders: mental health or substance use disorders or intellectual disability.
Individuals may have more than one substance use disorder and more than one mental health
disorder. At an individual level, co-occurring disorders exist when at least one disorder of each
type (e.g., mental health and substance use disorder or intellectual disability and mental health
disorder) can be identified independently of the other and are not simply a cluster of symptoms
resulting from a single disorder. The mental health and substance use disorders of some individuals
may not, at a given point in time, fully meet the criteria for diagnoses in DSM IV categories. While
conceptually ideal, diagnostic certainty cannot be the sole basis for system planning and program
implementation.
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A service definition of co-occurring disorders includes individuals who are pre-diagnosis in that an
established diagnosis in one domain (mental health disorder, intellectual disability, or substance use
disorder) is matched with signs or symptoms of an evolving disorder in another domain. Similarly,
the service definition also includes individuals who are post-diagnosis in that one or both of their
substance use disorder and their mental health disorder may have resolved for a substantial period
of time, but who present for services with a unitary disorder and acute signs or symptoms of a cooccurring condition. For example, an individual with a substance use disorder who is now suicidal
may not meet the formal criteria for a DSM IV diagnosis but is clearly in need of services that
address both conditions. Refer to State Board Policy 1015 (SYS) 86-22 for more information about
providing services to individuals with co-occurring mental health disorders, intellectual disability,
or substance use disorders.
The definition of co-occurring disorders for the Community Consumer Submission data set is
individuals shall be identified as having co-occurring mental health and substance use disorders if
there is (1) an Axis I or Axis II mental health diagnosis and (a) an Axis I substance use disorder
diagnosis or (b) admission to the substance abuse program area (denoted in a type of care record) or
(2) an Axis I substance use disorder diagnosis and (a) an Axis I or Axis II mental health diagnosis
or (b) admission to the mental health program area (denoted in a type of care record).
Discharge means the process by which a CSB documents the completion of a person’s episode of
care in a program area. Discharge occurs at the program area level, as opposed to a specific service.
When an individual has completed receiving all services in the program area to which he or she was
admitted, the person has completed the current episode of care and is discharged from that program
area. A person is discharged from a program area if any of the following conditions exists; the
individual has:
been determined to need no further services in that program area,
completed receiving services from all CSB and CSB-contracted services in that program area,
received no program area services in 90 days from the date of the last face-to-face service or
service-related contact or indicated that he no longer desires to receive services, or
relocated or died.
Persons may be discharged in less than the maximum time since the last face-to-face contact (i.e.,
less than 90 days) at the CSB’s discretion, but the person must be discharged if no face-to-face
services have been received in the maximum allowable time period for that episode of care. Once
discharged, should an individual return for services in a program area, that person would be
readmitted to that program area; the subsequent admission would begin a new episode of care. If
the person is discharged because he or she has received no services in 90 days, the discharge date
must be the date of the last face-to-face or other contact with the person, not the 90th day.
In the rare circumstance in which services are provided for an individual after he or she has been
discharged (e.g., completing a discharge summary), the units of service should be collected and
reported in the core service category or subcategory (e.g., outpatient or case management services)
where the activity occurred using the z-consumer function (NC service file), a service with no
associated individual receiving services, for CCS purposes.
Episode of Care means all of the services provided to an individual to address an identified
condition or support need over a continuous period of time between an admission and a discharge.
An episode of care begins with admission to a program area, and it ends with the discharge from
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that program area. An episode of care may consist of a single face-to-face encounter or multiple
services provided through one or more programs. A person is not admitted to emergency services
or ancillary services; those services are outside of an episode of care. If a person has received his or
her last service but has not yet been discharged from a program area, and he or she returns for
services in that program area within 90 days, the person is not readmitted, since he or she has not
been discharged; the person is merely accepted into that program area for the needed services.
Intellectual Disability means a disability, originating before the age of 18 years, characterized
concurrently by (i) significantly sub average intellectual functioning as demonstrated by
performance on a standardized measure of intellectual functioning, administered in conformity with
accepted professional practice, that is at least two standard deviations below the mean and (ii)
significant limitations in adaptive behavior as expressed in conceptual, social, and practical adaptive
skills (§ 37.2-100 of the Code of Virginia).
Mental Illness means a disorder of thought, mood, emotion, perception, or orientation that
significantly impairs judgment, behavior, capacity to recognize reality, or ability to address basic
life necessities and requires care and treatment for the health, safety, or recovery of the individual or
for the safety of others (§ 37.2-100 of the Code of Virginia).
Serious Mental Illness means a severe and persistent mental or emotional disorders that seriously
impair the functioning of adults, 18 years of age or older, in such primary aspects of daily living as
personal relations, self-care skills, living arrangements, or employment. Individuals with serious
mental illness who have also been diagnosed as having a substance abuse disorder or developmental
disability are included in this definition. Serious mental illness is defined along three dimensions:
diagnosis, level of disability, and duration of illness. All three dimensions must be met to meet the
criteria for serious mental illness.
a. Diagnosis: The person must have a major mental disorder diagnosed using the Diagnostic and
Statistical Manual of Mental Disorders (DSM). These disorders are: schizophrenia, major
affective disorders, paranoia, organic or other psychotic disorders, personality disorders, or other
disorders that may lead to chronic disability. A diagnosis of adjustment disorder or a V Code
diagnosis cannot be used to satisfy these criteria.
b. Level of Disability: There must be evidence of severe and recurrent disability resulting from
mental illness. The disability must result in functional limitations in major life activities.
Individuals should meet at least two of the following criteria on a continuing or intermittent
basis. The person:
1.) Is unemployed; is employed in a sheltered setting or supportive work situation; has markedly
limited or reduced employment skills; or has a poor employment history;
2.) Requires public financial assistance to remain in the community and may be unable to
procure such assistance without help;
3.) Has difficulty establishing or maintaining a personal social support system;
4.) Requires assistance in basic living skills such as personal hygiene, food preparation, or
money management; or
5.) Exhibits inappropriate behavior that often results in intervention by the mental health or
judicial system.
c. Duration of Illness: The individual is expected to require services of an extended duration, or the
individual’s treatment history meets at least one of the following criteria.
Core Services Taxonomy 7.3
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1.) The individual has undergone psychiatric treatment more intensive than outpatient care more
than once in his or her lifetime (e.g., crisis response services, alternative home care, partial
hospitalization, and inpatient hospitalization), or
2.) The individual has experienced an episode of continuous, supportive residential care, other
than hospitalization, for a period long enough to have significantly disrupted the normal
living situation.
Serious Emotional Disturbance means a serious mental health problem that can be diagnosed under
the DSM-IV in children ages birth through 17 (until the 18th birthday), or the child must exhibit all
of the following:
a. Problems in personality development and social functioning that have been exhibited over at
least one year’s time, and
b. Problems that are significantly disabling based upon the social functioning of most children that
age, and
c. Problems that have become more disabling over time, and
d. Service needs that require significant intervention by more than one agency.
At Risk of Serious Emotional Disturbance means children aged birth through seven are considered
at risk of developing serious emotional disturbances if they meet at least one of the following
criteria.
a. The child exhibits behavior or maturity that is significantly different from most children of that
age and is not primarily the result of developmental disabilities; or
b. Parents or persons responsible for the child’s care have predisposing factors themselves that
could result in the child developing serious emotional or behavioral problems (e.g., inadequate
parenting skills, substance abuse, mental illness, or other emotional difficulties, etc.); or
c. The child has experienced physical or psychological stressors that have put him or her at risk for
serious emotional or behavioral problems (e.g., living in poverty, parental neglect, physical or
emotional abuse, etc.).
Please refer to Appendix A that contains detailed criteria in checklists for serious mental illness,
serious emotional disturbance, and at risk of serious emotional disturbance. Those criteria are
congruent with these definitions and will ensure consistent screening for and assessment of these
conditions.
Program Area means the general classification of service activities for one of the following
defined conditions: a mental health disorder, intellectual disability, or a substance use disorder. The
three program areas in the public services system are mental health, developmental, and substance
abuse services. In the taxonomy, mental health or substance use disorder or intellectual disability
refers to a condition experienced by an individual; and mental health, substance abuse, or
developmental refers respectively to the services that address that condition.
Service Area means the city or county or any combination of cities and counties or counties or
cities that established and is served by the CSB.
Service Location means the location in which the service for which a service.txt file is submitted in
the Community Consumer Submission (CCS) was provided to an individual. Service location is
reported in the service file for every service in all program areas (100, 200, and 300) and for
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emergency and ancillary services (400). Service location is collected at every service encounter.
Service locations are defined in CCS data element 65.
Service Subtype is a specific activity associated with a particular core service category or
subcategory for which a service.txt file is submitted in the Community Consumer Submission.
Service Subtypes now are defined only for emergency services and case management services.
Service subtypes are defined in CCS data element 64.
Substance Abuse means the use of drugs, enumerated in the Virginia Drug Control Act (§ 54.01-
3400 et seq.), without a compelling medical reason or alcohol that (i) results in psychological or
physiological dependence or danger to self or others as a function of continued and compulsive use
or (ii) results in mental, emotional, or physical impairment that causes socially dysfunctional or
socially disordering behavior and (iii), because of such substance abuse, requires care and treatment
for the health of the individual. This care and treatment may include counseling, rehabilitation, or
medical or psychiatric care (§ 37.2-100 of the Code of Virginia). Substance abuse is now beginning
to be defined and described as substance use disorder. There are two levels of substance use
disorder: substance addiction (dependence) and substance abuse.
Substance Addiction (Dependence), as defined by ICD-9, means uncontrollable substance-seeking
behavior involving compulsive use of high doses of one or more substances resulting in substantial
impairment of functioning and health. Tolerance and withdrawal are characteristics associated with
dependence. ICD-9 defines substance dependence as a maladaptive pattern of substance use,
leading to clinically significant impairment or distress, as manifested by three (or more) of the
following, occurring at any time in the same 12-month period:
tolerance, as defined by a need for markedly increased amounts of the substance to achieve
intoxification or desired effect or markedly diminished effect with continued use of the same
amount of the substance;
withdrawal, as manifested by the characteristic withdrawal syndrome for the substance or the
same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms;
the substance is often taken in larger amounts or over a longer period than was intended;
there is a persistent desire or unsuccessful efforts to cut down or control substance use;
a great deal of time is spent on activities necessary to obtain the substance, use the substance, or
recover from its effects;
important social, occupational, or recreational activities are given up or reduced because of
substance use; and
the substance use is continued despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by the substance.
Substance Abuse, as defined by ICD-9, means a maladaptive pattern of substance use manifested by
recurrent and significant adverse consequences related to the repeated use of substances. It leads to
clinically significant impairment or distress, as manifested by one (or more) of the following
occurring within a 12-month period:
recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or
home (e.g., repeated absences or poor work performance related to substance use; substancerelated absences, suspensions, or expulsions from school; neglect of children or household);
Core Services Taxonomy 7.3
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recurrent substance use in situations in which it is physically hazardous (e.g., driving an
automobile or operating a machine when impaired by substance use);
recurrent substance-related legal problems (e.g., arrests for substance-related disorderly
conduct); and
continued substance use despite having persistent or recurrent social or interpersonal problems
caused or exacerbated by the effects of the substance (e.g., arguments with spouse about
consequences of intoxification, physical fights).
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Appendix A: Diagnostic Criteria Checklists
Serious Mental Illness Criteria Checklist
Yes No Criteria
Age: The individual is 18 years of age or older.
DIAGNOSIS: The individual has a major mental disorder diagnosed using the DSM
IV. At least one of the following diagnoses must be present. Adjustment disorder or
V Code diagnoses do not meet this criterion.
Schizophrenia, all types
Major Affective Disorder
Paranoid Disorder
Organic Disorder
Other Psychotic Disorder
Personality Disorder
Other mental health disorder that may lead to chronic disability
Level Of Disability: There must be evidence of severe and recurrent disability
resulting from mental illness. The disability must result in functional limitations in
major life activities. The individual must meet at least two of these criteria on a
continuing or intermittent basis. The individual:
Is unemployed; employed in a sheltered setting or a supportive work situation; has
markedly limited or reduced employment skills; or has a poor employment history.
Requires public financial assistance to remain in the community and may be unable to
procure such assistance without help.
Has difficulty establishing or maintaining a personal social support system.
Requires assistance in basic living skills such as personal hygiene, food preparation, or
money management.
Exhibits inappropriate behavior that often results in intervention by the mental health or
judicial system.
Duration Of Illness: The individual’s treatment history must meet at least one of
these criteria. The individual:
Is expected to require services of an extended duration.
Has undergone psychiatric treatment more intensive than outpatient care more than
once in his or her lifetime (e.g., crisis response services, alternative home care, partial
hospitalization, and inpatient hospitalization).
Has experienced an episode of continuous, supportive residential care, other than
hospitalization, for a period long enough to have significantly disrupted the normal
living situation.
If Yes is checked for criterion 1, and for at least one response in criterion 2, and for at least
two responses in criterion 3, and for at least one response in criterion 4, then check Yes
here to indicate that the individual has serious mental illness.
NOTE: Any diagnosis checked in 2 above must be documented in the individual’s clinical record and
in the CSB’s information system, and the individual’s clinical record also must contain documentation
that he or she meets any criteria checked in 3 and 4 above.
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Appendix A: Diagnostic Criteria Checklists
Serious Emotional Disturbance Criteria Checklist
Yes No Criteria
Age: The individual is a child, age birth through 17 (until the 18th birthday).
Diagnosis: The child has a serious mental health problem that can be
diagnosed under the DSM IV. Specify the diagnosis: _______
Problems And Needs: The child must exhibit all of the following:
Problems in personality development and social functioning that have been
exhibited over at least one year’s time, and
Problems that are significantly disabling based upon the social functioning of
most children that child’s age, and
Problems that have become more disabling over time, and
Service needs that require significant intervention by more than one agency.
If Yes is checked for criterion 1 and for criterion 2 OR for all four responses in
criterion 3, then check Yes here to indicate that the child has serious emotional
disturbance.
NOTE: Any diagnosis in criterion 2 above must be documented in the child’s clinical
record and in the CSB’s information system, and the child’s clinical record also must contain
documentation of any of the problems or needs checked in criterion 3 above.
At Risk Of Serious Emotional Disturbance Criteria Checklist
Yes No Criteria
Age: The person is a child, age birth through 7.
Problems: The child must meet at least one of the following criteria.
The child exhibits behavior or maturity that is significantly different from
most children of that age and which is not primarily the result of
developmental disabilities; or
Parents or persons responsible for the child’s care have predisposing factors
themselves that could result in the child developing serious emotional or
behavioral problems (e.g., inadequate parenting skills, substance use disorder,
mental illness, or other emotional difficulties, etc.); or
The child has experienced physical or psychological stressors that have put
him or her at risk for serious emotional or behavioral problems (e.g., living in
poverty, parental neglect, or physical or emotional abuse, etc,).
If Yes is checked for criterion 1 and for any problem in criterion 2, then check
Yes here to indicate that the child is at risk of serious emotional disturbance.
NOTES: These criteria should be used only if the child does not have serious emotional
disturbance. The child’s clinical record must contain documentation of any of the problems
checked in criterion 2 above.
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Appendix B: Core Services Taxonomy and Medicaid Intellectual Disability
Home and Community-Based Waiver (ID Waiver) Services Crosswalk
Core Services Taxonomy Service ID Home and Community-Based Waiver Service
Emergency Services Crisis Stabilization/Crisis Supervision
Personal Emergency Response System 1
Inpatient Services None
Outpatient Services Skilled Nursing Services 2
Therapeutic Consultation 3
Case Management Services None. Case Management is not a Waiver service.
Day Support: Habilitation Day Support (Center-Based and Non-Center-Based) and
Prevocational
Sheltered Employment None
Group Supported Employment Supported Employment – Group Model
Individual Supported Employment Supported Employment – Individual Placement
Highly Intensive Residential Services None, this is ICF/ID services in the taxonomy.
Intensive Residential Services Congregate Residential Support Services 5
Supervised Residential Services Congregate Residential Support Services 5
Supportive Residential Services Supported Living/In-Home Residential Supports
Agency and Consumer-Directed Respite Services,
Personal Assistance Services 4
, and Companion Services
Early Intervention, Ancillary Services None
This crosswalk is included for information purposes. When there is an inconsistency between
Medicaid service units and taxonomy units of service, taxonomy units of service will be used for
uniform cost report and CCS purposes. Medicaid service definitions can be accessed at
https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManuals
1 Personal Emergency Response System will be counted in the taxonomy and performance
contract in terms of numbers of individuals served and expenses; there are no core services
taxonomy units of service for this Medicaid service.
2
Skilled Nursing Services are available to individuals with serious medical conditions and
complex health care needs that require specific skilled nursing services that are long term and
maintenance in nature ordered by a physician and which cannot be accessed under the Medicaid
State Plan. Services are provided in the individual’s home or a community setting on a regularly
scheduled or intermittent need basis. The Medicaid service unit is one hour.
3 Therapeutic Consultation provides expertise, training, and technical assistance in a specialty area
(psychology, behavioral consultation, therapeutic recreation, rehabilitation engineering, speech
therapy, occupational therapy, or physical therapy) to assist family members, care givers, and
other service providers in supporting the individual receiving services. ID Waiver therapeutic
consultation services may not include direct therapy provided to Waiver recipients or duplicate the
activities of other services available to the person through the State Plan for Medical Assistance.
This service may not be billed solely for monitoring purposes. The Medicaid service unit is one
hour. Therapeutic consultation is included under outpatient services in the crosswalk, instead of
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case management services, to preserve the unique nature of case management services and
because it seemed to fit most easily in outpatient services. This also is the preference expressed by
the VACSB Developmental Services Council.
4 Personal Assistance Services are available to ID Waiver recipients who do not receive
congregate residential support services or live in an assisted living facility and for whom training
and skills development are not primary objectives or are received in another service or program.
Personal assistance means direct assistance with personal care, activities of daily living,
medication or other medical needs, and monitoring physical condition. It may be provided in
residential or non-residential settings to enable an individual to maintain health status and
functional skills necessary to live in the community or participate in community activities.
Personal assistance services may not be provided during the same hours as Waiver supported
employment or day support, although limited exceptions may be requested for individuals with
severe physical disabilities who participate in supported employment. The Medicaid service unit
is one hour. Personal Assistance Services and Companion Services are included under supportive
residential services because they are more residentially based than day support based. The
credentials for both include Department residential services licenses. This is the preference
expressed by the VACSB Developmental Services Council. The Medicaid service unit and
taxonomy unit are the same, a service hour.
5Congregate Residential Support Services have a Medicaid service unit measured in hours; this is
inconsistent with the taxonomy bed day unit of service for intensive and supervised residential
services. Therefore, congregate residential support services will be counted in the taxonomy and
performance contract reports in terms of numbers of individuals served and expenses; there are no
taxonomy units of service for these Medicaid services.
Environmental Modifications are available to individuals who are receiving at least one other ID
Waiver service along with Medicaid targeted case management services. Modifications are
provided as needed only for situations of direct medical or remedial benefit to the individual. These
are provided primarily in an individual’s home or other community residence. Modifications may
not be used to bring a substandard dwelling up to minimum habitation standards. Environmental
modifications include physical adaptations to a house or place of residence necessary to ensure an
individual’s health or safety or to enable the individual to live in a non-institutional setting,
environmental modifications to a work site that exceed reasonable accommodation requirements of
the Americans with Disabilities Act, and modifications to the primary vehicle being used by the
individual. The Medicaid service unit is hourly for rehabilitation engineering, individually
contracted for building contractors, and may include supplies. Environmental Modifications are
included in the core service in which they are implemented (e.g., various residential services or case
management services).
Assistive Technology is available to individuals who are receiving at least one other ID Waiver
service along with Medicaid targeted case management services. It includes specialized medical
equipment, supplies, devices, controls, and appliances not available under the State Plan for
Medical Assistance that enable individuals to increase their abilities to perform activities of daily
living or to perceive, control or communicate with the environment in which they live or that are
necessary to their proper functioning. It may be provided in a residential or non-residential setting.
The Medicaid service unit is hourly for rehabilitation engineering or the total cost of the item or the
supplies. Assistive technology is included in the core service in which it is implemented (e.g.,
various residential services or case management services).
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Appendix C: Retired Core Services Service Codes
The following core services service codes have been retired from use. The codes are listed in this
appendix so that when core service categories or subcategories are added to the taxonomy in the
future, none of these retired codes will be assigned to those new services.
Retired Core Services Service Codes
Core Service Category Former Core Services Subcategory Service Code
Outpatient Services Medical Services 311
Outpatient Services Intensive In-Home Services 315
Outpatient Services Opioid Detoxification Services 330
Outpatient Services Opioid Treatment Services 340
Day Support Therapeutic Day Treatment for Children and
Adolescents
415
Day Support Alternative Day Support Arrangements 475
Residential Services Jail-Based Habilitation Services 531
Residential Services Family Support Services 587
Limited Services Substance Abuse Social Detoxification Services 710
Appendix D: Reserved for Future Use

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Appendix E: Regional Program Operating Principles
A regional program is funded by the Department through the community services board or
behavioral health authority, hereafter referred to as the CSB, and operated explicitly to provide
services to individuals who receive services from the CSBs participating in the program. A regional
program may be managed by the participating CSBs or by one CSB, have single or multiple service
sites, and provide one or more types of service. A regional program also may include selfcontained, single purpose programs (e.g., providing one type of core service, usually residential)
operated by one CSB for the benefit of other CSBs or programs contracted by one CSB that serve
individuals from other CSBs.
A regional program can be a highly effective way to allocate and manage resources, coordinate the
delivery and manage the utilization of high cost or low incidence services, and promote the
development of services where economies of scale and effort could assist in the diversion of
individuals from admission to state facilities. Each individual receiving services provided through a
regional program must be identified as being served by a particular CSB. That CSB will be
responsible for contracting for and reporting on the individuals that it serves and the services that it
provides; and each individual will access services through and have his or her individualized
services plan managed by that particular CSB. CSBs are the single points of entry into publicly
funded mental health, developmental, and substance abuse services, the local points of
accountability for coordination of those services, and the only entities identified in the Code of
Virginia that the Department can fund for the delivery of community mental health, developmental,
or substance abuse services.
The regional program operating principles provide guidance for CSBs to implement and manage
identified regional programs and to account for services provided by the programs. The principles
also provide guidance for the Department to monitor regional programs on a more consistent basis.
Adherence to these principles will ensure that performance contracts and reports, including the
Community Automated Reporting System (CARS) and the Community Consumer Submission
(CCS) reports, contain complete and accurate information about individuals receiving services,
services, funding, and expenses.
Regional Program Operating Principles
Individual CSB Reporting: The CCS, a secure and HIPAA-compliant individual data
reporting system, is the basis for all statewide individual and service data. Therefore, every
individual served in any manner must be included in some CSB’s information system, so that
necessary individual and service information can be extracted by CSBs and provided to the
Department using the CCS. If a CSB does not collect information about all of the individuals it
serves and services, including those served by regional programs, in its information system, it
will not be able to report complete information about its operations to the Department.
a. Unless subsection b. is applicable, each CSB participating in a regional program shall admit
individuals that it serves through the regional program to the applicable program area(s) and
maintain CCS data about them in its information system. For performance contract and
report purposes (CARS and CCS), each participating CSB shall maintain and report funding,
expense, cost, individual, and service information associated with the regional program for
each individual that it serves through the regional program.
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b. If one CSB operates a regional program on behalf of other CSBs in a region, it shall admit
all individuals for services provided by the regional program, maintain CCS data about these
individuals in its information system, and maintain and report funding, expense, cost,
individual, and service information associated with those individuals, or, if the participating
CSBs elect, each referring CSB may report on the individuals it serves.
Regional Program Funding: Depending on the design of a regional program, the Department
may disburse state or federal funds for a regional program to each participating CSB or to one
CSB that operates a regional program or agrees to serve as the fiscal agent for a regional
program. Sections 37.2 -504 and 37.2-508 of the Code of Virginia establish the community
services performance contract as the mechanism through which the Department provides state
and federal funds to CSBs for community services and through which CSBs report on the use of
those and other funds. All regional programs shall be included in the performance contract and
reflected in CARS and CCS reports.
a. If the Department disburses regional program funds to each participating CSB, each
participating CSB shall follow existing performance contract and report requirements and
procedures for that portion of the regional program funded by that CSB.
b. If the Department disburses regional program funds to a CSB that operates a regional
program on behalf of the other CSBs in a region, the operating CSB shall follow existing
performance contract and report requirements and procedures, as if the regional program
were its own program.
c. If the Department disburses regional program funds to a CSB that has agreed to serve as the
fiscal agent (fiscal agent CSB) for the regional program, disbursements will be based on,
accomplished through, and documented by appropriate procedures, developed and
implemented by the region.
d. When funds are disbursed to a fiscal agent CSB, each participating CSB shall identify, track,
and report regional program funds that it receives and spends as funds for that regional
program. Each participating CSB, including the fiscal agent CSB, shall reflect in its CARS
reports and CCS 3 extracts only its share of the regional program, in terms of individuals
served, services provided, funds received, expenses made, and costs of the services. Any
monitoring and reporting of and accountability for the fiscal agent CSB’s handling of state
or federal funds for a regional program shall be accomplished through the performance
contract and reports. Alternately, if the participating CSBs elect, each CSB may perform
these functions for its share of the regional program.
e. When funds are disbursed to a fiscal agent CSB that pays a contract agency to deliver
regional program services, the fiscal agent CSB and participating CSBs may elect to
establish an arrangement in which the fiscal agent CSB reports all of the funds and
expenditures in the fiscal pages of Exhibit A while the participating CSBs and the fiscal
agent CSB report information about individuals served, units of services, and expenses for
those units only for the individuals it serves on the program pages of Exhibit A, with a note
on the Comments page of Exhibit A explaining the differences between the fiscal and
program pages. Alternately, if the participating CSBs elect, the fiscal agent CSB may admit
the individuals served by other participating CSBs and, for purposes of this regional
program, treat those individuals as its own for documentation and reporting purposes.
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Financial Reporting: All funds, expenses, and costs for a regional program shall be reported to
the Department only once; they may be reported by individual CSBs, the CSB that serves as the
fiscal agent, or both, depending on how the regional program is designed and operates. For
example, the fiscal agent CSB might report the revenues and expenses for a regional program
provided by a contract agency, and a CSB that refers individuals it serves to that regional
program may report the service and cost information related to those individuals.
Consumer Reporting: Each individual who receives services through a regional program shall
be reported to the Department only once for a particular service. However, an individual who
receives services from more than one CSB should be reported by each CSB that provides a
service to that individual. For example, if an individual receives outpatient mental health
services from one CSB and residential crisis stabilization services from a second CSB operating
that program on behalf of a region, the individual would be admitted to each CSB and each CSB
would report information about the individual and the service it provided to the individual.
Service Reporting: Each service provided by a regional program shall be reported only once,
either by the CSB providing or contracting for the service or the CSB that referred individuals it
served to the regional program operated or contracted by another CSB or by the region.
Contracted Regional Programs: When the case management CSB refers an individual to a
regional program that is operated by a contract agency and paid for by the regional program’s
fiscal agent CSB, the case management CSB shall report the service and cost information, but
not the funding and expense information, even though it did not provide or pay for it, since there
would be no other way for information about it to be extracted through the CCS. Alternately, if
the participating CSBs elect, the fiscal agent CSB could admit the individual for this service and
report information about the individual receiving services, services, costs, funds, and expenses
itself; in this situation, the case management CSB would report nothing about this service.
Transfers of Resources Among CSBs: CSBs should be able to transfer state, local, and
federal funds to each other to pay for services that they purchase from each other.
Use of Existing Reporting Systems: Existing reporting systems (the CCS and CARS) shall be
used wherever possible, rather than developing new reporting systems, to avoid unnecessary or
duplicative data collection and entry. Any new service or program shall be implemented as
simply as possible regarding reporting requirements.
Regional Administrative and Management Expenses: CSBs and the Department have
provider and local or state authority roles that involve non-direct services tasks such as
utilization management and regional authorization committees. These roles incur additional
administrative and management expenses for the programs. CSBs shall report these expenses as
part of their costs of delivering regional services. The Department shall factor in and accept
reasonable administrative and management expenses as allowable costs in regional programs.
Local Supplements: If a CSB participating in a regional program supplements the allocation of
state or federal funds received by the CSB operating that program through transferring resources
to the operating CSB, the participating CSB shall show the transfer as an expense on financial
forms but not as a cost on service forms in its performance contract and reports. Then, the
participating CSB will avoid displaying an unrealistically low service cost in its reports for the
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regional program and double counting individuals served by and service units delivered in the
regional program, since the operating CSB already reports this information.
Balances: Unexpended balances of current or previous fiscal year regional program funds
should not be retained by the participating CSBs to which the regional fiscal agent CSB or the
Department disbursed the funds, unless this is approved by the region for purposes that are
consistent with the legislative intent of the Appropriation Act item that provided the funds.
Otherwise, the balances should be available for redistribution during the fiscal year among
participating CSBs to ensure maximum utilization of these funds. Each region should establish
procedures for monitoring expenditures of regional program funds and redistributing those
unexpended balances to ensure that uses of those funds are consistent with the legislative intent
of the Appropriation Act item that provided the funds.
Issue Resolution: Regional program funding issues, such as the amount, sources, or adequacy
of funding for the program, the distribution of state allocations for the regional program among
participating CSBs, and financial participation of each CSB whose individuals receive services
from the regional program, should be resolved at the regional level among CSBs participating in
the program, with the Department providing information or assistance upon request.
Local Participation: Whenever possible, regional funding and reporting approaches should
encourage or provide incentives for the contribution of local dollars to regional activities.
Four Regional Program Models
The following models have been developed for CSBs and the Department to use in designing,
implementing, operating, monitoring, and evaluating regional programs. These models are
paradigms that could be altered by mutual agreement among the CSBs and the Department as
regional circumstances warrant. However, to the greatest extent possible, CSBs and the Department
should adhere to these models to support and reinforce more consistent approaches to the operation,
management, monitoring, and evaluation of regional programs. CSBs should review these models
and, in consultation with the Department, implement the applicable provisions of the model or
models best suited to their particular circumstances, so that the operations of any regional program
will be congruent with one of these models.
Operating CSB-Funded Regional Program Model
The CSB that operates a regional program receives state and sometimes other funds from the
Department for the program. The operating CSB provides the services, projects the total
funding and cost for the regional program in its performance contract and contract revision(s),
and reports total actual individuals served and units of service(s) delivered in its Community
Consumer Submission 3 (CCS 3) extracts and reports funding, expenses, costs, and static
capacities in its CARS. Other CSBs, which refer individuals to the regional program for
services, project and report nothing for the regional program in their contracts, CARS reports, or
CCS 3 extracts.
The operating CSB admits individuals receiving services from the regional program to the
applicable program area (all MH, DV, or SA services) and develops individualized services
plans (ISPs) for them for service(s) provided by the regional program. When individuals
complete receiving all services from the regional program, they are discharged from the
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applicable program area by the operating CSB, unless they are receiving other services in that
program area from that operating CSB. If individuals also are receiving services from the
operating CSB in another program area, the CSB admits them to that program area. The
operating CSB provides appropriate information about the services provided and other clinical
information to the CSB that referred the individual to the regional program for clinical record
keeping purposes at the referring CSB.
The operating CSB ensures that the appropriate information about individuals and services in
the regional program is entered into its information system, so that the information can be
extracted by the CCS 3 and reported in the CCS 3 and applicable CARS reports. Thus, for
performance contract and reporting purposes, individuals receiving services from a regional
program operated by that CSB are reported by that operating CSB.
Each of the other CSBs with individuals receiving services from this regional program admits
those individuals to the applicable program area and provides a service, such as case
management, consumer monitoring, or another appropriate service, but not in service(s)
provided by the regional program. Thus, individuals receiving services from a regional program
will appear in the CCS 3 extracts for two CSBs, but not for the same services.
If the other CSBs with individuals receiving services from this regional program provide
additional funds to the operating CSB to supplement the funds that the operating CSB receives
from the Department for the regional program, these other CSBs show the revenues and
expenses for this supplement on the financial forms in their performance contracts, contract
revisions, and reports. However, these other CSBs do not show any services provided,
individuals served, or costs for the regional program’s services on the service forms in their
contracts, revisions, or reports. These other CSBs include an explanation on the Financial
Comments page of the difference between the expenses on the financial forms and the costs on
the service forms. The operating CSB shows the services provided, individuals served, and total
costs (including costs supported by supplements from the other CSBs) for the regional
program’s services on its service forms, but it does not show any revenues or expenses
associated with the supplements on the financial pages in its contract, contract revision(s), and
reports. The operating CSB includes an explanation of the difference between the expenses on
the financial forms and the costs on the service forms on the Financial Comments page.
All of the CSBs, to the extent practicable, determine individual CSB allocations of the state and
sometimes other funds received from the Department, based on service utilization or an agreedupon formula.
Regional programs should receive the same state funding increases as regular CSB grantfunded activities, such as the salary increases for community services provided from time to
time by the General Assembly in the Appropriation Act.
This model also could be adapted by a region to handle its LIPOS services, if one CSB receives all
of the LIPOS funds, admits all of the individuals receiving LIPOS services, and pays all of the
LIPOS providers. Participating CSBs should negotiate this adaptation with the Department.
All Participating CSBs-Funded Regional Program Model
Each CSB that participates in a regional program that is operated by one of those CSBs receives
state and sometimes other funds from the Department for that program. Each participating CSB
may supplement this amount with other funds available to it if the funds received from the
Department are not sufficient to cover the regional program’s expenses. Each participating CSB
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uses those funds to purchase services from the regional program for the individuals it serves,
projects the funding and cost for the regional program in its performance contract) and reports
actual individuals served and units of service(s) delivered in its Community Consumer
Submission 3 (CCS 3) extracts and reports funding, expenses, costs, and static capacities in its
performance contract reports (CARS) only for the individuals it serves.
The regional program operated by one of the participating CSBs functions like a contract
agency provider. All of the individual, service, static capacity, funding, expense, and cost
information for the whole program is maintained separately and is not included in the contract,
contract revision(s), reports (CARS), and CCS 3 extracts of the CSB operating the program.
The participating CSBs, including the CSB operating the program, include only the parts of this
information that apply to the individuals it serves in their contracts, contract revisions, reports,
and extracts. The regional program is licensed by the Department, when applicable, and
develops and maintains individualized services plans (ISPs) for individuals that it serves.
Each participating CSB admits individuals receiving services from the regional program to the
applicable program area (all MH, DV, or SA services) for the services provided by the regional
program. The services provided by the regional program are listed in the ISPs maintained by
the participating CSBs for these individuals. When individuals complete receiving all services
from the regional program, they are discharged from the applicable program area by the
participating CSB, unless they continue to receive other services in that program area from that
participating CSB. The regional program provides appropriate information about the services
provided and other clinical information to the CSB that referred the individual to the program,
as any contract agency would provide such information to the contracting CSB.
Each participating CSB, including the CSB operating the regional program, ensures that the
appropriate information about the individuals it serves and their services is entered into its
information system, so that the information can be extracted by the CCS 3 and reported in the
CCS 3 submissions and applicable CARS reports for that participating CSB.
Regional programs should receive the same state funding increases as regular CSB grantfunded activities, such as the salary increases for community services provided from time to
time by the General Assembly in the Appropriation Act.
Fiscal Agent CSB-Funded Regional Program Model
One CSB receives state and sometimes other funds from the Department and acts as the fiscal
agent for a regional program. The Department disburses the regional allocation to the fiscal
agent CSB on behalf of all CSBs participating in the regional program.
The fiscal agent CSB, in collaboration with the other participating CSBs, develops agreed-upon
procedures that describe how the CSBs implement the regional program and jointly manage the
use of these funds on a regional basis. The procedures also establish and describe how unused
funds can be reallocated among the participating CSBs to ensure the greatest possible utilization
of the funds. These procedures should be documented in a regional memorandum of agreement
(MOA) that is available for review by the Department.
The fiscal agent CSB receives the semi-monthly payments of funds from the Department for the
regional program. The fiscal agent CSB disburses the regional program funds to individual
CSBs, including itself when applicable, in accordance with the procedures in paragraph 2. The
fiscal agent CSB displays such disbursements on a Transfer In/Out line of the applicable
resources page in its final performance contract revision and its reports. The other CSBs
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receiving the transferred funds show the receipt of these funds on the same line. CSBs provide
more detailed information about these transfers on the Financial Comments pages of contract
revisions and reports.
Each CSB implementing a regional program accounts for and reports the funds and expenses
associated with the program in its final performance contract revision and CARS reports. The
fiscal agent CSB displays the total amount of the allocation as funding and all Transfers Out in
its CARS reports, but it only displays in its reports the expenses for any regional program that it
implements.
As an alternative to paragraphs 1 through 4 for some kinds of programs, such as the Discharge
Assistance Program, and with the concurrence of the Department, instead of one CSB acting as
a fiscal agent, all CSBs participating in that program establish a regional mechanism for
managing the use of the regional program funds. The CSBs decide through this regional
management mechanism how the total amount of funds for the program should be allocated
among them on some logical basis (e.g., approved regional discharge assistance program ISPs).
The region informs the Department of the allocations, and the Department adjusts the allocation
of each participating CSB and disburses these allocations directly to the participating CSBs.
Those CSBs agree to monitor and adjust allocations among themselves during the fiscal year
through this regional management mechanism to ensure the complete utilization of these
regional program funds, in accordance with the MOA in paragraph 2.
Each CSB implementing a regional program ensures that appropriate information about the
individuals it serves and their services is entered into its information system, so that the CCS 3
can extract the information and report it in the CCS 3 submissions and applicable CARS reports.
Regional programs should receive the same state funding increases as regular CSB grantfunded activities, such as the salary increases for community services provided from time to
time by the General Assembly in the Appropriation Act.
A variation of this model, the Fiscal Agent CSB-Funded Regional Local Inpatient POS Program
Model, can be used to implement and manage regional local acute psychiatric inpatient bed
purchases.
3.a. Fiscal Agent CSB-Funded Regional Local Inpatient POS Program Model
One CSB agrees to act as the fiscal agent for the regional Local Inpatient Purchase of Services
(LIPOS) program. The Department disburses the regional LIPOS allocation to the fiscal agent
CSB on behalf of all of the CSBs participating in the regional LIPOS program.
The fiscal agent CSB, in collaboration with all of the participating CSBs and with consultation
from the Department, develops procedures that describe how the CSBs will implement the
regional LIPOS program and jointly manage the use of these funds on a regional basis. The
procedures include regional utilization management mechanisms, such as regional authorization
committees (RACs) and regional procurements of beds through contracts with private providers.
Such contracts may reserve blocks of beds for use by the region or purchase beds or bed days on
an as available basis. The procedures also establish and describe how unused funds can be
reallocated among the participating CSBs to ensure the greatest possible utilization of the funds.
These procedures should be documented in a regional memorandum of agreement (MOA) that
is available for review by the Department.
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The fiscal agent CSB receives the semi-monthly payments of funds from the Department for the
regional LIPOS program. The fiscal agent CSB disburses regional LIPOS funds to individual
CSBs or uses such funds itself to pay for the costs of local inpatient hospitalizations that have
been approved by a regional review and authorization body established by and described in the
MOA in paragraph 2. The fiscal agent CSB displays such disbursements on a Transfer In/Out
line of the mental health resources page in its final performance contract revision and reports,
and the CSB receiving the transferred funds shows the receipt of these funds on the same line.
CSBs provide more detailed information about these transfers on the Financial Comments page
of contract revisions and reports.
The CSB that purchases local inpatient services accounts for and reports the funds and expenses
associated with its LIPOS in its final performance contract revision and CARS reports. The
fiscal agent CSB displays the total amount of the allocation as funds and all Transfers Out in its
CARS reports, but it displays in its reports only the expenses for its own LIPOS.
The CSB that purchases the local inpatient services ensures that appropriate information about
individuals, services, and costs is entered into its management information system, so that the
CCS 3 can extract the information and report it in the CCS 3 submissions and applicable CARS
reports.
Regional programs should receive the same state funding increases as regular CSB grantfunded activities, such as the salary increases for community services provided from time to
time by the General Assembly in the Appropriation Act.
Fiscal Agent CSB-Funded Contract Agency Regional Program Model
One CSB receives state and sometimes other funds from the Department and acts as the fiscal
agent for a regional program that is contracted by this fiscal agent CSB to a public or private
agency. The Department disburses the regional allocation to the fiscal agent CSB on behalf of
all CSB participating in the contracted regional program.
The fiscal agent CSB contracts with and provides set monthly payments to a regional program
provided by a public or private contract agency on behalf of all of the CSB participating in this
regional program. The contract may purchase a pre-set amount of specified services from the
contract agency and pay the agency a predetermined cost, whether or not the participating CSBs
use the services.
Each participating CSB referring one of the individuals it serves to this contracted regional
program admits the individual, enrolls him in the regional program service, and refers him to the
contract agency. The contract agency provides information to the referring (case management)
CSB, and that CSB maintains information about the individual and the service units in its
information system, where the CCS 3 can extract the information.
The fiscal agent CSB provides program cost information to each referring CSB, based on its use
of the regional program, and the referring CSB enters this information in the cost column of the
program services form (pages AP-1 through AP-4) but does not enter any funding or expenditure
information in its performance contract report (CARS). The fiscal agent CSB enters the funding
and expenditure information associated with the regional program on the financial forms in its
performance contract report, but it enters cost information on the program services form only for
the individuals that it referred to the regional program. Each CSB will explain the differences
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between the financial and program service forms in its performance contract report on the
Financial Comments page. The Department will reconcile the differences among the
participating CSBs’ reports using these comments. Because of the difficulty in calculating the
program cost information for each participating CSB, program cost information would only need
to be included in end of the fiscal year performance contract (CARS) reports.
All of the participating CSBs, to the extent practicable, determine individual CSB allocations of
the state and sometimes other funds received from the Department, based on service utilization
or an agreed-upon formula.
Regional programs should receive the same state funding increases as regular CSB grant-funded
activities, such as the salary increases for community services provided from time to time by the
General Assembly in the Appropriation Act.
This model also could be adapted by a region to handle its LIPOS services, if one CSB acts as the
fiscal agent and pays all of the LIPOS providers. This adaptation should be negotiated with the
Department by the participating CSBs.
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Appendix F: Regional Program Procedures
A regional program is funded by the Department through the community services board or
behavioral health authority, hereafter referred to as the CSB, and operated explicitly to provide
services to individuals who receive services from the CSBs participating in the program.
Purpose
The CSB may collaborate and act in concert with other CSBs or with other CSBs and state
hospitals or training centers, hereafter referred to as state facilities, to operate regional
programs, provide or purchase services on a regional basis, conduct regional utilization
management, or engage in regional quality improvement efforts. Regional programs include
regional discharge assistance programs (RDAP), local inpatient purchases of services (LIPOS),
and other programs such as residential or ambulatory crisis stabilization programs. These
procedures apply to all regional programs. While this appendix replaces earlier regional
memoranda of agreement (MOAs), CSBs, state facilities, private providers participating in the
regional partnership, and other parties may still need to develop MOAs to implement specific
policies or procedures to operate regional or sub-regional programs or activities. Also, an MOA
must be developed if a regional program intends to established a peer review committee (e.g., a
regional utilization review and consultation team) whose records and reviews would be
privileged under § 8.01-581.16 of the Code of Virginia. When the CSB receives state or federal
funds from the Department for identified regional programs or activities, it shall adhere to the
applicable parts of these procedures, which are subject to all applicable provisions of the
community services performance contract. In the event of a conflict between any regional
program procedures and any provisions of the contract, provisions of the contract shall apply.
Regional Management Group (RMG)
a. The participating CSBs and state facilities shall establish an RMG. The executive director
of each participating CSB and the director of each participating state facility shall each serve
on or appoint one member of the RMG. The RMC shall manage the regional program and
coordinate the use of funding provided for the regional program, review the provision of
services offered through the regional program, coordinate and monitor the effective
utilization of the services and resources provided through the regional program, and perform
other duties that the members mutually agree to carry out. An RMG may deal with more
than one regional program.
b. Although not members of the RMG, designated staff in the Central Office of the Department
shall have access to all documents maintained or used by this group, pursuant to applicable
provisions of the performance contract, and may attend and participate in all meetings or
other activities of this group.
c. In order to carry out its duties, the RMG may authorize the employment of one or more
regional managers to be paid from funds provided for a regional program and to be
employed by a participating CSB. The RMG shall specify the job duties and responsibilities
for and supervise the regional manager or managers.
Regional Utilization Review and Consultation Team (RURCT)
a. The RMG shall establish a RURCT pursuant to § 8.01-581.16 of the Code of Virginia to,
where applicable:
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1.) review the implementation of the individualized services plans (ISPs) or individualized
Discharge Assistance Program plans (IDAPPs) developed through the regional program
to ensure that the services are the most appropriate, effective, and efficient services that
meet the clinical needs of the individual receiving services and report the results of these
reviews to the RMG;
2.) review individuals who have been on the state facility extraordinary barriers to discharge
list for more than 30 days to identify or develop community services and funding
appropriate to their clinical needs and report the results of these reviews and subsequent
related actions to the RMG;
3.) review, at the request of the case management CSB, other individuals who have been
determined by state facility treatment teams to be clinically ready for discharge and
identify community services and resources that may be available to meet their needs;
4.) facilitate, at the request of the case management CSB, resolution of individual situations
that are preventing an individual’s timely discharge from a state facility or a private
provider participating in the regional partnership or an individual’s continued tenure in
the community;
5.) identify opportunities for two or more CSBs to work together to develop programs or
placements that would permit individuals to be discharged from state facilities or private
providers participating in the regional partnership more expeditiously;
6.) promote the most efficient use of scarce and costly services; and
7.) carry out other duties or perform other functions assigned by the RMG.
b. The RURCT shall consist of representatives from participating CSBs in the region,
participating state facilities, private providers participating in the regional partnership, and
others who may be appointed by the RMG, such as the regional manager(s) employed
pursuant to section II.C. The positions of the representatives who serve on this team shall be
identified in local documentation.
c. The RURCT shall meet monthly or more frequently when necessary, for example,
depending upon census issues or the number of cases to be reviewed. Minutes shall be
recorded at each meeting. Only members of the team and other persons who are identified
by the team as essential to the review of an individual’s case, including the individual’s
treatment team and staff directly involved in the provision of services to the individual, may
attend meetings. All proceedings, minutes, records, and reports and any information
discussed at these meetings shall be maintained confidential and privileged, as provided in §
8.01-581.17 of the Code of Virginia.
d. For the regional program, the RURCT or another group designated by the RMG shall
maintain current information to identify and track individuals served and services provided
through the regional program. This information may be maintained in participating CSB
information systems or in a regional data base. For example, for the RDAP, this information
shall include the individual’s name, social security number or other unique identifier, other
unique statewide identifier, legal status, case management CSB, state hospital of origin,
discharge date, state re-hospitalization date (if applicable), and the cost of the IDAPP. This
team shall maintain automated or paper copies of records for each RDAP-funded IDAPP.
Changes in responsibilities of the case management CSB, defined in the core services
taxonomy, and the transfer of RDAP funds shall be reported to the Offices of Grants
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Management and Mental Health Services in the Department as soon as these changes or
transfers are known or at least monthly.
e. For RDAP, the RURCT shall conduct utilization reviews of ISPs as frequently as needed to
ensure continued appropriateness of services and compliance with approved IDAPPs and
reviews of quarterly utilization and financial reports and events related to the individual
such as re-hospitalization, as appropriate. This utilization review process may result in
revisions of IDAPPs or adjustment to or redistribution of RDAP funds. This provision does
not supersede utilization review and audit processes conducted by the Department pursuant
to the performance contract.
f. Although not members of the RURCT, designated staff in the Central Office of the
Department shall have access to all documents, including ISPs or IDAPPs, maintained or
used by this body, pursuant to applicable provisions of the performance contract, and may
attend and participate in all meetings as non-voting members and in other activities of this
team.
Operating Procedures for Regional Programs: These operating procedures establish the
parameters for allocating resources for and monitoring continuity of services provided to
individuals receiving regional program services. Some of the procedures apply to regional
programs generally; others apply to particular regional programs, although they may be able to
be adapted to other regional programs.
a. Funding for a regional program shall be provided and distributed by the Department to
participating CSBs or to a CSB on behalf of the region through their community services
performance contracts in accordance with the conditions specified the contract, often in an
Exhibit D.
b. Each participating CSB or a CSB on behalf of the region shall receive semi-monthly
payments of state funds from the Department for the regional program through its
community services performance contract, as long as it satisfies the requirements of this
appendix and the performance contract, based upon its total base allocation of previously
allotted and approved regional program funds.
c. Participating CSBs and state facilities shall develop agreed-upon procedures that describe
how they will implement a regional program and jointly manage the use of regional program
funds on a regional basis. These procedures shall be reduced to writing and provided to the
Department upon request.
d. Regional program funds may be used to support the activities of the RMG and RURCT.
e. Within the allocation of funds for the regional program, funds may be expended for any
combinations of services and supports that assure that the needs of individuals are met in
community settings. ISPs or IDAPPs must be updated and submitted, as revisions occur or
substitute plans are required, to the RMG for approval according to procedures approved by
the RMG.
f. Regional program funds used to support ISPs or IDAPPs shall be identified on a fiscal year
basis. Amounts may be adjusted by the RMG to reflect the actual costs of care based on the
regional program’s experience or as deemed appropriate through a regional management and
utilization review process.
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g. The CSB responsible for implementing an individual’s regional program ISP or IDAPP shall
account for and report the funds and expenses associated with the regional program ISP or
IDAPP in its community services performance contract and in its quarterly performance
contract reports submitted through the Community Automated Reporting System (CARS).
h. The CSB responsible for implementing an individual’s regional program ISP or IDAPP shall
ensure that the appropriate information about that individual and his or her services is
entered into its management information system so that the information can be extracted by
the Community Consumer Submission (CCS) and reported in the monthly CCS extracts and
applicable CARS reports to the Department.
i. The participating CSBs may use regional program funds to establish and provide regional or
sub-regional services when this is possible and would result in increased cost effectiveness
and clinical effectiveness.
j. Operation of a RDAP is governed by the Discharge Assistance Program Manual issued by
the Department and provisions of Exhibit C of the performance contract.
General Terms and Conditions
a. CSBs, the Department, and any other parties participating in a regional program agree that
they shall comply with all applicable provisions of state and federal law and regulations in
implementing any regional programs to which these procedures apply. The CSB and the
Department shall comply with or fulfill all provisions or requirements, duties, roles, or
responsibilities in the current community services performance contract in their
implementation of any regional programs pursuant to these procedures.
b. Nothing in these procedures shall be construed as authority for the CSB, the Department, or
any other participating parties to make commitments that will bind them beyond the scope
of these procedures.
c. Nothing in these procedures is intended to, nor does it create, any claim or right on behalf of
any individual to any services or benefits from the CSB or the Department.
Privacy of Personal Information
a. The CSB, the Department, and any other parties participating in a regional program agree to
maintain all protected health information (PHI) learned about individuals receiving services
confidential and agree to disclose that information only in accordance with applicable state
and federal law and regulations, including the regulations promulgated under the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), 42 CFR Part 2, the Virginia
Health Records Privacy Act, the Department’s human rights regulations, and each party’s
own privacy policies and practices. The organization operating the regional program shall
provide a notice to individuals participating in or receiving services from the regional
program that it may share protected information about them and the services they receive, as
authorized by HIPAA and other applicable federal and state statutes and regulations. The
organization shall seek the authorization of the individual to share this information
whenever possible.
b. Even though each party participating in a regional program may not provide services
directly to each of the individuals served through the regional program, the parties may
disclose the PHI of individuals receiving services to one another under 45 C.F.R. §
164.512(k)(6)(ii) in order to perform their responsibilities related to this regional program,
Core Services Taxonomy 7.3
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including coordination of the services and functions provided under the regional program
and improving the administration and management of the services provided to the
individuals served in it.
c. In carrying out their responsibilities in the regional program, the CSB, the Department, and
any other parties involved in this regional program may use and disclose PHI to one another
to perform the functions, activities, or services of the regional program on behalf of one
another, including utilization review, financial and service management and coordination,
and clinical case consultation. In so doing, the parties agree to:
1.) Not use or further disclose PHI other than as permitted or required by the performance
contract or these procedures or as required by law;
2.) Use appropriate safeguards to prevent use or disclosure of PHI other than as permitted
by the performance contract or these procedures;
3.) Report to the other parties any use or disclosure of PHI not provided for by the
performance contract or these procedures of which they become aware;
4.) Impose the same requirements and restrictions contained in the performance contract or
these procedures on their subcontractors and agents to whom they provide PHI received
from or created or received by the other parties to perform any services, activities, or
functions on behalf of the other parties;
5.) Provide access to PHI contained in a designated record set to the other parties in the time
and manner designated by the other parties or at the request of the other parties to an
individual in order to meet the requirements of 45 CFR 164.524;
6.) Make available PHI in its records to the other parties for amendment and incorporate
any amendments to PHI in its records at the request of the other parties;
7.) Document and provide to the other parties information relating to disclosures of PHI as
required for the other parties to respond to a request by an individual for an accounting
of disclosures of PHI in accordance with 45 CFR 164.528;
8.) Make their internal practices, books, and records relating to use and disclosure of PHI
received from or created or received by the other parties on behalf of the other parties,
available to the Secretary of the U.S. Department of Health and Human Services for the
purposes of determining compliance with 45 CFR Parts 160 and 164, subparts A and E;
9.) Implement administrative, physical, and technical safeguards that reasonably and
appropriately protect the confidentiality, integrity, and availability of electronic PHI that
they create, receive, maintain, or transmit on behalf of the other parties as required by
the HIPAA Security Rule, 45 C.F.R. Parts 160, 162, and 164;
10.) Ensure that any agent, including a subcontractor, to whom they provide electronic PHI
agrees to implement reasonable and appropriate safeguards to protect it;
11.) Report to the other parties any security incident of which they become aware; and
12.) At termination of the regional program, if feasible, return or destroy all PHI received
from or created or received by the parties on behalf of the other parties that the parties
still maintain in any form and retain no copies of such information or, if such return or
destruction is not feasible, extend the protections in this appendix to the information and
Core Services Taxonomy 7.3
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limit further uses and disclosures to those purposes that make the return or destruction
of the information infeasible.
d. Each of the parties may use and disclose PHI received from the other parties, if necessary, to
carry out its legal responsibilities and for the proper management and administration of its
business. Each of the parties may disclose PHI for such purposes if the disclosure is
required by law, or if the party obtains reasonable assurances from the person to whom the
PHI is disclosed that it will be held confidentially, that it will be used or further disclosed
only as required by law or for the purpose for which it was disclosed to the person, and that
the person will notify the party of any instances of which it is aware in which the
confidentiality of the information has been breached.
Reporting: The CSB shall provide all required information (e.g., the number of individuals
receiving services, the total expenditures for the regional program, and the total amount of
regional program restricted funds expended) to the Department about the regional programs in
which it participates, principally through CCS and CARS reports. CSBs shall not be required to
submit more frequent standard reports or reports on individuals, unless such requirements have
been established in accordance with the applicable sections of the performance contract. The
CSB also shall identify all individuals in regional programs that it serves in its CCS extract
submissions using the applicable consumer designation codes.
Project Management
a. The Department shall be responsible for the allocation of regional program state and federal
funds and the overall management of the regional program at the state level.
b. The RMG shall be responsible for overall management of the regional program and
coordination of the use of funding provided for the regional program in accordance with
these procedures.
c. The CSB shall be responsible for managing regional program funds it receives in accordance
with these regional program procedures.
d. Payments generated from third party and other sources for any regional program shall be
used by the region or CSB to offset the costs of the regional program. The CSB shall collect
and utilize all available funds from other appropriate specific sources before using state and
federal funds to ensure the most effective use of these state and federal funds. These other
sources include Medicare; Medicaid-fee-for service, targeted case management payments,
rehabilitation payments, and ID waiver payments; other third party payors; auxiliary grants;
SSI, SSDI, and direct payments by individuals; payments or contributions of other resources
from other agencies, such as social services or health departments; and other state, local, or
Department funding sources.
e. The Department may conduct on-going utilization review and analyze utilization and
financial information and events related to individuals served, such as re-hospitalization, to
ensure the continued appropriateness of services and to monitor the outcomes of the regional
program. The utilization review process may result in adjustment to or reallocation of state
general and federal funding allocations for the regional program.
Compensation and Payment: The Department shall disburse semi-monthly payments of state
general and federal funds to the CSB for the regional program as part of its regular semimonthly disbursements to the CSB.
Core Services Taxonomy 7.3
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Appendix G: Core Services Taxonomy Work Group Commentary
The following comments reflect the deliberations and decisions of the Core Services Taxonomy
Work Group and the VACSB Data Management Committee. These comments are included for
information or historical background purposes.
Peer-provided services are included and reported where they are delivered, for example, in
outpatient, rehabilitation, or residential services, rather than in consumer-run services. Peerprovided services are provided by individuals who identify themselves as having mental health,
substance use, or co-occurring disorders and are receiving or have received mental health, substance
abuse, or co-occurring services. The primary purpose of peer-provided services is to help others
with mental health, substance use, or co-occurring disorders. Peer-provided services involve
partnering with non-peers, such as being hired by community mental health or substance abuse
programs in designated peer positions or traditional clinical positions. Peers may serve as recovery
coaches, peer counselors, case managers, outreach workers, crisis workers, and residential staff,
among other possibilities. Units of service provided by peers in core services should be included
with all service units collected and reported through the CCS. CSBs will report the numbers of
peers they employ in each program area to provide core in their CARS management reports.
Family Support was a separate core services subcategory in Taxonomy 6; however, it was
eliminated as a separate subcategory in Taxonomy 7. Family support offers assistance for families
who choose to provide care at home for family members with mental disabilities. Family support is
a combination of financial assistance, services, and technical supports that allows families to have
control over their lives and the lives of their family members. Family is defined as the natural,
adoptive, or foster care family with whom the person with a mental disability resides. Family can
also mean an adult relative (i.e., sister, brother, son, daughter, aunt, uncle, cousin, or grandparent) or
interested person who has been appointed full or limited guardian and with whom the person with
the mental disability resides. The family defines the support. While it will be different for each
family, the support should be flexible and individualized to meet the unique needs of the family and
the individual with the mental disability. Family support services include respite care, adaptive
equipment, personal care supplies and equipment, behavior management, minor home adaptation or
modification, day care, and other extraordinary needs. Funds and expenses for family support
activities should be included in the applicable core service subcategories, but numbers of
individuals would not be included separately, since those individuals are already receiving the
service in the category or subcategory. If an individual is receiving nothing but family support, he
or she should be opened to consumer monitoring and the family member with a mental disability
would be counted and reported as an individual receiving services in consumer monitoring.
Consultations include professional and clinical consultations with family assessment and planning
teams (CSA), other human services agencies, and private providers. No ISPs are developed, and
Department licensing is not required. In consultations, CSB staff members are not providing
services or care coordination to individuals; the staff are only consulting with service providers and
other agencies about individuals who are receiving services from other organizations. Since there
are no individuals receiving services counted for consultations, service units will be collected
through the z-consumer function in the CCS. Traditionally, consultations have been and will
continue to be included in outpatient or case management services. However, if a CSB is providing
other services, this is not a consultation situation; the CSB opens a case for the individual or admits
the individual to a program area, depending on the other services received. For example, if a CSB
is providing significant amounts of staff support associated with FAPT or Title IV-E activities, it
may include this support as part of consumer monitoring services.
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Appendix H: REACH Services Crosswalk and Reporting Requirements
This exhibit provides guidance to the CSBs providing Regional Education Assessment Crisis
Services and Habilitation (REACH) program services about how to report those services in their
monthly CCS 3 submissions to the Department. REACH program services must be reported only in
emergency services, ancillary services and the developmental services program area; they must not
be reported in the mental health services or substance abuse services program areas. There are only
seven services that CSBs providing REACH program services directly or contractually must include
in their information systems in a way that information about them can be extracted and exported to
the Department through CCS 3. These services are:
100 Emergency Services, licensed by the Department as crisis intervention services;
390 Consumer Monitoring Services (ancillary services), not licensed by the Department;
720 Assessment and Evaluation Services (ancillary services), not licensed by the Department;
420 Ambulatory Crisis Stabilization Services (in the developmental services program area),
licensed by the Department as mental health non-residential crisis stabilization;
510 Residential Crisis Stabilization Services (in the developmental services program area),
licensed by the Department as mental health residential crisis stabilization services for adults;
521 Intensive Residential Services (in the developmental services program area),licensed by
the Department as intellectual disability residential therapeutic respite group home services for
adults – includes ID assessment/treatment beds; and
581 Supportive Residential Services (in the developmental services program area), licensed by
the Department as REACH intellectual disability supportive in-home services for adults.
These are the only services provided to individuals who have been determined to be served in the
REACH program that should be included in CCS 3 submissions to the Department. When they
provide them, CSBs that operate or contract for REACH program services must include the
following information about these seven services in their CCS 3 submissions.
Consumer File: Include all applicable CCS 3 consumer data elements on an individual receiving
REACH program services if the individual has not already been admitted to the developmental
services program area (for services 4 through 7 above) or if the CSB has not opened a case on the
individual for emergency services or ancillary services (for services 1 through 3 above).
Type of Care File: Include a type of care file on the individual if he or she receives services 4
through 7 above and has not already been admitted to the developmental services program area.
Service Files: Include service files to report receipt of:
Emergency services (pseudo program area code 400 and service code 100) if the individual
receives crisis intervention services,
Consumer monitoring (pseudo program area code 400 and service code 390) if the individual
receives consumer monitoring services,
Assessment and evaluation (pseudo program area code 400 and service code 720) if the
individual receives assessment and evaluation services,
Ambulatory crisis stabilization (developmental services program area code 200 and service code
420) if the individual receives mental health non-residential crisis stabilization,
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Residential crisis stabilization (developmental services program area code 200 and service code
510) if the individual receives mental health residential crisis stabilization services for adults,
Intensive residential services (developmental services program area code 200 and service code
521) if the individual receives intellectual disability residential therapeutic respite group home
services for adults, or
Supportive residential services (developmental services program area code 200 and service code
581) if the individual receives REACH intellectual disability supportive in-home services for
adults.
When they provide these services, CSBs that operate or contract for REACH program services also
must include funding, expenditure, cost, and static capacity information about these seven servi

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