LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 302.01 First Service Contact
 
  PROCEDURES
  1. Obtaining Consent for Outpatient Mental Health Services
    1. The Consent for Services form shall be used to obtain informed consent for outpatient mental health services.
      1. Verbal consent or electronic signature may be obtained and documented on the Consent for Services form. In the case of verbal consent or electronic signature, information on the Consent for Services form must be made available (e.g., the blank form provided) to the client so the client is aware of what they are consenting to.
    2. In most cases, the following individuals can consent for outpatient mental health services:
      1. Adult Clients, 18 years of age and older
      2. Parents/Legal Guardians of clients who are minors
      3. Conservators of clients as designated by the court
      4. Minor Clients, 12 through 17 years of age, who meet State legal criteria as applicable (e.g., Family Code 6924, Health & Safety Code 124260, Family Code 7002, Family Code 7120)
        1. The legal criteria for minor consent are identified in the Consent for Services form, and staff must attest to the criteria being met
        2. If the minor qualifies under both Family Code 6924 and Health & Safety Code 124260, consent should be obtained under the Family Code.
      5. “Qualified Relatives” of the minor using the Caregiver Authorization Affidavit when appropriate (i.e., spouse, parent, stepparent, brother, sister, stepbrother, stepsister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any person denoted by the prefix “grand” or “great,” or the spouse of any of the persons specified in this definition, even after the marriage has been terminated by death or dissolution.)
    3. In most cases, the following individuals cannot consent for outpatient mental health services:
      1. Foster Parents
      2. Attorneys
      3. Caregivers not meeting criteria in #2
      4. Social Workers
    4. A Court Order, Minute Order, or DCFS 179MH may be obtained in lieu of the Consent for Services form. The information within the Consent for Services form and the Frequently Asked Questions shall be provided to the client.
    5. For emergency psychiatric conditions, completing the Consent for Services form is not required. Consent for Services shall be obtained at the next contact that occurs when the emergency condition has been resolved.
    6. In situations where the client appears to be unable to provide written or verbal consent in the standard manner, client engagement in the assessment process may be considered implicit consent. It shall be documented that the potential client was informed that the client’s information will be entered into the DMH electronic health information system.
    7. The Consent for Services form covers all directly operated providers from which the client receives services.  When the client leaves treatment and returns, a new Consent for Services form is required to be signed.
    8. If the individual who is eligible to consent for services changes (e.g., legal guardianship changes), a new Consent for Services form shall be obtained.
    9. If, at any point, the client/legal representative wishes to revoke consent for any item on the Consent for Services form, a new form shall be completed.
  2. Financial Screening
    1. Providers must complete financial screening in order to provide the client with a preliminary assessment of whether there will be a fee related to the services in accordance with DMH Policy 807.01.
    2. For emergency psychiatric conditions, financial screening is not required prior to services. Upon resolution of the emergency psychiatric condition, the financial screening shall be completed if the client is to continue with services.
  3. Opening Episodes 
    1. For episodes created by DMH and Legal Entity providers, the episode shall be opened at the legal entity level.  If an outpatient episode is already open at the legal entity level, another episode is not required to be opened when the client returns for treatment. The episode shall remain open until the death of the client unless otherwise directed by the QA Unit.
    2. In most cases, the episode admission date should be the date Consent for Services is obtained. In all cases, the episode admission date shall be no later than the date of the first claimed service.
  4. Service Contacts
    1. If the first contact is with a practitioner for whom diagnosing is not within the scope of practice, the following apply:
      1. In order to submit claims, a Z55-Z65 Social Determinants of Health ICD code shall be utilized based upon the initial observations of the non-diagnosing practitioner until a diagnosing practitioner can determine the presence/absence of an additional ICD 10 code(s).
      2. Non-diagnosing practitioners shall minimally document in the progress note information that supports that the service provided was medically necessary.
    2. An assessment shall be done with a practitioner who can diagnose as soon as possible and in accordance with clinically accepted practice.
      1. As a best practice, an assessment by a diagnosing practitioner should be started within five (5) service contacts and/or thirty (30) days of treatment unless there is a clear clinical rationale as to why this did not occur.
      2. Once the assessment is completed, the diagnosis shall be updated with the most appropriate diagnosis by the assessing/diagnosing practitioner.