Service Review Criteria

Size: px
Start display at page:

Download "Service Review Criteria"

Transcription

1 Client Name: SAR#: Administrative Review Process notes: When documenting call outs to provider, please document the call in a patient note in Alpha the day the call is made. tes should be coded as Care Management. Review for HUM 26: are there immediate health/safety concerns? If YES, consult with medical staff and document recommendations in a physician consult note. Review for Unable to Process Criteria The requested effective start date does not precede the submission date of request. t If unjustified retro request, then unable to process. t The dates of the request do not overlap with an existing authorization for the same service. If more than 5 days overlap, then unable to process. If overlap is 5 days or less, then make documented contact with provider to verify intended request dates. Please make a note for Care Manager for dates of service adjustment as requested by provider here: t For initial, the recipient s age is under 65. If met, please note age here: If not met, then unable to process. The SAR is submitted no more than 30 days before requested start date. If not met, t then unable to process. Did the provider state a desire to withdraw or rescind the request, but was unable to use the rescind option in Alpha? If yes, then unable to process. Review for Administrative Denial: If anything is not met, please submit for QOC tracking For initial, signed service order and dated by Approved Signatory. If not met, contact t the provider to request and give deadline to submit. If not received, administratively deny the request. t t t t For concurrent, the updated PCP is present, which includes ACT and provider and a valid service order. If none present, then contact the provider to request and give deadline to submit. If not received, administratively deny the request. For concurrent, the Comprehensive Crisis Plan is present. If none present, then contact provider and give a deadline to submit. If not received, administratively deny the request. For initial, the Comprehensive Clinical Assessment and/or Addendum is present. If not present, then document call to provider. If not provided by deadline, administratively deny. LOCUS/ASAM level noted is in SAR or other documentation. If not, then contact the provider to request and give deadline to submit. If not received, administratively deny the request. Is LOCUS/ASAM worksheet submitted? If not present, contact provider to request and document call to provider (can NOT administratively deny for lack of worksheet). Are there any current authorizations for other services? If so, consider if there are ACTT 1

2 service exclusions and if so, contact provider for clarification. If no response, administratively deny the request. te the services here: Other Items of Review: If documents are not present, please submit for QOC tracking Is the Consumer s Name, DOB, and MID number accurate on submitted documents? If not, contact provider for clarification. Report to appropriate HIPAA personnel if violation has occurred. For concurrent, is there evidence of active discharge planning? Consider reviewing for the following elements: anticipated discharge date barriers to discharge anticipated discharge level of care efforts made to coordinate discharge appointment If not, then make documented call to provider to request. Is the ATR worksheet submitted? If not, contact provider and ask for worksheet to be submitted. If not present, can NOT administratively deny. Document contact. For concurrent requests, is the contact spreadsheet submitted? If not, contact provider and ask for worksheet to be submitted. If not present, can NOT administratively deny. Document contact. Are there any past denials or partial approvals within this current episode of care? Please note here: Do the # of units requested match calendar days requested? (4 for each full or partial month. Requested lapse dates should end at month s end or their billing will be compromised). If not, make documented contact with provider to verify intended request dates/units. Please note here: Length of stay in current service (if applicable). te here: Review current medications. Is a referral to medical review needed? If review is needed (yes), complete Medication Review Consultation Form: AllItems.aspx?RootFolder=%2Fdept%2Eclop%2Fcm%2FShared%20Documents%2FMH SA%20UM%20FORMS%20AND%20REVIEW%20TOOLS&FolderCTID=0x012000B4D86B 6A1F01BA459A100B130004E563&View={AD74E0AD-01EF E0F75027}, to Dr. Cree, and document all of the above in a patient note. This note should be labeled as Pharmacist Consult. Is consumer identified as dually diagnosed (either I/DD or SU along with MH)? If so, please note here: The above administrative review was completed by Care Reviewer: Unable to Process (if checked, upload checklist in to SAR Service Tile) Administrative Denial (if checked, upload checklist in to SAR Service Tile and notify Clinical Support Team of an Administrative Denial): 1. Please complete the Request Template and note Administrative Denial. 2. Send to Clinical Support Team. 3. te that, if within 24 hours of submitting the Request Template to Clinical Support, a new ACTT 2

3 SAR is received from the provider that contains the needed documentation, notify Clinical Support Team so that they may halt the process for generating and mailing the Administrative Denial Letter. 4. When a new SAR is received as described above, please document in a patient note a description of why an administrative denial letter was not generated for the initial SAR. Sending to Care Manager for Clinical Review (if checked, re-assign the SAR and the checklist to the Care Manager that previously reviewed any SARs for the consumer. If not previously reviewed for services prior to this request, please circular assign the SAR) Clinical Review Is the recipient under 21? If yes, review for EPSDT. For concurrent, is the recipient over 64, or will he/she turn 65 during the next 6 months? If yes, consider transition plans and implications of approving. Have the consumer s concurrent medical needs been appropriately assessed or reassessed? If not, make documented contact with provider to make recommendations regarding this and refer to QOC. Review for QOC Concerns specific to CCA. First, complete this section. If any boxes are selected no in this section, send for QOC tracking with inadequate CCA as the concern. Assess for Diagnostic Clarity: - If concurrent review, check the box and proceed to continued stay review. Is there a description of the presenting problems including: source of distress precipitating events, and associated problems or symptoms, and recent progressions? (all above should be selected to choose ) Was the course of illness clearly documented regarding: onset, triggers, intensity, frequency, duration of symptoms, and course of illness? (all above should be selected to choose ) Is the diagnosis clear? (i.e. there aren t multiple, incompatible or frequently changing diagnoses.) Was there adequate assessment of co-occurring behavioral health/substance abuse/idd conditions? Are current physical/medical medications listed? Are current psychiatric medications listed? ACTT 3

4 Service Review Criteria Are known allergies and adverse reactions clearly documented? (Or if there are no known allergies, is this documented?) Is the mental status sufficiently documented and does it support the diagnosis? A review of the following dimensions is included: biological (include strengths, weaknesses, risks, and protective factors) psychological (include strengths, weaknesses, risks, and protective factors) familial (include strengths, weaknesses, risks, and protective factors) social (include strengths, weaknesses, risks, and protective factors) developmental (include strengths, weaknesses, risks, and protective factors) environmental (include strengths, weaknesses, risks, and protective factors) (all above should be selected to choose ) Environment and psychosocial factors potentially contributing to functional status are identified and considered: housing, legal, financial, educational or vocational, and nutrition or sleep. (all above should be selected to choose ) Is the treatment history adequate; information went beyond prior dates of service to include: levels of care, types of interventions, and responsiveness to/engagement with prior treatment? (all above should be selected to choose ) Is there evidence of beneficiary and family and/or legally responsible person s involvement in the assessment (if applicable)? Is there evidence of provider discussion of results with beneficiary and family and/or legally responsible person? Is there analysis and interpretation of the assessment information with an appropriate case formulation? (i.e. does this assessment support the diagnosis?) Are there recommendations for additional assessments, services, support, or treatment including specific evidence-based practices based on the results of the CCA? Is there a strengths/protective factors/problem summary which addresses: risk of harm, functional status, co-morbidity, (behavioral and medical) recovery environment, and treatment and recovery history? (all above should be selected to choose ) Is the CCA dated and signed by the assessor? Monitoring Adherence to Clinical Guidelines Major Depressive Disorder ACTT 4

5 Is the consumer diagnosed with Major Depressive Disorder? (This is documented in the SAR and/or accompanying clinical documentation). If yes, complete the following questions and send for Clinical Guideline tracking with SAR ID and MDD in the subject line. If no, move on to Medical Necessity Criteria review and select for the next 3 lines. Is there documented evidence that the consumer received, or will receive a standardized assessment for depression (examples include but are not limited to the following: PHQ-9, Beck Depression Inventory, Child Depression Inventory, etc.)? If yes, ask provider to upload copy of assessment or the score. If no, recommend that standardized assessment be completed and document recommendation. Is there documented evidence that the provider gave psychoeducational information about the following?: The nature of depression, its typical course and treatment alternatives available. If no, recommend provider share psychoeducational information with consumer and document. Is the Major Depressive Disorder severity noted as moderate or severe? If so, is there documented evidence that a referral/recommendation for a medical evaluation was made? If not, contact the provider and ask about whether a referral was made for medical evaluation either with primary care physician or psychiatrist. If no, recommend referral and document. Eligibility Criteria Medicaid shall cover ACT services for a beneficiary 18 years and older with schizophrenia, other psychotic disorders (e.g., schizoaffective disorder), and bipolar disorder because these illnesses more often cause long-term psychiatric disability. Beneficiaries with other psychiatric illnesses are eligible dependent on the level of the long-term disability. Beneficiaries with a primary diagnosis of a substance use disorder, or intellectual developmental disabilities, borderline personality disorder, traumatic brain injury, or an autism spectrum disorder are not the intended beneficiary group and should not be referred to ACT if they do not have a co-occurring psychiatric disorder. ACT teams shall document written admission criteria that reflect the following medical necessity criteria required for admission: A. Has a current Diagnostic and Statistical Manual (DSM) 5 (or its successor) diagnosis consistent with a serious and persistent mental illness (SPMI) reflecting the need for treatment and the covered treatment must be t medically necessary for meeting the specific preventive, diagnostic, therapeutic, and rehabilitative needs of the beneficiary. AND t B. Has significant functional impairment as demonstrated by at least one of the following conditions: 1) Significant difficulty consistently performing the range of routine tasks required for basic adult functioning in the community (for example, caring for personal business affairs; obtaining medical, legal, and housing services; recognizing and avoiding common dangers or hazards to self and possessions; meeting nutritional needs; attending to personal hygiene) or persistent or recurrent difficulty performing daily living tasks except with ACTT 5

6 t t t Service Review Criteria significant support or assistance from others such as friends, family, or relatives; 2) Significant difficulty maintaining consistent employment at a selfsustaining level or significant difficulty consistently carrying out the headof-household responsibilities (such as meal preparation, household tasks, budgeting, or child-care tasks and responsibilities); or 3) Significant difficulty maintaining a safe living situation (for example, repeated evictions or loss of housing or utilities); AND C. Has one or more of the following problems, which are indicators of continuous high-service needs: 1) High use of acute psychiatric hospital (2 or more admissions during the past 12 months) or psychiatric emergency services; 2) Intractable (persistent or recurrent) severe psychiatric symptoms (affective, psychotic, suicidal, etc.); 3) Coexisting mental health and substance use disorders of significant duration (more than 6 months); 4) High risk or recent history of criminal justice involvement (such as arrest, incarceration, probation); 5) Significant difficulty meeting basic survival needs, residing in substandard housing, homelessness, or imminent risk of homelessness; 6) Residing in an inpatient or supervised community residence, but clinically assessed to be able to live in a more independent living situation if intensive services are provided; or requiring a residential or institutional placement if more intensive services are not available; or 7) Difficulty effectively using traditional office-based outpatient services; AND D. There are no indications that available alternative interventions would be equally or more effective based on rth Carolina community practice standards and within the Local Management Entity-Managed Care Organization (LME-MCO) service array. Continued Stay Criteria Medicaid shall cover a continued stay if the desired outcome or level of functioning has not been restored, improved, or sustained over the time frame outlined in the beneficiary s PCP or the beneficiary continues to be at risk for relapse based on current clinical assessment, history, or the tenuous nature of the functional gains; AND ONE of the following applies: ACTT 6

7 t t Service Review Criteria a. The beneficiary has achieved current PCP goals and additional goals are indicated as evidenced by documented symptoms; b. The beneficiary is making satisfactory progress toward meeting goals and there is documentation that supports that continuation of this service will be effective in addressing the goals outlined in the PCP; c. The beneficiary is making some progress, but the specific interventions in the PCP need to be modified so that greater gains, which are consistent with the beneficiary s pre-morbid or potential level of functioning, are possible; d. The beneficiary fails to make progress or demonstrates regression in meeting goals through the interventions outlined in the PCP. (In this case, the beneficiary s diagnosis must be reassessed to identify any unrecognized cooccurring disorders, and treatment recommendations should be revised based on the findings); or e. If the beneficiary is functioning effectively with this service and discharge would otherwise be indicated, the ACT team services must be maintained when it can be reasonably anticipated that regression is likely to occur if the service is withdrawn. The decision must be based on either of the following; 1) The beneficiary has a documented history of regression in the absence of ACT team services, or attempts to titrate ACT team services downward have resulted in regression; or 2) There is an epidemiologically sound expectation that symptoms will persist and that ongoing outreach treatment interventions are needed to sustain functional gains. Transition or Discharge Criteria Beneficiary shall meet at least ONE of the following: a. The beneficiary and team determine that ACT services are no longer needed based on the attainment of goals as identified in the person-centered plan and a less restrictive level of care would adequately address current goals; b. The beneficiary moves out of the catchment area and the ACT has facilitated the referral to either a new ACT provider or other appropriate mental health service in the new place of primary private residence and has assisted the beneficiary in the transition process; c. The beneficiary and, if appropriate, the legally responsible person, choose to withdraw from services and documented attempts by the program to reengage the beneficiary with the service have not been successful; or d. The beneficiary has not demonstrated significant improvement following reassessment and several adjustments to the treatment plan over at least three months and: 1) Alternative treatment of providers have been identified that are deemed necessary and are expected to result in greater improvement; or ACTT 7

8 2) The beneficiary s behavior has worsened, such that continued treatment is not anticipated to result in sustainable change; or 3) More intensive levels of care are indicated. Clinical Review: Approved Send to Peer Review (see below for notes on this process) Reviewer Name, Credentials: Date: Clinical Justification: Process tes: If Approval is granted under EPSDT, please include the following in Clinical Justification: An individualized statement about why this service is needed that provides explanation of how EPSDT criteria are met. A checklist that notes generalized EPSDT criteria is not sufficient to document the need for an EPSDT service. Document consideration/exploration of less restrictive/less costly community-based alternatives and include rationale for appropriate rejection of such alternatives If continued stay review, document progress/lack of progress or changing needs since last review and sufficiently document needs that support the continued stay determination To best understand the whole picture of what is going on for the individual receiving services, please review Care Coordination notes (if applicable) in the EHR. Sending to Peer Review: Complete the initial peer review referral form Ensure that the contact information provided to the Peer Reviewer is correct by calling the number yourself and verifying that a clinician can be contacted. If the number provided is not correct, please note on the QOC spreadsheet. Complete the template for the Clinical Support Team and attach the necessary documents Ensure that the SAR is designated as being in peer review status in Alpha ACTT 8

(c) A small client to staff caseload, typically 10:1, to consistently provide necessary staffing diversity and coverage;

(c) A small client to staff caseload, typically 10:1, to consistently provide necessary staffing diversity and coverage; 309-019-0225 Assertive Community Treatment (ACT) Overview (1) The Substance Abuse and Mental Health Services Administration (SAMHSA) characterizes ACT as an evidence-based practice for individuals with

More information

Assertive Community Treatment (ACT)

Assertive Community Treatment (ACT) Assertive Community Treatment (ACT) Assertive Community Treatment (ACT) services are therapeutic interventions that address the functional problems of individuals who have the most complex and/or pervasive

More information

Division of Mental Health, Developmental Disabilities & Substance Abuse Services NC Mental Health and Substance Use Service Array Survey

Division of Mental Health, Developmental Disabilities & Substance Abuse Services NC Mental Health and Substance Use Service Array Survey Table 1 Service Name Include any subcategories of service on a separate line In Table 2, please add service description and key terms Outpatient Treatment Behavioral Health Urgent Care (a type of outpatient)

More information

Substance Abuse Services Published Date: December 1, 2015 Table of Contents

Substance Abuse Services Published Date: December 1, 2015 Table of Contents Table of Contents 1.0 Description of the Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 2 2.1 Provisions... 2 2.1.1 General... 2 2.1.2 Specific... 2 3.0 When the Service Is Covered...

More information

Intensive In-Home Services (IIHS): Aligning Care Efficiencies with Effective Treatment. BHM Healthcare Solutions

Intensive In-Home Services (IIHS): Aligning Care Efficiencies with Effective Treatment. BHM Healthcare Solutions Intensive In-Home Services (IIHS): Aligning Care Efficiencies with Effective Treatment BHM Healthcare Solutions 2013 1 Presentation Objectives Attendees will have a thorough understanding of Intensive

More information

Medicaid Funded Services Plan

Medicaid Funded Services Plan Clinical Communication Bulletin 007 To: From: All Enrollees, Stakeholders, and Providers Cham Trowell, UM Director Date: May 10, 2016 Subject: Medicaid Funded Services Plan benefit changes, State Funded

More information

Macomb County Community Mental Health Level of Care Training Manual

Macomb County Community Mental Health Level of Care Training Manual 1 Macomb County Community Mental Health Level of Care Training Manual Introduction Services to Medicaid recipients are based on medical necessity for the service and not specific diagnoses. Services may

More information

Psychosocial Rehabilitation Medical Necessity Criteria

Psychosocial Rehabilitation Medical Necessity Criteria Program Description Psychosocial Rehabilitation Medical Necessity Criteria Psychosocial Rehabilitation (PSR) is a community-based program that promotes recovery, community integration, and improved quality

More information

Critical Time Intervention (CTI) (State-Funded)

Critical Time Intervention (CTI) (State-Funded) Critical Time (CTI) (State-Funded) Service Definition and Required Components Critical Time (CTI) is an intensive 9 month case management model designed to assist adults age 18 years and older with mental

More information

Prior Authorization and Continued Stay Criteria for Adult Serious Mentally Ill (SMI) Behavioral Health Residential Facility

Prior Authorization and Continued Stay Criteria for Adult Serious Mentally Ill (SMI) Behavioral Health Residential Facility Prior Authorization and Continued Stay Criteria for Adult Serious Mentally Ill (SMI) Behavioral Health Residential Facility AUTHORIZATION CRITERIA FOR BEHAVIORAL HEALTH RESIDENTIAL FACILITY, ADULT Title

More information

BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care

BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care Acute Inpatient Hospitalization I. DEFINITION OF SERVICE: Acute Inpatient Psychiatric Hospitalization is a 24-hour secure and protected, medically

More information

Inpatient Psychiatric Services for Under Age 21 Arkansas Medicaid Regulations and Documentation

Inpatient Psychiatric Services for Under Age 21 Arkansas Medicaid Regulations and Documentation Inpatient Psychiatric Services for Under Age 21 Arkansas Medicaid Regulations and Documentation Presented by: Shelly Rhodes Shelly.Rhodes@beaconhealthoptions.com Disclaimer Disclaimer: This presentation

More information

Intensive In-Home Services Training

Intensive In-Home Services Training Intensive In-Home Services Training Intensive In Home Services Definition Intensive In Home Services is an intensive, time-limited mental health service for youth and their families, provided in the home,

More information

Alternative or in Lieu of Service Description Alliance Behavioral Healthcare

Alternative or in Lieu of Service Description Alliance Behavioral Healthcare Alternative or in Lieu of Service Description Alliance Behavioral Healthcare 1. Service Name and Description: Rapid Response Crisis Services for Children and Youth Service Name: Rapid Response Procedure

More information

POLICY TITLE: CONTINUED STAY REVIEWS EFFECTIVE DATE REVISED DATE. (Signature)

POLICY TITLE: CONTINUED STAY REVIEWS EFFECTIVE DATE REVISED DATE. (Signature) Policy 5.13 Page 1 of 2 POLICY TITLE: CONTINUED STAY REVIEWS EFFECTIVE DATE REVISED DATE CHAPTER: SYSTEMS OF CARE Approved by: LRE BOARD OF DIRECTORS Approval Date: Maintained by: LRE Clinical Director,

More information

October 5 th & 6th, The Managed Care Technical Assistance Center of New York

October 5 th & 6th, The Managed Care Technical Assistance Center of New York October 5 th & 6th, 2015 The Managed Care Technical Assistance Center of New York What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health

More information

SUPPLEMENTAL GUIDELINES FOR MENTAL HEALTH UTILIZATION MANAGEMENT AND TREATMENT PLANNING

SUPPLEMENTAL GUIDELINES FOR MENTAL HEALTH UTILIZATION MANAGEMENT AND TREATMENT PLANNING SUPPLEMENTAL GUIDELINES FOR MENTAL HEALTH UTILIZATION MANAGEMENT AND TREATMENT PLANNING Produced for the Magellan Mental Health Guidelines for the Pennsylvania HealthChoices Project Magellan Behavioral

More information

Contemporary Psychiatric-Mental Health Nursing. Deinstitutionalization. Deinstitutionalization - continued

Contemporary Psychiatric-Mental Health Nursing. Deinstitutionalization. Deinstitutionalization - continued Contemporary Psychiatric-Mental Health Nursing Chapter 12 Creating Hospital and Community-Based Therapeutic Environments Deinstitutionalization Began in the post World War II period Large public mental

More information

NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES

NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Mental Health, Developmental Disabilities and Substance Abuse Services State-Funded MH/DD/SA SERVICE DEFINITIONS Revision Date: September

More information

IV. Clinical Policies and Procedures

IV. Clinical Policies and Procedures A. Introduction The role of ValueOptions NorthSTAR is to coordinate the delivery of clinical services. There are three parties to this care coordination process: the Enrollee, the Provider(s), and the

More information

San Diego County Funded Long-Term Care Criteria

San Diego County Funded Long-Term Care Criteria San Diego County Funded Long-Term Care Criteria Prepared By: 6/23/16 Table of Contents San Diego County Funded Long Term Care Criteria... 2 Referral Criteria by Level of Care: Institute of Mental Disease

More information

UnitedHealthcare Guideline

UnitedHealthcare Guideline UnitedHealthcare Guideline TITLE: CRS BEHAVIORAL HEALTH HOME CARE TRAINING TO HOME CARE CLIENT (HCTC) PRACTICE GUIDELINES EFFECTIVE DATE: 1/1/2017 PAGE 1 of 14 GUIDELINE STATEMENT This guideline outlines

More information

4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents)

4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) 4.40 STRUCTURED DAY TREATMENT SERVICES 4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) Description of Services: Substance use partial hospitalization is a nonresidential treatment

More information

Inpatient IOC Checklist Clinical Record Review

Inpatient IOC Checklist Clinical Record Review Date of Review Reason for Review: Inspection of Care Action Plan Follow-up (Focus of Follow-up: ) Beneficiary Record ID: Beneficiary Age: Custody: DCFS DYS Provider Name: Acute RTC PRTF Date of Admission:

More information

STATE OF CONNECTICUT. Department of Mental Health and Addiction Services. Concerning. DMHAS General Assistance Behavioral Health Program

STATE OF CONNECTICUT. Department of Mental Health and Addiction Services. Concerning. DMHAS General Assistance Behavioral Health Program Page 1 of 81 pages Concerning Subject Matter of Regulation DMHAS General Assistance Behavioral Health Program a The Regulations of Connecticut State Agencies are amended by adding sections 17a-453a-1 to

More information

Cardinal Innovations Child Continuum of Care Philosophy. March 2014

Cardinal Innovations Child Continuum of Care Philosophy. March 2014 Cardinal Innovations Child Continuum of Care Philosophy March 2014 Disclaimer Information provided in this presentation pertains only to the counties in the Cardinal Innovations Healthcare Solutions Region.

More information

Assertive Community Treatment

Assertive Community Treatment HIPAA Transaction Code Assertive Community Treatment Assertive Community Treatment Code Detail Code Mod 1 Mod 2 Mod 3 Mod 4 Rate Practitioner Level 1, In-Clinic H0039 U1 U6 $32.46 Practitioner Level 2,

More information

STAR+PLUS through UnitedHealthcare Community Plan

STAR+PLUS through UnitedHealthcare Community Plan STAR+PLUS through UnitedHealthcare Community Plan Optum 06012014 Who We Are United Behavioral Health (UBH) was created February 2, 1997, through a merger of U.S. Behavioral Health, Inc. (USBH) and United

More information

Provider Frequently Asked Questions

Provider Frequently Asked Questions Provider Frequently Asked Questions Strengthening Clinical Processes Training CASE MANAGEMENT: Q1: Does Optum allow Case Managers to bill for services provided when the Member is not present? A1: Optum

More information

BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care MCOs. Table of Contents

BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care MCOs. Table of Contents BEHAVIOR HEALTH LEVEL OF CARE GUIDELINES for Centennial Care MCOs Table of Contents Section Page Medical Necessity Definition 2 Acute Inpatient Hospitalization 5 Waiting Placement Days (DAP) Rate 7 23

More information

Sustaining Open Access. Annie Jensen LCSW Clinical Consultant, MTM Services

Sustaining Open Access. Annie Jensen LCSW Clinical Consultant, MTM Services Sustaining Open Access Annie Jensen LCSW Clinical Consultant, MTM Services Annie.Jensen@mtmservices.org Healthcare Reform Context Under an Accountable Care Organization Model the Value of Behavioral Health

More information

Clinical Criteria Inpatient Medical Withdrawal Management Substance Use Inpatient Withdrawal Management (Adults and Adolescents)

Clinical Criteria Inpatient Medical Withdrawal Management Substance Use Inpatient Withdrawal Management (Adults and Adolescents) 4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents) Description of Services: Inpatient withdrawal management is comprised of services

More information

-OPTUM PIERCE BEHAVIORAL HEALTH ORGANIZATION

-OPTUM PIERCE BEHAVIORAL HEALTH ORGANIZATION -OPTUM PIERCE BEHAVIORAL HEALTH ORGANIZATION CARE MANAGEMENT AND SERVICE PLANNING POLICY Policy: CM-10 Section: Care Management and Service Planning Approved by Bea Dixon, Executive Director Effective

More information

Alliance Behavioral Healthcare Level of Care Guidelines for State Funded Adult Mental Health and Substance Abuse Services

Alliance Behavioral Healthcare Level of Care Guidelines for State Funded Adult Mental Health and Substance Abuse Services Alliance Behavioral Healthcare of Care Guidelines for State Funded Adult Mental Health and Substance Abuse s Mental Health (Effective 10/1/2012) The levels of care criteria provide a framework for the

More information

Family Centered Treatment Service Definition

Family Centered Treatment Service Definition Family Centered Treatment Service Definition Title: Family Centered Treatment Type: Alternative Service Definition H2022 Z1 - Engagement Effective Date: 8/1/2015 Codes: H2022 HE Core H2022 Z1 - Transition

More information

Statewide Inpatient Psychiatric Programs Admission Process and Level of Care Criteria. Effective August 1, 2014

Statewide Inpatient Psychiatric Programs Admission Process and Level of Care Criteria. Effective August 1, 2014 Statewide Inpatient Psychiatric Programs Admission Process and Level of Care Criteria Effective August 1, 2014 1 Table of Contents Florida Medicaid Handbook... 3 Clinical Practice Guidelines... 3 Description

More information

Partial Hospitalization. Shelly Rhodes, LPC

Partial Hospitalization. Shelly Rhodes, LPC Partial Hospitalization Shelly Rhodes, LPC Shelly.Rhodes@beaconhealthoptions.com Transition and Certification 2 Transition and Certification Current Rehabilitative Services for Persons with Mental Illness

More information

For initial authorization or authorization of continued stay, the following documents must be submitted:

For initial authorization or authorization of continued stay, the following documents must be submitted: Appendix F3 Instructions for Funding Authorization/Reauthorization SUD Residential Treatment Programs Authorization Form Clinician Instructions: For initial authorization or authorization of continued

More information

NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Comprehensive Case Management for AMH/ASU.

NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Comprehensive Case Management for AMH/ASU. NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Comprehensive Case Management for AMH/ASU Table of Contents 1.0 Description of the Procedure, Product, or Service...

More information

The goal of Utilization Management (UM) is to ensure that all services that are authorized meet the Departments definition of medical necessity.

The goal of Utilization Management (UM) is to ensure that all services that are authorized meet the Departments definition of medical necessity. The primary vision that guided the development of the CT BHP was to develop an integrated public behavioral health service system that offers enhanced access as well as increased coordination of a more

More information

Voluntary Services as Alternative to Involuntary Detention under LPS Act

Voluntary Services as Alternative to Involuntary Detention under LPS Act California s Protection & Advocacy System Toll-Free (800) 776-5746 Voluntary Services as Alternative to Involuntary Detention under LPS Act March 2010, Pub #5487.01 This memo outlines often overlooked

More information

HCMC Outpatient Mental Health Programs. External Referral Form

HCMC Outpatient Mental Health Programs. External Referral Form HCMC Outpatient Mental Health Programs External Referral Form Thank you for your interest in the Day Treatment, Partial Hospital Program, or Dialectical Behavior Therapy Intensive Outpatient Program. All

More information

Common ACTT Referral Form

Common ACTT Referral Form Common ACTT Referral Form WELCOME! Please ensure that you have completed the accompanying screening tool to ensure that the applicant qualifies for this service. We want to process this application as

More information

HIV HEALTH & HUMAN SERVICES PLANNING COUNCIL OF NEW YORK Mental Health Service Directive - Tri-County Approved by the HIV Planning Council 3/31/16

HIV HEALTH & HUMAN SERVICES PLANNING COUNCIL OF NEW YORK Mental Health Service Directive - Tri-County Approved by the HIV Planning Council 3/31/16 Goals: 1) Provide treatment and counseling services to individuals living with HIV and mental illness, with or without cooccurring substance use disorders, that aim to improve quality of life and mental

More information

Psychiatric Services Provider Manual 10/9/2007. Covered Services and Limitations CHAPTER IV COVERED SERVICES AND LIMITATIONS. Manual Title.

Psychiatric Services Provider Manual 10/9/2007. Covered Services and Limitations CHAPTER IV COVERED SERVICES AND LIMITATIONS. Manual Title. Subject Revision Date CHAPTER COVERED SERVICES AND LIMITATIONS Subject Revision Date i CHAPTER TABLE OF CONTENTS Inpatient Psychiatric Services (Acute Hospital and Residential) 1 Acute Care Hospitals 1

More information

State-Funded Enhanced Mental Health and Substance Abuse Services

State-Funded Enhanced Mental Health and Substance Abuse Services and and Contents 1.0 Description of the Service... 3 2.0 Individuals Eligible for State-Funded Services... 3 3.0 When State-Funded Services Are Covered... 3 3.1 General Criteria... 3 3.2 Specific Criteria...

More information

CCBHC Standards of Care

CCBHC Standards of Care CCBHC Standards of Care Mark Disselkoen, MSW, LCSW, LADC CASAT March 7, 2017 Disclaimer The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or

More information

INTEGRATED CASE MANAGEMENT ANNEX A

INTEGRATED CASE MANAGEMENT ANNEX A INTEGRATED CASE MANAGEMENT ANNEX A NAME OF AGENCY: CONTRACT NUMBER: CONTRACT TERM: TO BUDGET MATRIX CODE: 32 This Annex A specifies the Integrated Case Management services that the Provider Agency is authorized

More information

Residential Treatment Facility TRR Tool 2016

Residential Treatment Facility TRR Tool 2016 Provider Name: Address: Provider Type: Name of Reviewer: Date of Review: Residential Treatment Facility TRR Tool 2016 Member ID Auth Dates 1 Initial Assessment Areas of Review Reference Record 1 Record

More information

BEHAVIORAL HEALTH PLAN SYSTEM REDESIGN 2003

BEHAVIORAL HEALTH PLAN SYSTEM REDESIGN 2003 BEHAVIORAL HEALTH PLAN SYSTEM REDESIGN 2003 EXHIBIT N MentalHealth 1 Document consists of 50 pages. Entire document provided. Due to size limitations, pages provided. A copy of the complete document is

More information

NASSAU COUNTY SINGLE POINT OF ACCESS (SPOA) CHILDREN S INTENSIVE MENTAL HEALTH PROGRAMS

NASSAU COUNTY SINGLE POINT OF ACCESS (SPOA) CHILDREN S INTENSIVE MENTAL HEALTH PROGRAMS NASSAU COUNTY SINGLE POINT OF ACCESS (SPOA) CHILDREN S INTENSIVE MENTAL HEALTH PROGRAMS Date of Referral: Child s Name: Date of Birth: Gender: Social Security Number: Age: Address: Town: Zip: Phone: Legal

More information

Chapter 2 Provider Responsibilities Unit 6: Behavioral Health Care Specialists

Chapter 2 Provider Responsibilities Unit 6: Behavioral Health Care Specialists Chapter 2 Provider Responsibilities Unit 6: Health Care Specialists In This Unit Unit 6: Health Care Specialists General Information 2 Highmark s Health Programs 4 Accessibility Standards For Health Providers

More information

Clinical Utilization Management Guideline

Clinical Utilization Management Guideline Clinical Utilization Management Guideline Subject: Therapeutic Behavioral On-Site Services for Recipients Under the Age of 21 Years Status: New Current Effective Date: January 2018 Description Last Review

More information

PART 512 Personalized Recovery Oriented Services

PART 512 Personalized Recovery Oriented Services PART 512 Personalized Recovery Oriented Services (Statutory authority: Mental Hygiene Law 7.09[b], 31.04[a], 41.05, 43.02[a]-[c]; and Social Services Law, 364[3], 364-a[1]) Sec. 512.1 Background and intent.

More information

Acute Crisis Units. Shelly Rhodes, Provider Relations Manager

Acute Crisis Units. Shelly Rhodes, Provider Relations Manager Acute Crisis Units Shelly Rhodes, Provider Relations Manager Shelly.Rhodes@beaconhealthoptions.com Training Agenda Agenda: Transition and Certification Coverage of Services Service Code Definition Documentation

More information

Program of Assertive Community Treatment (PACT) BHD/MH

Program of Assertive Community Treatment (PACT) BHD/MH Program of Assertive Community Treatment () BHD/MH Luis Marcano, x5343 Alan Orenstein, x0927 Program Purpose Help individuals with serious mental illness achieve and maintain community integration through

More information

Covered Service Codes and Definitions

Covered Service Codes and Definitions Covered Service Codes and Definitions [01] Assessment Assessment services include the systematic collection and integrated review of individualspecific data, such as examinations and evaluations. This

More information

ILLINOIS 1115 WAIVER BRIEF

ILLINOIS 1115 WAIVER BRIEF ILLINOIS 1115 WAIVER BRIEF STATE TESTING FOR THE FOLLOWING ACHIEVED RESULTS: 1. Increased rates of identification, initiation, and engagement in treatment 2. Increased adherence to and retention in treatment

More information

IDAHO SCHOOL-BASED MENTAL HEALTH SERVICES (EFFECTIVE JULY 1, 2016) PSYCHOTHERAPY & COMMUNITY BASED REHABILITATION SERVICES (CBRS)

IDAHO SCHOOL-BASED MENTAL HEALTH SERVICES (EFFECTIVE JULY 1, 2016) PSYCHOTHERAPY & COMMUNITY BASED REHABILITATION SERVICES (CBRS) IDAHO SCHOOL-BASED MENTAL HEALTH SERVICES (EFFECTIVE JULY 1, 2016) PSYCHOTHERAPY & COMMUNITY BASED REHABILITATION SERVICES (CBRS) IMPORTANT Medicaid providers are required to provide services in accordance

More information

Tennessee Health Link Guidelines: Adults Medical Necessity Criteria-Final

Tennessee Health Link Guidelines: Adults Medical Necessity Criteria-Final Tennessee Health Link Guidelines: Adults Medical Necessity Criteria-Final Program Description Tennessee Health Link service model is a program created to address the diverse needs of individuals requiring

More information

Service Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note:

Service Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note: Service Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note: If you are a Medicaid beneficiary and have a serious mental illness, or serious emotional disturbance, or developmental

More information

WYOMING MEDICAID PROGRAM

WYOMING MEDICAID PROGRAM WYOMING MEDICAID PROGRAM COMMUNITY MENTAL HEALTH & SUBSTANCE USE TREATMENT SERVICES MANUAL MENTAL HEALTH/SUBSTANCE USE REHABILITATION OPTION EPSDT CHILD & ADOLESCENT MENTAL HEALTH SERVICES TARGETED CASE

More information

ADULT SERVICE COORDINATION PROVIDERS IN ALLEGHENY COUNTY

ADULT SERVICE COORDINATION PROVIDERS IN ALLEGHENY COUNTY Allegheny County Department of Human Services Service Coordination Referral Form ADULT SERVICES FORM INSTRUCTIONS 1. Only one service provider can be requested at a time. 2. All sections of this document

More information

Comprehensive Community Services (CCS) File Review Checklist Comprehensive

Comprehensive Community Services (CCS) File Review Checklist Comprehensive This is a sample form developed by the "CCS Statewide QA/QI Work Group", and is available to CCS sites as a sample for consideration of use, modification, and customization. There is no implicit or explicit

More information

Interactive Voice Registration (IVR) System Manual WASHINGTON STREET, SUITE 310 BOSTON, MA

Interactive Voice Registration (IVR) System Manual WASHINGTON STREET, SUITE 310 BOSTON, MA Interactive Voice Registration (IVR) System Manual 1000 WASHINGTON STREET, SUITE 310 BOSTON, MA 02118-5002 1-800-495-0086 www.masspartnership.com TABLE OF CONTENTS INTRODUCTION... 3 IVR INSTRUCTIONS...

More information

A SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS

A SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS A SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS This tool is intended to provide a broad overview of common Medicaid (MA) requirements in relation to COA s Standards. While there are specific

More information

CODES: H0045-U4 = Individual Respite H0045-HQ-U4 = Group Respite T1005-TD-U4 = Nursing Respite-RN T1005-TE-U4 = Nursing Respite-LPN

CODES: H0045-U4 = Individual Respite H0045-HQ-U4 = Group Respite T1005-TD-U4 = Nursing Respite-RN T1005-TE-U4 = Nursing Respite-LPN CODES: H0045-U4 = Individual Respite H0045-HQ-U4 = Group Respite T1005-TD-U4 = Nursing Respite-RN T1005-TE-U4 = Nursing Respite-LPN (b)(3) Respite Children MH/ID/DD/SUD and Adults with Developmental Disabilities

More information

Mississippi Medicaid Autism Spectrum Disorder Services for EPSDT Eligible Beneficiaries Provider Manual

Mississippi Medicaid Autism Spectrum Disorder Services for EPSDT Eligible Beneficiaries Provider Manual Mississippi Medicaid Services for EPSDT Eligible Beneficiaries Provider Manual Effective Date: July 1, 2017 Services for Introduction: eqhealth Solutions Services (ASD) Utilization Management Program includes

More information

Provider Orientation to Magellan s Outpatient Behavioral Health Model

Provider Orientation to Magellan s Outpatient Behavioral Health Model Provider Orientation to Magellan s Outpatient Behavioral Health Model July 2017 Big-picture objectives Magellan Healthcare s outpatient care management model: Reduces provider administrative tasks Expedites

More information

CHAPTER 24 ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, MENTAL RETARDATION, AND DEVELOPMENTAL DISABILITIES PREAMBLE

CHAPTER 24 ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, MENTAL RETARDATION, AND DEVELOPMENTAL DISABILITIES PREAMBLE Human Services[441] Ch 24, p.1 CHAPTER 24 ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, MENTAL RETARDATION, AND DEVELOPMENTAL DISABILITIES PREAMBLE The mental health, mental retardation,

More information

Practical Facts about Adult Behavioral Health Home and Community Based Services. (Adult BH HCBS)

Practical Facts about Adult Behavioral Health Home and Community Based Services. (Adult BH HCBS) Section I: Introduction: Practical Facts about Adult Behavioral Health Home and Community Based Services (Adult BH HCBS) The development of Health and Recovery Plans (HARPs) is intended to promote significant

More information

COMMUNITY MENTAL HEALTH PROGRAM REFERENCE GUIDE

COMMUNITY MENTAL HEALTH PROGRAM REFERENCE GUIDE COMMUNITY MENTAL HEALTH PROGRAM REFERENCE GUIDE Contents Acknowledgements... 2 Community Mental Health Program Overview... 3 Introduction...4 Program Objectives...4 WSIB Community Mental Health Network...

More information

Interactive Voice Registration (IVR) System Manual WASHINGTON STREET, SUITE 310 BOSTON, MA (800)

Interactive Voice Registration (IVR) System Manual WASHINGTON STREET, SUITE 310 BOSTON, MA (800) Interactive Voice Registration (IVR) System Manual 1000 WASHINGTON STREET, SUITE 310 BOSTON, MA 02118-5002 (800) 495-0086 www.masspartnership.com TABLE OF CONTENTS INTRODUCTION... 3 IVR INSTRUCTIONS...

More information

NO Tallahassee, December 15, Mental Health/Substance Abuse RECOVERY PLANNING AND IMPLEMENTATION IN MENTAL HEALTH TREATMENT FACILITIES

NO Tallahassee, December 15, Mental Health/Substance Abuse RECOVERY PLANNING AND IMPLEMENTATION IN MENTAL HEALTH TREATMENT FACILITIES CFOP 155-16 STATE OF FLORIDA DEPARTMENT OF CF OPERATING PROCEDURE CHILDREN AND FAMILIES NO. 155-16 Tallahassee, December 15, 2017 Mental Health/Substance Abuse RECOVERY PLANNING AND IMPLEMENTATION IN MENTAL

More information

Santa Clara County, California Medicare- Medicaid Plan (MMP)

Santa Clara County, California Medicare- Medicaid Plan (MMP) Santa Clara County, California Medicare- Medicaid Plan (MMP) Behavioral health overview topics Topics covered: o Behavioral health (BH) covered services overview o BH noncovered services o Early and Periodic

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

PENNSYLVANIA PREADMISSION SCREENING RESIDENT REVIEW (PASRR) IDENTIFICATION LEVEL I FORM (Revised 9/1/2018)

PENNSYLVANIA PREADMISSION SCREENING RESIDENT REVIEW (PASRR) IDENTIFICATION LEVEL I FORM (Revised 9/1/2018) PENNSYLVANIA PREADMISSION SCREENING RESIDENT REVIEW (PASRR) IDENTIFICATION LEVEL I FORM (Revised 9/1/2018) This process applies to all nursing facility (NF) applicants, regardless of payer source. All

More information

MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE

MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE SUBJECT BY NUMBER: ISSUE DATE: September 8, 1995 EFFECTIVE DATE: September 8, 1995 Mental Health Services Provided

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

The Managed Care Technical Assistance Center of New York

The Managed Care Technical Assistance Center of New York The Managed Care Technical Assistance Center of New York The Managed Care Technical Assistance Center of New York What is MCTAC? MCTAC is a training, consultation, and educational resource center that

More information

Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012

Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Table of Contents CARE COORDINATION GENERAL REQUIREMENTS...4 RISK STRATIFICATION AND HEALTH ASSESSMENT PROCESS...6

More information

CMS Local Coverage Determination (LCD) of Psychiatric Partial Hospitalization Programs for Massachusetts, New York, and Rhode Island

CMS Local Coverage Determination (LCD) of Psychiatric Partial Hospitalization Programs for Massachusetts, New York, and Rhode Island CMS Local Coverage Determination (LCD) of Psychiatric Partial Hospitalization Programs for Massachusetts, New York, and Rhode Island L33626 Coverage Indications and Limitations Psychiatric partial hospitalization

More information

UCARE MODEL OF CARE SUMMARY FOR MH-TCM (February 2009)

UCARE MODEL OF CARE SUMMARY FOR MH-TCM (February 2009) UCARE MODEL OF CARE SUMMARY FOR MH-TCM (February 2009) The UCare Model of Care for Mental Health Targeted Case Management is designed to provide care for the child member and their families and adult members,

More information

Transition Management Services (TMS) (Previously known as Tenancy Support Team) Revised 6/3/16

Transition Management Services (TMS) (Previously known as Tenancy Support Team) Revised 6/3/16 Transition Management Services (TMS) (Previously known as Tenancy Support Team) Revised 6/3/16 Service Definition and Required Components Transition Management Services (TMS) is a service provided to individuals

More information

Treatment Planning. General Considerations

Treatment Planning. General Considerations Treatment Planning CBH Compliance has been tasked with ensuring that our providers adhere to documentation standards presented in state regulations, bulletins, CBH contractual documents, etc. Complying

More information

FLORIDA DEPARTMENT OF CORRECTIONS OFFICE OF HEALTH SERVICES. HEALTH SERVICES BULLETIN NO Page 1 of 15

FLORIDA DEPARTMENT OF CORRECTIONS OFFICE OF HEALTH SERVICES. HEALTH SERVICES BULLETIN NO Page 1 of 15 FLORIDA DEPARTMENT OF CORRECTIONS OFFICE OF HEALTH SERVICES HEALTH SERVICES BULLETIN NO. 15.05.05 Page 1 of 15 I. PURPOSE EFFECTIVE DATE: 08/27/13 The purpose of this health services bulletin is to ensure

More information

VSHP/ Behavioral Health

VSHP/ Behavioral Health VSHP/ Behavioral Health Deb Dukes & Dr Kelly Askins The contact numbers in the presentation apply to WEST Member Services ONLY. New numbers for EAST Member Services will be published and distributed by

More information

Ryan White Part A Quality Management

Ryan White Part A Quality Management Quality Management Mental Health Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part A grant

More information

Sherri Proffer, RN, Program Manager. Dorothy Ukegbu, RN Coordinator, 02/20/2014 1

Sherri Proffer, RN, Program Manager. Dorothy Ukegbu, RN Coordinator, 02/20/2014 1 Sherri Proffer, RN, Program Manager Dorothy Ukegbu, RN Coordinator, 02/20/2014 1 Procedures for Determination of Medical Need for Nursing Home Services I. Medical Need Assessments A. Nursing Facility Procedures

More information

National Program Standards for ACT Teams

National Program Standards for ACT Teams National Program Standards for ACT Teams Deborah Allness, M.S.S.W. and William Knoedler, M.D. Revised June 2003 by D. Allness A number of second and third generation studies have shown that ACT programs

More information

Appendix 1: Business Rules by Section

Appendix 1: Business Rules by Section Appendix 1: Rules by Section Child/Adolescent Uniform Assessment Header: Last Name, etc. 1 Access to WebCARE screens is restricted to authorized users only. 2 Component Code entered must be valid, non-blank,

More information

SoonerCare Medical Necessity Criteria for Inpatient Behavioral Health Services

SoonerCare Medical Necessity Criteria for Inpatient Behavioral Health Services SoonerCare Medical Necessity Criteria for Inpatient Behavioral Health Services OKLAHOMA HEALTH CARE AUTHORITY Updated: May 14, 2018 PURPOSE OF MANUAL... 3 OHCA INPATIENT REVIEW REQUEST LINE... 4 TELEPHONIC

More information

Name: Intensive Service Array Responsible Department: Lane County Health and Human Services- Trillium Behavioral Health

Name: Intensive Service Array Responsible Department: Lane County Health and Human Services- Trillium Behavioral Health Procedure Name: Responsible Department: Lane County Health and Human Services- Trillium Behavioral Health Plans: Medicaid Medicare Marketplace PEBB Current Effective Date: 1-26-16 Scheduled Review Date:

More information

FIDELIS CARE'S BEHAVIORAL HEALTH DEPARTMENT

FIDELIS CARE'S BEHAVIORAL HEALTH DEPARTMENT INTRODUCTION This section of the Fidelis Care Provider Manual (hereafter called the Manual) was created to assist participating providers and their office staff in understanding Fidelis Care's policies

More information

907 KAR 10:014. Outpatient hospital service coverage provisions and requirements.

907 KAR 10:014. Outpatient hospital service coverage provisions and requirements. 907 KAR 10:014. Outpatient hospital service coverage provisions and requirements. RELATES TO: KRS 205.520, 42 C.F.R. 447.53 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3), 205.560, 205.6310,

More information

Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Request

Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Request MIS# Name: Address: City/State/Zip: Phone #: Fax #: Client Information: Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Request Clinical Contact Information * * * * Attachments *

More information

Ryan White Part A. Quality Management

Ryan White Part A. Quality Management Quality Management Mental Health Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part A grant

More information

Behavioral health provider overview

Behavioral health provider overview Behavioral health provider overview KSPEC-1890-18 February 2018 Agenda Provider manual and provider website Behavioral Health (BH) program goals Access and availability standards Care coordination and

More information

Eau Claire County Mental Health Court. Presentation December 15, 2011

Eau Claire County Mental Health Court. Presentation December 15, 2011 Eau Claire County Mental Health Court Presentation December 15, 2011 Collaboration State & County Government Eau Claire County Mental Health & Jail Diversion Task Force First Brought State & County Agencies

More information

Understanding and Using ASAM Criteria in Substance Use Disorder Treatment Planning

Understanding and Using ASAM Criteria in Substance Use Disorder Treatment Planning Understanding and Using ASAM Criteria in Substance Use Disorder Treatment Planning WHAT? This guidance document has been developed to provide an overview of the American Society of Addiction Medicine (ASAM)

More information