Optum By United Behavioral Health Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
|
|
- Christal Hancock
- 8 years ago
- Views:
Transcription
1 Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Statewide Inpatient Psychiatric Program Services (SIPP) Statewide Inpatient Psychiatric Program Services are sub-acute medical and mental health-related services provide by or under the direction of professional or technical personnel, in an institution that is privately owned, licensed as a psychiatric hospital or residential treatment center for children and adolescents and enrolled as a SIPP provider in the Florida Medicaid program. SIPP serves high-risk Medicaid recipients under age 21 who require placement in a psychiatric residential setting due to a primary diagnosis of serious mental illness or emotional disturbance. Recipients served in SIPP typically require a level of service beyond that which is provided in community-based services or acute inpatient settings. SIPP is intended to stabilize and adequately resolve presenting problems and symptoms, incorporate permanency, design effective aftercare treatment plans, and ensure coordination with State agencies and community services where applicable with the goals of reducing recidivism and relapse, and reducing the length and frequency of acute inpatient admissions. INSTRUCTIONS FOR USE Optum s Level of Care Guidelines are used to standardize coverage determinations, promote evidence-based practices, and support member s recovery, resiliency, and wellbeing. Optum s Level of Care Guidelines are derived from generally accepted standards of behavioral health practice. These standards include guidelines and consensus statements produced by professional specialty societies, as well as guidance from governmental sources such as CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). While this Level of Care Guideline does reflect Optum s understanding of current best practices in care, it does not constitute medical advice. Optum reserves the right, in its sole discretion, to modify its Level of Care Guidelines as necessary. Optum is a brand used by United Behavioral Health and its affiliates.
2 1. Admission Criteria 1.1. The member is under age 21 and is eligible under one of the following Medicaid eligibility categories: TANF-related Supplemental Security Income (SSI) SSI-related 1.2. If under the care and custody of the State, the child has been assessed by a qualified evaluator, and the need for SIPP is indicated. OR 1.3. If in parental custody, the child has been assessed by a psychologist or psychiatrist, and the assessment has determined that the child has an emotional disturbance i or a serious emotional disturbance ii 1.4. All available treatment that is less restrictive than residential treatment has been considered or is unavailable. The member s current condition cannot be safely, efficiently and effectively addressed and/or treated in a less intensive setting due to changes in the member s signs and symptoms, level of functioning, and/or psychosocial and environmental factors (i.e., the why now factors leading to admission) Failure of treatment in a lower level of care is not a prerequisite for authorizing coverage Treatment is reasonably likely to resolve the child s presenting problem Services are medically necessary iii 2. Continue Service Criteria 2.1. The admission criteria are still met, and active treatment iv is being provided The why now factors leading to admission have been identified and are integrated into the treatment and discharge plans Clinical best practices are being provided timely with sufficient intensity to address the member s treatment needs. 2
3 2.4. The member s parent or guardian is engaged to participate in treatment as clinically indicated. 3. Discharge Criteria 3.1. The continued service criteria are no longer met. Examples include: The why now factors which led to admission have been addressed to the extent that the member can be safely transitioned to a less intensive level of care, or no longer requires treatment Active treatment is not being provided The member requires care that is primarily social, custodial, recreational or for purposes of respite The member requires treatment in a medical-surgical setting The member is unwilling or unable to participate in treatment. 4. Clinical Best Practices 4.1. Evaluation and Treatment Planning Prior to admission, the member s parent or guardian should receive an explanation of why SIPP is being recommended. The explanation should include the nature, purpose and expected length of treatment. The member s parent or guardian should also be informed of safe and effective treatment alternatives, potential risks and benefits of SIPP. This information is provided so that the member s parent or guardian can give informed consent The provider collects information from the member and other sources, and completes an initial evaluation of the following: The member s chief complaint; A description of the acute condition or exacerbation of a chronic condition; The why now factors; The member s psychiatric and social histories including the histories of substance use and trauma; The history of treatment; Psychosocial and environmental problems; Mental status examination; Physical examination (when appropriate); Risk factors including those related to harm to self or others, as well as risk stemming from co-occurring behavioral health or medical conditions; Assessment of the member s coping strategies; 3
4 The member and parent or guardian s understanding of the need for change as context for treatment planning including interventions that will promote informed decision-making and participation in care; Resilience factors; Recover and resiliency goals In that event that not all information is available at the time of evaluation, there must be enough information to provide a basis for the diagnosis, guide development of the treatment plan, and support the need for SIPP The provider uses the findings of the evaluation to assign a DSM/ICD diagnosis The treatment plan should: Be developed and implemented within 14 calendar days of admission; Be based on the findings of the initial evaluation; Be developed by a multidisciplinary team comprised of the following: Member; Member s psychiatrist; Psychiatric social workers; Registered Nurse, Occupational Therapist, or Licensed Psychologist; The member s parent; The member s legal representative; The targeted case manager; Guardian or Child Welfare or Community Based Care counselor; Primary clinician; Direct child care staff; Activities staff; School personnel; Regional care coordinator; Medicaid utilization management specialist; and Others who are involved in the care of the member; 4
5 State treatment objectives in terms that are measurable, functional, time-framed and directly related to the why now factors; Prescribe an integrated program of therapies, activities, and experiences designed to meet the objectives, and include the amount, frequency and duration of each component of the program; Include interventions such as psychoeducation or motivational interviewing designed when necessary to engage the member and/or the member s parent or guardian in treatment, promote informed decisions, and support the member s broader recovery and resiliency goals; Define how the member s family and other natural resources will participate in treatment when clinically indicated; Provide for on-site educational services Reflect coordination with the member s designated Child Welfare or Community Based Care counselor and permanency plan, if the member is in state custody and with any assigned Targeted Case Manager during the last 120 calendar days of a member s admission; Be focused on allowing the member s safe return to the family and community services as soon as possible including how treatment will be coordinated with other providers as well as with agencies or programs with which the member is involved; Include an initial formulation of the discharge plan The psychiatrist shall, at a minimum: Be on call 24 hours a day; Interview the member weekly to assess progress toward meeting treatment goals, or more often if medically necessary; Supervise treatment for members who are on psychotropic medications; Coordinate care with the member s primary care physician when indicated by the member s medical condition; and Attend member staffings The provider will deliver, at a minimum: individual session and 1 family therapy session weekly, based on best practices and accepted clinical guidelines and provided in accordance with the member s individual needs; 5
6 If the member is unable to participate in 60 minute sessions for family and individual therapy, shorter and more frequent sessions should be offered during the week to provide comparable intervention duration; When more appropriate to a member s developmental and cognitive style, the member may have weekly individual sessions with the behavior analyst in place of weekly individual therapy; Weekly group therapy services; Therapeutic home assignments to allow the member and the member s family to practice skills learned in the program; Assistance with helping the member and the member s parent learn to manage the member s behaviors in age appropriate ways The behavior analysts shall complete a behavioral review of any of the following: Members ages 10 and under (upon admission); Members with an IQ of 69 or below (upon admission); Members whose rate of time out is not decreasing in the time frame anticipated by the treatment team; As used here, time out does not include voluntary time outs that the member requests or initiates in the process of learning and practicing self-management of behavior; Members who have required the use of seclusion or restraint The behavioral review shall: Identify behaviors contributing to the need for residential treatment so it may be addressed in the treatment plan; Identify factors contributing to the need for time out, seclusion and restraint so early intervention measures can be taken; Assess the seriousness of the member s behavior and identify trends to determine if additional assessment or a behavior plan is necessary; and Ensure that the level of point system, if one is used, or other similar method is appropriate and understood by the member The behavior analyst must complete a Comprehensive Behavior Analysis Assessment on any of the following: 6
7 Any member who has been restrained at least 2 times within any 30-day period; Any member who has been in seclusion at least 3 times within a 30-day period; or Any member referred by the treatment team The Comprehensive Behavior Analysis Assessment shall: Describe the target behaviors; Identify the events, times and situations when the target behaviors occur and do not occur; Describe the antecedents and consequences controlling the target behaviors; Describe the assessment methods used; Describe the direct observation of the member; Display the data collected in graphic form; and Summarize the findings of the assessment and individualized recommendations The behavior analyst will develop a behavior plan in consultation with the treatment team The behavior analyst will train and monitor staff on the implementation of behavioral interventions and the collection of data Treatment should be active, individualized, family-centered, culturally sensitive, trauma-informed, and focused on problems that necessitated SIPP The treatment plan is reviewed every 30 days to determine if SIPP is required and to recommend changes in the plan as indicated by the member s overall adjustment. The treatment plan should be reviewed sooner when there has been a change in the member s condition, or the member s condition is not improving or it has worsened. When the member s condition has not improved or it has worsened, the reassessment should determine whether the diagnosis is accurate, the treatment plan should be modified, or the member s condition should be treated in another level of care Discharge Planning The provider begins discharge planning at the time of admission. Modifications to the discharge plan continue throughout treatment ensuring that: 7
8 An appropriate discharge plan is in place prior to discharge; The discharge plan is designed to mitigate the risk that the why now factors which precipitated admission will reoccur; and The member and the member s parent or guardian agree with the discharge plan The provider shall develop a detailed discharge plan that identifies treatment needs and provides access to resources There must be documentation of provider and community liaison activities carried out throughout the stay to promote a coordinated community transition and a well-developed aftercare plan Within 30 calendar days of the planned discharge, the primary therapist shall contact the following to coordinate discharge: The discharge setting; The member s school; The receiving treatment provider; The Regional Substance Abuse and Mental Health office; Other agencies, programs, or community services from which the member will receive assistance Within 1 week prior to discharge the provider will ensure that community supports and aftercare treatment services are in place. References 1. Armstrong, M., Blasé, K., Dailey, K., Larkins, M., Chen. R., & Reyes, F. (2003). Statewide Inpatient Psychiatric Program: Report 4 - June Tampa FL: University of South Florida, Louis de la Parte Florida Mental Health Institute. AHCA series, State of Florida, Administrative Code. (2008). 65E-9.008, Mental Health Program, Licensure of Residential Treatment Centers, Admission. Retrieved from 3. State of Florida, Administrative Code. (2008). 65E-9.009, Mental Health Program, Licensure of Residential Treatment Centers, Treatment Planning. Retrieved from 4. State of Florida, Administrative Code. (2008). 65E-9.010, Mental Health Program, Licensure of Residential Treatment Centers, Length of Stay. Retrieved from 8
9 5. State of Florida, Administrative Code. (2008). 65E-9.011, Mental Health Program, Licensure of Residential Treatment Centers, Discharge and Discharge Planning. Retrieved from State of Florida, Agency for Health Care Administration. (2014). Florida Medicaid: Statewide Inpatient Psychiatric Program Coverage and Limitations Handbook. Retrieved from i Per F.S an emotional disturbance is present when a child is diagnosed with a mental, emotional, or behavioral disorder of sufficient duration to meet one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, but who does not exhibit behaviors that substantially interfere with or limit his or her role or ability to function in the family, school, or community. The emotional disturbance must not be considered to be a temporary response to a stressful situation. The term does not include a child or adolescent who meets the criteria for involuntary placement. ii Per F.S a serious emotional disturbance is present when a child diagnosed as having a mental, emotional, or behavioral disorder that meets one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association; and exhibits behaviors that substantially interfere with or limit his or her role or ability to function in the family, school, or community, which behaviors are not considered to be a temporary response to a stressful situation. iii Rule 59G (166), Florida Administrative Code defines medically necessary or medical necessity as follows: The medical or allied care, gods, or services furnished or ordered must meet the following conditions: 1) be necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain 2) be individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient s needs 3) be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational 4) reflect the level of services that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide 5) be furnished in a manner, not primarily intended for the convenience of the recipient, the recipient s caretaker, or the provider. The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services, does not, in itself, make such care, goods or services medically necessary or a covered service. iv Per 42 CFR Part 441inpatient psychiatric services must involve active treatment, which means implementation of a professionally developed and supervised individual plan of care, that is developed and implemented no later than 14 days after admission; and is designed to achieve the beneficiary's discharge from inpatient status at the earliest possible time. 9
Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines (TBOS) Therapeutic behavioral on-site services are intended to prevent members under the
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Therapeutic group care services are community-based, psychiatric residential treatment
More informationOptum By United Behavioral Health. 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines is a behavioral intervention program, provided in the context of a therapeutic milieu,
More informationOptum By United Behavioral Health. 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines Assertive Community Treatment is a multi-disciplinary, selfcontained clinical team
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines (PSR) services combine daily medication use, independent living and social skills training,
More informationOptum By United Behavioral Health. 2015 New Jersey Managed Long-Term Services and Support (MLTSS) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 New Jersey Managed Long-Term Services and Support (MLTSS) Medicaid Level of Care Guidelines (AMHR) AMHR provides services in/by a licensed community residence. Services
More informationSubacute Inpatient MH - Adult
Subacute Inpatient MH - Adult Definition Subacute Inpatient hospital psychiatric services are medically necessary short-term psychiatric services provided to a client with a primary psychiatric diagnosis
More informationHow To Know If You Can Get Help For An Addiction
2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA Overview Psychcare strives to provide quality care in the least restrictive environment. An
More informationPlease see Section IX. for Additional Information:
The Florida Senate BILL ANALYSIS AND FISCAL IMPACT STATEMENT (This document is based on the provisions contained in the legislation as of the latest date listed below.) BILL: CS/SB 998 Prepared By: The
More informationMEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT
Summary of Changes MEDICAL POLICY MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD ADOLESCENT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 14, 2014 Status: Current Clarifications:
More informationPsychiatric Residential Treatment Facility (PRTF): Aligning Care Efficiencies with Effective Treatment. BHM Healthcare Solutions 2013 1
Psychiatric Residential Treatment Facility (PRTF): Aligning Care Efficiencies with Effective Treatment 1 Presentation Objectives Attendees will have a thorough understanding of Psychiatric Residential
More informationMEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT
MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated
More informationother caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization.
4.b.(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services (continued) Attachment 3.1-A.1 Page 7c.2 (a) Psychotherapy Services: For the complete description of the service providers,
More informationMedical Necessity Criteria
Medical Necessity Criteria 2015 Updated 03/04/2015 Appendix B Medical Necessity Criteria Purpose: In order to promote consistent utilization management decisions, all utilization and care management staff
More informationIntensive Outpatient Psychotherapy - Adult
Intensive Outpatient Psychotherapy - Adult Definition Intensive Outpatient Psychotherapy services provide group based, non-residential, intensive, structured interventions consisting primarily of counseling
More informationSTATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION REQUEST FOR INFORMATION 09/10-RFI-003
STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION REQUEST FOR INFORMATION 09/10-RFI-003 Statewide Inpatient Psychiatric Program for Individuals Under the Age of Eighteen PURPOSE The State of Florida,
More informationFlorida Medicaid COMMUNITY BEHAVIORAL HEALTH SERVICES COVERAGE AND LIMITATIONS HANDBOOK
Florida Medicaid COMMUNITY BEHAVIORAL HEALTH SERVICES COVERAGE AND LIMITATIONS HANDBOOK Agency for Health Care Administration March 2014 How to Use the Update Log COMMUNITY BEHAVIORAL HEALTH SERVICES COVERAGE
More information907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies.
907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B.459 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1),
More informationPartial Hospitalization - MH - Adult (Managed Medicaid only Service)
Partial Hospitalization - MH - Adult (Managed Medicaid only Service) Definition Partial hospitalization is a nonresidential treatment program that is hospital-based. The program provides diagnostic and
More informationAppendix B NMMCP Covered Services and Exceptions
Acute Inpatient Hospitalization MH - Adult Definition An Acute Inpatient program is designed to provide medically necessary, intensive assessment, psychiatric treatment and support to individuals with
More informationDEPARTMENT OF SERVICES FOR CHILDREN, YOUTH AND THEIR FAMILIES DIVISION OF CHILD MENTAL HEALTH SERVICES PROGRAM DESCRIPTIONS
DEPARTMENT OF SERVICES FOR CHILDREN, YOUTH AND THEIR FAMILIES DIVISION OF CHILD MENTAL HEALTH SERVICES PROGRAM DESCRIPTIONS OVERVIEW The Division of Child Mental Health Services provides both mental health
More informationMental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005
Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 By April 1, 2006, the Department, in conjunction with the Department of Corrections, shall report the following
More informationRESIDENTIAL TREATMENT CENTER (RTC)
RESIDENTIAL TREATMENT CENTER (RTC) Service Description Residential Treatment Center (RTC) IOS provides 24-hour staff supervised all-inclusive clinical services in a community-based therapeutic setting
More informationFlorida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the
More informationPsychiatric Rehabilitation Clinical Coverage Policy No: 8D-1 Treatment Facilities Revised Date: August 1, 2012. Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 2.0 Eligible Recipients... 1 2.1 Provisions... 1 2.2 EPSDT Special Provision: Exception to Policy Limitations for Recipients
More informationMEDICAL ASSOCIATES HEALTH PLANS HEALTH CARE SERVICES POLICY AND PROCEDURE MANUAL POLICY NUMBER: PP 27
POLICY TITLE: RESIDENTIAL TREATMENT CRITERIA POLICY STATEMENT: Provide consistent criteria when determining coverage for Residential Mental Health and Substance Abuse Treatment. NOTE: This policy applies
More informationDepartment of Mental Health and Addiction Services 17a-453a-1 2
17a-453a-1 2 DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES General Assistance Behavioral Health Program The Regulations of Connecticut State Agencies are amended by adding sections 17a-453a-1 to 17a-453a-19,
More informationPerformance Standards
Performance Standards Outpatient Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice performances,
More informationOUTPATIENT DAY SERVICES
OUTPATIENT DAY SERVICES Intensive Outpatient Programs (IOP) Intensive Outpatient Programs (IOP) provide time limited, multidisciplinary, multimodal structured treatment in an outpatient setting. Such programs
More informationOptum By United Behavioral Health. 2015 KanCare Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 KanCare Medicaid Level of Care Guidelines (PRTF) A sub-acute facility-based program which delivers 24-hour/7-day assessment and diagnostic services, and active behavioral
More informationProfessional Treatment Services in Facility-Based Crisis Program Children and Adolescents
Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Medicaid and North Carolina Health Choice (NCHC) Billable Service WORKING DRAFT Revision Date: September 11, 2014
More informationClinical Criteria 4.201 Inpatient Medical Withdrawal Management 4.201 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 informationLEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE)
LEVEL III.5 SA: SHT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders
More information4.401 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 informationDay Treatment Mental Health Adult
Day Treatment Mental Health Adult Definition Day Treatment provides a community based, coordinated set of individualized treatment services to individuals with psychiatric disorders who are not able to
More informationTreatment Facilities Amended Date: October 1, 2015. Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 1 2.2 Special
More informationFlorida Medicaid. Mental Health Targeted Case Management Handbook. Agency for Health Care Administration
Florida Medicaid Mental Health Targeted Case Management Handbook Agency for Health Care Administration JEB BUSH, GOVERNOR ALAN LEVINE, SECRETARY June 7, 2006 Dear Medicaid Provider: Enclosed please find
More information[Provider or Facility Name]
[Provider or Facility Name] SECTION: [Facility Name] Residential Treatment Facility (RTF) SUBJECT: Psychiatric Security Review Board (PSRB) In compliance with OAR 309-032-0450 Purpose and Statutory Authority
More informationTitle 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 21 MENTAL HYGIENE REGULATIONS Chapter 26 Community Mental Health Programs Residential Crisis Services Authority: Health-General Article, 10-901
More informationLEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult
LEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders of the American
More informationAddressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses
Addressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses Contract Number 732HC08B Prepared by Human Systems and Outcomes, Inc. Edited by Celeste
More informationDurham SOC Care Review LEVELS OF RESIDENTIAL CARE
The following is a description of the levels of residential care available to the children of North Carolina. These services can be provided in a variety of locations from urban to rural, from facility
More informationTN No: 09-024 Supersedes Approval Date:01-27-10 Effective Date: 10/01/09 TN No: 08-011
Page 15a.2 (iii) Community Support - (adults) (CS) North Carolina is revising the State Plan to facilitate phase out of the Community Support - Adults service, which will end effective July 1, 2010. Beginning
More informationResidential Treatment Services for Children in the Dependency System Under Managed Care
Residential Treatment Services for Children in the Dependency System Under Managed Care Residential Mental Health Treatment in Florida (Ch. 39 & 394 F.S.) March 10, 2015 1 Presenter: Heather Allman, LCSW
More informationINPATIENT SERVICES. Inpatient Mental Health Services (Adult/Child/Adolescent)
INPATIENT SERVICES Inpatient Mental Health Services (Adult/Child/Adolescent) Acute Inpatient Mental Health Services represent the most intensive level of psychiatric care and is delivered in a licensed
More informationTargeted Case Management Services
Targeted Case Management Services 2013 Acronyms and Abbreviations AHCA Agency for Health Care Administration MMA Magellan Medicaid Administration CBC Community Based Care CBH Community Behavioral Health
More informationEvidence Based Approaches to Addiction and Mental Illness Treatment for Adults
Evidence Based Practice Continuum Guidelines The Division of Behavioral Health strongly encourages behavioral health providers in Alaska to implement evidence based practices and effective program models.
More informationKeeping Families Together. A guide for families to understand intensive treatment options for children with mental illnesses
Keeping Families Together A guide for families to understand intensive treatment options for children with mental illnesses CONTENTS Introduction... 1 Children with Mental Illnesses... 3 Emotional Disturbance
More informationTRANSITIONAL RESIDENTIAL TREATMENT PROGRAM Session Law 2007-323 House Bill 1473, Section 10.49(i)
REPORT TO THE THE JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES TRANSITIONAL RESIDENTIAL TREATMENT PROGRAM Session Law 2007-323 House Bill
More informationADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015
The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least
More informationPERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM. Final Updated 04/17/03
PERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM Final Updated 04/17/03 Community Care is committed to developing performance standards for specific levels of care in an effort to
More informationMagellan Health Services Request for Proposal Psychiatric Residential Treatment Facility
Magellan Health Services Request for Proposal Psychiatric Residential Treatment Facility Magellan Health Services is seeking a provider interested in developing and operating a Psychiatric Residential
More informationDiagnostic, Screening, Treatment, Preventive and Rehabilitative Services
Page 7c.1 4.b(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services Services provided under this section are provided by licensed practitioners (within their scope of practice as
More informationCoordinating Access to Residential Behavioral Health Services for Children
Coordinating Access to Residential Behavioral Health Services for Children Shevaun Harris Chief, Bureau Medicaid Policy Agency for Health Care Administration May 22, 2015 Objectives Provide an overview
More informationInpatient Behavioral Health and Inpatient Substance Abuse Treatment: Aligning Care Efficiencies with Effective Treatment
Inpatient Behavioral Health and Inpatient Substance Abuse Treatment: Aligning Care Efficiencies with Effective Treatment BHM Healthcare Solutions 2013 1 Presentation Objectives Attendees will have a thorough
More informationPSYCHIATRIC UNIT CRITERIA WORK SHEET
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PSYCHIATRIC UNIT CRITERIA WORK SHEET RELATED MEDICARE PROVIDER NUMBER ROOM NUMBERS IN THE UNIT FACILITY NAME AND ADDRESS
More informationMental Health Emergency Service Interventions for Children, Youth and Families
State of Rhode Island Department of Children, Youth and Families Mental Health Emergency Service Interventions for Children, Youth and Families Regulations for Certification May 16, 2012 I. GENERAL PROVISIONS
More informationState of Illinois. Department of Human Services/Division of Mental Health. Medical Necessity Criteria and Guidance Manual
Introduction Consistent with Rule 132, DHS/DMH is providing enhanced Medical Necessity Guidance for the following Rule 132 services: Assertive Community Treatment (ACT) adult only Community Support Team
More informationPsychiatric Day Rehabilitation MH - Adult
Psychiatric Day Rehabilitation MH - Adult Definition Day Rehabilitation services are designed to provide individualized treatment and recovery, inclusive of psychiatric rehabilitation and support for clients
More informationPerformance Standards
Performance Standards Co-Occurring Disorder Competency Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best
More informationPublished Date: January 1, 2016 Table of Contents
NC Division of Mental Health, Facility-Based Developmental Disabilities & Crisis Service for Children Substance Abuse Services and Adolescents Published Date: January 1, 2016 Table of Contents Description
More informationTREATMENT PLANNING As outlined in the CBH Credentialing Manual
TREATMENT PLANNING As outlined in the CBH Credentialing Manual All providers must develop a policy and procedure on the development and construction of treatment plans to include the following requirements:
More informationAutism Spectrum Disorder: ABA Services Delivery Model for Medicaid & PEBB Gail Kreiger, BSN Manager, Healthcare Benefits and Utilization Management
Autism Spectrum Disorder: ABA Services Delivery Model for Medicaid & PEBB Gail Kreiger, BSN Manager, Healthcare Benefits and Utilization Management Health Care Services May 2, 2013 What: A benefit for
More informationOther diagnostic, screening, preventive, and rehabilitative services, i.e., other. than those provided elsewhere in the plan.
State Ut Ohio Attachment 3.1 -A Item 13 -d 1- Page 1 of 28 13. Other diagnostic, screening, preventive, and rehabilitative services, i.e., other 1. Rehabilitative services provided by community mental
More informationSupplemental Manual for Substance Abuse Treatment Services(SATS) RULES OF PRACTICE AND PROCEDURE
ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF BEHAVIORAL HEALTH SERVICES OFFICE OF ALCOHOL AND DRUG ABUSE PREVENTION Supplemental Manual for Substance Abuse Treatment Services(SATS) RULES OF PRACTICE
More informationProcedure/ Revenue Code. Billing NPI Required. Rendering NPI Required. Service/Revenue Code Description. Yes No No
Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI 0100 Inpatient Services Yes No Yes 0114 Room & Board - private psychiatric Yes No Yes 0124 Room
More informationPsychiatric Rehabilitation Services
DEFINITION Psychiatric or Psychosocial Rehabilitation Services provide skill building, peer support, and other supports and services to help adults with serious and persistent mental illness reduce symptoms,
More informationCIGNA MEDICAL NECESSITY CRITERIA
CIGNA MEDICAL NECESSITY CRITERIA for Treatment of Behavioral Health and Substance Use Disorders 839233 a 11/12 Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance
More informationTHE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES
THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the
More informationIntensive Customized Care Coordination Transaction
Transaction Code Detail Code Mod 1 Mod 2 Mod 3 Mod 4 Rate Code Communitybased wraparound Community-based wrap-around services H2022 HK services, monthly Unit Value 1 month Maximum Daily Units Initial 12
More informationAppendix D. Behavioral Health Partnership. Adolescent/Adult Substance Abuse Guidelines
Appendix D Behavioral Health Partnership Adolescent/Adult Substance Abuse Guidelines Handbook for Providers 92 ASAM CRITERIA The CT BHP utilizes the ASAM PPC-2R criteria for rendering decisions regarding
More informationAssertive Community Treatment (ACT)
Assertive Community Treatment (ACT) Definition The Assertive Community Treatment (ACT) Team provides high intensity services, and is available to provide treatment, rehabilitation, and support activities
More informationAmerican Society of Addiction Medicine
American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,
More informationJanuary 2003 Report No. 03-03
January 2003 Report No. 03-03 Residential Mental Health Assessment Process Working Well with Minor Delays Purpose at a glance Prior to 2000, procedures for placing a child in residential mental health
More informationTexas Resilience and Recovery
Texas Resilience and Recovery Utilization Management Guidelines Child & Adolescent Services Texas Resilience and Recovery Utilization Management Guidelines: Child and Adolescent Services Effective September
More informationFlorida Medicaid. Provider Handbook Universal Health Care Comprehensive Behavioral Care, Inc.
Florida Medicaid Provider Handbook Universal Health Care Comprehensive Behavioral Care, Inc. January 2010 Introduction: Comprehensive Behavioral Care (CompCare ) welcomes you as a provider in our network
More informationLEVEL II.1 SA: INTENSIVE OUTPATIENT - Adult
LEVEL II.1 SA: INTENSIVE OUTPATIENT - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance- Related Disorders of the American Society
More informationAgency for Health Care Administration
Page 1 of 45 FED - N0000 - Initial Comments Title Initial Comments CFR Type Memo Tag FED - N0100 - USE OF RESTRAINT AND SECLUSION Title USE OF RESTRAINT AND SECLUSION CFR 483.354 Type Condition Subpart
More informationTREATMENT MODALITIES. May, 2013
TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.
More informationPolicy and Procedure Manual
Policy and Procedure Manual Resident Assessment (RA) Table of Contents RA-01 RA-02 RA-03 RA-04 RA-05 RA-06 RA-07 RA-08 RA-09 RA-10 RA-11 RA-12 Physical Health Services Dental Services Initial Nursing Summary
More informationFLORIDA MEDICAID PROVIDER HANDBOOK. Freedom Health Care Comprehensive Behavioral Care, Inc.
FLORIDA MEDICAID PROVIDER HANDBOOK Freedom Health Care Comprehensive Behavioral Care, Inc. January 2010 Introduction: Comprehensive Behavioral Care (CompCare ) welcomes you as a provider in our network
More informationWORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL
WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL General Guidelines for Treatment of Compensable Injuries Patient must have a diagnosed mental illness as defined by DSM-5
More informationKANSAS MEDICAL ASSISTANCE PROGRAM. Provider Manual. Psychiatric Residential Treatment Facility
Provider Manual Psychiatric Residential Treatment Facility Updated 11/2011 PART II Introduction Section 7000 7010 7020 8100 8300 8400 BILLING INSTRUCTIONS Introduction to the CMS-1500 Claim Form......
More informationPerformance Standards
Performance Standards Psychiatric Rehabilitation Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice
More information1. The youth is between the ages of 12 and 17.
Clinical MULTISYSTEMIC THERAPY (MST) Definition Multisystemic therapy (MST) is an intensive family and community-based treatment that addresses multiple aspects of serious antisocial behavior in adolescents.
More informationUsing Home-Based Programs in Other States to Support a Medicaid Claim to Intensive Home-Based Services Under EPSDT
Using Home-Based Programs in Other States to Support a Medicaid Claim to Intensive Home-Based Services Under EPSDT December 2005 QA Center for Public Representation I. Introduction Because EPSDT requires
More informationMEDICAID SERVICES MANUAL TRANSMITTAL LETTER CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY
MEDICAID SERVICES MANUAL TRANSMITTAL LETTER October 19, 2015 TO: FROM: SUBJECT: CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL CHANGES CHAPTER
More informationOUTPATIENT SERVICES. Components of Service
OUTPATIENT SERVICES Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance specifications. Additionally, providers contracted
More informationTreatment Services for Individuals with Co-Occurring Mental Health and Intellectual Disability/Developmental Disabilities
Two types of individuals 1. People with primary diagnosis of intellectual disability/developmental disability Mental health diagnosis is secondary Primary services through ID/DD system Residential/Housing
More informationPOLICY #1571.00 SUBJECT: INPATIENT CERTIFICATION AND AUTHORIZATION
Effective Date: 9/13/2007; 7/13/2005 Revised Date: 11/7/07 Review Date: North Sound Mental Health Administration Section 1500 Clinical: Inpatient Certification and Authorization Authorizing Source: WAC
More informationCHAPTER 5 SERVICE DESCRIPTIONS. Inpatient Hospital Psychiatric Services. Service Coverage
CHAPTER 5 SERVICE DESCRIPTIONS Inpatient Hospital Psychiatric Services Service Coverage Inpatient psychiatric care involves skilled psychiatric services in a hospital setting. The care delivered includes
More informationProgram of Assertive Community Services (PACT)
Program of Assertive Community Services (PACT) Service/Program Definition Program of Assertive Community Services (PACT) entails the provision of an array of services delivered by a community-based, mobile,
More information- 11-72) 120.745, 65-6: STATE RESIDENTIAL TREATMENT FACILITIES - FEE COLLECTION SYSTEM
State of Florida - Governor Rick Scott The Office of Fiscal Accountability and Regulatory Reform (OFARR) Results of the Comprehensive Rule Review (Executive Order 11-72) as supplemented by the Enhanced
More informationItem 4b: Early and Periodic Screening, Diagnostic and Treatment services for individuals under 21 years of age, and treatment of conditions found.
Page 1a Item 2.a: Outpatient Hospital Services See Supplement to Attachment 3.1-A, page 1, Item 1, #1 and #4. Item 4.a: Nursing Facilities Services If a utilization review team recommends that a recipient
More informationSTRUCTURED OUTPATIENT ADDICTION PROGRAM (SOAP)
STRUCTURED OUTPATIENT ADDICTION PROGRAM (SOAP) Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance specifications.
More informationBehavioral Health: Psychiatric Residential Treatment
UTILIZATION MANAGEMENT GUIDELINE COVERAGE GUIDELINE CODING RELATED POLICIES SCOPE ADDITIONAL INFORMATION HISTORY Behavioral Health: Psychiatric Residential Treatment Number 3.01.508 Effective Date February
More informationInpatient Mental Health Services and Psychiatric Care
INPATIENT MENTAL HEALTH SERVICES Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance specifications. Additionally,
More informationConnecticut Data as of July 2003
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Connecticut As of July 2003, 378,961 people were covered under Connecticut Medicaid/SCHIP programs. There were 364,692 enrolled in the
More informationCHAPTER 37H. YOUTH CASE MANAGEMENT SERVICES SUBCHAPTER 1. GENERAL PROVISIONS Expires December 2, 2013
CHAPTER 37H. YOUTH CASE MANAGEMENT SERVICES SUBCHAPTER 1. GENERAL PROVISIONS Expires December 2, 2013 10:37H-1.1 Purpose and scope The rules in this chapter govern the provision of case management services
More information