PART I - Department of Behavioral Health and Developmental ...

Consumer/Family AssistanceTransactionCodeCode Detail Code Mod1Mod2Mod3Mod4Rate Code Detail Code Mod1Mental HealthVariable inServices, NotaccordanceH0046Otherwisewith ItemsSpecifiedC.6. belowUnit Value Variable in accordance with Items C.6. below Maximum Daily UnitsWhile the actual assistance should be very short-term in nature, this service can beInitialauthorized as part of a 180 day Recovery plan.AuthorizationRe-AuthorizationAuthorizationPeriodServiceDefinitionAdmissionCriteriaContinuingStay CriteriaDischargeCriteriaFinancial max $2000/$5000 (see Clinical Operations section below)Mod2Mod3One within a single fiscal year.180 days Utilization Criteria LOCUS scores: 2-6Individuals may need a range of goods and community support services to fully benefit from mental health and addictive disease services. This time-limited serviceconsists of goods and services purchased/procured on behalf of the consumer (e.g. purchase of a time-limited mentor, a utility deposit to help an individual move into thecommunity and/or their own housing, environmental modification to the individual’s home to enhance safety and ability to continue living independently etc) that will helppromote individual functional enhancement to the benefit of the individual and his/her behavioral health stability. The goods/services procured must provide a direct andcritical benefit to the individualized needs of the consumer, in accordance with the IRP, and lead to an enhancement of specific positive behaviors/skills/resources that willallow the individual to leave an institution and/or achieve a more independent living status, or prevent an imminent crisis or out-of home placement (e.g. eviction,homelessness, loss of independent living, loss of ability or resources needed to maintain the individual’s living in the home, etc). This service is intended to be of shortduration and is not intended to pay for/provide ongoing service programming through the provider agency.1. Individual must meet Core Customer criteria for Ongoing services, and2. Individual must be in need of a specific good or service that will directly improve functioning (e.g. directly lead to an enhancement of specific positivebehaviors/skills/resources that will allow the individual to leave an institution and/or achieve a more independent living status), or prevent a crisis or out-of homeplacement (e.g. eviction, homelessness, loss of independent living, loss of ability or resources needed to maintain the individual’s living in the home, etc.), and3. Individual or provider must exhaust all other possible resources for obtaining the needed goods/services—this service provides payment of last resort, and4. Individual has not received this service for more than one other episode of need during the current fiscal year.1. Individual must continue to meet Core Customer criteria for Ongoing services, and2. Individual must continue to be in need of the same specific good or service as when enrolled in Consumer/Family Assistance, that will directly improve functioning(e.g. directly lead to an increase in specific positive behaviors/skills/resources that will allow the individual to leave an institution and/or obtain more independentliving), or prevent a crisis or out-of home placement (e.g. eviction, homelessness, loss of independent living, loss of ability or resources needed to maintain theindividual’s living in the home, etc.), and3. Individual or provider must continue to lack any other possible resources for obtaining the needed goods/services.1. Individual no longer meets Core Customer criteria for Ongoing services, or2. Individual no longer continues to be in need of the good or service, or3. Individual has received the good in the allotted amount or service for the allotted timeframe as described below in “Additional Service Criteria” # 3, or4. The individual requests discontinuance of the service.Mod4RateFY2013 Provider Manual for Community Behavioral Health Providers Page 105