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

Crisis Stabilization Unit (CSU) ServicesResidentialTreatmentProgramWithout Room& Board, PerDiem)BehavioralHealth; ShorttermResidential(Non-HospitalResidentialTreatmentProgramWithout Room& Board, PerDiem)H0018 HA TB U2 209.22Unit Value 1 day Maximum Daily Units 1 unitInitial20 unitsAuthorizationUtilization CriteriaAuthorization20 daysPeriodServiceDefinitionAdmissionCriteriaCAFAS scores: 140-240; OR “clinical information tojustify the service provided in the “justification text”on the MICP if CAFAS scores are higher/lower.This is a residential alternative to or diversion from inpatient hospitalization, offering psychiatric stabilization and detoxification services. The program provides medicallymonitored residential services for the purpose of providing psychiatric stabilization and substance detoxification services on a short-term basis. Specific services mayinclude:1) Psychiatric medical assessment;2) Crisis assessment, support and intervention;3) Medically Monitored Residential Substance Detoxification (at ASAM Level III.7-D).4) Medication administration, management and monitoring;5) Brief individual, group and/or family counseling; and6) Linkage to other services as needed.1. Treatment at a lower level of care has been attempted or given serious consideration; and #2 and/or #3 are met:2. Child/Youth has a known or suspected illness/disorder in keeping with target populations listed above; or3. Child/Youth is experiencing a severe situational crisis which has significantly compromised safety and/or functioning; and one or more of the following:a. Child/Youth presents a substantial risk of harm or risk to self, others, and/or property or is so unable to care for his or her own physical health and safety as tocreate a life-endangering crisis. Risk may range from mild to imminent; orb. Child/Youth has insufficient or severely limited resources or skills necessary to cope with the immediate crisis; orc. Child/youth demonstrates lack of judgment and/or impulse control and/or cognitive/perceptual abilities to manage the crisis; ord. For detoxification services, individual meets admission criteria for Medically Monitored Residential Detoxification.FY2013 Provider Manual for Community Behavioral Health Providers Page 41