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

Community Transition Planning3. Jail/Prison4. Other (ex: Community Psychiatric Hospital)ContinuingStay CriteriaDischargeCriteriaServiceExclusionsClinicalExclusionsRequiredComponentsClinicalOperationsServiceAccessibilityReporting andBillingRequirementsDocumentationRequirementsSame as above.1. Individual/family requests discharge; or2. Individual no longer meets Core Customer Eligibility; or3. Individual is discharged from a state hospital or qualifying facility.This service is utilized only when an individual is transitioning from an institutional setting and therefore is not provided concurrent to an ongoing community-basedservice package.Individuals with the following conditions are excluded from admission unless there is clearly documented evidence of a co-occurring Behavioral Health condition:Developmental Disability, Autism, Organic Mental Disorder, Traumatic Brain InjuryPrior to Release from a State Hospital or Qualifying Facility: When the person has had (a) a length of stay of 60 days or longer in a facility or (b) youth is readmitted to afacility within 30 days of discharge, a community transition plan in partnership with the facility is required. Evidence of planning shall be recorded and a copy of the Planshall be included in both the adult’s hospital and community records.Community Transition Planning activities shall include:1. Telephone and Face-to-face contacts with consumer and their identified family;2. Participating in consumer’s clinical staffing(s) prior to their discharge from the facility;3. Applications for consumer resources and services prior to discharge from the facility including:a. Healthcareb. Entitlements (i.e., SSI, SSDI) for which they are eligiblec. Self-Help Groups and Peer Supportsd. Housinge. Employment, Education, Trainingf. Consumer Support Services1. This service must be available 7 days a week (if the state hospital/qualifying facility discharges or releases 7 days a week).2. This service may be delivered via telemedicine technology or via telephone conferencing.1. The modifier on Procedure Code indicates setting from which the consumer is transitioning.2. There must be a minimum of one face-to-face with the individual prior to release from hospital or qualifying facility in order to bill for any telephone contacts.1. A documented Community Transition Plan for:a. Individuals with a length of stay greater than 60 days; orb. Individuals readmitted within 30 days of discharge.2. Documentation of all face-to-face and telephone contacts and a description of progress with Community Transition Plan implementation and outcomes.FY2013 Provider Manual for Community Behavioral Health Providers Page 65