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Skills Training and Development and Psychosocial Rehabilitation Criteria

Date: 10/11/24

Skills Training and Development and Psychosocial Rehabilitation Criteria

Arizona Complete Health-Complete Care Plan (AzCH-CCP) requires prior authorization for all providers for adult Skills Training and Development (H2014) and Psychosocial Rehabilitation services (H2017) when more than 8 units are needed in a day. This change is effective 10/15/2024 and was previously communicated to you on 9/13/24. Prior authorization requests for these services can be submitted via our secure provider portal (preferred) or fax.

AzCH-CCP Prior Authorization Forms are located on our website:> For Providers > Pre-Auth Check  

Initial Requests:

BH UM has outlined medical necessity criteria and documentation requirements for submitting an admission request for these services. Clinical packets are required and should include at minimum:

  1. BH Assessment identifying symptoms of condition and functional impairments contributing to need for services
  2. ART meeting notes, as applicable
  3. Service plan with H2014/H2017 goals
  4. Progress notes i.e. counseling, case management, etc.
  5. Any other clinical documentation that speaks to the criteria elements

Continued Treatment Requests:

Updated clinical packets are required for requests for continued services and should be submitted 3-5 days prior to a member’s last covered day. These updated clinical packets should include at minimum:

  1. Documentation that describes the functional impairment and BH symptoms that persist since the last review
  2. Recent progress notes i.e. counseling, case management, etc.
  3. Recent ART notes, as applicable
  4. Updated assessments, as applicable
  5. Updated service plan when goals change, as applicable
  6. Any other clinical documentation that speaks to the criteria elements

Medical Necessity Criteria for Skills Training and Development and Psychosocial Rehabilitation Procedure Codes H2014 and H2017

 

Admission Criteria

ALL of the following criteria must be met to demonstrate need for Admission:

  • Member has a valid behavioral health diagnosis.
  • Services provided under H2014 and/or H2017 are documented in the member’s signed service plan.
  • Member experiences specific daily functional impairment caused by a behavioral health disorder. Functional impairments are documented.

And must meet at least 1 of the following:

  • Without this service the member is at risk of experiencing a relapse, homelessness, eviction from housing, and/or other major disruption of lifestyle. Risk of disruption is documented.
  • Member experiences persistent inability to be employed and/or carry out homemaker roles.
  • Member experiences persistent or recurrent major symptoms that might require frequent contact from crisis teams, justice system, additional providers, or other services/supports.

 

Continued Stay Criteria

ALL of the following criteria must be met to demonstrate need for Continued Stay:

  • The member continues to meet admission guidelines and medical necessity for Skills Training and Development and/or Psychosocial Rehabilitation services.
  • The member does not require a more intensive level of service and no less intensive level of care is appropriate.
  • There is reasonable likelihood of substantial benefits as demonstrated by objective behavioral measurements of improvement in functional areas.
  • The member is making progress towards treatment/rehabilitation goals.
  • The member’s service plan continues to reflect current and active treatment goals for H2014 and/or H2017 services.

Discharge Criteria

At least 1 of the following criteria must be met for safe discharge:

  • The member has met their treatment plan goals and objectives.
  • The precipitating condition and relapse potential is stabilized such that individual’s condition can be managed without professional external supports and interventions.
  • Individual has alternative support systems secured to help the individual maintain stability in the community.

If you have questions on these criteria, please contact your Provider Engagement Specialist who will coordinate with the BH UM team in order to assist you. If you need your assigned Provider Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.