Placement Criteria Guide for BHRFs, ABHTHs, and TFCs

1.  Does the member need placement for any of the following reasons?

·         An alternative to detention or incarceration

·         Ensure community safety in circumstances where a member is exhibiting primarily conduct disorder behaviors

·         Provide safe housing, shelter, supervision, or permanency placement

·         A behavioral health intervention when other less restrictive alternatives are available and meet the member’s treatment needs, including situations when the member/Health Care Decision Maker is unwilling to participate in the less restrictive alternative.

STOP

***MEMBER DOES NOT MEET CRITERIA FOR ADULT BEHAVIORAL HEALTH THERAPEUTIC HOME PLACEMENT***

zADMISSION REQUIREMENTS

A RECOMMENDATION FOR ADULT BEHAVIORAL HEALTH THERAPEUTIC HOME PLACEMENT MUST BE INITIATED BY THE ART

2.  Does the member exhibit any of the following?

·         A documented diagnosed Behavioral Health Condition, in an assessment done by a licensed BHP, which reflects the symptoms and behaviors necessary for a request for ABHTH.

·         As a result of the behavioral health condition, there is evidence that the member has recently (within the past 90 days) had a disturbance of mood, thought, or behavior which renders the member incapable of independent or age-appropriate self-care or self-regulation. This moderate functional and/or psychosocial impairment per Assessment by a BHP:

                              I.            Cannot be reasonably expected to improve in response to a less intensive level of care, and

                            II.            Does not require or meet clinical criteria for a higher level of care, or

                          III.            Demonstrates that appropriate treatment in a less restrictive environment has not been successful or is not available, therefore warranting a    higher level of care.

·         At time of admission to an ABHTH, in participation with the Health Care Decision Maker and all relevant stakeholders, there is a documented plan for discharge which includes:

                              I.            Tentative disposition/living arrangement identified, and

                            II.            Recommendations for aftercare treatment based upon treatment goals.

DOCUMENTATION SUBMITTED MUST ADDRESS THE ABOVE ISSUES, failure to send complete documentation will result in return of the request.

AzCH utilizes INTERQUAL criteria guidelines in conjunction with the above medical necessity guidance from AHCCCS, AMPM 320 X.

AzCH utilizes INTERQUAL and ASAM criteria guidelines to determine medical necessity in conjunction with guidance from AHCCCS, AMPM 320 X

All of the following shall be met:

1.       The member continues to meet diagnostic threshold for the behavioral health condition that warranted admission to ABHTH,

2.       The member continues to demonstrate (within the last 90 days) moderate functional or psychosocial impairment as a result of the behavioral health condition, as identified through disturbances of mood, thought, or behavior, which substantially impairs independent or appropriate self-care or self-regulation,

3.       Active treatment is reducing the severity of disturbances of mood, thought, or behaviors, which were identified as reasons for admission to ABHTH, and treatment at the ABHTH is empowering the member to gain skills to successfully function in the community,

4.       There is an expectation that continued treatment at the ABHTH shall improve the member’s condition so that this type of service shall no longer be needed, and

5.       The ART is meeting at least monthly to review progress, and have revised the Treatment Plan and/or Service Plan to respond to any lack of progress.

AzCH utilizes INTERQUAL and ASAM criteria guidelines to determine discharge readiness in conjunction with guidance from AHCCCS, AMPM 320 X

·         Discharge planning shall begin at the time of admission.

·         Discharge readiness shall be assessed by the ABHTH staff and the ART during each Treatment Plan review and update.

The following criteria shall be considered when determining discharge readiness:

1.       Sufficient symptom or behavior relief is achieved as evidenced by completion of the ABHTH treatment goals.

2.       The member’s functional capacity is improved and the member can be safely cared for in a less restrictive level of care.

3.       The member can participate in needed monitoring and follow-up services or a Provider is available to provide monitoring in a less restrictive level of care.

4.       Appropriate services, Providers, and supports are available to meet the member’s current behavioral health needs at a less restrictive level of care.

5.       There is no evidence to indicate that continued treatment in an ABHTH would improve member’s clinical outcome.

6.       There is potential risk that continued stay in an ABHTH may precipitate regression or decompensation of member’s condition.