VBH-PA: For Providers: Medical Necessity Criteria

Medical Necessity Criteria

1. 000	INTRODUCTION
SECTION	TITLE	DATE REVISED
1.100	Individuals Served by VBH-PA’s Public Sector Programs
1.200	Clinical Criteria Manual Development
2. 000	CLINICAL CRITERIA
2.000	Clinical Criteria Concepts
2.100	Assessment and Referral Risk-Rating Scale
2.200	Determining Clinical Necessity
2.300	Determining Appropriate Level of Care
2.400	Evaluating Clinical Necessity for Continued Care
2.500	Discharge Criteria
3. 000	SERVICE MANAGEMENT
3.100	Overview
3.200	Outcomes
3.300	Individualized Service Plans
3.400	Coordination of Care
3.500	Discharge and Transition Plans
4.000	IN-PLAN ADULT MENTAL HEALTH SERVICES
4.100	Emergency/Crisis Services
4.101	Telephone Crisis Service
4.102	Walk-in Crisis Service
4.103	Mobile Crisis Service
4.200	Inpatient Programs
4.201	Acute Inpatient Mental Health
4.202	Subacute Inpatient Mental Health
4.300	Outpatient Treatment
4.300	Outpatient Psychotherapy Criteria
4.301	Outpatient therapy
4.302	Psychological Testing
4.303	Family Therapy
4.304	Partial Hospitalization
4.306	Medication Management
4.307	Group Psychotherapy
4.308	Diagnostic Evaluation
4.309	Intensive Outpatient Programs (IOP) Adults
4.400	Case Management
4.401- 4.402	Intensive Case Management for Adults/Resource Coordination for Adults
4.500	Clozapine Support Services
4.501	Clozapine (Clozaril Management)
4.600	Electroconvulsive Therapy (ECT)
4.601	Electroconvulsive Therapy (ECT)
Pennsylvania’s Client Placement Criteria for Adults (PCPC)
5.000	Level I (PCPC)
5.100	Pennsylvania’s Client Placement Criteria for Adults (PCPC) Entire Document
5.101	Outpatient (1A)
5.102	Intensive Outpatient (1B)
5.200	Level II (PCPC)
5.201	Partial Hospitalization (2A) (Supplemental Service)
5.202	Halfway House (2B)
5.300	Level III (PCPC)
5.301	Medically Monitored Inpatient Detoxification (3A)
5.302	Medically Monitored Short-Term Residential (3B)
5.303	Medically Monitored Long-Term Residential (3C)
5.400	Level IV (PCPC)
5.401	Medically Managed Inpatient Detoxification (4A)
5.402	Medically Managed Inpatient Residential (4B)
5.405	Pennsylvania’s Client Placement Criteria for Adults (PCPC) Appendix A Special Needs
5.500	Methadone Maintenance Services
5.501- 5.502	Standard Level, Intense Level
5.700	Comprehensive Psychiatric Evaluation
6.000	IN PLAN CHILD/ADOLESCENT MENTAL HEALTH SERVICES
6.100	Emergency / Crisis Services
6.101	Telephone Crisis Service
6.102	Walk In Crisis Service
6.103	Mobile Crisis Service
6.200	Inpatient Programs
6.201	Acute Inpatient Mental Health
6.202	Subacute Inpatient Mental Health
6.300	Non-Hospital, Out-of-Home Placement
6.301	Residential Treatment (JCAHO and non-JCAHO)
6.302	Community Residential Rehabilitation Host Home
6.400	Outpatient Treatment
6.400	Outpatient Psychotherapy Criteria
6.401	Outpatient Therapy
6.402	Partial Hospitalization
6.403	Psychological Testing
6.404	Group Psychotherapy
6.405	Family Therapy
6.406	Medication Management
6.407	Diagnostic Evaluation
6.408	Intensive Outpatient Program (IOP) Child / Adolescent)
6.500	Case Management Services
6.502- 6.503	Resource Coordination & Intensive Case Management (Children / Adolescent)
6.600	Family Based Mental Health Services
6.601	Family Based Mental Health Services
7. 000	IN PLAN ADOLESCENT DRUG AND ALCOHOL SERVICES
7.001	Adolescent ASAM Criteria 2001 Cliff notes
7.002	Adolescent ASAM Criteria 2001 Cliff Notes (III & IV)
7.003	Adolescent ASAM Criteria Overview
7.100	Level 0.5 (ASAM PPC-2) Early Intervention
7.200	Level I (ASAM PPC-2) Outpatient Services
7.300	Level II (ASAM PPC-2) Intensive Outpatient/Partial Hospitalization Services (Supplemental Service)
7.400	Level III (ASAM PPC-2) Medically-Monitored Intensive Inpatient Services
7.500	Level IV Medically-Managed Intensive Inpatient Services
7.600	Drug and Alcohol Assessment/Level of Care Determination
8.000	BEHAVIORAL HEALTH REHABILITATION (EPSDT) SERVICES
8.000	Children and Adolescents BHRS Services Appendix T Part B (2)
8.400	Summer Therapeutic Activities Program
9.000	SUPPLEMENTAL ADULT MENTAL HEALTH SERVICES
	Residential Programs
9.103	Crisis Residential Services
9.104	Long Term Structured Residential Treatment Centers
9.200	Outpatient Treatment
9.201	Psychiatric Rehabilitation Program	9-20-07
10.000	SUPPLEMENTAL ADULT DRUG AND ALCOHOL SERVICES
10.101	Drug and Alcohol Intensive Case Management (Formerly, Targeted Case Management) For Adults
10.102	Drug and Alcohol Assessment / Level of Care determination
10.105	Partial Hospitalization (2A) (PCPC)
11.000	SUPPLEMENTAL CHILD/ADOLESCENT MENTAL HEALTH SERVICES
11.600	Crisis Residential Service
12.000	SUPPLEMENTAL CHILD/ADOLESCENT DRUG AND ALCOHOL SERVICES
12.101	Drug and Alcohol Intensive Case Management (Formerly, Targeted Case Management) For Children/Adolescents
13.000	OTHER ADULT MENTAL HEALTH SERVICES
13.100	Emergency/Crisis Services
13.101	Medical Mobile Crisis Team Service
13.102	23-Hour Assessment and Crisis Stabilization
13.103	23-Hour Crisis Observation, Evaluation, Holding, and Stabilization (Adult)
13.104	Non-Hospital Observation and Supervision
13.200	Outpatient Treatment
13.201	Acute Partial Hospitalization
14.000	OTHER CHILD AND ADOLESCENT MENTAL HEALTH SERVICES
14.100	Emergency/Crisis Services
14.101	23-Hour Crisis Observation, Evaluation, Holding, and Stabilization (Child / Adolescent)
14.102	Non-Hospital Observation and Supervision
14.103	Acute Partial Hospitalization
14.104	Medical Mobile Crisis Team Service
14.105	Multisystemic Therapy (MST)
14.106	Functional Family Therapy (FFT) Service
15.000	APPENDIX T HEALTHCHOICES BEHAVIORAL HEALTH SERVICES
15.101	Guidelines for Mental Health Medical Necessity Criteria