Local Planning and Network Development Service Package Definitions

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The following list of Service Package (SP) definitions and service descriptions come from the currently posted Utilization Management (UM) Guidelines. These guidelines are currently under revision to incorporate Crisis Redesign changes made to Service Packages 0 and 5 and will be posted to the website as soon as possible. The complete UM Guidelines may be found at http://www.dshs.state.tx.us/mhprograms/RDMClinGuide.shtm.

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Index

RDM Service Package Definitions And Service Descriptions For Adult Service Packages

Service Package 1 – Adult

Service Package Definition

Services in this package are generally intended for individuals with major depressive disorder (GAF ≤ 50), bipolar disorder, or schizophrenia and related disorders who present with very little risk of harm and who have supports and a level of functioning that does not require higher levels of care.

The general focus of this array of services is to reduce or stabilize symptoms, improve the level of functioning, and/or prevent deterioration of the person's condition. Natural and/or alternative supports are developed to help the person move out of the public mental health system. Services are most often provided in outpatient, office-based settings, and are primarily limited to medication, rehabilitative services, and education.

Service Descriptions

Basic Services
  1. Pharmacological management services
    Supervision of administration of medication, monitoring of effects and side effects of medication, assessment of symptoms. Includes one psychiatric evaluation per year.
  2. Routine Case Management
    Includes basic facilitation of access to resources and services, coordination of services with consumer, as well as administration of TIMA scales. This service is generally facility-based and not generally delivered in-vivo.
  3. "Medication Training & Support Services"
    (also referred to as "TIMA Patient and Family Education Program") Includes education on diagnosis, medications, monitoring and management of symptoms, and side effects.
Specialty Services/Add-Ons
  1. Skills Training & Development
    The building of skills to facilitate community integration and tenure
  2. Supported Employment
    Provides individualized assistance in choosing and obtaining employment, at integrated work sites in jobs in the community of the consumer's choice, and supports provided by identified staff who will assist individuals in keeping employment and/or finding another job as necessary. This includes "Skills Training & Development" related to addressing the symptoms of mental illness affecting an individual's ability to obtain and retain employment, as well as non-billable vocational specific training.
  3. Supported Housing
    Provides individualized assistance in choosing and obtaining integrated housing in the community of the consumer's choice, and supports provided by identified staff who shall assist individuals in retaining housing and/or finding new housing as necessary. This includes "Skills Training & Development" related to addressing the symptoms of mental illnesses affecting an individual's ability to obtain and retain housing, as well as non-billable housing specific support services (e.g., locating housing, assistance with moving).
  4. Crisis Intervention Services
    These are individual interventions provided in response to a crisis in order to reduce symptoms of severe and persistent mental illness or serious emotional disturbance and to prevent admission of an individual to a more restrictive environment. This service may be delivered to anyone with a mental health crisis. This service does not require prior authorization.
  5. Day Programs for Acute Needs
    These are site-based rehabilitative day programs that provide short-term, intensive treatment in a highly structured environment to individuals who require multidisciplinary treatment in order to stabilize acute psychiatric symptoms and to facilitate crisis resolution in order avoid placement in a more restrictive setting. This service is intended to stabilize individuals who are experiencing acute distress and who would be unable to function independently in the community without this intervention. Day Programs for Acute Needs are generally provided in settings such as Crisis Stabilization Units and Crisis Residential Settings.

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Service Package 2 – Adult

Service Package Definition

Services in this package are intended for individuals with residual symptoms of major depressive disorder, with an intake GAF ≤50, who present very little risk of harm, who have supports, and a level of functioning that does not require more intensive levels of care, and who can benefit from psychotherapy.

The general focus of services in this package is to improve level of functioning and/or prevent deterioration of the person's condition. Natural and/or alternative supports are developed to help the person move out of the public mental health system. Services are most often provided in outpatient, office-based settings and include psychotherapy services in addition to those offered in Service Package 1.

Service Descriptions

Basic Services
  1. Pharmacological Management Services
    Supervision of administration of medication, monitoring of effects and side effects of medication, assessment of symptoms. Includes 30 minutes of psychiatric evaluation per 180 days. For most individuals in SP2, this is a continuation of a service from SP1.
  2. Routine Case Management
    Includes basic facilitation of access to resources and services, coordination of services with consumer and family, administration of TIMA scales. For most individuals in SP2, this is a continuation of the service from SP1.
  3. Counseling (cognitive behavioral therapy – CBT)
    Provided in order to resolve a concrete problem in daily functioning (problem focused, solution oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances, and/or experiences consistent with DSM diagnosis. Counseling is intended to be brief, time-limited, and focused.
  4. Medication Training & Support Services
    (Also referred to as "TIMA Patient and Family Education Program") This includes education on diagnosis, medications, monitoring, and management of symptoms and side effects.
Specialty Services/Add-Ons
  1. Skills Training & Development
    The building of skills in order to facilitate community integration and tenure.
  2. Supported Employment
    Provides individualized assistance in selecting and obtaining employment, at integrated work sites in jobs in the community of the consumer's choice, and supports provided by identified staff who shall assist individuals in retaining employment and/or finding another job as necessary. This includes "Skills Training & Development" related to addressing the symptoms of mental illnesses affecting an individual's ability to obtain and retain employment, as well as non-billable vocational specific training.
  3. Supported Housing
    Provides individualized assistance in choosing and obtaining integrated housing in the community of their choice, and supports provided by identified staff who shall assist individuals in retaining housing and/or finding new housing as necessary. This includes "Skills Training & Development" related to addressing the symptoms of mental illnesses affecting an individual's ability to obtain and retain housing, as well as non-billable housing specific support services (e.g., locating housing, assistance with packing).
  4. Crisis Intervention Services
    These are individual interventions provided in response to a crisis in order to reduce symptoms of severe and persistent mental illness or serious emotional disturbance and to prevent admission of an individual to a more restrictive environment. This service may be delivered to anyone who is having / experiencing a mental health crisis. This service does not require prior authorization.
  5. Day Programs for Acute Needs
    These are site-based rehabilitative day programs that provide short-term, intensive treatment in a highly structured environment to individuals who require multidisciplinary treatment in order to stabilize acute psychiatric symptoms and to facilitate crisis resolution in order avoid placement in a more restrictive setting. This service is intended to stabilize individuals who are experiencing acute distress and who would be unable to function independently in the community without this intervention. Day Programs for Acute Needs are generally provided in settings such as Crisis Stabilization Units and Crisis Residential Settings.

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Service Package 3 – Adult

Service Package Definition

Service Package 3 (SP-3) must utilize a team approach to providing more intensive rehabilitative services for the individual. Services in this package are generally intended for individuals who enter the system of care with moderate to severe levels of need (or for those whose LOC-R has increased) who require intensive rehabilitation to increase community tenure, establish support networks, increase community awareness, and develop coping strategies in order to function effectively in their social environment (family, peers, school). This may include maintaining the current level of functioning. A rehabilitative case manager who is a member of the therapeutic team must provide supported Housing and COPSD services. Supported Employment services must be provided by both a Supported Employment specialist on the team and the rehabilitative case manager.

The general focus of services in this package is to stabilize symptoms, improve functioning, develop skills in self-advocacy, and increase natural supports in the community and / or sustain improvements made in more intensive service packages. Service focus is on amelioration of functional deficits through skill training activities focusing on symptom management, independent living, self-reliance, non-job-task specific employment interventions, impulse control, and effective interaction with peers, family, and community. Services are provided in outpatient office-based settings and community settings.

Service Descriptions

Basic Services
  1. Integrated Rehabilitative Teams
    This service package is a service delivery model that provides the defined services in an integrated treatment team structure. All persons served in SP-3 must at a minimum receive the following services unless the service is refused or is clinically contra-indicated (with documentation of the reason noted in the individual's medical record):
    1. Pharmacological management services
      Supervision of administration of medication, monitoring of effects and side effects of medication, assessment of symptoms. Includes a 30-minute psychiatric evaluation every 180 days.
  2. Rehabilitative Services, which include:
    1. "Medication Training & Support" that is education on diagnosis, medications, monitoring and management of symptoms and side effects (also referred to as "TIMA Patient and Family Education Program").
    2. "Psychosocial Rehabilitative Services" (also referred to as Rehabilitative Case Management) provide a variable level of integrated support to individuals assigned to this package. Includes:
      1. Assistance in accessing medical, social, educational, or other appropriate support services, as well as linkage to more intensive services if needed, in addition to monitoring (monthly or weekly as needed), assessment of service needs, service planning and coordination, administration of TIMA scales, and other TIMA medication management functions.
  3. A basic level of rehabilitative services addressing daily and independent living skills to persons on their caseload.
  4. Co-occurring Psychiatric and Substance use Disorder services.
  5. Medical:
    1. Psychosocial Rehabilitation
      Medication related services – services to provide training regarding an individual's medications in order to increase the individual's compliance with medication treatment. These include training in self administration of the individual's medications, the importance of taking one's medications as prescribed, determining the effectiveness of the individual's medications, identifying side-effects of the individual's medications; and
    2. Supplemental Nursing Services
      Provided in support of services provided by the physician, including but not limited to taking vital signs, weight monitoring, blood draws; etc. (Note: These services do not include nursing services that are incidental to a physician's office visit.).
Specialty Services/Add-Ons
  1. Supported Employment
    Provides individualized assistance in choosing and obtaining employment at integrated work sites in jobs in the community of one's choice, and supports provided by identified staff who will assist individuals in retaining employment and/or finding other jobs as necessary. This includes "Psychosocial Rehabilitative Services" related to addressing the symptoms of the mental illness affecting the individual's ability to obtain and retain employment, as well as non-billable vocational specific training. Need for Supported Employment is indicated by a score of 3-5 on Dimension 5: Employment Problems of the TRAG. For a subset of the population served in SP3 who have a need for Supported Employment, the following additional service will be provided based on selection by the individual and the treatment team.
  2. Supported Housing
    Provides individualized assistance in choosing and obtaining integrated housing in the community of one's choice and supports provided by designated staff who shall assist individuals in retaining housing and/or finding new housing as necessary. This includes "Psychosocial Rehabilitative Services" related to addressing the symptoms of mental illnesses affecting an individual's ability to obtain and retain housing, as well as non-billable housing specific support services (e.g., locating housing, assistance with moving). Need for Supported Housing is indicated by an allowable score on Dimension 6: Housing Instability of the TRAG (see "Add-on Service Criteria for SP-3"). For individuals who are a subset of the population served in SP3 and who have a need for Supported Housing, the following additional service will be provided based on the individual's preference and the conclusions of the treatment team.
  3. Crisis Intervention Services
    These are individual interventions provided by staff members other than members of the consumer's therapeutic team (SP-3 Team) in response to a crisis in order to (a) reduce symptoms of severe and persistent mental illnesses or serious emotional disturbances and (b) to prevent admission of an individual to a more restrictive environment. This service may be delivered to anyone who is having / experiencing a mental health crisis. This service does not require prior authorization. [NOTE: When members of the SP-3 Team address a crisis situation, the services are billed as Psychosocial Rehabilitation}
  4. Day Programs for Acute Needs
    These are site-based rehabilitative day programs that provide short-term, intensive treatment in a highly structured environment to individuals who require multidisciplinary treatment in order to stabilize acute psychiatric symptoms and to facilitate crisis resolution in order to avoid placement in a more restrictive setting. This service is intended to stabilize individuals who are experiencing acute distress and who would be unable to function independently in the community without this intervention. Day Programs for Acute Needs are generally provided in settings such as Crisis Stabilization Units and Crisis Residential Settings.

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Service Package 4 – Adult

Service Package Definition

A self-contained program which is the fixed point of responsibility for providing treatment, rehabilitation, and support services to identified consumers with severe and persistent mental illnesses and who have a history of multiple hospitalizations. Individuals that have experienced multiple hospitalizations and have needs that affect their ability to live independently in the community are appropriate for this level of care.

ACT is a comprehensive wrap-around service that includes Pharmacological Management, "Psychosocial Rehabilitative Services," Medical Related Services (Includes both "Medication Training & Supports" and "Psychosocial Rehabilitative Services" component "Medication related services"), Supported Employment, Supported Housing, and Co-occurring Psychiatric and Substance Use Disorder services.

Service Descriptions

Basic Services
  1. Pharmacological management services
    Supervision of administration of medication, self-medication training for individual or family, monitoring of effects and side effects of medication, assessment of symptoms.
  2. Rehabilitative Services
    "Psychosocial Rehabilitative Services" (also referred to as Rehabilitative Case Management) provides a variable level of integrated support to individuals assigned to this service package. Includes: Assistance in accessing medical, social, educational, or other appropriate support services as well as linkage to more intensive services if needed, in addition to monitoring (weekly or monthly as needed), assessment of service needs, service planning and coordination, administration of TIMA scales, and other TIMA medication management functions.
  3. A basic level of rehabilitative services
    Addressing daily and independent living skills to persons on their caseload.
  4. Co-occurring Psychiatric and Substance Use Disorder Services
    When the symptoms of the mental illness are addressed in relation to substance use.
  5. Supported Employment
    This provides individualized assistance in choosing and obtaining employment at integrated work sites in jobs in the community of one's choice, and supports provided by identified staff who shall assist individuals in retaining employment and/or finding other jobs as necessary. This includes "Psychosocial Rehabilitative Services" related to addressing the symptoms of any mental illness affecting an individual's ability to obtain and retain employment, as well as non-billable vocational specific training.
  6. Supported Housing
    These services assist clients in choosing, obtaining, and maintaining regular integrated housing. This includes "Psychosocial Rehabilitation" services related to addressing the symptoms of mental illnesses that affect an individuals ability to maintain housing, as well as non-billable activities that assist individuals in locating and obtaining housing.
  7. "Medication Training & Support"
    This is education regarding the diagnoses, medications, monitoring, and management of symptoms and side effects (also referred to as "TIMA Patient and Family Education Program").
  8. Medical
    1. Psychosocial Rehabilitation – Medication-related services
      These include education and training regarding the individual's prescribed medications for the purpose of enhancing compliance with pharmacological treatment. These focus on training in self-administration of the individual's medications, the importance of taking the medications as prescribed, determining the effectiveness of the individual's medications, identifying side-effects of the individual's medications; and
    2. Supplemental Nursing Services
      Provided in support of services provided by the physician, including but not limited to taking vital signs, weight monitoring, blood draws, etc. (Note: These services do not include nursing services that are incidental to a physician's office visit.).
Specialty Services/Add-Ons
  1. Crisis Intervention Services
    Individual interventions provided by staff members other than members of the consumer's therapeutic team (ACT Team) in response to a crisis in order to (a) reduce symptoms of severe and persistent mental illness or serious emotional disturbance and (b) reduce the risk of admission to a more restrictive environment. This service may be delivered to anyone who is having / experiencing a mental health crisis. This service does not require prior authorization. [NOTE: When members of the SP-4 (ACT) Team address a crisis situation, the services are billed as Psychosocial Rehabilitation.]
  2. Day Programs for Acute Needs
    Site-based rehabilitative day programs that provide short-term, intensive treatment in a highly structured environment to individuals who require multidisciplinary treatment in order to stabilize acute psychiatric symptoms and to facilitate crisis resolution in order avoid placement in a more restrictive setting. This service is intended to stabilize individuals who are experiencing acute distress and who would be unable to function independently in the community without this intervention. Day Programs for Acute Needs are generally provided in settings such as Crisis Stabilization Units and Crisis Residential Settings.

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Service Package 0 (Crisis Services) – Adult

Service Package Definition

Services in this package are brief interventions provided in the community that will ameliorate the crisis situation and prevent utilization of more intensive services. The desired outcome is resolution of the crisis and avoidance of more intensive and restrictive intervention.

Service Descriptions

Basic Services
  1. "Crisis Intervention Services"
    Includes face-to-face evaluation of risk, provision of skills training and guidance, and coordination of emergency services and:
  2. Psychiatric services
    Include services provided by a physician, including injections, medication adjustments, evaluation, and medical referrals.
  3. Observation – Assessment
    By a psychiatrist to avoid regular inpatient hospitalization. Placement based on need at time of crisis screening. The desired outcome is to remove stressors and return to home.
Specialty Services/Add-Ons
  1. Day Programs for Acute Needs
    Site-based rehabilitative day programs that provide short-term, intensive treatment to individuals who require multidisciplinary treatment in order to stabilize acute psychiatric symptoms or prevent admission to more restrictive settings.

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Service Package 5 (Crisis Follow-Up) – Adult

Brief interventions for individuals who are released from crisis services or hospitalization and are not eligible for on-going services.

Service Package Definition

  1. Routine Case Management
    Includes basic facilitation of access to resources and services, coordination of services with individual and family, and administration of TIMA scales.
  2. Psychiatric services
    Include services provided by a physician including injections, medication adjustments, evaluation, and medical referrals.

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RDM Service Package Definitions and Service Descriptions for Child/Adolescent Service Packages

Service Package 1.1 – Child/Adolescent

Service Package Definition

Basic Services

This level of care is targeted for children and adolescents with externalizing disorders (e.g., ADD/ADHD, Conduct or Oppositional Defiant Disorder) and a moderate level of functional impairment. The focus of the intervention is on psychosocial skill development in the child and the enhancement of parenting skills, especially in child behavior management. Access to parent support groups is available. Information regarding the diagnosis, medication, monitoring of symptoms and side effects is provided through Medication Training and Support. This level of care is generally considered short-term and time-limited.

The general goal of services at this level of care is to reduce or stabilize symptoms, decrease functional impairment or prevent deterioration of the child's condition. Family support is facilitated through linkage to natural and community resources. Services are provided in the office, school, home or other community setting.

Service Descriptions

Basic Services
  1. Skills Training and Development
    A structured intervention to provide and improve skills needed for the child to function appropriately in the community, and to enhance child behavior management and increase the skills necessary to manage/decrease the child's level of functional impairment.
  2. Medication Training and Support
    Information provided to the child and family on the mental health disorder, medications, monitoring of symptoms and side effects.
  3. Routine Case Management
    Facilitation of child/family's access to community resources and continuity of care between services. Parent Support Group: support and informational meetings for parents of children receiving services that are facilitated and routinely scheduled.
Specialty Services/Add-Ons
  1. Psychiatric Evaluation
    Psychiatric clinical diagnostic interview
  2. Medication Management
    A service provided by a licensed medical professional to a child or family to determine symptom remission and the medication regime needed to initiate and/or maintain the child's plan of care.
  3. Skills Training and Development (Group)
    A structured intervention provided in a group setting to provide and improve skills needed for the child to function appropriately in the community and to enhance child behavior management and increase the skills necessary to manage/decrease child's level of functional impairment. Group Skills Training and Development is limited to no more than 6 children per group.
    • NOTE – Medicaid reimbursement for Skills Training and Development in groups is not currently available.

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Service Package 1.2 – Child/Adolescent

Service Package Definition

This level of care is targeted for children and adolescents with internalizing disorders (depressive or anxiety disorders) and a moderate level of functional impairment. The focus of the intervention is on child and family counseling using Cognitive Behavioral Therapy (CBT) for ages 9 & above and CBT or other therapy approaches for children ages 3 through 8. Access to parent support groups is available. Information regarding the diagnosis, medication, monitoring of symptoms and side effects is provided through Medication Training and Support. This LOC is generally considered short-term and time-limited. The general goal of services at this level of care is to reduce or stabilize symptoms, decrease functional impairment or prevent deterioration of the child's condition. Family support is facilitated through linkage to natural and community resources and parent support groups. Services are provided in the office, school, home or other community setting.

Service Descriptions

Basic Services
  1. Counseling
    Provided in order to resolve a concrete problem in daily functioning (problem-focused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances, and/or experiences consistent with DSM–IV diagnoses. Counseling is intended to be brief, time-limited and focused.
  2. Medication Training and Support
    Information provided to the child and family on the mental health disorder, medications, monitoring of symptoms and side effects.
  3. Routine Case Management
    Facilitation of child/family's access to community resources and continuity of care between services.
  4. Parent Support Group
    Support and informational meetings for parents of children receiving services that are facilitated and routinely scheduled.
Specialty Services/Add-Ons
  1. Psychiatric Evaluation
    A psychiatric clinical diagnostic interview
  2. Group Counseling
    Provided in a group setting in order to resolve a concrete problem in daily functioning (problem-focused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances, and/or experiences consistent with DSM–IV diagnoses (CBT). Group Counseling is intended to be brief, time-limited and focused and limited to no more than 6 children per group.
  3. Family Counseling
    Provided to children and their families order to resolve a concrete problem in daily functioning (problem-focused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances, and/or experiences consistent with DSM–IV diagnoses (CBT).
  4. Medication Management
    A service provided by a licensed medical professional to a child or family to determine symptom remission and the medication regime needed to initiate and/or maintain the child's plan of care.

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Service Package 2.1 – Child/Adolescent

Service Package Definition

This level of care is targeted to youth with externalizing disorders and high levels of severe disruptive or aggressive behaviors who are in the juvenile justice system and at high risk of out of home placement or further penetration in the juvenile justice system due to presenting behaviors. Intensive parent-to-parent peer support is available to the family. The family service plan is developed using a wraparound planning approach.

Service Descriptions

Basic Services
  1. Multi-Systemic Therapy (MST)
    A comprehensive, intensive in-home and community-based treatment model. Service components include intensive case management, counseling (including family and group), and skills training and development (individual). Services are provided at an average of 8 hours/week. Family service planning is done through a wraparound planning approach. Extensive collaboration with juvenile justice professionals is required.
  2. Family Partner
    Peer mentoring, education and support provided by an experienced parent to the caregivers of a child in service.
  3. Medication Training and Support
    Information provided to the child and family on the mental health disorder, medications, monitoring of symptoms and side effects.
  4. Parent Support Group
    Support and informational meetings for parents of children receiving services that are facilitated and routinely scheduled.
Specialty Services/Add-Ons
  1. Psychiatric Evaluation
    A psychiatric clinical diagnostic interview
  2. Medication Management
    A service provided by a licensed medical professional to a child or family to determine symptom remission and the medication regime needed to initiate and/or maintain the child's plan of care.
  3. Flex Funds
    Non-clinical supports that that augment the service plan to reduce symptomatology and maintain quality of life and family integration. The provider may request authorization of flex funds to augment the family service plan, up to a $1,500/family cap. The UM manager may authorize an exception to the $1,500 per family cap with documented justification.

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Service Package 2.2 – Child/Adolescent

Service Package Definition

This level of care is targeted at children and adolescents with externalizing disorders and moderate to high functional impairment at home, school or in the community. The need for intensive case management and significant parent support is indicated. The family service plan is developed using a wraparound planning approach. Multi-Systemic Therapy is either not appropriate due to lack of juvenile justice involvement or unavailable.

Service Descriptions

Basic Services
  1. Intensive Case Management
    Activities that assist the child/family including service planning and coordination, monitoring service effectiveness, and proactive crisis planning and management.
  2. Skills Training and Development
    A structured intervention to provide and improve skills needed for the child to function appropriately in the community and to enhance child behavior management and increase the skills necessary to manage/decrease child's level of functional impairment.
  3. Medication Training and Support
    Information provided to the child and family on the mental health disorder, medications, monitoring of symptoms and side effects.
  4. Family Partner
    Peer mentoring, education and support provided by an experienced parent to the caregivers of a child in service.
  5. Parent Support Group
    Support and informational meetings for parents of children receiving services that are facilitated and routinely scheduled.
Specialty Services/Add-Ons
  1. Psychiatric Evaluation
    A psychiatric clinical diagnostic interview
  2. Medication Management
    A service provided by a licensed medical professional to a child or family to determine symptom remission and the medication regime needed to initiate and/or maintain the child's plan of care.
  3. Skills Training and Development (Group)
    A structured intervention provided in a group setting to provide and improve skills needed for the child to function appropriately in the community and to enhance child behavior management and increase the skills necessary to manage/decrease child's level of functional impairment. Group Skills Training and Development is limited to no more than 6 children per group.
    • NOTE – Medicaid reimbursement for Skills Training and Development in groups is not currently available.
  4. Flex Funds
    Non-clinical supports that that augment the service plan to reduce symptomatology and maintain quality of life and family integration. The provider may request authorization of flex funds to augment the family service plan, up to a $1,500/family cap. The UM manager may authorize an exception to the $1,500 per family cap with documented justification.

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Service Package 2.3 – Child/Adolescent

Service Package Definition

This level of care is targeted to children and adolescents with depressive or anxiety disorders and a moderate to high level of problem severity or functional impairment. The focus of the intervention is on child and family counseling using Cognitive Behavioral Therapy (CBT) for ages 9 & above and CBT or other therapy approaches for children ages 3 through 8. Multiple family concerns and significant parental stress indicate the need for intensive case management and the availability of parent-to-parent peer support. The family service plan is developed using a wraparound planning approach.

Service Descriptions

Basic Services
  1. Intensive Case Management
    Activities that assist the child/family including service planning and coordination, monitoring service effectiveness, and proactive crisis planning and management.
  2. Counseling
    Provided in order to resolve a concrete problem in daily functioning (problem-focused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances, and/or experiences consistent with DSM–IV diagnoses. Counseling is intended to be brief, time-limited and problem-focused.
  3. Medication Training and Support
    Information provided to the child and family on the mental health disorder, medications, monitoring of symptoms and side effects.
  4. Family Partner
    Peer mentoring, education and support provided by an experienced parent to the caregivers of a child in service.
  5. Parent Support Group
    Support and informational meetings for parents of children receiving services that are facilitated and routinely scheduled.
Specialty Services/Add-Ons

As clinically indicated, a psychiatric evaluation, medication management, group and family counseling, and flex funds can be authorized in addition to LOC 2.3 services.

  1. Psychiatric Evaluation
    A psychiatric clinical diagnostic interview.
  2. Medication Management
    A service provided by a licensed medical professional to a child or family to determine symptom remission and the medication regime needed to initiate and/or maintain the child's plan of care.
  3. Group Counseling
    Provided in a group setting in order to resolve a concrete problem in daily functioning (problem-focused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances, and/or experiences consistent with DSM–IV diagnoses (CBT). Group Counseling is intended to be brief, time-limited and focused and limited to no more than 6 children per group.
  4. Family Therapy
    Provided to children and their families order to resolve a concrete problem in daily functioning (problem-focused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances, and/or experiences consistent with DSM–IV diagnoses (CBT).
  5. Flex Funds
    Non-clinical supports that that augment the service plan to reduce symptomatology and maintain quality of life and family integration. The provider may request authorization of flex funds to augment the family service plan, up to a $1,500/family cap. The UM manager may authorize an exception to the $1,500 per family cap with documented justification.

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Service Package 2.4 – Child/Adolescent

Service Package Definition

This level of care is targeted for children and adolescents who are diagnosed with Bipolar Disorder, Schizophrenia, Major Depression with Psychosis, or other psychotic disorders and are not yet stable on medication. The major focus is on stabilizing the child and providing information and support to the family.

Service Descriptions

Basic Services
  1. Intensive Case Management
    Activities that assist the child/family including service planning and coordination, monitoring service effectiveness, and proactive crisis planning and management.
  2. Medication Training and Support
    Information provided to the child and family on the mental health disorder, medications, monitoring of symptoms and side effects.
  3. Family Partner
    Peer mentoring, education and support provided by an experienced parent to the caregivers of a child in service.
  4. Medication Management
    A service provided by a licensed medical professional to a child or family to determine symptom remission and the medication regime needed to initiate and/or maintain the child's plan of care.
  5. Psychiatric Evaluation
    A psychiatric clinical diagnostic interview.
  6. Parent Support Group
    Support and informational meetings for parents of children receiving services that are facilitated and routinely scheduled.
Specialty Services/Add-Ons

As clinically indicated, flex funds may be authorized in addition to LOC 2.4 services.

  1. Flex Funds
    Non-clinical supports that that augment the service plan to reduce symptomatology and maintain quality of life and family integration. The provider may request authorization of flex funds to augment the family service plan, up to a $1,500/family cap. The UM manager may authorize an exception to the $1,500 per family cap with documented justification.

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Service Package 4 – Child/Adolescent

Service Package Definition

This level of care is targeted to children and adolescents who have stabilized in terms of problem severity and functioning and require only medication and medication management to maintain their stability. If CA-TRAG scores indicate the need for a more intensive LOC, LOC 4 can only be authorized if 1) the parent refuses the recommended LOC, wants medication-only services and medication is clinically indicated; or 2) if the individual is NOT Medicaid eligible and the recommended LOC is not available due to limited resources but severe presenting problems that are responsive to medication suggest an authorization for LOC 4 during the waiting period.

Service Descriptions

Basic Services
  1. Medication Management
    A service provided by a licensed medical professional to a child or family to determine symptom remission and the medication regime needed to initiate and/or maintain the child's plan of care.
  2. Routine Case Management
    Facilitation of child/family's access to community resources and continuity of care between services.
  3. Parent Support Group
    Support and informational meetings for parents of children receiving services that are facilitated and routinely scheduled.

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Service Package 0 – Crisis – Child/Adolescent

Service Package Definition

Services in this package are brief interventions provided in the community that will ameliorate the crisis situation and prevent utilization of more intensive services. The desired outcome is resolution of the crisis and avoidance of more intensive and restrictive intervention.

Service Descriptions

Basic Services
  1. Crisis Intervention Services
    Includes face-to-face evaluation of risk, provision of skills training and guidance, and coordination of emergency services.
  2. Psychiatric Services
    Include services provided by a physician including injections, medication adjustments, evaluation, and medical referral

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Service Package 5 – Crisis Follow-Up – Child/Adolescent

Information available soon

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Last updated March 31, 2010