1.100 |
Individuals Served by Carelon’s Public Sector Programs |
|
1.200 |
Clinical Criteria Manual Development |
|
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 |
|
2.301 |
Residential Treatment Facility – Adult |
|
2.400 |
Evaluating Clinical Necessity for Continued Care |
|
2.500 |
Discharge Criteria |
|
2.503 |
Assertive Community Treatment (ACT) Criteria |
|
3.100 |
Overview |
|
3.200 |
Outcomes |
|
3.300 |
Individualized Service Plans |
|
3.400 |
Coordination of Care |
|
3.500 |
Discharge and Transition Plans |
|
4.101 |
Telephone Crisis Service |
|
4.102 |
Walk-in Crisis Service |
|
4.103 |
Mobile Crisis Service |
|
4.201 |
Acute Inpatient Mental Health |
|
4.202 |
Adult Inpatient Extended Acute Care Criteria |
|
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 |
|
4.401-
4.402 |
Intensive Case Management for Adults/Resource Coordination for Adults |
|
4.501 |
Clozapine (Clozaril Management) |
|
4.601 |
Electroconvulsive Therapy (ECT) |
|
|
ASAM Crosswalk |
|
|
Outpatient (OP) Services |
|
|
Intensive Outpatient (IOP) Services |
|
|
Partial Hospitalization (PHP) Services |
|
|
Clinically-Managed Low Intensity Residential Services, i.e., Halfway House (HWH) |
|
|
Clinically Managed High Intensity Residential Services |
|
|
Medically Monitored Inpatient Withdrawal Management – 3.7 WM |
|
|
Medically Monitored Intensive Inpatient Services |
|
|
Medically Managed Intensive Inpatient Withdrawal Management – 4 WM |
|
|
Medically Managed Intensive Inpatient Services – 4.0 |
|
6.101 |
Telephone Crisis Service |
|
6.102 |
Walk In Crisis Service |
|
6.103 |
Mobile Crisis Service |
|
6.201 |
Acute Inpatient Mental Health |
|
6.202 |
Subacute Inpatient Mental Health |
|
6.301 |
Residential Treatment (JCAHO and non-JCAHO) |
|
6.302 |
Community Residential Rehabilitation Host Home |
|
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) |
|
6.502-
6.503 |
Resource Coordination & Intensive Case Management (Children / Adolescent) |
|
6.601 |
Family Based Mental Health Services |
|
|
For all levels of adolescent Substance Use Disorder services, please follow the American Society of Addiction Medicine, Third Edition, 2013 Treatment Criteria: https://www.asam.org |
|
9.103 |
Crisis Residential Services |
|
9.104 |
Long Term Structured Residential Treatment Centers |
|
9.201 |
Psychiatric Rehabilitation Program – Admission Requirements |
|
9.202 |
Psychiatric Rehabilitation Program – Continued Stay Requirements |
|
9.203 |
Psychiatric Rehabilitation Program – Discharge Requirements |
|
10.101 |
Drug and Alcohol Intensive Case Management (Formerly, Targeted Case Management) For Adults |
|
10.102 |
Drug and Alcohol Assessment / Level of Care determination |
|
11.600 |
Crisis Residential Service |
|
12.101 |
Drug and Alcohol Intensive Case Management (Formerly, Targeted Case Management) For Children/Adolescents |
|
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 |
|
13.201 |
Acute Partial Hospitalization |
|
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 |
|
15.101 |
Guidelines for Mental Health Necessity Criteria (Appendix T) |
|
17.100 |
Medical Necessity Guidelines for IBHS Delivered through Individual Services, ABA Services and Group Services – Appendix S(2) |
|
17.101 |
IBHS Description of Applied Behavior Analysis |
|
17.102 |
IBHS Description of Individual Services |
|
17.103 |
IBHS Description of Group Services |
|