Provider Manual


Mental Health – Adult

In order to be in the Adult Priority Group, a person: must meet the federal definition of serious mental illness; must be age 18+, (or age 21+ if in Special Education); must have a diagnosis of schizophrenia, major affective disorder, psychotic disorder NOS or borderline personality disorder (DSM-IV or its successor documents as designated by the American Psychiatric Association, diagnostic codes 295.xx, 296.xx, 298.9x, or 301.83); and must meet at least one of the following criteria: A. (Treatment History), B. (Functioning Level) or C. (Coexisting Condition or Circumstance).

  1. Treatment History
    1. Current residence in or discharge from a state mental hospital within the past two years; or
    2. Two admissions to community or correctional inpatient psychiatric units or residential services totaling 20 or more days within the past two years; or
    3. Five or more face-to-face contacts with walk-in or mobile crisis or emergency services within the past two years; or
    4. One or more years of continuous attendance in a community mental health or prison psychiatric service (at least one unit of service per quarter) within the past two years; or
    5. History of sporadic course of treatment as evidenced by at least three missed appointments within the past six months, inability or unwillingness to maintain medication regimen or involuntary commitment to outpatient services; or
    6. One or more years of treatment for mental illness provided by a primary care physician or other non-mental health agency clinician, (e.g., Area Agency on Aging) within the past two years.
  2. Functioning Level
    1. Global Assessment of Functioning Scale rating of 50 or below.
  3. Coexisting Condition or Circumstance
    1. Coexisting Diagnosis:
      1. Psychoactive Substance Use Disorder; or
      2. Mental Retardation; or
      3. HIV/AIDS; or
      4. Sensory, Developmental and/or Physical Disability; or
    2. Homelessness; or
    3. Release from Criminal Detention.

In addition to the above, any adult who met the standards for involuntary treatment within 12 months preceding the assessment is automatically assigned to the high priority group.

Mental Health – Child and Adolescent

  1. The Child and Adolescent Priority Group 1 includes persons who meet all four criteria below:
    1. Age: birth to less than 18 (or age 18 to less than 21 and enrolled in special education service).
    2. Currently or at any time in the past year have had a DSM-IV diagnosis (excluding those whose sole diagnosis is mental retardation or psychoactive substance use disorder or a “V” code) that resulted in functional impairment, which substantially interferes with or limits the child’s role or functioning in family, school or community activities.
    3. Receives services from mental health and one or more of the following:
      1. Mental Retardation
      2. Children and Youth
      3. Special Education
      4. Drug and Alcohol
      5. Juvenile Justice
      6. Health (the child has a chronic health condition requiring treatment)
    4. Identified as needing mental health services by a local interagency team (e.g., CASSP, Cordero Workgroup).

    In addition to the above, any child or adolescent who met the standards for involuntary treatment within the 12 months preceding the assessment is automatically assigned to this priority group.

  2. Second priority is associated with children at risk of developing a serious emotional disturbance by virtue of:
    1. A parent’s serious mental illness
    2. Physical or sexual abuse
    3. Drug dependency
    4. Homelessness
    5. Referral to the Student Assistance Programs

Please refer to Section IV, “Reporting” for instructions on Performance Outcome Management System (POMS) data collection for mental health services.

Drug and Alcohol

The priority population for drug and alcohol treatment services includes:

  • Pregnant Females and Women with Children
  • Intravenous Drug Users
  • Adolescents
  • Persons with Severe Medical Conditions, such as Tuberculosis and HIV/AIDS
  • Mentally Ill Substance Abusers