GENERAL ELIGIBILITY

All services are provided to adults (over 18 years old) with the exception of rare circumstances when an individual age 16-18 may need skills training in mental health skills-building services to improve successful community independence.  Individuals must demonstrate clinical need for the services from a condition due to mental, behavioral, or emotional illness as well as functional deficits.  East Mental Health provides services to individuals with full Medicaid.


MENTAL HEALTH SKILLS-BUILDING

Admission:

Individuals must demonstrate a clinical need for the service arising from a condition due to mental, behavioral, or emotional illness, which results in significant functional impairments in major life activities. The individual must:

» Have a serious mental illness/emotional disturbance. This may include individuals with a dual diagnosis of either mental illness and mental retardation or mental illness and substance abuse disorder.

» Meet two of the following criteria on a continuous or intermittent basis:

» Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization or homelessness.

» Exhibit such inappropriate behavior that repeated interventions by the mental health, social services, or judicial system are necessary.

» Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or significantly inappropriate social behavior.

» Require help in basic living skills, such as maintaining personal hygiene, preparing food and maintaining adequate nutrition, or managing finances to such a degree that health or safety is jeopardized.

To receive

Mental Health Skills-Building Services with East Mental Health, LLC., the individual must be an active client, which means that the individual has an active plan of care in effect at the time services are rendered. In addition, the client may have an active plan of care with a Case management service that is licensed by the state of Virginia to provide Case Management Services.


 Treatment and Discharge:

Successful termination of treatment is based on goal attainment as noted on the plan of care. Joint decisions with the client, case manager, and East Mental Health, LLC staff is made as to the appropriate reauthorization or termination of services.

Services may be terminated when the client reaches treatment objectives, has stated that he or she no longer wishes to receive services, or withdraws from services, the client moves away or the death of a client.

East Mental Health, LLC staff collaborates with the client and case manager regarding appropriate discharge, referrals, and/or needs.

PSYCHIATRIC SUPPORT SERVICES

Admission, continued stay and exclusion criteria

Individuals must meet all of the following criteria:

» Adults age 18 or older (unless psychiatrist approves admission in advance);

» Has insurance and the ability to pay for services;

» Has a mental disorder according to the DSM-IV-TR and is In need of psychiatric evaluation and/or medication management.


Continued Stay

To receive Psychiatric services with East Mental Health, LLC The individual must be an active client, which means that the individual is in need of psychiatric care and attends appointments regularly.



Exclusion Criteria

» Individuals under the age of 18 years (unless prior approval is received from psychiatrist).

» Individuals who are unable to meet the financial requirements of services using insurance, co-pays, and self-pay.



Termination of treatment and discharge or transition criteria

Individuals are considered for discharge from Psychiatric services when:

» Services are completed and appropriate referral and linking services implemented

» An individual moves and chooses a provider in another location

» An individual no longer desires the assistance of Psychiatric Services

» A joint decision is made between individual and treatment team that services through Psychiatric Services no longer meet the needs of the individual either because an individual no longer desires services or due to transfer to a different program

» An individual dies

» Loss of contact


CRISIS INTERVENTION SUPPORT SERVICE

Eligibility

Adults (over age 18)
Individuals requesting Crisis Intervention Services must have full medicaid in order to cover the cost of services.
Individuals seeking Crisis Intervention services must have a diagnosis of mental illness.  Additionally, individuals must demonstrate and increase in symptoms or change in behavior demonstrating a reduction in the individual's psychiatric, adaptive, or behavioral functioning or increase in personal distress.

If an individual has co-occurring mental health and substance use disorders, integrated treatment for both disorders is allowed within Crisis Intervention Services as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition. The impact of the substance abuse condition on the mental health condition must be documented in the assessment, the treatment plan, (please see below for ISP requirements), and the progress notes.

Admission, continued stay and exclusion criteria

Admission

» Individuals must have a diagnosis of mental illness according to the DSM-IV-TR;

» Individuals must demonstrate and increase in symptoms or change in behavior demonstrating a reduction in the individuals psychiatric, adaptive or behavioral functioning or increase in personal distress;

» Individuals must have Medicaid in order to meet the financial obligations of the service.



Continued Stay

Individuals are eligible to continue to receive services until the crisis is resolved; a period not to exceed 30 days.

Exclusion Criteria

» Individuals who are non-ambulatory

» Individuals with history of aggression and/or violence will be considered on a case by case basis.



Termination of treatment and discharge or transition criteria


Individuals are considered for discharge from Crisis Intervention services when:

» Services are completed and appropriate referral and linking services implemented

» An individual moves and chooses a provider in another location

» An individual no longer desires the assistance of Crisis Intervention

» A joint decision is made between individual and treatment team that services through Crisis Intervention

» Services no longer meet the needs of the individual either because an individual no longer desires services or due to transfer to a different program30-days following first face to face

» An individual dies

» Loss of contact



CRISIS STABILIZATION SUPPORT SERVICE

Eligibility

Adults (over age 18) who are experiencing an acute psychiatric crisis that puts them at risk of psychiatric hospitalization, institutionalization, or other removal from their community setting.
Individuals requesting Crisis Stabilization Services must have full Medicaid.
Eligibility includes at least two of the following.
  • Difficulty in maintaining interpersonal relationships to such a degree that they are at risk of hospitalization or homelessness or isolation from social supports;
  • Difficulty in activities of daily living such as maintaining personal hygiene, preparing food and maintaining adequate nutrition, or managing finances to such a degree that health or safety is jeopardized;
  • Exhibiting such inappropriate behavior that immediate interventions by mental health, social services, or the judicial system are necessary;
  • Exhibiting difficulty in cognitive ability (eg. The individual is unable to recognize personal danger or recognize significantly inappropriate social behavior).

Admission, continued stay and exclusion criteria

Eligibility Criteria for Admission:

Individuals must meet eligibility criteria including a clinical necessity for the service arising from an acute crisis of a psychiatric nature that puts the individual at risk of psychiatric hospitalization. In addition, individuals must meet at least two of the follow criteria at the time of admission:

» Difficulty in maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization or homelessness or isolation from social supports.

» Difficulty in activities of daily living (ADLs) such as maintaining personal hygiene, preparing food and maintaining adequate nutrition, or managing finances to such a degree that health or safety is jeopardized.

» Exhibiting such inappropriate behavior that immediate interventions by mental health, social services, or the judicial system are necessary.

» Exhibiting difficulty in cognitive ability (e.g., the individual is unable to recognize personal danger or recognize significantly inappropriate social behavior).




Continued Stay

Individuals can receive services for up to 8 hours a day for up to 15 consecutive days as indicated by the recommendations of the assessment and treatment plan. Maximum days of service are 60 annually.




Exclusion Criteria

» Individuals who are non ambulatory

» Individuals who have a history of violence or aggression will be assessed on a case by case basis

» Individuals who reside in any domiciliary care facilities including but not limited to assisted living facilities, group homes, or nursing facilities

» Individuals in need of medical or psychiatric hospitalization including individuals who are of imminent danger to self or others

» Primary diagnoses of substance use disorders, developmental disorders, adjustment disorder, V-codes, organic brain disorder.

» Crisis stabilization cannot be billed for individuals in ICT/PACT programs or intensive in-home services.


Termination of treatment and discharge or transition criteria

Individuals are considered for discharge from crisis stabilization services when:

» Services are completed with an appropriate community referral including appropriate transition.

» An individual moves and chooses a provider in another locationAn individual no longer desires the assistance of Crisis Stabilization

» The psychiatric condition change to include a presentation of imminent danger to self or others and/or the individual requires medical or psychiatric hospitalization.

» A joint decision is made between individual and treatment team that services through Crisis Stabilization no longer meet the needs of the individual either because an individual no longer desires services or due to transfer to a different program

» An individual dies

» Loss of contact following multiple outreach attempts including telephone calls, home visits, and letters
.