SERVICE ELIGIBILITY


MENTAL HEALTH SUPPORT SERVICE DEFINITION

Mental Health Support services are training and support to enable individuals with significant psychiatric functional limitations to achieve and maintain community stability and independence in the most appropriate, least restrictive environment. The recommended age to receive the service will increase from 16 to 18 years of age and adults, as this service is focused on assisting clients to live independently. Persons under 18 may still be eligible for Mental Health Support Serviced if medical necessity criteria are met. This service is not a substitution for mental health counseling or psychotherapy.

MENTAL HEALTH SUPPORT ELIGIBILITY CRITERIA

Individuals must demonstrate a clinical need for the service arising from a condition due to mental, behavioral, or emotional illness that results in significant functional impairments in major life activities and affects their ability to remain stabilized in the community. Individuals must meet at least two of the following criteria on a continuing or intermittent basis:

  1. Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization, homelessness, or isolation from social supports.

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

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

  4. 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.

Individuals eligible for this service may have a dual diagnosis of either mental illness and mental retardation or mental illness and substance abuse disorder. If an individual has co-occurring mental health and substance abuse disorders, integrated treatment for both disorders is allowed within Mental Health Support 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 ISP, and the progress notes.

ELIGIBILITY REQUIREMENTS FOR CLIENTS UNDER 18

Individuals Must Meet At Least Two of the Following Eligibility Criteria:

  1. Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization or out-of-home placement because of conflicts with family or community.

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

  3. Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or recognize

Individuals Must Meet At Least One of the Following Criteria:

  1. Services that are far more intensive than outpatient clinic care are required to stabilize the child in the family situation and at least one parent or responsible adult with whom the child is living is willing to participate in in-home services, with the goal of keeping the child with the family.

  2. The child's residence, as the setting for services, is more likely to be successful than a clinic and at least one parent or responsible adult with whom the child is living must be willing to participate in in-home services, with the goal of keeping the child with the family.

 Individuals Must Meet At Least One of the Following Criteria

  1. The child is at risk of being moved to an out-of-home placement due to a documented medical need of the child.

  2. The child is being transitioned to home from out-of-home placement due to a documented medical need of the child.