Pennsylvania Mental Health and Substance Abuse ... - SAMHSA Store

PennsylvaniaData as of July 2003per 365-day periodInpatient Psychiatric Services (for persons under the age of 25)Service Description Coverage RequirementsInpatient PsychiatricFacility Services forindividuals under 22years of ageEvaluation, diagnostic and treatment services Provided without LimitationRehabilitative ServicesService Description Coverage RequirementsFamily-Based MentalHealth RehabilitativeServicesMental Health CrisisIntervention ServicesCommunity BasedMental HealthRehabilitativeServicesComprehensive mental healthservice provided primarily in thehome of a child or adolescent,including• assessment,• planning,• treatment (includingpsychotherapy/counseling(individual, group, and family);• play therapy;• recreational therapy;• behavior modeling andmodification;• cognitive therapy;• rational/emotive therapy;• reality therapy;• communication skills;• coping skills;• assertiveness training;• parenting skills;• sensitivity training; and• supportive services.Services include intervention,assessment, counseling,screening, and disposition.Services include psychiatric,medical, and psychological testing;art therapy, movement therapy,and music therapy; psychotherapyand counseling (includingindividual, group, and family);rehabilitation services; andmedication management.• To qualify for services a beneficiary must- Be under age 21- Have a mental illness or a serious behaviordisorder- At risk for psychiatric hospitalization andother out of the home placements.• Beneficiaries may only receive services fromproviders that are licensed as family basedmental health rehabilitative providers.• Services must be recommended by a physicianor licensed psychologist.• Services limited to a 32-week period starting onthe first date of service. Extensions must beapproved by the Department and deemedmedically necessary.• Beneficiaries must receive services fromproviders that are licensed as mental healthcrisis intervention providers• Services must be ordered by a physician orother licensed provider within the scope ofhis/her practice.• Beneficiaries must receive services fromproviders that are licensed as communitymental health treatment team providersTargeted Case ManagementService Description Coverage RequirementsTargeted CaseManagement forChildrenServices to assist qualifiedbeneficiaries to gain access tomedical, educational rehabilitativeand social services, includinglocating, coordinating andmonitoring services.• To qualify for services beneficiaries must- be under age 21- have a severe mental illness or emotionaldisturbance• Services may only be delivered as part of anactive treatment plan• Beneficiaries cannot receive services that areintegral part of another medical assistanceprogram or inpatient programInformation as reported by state Medicaid and SCHIP agencies Pennsylvania page 5 of 7