CONSUMER ADMISSIONS, RE-EVALUATIONS, TRANSFERS, DISCHARGES & DELIVERY OF QUALITY MEDICALLY NECESSARY SERVICES

CONSUMER ADMISSIONS, RE-EVALUATIONS, TRANSFERS, DISCHARGES & DELIVERY OF QUALITY MEDICALLY NECESSARY SERVICES

POLICY        In accordance with Critical Access Behavioral Health Agency guidelines, The Ship Group Community Services has developed Policies and Procedures for consumer admission, re-evaluation, transfer, and discharge. Clinicians will make every effort to follow procedures and timelines as outlined to ensure that processes from referral to service delivery are expedited responsibly and in accordance with clinical scopes of practice relative to consumer therapeutic needs. In accordance with our agency’s mission statement, education, safety, compassion, and self-determination are always considered in our promotion of behavioral health from the first point of contact to the last. 

OBJECTIVE: To outline the process for admissions, re-evaluations, transfers and discharges, including timelines, to provide clarity for staff and consumers relative to the delivery of quality, medically necessary services.

PROCEDURES

Admissions

STEP 1    Once a referral is received from the consumer’s Primary Care Physician, the LME, etc., a 

Pre-Admission Screening is completed based on triage severity criteria (within 1 hr if emergent, within 48 hours if urgent or within 10 days if routine). It is during this screening that preliminary appropriateness for services is determined based on service definition criteria.

STEP 2 

(A) Consumers who are found to be inappropriate for agency services are then referred to other community agencies/resources after a thorough Case Review. Documentation of this meeting having occurred will be maintained in either a Case Communication Note or a Progress Note.

(B) Consumers considered to be appropriate for services complete an Intake Packet (Part 1) within 24 hours of the Pre-Admission Screening, followed by a Comprehensive Clinical Assessment (CCA) within 48 hours.

STEP 3    Once the CCA is complete, an appointment will be made for a psychiatric evaluation, if indicated, as well as appropriate appointments and referrals for additional treatment recommendations as outlined by the clinical team in the Treatment Recommendations and/or Interdisciplinary Team Note sections of the CCA.

STEP 4    In the event that the clinical presentation aligns with program admission criteria and the consumer is prepared to engage in treatment (appropriate for service), the consumer’s case is then discussed in a Treatment Team Meeting / Case Review, where a treatment plan including an Initial Person Centered Plan (PCP) and Crisis Plan are developed and appropriate case assignments made.

STEP 5    If services require prior authorization (enhanced services & targeted case management) the CCA and PCP are then sent to the MD/NP/PA for review / signature and later submitted within 7 – 10 days for authorization.

STEP 6    Once authorized, the consumer would complete Intake Packet (Part 2) / the Welcome Packet and immediately begin services.

Enhanced Services

Refer to policies and procedures for providing enhanced services, specifically Service Definition/Program Descriptions.

Targeted Case Management

Refer to policies and procedures for admissions as above.

Outpatient Therapy

Refer to policies and procedures for providing Outpatient Therapy.

Medication Management

Refer to policies and procedures for providing Medication Management Services

(Also see Phases of Service Delivery Protocol)

Re-evaluations

All consumers will be evaluated annually to assess for any significant change in psychological, social or medical functioning. Additionally, re-evaluations will be completed when a significant change in clinical functioning and/or service needs is identified. These re-evaluations will be documented in the form of a new CCA or an addendum to an existing CCA. See Protocol for Re-evaluations (page 222)

Transfers

Consumers will be transferred to another service/level of care when they no longer meet criteria for the current service. Refer to specific Program Descriptions and Level of Care Graduation of Intensities protocol / pyramids. In such cases, the clinical justification for this change will be documented in an updated PCP and possibly in an addendum to an existing CCA following review by the clinical treatment team.

Discharges

Consumers will be discharged from treatment for a number of reasons including improvement (no longer meet treatment criteria), lack of interest or motivation, noncompliance, and/or upon request. In such cases, the clinical justification for the discharge will be documented in an updated PCP and a Discharge Summary following a discussion with the clinical treatment team. A copy of the Discharge Summary is made available for the consumer and other members of the consumer’s healthcare team, such as the Primary Care Physician, upon written authorization (Authorization to Disclose Protected Health Information) by the consumer or his/her legally responsible party.