Clinical Criteria

1. 1. INTRODUCTION (PDF)
   • 1.10 Clinical Philosophy
   • 1.20 Determining Medical Necessity
   • 1.30 Determining the Appropriate Level of Care
   • 1.40 Evaluating Necessity for Continued Care
   • 1.50 Discharge Criteria
   • 1.60 Clinical Criteria Development
   • 1.70 Account Specific Variations
2. 2. ADULT MENTAL HEALTH FACILITIES AND PROGRAMS
   1. 2.10 EMERGENCY/CRISIS SERVICES
      • 2.101 Crisis Response Team/Mobile Crisis Team (PDF)
      • 2.102 23-Hour Crisis Observation, Evaluation, Holding, and Stabilization (PDF)
      • 2.103 Crisis Residential/Crisis Stabilization Unit (PDF)
   2. 2.20 INPATIENT SERVICES
      • 2.201 Acute Inpatient Mental Health (PDF)
   3. 2.30 RESIDENTIAL TREATMENT SERVICES
      • 2.301 Residential Treatment Center (RTC) (PDF)
      • 2.302 Group Homes (PDF)
   4. 2.40 STRUCTURED DAY TREATMENT SERVICES
      • 2.401 Partial Hospitalization (PDF)
      • 2.402 Day Treatment (PDF)
      • 2.403 Intensive Outpatient Programs (PDF)
   5. 2.50 CASE MANAGEMENT SERVICES
      • 2.501 Case Management (PDF)
      • 2.502 Intensive Case Management (PDF)
      • 2.503 Assertive Community Treatment (Retired)
      • 2.504 Intensive Care Management (Adult) (PDF)
   6. 2.60 OUTPATIENT SERVICES
      • 2.601 Outpatient Services (PDF)
      • 2.602 Therapeutic Stabilization (Retired)
      • 2.603 Medication Management (PDF)
      • 2.604 Psychological Testing (PDF)
      • 2.605 Applied Behavioral Analysis (ABA) (PDF)
   7. 2.70 EMPLOYEE ASSISTANCE SERVICES Employee Assistance Program (EAP) – (See Guidelines)
   8. 2.80 COMMUNITY SUPPORT SERVICES
      • 2.801 Housing Programs
      • 2.802 Supported Education
      • 2.803 Vocational Rehabilitation
      • 2.804 Clubhouse Program
      • 2.805 Prevention Services
      • 2.806 Representative Payee Program
      • 2.807 Guardianship Program
      • 2.808 Family Support/Treatment Program
      • 2.809 Family Education and Training Program
   9. 2.90 CONSUMER-OPERATED SERVICES (PDF)
      • 2.901 Warm Line
      • 2.902 Safe House
      • 2.903 Peer Case Management
      • 2.904 Drop-In Center
      • 2.905 Recovery Group
      • 2.906 Peer Advocacy
      • 2.907 Peer-Run Housing
      • 2.908 Peer-Run Employment Services
3. 3. CHILD/ADOLESCENT MENTAL HEALTH FACILITIES AND PROGRAMS
   1. 3.10 EMERGENCY/CRISIS SERVICES
      • 3.101 Crisis Response Team/Mobile Crisis Team (PDF)
      • 3.102 23-Hour Crisis Observation, Evaluation, Holding, and Stabilization (PDF)
      • 3.103 Crisis Residential/Crisis Stabilization Unit (PDF)
   2. 3.20 INPATIENT SERVICES
      • 3.201 Acute Inpatient Mental Health (PDF)
   3. 3.30 RESIDENTIAL TREATMENT SERVICES
      • 3.301 Residential Treatment Center (RTC) (PDF)
      • 3.302 Group Home (PDF)
      • 3.303 Therapeutic Foster Care (PDF)
   4. 3.40 STRUCTURED DAY TREATMENT SERVICES
      • 3.401 Partial Hospitalization (PDF)
      • 3.402 Extended Day Treatment (PDF)
      • 3.403 Intensive Outpatient Programs (PDF)
   5. 3.50 CASE MANAGEMENT SERVICES
      • 3.501 Case Management (PDF)
      • 3.502 Intensive Case Management (PDF)
      • 3.503 Assertive Community Treatment (Retired)
      • 3.504 Intensive Care Management (Child/Adolescent) (PDF)
   6. 3.60 HOME/COMMUNITY SERVICES
      • 3.601 Family Stabilization (PDF)
   7. 3.70 OUTPATIENT SERVICES
      1. 3.701 Outpatient Services (PDF)
      2. 3.702 Therapeutic Stabilization (Retired)
      3. 3.703 Medication Management (PDF)
      4. 3.704 Psychological Testing (PDF)
         • 3.704.1 Request for Medical Necessity Determination for Psychological Testing (PDF)
         • 3.704.2 Sample Psychological Testing Evaluation Form (Retired)
         • 3.704.3 List of Psychological Tests (PDF)
4. 4. SUBSTANCE ABUSE PROGRAMS: ADULT AND CHILD/ADOLESCENT. SUBSTANCE ABUSE ValueOptions uses the ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders: Second Edition (ASAM PPC-2) published by the American Society of Addiction Medicine, Inc.
   • ValueOptions^® follows the criteria developed by the American Society of Addiction Medicine (ASAM) for treating adult and children/adolescent issues with substance abuse. If you do not already have a copy of the ASAM criteria, you can order it by going to the following Web site: www.asam.org/publications/patient-placement-criteria or call ASAM at 800-844-8948.
5. 5. CHILD WELFARE CRITERIA (Retired)
6. 6. DISABILITY CRITERIA
   • 6.101 Psychiatric Short-Term Disability (STD) Benefit Determinations (Retired)
   • 6.102 Psychiatric Long-Term Disability (LTD) Benefit Determinations (Retired)
   • 6.103 Psychiatric Disability Determination Criteria for Dependents (PDF)