Common use of Community Mental Health Center Services Clause in Contracts

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge October - December 2020 July - September 2020 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 0 1 Individual’s Clinical Need Does Not Meet ACT Criteria 0 0 Individual Placed on ACT Waitlist 0 1 Individual Awaiting CMHC Determination for ACT 6 14

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge October April - December June 2020 July January - September March 2020 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 1 0 1 Individual’s Clinical Need Does Not Meet ACT Criteria 0 0 1 Individual Placed on ACT Waitlist 0 1* 1 Individual Awaiting CMHC Determination for ACT 6 14** 15

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge October - December 2020 2019 July - September 2020 2019 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 1 0 Individual’s Insurance Does Not Cover ACT Services 0 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 0 2 3 Individual Placed on ACT Waitlist 0 1 0 Individual Awaiting CMHC Determination for ACT 6 148 6

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge October July – September 2021 April - December 2020 July - September 2020 June 2021 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 1 0 Individual’s Insurance Does Not Cover ACT Services 0 1 Individual’s Clinical Need Does Not Meet ACT Criteria 0 0 5 2 Individual Placed on ACT Waitlist 0 1 0 Individual Awaiting CMHC Determination for ACT 6 145 11

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge January - March 2020 October - December 2020 July - September 2020 2019 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 1 Individual’s Insurance Does Not Cover ACT Services 0 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 0 1 2 Individual Placed on ACT Waitlist 1 0 1 Individual Awaiting CMHC Determination for ACT 6 1415 8

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge October - December 2020 July - September 2020 2019 April - March 2019 Not Available in Individual’s Town of Residence 0 0 Individual Declined Refused 0 0 1 Individual’s Insurance Does Not Cover ACT Services 0 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 0 3 2 Individual Placed on ACT Waitlist 0 1 Individual Awaiting CMHC Determination for ACT 6 147

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge January - March 2021 October - December 2020 July - September 2020 Not Available in Individual’s Town of Residence 0 1 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 0 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 5 0 Individual Placed on ACT Waitlist 0 1 0 Individual Awaiting CMHC Determination for ACT 6 144 6

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge October - December 2020 July - September 2020 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 0 1 2 Individual’s Clinical Need Does Not Meet ACT Criteria 0 0 1 2 Individual Placed on ACT Waitlist 1 0 1 Individual Awaiting CMHC Determination for ACT 6 144 5

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge October - December 2020 July - September 2020 April - June 2020 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 0 1 Individual’s Clinical Need Does Not Meet ACT Criteria 0 0 Individual Placed on ACT Waitlist 0 1 Individual Awaiting CMHC Determination for ACT 6 7 14