Common use of Diversionary Behavioral Health Services Clause in Contracts

Diversionary Behavioral Health Services. Diversionary behavioral health services are home and community-based mental health and substance use disorder services furnished as clinically appropriate alternatives to and diversions from inpatient mental health and substance use disorder services in more community- based, less structured environments. Diversionary services are also provided to support an individual’s return to the community following a 24-hour acute placement; or to provide intensive support to maintain functioning in the community. There are two categories of diversionary services, those provided in a 24-hour facility, and those which are provided on an outpatient basis in a non-24-hour setting or facility. Generally, 24-hour and non- 24 hour diversionary behavioral health services are provided by free-standing (community- based) or hospital-based programs licensed by the Department of Mental Health or the Department of Public Health. Some of the 24 hour service providers of Diversionary Behavioral Health Services meet the definition of an Institution for Mental Diseases (IMD). Diversionary services are offered to provide interventions and stabilization to persons experiencing mental health or substance abuse crises in order to divert from acute inpatient hospitalization or to stabilize after discharge. These services do not include residential programs involving long-term residential stays. Any MassHealth member under the demonstration who is enrolled in managed care may be eligible to receive diversionary services. Managed care entities and the Prepaid Inpatient Health Plan (PIHP) for behavioral health services identify appropriate individuals to receive diversionary services. Managed care entities maintain a network of diversionary services and arrange, coordinate, and oversee the provision of medically necessary diversionary services, as described in Table C. Table C. Diversionary Behavioral Health Services Provided Through Managed Care Under the Demonstration Diversionary Behavioral Health Setting Definition of Service Community Crisis Stabilization 24-hour facility Services provided as an alternative to hospitalization, including short- term psychiatric treatment in structured, community-based therapeutic environments. Community Crisis Stabilization provides continuous 24-hour observation and supervision for Covered Individuals who do not require Inpatient Services. Community Support Program (CSP) Non-24-hour facility An array of services delivered by a community-based, mobile, multi-disciplinary team of professionals and paraprofessionals. These programs provide essential services to Covered Individuals with a long-standing history of a psychiatric or substance use disorder and to their families, or to Covered Individuals who are at varying degrees of increased medical risk, or to children/adolescents who have behavioral health issues challenging their optimal level of functioning in the home/community setting. Services include outreach and supportive services, delivered in a community setting, which will vary with respect to hours, type and intensity of services depending on the changing needs of the Enrollee. Community Support Program (CSP) (continued) Non-24-hour facility When provided to chronically homeless individuals, CSP services fall into the following domains: Assisting Members in enhancing daily living skills; Identifying and addressing barriers to attaining and maintaining community tenure Supporting members to mitigate barriers to community tenure, including coaching and connection with social services that assist them with issues such as credit history, presence of criminal record, and poor housing history Coaching members on budget strategies and/or supporting Members to connect with money management services, including financial counselors and representative payees Support to gather documentation such as government identification documents, medical records Linkages to education, vocational training/services Providing service coordination and linkages; Referrals to healthcare providers Providers make reasonable efforts to assist Members identify and/or facilitate transportation options, including community-based transportation resources, such as public transportation and/or community- or publically- subsidized transportation options Collaborating with state agencies, outpatient or community-based providers, Emergency Services Programs (ESPs), or other significant entities on service and discharge Community Support Program (CSP) (continued) Non-24-hour facility planning Discharge planning that involves collaterals as appropriate. Collaterals include state agencies, community-based programs, and other non-health care community supports Provider coordinates care with Members’ primary care providers to be knowledgeable of medical conditions, to assess Members’ compliance with medical treatment, and to assist with mitigating related barriers Assisting Members with obtaining benefits, housing, and health care; Providers work with housing agencies to obtain documentation of housing status Working with Members to identify transitional supports for move-in Connecting Members to housing search assistance, and helping to coordinate search(es) Linkages to primary and preventive health services Linkages to behavioral health and substance use disorder treatment Assistance with enrolling in community benefits (Social Security benefits, SNAP, VA benefits, MassHealth, Medicare, etc.) including obtaining needed documentation and helping to complete applications and attend appointments Working with Member to identify resources for home modifications as needed Developing a crisis plan in the event of a psychiatric crisis; Refer the Member to outpatient provider Refer the Member to an ESP Implement other interventions such as Member’s safety plan Community Support Program (CSP) (continued) Non-24-hour facility Collaborate with providers (including ESPs) and natural supports Providing prevention and intervention; Comprehensive assessment of needs (behavioral health, medical, substance use, developmental, and social history; linguistic and cultural background; mental status examination; medications and allergies; barriers to housing; diagnosis and clinical formulation supported by the clinical data gathered, rationale for treatment, and recommendations; level of functioning; and key providers) to identify ways to mitigate barriers to accessing clinical treatment and attaining the skills to obtain and maintain community tenure Developing a service plan/treatment plan (linkages to health, behavioral health, and substance use treatment) Assisting Members to prepare for transition to permanent supportive housing by linking Members to entities that provide transitional assistance resources. This may include referrals to churches, local housing authorities and non-profit agencies. Transitional assistance includes non-recurring household set-up expenses Discharge planning that involves collaterals Early intervention for potential issues/behavior intervention affecting tenancy Fostering empowerment and recovery, including linkages to peer support and self-help groups Community Support Program (CSP) (continued) Non-24-hour facility Recovery, wellness and empowerment principles and practices are incorporated in service delivery, trainings, and quality improvement activities Facilitates the use of formal and informal resources including community and natural support systems, wellness programs, vocational assistance programs, and peer and self-help supports and services Provider educates Members and their natural supports about substance use and psychiatric disorders, recovery and medications, and links with regular health services

Diversionary Behavioral Health Services. Diversionary behavioral health services are home and community-based mental health and substance use disorder services furnished as clinically appropriate alternatives to and diversions from inpatient mental health and substance use disorder services in more community- based, less structured environments. Diversionary services are also provided to support an individual’s return to the community following a 24-hour acute placement; or to provide intensive support to maintain functioning in the community. There are two categories of diversionary services, those provided in a 24-hour facility, and those which are provided on an outpatient basis in a non-24-hour setting or facility. Generally, 24-hour and non- 24 hour diversionary behavioral health services are provided by free-standing (community- based) or hospital-based programs licensed by the Department of Mental Health or the Department of Public Health. Some of the 24 hour service providers of Diversionary Behavioral Health Services meet the definition of an Institution for Mental Diseases (IMD). Diversionary services are offered to provide interventions and stabilization to persons experiencing mental health or substance abuse crises in order to divert from acute inpatient hospitalization or to stabilize after discharge. These services do not include residential programs involving long-term residential stays. Any MassHealth member under the demonstration who is enrolled in managed care may be eligible to receive diversionary services. Managed care entities and the Prepaid Inpatient Health Plan (PIHP) for behavioral health services identify appropriate individuals to receive diversionary services. Managed care entities maintain a network of diversionary services and arrange, coordinate, and oversee the provision of medically necessary diversionary services, as described in Table C. Table C. Diversionary Behavioral Health Services Provided Through Managed Care Under the Demonstration Diversionary Behavioral Health Setting Definition of Service Community Crisis Stabilization 24-hour facility Services provided as an alternative to hospitalization, including short- term psychiatric treatment in structured, community-based therapeutic environments. Community Crisis Stabilization provides continuous 24-hour observation and supervision for Covered Individuals who do not require Inpatient Services. Community Support Program (CSP) Non-24-hour facility An array of services delivered by a community-based, mobile, multi-disciplinary team of professionals and paraprofessionals. These programs provide essential services to Covered Individuals with a long-standing history of a psychiatric or substance use disorder and to their families, or to Covered Individuals who are at varying degrees of increased medical risk, or to children/adolescents who have behavioral health issues challenging their optimal level of functioning in the home/community setting. Services include outreach and supportive services, delivered in a community setting, which will vary with respect to hours, type and intensity of services depending on the changing needs of the Enrollee. Community Support Program (CSP) (continued) Non-24-hour facility When provided to chronically homeless individuals, CSP services fall into the following domains: Assisting Members in enhancing daily living skills; Identifying and addressing barriers to attaining and maintaining community tenure Supporting members to mitigate barriers to community tenure, including coaching and connection with social services that assist them with issues such as credit history, presence of criminal record, and poor housing history Coaching members on budget strategies and/or supporting Members to connect with money management services, including financial counselors and representative payees Support to gather documentation such as government identification documents, medical records Linkages to education, vocational training/services Providing service coordination and linkages; Referrals to healthcare providers Providers make reasonable efforts to assist Members identify and/or facilitate transportation options, including community-based transportation resources, such as public transportation and/or community- or publically- subsidized transportation options Collaborating with state agencies, outpatient or community-based providers, Emergency Services Programs (ESPs), or other significant entities on service and discharge Community Support Program (CSP) (continued) Non-24-hour facility planning Discharge planning that involves collaterals as appropriate. Collaterals include state agencies, community-based programs, and other non-health care community supports Provider coordinates care with Members’ primary care providers to be knowledgeable of medical conditions, to assess Members’ compliance with medical treatment, and to assist with mitigating related barriers Assisting Members with obtaining benefits, housing, and health care; Providers work with housing agencies to obtain documentation of housing status Working with Members to identify transitional supports for move-in Connecting Members to housing search assistance, and helping to coordinate search(es) Linkages to primary and preventive health services Linkages to behavioral health and substance use disorder treatment Assistance with enrolling in community benefits (Social Security benefits, SNAP, VA benefits, MassHealth, Medicare, etc.) including obtaining needed documentation and helping to complete applications and attend appointments Working with Member to identify resources for home modifications as needed Developing a crisis plan in the event of a psychiatric crisis; Refer Xxxxx the Member to outpatient provider Refer the Member to an ESP Implement other interventions such as Member’s safety plan Community Support Program (CSP) (continued) Non-24-hour facility Collaborate with providers (including ESPs) and natural supports Providing prevention and intervention; Comprehensive assessment of needs (behavioral health, medical, substance use, developmental, and social history; linguistic and cultural background; mental status examination; medications and allergies; barriers to housing; diagnosis and clinical formulation supported by the clinical data gathered, rationale for treatment, and recommendations; level of functioning; and key providers) to identify ways to mitigate barriers to accessing clinical treatment and attaining the skills to obtain and maintain community tenure Developing a service plan/treatment plan (linkages to health, behavioral health, and substance use treatment) Assisting Members to prepare for transition to permanent supportive housing by linking Members to entities that provide transitional assistance resources. This may include referrals to churches, local housing authorities and non-profit agencies. Transitional assistance includes non-recurring household set-up expenses Discharge planning that involves collaterals Early intervention for potential issues/behavior intervention affecting tenancy Fostering empowerment and recovery, including linkages to peer support and self-help groups Community Support Program (CSP) (continued) Non-24-hour facility Recovery, wellness and empowerment principles and practices are incorporated in service delivery, trainings, and quality improvement activities Facilitates the use of formal and informal resources including community and natural support systems, wellness programs, vocational assistance programs, and peer and self-help supports and services Provider educates Members and their natural supports about substance use and psychiatric disorders, recovery and medications, and links with regular health services

Diversionary Behavioral Health Services. Diversionary behavioral health services are home and community-based mental health and substance use disorder services furnished as clinically appropriate alternatives to and diversions from inpatient mental health and substance use disorder services in more community- based, less structured environments. Diversionary services are also provided to support an individual’s return to the community following a 24-hour acute placement; or to provide intensive support to maintain functioning in the community. There are two categories of diversionary services, those provided in a 24-hour facility, and those which are provided on an outpatient basis in a non-24-hour setting or facility. Generally, 24-hour and non- 24 hour diversionary behavioral health services are provided by free-standing (community- based) or hospital-based programs licensed by the Department of Mental Health or the Department of Public Health. Some of the 24 hour service providers of Diversionary Behavioral Health Services meet the definition of an Institution for Mental Diseases (IMD). Diversionary services are offered to provide interventions and stabilization to persons experiencing mental health or substance abuse crises in order to divert from acute inpatient hospitalization or to stabilize after discharge. These services do not include residential programs involving long-term residential stays. Any MassHealth member under the demonstration who is enrolled in managed care may be eligible to receive diversionary services. Managed care entities and the Prepaid Inpatient Health Plan (PIHP) for behavioral health services identify appropriate individuals to receive diversionary services. Managed care entities maintain a network of diversionary services and arrange, coordinate, and oversee the provision of medically necessary diversionary services, as described in Table C. Table C. Diversionary Behavioral Health Services Provided Through Managed Care Under the Demonstration Diversionary Behavioral Health Setting Definition of Service Community Crisis Stabilization 24-hour facility Services provided as an alternative to hospitalization, including short- term psychiatric treatment in structured, community-based therapeutic environments. Community Crisis Stabilization provides continuous 24-hour observation and supervision for Covered Individuals who do not require Inpatient Services. Community Support Program (CSP) Non-24-hour facility An array of services delivered by a community-based, mobile, multi-multi- disciplinary team of professionals and paraprofessionals. These programs provide essential services to Covered Individuals with a long-standing history of a psychiatric or substance use disorder and to their families, or to Covered Individuals who are at varying degrees of increased medical risk, or to children/adolescents who have behavioral health issues challenging their optimal level of functioning in the home/community setting. Services include outreach and supportive services, delivered in a community setting, which will vary with respect to hours, type and intensity of services depending on the changing needs of the Enrollee. Community Support Program (CSP) (continued) Non-24-hour facility When provided to chronically homeless individuals, CSP services fall into the following domains: Assisting Members in enhancing daily living skills; Identifying and addressing barriers to attaining and maintaining community tenure Supporting members to mitigate barriers to community tenure, including coaching and connection with social services that assist them with issues such as credit history, presence of criminal record, and poor housing history Coaching members on budget strategies and/or supporting Members to connect with money management services, including financial counselors and representative payees Support to gather documentation such as government identification documents, medical records Linkages to education, vocational training/services Providing service coordination and linkages; Referrals to healthcare providers Providers make reasonable efforts to assist Members identify and/or facilitate transportation options, including community-based transportation resources, such as public transportation and/or community- or publically- subsidized transportation options Collaborating with state agencies, outpatient or community-based providers, Emergency Services Programs (ESPs), or other significant entities on service and discharge Community Support Program (CSP) (continued) Non-24-hour facility planning Discharge planning that involves collaterals as appropriate. Collaterals include state agencies, community-based programs, and other non-health care community supports Provider coordinates care with Members’ primary care providers to be knowledgeable of medical conditions, to assess Members’ compliance with medical treatment, and to assist with mitigating related barriers Assisting Members with obtaining benefits, housing, and health care; Providers work with housing agencies to obtain documentation of housing status Working with Members to identify transitional supports for move-in Connecting Members to housing search assistance, and helping to coordinate search(es) Linkages to primary and preventive health services Linkages to behavioral health and substance use disorder treatment Assistance with enrolling in community benefits (Social Security benefits, SNAP, VA benefits, MassHealth, Medicare, etc.) including obtaining needed documentation and helping to complete applications and attend appointments Working with Member to identify resources for home modifications as needed Developing a crisis plan in the event of a psychiatric crisis; Refer the Member to outpatient provider Refer the Member to an ESP Implement other interventions such as Member’s safety plan Community Support Program (CSP) (continued) Non-24-hour facility Collaborate with providers (including ESPs) and natural supports Providing prevention and intervention; Comprehensive assessment of needs (behavioral health, medical, substance use, developmental, and social history; linguistic and cultural background; mental status examination; medications and allergies; barriers to housing; diagnosis and clinical formulation supported by the clinical data gathered, rationale for treatment, and recommendations; level of functioning; and key providers) to identify ways to mitigate barriers to accessing clinical treatment and attaining the skills to obtain and maintain community tenure Developing a service plan/treatment plan (linkages to health, behavioral health, and substance use treatment) Assisting Members to prepare for transition to permanent supportive housing by linking Members to entities that provide transitional assistance resources. This may include referrals to churches, local housing authorities and non-profit agencies. Transitional assistance includes non-recurring household set-up expenses Discharge planning that involves collaterals Early intervention for potential issues/behavior intervention affecting tenancy Fostering empowerment and recovery, including linkages to peer support and self-help groups Community Support Program (CSP) (continued) Non-24-hour facility Recovery, wellness and empowerment principles and practices are incorporated in service delivery, trainings, and quality improvement activities Facilitates the use of formal and informal resources including community and natural support systems, wellness programs, vocational assistance programs, and peer and self-help supports and services Provider educates Members and their natural supports about substance use and psychiatric disorders, recovery and medications, and links with regular health services

Diversionary Behavioral Health Services. Diversionary behavioral health services are home and community-based mental health and substance use disorder services furnished as clinically appropriate alternatives to and diversions from inpatient mental health and substance use disorder services in more community- based, less structured environments. Diversionary services are also provided to support an individual’s return to the community following a 24-hour acute placement; or to provide intensive support to maintain functioning in the community. There are two categories of diversionary services, those provided in a 24-hour facility, and those which are provided on an outpatient basis in a non-24-hour setting or facility. Generally, 24-hour and non- 24 hour diversionary behavioral health services are provided by free-standing (community- based) or hospital-based programs licensed by the Department of Mental Health or the Department of Public Health. Some of the 24 hour service providers of Diversionary Behavioral Health Services meet the definition of an Institution for Mental Diseases (IMD). Diversionary services are offered to provide interventions and stabilization to persons experiencing mental health or substance abuse crises in order to divert from acute inpatient hospitalization or to stabilize after discharge. These services do not include residential programs involving long-term residential stays. Any MassHealth member under the demonstration who is enrolled in managed care may be eligible to receive diversionary services. Managed care entities and the Prepaid Inpatient Health Plan (PIHP) for behavioral health services identify appropriate individuals to receive diversionary services. Managed care entities maintain a network of diversionary services and arrange, coordinate, and oversee the provision of medically necessary diversionary services, as described in Table C. Table C. Diversionary Behavioral Health Services Provided Through Managed Care Under the Demonstration Diversionary Behavioral Health Setting Definition of Service Community Crisis Stabilization 24-hour facility Services provided as an alternative to hospitalization, including short- term psychiatric treatment in structured, community-based therapeutic environments. Community Crisis Stabilization provides continuous 24-hour observation and supervision for Covered Individuals who do not require Inpatient Services. Community Support Program (CSP) Non-24-hour facility An array of services delivered by a community-based, mobile, multi-disciplinary team of professionals and paraprofessionals. These programs provide essential services to Covered Individuals with a long-standing history of a psychiatric or substance use disorder and to their families, or to Covered Individuals who are at varying degrees of increased medical risk, or to children/adolescents who have behavioral health issues challenging their optimal level of functioning in the home/community setting. Services include outreach and supportive services, delivered in a community setting, which will vary with respect to hours, type and intensity of services depending on the changing needs of the Enrollee. Community Support Program (CSP) (continued) Non-24-hour facility When provided to chronically homeless individuals, CSP services fall into the following domains: Assisting Members in enhancing daily living skills; Identifying and addressing barriers to attaining and maintaining community tenure Supporting members to mitigate barriers to community tenure, including coaching and connection with social services that assist them with issues such as credit history, presence of criminal record, and poor housing history Coaching members on budget strategies and/or supporting Members to connect with money management services, including financial counselors and representative payees Support to gather documentation such as government identification documents, medical records Linkages to education, vocational training/services Providing service coordination and linkages; Referrals to healthcare providers Providers make reasonable efforts to assist Members identify and/or facilitate transportation options, including community-based transportation resources, such as public transportation and/or community- or publically- subsidized transportation options Collaborating with state agencies, outpatient or community-based providers, Emergency Services Programs (ESPs), or other significant entities on service and discharge Community Support Program (CSP) (continued) Non-24-hour facility planning Discharge planning that involves collaterals as appropriate. Collaterals include state agencies, community-based programs, and other non-health care community supports Provider coordinates care with Members’ primary care providers to be knowledgeable of medical conditions, to assess Members’ compliance with medical treatment, and to assist with mitigating related barriers Assisting Members with obtaining benefits, housing, and health care; Providers work with housing agencies to obtain documentation of housing status Working with Members to identify transitional supports for move-in Connecting Members to housing search assistance, and helping to coordinate search(es) Linkages to primary and preventive health services Linkages to behavioral health and substance use disorder treatment Assistance with enrolling in community benefits (Social Security benefits, SNAP, VA benefits, MassHealth, Medicare, etc.) including obtaining needed documentation and helping to complete applications and attend appointments Working with Member to identify resources for home modifications as needed Developing a crisis plan in the event of a psychiatric crisis; Refer the Member to outpatient provider Refer the Member to an ESP Implement other interventions such as Member’s safety plan Community Support Program (CSP) (continued) Non-24-hour facility Collaborate with providers (including ESPs) and natural supports Providing prevention and intervention; Comprehensive assessment of needs (behavioral health, medical, substance use, developmental, and social history; linguistic and cultural background; mental status examination; medications and allergies; barriers to housing; diagnosis and clinical formulation supported by the clinical data gathered, rationale for treatment, and recommendations; level of functioning; and key providers) to identify ways to mitigate barriers to accessing clinical treatment and attaining the skills to obtain and maintain community tenure Developing a service plan/treatment plan (linkages to health, behavioral health, and substance use treatment) Assisting Members to prepare for transition to permanent supportive housing by linking Members to entities that provide transitional assistance resources. This may include referrals to churches, local housing authorities and non-profit agencies. Transitional assistance includes non-recurring household set-up expenses Discharge planning that involves collaterals Early intervention for potential issues/behavior intervention affecting tenancy Fostering empowerment and recovery, including linkages to peer support and self-help groups Community Support Program (CSP) (continued) Non-24-hour facility Recovery, wellness and empowerment principles and practices are incorporated in service delivery, trainings, and quality improvement activities Facilitates the use of formal and informal resources including community and natural support systems, wellness programs, vocational assistance programs, and peer and self-help supports and services Provider educates Members and their natural supports about substance use and psychiatric disorders, recovery and medications, and links with regular health servicesC.

Diversionary Behavioral Health Services. Diversionary behavioral health services are home and community-based mental health and substance use disorder services furnished as clinically appropriate alternatives to and diversions from inpatient mental health and substance use disorder services in more community- based, less structured environments. Diversionary services are also provided to support an individual’s return to the community following a 24-hour acute placement; or to provide intensive support to maintain functioning in the community. There are two categories of diversionary services, those provided in a 24-hour facility, and those which are provided on an outpatient basis in a non-24-hour setting or facility. Generally, 24-hour and non- 24 hour diversionary behavioral health services are provided by free-standing (community- based) or hospital-based programs licensed by the Department of Mental Health or the Department of Public Health. Some of the 24 hour service providers of Diversionary Behavioral Health Services meet the definition of an Institution for Mental Diseases (IMD). Diversionary services are offered to provide interventions and stabilization to persons experiencing mental health or substance abuse crises in order to divert from acute inpatient hospitalization or to stabilize after discharge. These services do not include residential programs involving long-term residential stays. Any MassHealth member under the demonstration who is enrolled in managed care may be eligible to receive diversionary services. Managed care entities and the Prepaid Inpatient Health Plan (PIHP) for behavioral health services identify appropriate individuals to receive diversionary services. Managed care entities maintain a network of diversionary services and arrange, coordinate, and oversee the provision of medically necessary diversionary services, as described in Table C. Table C. Diversionary Behavioral Health Services Provided Through Managed Care Under the Demonstration Diversionary Behavioral Health Setting Definition of Service Community Crisis Stabilization 24-hour facility Including IMDs Services provided as an alternative to hospitalization, including short- term psychiatric treatment in structured, community-based therapeutic environments. Community Crisis Stabilization provides continuous 24-hour observation and supervision for Covered Individuals who do not require Inpatient Services. Services are also provided through fee-for-service. Community Support Program (CSP) Non-24-hour facility An array of services delivered by a community-based, mobile, multi-disciplinary team of professionals and paraprofessionals. These programs provide essential services to Covered Individuals with a long-standing history of a psychiatric or substance use disorder and to their families, or to Covered Individuals who are at varying degrees of increased medical risk, or to children/adolescents who have behavioral health issues challenging their optimal level of functioning in the home/community setting. Services include outreach and supportive services, delivered in a community setting, which will vary with respect to hours, type and intensity of services depending on the changing needs of the Enrollee. Community Support Program (CSP) (continued) Non-24-hour facility When provided to chronically homeless individualsindividuals or individuals with justice involvement living in the community1, CSP services fall into the following domains, as applicable to the individual’s needs: Assisting Members in enhancing daily living skills; Identifying and addressing barriers to attaining and maintaining community tenure Supporting members to mitigate barriers to community tenure, including coaching and connection with social services that assist them with issues such as credit history, presence of criminal record, and poor housing history Coaching members on budget strategies and/or supporting Members to connect with money management services, including financial counselors and representative payees Support to gather documentation such as government identification documents, medical records Linkages to education, vocational training/services Providing service coordination and linkages; Referrals to healthcare providers Providers make reasonable efforts to assist Members identify and/or facilitate transportation options, including community-based transportation resources, such as public transportation and/or community- or publically- publicly- subsidized transportation options Collaborating with state agencies, outpatient or community-based providers, Emergency Services Programs (ESPs), criminal justice entities, or other significant entities on service and discharge planning. Community Support Program (CSP) (continued) Non-24-hour facility planning Discharge planning that involves collaterals as appropriate. Collaterals include state agencies, community-based programs, criminal justice entities, and other non-health care community supports Provider coordinates care with Members’ primary care providers to be knowledgeable of medical conditions, to assess Members’ compliance with medical treatment, and to assist with mitigating related barriers Assisting Members with obtaining benefits, housing, and health care; Providers work with housing agencies to obtain documentation of housing status Working with Members to identify transitional supports for move-in Connecting Members to housing search assistance, and helping to coordinate search(es) Linkages to primary and preventive health services Linkages to behavioral health and substance use disorder treatment Assistance with enrolling in community benefits (Social Security benefits, SNAP, VA benefits, MassHealth, Medicare, etc.) including obtaining needed documentation and helping to complete applications and attend appointments Working with Member to identify resources for home modifications as needed Developing a crisis plan in the event of a psychiatric crisis; Refer the Member to outpatient provider Refer the Member to an ESP Implement other interventions such as Member’s safety plan Community Support Program (CSP) (continued) Non-24-hour facility Collaborate with providers (including ESPs) and natural supports Providing prevention and intervention; Comprehensive assessment of needs (behavioral health, medical, substance use, developmental, and social history; linguistic and cultural background; mental status examination; medications and allergies; barriers to housing; diagnosis and clinical formulation supported by the clinical data gathered, rationale for treatment, and recommendations; level of functioning; justice involvement; criminogenic needs; and key providers) to identify ways to mitigate barriers to accessing clinical treatment and attaining the skills to obtain and maintain community tenure Developing a service plan/treatment plan (linkages to health, behavioral health, and substance use treatment; and addressing criminogenic needs) Assisting Members to prepare for transition to permanent supportive housing by linking Members to entities that provide transitional assistance resources. This may include referrals to churches, local housing authorities and non-profit agencies. Transitional assistance includes non-recurring household set-up expenses Discharge planning that involves collaterals Early intervention for potential issues/behavior intervention affecting tenancy or community tenure Fostering empowerment and recovery, including linkages to peer support and self-help groups Community Support Program (CSP) (continued) Non-24-hour facility Recovery, wellness and empowerment principles and practices are incorporated in service delivery, trainings, and quality improvement activities Facilitates the use of formal and informal resources including community and natural support systems, wellness programs, vocational assistance programs, and peer and self-help supports and services Provider educates Members and their natural supports about substance use and psychiatric disorders, recovery and medications, and links with regular health services Partial Hospitalization* Non-24-hour facility An alternative to Inpatient Mental Health Services, PHP services offer short-term day mental health programming available seven days per week. These services consist of therapeutically intensive acute treatment within a stable therapeutic milieu and include daily psychiatric management. Transitional Care Unit Services addressing the needs of children and adolescents, under age 19, in the custody of the Department of Children and Families (DCF), who need group care or xxxxxx care and no longer meet the clinical criteria for continued stay at an acute level of care. 24-hour facility, including IMDs A community based therapeutic program offering high levels of supervision, structure and intensity of service within an unlocked setting. The TCU offers comprehensive services, including but not limited to, a therapeutic milieu**, psychiatry, aggressive case management, and multidisciplinary, multi-modal therapies. Psychiatric Day Treatment* Non-24-hour facility Services which constitute a program of a planned combination of diagnostic, treatment and rehabilitative services provided to a person with mental illness who needs more active or inclusive treatment than is typically available through a weekly visit to a mental health center, individual Provider’s office or hospital outpatient department, but who does not need 24-hour hospitalization. Intensive Outpatient Program Non-24-hour A clinically intensive service designed to improve functional status, provide stabilization in the community, divert an admission to an Inpatient Service, or facilitate a rapid and stable reintegration into the community following a discharge from an inpatient service. The IOP provides time-limited, comprehensive, and coordinated multidisciplinary treatment. Structured Outpatient Addiction Program Non-24-hour facility Clinically intensive, structured day and/or evening substance use disorder services. These programs can be utilized as a transition service in the continuum of care for an Enrollee being discharged from Acute Substance Abuse Treatment, or can be utilized by individuals, who need Outpatient Services, but who also need more structured treatment for a substance use disorder. These programs may incorporate the evidence-based practice of Motivational Interviewing (as defined by Substance Abuse and Mental Health Services Administration) into clinical programming to promote individualized treatment planning. These programs may include specialized services and staffing for targeted populations including pregnant women, adolescents and adults requiring 24-hour monitoring. Program of Assertive Community Treatment Non-24-hour facility A multi-disciplinary team approach to providing acute, active, ongoing, and long-term community-based psychiatric treatment, assertive outreach, rehabilitation and support. The program team provides assistance to Covered Individuals to maximize their recovery, ensure consumer-directed goal setting, assist individuals in gaining a sense of hope and empowerment, and provide assistance in helping the individuals served become better integrated into the community. Services are provided in the community and are available, as needed by the individual, 24 hours per day, seven days per week, 365 days per year. Emergency Services Program* Non-24-hour facility Services provided through designated contracted ESPs, and which are available seven days per week, 24 hours per day to provide treatment of any individual who is experiencing a mental health crisis. Community Based Acute Treatment for Children and Adolescents 24-hour facility Mental health services provided in a staff-secure setting on a 24-hour basis, with sufficient clinical staffing to insure safety for the child or adolescent, while providing intensive therapeutic services including, but not limited to, daily medication monitoring; psychiatric assessment; nursing availability; Specialing (which is defined as one- on- one therapeutic monitoring as needed for individuals who may be at immediate risk for suicide or other self- harming behavior); individual, group and family therapy; case management; family assessment and consultation; discharge planning; and psychological testing, as needed. This service may be used as an alternative to or transition from Inpatient services.

Diversionary Behavioral Health Services. Diversionary behavioral health services are home and community-based mental health and substance use disorder services furnished as clinically appropriate alternatives to and diversions from inpatient mental health and substance use disorder services in more community- based, less structured environments. Diversionary services are also provided to support an individual’s return to the community following a 24-hour acute placement; or to provide intensive support to maintain functioning in the community. There are two categories of diversionary services, those provided in a 24-hour facility, and those which are provided on an outpatient basis in a non-24-hour setting or facility. Generally, 24-hour and non- 24 non-24 hour diversionary behavioral health services are provided by free-standing (community- community-based) or hospital-based programs licensed by the Department of Mental Health or the Department of Public Health. Some of the 24 hour service providers of Diversionary Behavioral Health Services meet the definition of an Institution for Mental Diseases (IMD). Diversionary services They are offered to provide interventions and stabilization to persons experiencing mental health or substance abuse crises in order to divert from acute inpatient hospitalization or to stabilize after discharge. These services do not include residential programs involving long-term residential stays. Any MassHealth member under the demonstration who is enrolled in managed care may be eligible to receive diversionary services. Managed care entities and the Prepaid Inpatient Insurance Health Plan (PIHP) for behavioral health services identify appropriate individuals to receive diversionary services. Managed care entities maintain a network of diversionary services and arrange, coordinate, and oversee the provision of medically necessary diversionary services, as described in Table C. Table C. Diversionary Behavioral Health Services Provided Through Managed Care Under the Demonstration Diversionary Behavioral Health Service Setting Definition of Service Community Crisis Stabilization 24-hour facility Services provided as an alternative to hospitalization, including short- term psychiatric treatment in structured, community-based therapeutic environments. Community Crisis Stabilization provides continuous 24-hour observation and supervision for Covered Individuals who do not require Inpatient Services. Community Support Program (CSP) Non-24-hour facility An array of services delivered by a community-based, mobile, multi-multi- disciplinary team of professionals and paraprofessionals. These programs provide essential services to Covered Individuals with a long-long standing history of a psychiatric or substance use disorder and to their families, or to Covered Individuals who are at varying degrees of increased medical risk, or to children/adolescents who have behavioral health issues challenging their optimal level of functioning in Diversionary Behavioral Health Service Setting Definition of Service the home/community setting. Services include outreach and supportive services, delivered in a community setting, which will vary with respect to hours, type and intensity of services depending on the changing needs of the Enrollee. Community Support Program (CSP) (continued) Partial Hospitalization** Non-24-hour facility When provided An alternative to chronically homeless individualsInpatient Mental Health Services, CSP PHP services fall into the following domains: Assisting Members in enhancing offer short-term day mental health programming available seven days per week. These services consist of therapeutically intensive acute treatment within a stable therapeutic milieu and include daily living skills; Identifying and addressing barriers to attaining and maintaining community tenure Supporting members to mitigate barriers to community tenurepsychiatric management. Acute Treatment Services for Substance Abuse 24-hour facility 24-hour, including coaching and connection with social seven days week, medically monitored addiction treatment services that assist them provide evaluation and withdrawal management. Detoxification services are delivered by nursing and counseling staff under a physician-approved protocol and physician-monitored procedures and include: bio-psychosocial assessment; individual and group counseling; psychoeducational groups; and discharge planning. Pregnant women receive specialized services to ensure substance use disorder treatment and obstetrical care. Covered Individuals with issues such as credit historyCo- occurring Disorders receive specialized services to ensure treatment for their co-occurring psychiatric conditions. These services may be provided in licensed freestanding or hospital-based programs. Clinical Support Services for Substance Abuse 24-hour facility 24-hour treatment services, presence of criminal recordwhich can be used independently or following Acute Treatment Services for substance use disorders, and poor housing history Coaching members on budget strategies and/or supporting Members including intensive education and Diversionary Behavioral Health Service Setting Definition of Service counseling regarding the nature of addiction and its consequences; outreach to connect families and significant others; and aftercare planning for individuals beginning to engage in recovery from addiction. Covered Individuals with money management Co-Occurring Disorders receive coordination of transportation and referrals to mental health providers to ensure treatment for their co-occurring psychiatric conditions. Pregnant women receive coordination of their obstetrical care. Transitional Care Unit Services addressing the needs of children and adolescents, under age 19, in the custody of the Department of Children and Families (DCF), who need group care or xxxxxx care and no longer meet the clinical criteria for continued stay at an acute level of care. 24-hour facility A community based therapeutic program offering high levels of supervision, structure and intensity of service within an unlocked setting. The TCU offers comprehensive services, including financial counselors but not limited to, a therapeutic milieu**, psychiatry, aggressive case management, and representative payees Support to gather documentation such as government identification documentsmultidisciplinary, medical records Linkages to education, vocational training/services Providing service coordination and linkages; Referrals to healthcare providers Providers make reasonable efforts to assist Members identify and/or facilitate transportation options, including communitymulti-based transportation resources, such as public transportation and/or community- or publically- subsidized transportation options Collaborating with state agencies, outpatient or community-based providers, Emergency Services Programs (ESPs), or other significant entities on service and discharge Community Support Program (CSP) (continued) modal therapies. Psychiatric Day Treatment* Non-24-hour facility planning Discharge planning that involves collaterals as appropriate. Collaterals include state agencies, community-based programs, and other non-health care community supports Provider coordinates care with Members’ primary care providers to be knowledgeable of medical conditions, to assess Members’ compliance with medical treatment, and to assist with mitigating related barriers Assisting Members with obtaining benefits, housing, and health care; Providers work with housing agencies to obtain documentation of housing status Working with Members to identify transitional supports for move-in Connecting Members to housing search assistance, and helping to coordinate search(es) Linkages to primary and preventive health services Linkages to behavioral health and substance use disorder treatment Assistance with enrolling in community benefits (Social Security benefits, SNAP, VA benefits, MassHealth, Medicare, etc.) including obtaining needed documentation and helping to complete applications and attend appointments Working with Member to identify resources for home modifications as needed Developing Services which constitute a crisis plan in the event program of a psychiatric crisis; Refer the Member planned combination of diagnostic, treatment and rehabilitative services provided to a person with mental illness who needs more active or inclusive treatment than is typically available through a weekly visit to a mental health center, individual Provider’s office or hospital outpatient provider Refer the Member to an ESP Implement other interventions such as Member’s safety plan Community Support department, but who does not need 24-hour hospitalization. Intensive Outpatient Program (CSP) (continued) Non-24-hour facility Collaborate with providers (including ESPs) A clinically intensive service designed to improve functional status, provide stabilization in the community, divert an admission to an Inpatient Service, or facilitate a rapid and natural supports Providing prevention and intervention; Comprehensive assessment of needs (behavioral health, medical, substance use, developmental, and social history; linguistic and cultural background; mental status examination; medications and allergies; barriers to housing; diagnosis and clinical formulation supported by stable reintegration into the clinical data gathered, rationale for treatment, and recommendations; level of functioning; and key providers) to identify ways to mitigate barriers to accessing clinical treatment and attaining the skills to obtain and maintain community tenure Developing following a service plan/treatment plan (linkages to health, behavioral health, and substance use treatment) Assisting Members to prepare for transition to permanent supportive housing by linking Members to entities that provide transitional assistance resources. This may include referrals to churches, local housing authorities and non-profit agencies. Transitional assistance includes non-recurring household set-up expenses Discharge planning that involves collaterals Early intervention for potential issues/behavior intervention affecting tenancy Fostering empowerment and recovery, including linkages to peer support and self-help groups Community Support Program (CSP) (continued) Non-24-hour facility Recovery, wellness and empowerment principles and practices are incorporated in service delivery, trainings, and quality improvement activities Facilitates the use of formal and informal resources including community and natural support systems, wellness programs, vocational assistance programs, and peer and self-help supports and services Provider educates Members and their natural supports about substance use and psychiatric disorders, recovery and medications, and links with regular health servicesdischarge from an inpatient service.