Common use of Hour Diversionary Services Clause in Contracts

Hour Diversionary Services. Community Crisis Stabilization – 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-Based Acute Treatment for Children and Adolescents (CBAT) – 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 (as needed); 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. Medically Monitored Intensive Services – Acute Treatment Services (ATS) for Substance Use Disorders (Level 3.7) – 24-hour, seven days week, medically monitored addiction treatment services that provide evaluation and withdrawal management services delivered by nursing and counseling staff under a physician-approved protocol and physician-monitored procedures. Services include bio-psychosocial assessment; induction to FDA approved medications for addictions when appropriate, 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 Co-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 Use Disorders (Level 3.5) – 24-hour treatment services including comprehensive bio-psychosocial assessments and treatment planning, therapeutic milieu, intensive psychoeducation education and counseling; outreach to families and significant others; linkage to medications for addiction therapy, connection to primary care and community supports, and aftercare planning for individuals beginning to engage in recovery from addiction. Covered Individuals with 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. Clinically Managed Population-Specific High Intensity Residential Services (Level 3.3) – 24 hour structured recovery environment in combination with high-intensity clinical services provided in a manner to meet the functional limitations of patients with cognitive impairments who may be unable, or have difficulty, participating in treatment that is primary cognitively based. Level 3.3 programs focus on a tailored treatment approach to serve individuals with developmental delays, traumatic brain injuries, fetal alcohol spectrum disorder, and others who require a high intensity, repetition based, or non-cognitive clinical and recovery protocol and environment. Transitional Support Services (TSS) for Substance Use Disorders (Level 3.1) – 24 hour, short term intensive case management and psycho-educational residential programming with nursing available for Covered Individuals requiring short term placements. Covered Individuals with 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. Residential Rehabilitation Services for Substance Use Disorders (Level 3.1) – 24 hour structured and comprehensive rehabilitative environment that supports Covered Individual’s independence and resilience and recovery from alcohol and/or other drug problems. Scheduled, goal-oriented clinical services are provided in conjunction with ongoing support and assistance for developing and maintaining interpersonal skills necessary to lead an alcohol and/or drug-free lifestyle. Specialized RRS services tailored for the needs of Youth, Transitional Age Youth, Young Adults, Families and Pregnant and Post-Partum Women are also available to eligible Covered Individuals. Enhanced Residential Rehabilitation Services for Dually Diagnosed (Level 3.1 co-occurring enhanced) – 24 hour residential environment intended to serve Covered Individuals with higher levels of complexity and acuity, including co-occurring substance use and mental health disorders. Programs are staffed to adequately identify and treat both substance use and mental health disorders in an integrated fashion. Programs are expected to provide holistic and integrated care that facilitates access to medications for addiction treatment (MAT), primary care and medical supports, and psychiatric care as needed.

Hour Diversionary Services. Community Crisis Stabilization – - 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 Enrollees who do not require Inpatient Services. Community-Based Acute Treatment for Children and Adolescents (CBAT) – 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 (as needed); 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. Medically Monitored Intensive Services – - Acute Treatment Services (ATS) for Substance Use Disorders (Level 3.7) – 24-hour, seven days week, medically monitored addiction treatment services that provide evaluation and withdrawal management services delivered by nursing and counseling staff under a physician-approved protocol and physician-monitored procedures. Services include bio-psychosocial assessment; induction to FDA approved medications for addictions when appropriate, individual and group counseling; psychoeducational groups; and discharge planning. Pregnant women receive specialized services to ensure substance use disorder treatment and obstetrical carecare until disenrolled from CarePlus. Covered Individuals with Co-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. Clinically Managed High-Intensity Residential Services - Clinical Support Services for Substance Use Disorders (Level 3.5) – 24-hour treatment services including comprehensive bio-psychosocial assessments and treatment planning, therapeutic milieu, intensive psychoeducation education and counseling; outreach to families and significant others; linkage to medications for addiction therapy, connection to primary care and community supports, and aftercare planning for individuals beginning to engage in recovery from addiction. Covered Individuals with 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 carecare until disenrolled from CarePlus. Clinically Managed Population-Specific High Intensity Residential Services (Level 3.3) – - 24 hour structured recovery environment in combination with high-intensity clinical services provided in a manner to meet the functional limitations of patients with cognitive impairments who may be unable, or have difficulty, participating in treatment that is primary cognitively based. Level 3.3 programs focus on a tailored treatment approach to serve individuals with developmental delays, traumatic brain injuries, fetal alcohol spectrum disorder, and others who require a high intensity, repetition based, or non-cognitive clinical and recovery protocol and environment. Transitional Support Services (TSS) for Substance Use Disorders (Level 3.1) – 24 hour, short term intensive case management and psycho-educational residential programming with nursing available for Covered Individuals requiring short term placements. Covered Individuals with 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. Residential Rehabilitation Services for Substance Use Disorders (Level 3.1) – RRS services under CY2018 have a staggered start date and coverage will begin for these services on March 1, 2018. 24 hour structured and comprehensive rehabilitative environment that supports Covered Individual’s independence and resilience and recovery from alcohol and/or other drug problems. Scheduled, goal-oriented clinical services are provided in conjunction with ongoing support and assistance for developing and maintaining interpersonal skills necessary to lead an alcohol and/or drug-free lifestyle. Specialized RRS services tailored for the needs of Youth, Transitional Age Youth, Young Adults, Families and Pregnant and Post-Partum Women are also available to eligible Covered Individuals. Enhanced Residential Rehabilitation Services for Dually Diagnosed (Level 3.1 co-occurring enhanced) – 24 24-hour residential environment intended to serve Covered Individuals with higher levels of complexity and acuity, including co-occurring substance use and mental health disorders. Programs are staffed to adequately identify and treat both substance use and mental health disorders in an integrated fashion. Programs are expected to provide holistic and integrated care that facilitates access to medications for addiction treatment (MAT), primary care and medical supports, and psychiatric care as needed.

Hour Diversionary Services. Community Crisis Stabilization Stabilization– 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-Based Acute Treatment for Children and Adolescents (CBAT) – 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 (as needed); 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. Medically Monitored Intensive Services – - Acute Treatment Services (ATS) for Substance Use Disorders (Level 3.7) – 24-hour, seven days week, medically monitored addiction treatment services that provide evaluation and withdrawal management services delivered by nursing and counseling staff under a physician-approved protocol and physician-monitored procedures. Services include bio-psychosocial assessment; induction to FDA approved medications for addictions when appropriate, 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 Co-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. Clinically Managed High-Intensity Residential Services - Clinical Support Services for Substance Use Disorders (Level 3.5) – 24-hour treatment services including comprehensive bio-psychosocial assessments and treatment planning, therapeutic milieu, intensive psychoeducation education and counseling; outreach to families and significant others; linkage to medications for addiction therapy, connection to primary care and community supports, and aftercare planning for individuals beginning to engage in recovery from addiction. Covered Individuals with 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. Clinically Managed Population-Specific High Intensity Residential Services (Level 3.3) – 24 24-hour structured recovery environment in combination with high-intensity clinical services provided in a manner to meet the functional limitations of patients with cognitive impairments who may be unable, or have difficulty, participating in treatment that is primary cognitively based. Level 3.3 programs focus on a tailored treatment approach to serve individuals with developmental delays, traumatic brain injuries, fetal alcohol spectrum disorder, and others who require a high intensity, repetition based, or non-cognitive clinical and recovery protocol and environment. Transitional Support Services (TSS) for Substance Use Disorders (Level 3.1) – 24 hour, short term intensive case management and psycho-educational residential programming with nursing available for Covered Individuals requiring short term placements. Covered Individuals with 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. Residential Rehabilitation Services for Substance Use Disorders (Level 3.1) – 24 hour structured and comprehensive rehabilitative environment that supports Covered Individual’s independence and resilience and recovery from alcohol and/or other drug problems. Scheduled, goal-oriented clinical services are provided in conjunction with ongoing support and assistance for developing and maintaining interpersonal skills necessary to lead an alcohol and/or drug-free lifestyle. Specialized RRS services tailored for the needs of Youth, Transitional Age Youth, Young Adults, Families and Pregnant and Post-Partum Women are also available to eligible Covered Individuals. Enhanced Residential Rehabilitation Services for Dually Diagnosed (Level 3.1 co-occurring enhanced) – 24 hour residential environment intended to serve Covered Individuals with higher levels of complexity and acuity, including co-occurring substance use and mental health disorders. Programs are staffed to adequately identify and treat both substance use and mental health disorders in an integrated fashion. Programs are expected to provide holistic and integrated care that facilitates access to medications for addiction treatment (MAT), primary care and medical supports, and psychiatric care as needed.

Hour Diversionary Services. a. Community Crisis Stabilization – 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. ✓ ✓ ✓ Coverage Types Service MassHealth Standard & CommonHealth Covered Individuals MassHealth Family Assistance Covered Individuals CarePlus Covered Individuals Uninsured Individuals and Persons Covered by Medicare Only b. Community-Based Acute Treatment for Children and Adolescents (CBAT) – 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 (as needed); 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. ✓ ✓ c. Medically Monitored Intensive Services – Acute --Acute Treatment Services (ATS) for Substance Use Disorders (Level 3.7) – 24-hour, seven days week, medically monitored addiction treatment services that provide evaluation and withdrawal management services delivered by nursing and counseling staff under a physician-approved protocol and physician-monitored procedures. Services include bio-psychosocial assessment; induction to FDA approved medications for addictions when appropriate, 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 Co-occurring 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. ✓ ✓ ✓ d. Clinical Support Services for Substance Use Disorders (Level 3.5) – 24-hour treatment services including comprehensive bio-bio- psychosocial assessments and treatment planning, therapeutic milieu, intensive psychoeducation psycho education and counseling; , outreach to families and significant others; linkage to medications for addiction therapy, connection to primary care and community supports, supports and aftercare planning for individuals beginning to engage in recovery from addiction. Covered Individuals with Co-Co- Occurring Disorders receive coordination of transportation and referrals to mental health providers to ensure treatment for their co-co- occurring psychiatric conditions. Pregnant women receive coordination of their obstetrical care. Clinically Managed Population-Specific High Intensity Residential Services (Level 3.3) – 24 hour structured recovery environment in combination with high-intensity clinical services provided in a manner to meet the functional limitations of patients with cognitive impairments who may be unable, or have difficulty, participating in treatment that is primary cognitively based. Level 3.3 programs focus on a tailored treatment approach to serve individuals with developmental delays, traumatic brain injuries, fetal alcohol spectrum disorder, and others who require a high intensity, repetition based, or non-cognitive clinical and recovery protocol and environment. Transitional Support Services (TSS) for Substance Use Disorders (Level 3.1) – 24 hour, short term intensive case management and psycho-educational residential programming with nursing available for ✓ ✓ ✓ Coverage Types Service MassHealth Standard & CommonHealth Covered Individuals requiring short term placements. MassHealth Family Assistance Covered Individuals with 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. Residential Rehabilitation Services for Substance Use Disorders (Level 3.1) – 24 hour structured and comprehensive rehabilitative environment that supports Covered Individual’s independence and resilience and recovery from alcohol and/or other drug problems. Scheduled, goal-oriented clinical services are provided in conjunction with ongoing support and assistance for developing and maintaining interpersonal skills necessary to lead an alcohol and/or drug-free lifestyle. Specialized RRS services tailored for the needs of Youth, Transitional Age Youth, Young Adults, Families and Pregnant and Post-Partum Women are also available to eligible Covered Individuals. Enhanced Residential Rehabilitation Services for Dually Diagnosed (Level 3.1 co-occurring enhanced) – 24 hour residential environment intended to serve CarePlus Covered Individuals with higher levels of complexity Uninsured Individuals and acuity, including co-occurring substance use and mental health disorders. Programs are staffed to adequately identify and treat both substance use and mental health disorders in an integrated fashion. Programs are expected to provide holistic and integrated care that facilitates access to medications for addiction treatment (MAT), primary care and medical supports, and psychiatric care as needed.Persons Covered by Medicare Only

Hour Diversionary Services. a. Community Crisis Stabilization – 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.    Coverage Types Service MassHealth Standard & CommonHealth Covered Individuals MassHealth Family Assistance Covered Individuals CarePlus Covered Individuals Uninsured Individuals and Persons Covered by Medicare Only b. Community-Based Acute Treatment for Children and Adolescents (CBAT) – 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 (as needed); 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.   c. Medically Monitored Intensive Services – Acute --Acute Treatment Services (ATS) for Substance Use Disorders (Level 3.7) – 24-hour, seven days week, medically monitored addiction treatment services that provide evaluation and withdrawal management services delivered by nursing and counseling staff under a physician-approved protocol and physician-monitored procedures. Services include bio-psychosocial assessment; induction to FDA approved medications for addictions when appropriate, 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 Co-occurring 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.    d. Clinical Support Services for Substance Use Disorders (Level 3.5) – 24-hour treatment services including comprehensive bio-bio- psychosocial assessments and treatment planning, therapeutic milieu, intensive psychoeducation psycho education and counseling; , outreach to families and significant others; linkage to medications for addiction therapy, connection to primary care and community supports, supports and aftercare planning for individuals beginning to engage in recovery from addiction. Covered Individuals with Co-Co- Occurring Disorders receive coordination of transportation and referrals to mental health providers to ensure treatment for their co-co- occurring psychiatric conditions. Pregnant women receive coordination of their obstetrical care. Clinically Managed Population-Specific High Intensity Residential Services (Level 3.3) – 24 hour structured recovery environment in combination with high-intensity clinical services provided in a manner to meet the functional limitations of patients with cognitive impairments who may be unable, or have difficulty, participating in treatment that is primary cognitively based. Level 3.3 programs focus on a tailored treatment approach to serve individuals with developmental delays, traumatic brain injuries, fetal alcohol spectrum disorder, and others who require a high intensity, repetition based, or non-cognitive clinical and recovery protocol and environment. Transitional Support Services (TSS) for Substance Use Disorders (Level 3.1) – 24 hour, short term intensive case management and psycho-educational residential programming with nursing available for    Coverage Types Service MassHealth Standard & CommonHealth Covered Individuals requiring short term placements. MassHealth Family Assistance Covered Individuals with 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. Residential Rehabilitation Services for Substance Use Disorders (Level 3.1) – 24 hour structured and comprehensive rehabilitative environment that supports Covered Individual’s independence and resilience and recovery from alcohol and/or other drug problems. Scheduled, goal-oriented clinical services are provided in conjunction with ongoing support and assistance for developing and maintaining interpersonal skills necessary to lead an alcohol and/or drug-free lifestyle. Specialized RRS services tailored for the needs of Youth, Transitional Age Youth, Young Adults, Families and Pregnant and Post-Partum Women are also available to eligible Covered Individuals. Enhanced Residential Rehabilitation Services for Dually Diagnosed (Level 3.1 co-occurring enhanced) – 24 hour residential environment intended to serve CarePlus Covered Individuals with higher levels of complexity Uninsured Individuals and acuity, including co-occurring substance use and mental health disorders. Programs are staffed to adequately identify and treat both substance use and mental health disorders in an integrated fashion. Programs are expected to provide holistic and integrated care that facilitates access to medications for addiction treatment (MAT), primary care and medical supports, and psychiatric care as needed.Persons Covered by Medicare Only