COMMUNITY-BASED MENTAL HEALTH SERVICES Sample Clauses

COMMUNITY-BASED MENTAL HEALTH SERVICES. 1. The State shall provide access to the array and intensity of services and supports necessary to enable individuals with SMI in or at risk of entry in adult care homes to successfully transition to and live in community-based settings. The State shall provide each individual receiving a Housing Slot under this Agreement with access to services for which that individual is eligible that are covered under the North Carolina State Plan for Medical Assistance, the Centers for Medicare and Medicaid Services (“CMS”) approved Medicaid 1915(b)/(c) waiver, or the State-funded service array.
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COMMUNITY-BASED MENTAL HEALTH SERVICES o Ensures that individuals with mental illness receive the array and intensity of services to enable them to successfully transition to, and remain in, community-based settings. These services include ACT, Community Support Teams, case management services, peer support services, and psychosocial rehabilitation services.  Following a nationally recognized fidelity model, the number of ACT teams throughout the State will expand to 50 ACT teams with the capacity to serve 5,000 individuals by July 1, 2019. o Requires development of a crisis service system that offers timely and accessible services and supports in the least restrictive setting, including mobile crisis teams, walk-in crisis clinics, short-term community hospital beds, and 24/7 crisis hotlines. o Significant expansion of supported employment, which assists individuals in preparing for, identifying, and maintaining integrated, paid, competitive employment. • Discharge Planning and Diversion Process o Implements procedures for discharge planning that ensure that individuals with serious mental illness in, or later admitted to, an adult care home or State psychiatric hospital are fully informed about all community-based options, including supported housing. o Provides information frequently about the benefits of supported housing. o Provides each individual with serious mental illness in, or later admitted to, an adult care home or State psychiatric hospital with a written discharge plan that is:  Person-centered and strengths-based  Based on the principles of self-determination and integration  Implemented by a transition team o Includes a process to identify barriers to discharge and ensure a safe and timely transition. o Implements a pre-admission screening and diversion process to prevent unnecessary institutionalization.
Sample 1
COMMUNITY-BASED MENTAL HEALTH SERVICES. DOJ recognizes that there are other participants in the mental health infrastructure besides the City that control the quality of mental health care, including the State of Oregon, Multnomah County, Community Care Organizations (CCOs), community mental health providers, health care and emergency department providers, private insurers, and many others. This proposed Agreement is only binding on the City of Portland, but DOJ expects community partners to assist the City to remedy lack of community‐based addiction and mental health services to Medicaid and uninsured residents. The City is grateful that CCOs and community partners have agreed to fast‐track mental health service improvements to mid‐2013. Through that process the City, CCOs and community partners will identify opportunities for the dispatch of mental health professional instead of police officers if and when appropriate. Additionally we will pursue better real‐time access to information when a person who has encountered the police is having a mental health crisis and needs assistance.
Sample 1
COMMUNITY-BASED MENTAL HEALTH SERVICES. Ensures that individuals with mental illness receive the array and intensity of services to enable them to successfully transition to, and remain in, community-based settings. These services include ACT, Community Support Teams, case management services, peer support services, and psychosocial rehabilitation services. Following a nationally recognized fidelity model, the number of ACT teams throughout the State will expand to 50 ACT teams with the capacity to serve 5,000 individuals by July 1, 2019. Requires development of a crisis service system that offers timely and accessible services and supports in the least restrictive setting, including mobile crisis teams, walk-in crisis clinics, short-term community hospital beds, and 24/7 crisis hotlines. Significant expansion of supported employment, which assists individuals in preparing for, identifying, and maintaining integrated, paid, competitive employment. Discharge Planning and Diversion Process Implements procedures for discharge planning that ensure that individuals with serious mental illness in, or later admitted to, an adult care home or State psychiatric hospital are fully informed about all community-based options, including supported housing. Provides information frequently about the benefits of supported housing. Provides each individual with serious mental illness in, or later admitted to, an adult care home or State psychiatric hospital with a written discharge plan that is: Person-centered and strengths-based Based on the principles of self-determination and integration Implemented by a transition team Includes a process to identify barriers to discharge and ensure a safe and timely transition. Implements a pre-admission screening and diversion process to prevent unnecessary institutionalization. Develops and implements person-centered service plans for each individual that will be implemented by a qualified professional in a coordinated manner. IMD-Related Provisions Priority for housing slots is given to people with mental illness in adult care homes determined to be institutions for mental disease (“IMDs”). Requires individuals in adult care homes determined to be at risk of IMD status to be connected with appropriate alternate settings and mental health services. Will track the location of individuals with mental illness who move out of an adult care home that it is at risk of an IMD determination, to ensure that such individuals will be offered the relief provided under the Agreement.
Sample 1
COMMUNITY-BASED MENTAL HEALTH SERVICES. 19. III. C. 1. The State shall provide access to the array and intensity of services and supports necessary to enable individuals with SMI in or at risk of entry in adult care homes to successfully transition to and live in community-based settings. The State shall provide each individual receiving a Housing Slot under this Agreement with access to services for which that individual is eligible that are covered under the North Carolina State Plan for Medical Assistance, the Centers for Medicare and Medicaid Services (“CMS”) approved Medicaid 1915(b)/(c) waiver, or the State-funded service array. NC As reported in FY 2016, the array and intensity of services available remains limited and variable depending on where an individual lives (catchment, county or community) and where housing is available. Network management oversight, network sufficiency, eligibility, county of origin problems slow down the process and interfere with timely access. There are not sufficient services provided in a timely manner for individuals to be diverted from ACHs. The current array (and use of current array) does not yet provide opportunity for all the individuals who could live in the community to transition to and live in community-based settings. 20.
Sample 1
COMMUNITY-BASED MENTAL HEALTH SERVICES. 19. III. C. 1. The State shall provide access to the array and intensity of services and supports necessary to enable individuals with SMI in or at risk of entry in adult care homes to successfully transition to and live in community-based settings. The State shall provide each individual receiving a Housing Slot under this Agreement with access to services for which that individual is eligible that are covered under the North Carolina State Plan for Medical Assistance, the Centers for Medicare and Medicaid Services (“CMS”) approved Medicaid 1915(b)/(c) waiver, or the State-funded service array. NC The State has expanded its array of services but there was not evidence in FY 2019 that individuals had access to the full array. Network management, network sufficiency, eligibility, county of origin problems slow down the process and interfere with timely access. Service providers do not consistently assist individuals to access supported employment and other services in the array. 20. III. C. 2. The State shall also provide individuals with SMI in or at risk of entry to adult care homes who do not receive a Housing Slot under this Agreement with access to services for which that individual is eligible that are covered under the North Carolina State Plan for Medical Assistance, the CMS-approved Medicaid 1915(b)/(c) waiver, or the State funded service array. Services provided with State funds to non-Medicaid eligible individuals who do not receive a Housing Slot shall be subject to availability of funds in accordance with State laws and regulations regarding access services. NC Same as above 20 III. C.3.a.- d. The services and supports referenced in Sections III(C)(1) and (2), above, shall: a. be evidence-based, recovery-focused and community-based; b. be flexible and individualized to meet the needs of each individual; c. help individuals to increase their ability to recognize and deal with situations that may otherwise result in crises; and d. increase and strengthen individuals’ networks of community and natural supports, as well as their use of these supports for crisis prevention and intervention. NC Services are not always recovery oriented. Most services definitions are evidenced based but delivery is not. The ratings on these two items are higher than the remaining three in this requirement. Services and service plans are not always individuals with flexibility to meet individual needs. Services do not always assist individuals to increase their ability...
Sample 1

Related to COMMUNITY-BASED MENTAL HEALTH SERVICES

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. Inpatient This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Health Services At the time of employment and subject to (b) above, full credit for registered professional nursing experience in a school program shall be given. Full credit for registered professional nursing experience may be given, subject to approval by the Human Resources Division. Non-degree nurses shall be placed on the BA Track of the Teachers Salary Schedule and shall be ineligible for movement to any other track.

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

  • Mental Health The parties recognize the importance of supporting and promoting a psychologically healthy workplace and as such will adhere to all applicable statutes, policy, guidelines and regulations pertaining to the promotion of mental health.

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Health Care Savings Plan As provided in this Agreement, eligible ASF Members will participate in the health care savings plan (HCSP) established under Minnesota Statute 352.98, and as administered by the Plan Administrator. The Employer is responsible only for transferring funds, as specified in this agreement, to the Plan Administrator.

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. Respiratory Therapy This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. Preauthorization may be required for certain surgical services. Reconstructive Surgery for a Functional Deformity or Impairment This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia. Preauthorization may be required for these services.

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