Common use of Community Mental Health Center Services Clause in Contracts

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April - June 2020 January - March 2020 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 Individual Placed on ACT Waitlist 1* 1 Individual Awaiting CMHC Determination for ACT 14** 15 Total Unique Clients 16 17

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April October - June December 2020 January July - March September 2020 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 0 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 0 Individual Placed on ACT Waitlist 1* 0 1 Individual Awaiting CMHC Determination for ACT 14** 15 6 14 Total Unique Clients 16 176 16

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge July - September 2019 April - June 2020 January - March 2020 2019 Not Available in Individual’s Town of Residence 0 0 Individual Declined Refused 0 0 1 Individual’s Insurance Does Not Cover ACT Services 1 0 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 3 2 Individual Placed on ACT Waitlist 1* 0 1 Individual Awaiting CMHC Determination for ACT 14** 15 6 7 Total Unique Clients 16 179 11

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge July - September 2020 April - June 2020 January - March 2020 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 0 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 0 Individual Placed on ACT Waitlist 1* 0 1 Individual Awaiting CMHC Determination for ACT 14** 15 7 14 Total Unique Clients 7 16 17Revisions to Prior Period: None. Data Source: New Hampshire Hospital.

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April - June 2020 January - March 2021 October - December 2020 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 5 0 1 Individual Placed on ACT Waitlist 1* 1 0 0 Individual Awaiting CMHC Determination for ACT 14** 15 4 6 Total Unique Clients 16 1710 6 Revisions to Prior Period: None.

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April - June 2020 January - March 2020 October – December 2022 July – September 2022 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 1 0 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 2 Individual Placed on ACT Waitlist 1* 0 1 Individual Awaiting CMHC Determination for ACT 14** 15 2 0 Total Unique Clients 16 173 3 Revisions to Prior Period: None.

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April - June 2020 January - March 2021 October - December 2020 Not Available in Individual’s Town of Residence 0 1 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 1 0 0 Individual’s Clinical Need Does Not Meet ACT Criteria 5 0 1 Individual Placed on ACT Waitlist 1* 1 0 0 Individual Awaiting CMHC Determination for ACT 14** 15 4 6 Total Unique Clients 16 1710 6 Revisions to Prior Period: None.

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April - – June 2020 2022 January - – March 2020 2022 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 1 0 2 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 2 Individual Placed on ACT Waitlist 1* 1 0 Individual Awaiting CMHC Determination for ACT 14** 15 4 5 Total Unique Clients 16 176 9 Revisions to Prior Period: None.

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April - – June 2020 2023 January - March 2020 2023 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 Individual’s Insurance Does Not Cover ACT Services 1 0 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 2 2 Individual Placed on ACT Waitlist 1* 0 1 Individual Awaiting CMHC Determination for ACT 14** 15 8 3 Total Unique Clients 16 1710 6 Revisions to Prior Period: None.

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April October - June 2020 January December 2019 July - March 2020 September 2019 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 1 0 Individual’s Insurance Does Not Cover ACT Services 1 0 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 2 3 Individual Placed on ACT Waitlist 1* 1 0 0 Individual Awaiting CMHC Determination for ACT 14** 15 8 6 Total Unique Clients 16 1711 9

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge July – September 2021 April - June 2020 January - March 2020 2021 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 1 0 Individual’s Insurance Does Not Cover ACT Services 0 1 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 5 2 Individual Placed on ACT Waitlist 1* 1 0 0 Individual Awaiting CMHC Determination for ACT 14** 15 5 11 Total Unique Clients 16 1711 14 Revisions to Prior Period: None.

Community Mental Health Center Services. Assertive Community Treatment – Reasons Not Accepted to ACT at New Hampshire Hospital Discharge Referral Reason Not Accepted at Discharge April - June 2020 January - March 2020 October - December 2019 Not Available in Individual’s Town of Residence 0 0 Individual Declined 0 0 1 Individual’s Insurance Does Not Cover ACT Services 1 0 0 Individual’s Clinical Need Does Not Meet ACT Criteria 0 1 2 Individual Placed on ACT Waitlist 1* 1 0 Individual Awaiting CMHC Determination for ACT 14** 15 8 Total Unique Clients 16 1717 11 Revisions to Prior Period: None.