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Behaviorial Health Recovery Facility

Admission Requirements

1. Does the member need placement for any of the following reasons?

  • An alternative to detention or incarceration
  • Ensure community safety in circumstances where a member is exhibiting primarily conduct disorder behavior without the presence of risk or functional impairment
  • Provide safe housing, shelter, supervision, or permanency placement
  • Member/health care decision maker are unwilling to participate in less restrictive alternative behavioral health interventions that meet the member’s treatment needs. 
  • An intervention for runaway behaviors unrelated to a Behavioral Health Condition

Stop!

***MEMBER DOES NOT MEET CRITERIA FOR BEHAVIORAL HEALTH RESIDENTIAL FACILITY PLACEMENT***

2. Does the member exhibit any of the following?

  • Member has a diagnosed Behavioral Health Condition which reflects the symptoms and behaviors necessary for a request for residential treatment. 
  • The member’s Behavioral Health Condition is causing significant functional and/or psychosocial impairment as evidenced by the following:

A. At least one is of significant risk of harm documented within the past three months as a result of:

  • Suicidal/aggressive/self-harm/homicidal thoughts or behaviors without current plan or intent,
    • Impulsivity with poor judgement/insight
    • Maladaptive physical or sexual behavior
  • Inability to remain safe within environment, despite environmental supports
  • Medication side effects due to toxicity or contraindications

B. At least one is of serious functional impairment as evidenced by:

  • Inability to complete developmentally appropriate self-care or self-regulation due to their Behavioral Health Condition
  • Neglect or disruption of ability to attend to majority of their basic needs, such as personal safety, hygiene, nutrition or medical care
  • Frequent inpatient psychiatric admissions, or legal involvement due to lack of insight or judgment associated with psychotic or affective mood symptoms or major psychiatric disorders
  • Frequent withdrawal management services, which can include but are not limited to, detox facilities, MAT, and ambulatory detox
  • Inability to independently self-administer medically necessary psychotropic medications despite interventions such as education, regimen simplification, daily outpatient dispensing, and long-acting injectable medications
  • Impairments persisting in the absence of situational stressors that delay recovery from the presenting problem

AND ALL OF THE FOLLOWING CRITERIA

  1. A need for 24 hour behavior health care and supervision to develop adequate and effective coping skills that will allow the member to live safely in the community
  2. Anticipated stabilization cannot be achieved in a less restrictive setting
  3. Evidence that appropriate treatment in a less restrictive environment has not been successful or is not available, therefore warranting a higher level of care

Member agrees to participate in treatment.  In the case of those who have a health care decision maker, including minors, the health care decision maker also MUST agree to and participate as part of the treatment team

Continued Stay Requirements

AzCH utilizes INTERQUAL and ASAM criteria guidelines to determine medical necessity in conjunction with guidance from AHCCCS, AMPM 320 V.

  • Continued stay shall be assessed by the BHRF staff and the CFT/ART during Treatment Plan review and update.
  • Progress towards the treatment goals and continued display of risk and functional impairment shall also be assessed.
  • Treatment interventions, frequency, crisis/safety planning, and targeted discharge shall be adjusted accordingly to support the need for continued stay.

The following criteria shall be considered when determining continued stay:

  1. The member continues to demonstrate significant risk of harm and/or functional impairment as a result of a Behavioral Health Condition.
  2. Providers and supports are not available to meet current behavioral and physical health needs at a less restrictive lower level of care.

Discharge Readiness Requirements

AzCH utilizes INTERQUAL and ASAM criteria guidelines to determine discharge readiness in conjunction with guidance from AHCCCS, AMPM 320 V.

  • Discharge planning shall begin at the time of admission.
  • Discharge readiness shall be assessed by the BHRF staff and the CFT/ART during each Treatment Plan review and update.

The following criteria shall be considered when determining discharge readiness:

  1. Symptom or behavior relief is reduced as evidenced by completion of Treatment Plan goals;
  2. Functional capacity is improved, essential functions such as eating or hydrating necessary to sustain life has significantly improved or is able to be cared for in a less restrictive level of care;
  3. Member can participate in needed monitoring or a caregiver is available to provide monitoring in a less restrictive level of care;
  4. Providers and supports are available to meet current behavioral and physical health needs at a less restrictive level of care.

Reference AHCCCS AMPM Policy 320-V