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    v1.0.31
    OpenPayerPolicy Updatesmagellan_healthcareMagellan Youth Peer Support Coverage | OpenPayer
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    CurrentMagellan HealthcarePolicy N/A

    Youth Peer Support

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    Establishes medical necessity criteria for Youth Peer Support services for youth referred to the CME within Connect Nevada, including access, service limits, care-plan recommendation, and continued participation criteria.

    Policy Summary
    PayerMagellan Healthcare
    PolicyYouth Peer Support
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionEnsure Youth Peer Support is recommended on the youth’s plan of care and provided within the 12-hours-per-month, 6-month maximum.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    12 hours/monthService limit
    6 monthsMaximum duration
    12+Minimum age
    3Impairment domains

    Medical Necessity Criteria

    Admission Criteria

    Must meet all admission requirements.

    Admission criteria

    • Referral access: Youth is referred to the CME and is provided access to Youth Peer Support.
    • Plan of care: Youth Peer Support is recommended on the plan of care.

    Continued Service Criteria

    Must meet all of the following continued service criteria.

    Continued service criteria

    Policy Summary
    PayerMagellan Healthcare
    PolicyYouth Peer Support
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionEnsure Youth Peer Support is recommended on the youth’s plan of care and provided within the 12-hours-per-month, 6-month maximum.
    SourceLink
    On This Page
    Medical Necessity CriteriaAuthorization and Service RequirementsYouth Peer Support OverviewKey DefinitionsYouth Peer Support Level of CareService Limits

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    Age and clinical complexity:
    Individual is at least 12 years old with complex behavioral health challenges.
    Age >= 12 years

  1. Functional impairment

    • Impairment domains: Impairment is present in at least one of the following domains: Risk, Emotional/Behavioral, or Child/Youth Functioning.At least 1 domain

      Risk examples include suicide risk/danger to self and delinquency; Emotional/Behavioral examples include substance use, anxiety, and mood; Child/Youth Functioning examples include family/home and school.

  2. Active participation: The youth is actively participating in Youth Peer Support.
  3. Placement-risk mitigation: There is reasonable evidence that additional peer support may help alleviate the risk of out-of-home placement, such as acute or residential treatment.

    4. Authorization and Service Requirements

    Documentation Required

    Plan of Care Recommendation Required

    Youth Peer Support must be recommended on the youth’s plan of care before the service is authorized.

    Prior Authorization

    Admission Requirements and Service Limits

    All youth referred to the CME must be provided access to Youth Peer Support. Authorization may be denied when the youth is not referred to the CME or when requested services exceed the applicable service limit.

    • Service limit: 12 hours per month
    • Duration limit: no more than 6 months
    Denial Risk

    Continued Service Criteria

    Continued participation requires all criteria below. Continued service may be denied if any requirement is not met, including age and behavioral health complexity, functional impairment, active participation, or evidence that additional peer support may help prevent out-of-home placement.

    • Individual is at least 12 years old and has complex behavioral health challenges.
    • Youth demonstrates moderate to severe functional impairment in at least one domain: Risk (including suicide risk/danger to self or delinquency); Emotional/Behavioral (including substance use, anxiety, or mood); or Child/Youth Functioning (including family/home or school).
    • Youth is actively participating in Youth Peer Support.
    • Reasonable evidence supports that additional peer support may help alleviate the risk of out-of-home placement, such as acute or residential treatment.

    Youth Peer Support Overview

    Youth Peer Support Specialists are young adults with lived experience of mental and/or behavioral health challenges who are trained and certified to work collaboratively with youth-serving systems. As part of the children’s System of Care continuum, they provide peer support in person, by phone, or through telehealth to individuals or groups. Services may include emotional, informational, and educational support; advocacy; help navigating community resources and care services; and connections to social activities and informal supports. Youth peer support is intended to strengthen social support, self-advocacy, self-care and wellness, and personal empowerment.

    Key Definitions

    Youth Peer Support Specialist
    RoleYoung adults who provide peer support and work collaboratively with youth-serving systems in their communities.
    Lived experiencePersonal lived experience with mental and/or behavioral health challenges.
    Skills and abilitiesAbility to navigate and work collaboratively with youth-serving systems in their communities.
    Youth Peer Support
    Support providedPeer-delivered emotional, informational, and educational support and advocacy.
    Navigation and linkageStrategies to navigate community resources and care services, with assistance linking youth to social activities and informal supports.
    Delivery methodsServices may be delivered in person, by phone, or via telehealth to individuals and/or groups.

    Youth Peer Support Level of Care

    Youth Peer Support

    Youth Peer Support level-of-care decisions follow the documented admission and continued service requirements.

    Admission requirements

    • Referral access: Youth is referred to the CME and is provided access to Youth Peer Support.
    • Plan of care: Youth Peer Support is recommended on the plan of care.

    Continued service requirements

    • Age and clinical complexity: Individual is at least 12 years old with complex behavioral health challenges.Age >= 12 years

    • Functional impairment

      • Impairment domains: Impairment is present in at least one of the following domains: Risk, Emotional/Behavioral, or Child/Youth Functioning.At least 1 domain
    • Active participation: The youth is actively participating in Youth Peer Support.
    • Placement-risk mitigation: There is reasonable evidence that additional peer support may help alleviate the risk of out-of-home placement, such as acute or residential treatment.

    Service Limits

    Youth Peer Support — Monthly Limit
    ServiceYouth Peer Support
    Maximum monthly limit12 hours per month
    Limit typeMaximum service hours
    Youth Peer Support — Maximum Duration
    ServiceYouth Peer Support
    Maximum duration6 months
    Duration typeNo more than 6 months