New Jersey Medicaid Supplemental Clinical Criteria
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This policy governs medical-necessity determinations for behavioral health services covered for New Jersey FamilyCare/Medicaid members managed by Optum, including developmental services for children with autism spectrum disorder, adult mental health rehabilitation services, and youth and adult partial-care and partial-hospitalization services.
Policy Summary
PayerOptum
PolicyNew Jersey Medicaid Supplemental Clinical Criteria
Policy CodePolicy N/A
Change TypeModified
Effective DateNovember 1, 2026
Next Review DateN/A
Key ActionDocument adult partial-care medical necessity and obtain confirmation from a psychiatrist or advanced practice nurse and the interdisciplinary treatment team.
The revision history identifies the addition of a Partial Care Services guideline.
The revision history identifies revisions to partial care requirements, including a partial-care age requirement revision.
The revision history identifies the addition and finalization of Partial Care/Partial Hospitalization Youth criteria.
Under 21Developmental ASD eligibility
14–20 hr/wkParent-led Floortime
25 hr/wk
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Adult partial-care maximum
30 daysRehabilitation plan deadline
1:5Youth staffing ratio
Medical Necessity and Coverage Criteria
Developmental Services for Autism Spectrum Disorder
Developmental Services are covered for eligible children diagnosed with autism spectrum disorder when the applicable benefit and regulatory requirements are met.
ALL of the following
The child is under age 21 and eligible for New Jersey FamilyCare/Medicaid.
The child has been diagnosed with autism spectrum disorder by a qualified healthcare provider, using ICD-10 diagnosis codes F84.0 through F84.9.
The requested developmental services are medically necessary to support the child's development and may be provided as part of a combination of therapies targeting different skill areas.
Assessment and treatment planning use clinically appropriate methods, which may include the Functional Emotional Assessment Scale (FEAS), Childhood Autism Rating Scale (CARS), Autism Diagnostic Observation Schedule (ADOS), Bayley Scales of Infant and Toddler Development, and the DIR® Intensity of Services Decision Support Tool (DIR-ISDT).
DIR/Floortime Intensity Planning
DIR/Floortime intensity and duration should be individualized using the following clinical dimensions.
ALL of the following treatment-planning dimensions
Frequency: Professional services may range from up to 5 hours per week at the least intense level to up to 30 hours per week at the most intense level.
The actual number of professional service hours may be substantially lower when the DIR home program is effectively supporting the child. Natural supports are intended to be the primary deliverer of Floortime intervention, and their availability must be considered when determining professional-service frequency.
Duration: Treatment duration is directly related to functional emotional developmental progress and the success of the DIR home program.
Because autism commonly has lifelong implications, treatment may be significant in duration and is rarely less than 12 months. Professional services to support home implementation generally decrease over time as the family develops ongoing Floortime skills.
Functional Emotional Development, typically measured using the FEAS and/or clinical observation.
Adult Mental Health Rehabilitation Services Admission
AMHR admission requires that all of the following criteria are met.
ALL of the following
The member is 18 years or older.
The member has a Serious Mental Illness that seriously impairs the member's capacity to live independently, with appropriate supports as needed.
The member is referred to AMHR by a licensed professional of the healing arts, including a physician.
Services are medically necessary.
Additional AMHR Admission Criteria
The member must also be appropriate for the AMHR setting.
ALL of the following
The member does not have an acute medical condition requiring inpatient hospitalization.
The member does not need nursing-home level of care.
The member is able to evacuate the residence within 3 minutes.
The member is capable of managing incontinence and other medical-care needs.
Youth Partial Hospitalization Admission
All of the following criteria are necessary for admission to youth partial hospitalization.
ALL of the following
The youth is under age 18.
For programs serving youth under age 18, the PerformCare website criteria titled CSOC service guidelines 1798 clinical criteria are used for admission and continued stay.
The youth needs clinical and social support to remain stable outside an inpatient or out-of-home environment or to transition to community living from a more restrictive setting.
The CSOC Assessment and other relevant information indicate that a comprehensive, integrated program of clinical and psychosocial rehabilitation services is needed to improve functioning in the community.
The youth presents with symptomatology consistent with a DSM-5 diagnosis and/or emotional or behavioral symptoms consistent with a DSM-5 diagnosis for which treatment more intensive than outpatient services is clinically indicated.
Adult Partial Care Admission
Adult partial care admission requires the following applicable elements.
ALL of the following
The member demonstrates impaired functioning requiring the acquisition of critical skills to achieve valued community roles and community integration in at least one domain: personal self-care, interpersonal relationships, work, school, ability to live in the community, or ability to acquire and/or maintain safe, affordable housing while at risk of requiring a more restrictive living situation.>= 1 qualifying domain; impairment continuing intermittently for at least 1 year
Clinical evidence justifies the necessity for partial care services, confirmed by the psychiatrist or advanced practice nurse and the interdisciplinary treatment team and documented in the record.
The member needs psychiatric rehabilitation and active treatment no less than 2 hours daily and no more than 25 hours weekly.>= 2 hours daily and <= 25 hours weekly
At least ONE primary diagnosis
Youth Partial Hospitalization Exclusion Criteria
Any one of the following is sufficient to exclude the youth from this intensity of service.
ANY of the following
The youth and/or parent, guardian, or caregiver does not voluntarily consent to treatment and there is no court order requiring treatment.
The CSOC Assessment and other relevant information indicate that the youth's treatment needs are inconsistent with partial hospitalization because a less intensive or more intensive therapeutic service is needed.
The behavioral symptoms result from a medical condition that warrants treatment in a medical setting.
The youth has a primary treatment need related to substance use requiring primary medical stabilization or intervention.
The youth has a sole diagnosis of autism and/or intellectual disability without a co-occurring DSM-5 diagnosis or symptoms/behaviors consistent with a behavioral health DSM-5 diagnosis.
When deciding coverage, the member's specific benefits must be referenced. Reviewers must first identify member eligibility, the member-specific benefit plan coverage, and any federal or state regulatory requirements that supersede the member's benefits. If the requested service is limited or excluded, defined differently, or otherwise conflicts with the member's specific benefit, the member's specific benefit supersedes these Clinical Criteria.
AMHR is not appropriate when the member has an acute medical condition requiring inpatient hospitalization, needs nursing-home level of care, cannot evacuate the residence within 3 minutes, or cannot manage incontinence and other medical-care needs.
Youth partial hospitalization is limited to New Jersey residents. For youth under age 18, the legal residency of the parent or legal guardian determines the minor's residence.
Medication evaluation and prescribing are separate from Partial Care reimbursement.
Coding and Service Parameters
Covered ASD Diagnosis CodesICD-10Covered
F84.0-F84.9
ICD-10 diagnosis codes defining autism spectrum disorder for the developmental services benefit
Verify that the member is an eligible New Jersey FamilyCare/Medicaid child under age 21 and has ASD diagnosed by a qualified healthcare provider. The diagnosis must be documented using ICD-10 codes F84.0 through F84.9.
Confirm NJ FamilyCare/Medicaid eligibility.
Confirm age is under 21.
Confirm qualified-provider ASD diagnosis and applicable ICD-10 code F84.0–F84.9.
Prior Authorization
Complete QHP Assessment and Proposed Treatment Plan
After ASD is appropriately diagnosed, a DIR Qualified Healthcare Provider (QHP) must assess the child for developmental therapy and prepare the proposed treatment plan. The QHP must be a New Jersey FamilyCare Medicaid provider or work for one.
Assessment and treatment planning must be performed by an appropriately licensed or nationally credentialed provider.
Policy Background
Developmental services for children with autism spectrum disorder (ASD) use social-emotional, relationship-based, child-directed, and parent-coached interventions to support engagement, communication, thinking, and functional emotional development. DIR/Floortime emphasizes the child’s developmental profile and the involvement of natural supports, while related approaches include developmental and blended developmental-behavioral interventions such as DRBI and NDBI.
Key Definitions
DIR
MeaningDevelopmental, Individual-difference, and Relationship-based framework
Developmental focusUnderstands the social-emotional developmental process from birth through the lifespan
Common applicationFloortime, also called DIRFloortime, is the most common and direct application of the framework
DIR home program
Program typeParent-mediated intervention program
Primary deliverersNatural supports, including parents or other actively involved attached relationships
Home target
Level-of-Care Requirements
Adult Mental Health Rehabilitation Services — Level-of-Care Criteria
The adult AMHR level of care requires all of the following:
Adult AMHR level-of-care criteria: The member is 18 years or older; has Serious Mental Illness seriously impairing the capacity to live independently with appropriate supports; has a referral from a licensed professional of the healing arts; does not require inpatient hospitalization or nursing-home level of care; can evacuate within 3 minutes; can manage incontinence and other medical-care needs; and services are medically necessary.Age 18 or older; evacuation within 3 minutes
Adult Mental Health Rehabilitation Services — Additional Level-of-Care Criteria
Adult AMHR remains appropriate only when all admission and safety requirements are met:
Adult AMHR additional level-of-care criteria: The member is at least 18, has serious mental illness impairing independent living, is referred by a licensed healing-arts professional, does not require acute inpatient or nursing-home care, can evacuate the residence within 3 minutes, can manage medical-care needs, and continues to require medically necessary services.
Covered Treatment Modalities
DIR/Floortime — Treatment Modality Criteria and Structure
DIR/Floortime is medically necessary when the treatment is structured as follows:
DIR/Floortime treatment modality: Use relationship-based, child-directed, social-emotional interventions with parent coaching, informed by the child's developmental profile and individual differences, and directed toward social-emotional development and engagement.Parent/caregiver home program target: 14-20 hours per week; professional services: up to 5 hours per week at least intense and up to 30 hours per week at most intense
The treatment plan must address Functional Emotional Development, natural supports, individual differences, safety, and course of intervention. Services may be provided in a clinic, center, home, or by telehealth as appropriate; school delivery is permitted outside normal school hours.
DRBI — Treatment Modality Criteria
Covered developmental relationship-based behavioral interventions may include:
DRBI treatment modalities
Frequency and Duration Limits
Youth partial hospitalization
Weekly limit2 to 5 treatment days per week
Daily limitUp to 5 hours per day
Setting and coordinationNonresidential program coordinated with the youth's educational program
Adult partial care
Minimum treatmentNo less than 2 hours daily
Maximum treatmentNo more than 25 hours weekly
Active-treatment scheduleUp to 5 hours per day, limited to 5 days per week
Policy Summary
PayerOptum
PolicyNew Jersey Medicaid Supplemental Clinical Criteria
Policy CodePolicy N/A
Change TypeModified
Effective DateNovember 1, 2026
Next Review DateN/A
Key ActionDocument adult partial-care medical necessity and obtain confirmation from a psychiatrist or advanced practice nurse and the interdisciplinary treatment team.
Availability of Natural Supports, including factors that may affect the family's and natural supports' ability to implement 14 to 20 hours of Floortime each week at home and how those factors affect the need for professional services.
Complexity of Individual Differences, including the complexity affecting development of the core Functional Emotional Development Capacities (FEDCs) and how it affects the need for professional services.
Safety, including factors increasing safety risk for the child or others and how those factors affect the need for professional services.
Course of Intervention Modifier, including circumstances that should be considered in determining the overall intensity of the DIR program.
The youth has the capacity and support for regular attendance and the stability necessary for maintenance in the program.
There is risk to self or others that does not require 24-hour medical or nursing supervision but does require structure and supervision for a significant portion of the day.
The youth's condition requires a comprehensive, multidisciplinary, multimodal course of treatment, including routine psychiatric observation or supervision, to regulate medication and provide behavioral intervention that maximizes functioning and minimizes risks to self, others, and property.
Schizophrenia or another psychotic disorder.
Major depressive disorder.
Bipolar disorder.
Delusional disorder.
Schizoaffective disorder.
Affective disorder.
The youth is not a resident of New Jersey.
For a youth under age 18, the legal residency of the parent or legal guardian determines the minor's residence.
Relationship to home programProfessional hours may be less when the DIR home program effectively supports the child
Most intense professional DIRFloortime services
Service intensityUp to 30 hours of professional DIRFloortime services per week
Adjustment factorActual professional-service hours depend on the effectiveness of the DIR home program and the child's needs
DIR treatment duration
Expected durationRarely less than 12 months
Duration driverFunctional emotional developmental progress and successful implementation of the DIR home program
Long-term objectiveSupport the family in using Floortime strategies at home on an ongoing basis
Supervision for providers below bachelor's degree
Minimum supervision1 hour per week
Maximum supervision2 hours per week
Supervision formatFace-to-face supervision is required
Parent Floortime dosing
Daily frequencyGenerally 6 to 8 sessions per day
Session duration20 or more continuous, undisturbed minutes per session
Preferred settingPreferably in the home in a space free of interruptions
Youth partial hospitalization frequency and duration
Weekly frequency2 to 5 days per week
Daily durationUp to 5 hours per day
Program coordinationTreatment should be coordinated with the youth's educational program
Adult partial care active treatment
Minimum active treatmentNo less than 2 hours daily
Maximum weekly treatmentNo more than 25 hours weekly
Daily and weekly limitsUp to 5 hours of active treatment per day, limited to 5 days per week
Staff-to-consumer ratio
Qualified worker ratioNot to exceed 1 qualified mental health services worker to 12 consumers
Applicable servicesDirect staff-to-consumer ratio for skill development provided individually or in groups
Service purposeSkill development for consumer-chosen community environments and valued community roles
Youth partial hospitalization staffing
Staffing ratio1 staff member to 5 youth
Team compositionMultidisciplinary team including a master's-level clinician and a licensed psychiatric provider
PurposeEnsure necessary therapeutic services and supervision
AMHR nursing visit interval
Initial assessmentComprehensive nursing assessment within the first 14 calendar days after admission
Required intervalOne face-to-face nursing visit every 90 days thereafter
DocumentationVisits must be documented in the consumer's progress notes while residing in a supervised residence
Permitted disciplines include, among others, LCSW, occupational therapist, LPC, LMFT, LAC, LSW, LCPC, and certified special education teacher.
Master's- or bachelor's-level professionals may provide services under supervision of a licensed or certified independent practitioner.
Prior Authorization
AMHR Referral and Medical Necessity Required
For Adult Mental Health Rehabilitation (AMHR), confirm that the member is at least 18, has serious mental illness that substantially impairs independent living with appropriate supports, and is referred by a licensed professional of the healing arts. Services must be medically necessary.
Document the licensed-professional referral.
Document the serious mental illness and resulting functional impairment.
Document medical necessity for AMHR.
Documentation Required
Include Required DIR Treatment-Plan Elements
The DIR treatment plan must connect the child’s functional-emotional developmental needs and individual differences to the requested professional-service intensity, duration, and safety supports.
Functional Emotional Development, typically measured by FEAS and/or clinical observation.
Availability of natural supports, including factors affecting the ability to provide 14–20 hours of home Floortime weekly and the effect on professional-service needs.
Complexity of individual differences affecting development of core Functional Emotional Development Capacities and professional-service needs.
Safety factors increasing risk for the child or others and their effect on service needs.
Course of Intervention Modifier circumstances affecting overall DIR intensity.
Documentation Required
Use Qualified Clinicians for Treatment Planning
Ensure assessment and treatment planning are completed by a licensed master’s-level clinician whose scope permits those functions. Only the DIR QHP may review or revise the treatment plan while supervising the DIR provider.
The QHP must have specialized training and required credentials in a recognized developmental model.
Recognized DIR credentialing organizations include ICDL, Profectum Foundation, The Play Project, and Greenspan Floortime Approach.
Recognized DRBI credentials include RDI, DMAI, and NJAIMH Level II or IV Infant Mental Health Endorsements; ESDM is recognized for NDBI.
DIR providers with a high school diploma or less than a bachelor's degree must be appropriately certified and supervised by a master's-level practitioner with advanced DIR certification.
Documentation Required
Assess and Document Natural Supports
Assess and document whether parents, caregivers, or other secured attached relationships are available to implement the DIR home program. The assessment must explain how family circumstances affect the feasible home-program intensity and the need for professional services.
Consider emotional, physical, cognitive, sensory, or medical limitations of natural supports.
Consider vocational demands, demands of other children, psychosocial stress, and home stability or permanency.
The target home program is generally 14–20 hours of parent- or caregiver-led Floortime weekly.
Denial Risk
Do Not Deny Solely for Limited Home-Program Capacity
Do not deny Floortime eligibility solely because the family has limited capacity to provide the full home program. Develop a more comprehensive plan to support the family and identify other ways to provide the intensity of services the child requires.
Limited home-program hours do not by themselves make a child ineligible for Floortime.
Adjust professional-service intensity and supports to address the documented family limitations.
Denial Risk
Apply AMHR Medical and Level-of-Care Screening
For AMHR admission, confirm that the member does not require inpatient hospitalization or nursing-home-level care, can evacuate the residence within three minutes, and can manage incontinence and other medical-care needs.
Exclude acute medical conditions requiring inpatient hospitalization.
Exclude members requiring nursing home level of care.
Confirm ability to evacuate within 3 minutes.
Confirm ability to manage incontinence and other medical needs.
Documentation Required
Complete Initial AMHR Assessments on Time
Within 14 days after AMHR admission, complete the required written comprehensive rehabilitation needs assessment and the initial nursing assessment. The nursing assessment must justify AMHR and recommend an appropriate service level.
Use the initial nursing assessment with the comprehensive intake assessment to develop the comprehensive service plan.
Document both assessments within the first 14 calendar days.
Documentation Required
Develop and Maintain the Individualized Rehabilitation Plan
Within 30 days of admission, staff must partner with the consumer to develop, implement, monitor, and update an individualized rehabilitation plan. The plan must be reviewed at the consumer’s request and at least every three months thereafter.
Develop the plan no later than 30 days after admission.
Permit a consumer-requested review or revision at any time.
Review and revise as necessary within three months of development and every three months thereafter.
Documentation Required
Document Required Nursing Visits
A registered nurse or higher-level nursing professional must provide face-to-face nursing visits every 90 days after the initial comprehensive nursing assessment while the consumer resides in a supervised residence. Document each visit in the consumer’s progress notes and assess clinical condition and consistency of care with the individualized rehabilitation plan.
Provide additional nursing visits when needed to evaluate the consumer’s condition and appropriateness of staff-provided care.
Document the 90-day visit and clinical review in the progress notes.
Unsupported block type: documentation
Documentation Required
Maintain Therapeutic Subcontract Work Records
Therapeutic subcontract work may be provided as prevocational therapy only when it is included in the consumer’s individualized service plan as an intervention addressing assessed needs. It must be facilitated by a qualified mental health services worker and performed within that worker’s line of sight.
Document the activity and its therapeutic purpose in the individualized service plan.
Base selected prevocational interventions on assessed interests, needs, skills, and supports.
Maintain the required qualified-worker supervision and line-of-sight oversight.
Documentation Required
Document Medication Treatment and Therapies
Document each consumer’s current medication treatment and therapies and maintain a mechanism for staff to share clinical information about medication utilization. Medication evaluation and prescribing are separate from Partial Care reimbursement.
Provide medication counseling and education as needed.
Document current medications and therapies.
Educate beneficiaries, staff, and caregivers about adverse reactions, side effects, and crisis-response procedures.
Billing Rule
Apply Member-Specific Benefit Controls
Before applying these criteria, identify member eligibility, the member-specific benefit plan, and any federal or state requirements that supersede the policy. If the benefit limits or excludes the requested service, defines it differently, or conflicts with these criteria, the member-specific benefit controls.
Verify the member’s specific benefit coverage before making a coverage determination.
Apply superseding federal or state requirements.
Do not use these criteria to expand a benefit that is limited or excluded by the member’s plan.
Denial Risk
Apply AMHR Admission Exclusions
Do not admit a member to AMHR when an acute medical condition requires inpatient hospitalization, nursing-home-level care is needed, the member cannot evacuate within three minutes, or the member cannot manage incontinence or other medical needs. Medical necessity must also be established.
Screen for medical conditions requiring a medical or inpatient setting.
Confirm the requested AMHR level of care is appropriate.
Document the exclusion review and medical-necessity determination.
Denial Risk
Screen Adult AMHR Medical and Safety Exclusions
For adult AMHR, exclude members who cannot safely function in the supervised-residence setting because of acute medical needs, nursing-home-level needs, inability to evacuate within three minutes, or inability to manage required medical care.
Use a medical and safety screen before admission.
Refer members needing a more intensive medical or nursing level of care to the appropriate setting.
Denial Risk
Apply Youth PHP Exclusion Criteria
For youth partial hospitalization, any listed exclusion is sufficient to deny this intensity of service. Apply the consent, level-of-care, medical, substance-use, diagnostic, and New Jersey residency requirements.
Exclude when the youth or parent/guardian/caregiver does not voluntarily consent and no court order requires treatment.
Exclude when needs require a less or more intensive service.
Exclude when symptoms result from a medical condition requiring a medical setting.
Exclude when primary substance-use needs require medical stabilization or intervention.
Exclude when the youth has sole Autism and/or Intellectual Disability without a co-occurring DSM-5 or behavioral-health diagnosis or consistent symptoms.
Confirm New Jersey residency; for minors, use the parent or legal guardian’s legal residency.
Denial Risk
Confirm Consent or Court-Order Authority
Youth partial hospitalization requires voluntary consent by the youth and/or parent, guardian, or caregiver unless a court order requires treatment. Document the consent or applicable court order before treatment begins.
A lack of voluntary consent without a treatment-requiring court order is an exclusion.
Apply the same consent requirement during continued-stay review.
Prior Authorization
Confirm Adult Partial-Care Medical Necessity
Adult partial-care medical necessity must be supported by clinical evidence and documented in the record. Necessity must be confirmed by the psychiatrist or advanced practice nurse and the interdisciplinary treatment team.
Document the clinical evidence supporting partial care.
Obtain confirmation from the psychiatrist or advanced practice nurse.
Support psychiatric rehabilitation and active treatment of at least two hours daily and no more than 25 hours weekly.
14 to 20 hours of Floortime per week at home
NDBI
Full termNaturalistic Developmental Behavioral Intervention
ApproachTargeted blended developmental and behavioral approach
Included modelEarly Start Denver Model
AMHR
Service typeAdult behavioral health rehabilitation delivered in or by a licensed community residence
Included servicesAssessment, service coordination, daily-skills training, residential counseling, support, crisis intervention, medication education, and healthcare monitoring
GoalSupport life skills needed for successful living in the least restrictive community environment
Active treatment
Starting pointProcess initiated at intake for a partial care program
PhasesAssessment, treatment, psychiatric rehabilitation, and discharge planning
PurposeMaximize independence and community living skills, promote valued roles, and reduce unnecessary hospitalizations
Prevocational services
Service typeInterventions, strategies, and activities within a partial care program
Work-related focusHelp individuals acquire general work behaviors, attitudes, and skills needed to assume the role of worker
Other applicationsSkills may also support functioning in other life domains, including decision-making, interpersonal issues, symptom management, and medication adherence
Skill development
Core meaningAcquiring the knowledge, attitudes, and specific behaviors needed to master identified critical competencies
Use of skillsApplying competencies in the settings where they are needed
Program typeIntensive, nonresidential, therapeutic treatment program
Primary useTime-limited response to stabilize acute symptoms
Care transitionsMay step down from inpatient or out-of-home treatment, or stabilize deterioration and avert hospitalization
18 years or older; evacuation within 3 minutes
Adult Partial Care Services — Level-of-Care Criteria
Adult partial care level-of-care eligibility requires all of the following:
Adult partial care level-of-care criteria
Functional impairment: The member has continuing and intermittent impaired functioning for at least one year requiring critical-skill development in personal self-care, interpersonal relationships, work, school, community living, or safe and affordable housing.At least 1 year
Confirmed clinical necessity: Clinical evidence supports partial care, confirmed by a psychiatrist or advanced practice nurse and the interdisciplinary treatment team, with the need documented in the record.
Active treatment need: Psychiatric rehabilitation and active treatment are needed.At least 2 hours daily and no more than 25 hours weekly; up to 5 hours per day and 5 days per week
Qualifying primary diagnosis: The member has schizophrenia or another psychotic disorder, major depressive disorder, bipolar disorder, delusional disorder, schizoaffective disorder, or an affective disorder.
Relationship Development Intervention (RDI).
Developmental models in autism interventions.
Infant Mental Health.
NDBI — Treatment Modality Criteria
Covered naturalistic developmental behavioral interventions may include:
NDBI treatment modalities
A naturalistic developmental behavioral intervention using a blended developmental and behavioral approach.
Early Start Denver Model.
Partial Care Rehabilitation and Recovery Services — Service Criteria and Components
Partial care rehabilitation and recovery services may include the following medically necessary components:
Partial care rehabilitation and recovery services
Core service components
Engagement strategies and activities supporting personally meaningful recovery goals and valued community roles.
Illness Management and Recovery, including psychoeducation, social-skills training, cognitive-behavioral therapy, motivational interviewing, behavioral tailoring, relapse prevention, coping skills, and adaptive problem solving.
Medication education and self-management support, wellness activities, and dual-disorder education when applicable.
Skill development for consumer-chosen community environments, including cognitive, physical, interpersonal, daily-living, and community-integration skills.Qualified mental health services worker-to-consumer ratio not exceeding 1:12
Goal-oriented individual, group, or family counseling, including motivational interviewing and cognitive-behavioral therapy when appropriate.
Age-appropriate learning activities tied to daily living or community-integration competencies, and social or leisure services.
Medication-related services, including medication counseling and education, documentation of current medication treatment and therapies, and communication of medication-use information among staff.
Medication evaluation and prescribing are separate from Partial Care reimbursement.
Psychiatric assessment and ongoing treatment supervision.
Youth partial hospitalization requires an intensive, structured, nonresidential program with all of the following components:
Youth partial hospitalization program structure: The program is nonresidential and intensive; provides treatment two to five days weekly for up to five hours daily; coordinates treatment with the youth's educational program; uses a multidisciplinary team including a master's-level clinician and a licensed psychiatric provider; and maintains a 1:5 staff-to-youth ratio.2-5 days per week; up to 5 hours per day; 1 staff member to 5 youth
Treatment may include individual and group counseling, family services, psychiatric assessment and medication management, case coordination, therapeutic activities, and service linkages.
Adult mental health rehabilitation nursing
Initial nursing assessmentCompleted within the first 14 calendar days after admission
Required intervalOne face-to-face nursing visit every 90 days after the initial comprehensive nursing assessment
ApplicabilityRequired while the consumer resides in a supervised residence