THE MASSACHUSETTS DEPARTMENT OF MENTAL HEALTH- 2000

Who is eligible for service from The Massachusetts Department of Mental Health (DMH)? And how do I help my patient apply? DMH changed some policies as of January 1, 2000, so what follows is a summary of the DMH "Interpretive Guidelines for 104 CMR 29.00, Determining Eligibility for DMH Continuing Care Services for Children, Adolescents and Adults". Copies are available from the Community Resource Center. It also serves as an update to and more detailed explanation of the article that appeared in this space in July 1998.   As you will see the application process is designed to limit clients only to those with major chronic illness who have needs which no other public or private entity will serve. And even if one is granted "DMH client" status, there is no guarantee that the appropriate services will be available.

WHO MAY APPLY? An individual, his/her Legally Authorized Representative or LAR (such as a parent or guardian), or an institution if the individual gives consent or the institution has filed a petition for guardianship.

WHERE CAN AN APPLICATION BE SUBMITTED? To the DMH Area or Site office with responsibility for the community where the applicant or LAR lives. The Community Resource Center has copies of the list of offices which we will send on request, and these offices are being added to IRis.

WHAT IS THE PROCESS? The clinician and the patient complete an application. This must include the Clinical Assessment of Risk, Behavior and Rehabilitation Needs of Adults (CARBRN) for adult applicants. DMH then may request an interview to clarify information and or supplement information in the application. For children and adolescents an interview is required to administer the Child and Adolescent Functional Assessment Scale (CAFAS). Copies of the current (1/1/2000) applications, and the CARBRN are available in the SW main offices. Please destroy any old copies you may have. Copies of all forms mentioned below are available through the CRC and from the DMH area offices.

ELIGIBILITY CRITERIA:

Client must be a resident of Massachusetts AND

  1. meet the Adult or Child Clinical Criteria, AND

  2. require DMH continuing care services AND

  3. have no other means for obtaining them.

1. Adult and Child Clinical Criteria: Must have a severe and persistent mental illness that has resulted in functional impairment that substantially interferes with or limits one or more major life activities. An individual with a substance abuse problem is eligible if he or she is determined to have a qualifying mental disorder, meets impairment and duration criteria, requires DMH continuing care services and has no other means for obtaining them. (Note that in the past substance abuse was a reason for exclusion; this is no longer the case.) Functional impairment will be assumed to be due to the mental illness; it is not necessary to try to attribute it to either the substance abuse or mental illness. Duration must have lasted or be expected to last one year.

Adult functional impairment is measured by the Tennessee Adult Functional Assessment Tool.

Children require an interview for DMH to administer the CAFAS.

Transitional Age (16 -19) - Exact age will determine whether an adult or child/adolescent application is filed. Contact the CRC for details.

2. DMH Continuing Care Services are defined as "community-based services contracted by or operated by DMH, but which do not include: services of brief duration, outpatient services, court evaluations, or acute mental health services, such as crisis intervention or emergency screening."

3. Alternative sources: if the service is available through insurance or medical entitlement (MassHealth, Medicare) then DMH will not provide it. If similar services are available from another entity such as the Mass. Rehabilitation Commission, DSS or the VA, DMH will not provide continuing care services.

WHEN WILL A DECISION BE MADE? The time-frames that follow start once DMH has received the application AND all of the supporting documentation from all sources. If the applicant is hospitalized through the Mass. Behavioral Health Partnership a decision will be rendered within 5 business days after receiving a complete application. When hospitalized through any other insurer a decision will be rendered within 10 business days. And for all others a decision will be rendered within 20 business days. All decisions will be made within 90 days after receipt of application whether or not complete.

SHORT-TERM SERVICES (emergency services): These are provided on a case-by-case basis for up to 60 days during the application process with the approval of the Area Director or designee. Services may include case management or other DMH services. Receipt of these services does not indicate the final outcome of the application, nor guarantee they will continue even if approved.

IF AN APPLICANT IS DETERMINED INELIGIBLE for services they should be informed of their right to appeal, the process and steps for taking this appeal further if necessary.

IF AN APPLICATION IS APPORVED THEY PROCEED TO PRIORITY ASSIGNMENT AS DETAILED BELOW:

PRIORITY OF NEEDS DETERMINATION

In order to be assigned the top priority rank of need one must either require continuing care community services designed to contain significant risk of harm to self or others, be awaiting discharge from DMH operated or contracted inpatient unit (except acute) or be homeless or be transitioning from DMH child/adult system to the adult system. The lower priority rank includes those who have had two or more psychiatric hospitalizations within the past 12 months (for adults), or are awaiting discharge from a non-DMH acute inpatient or correctional setting, children deemed eligible through the Collaborative Assessment Program, at risk of need for services more intensive than those being requested or are custodial parent of a minor child. All others are lower priority still.

Based on this priority, and availability of the requested services a client is assigned to one of THREE LEVELS OF OVERALL PRIORITY:

Client status- a high priority rank for needing DMH services AND some or all of the needed services are available immediately. A DMH case manager is to be assigned within 5 business days.

Pending services status- a high priority rank, BUT none of the needed services is available immediately, but it is expected that at least one of the needed services will be available in less than one year. The client will be contacted at least monthly regarding his or her status until some or all of the needed services become available.

Low priority status- low priority and it is anticipated that none of the needed services will be available for a year or more. The individual will only be notified of his or her "low-priority status".

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