- Spravato Coverage Guidelines
- Youth BHP Level of Care Guidelines Complete View Sections Hide Sections
- Guidelines for Making Level of Care Decisions
- Acute Inpatient Psychiatric Hospitalization (Child/Adolescent)
- Albert J. SOLNIT Center – Inpatient Psychiatric Hospitalization
- Psychiatric Residential Treatment Facility (PRTF)
- Residential Treatment Center (RTC)
- Therapeutic Group Home: LEVEL II
- Intermediate Care
- Intensive In Home Children And Adolescent Psychiatric Services
- Multidimensional Family Therapy (MDFT)
- Multisystemic Therapy (MST)
- Functional Family Therapy (FFT)
- Outpatient (OTP)
- Psychological And Neuropsychological Testing – Youth
- Case Management Services (for clients under 21 years of age)
- Adult BHP Level of Care Guidelines Complete View Sections Hide Sections
- Introduction to ASAM
- Home Health – Adult and Child – Level of Care Guidelines
- Autism Spectrum Disorder Services Level of Care Guidelines Complete View Sections Hide Sections
Please Note: Any and all decisions to deny a service are based on the following new medical necessity definition. For purposes of the administration of the medical assistance programs by the Department of Social Services, “medically necessary” and “medical necessity” mean those health services required to prevent, identify, diagnose, treat, rehabilitate or ameliorate an individual’s medical condition, including mental illness, or its effects, in order to attain or maintain the individual’s achievable health and independent functioning provided such services are: (1) Consistent with generally-accepted standards of medical practice that are defined as standards that are based on (A) credible scientific evidence published in peer-reviewed medical literature that is generally recognized by the relevant medical community, (B) recommendations of a physician-specialty society, (C) the views of physicians practicing in relevant clinical areas, and (D) any other relevant factors; (2) clinically appropriate in terms of type, frequency, timing, site, extent and duration and considered effective for the individual’s illness, injury or disease; (3) not primarily for the convenience of the individual, the individual’s health care provider or other health care providers; (4) not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the individual’s illness, injury or disease; and (5) based on an assessment of the individual and his or her medical condition.
The Connecticut Behavioral Health Partnership (CT BHP) uses the ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders: Second Edition (ASAM PPC-2) Published by the American Society of Addiction Medicine, Inc.
If you do not already have a copy of the ASAM Criteria, you can order it on the ASAM website.