Section
3.22 Out-of-State Placements for Children and Young Adults
3.22.1
Introduction
3.22.2 References
3.22.3 Scope
3.22.4 Did you know…?
3.22.5 Definitions
3.22.6 Objectives
3.22.7 Procedures
3.22.7-A: General requirements
3.22.7-B: Conditions to be met before a referral
for out-of-state
placement is made
3.22.7-C: The Individual Service Plan
3.22.7-D: Initial notification
to ADHS/DBHS
Office of Utilization Management
3.22.7-E Periodic updates to ADHS/DBHS
Office of Utilization Management
3.22.1
Introduction
At times, it may be necessary to consider an out-of-home placement
for a child or young adult to meet the person’s unique circumstances
or clinical needs. The following factors may lead the person’s
Child and Family Team (CFT) or Adult Recovery Team (ART) to consider the temporary
out-of-state placement of a child or young adult.
- A child or
young adult needs specialized programming not currently available
in Arizona to effectively treat a specified behavioral health
condition;
- An out-of-state
placement’s approach to treatment incorporates and supports
the child’s or young adult’s unique cultural heritage;
- A lack of
current in-state bed capacity and/or
- Geographical
proximity encourages support and facilitates family involvement
in the person’s treatment.
The Arizona Department of Health Services/Division
of Behavioral Health Services (ADHS/DBHS) expects that decisions to place children or young adults in out-of-state
placements for behavioral health care and treatment are examined
closely and made after the CFT or ART have reviewed all other
in-state options. Other options may include the provision of support services
in the context of the person’s current living situation, single
case agreements with in-state providers that would allow enhanced
programming or staffing patterns to meet the specific needs of the
person, or the development of a service plan that incorporates a
combination of support services and clinical interventions and takes
advantage of the full extent of all available covered services.
In the event that an out-of-state placement is necessary and supported
by the Child and Family Team and/or Adult Clinical Team, Tribal
and Regional Behavioral Health Authorities (T/RBHAs) and their providers must follow the
steps and procedures outlined in this section. In addition,
services provided out-of-state must meet appointment standards and
timelines specified in
Section 3.2, Appointment Standards and Timeliness of Service.
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3.22.2
References
The following citations can serve as additional resources for this
content area:
3.22.3
Scope
To whom does this apply?
All persons under the age of 21 being considered for, or currently
placed in, an out-of-state placement.
3.22.4
Did you know?
Coordination must occur with the person’s Arizona
Health Care Cost Containment System (AHCCCS)
Health Plan Behavioral Health Coordinator or other health care provider for the provision of acute
care services in the state in which the person will be placed. It
is also required that coordination with the school system in
the area occurs.
3.22.5 Definitions
Adult
Recovery Team (ART)
Child and
Family Team
Prior
Authorization_PM3.22
Individual Service Plan (ISP)
Single Case Agreement
3.22.6 Objectives
To ensure that out-of-state placements for persons under
the age of 21:
- Serve the
individual needs of the person;
- Are determined
to be more appropriate and beneficial than available in-state
services;
- Facilitate family member involvement; and
- Promote the person’s timely return to a
community living environment.
3.22.7
Procedures
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3.22.7-A.
General Requirements
When the T/RBHA is considering an out-of-state placement for a child
or young adult, the following conditions apply:
- The CFT or
ART will consider all
applicable and available in-state services
and determine that the services do not adequately meet the specific
needs of the person and the person’s family/guardian (not
including those not under guardianship between 18 and under 21
years of age) is
in agreement with the out-of-state placement;
- The out-of-state
placement is must be registered as an AHCCCS provider;
- The out-of-state
placement meets the
Arizona Department of Education Academic Standards; and
- A plan for
the provision of non-emergency medical care must be established.
3.22.7-B:
Conditions to be met before a referral for out-of-state placement
is made
Documentation in the clinical record must indicate that the
following conditions have been met before a referral for an
out-of-state placement is made:
- All less
restrictive clinically appropriate approaches have either been
provided or considered by the CFT or ART and found not to meet the person’s
needs;
- The CFT or ART
has been involved in the service-planning
process, and is in agreement with the out-of-state placement;
- The CFT or
ART has determined how
they will remain active and involved in
service planning once the out-of-state placement has occurred;
- A proposed
ISP that includes a discharge plan has been developed
that addresses the needs and strengths of the person (see Section
3.9, Assessment and Service Planning);
- All applicable
prior authorization requirements have been met (see Section
3.14, Securing Services and Prior Authorization);
- The
Arizona Department of Education has been consulted to ensure
that the educational program in the out-of-state placement meets
the
Arizona Department of Education Academic Standards and the
specific educational needs of the person;
- Coordination
has occurred with other state agencies involved with the person;
- The person’s
AHCCCS Health Plan Behavioral Health Coordinator or Health Care Provider has been contacted
and a plan for the provision of any necessary non-emergency medical
care has been established and is included in the comprehensive
clinical record by the assigned Gila River RBHA Clinician (Clinical
Liaison); and
- Cultural
considerations have been explored and incorporated into the ISP.
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3.22.7-C:
Individual Service Plan
For a person placed out-of-state, the ISP developed
by the CFT or ART must require that:
- Discharge
planning is initiated at the time of referral, including:
- The measurable
treatment goals being addressed by the out-of-state placement and the criteria
necessary for discharge back to in-state services;
- The possible
or proposed in-state residence where the person will be returning
and the recommended services and supports required once the
person returns from the out-of-state placement;
- What needs
to be changed or arranged to accept the person for subsequent
in-state placement to meet the person’s needs;
- How effective
strategies implemented in the out-of-state placement will be transferred
to the persons’ subsequent in-state placement; and
- The actions necessary to integrate the person into family and community life upon discharge.
- The CFT or ART actively reviews the person’s progress with clinical staffings occurring at least every 30 days. Clinical staffings
must include the staff of the out-of-state facility;
- The person’s
family/guardian is involved throughout the placement; this may
include family counseling in person or by teleconference or videoconference;
- The CFT or
ART must ensure that essential and necessary health care services
are provided; and
- Home passes
are allowed as clinically appropriate and in accordance with the
ADHS/DBHS
Covered Behavioral Health Services Guide. For youth in
Child Protective Services (CPS) custody, home
passes must be determined only in close collaboration with CPS.
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3.22.7-D.
Initial notification to ADHS/DBHS Office of Utilization Management
T/RBHAs or subcontracted behavioral health providers are
required to notify ADHS/DBHS Office of Utilization Management prior to a referral for out-of-state placement
and upon discovering that a T/RBHA enrollee is in an out-of-state placement, using
PM
Form 3.22.1, Out-of-State Placement, Initial Notice.
T/RBHAs may ask that providers assist with supplying the information
required on the form and with providing copies of supporting
clinical documentation. Prior authorization must
be obtained prior to making a referral for out-of-state placement,
in accordance with T/RBHA criteria (see
Section 3.14, Securing
Services and Prior Authorization).
What is
the process for providing initial notification to ADHS/DBHS?
For Tribal RBHAs, the TRBHA completes
PM Form 3.22.1, Out-of-State
Placement, Initial Notice, and a request for prior authorization,
and compiles supporting clinical documentation in accordance with
Section 3.14, Securing Services and Prior Authorization.
PM Form
3.22.1 is then submitted via fax or e-mail to ADHS/DBHS Office of Utilization Management
along with the request for prior authorization using the established
prior authorization request process (facsimile number (602)
364-4749, e-mail address:
DMHSMEDICALMANAGEMENT@azdhs.gov).
3.22.7-E
Periodic updates to ADHS/DBHS Office of Utilization Management
In addition to providing initial notification,
every 90 days the T/RBHA is required to submit updates to ADHS/DBHS
Office of Utilization Management regarding the person’s progress in
meeting the identified criteria for discharge from the out-of-state
placement. T/RBHAs must use
PM Form 3.22.2, Out-of-State Placement, 90-Day Update, to
adhere to this requirement. T/RBHAs may ask that providers assist
with providing the information required on the form.
T/RBHAs must complete
PM Form 3.22.2 and submit
the form via facsimile or e-mail to the ADHS/DBHS Office of Utilization
Management (facsimile number (602) 364-4749, e-mail:
DBHSMEDICALMANAGEMENT@azdhs.gov) every 90 days that the
person continues to remain in out-of-state placement.
The Gila River
RBHA may require its subcontracted behavioral health providers to
provide information to include on
PM
Form 3.22.2. In addition, out-of-state providers are
required to provide periodic clinical information to the assigned
RBHA Clinician in a reporting format approved by the Gila River
RBHA.
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3.22
Out-of-State Placements for Children and Young Adults
Last Revised: 10/04/2011
Effective Date: 12/01/2011
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