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 an out-of-state
placement is made
3.22.7-C: The 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 and/or adult clinical team to consider the temporary placement of a child or
young adult in an out-of-state treatment facility or program.
- A child or
young adult may need specialized programming not currently available
in Arizona to effectively treat a specified behavioral health
condition;
- An out-of-state
placement’s approach to treatment may incorporate and support
the child’s or young adult’s unique cultural heritage;
- A lack of
current in-state bed capacity may occur; or
- Geographical
proximity may encourage support and facilitate family involvement
in the person’s treatment.
ADHS/DBHS wants
to ensure that decisions to place children or young adults in out-of-state
placements for behavioral health care and treatment are examined
closely and are made after the child and family team and/or adult
clinical team has reviewed all other
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.
Go
to top
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 or other health care provider for the provision of acute
care services in the state in which the person will be placed. It
is recommended that coordination with the school system in
the area also occurs if applicable.
3.22.5 Definitions
Adult
Clinical Team
Child and
Family Team
Family Member
Prior
Authorization
Service Plan
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
Go
to top
3.22.7-A.
General Requirements
When considering an out-of-state placement for a child
or young adult, the following conditions apply:
- The child
and family team and/or adult clinical team must consider all appropriate 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 is
in agreement with the placement;
- The out-of-state
placement must be registered as an AHCCCS provider;
- The out-of-state
placement must meet 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 and found not to meet the person’s
needs;
- A child
and family team and/or adult clinical team has been developed, has been involved in the service-planning
process, and is in agreement with the out-of-state placement;
- The child
and family team and/or adult clinical team has determined how it will remain active and involved in
service planning once the out-of-state placement has occurred;
- A proposed
service plan that includes a discharge plan has been developed
that addresses the needs and strengths of the person (see Section
3.9, Intake, 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’s certification standards and the
specific educational needs of the person;
- Coordination
has occurred with other state agencies involved with the person;
- The person’s
Behavioral Health Coordinator or Health Care Provider or Indian Health Services 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 service
plan.
Go
to top
3.22.7-C:
The service plan
For a person placed out-of-state, the service plan developed
by the child and family team and/or adult clinical team must require that:
- Discharge
planning is initiated at the time of placement, including:
- The measurable
treatment goals being addressed by the facility and the criteria
necessary for discharge back to in-state services;
- The possible
or proposed in-state residence where the person will be returning
to and the recommended services and supports required once the
person is discharged from the facility;
- What needs
to be changed or arranged in order 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 child and family team and/or adult clinical
team actively review 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 child
and family team and/or adult clinical team actively reviews the progress of the person and clinical staffings occur every 30 days. To the extent possible, 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 child
and family team and/or adult clinical team ensures 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.
Go
to top
3.22.7-D.
Initial notification and periodic updates
T/RBHAs or subcontracted behavioral health providers are required
to notify the ADHS/DBHS prior to a referral for 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 accompanying copies of supporting
clinical documentation. As applicable, prior authorization must
be obtained prior to making a referral for out-of-state placement.
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 faxed 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).
3.22.7-E
Periodic updates to ADHS/DBHS
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 to the ADHS/DBHS Office of Utilization
Management (facsimile number (602) 364-4749) 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.
Go
to top
3.22
Out-of-State Placements for Children and Young Adults
Last Revised: 02/15/2007
Effective Date: 06/01/2008
|
