1. Have a severe and persistent behavioral health condition as defined by the most recent version of the DSM and document by an independent clinician
2. Any one of the following criteria must also be documented in the request for services.
a. The member has significant difficulty consistently and independently accessing or utilizing ambulatory behavioral health care or medical care. For example, the member relies primarily on emergency room services as evidenced by three (3) or more visit to the ER within the six (6) months or has had two (2) or more inpatient admissions in the last year.
b. The member is either being discharged from a hospital or a facility-based program or being released from incarceration.
c. The member has significant difficulty consistently and independently managing age-appropriate activities of daily living, including finances, hygiene, nutrition and meal preparation, home maintenance, childcare, or legal, housing, transportation, and other community service needs.
d. The member has significant difficulty obtaining or maintaining employment
e. The member lives in an unsafe environment or impermanent housing. For example, an unsafe living environment may include abusive, enabling, living situation poses a significantly increased risk for the individual due to the uncontrolled psychiatric, substance use disorder, dangerous, or illegal behaviors (e.g., drug−dealing or sexual exploitation) of others living in the residence
f. The member does not have family or social supports, or the family or social supports cannot or are not capable of helping the member utilize care or manage his or her behavioral health condition.
3. All of the following criteria must also be met.
a. The member is not at imminent risk of serious harm to self or others.
b. The member has a treatment plan that adequately addresses his or her behavioral health and co-occurring general medical conditions
c. The member is not getting duplicative services from an already existing program such as 1915i.