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COMBINED MANUAL

ISSUE DATE 09/2016

SPECIAL MEDICAL CRITERIA

0011.36

- Has been admitted within the last 3 years or is at risk of being admitted to inpatient or residential treatment.

OR - Is a Minnesota resident receiving inpatient treatment or residential treatment for the emotional disturbance through the interstate compact.

OR - Has been determined by a mental health professional to have psychosis or clinical depression, to be at risk of harming self or others, or to have psychopathological symptoms that resulted from physical or sexual abuse or psychic trauma within the past year.

OR - Has significantly impaired home, school, or community functioning for at least 1 year or for a period that a mental health professional documents as presenting substantial risk of lasting at least a year.

● SERIOUS AND PERSISTENT MENTAL ILLNESS (SPMI) There is an adult or adults who meet the definition of “serious and persistent mental illness” as determined by a qualified professional such that he/she:

- Has undergone 2 or more episodes of inpatient care for a mental illness within the preceding 24 months.

OR - Continuously experienced a psychiatric hospitalization or residential treatment exceeding 6 months' duration within the preceding 12 months.

OR - Has been treated by a crisis team 2 or more times within the preceding 24 months.

OR - Has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline personality disorder which significantly impairs functioning; and a mental health professional documents that he/she is reasonably likely to have future episodes requiring inpatient or residential treatment unless ongoing case management or community support services are provided.

OR - Has been court-committed as a mentally ill person in the past 3 years or has had the commitment stayed or continued.

OR - Meets any of the criteria above but the specified time period has expired.

OR - Was diagnosed with severe emotional disturbance as a child and who a mental health professional has documented in the past 3 years is reasonably likely to have future episodes requiring inpatient or residential treatment unless ongoing case management or community support services are provided.

BANKED MONTHS

If a participant who has accrued time beginning 1-1-98 while exempt from Employment Services under the special medical criteria exemption reaches the time limit and is no longer eligible for the special medical criteria extension, the participant must use the banked months before applying for a different type of extension. A caregiver may accrue months back to 1-1-98 if someone in the household met special medical criteria. Review caregivers who might be retroactively eligible for this exemption so that accrued months can be allowed correctly. See BANKED MONTHS in 0002.05 (Glossary: Assistance Standard...). Participants are subject to regular Employment Services requirements and pre 60 month sanction policies while using banked months. If there is information known to the county or employment services provider that the participant may meet one of the other Family Stabilization Services (FSS) eligibility criteria then FSS sanction provisions must be followed prior to imposing a sanction. See Employment Services Manual Appendix H (FSS Sanction Guidance). After the banked months have been exhausted, evaluate the caregiver to see if there is eligibility for an extension under another extension category.

MAXIS is unable to differentiate between extensions for the purpose of drawing on the banked months. Therefore, to ensure the system pulls the banked months before the participant is extended under a different category, code the STAT/TIME panel “Extension” field “NO” (no extension identified) when the participant no longer qualifies for the special medical criteria extension, even if the participant meets the criteria for a different type of extension.

Banked months are accrued based on the special medical criteria of an adult or child in the household, NOT based on a caregiver’s own special medical criteria. If a caregiver meets any of the special medical criteria on his or her own, he/she may be