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Pennsylvania Keystones of Health Section 1115 Demonstration Approval Period: December 26, 2024 through December 31, 2029 Page 87 of 90 ATTACHMENT I Reentry Demonstration Initiative Health-Related Criteria Qualifying Condition Definition One or more substance use disorders (SUD) Individuals who are preparing for release from correctional setting and have a substance use disorders (as defined by The Pennsylvania adopted version of the ASAM Criteria) in addition to a diagnosis identified on the Department approved SUD ICD 10 codes list. Serious mental illness (SMI) Individuals who are preparing for release from correctional setting and meets the criteria for the Adult Priority Group for adults with serious mental illness (SMI) set forth in bulletin OMHSAS-19-03, “Serious Mental Illness: Adult Priority Group,” issued August 6, 2019 or most current version. Eligible for Medicaid funded 1915(c) home and community-based services (HCBS) administered by the Office of Long Term Living or Office of Developmental Programs upon release Individuals who are preparing for release from correctional setting and are found eligible for Pennsylvania’s approved Medicaid funded 1915(c) home and community-based services waivers through the approved 1915 (c) assessments identified in OLTL IEB-19-04, IAE-19- 04, 07-19-04 and ODP 00-19-04. One or more chronic health conditions Individuals who are preparing for release from correctional setting and have a chronic Health condition with treatment plan of: •End-stage renal disease with active dialysis; •Chronic pulmonary disease requiring oxygen; •Type 1 diabetes; •Type 2 diabetes requiring at least one injectable insulin/day; or •Acute cancer with active chemotherapy.
Pregnant or in the 12- month postpartum period Individuals who are preparing for release from correctional setting and are pregnant or in the 12-month postpartum period Autism Spectrum Disorder (ASD) Individuals who are preparing for release from correctional setting and have a diagnosis of Autism Spectrum Disorder.