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STATE CHILD HEALTH PLAN UNDER TITLE XXI OF THE SOCIAL SECURITY ACT

STATE: Virginia Page 6-37

Effective Date: 07/01/05

37 Approval Date: _____________/06 6.2.11.A ⌧ Outpatient mental health services, other than services described in 6.2.19, but including services furnished in a state-operated mental hospital and including community-based services (Section 2110(a)(11)

A. Psychiatric services are limited to an initial availability of 26 sessions without prior authorization during the first year of treatment. An additional extension of up to 47 sessions during the first treatment year must be prior authorized by DMAS. The availability is further restricted to no more than 26 sessions each succeeding year when approved by DMAS. Psychiatric services are further restricted to no more than three sessions in any given seven-day period. Consistent with the Omnibus Budget Reconciliation Act of 1989 §6403, medically necessary psychiatric services shall be covered when prior authorized by DMAS for individuals younger than 19 year of age when the need for such services has been identified through an EPSDT screen. B. Community Mental Health Services: 1. Intensive in-home services to children and adolescents under age 19 - Shall be time-limited interventions provided typically but not solely in the residence of a child who is at risk of being moved into an out-of-home placement or who is being transitioned to home from out-of-home placement due to a documented medical need of the child. These services provide crisis treatment; individual and family counseling; and communication skills (e.g., counseling to assist the child and his parents to understand and practice appropriate problem- solving, anger management, and interpersonal interaction, etc.); case management activities and coordination with other required services; and 24- hour emergency response. These services shall be limited annually to 26 weeks. Services must be directed toward the treatment of the eligible child and delivered primarily in the family's residence with the child present.

2 Therapeutic day treatment for children and adolescents - Provides evaluation; medication; education and management; opportunities to learn and use daily living skills and to enhance social and interpersonal skills (e.g., problem-solving, anger management, community responsibility, increased impulse control, and appropriate peer relations, etc.); and individual, group and family psychotherapy. The service shall be provided two or more hours per day in order to provide therapeutic interventions. Services are limited annually to 780 units: one unit of service is defined as a minimum of two hours but less than three hours in a given day. Two units of service shall be defined as a minimum of three but less than five hours in a given day. Three units of service shall be defined as five or more hours of service in a given day.

3. Day Treatment/Partial Hospitalization - Day treatment/partial