Submission Requirements
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Acute and Subacute Services Provided in an Institute for Mental Disease (IMD):
Service Authorization Request (SAR)
State Hospital Mental Health/Substance Abuse (MHSA) Inpatient:
Service Authorization Request (SAR)
Certificate of Need (CON) if under 21 years old
Comprehensive Clinical Assessment (CCA) or Diagnostic Assessment (DA)
I/DD exception form per Diversion Law, if applicable
Inpatient Hospital Substance Abuse Treatment:
Service Authorization Request (SAR)
Certificate of Need (CON) if under 21 years old for freestanding psychiatric facility
Comprehensive Clinical Assessment (CCA) or Diagnostic Assessment (DA)
Non-State Hospital Mental Health/Substance Abuse (MHSA) Inpatient:
Service Authorization Request (SAR)
Certificate of Need (CON) if under 21 years old for freestanding psychiatric facility
Comprehensive Clinical Assessment (CCA) or Diagnostic Assessment (DA)
Service Definition Authorization Parameters
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Acute and Subacute Services Provided in an Institute for Mental Disease (IMD) :
Adults ages 21-64
Prior approval required
Initial : Up to 7 days
Concurrent : Up to 4 days
For MH admissions, authorization may not exceed 15 days per admission AND no more than 15 days per calendar month
State Hospital Mental Health/Substance Abuse (MHSA) Inpatient :
Under age 21 and Over age 64
Prior approval is not required upon admission through the first 72 hours of service
Initial : up to 7 calendar days
Concurrent : up to 7 calendar days
Inpatient Hospital Substance Abuse Treatment:
Children and Adults
Prior approval is not required upon admission through the first 72 hours of service
Initial : up to 7 calendar days
Concurrent : up to 3 calendar days
Non-State Hospital Mental Health/Substance Abuse (MHSA) Inpatient :
Children and Adults
Prior approval is not required upon admission through the first 72 hours of service
Initial : up to 7 calendar days
Concurrent : up to 3 calendar days