Child & Adolescent Mental Health Higher Level of Care

To expedite the review process, be sure to review our medical necessity criteria expectations for admission, continued stay and discharge.

Medical necessity criteria

Below is a general outline that our care managers will follow when reviewing Child and Adolescent Mental Health Cases; however depending on the specifics, the care manager may ask for additional information. Please note, in order to ensure that clinical collaboration occurs, we may only authorize a few days at a time.

DSM Diagnosis Information

• Include any Clinical Disorders, Personality Disorders, Intellectual Disability, or General Medical Conditions

Clinical Presentation

• Reason for admission (MH & SA HX, SU issues, mental health status, stressors)
• Clinical factors that support your requested level of care
• Medications: Types, dosage, frequency, titration plan and who prescribed
• Additional comments and/or concerns about medication use as it relates to current diagnosis
• Family assessment

Treatment Intervention/ Planning

• Identify specific and measurable treatment goals and interventions
• Behavioral modification plan
• Coordination with external supports such as family, school and ancillary professionals
• Frequency of family sessions in order to address admission precipitant
• If in a Partial Program: Describe how patient is using the skills outside of treatment hours
• If in Residential: Is the program close enough for consistent family involvement

Discharge Planning

• Identify discharge plan including the behavioral modification, family and medication management
• 7-day follow up appointments
• Identify any barriers to follow-up
• Has the outpatient provider been notified of the admission?
• Please provide the discharge information during last review or if no further authorization is needed, you may leave the information on the designated staff’s voicemail.