ACCESS Team - Medical Necessity For Specialty Mental Health Services That Are The Responsibility of Mental Health Plans
Must have all A, B and C
A. Diagnosis - Must have one of the following DSM IV diagnoses, which will be the focus of the intervention provided
Included Diagnosis:
- Pervasive Development Disorders, except Autistic Disorder which is excluded
- Attention Deficit and Disruptive Behavior Disorders
- Feeding & Eating Disorders of Infancy or Early Childhood
- Elimination Disorders
- Other Disorders of Infancy, Childhood or Adolescence
- Schizophrenia & Other Psychotic Disorders
- Mood Disorders
- Anxiety Disorders
- Somatoform Disorders
- Factitous Disorders
- Dissociative Disorders
- Paraphilias
- Gender Identity Disorders
- Eating Disorders
- Impulse-Control Disorder, Not Elsewhere Classified
- Adjustment Disorders
- Personality Disorders, Excluding Antisocial Personality Disorder
- Medication-Induced Movement Disorders
Excluded Diagnosis
- Mental Retardation
- Motor Skills Disorders
- Communication Disorders
- Autistic Disorders
- Tic Disorders
- Delirium, Dementia and Amnestic and Other Cognitive Disorders
- Mental Disorders due to a General Medical Condition
- Substance Related Disorders
- Sexual Disorders
- Antisocial Personality Disorder
- Other conditions that may be a focus of clinical attention, except medication induced movement disorders which are included
B. Impairment Criteria - Must have one of the following as a result of the mental disorder(s) identified in the diagnostic ("A") criteria; must have 1,2, or 3:
- A siginificant impairment in an important area of life functioning; or
- A probability of significant deterioration in an important area of life functioning; or
- Children also qualify if there is a probability the child will not progress developmentally as individually appropriate.
C. Intervention Related Criteria - Must have all 1, 2, 3 below
- The focus of proposed intervention is to address the condition identified in impairment criteria "B" above, and
- It is expected the beneficiary will benefit from the proposed intervention by significantly diminishing the impairment, or preventing significant deterioration in an impairment area of life functioning, and/or for children it is probable the child will progress developmentally as individually appropriate, and
- The condition would be responsive to physical healthcare-based treatment