Sec. 10.09.90.07. Participant Eligibility — Level III — Intensive Care Coordination

A. The participant shall meet at least one of the following conditions:

(1) The participant has been enrolled in the 1915(i) program for 6 months or less;

(2) The participant is currently enrolled in Level I or Level II Care Coordination services under this chapter and has experienced one of the following adverse childhood experiences during the preceding 6 months:

(a) Emotional, physical, or sexual abuse;

(b) Serious emotional or physical neglect; or

(c) Significant family disruption or stressors;

(3) The participant meets the following conditions:

(a) The participant has a behavioral health disorder amenable to active clinical treatment, diagnosed through a face-to-face psychosocial assessment by a licensed mental health professional;

(b) There is clinical evidence the minor has a SED and continues to meet the service intensity needs and medical necessity criteria for the duration of their enrollment;

(c) A comprehensive psychosocial assessment performed by a licensed mental health professional finds that the participant exhibits a significant impairment in functioning, representing potential serious harm to self or others, across settings, including the home, school, or community;

(d) The psychosocial assessment supports the completion of the Early Childhood Service Intensity Instrument (ECSII) for youth ages 0-5 or the Child and Adolescent Service Intensity Instrument (CASII) for youth ages 6-21, by which the participant receives a score of:

(i) 3 on the ECSII; or

(ii) 3 or higher on the CASII;

(e) Youth with a score of 3, 4, or 5 on the CASII also shall meet the conditions outlined in §B of this regulation; and

(f) Youth with a score of 3 or 4 on the ECSII also shall meet the conditions outlined in §C of this regulation.

B. Youth with a score of 3, 4, or 5 on the CASII shall meet one of the following criteria to be eligible based on their impaired functioning and service intensity level:

(1) Transitioning from a residential treatment center; or

(2) Living in the community, be 6 through 21 years old, and have:

(a) Any combinations of 2 or more inpatient psychiatric hospitalizations or emergency room visits in the past 12 months; or

(b) Been in an RTC within the past 90 calendar days.

C. Youth who are younger than 6 years old who have a score of a 3 or 4 on the ECSII shall either:

(1) Be referred directly from an inpatient hospital unit; or

(2) If living in the community, have one or more psychiatric inpatient hospitalizations or emergency room visits in the past 12 months.