Applying for Adult Department of Mental Health (DMH) Services in Massachusetts

1. Applying for Adult Department of Mental Health (DMH) Services in Massachusetts Felice De Ruggiero, LICSW, LADC-1 Adult Clinical Service Authorization Unit DMH Northeast Area, Tewksbury

2. Objectives • Summarize the Adult DMH determination process and eligibility criteria • Assess an applicant’s immediate or emerging needs in relation to eligibility criteria • Identify the steps in the appeals process • Submit a comprehensive DMH adult application in order to secure appropriate clinical and professional services for the applicant

3. Applicants for Adult Services • The adult application must be signed by the applicant or the legal guardian (DCF guardian, custodial guardian or permanent legal guardian) • Include a copy of the guardianship decree or the DCF Care and Protection order • Include DMH two-way releases of information signed by the applicant or legal guardian for all psychiatric hospitalizations in the past 5 years, any neuropsychological testing reports, residential programs, and outpatient providers

4. If there is a history of substance abuse, the applicant or their guardian must initial, sign, and date the Protected HealthInformation Section on the second page of the release in order for DMH to obtain records • Submit as much current clinical information as possible with the application

5. Summarize the Adult DMH determination process and eligibility criteria • What happens when the application is received • What diagnoses are qualifying vs. non-qualifying

6. Qualifying vs. Non-Qualifying DiagnosesFrom Commonwealth of Massachusetts DMH Interpretive Guidelines for 104 CMR 29.00 Determining Service Authorization for Children Adolescents and Adults, December 2011) • Qualifying diagnoses: • Schizophrenia, Schizoaffective Disorder, Psychotic Disorder, NOS • Mood Disorder, NOS, Depressive Disorder, NOS, Major Depressive Disorder, Bipolar Disorder • Anxiety Disorder, NOS, Generalized Anxiety Disorder, Panic Disorder with or without Agoraphobia, Obsessive Compulsive Disorder, Social Anxiety Disorder, PTSD • Dissociative Identity Disorder, Delusional Disorder • Anorexia Nervosa, Bulimia • On Axis II: Borderline Personality Disorder (the only qualifying Axis II diagnosis)

7. Non-Qualifying Diagnoses • Adjustment Disorder, Dysthymia, Cyclothymia • Schizophreniform Disorder • ADHD • Any disorder that is due to a medical condition (i.e. Mood Disorder Due to a Medical Condition, Substance-Induced Mood Disorder, etc.) • Dementia • Delirium • Cognitive Disorder, NOS

8. Non-Qualifying Diagnoses, Continued • Traumatic Brain Injury or Head Injury • Mental Retardation • Learning Disorder, NOS • Autism Spectrum Disorder • Pervasive Developmental Disorder • Asperger’s Syndrome • Any personality disorder other than Borderline

9. A Word About Substance AbuseFrom Commonwealth of Massachusetts DMH Interpretive Guidelines for 104 CMR 29.00 Determining Service Authorization for Children Adolescents and Adults, December 2009 (Revised December 1, 2011) • An individual with a substance abuse problem is eligible if he or she is determined to have a qualifying mental disorder, meets impairment and duration criteria, requires DMH continuing care services, and has no other means for obtaining them. The qualifying mental disorder must be confirmed before assessing whether the applicant meets duration and functional impairment criteria. Functional impairment will be determined based on the applicant’s presentation. It is presumed that the functional impairment in a person with a co-occurring disorder is due to the primary psychiatric diagnosis.

10. Needs and Means Determination • How is it determined if the applicant has a need for a DMH service? • A site representative conducts an informal in person interview with the applicant or their legal representative • The applicant is asked why they are applying for services and what kind of services they think they need • The site determines whether the service can be obtained through other means (i.e. through insurance or another state agency)

11. Needs and Means Approved • If approved overall, what services can be received? • Case Management vs. CBFS: What is the difference? • Case Management (CM)= Brokerage & linkeages • CBFS= Community Based Flexible Supports that provides wrap around programming with a team with intensity of service fluctuating based on need • Both CM and CBFS can assist with vocational training, housing referrals, health and wellness referrals, and residential placement • A word about DMH and housing....

12. What happens if there is no need for a DMH service? • Applicants can be denied on need if they can obtain services through other means, are assessed to have no need for a DMH service, or if they decline/refuse DMH services • Applicants who are found to meet the clinical criteria for DMH services but are denied on need remain clinically authorized for 6 months. If their situation changes, a new application is not needed if they wish to reapply during this time period, but they will need a new Needs/Means interview at the site to reassess their need for a DMH service.

13. What about clients who were previously served by DMH? • If a client was previously served, they will remain meeting the clinical criteria for 1 year from the date that their case was closed • They will not need to fill out a new DMH application if they want to reapply within the one year time frame • A new Needs/Means interview will be required at the site level to determine if there is still a need for a DMH service • Prior to filling out a DMH application, have the client sign a release of information to check on their Service Authorization status. It could save you a lot of work!

14. Appealing a Denial • Identify the steps in the appeals process • Gather support letters from current providers that outline the symptoms that support the diagnoses • Importance of the face to face interview • Present any new documentation to support the application at this time

15. Application Cheat Sheet Make sure to include: An application that is signed and dated by the applicant or their legal guardian Guardianship decree, if applicable DMH two way releases completely filled out and signed, initialed and dated by both the applicant and guardian for all psychiatric hospitalizations in the past 5 years, any neuropsychological testing reports, any residential programs, and outpatient providers A support letter from a clinician (therapist or psychiatrist) outlining Axis I-V diagnoses and the specific symptoms that support those diagnoses Submit as much clinical information as possible with the application

16. In Summary • Questions