DHSS / Behavioral Health P&P Template
STATE OF ALASKA
DEPARTMENT OF HEALTH & SOCIAL SERVICES
SECTION:
NUMBER:
PAGE:
TITLE:
BEHAVIORAL HEALTH
RECIPIENT ELIGIBILITY
POLICY & PROCEDURE
ATTACHMENTS/FORMS:
APPROVED:
“Alaska Medical Assistance Program Policies and Claims Billing
Procedures for Community Behavioral Health Services” at:
http://www.hss.state.ak.us/dbh/PDF/BHS_Manual_PartA_PartB_%20
Apndx%202011Dec1_b.pdf
INITIATED: 5/29/12
REVIEWED:
REVISED:
POLICY OWNER:
DATE:
“Tribal Rural Behavioral Health Provider Clinical Handbook Desk
Guide”
Purpose: The purpose of this policy is to identify the recipient eligibility categories for
behavioral health services.
Scope: This policy applies to all participating rural tribal community behavioral health centers identified
in the Bring the Kids Home Tribal Rural Gaps Assessment Follow-Up Project.
Policy: Recipients and behavioral health services are eligible for either clinic, rehabilitation, or
both based on criteria identified in this policy.
Definitions:
Adult Experiencing an Emotional Disturbance- A recipient 21 years of age or older who is experiencing
a non-persistent mental, emotional, or behavioral disorder that is identified and diagnosed during a
professional behavioral health assessment; and is not the result of intellectual, physical, or sensory
deficits.
Adult Experiencing a Serious Mental Illness (SMI)- A recipient 21 years of age or older who: has or at
any time in the past year had a diagnosable mental, emotional, or behavioral disorder of sufficient
duration to meet diagnostic criteria specified within the American Psychiatric Association’s Diagnostic
and Statistical Manual of Mental Disorders that has resulted in a functional impairment which
substantially interferes with or limits one or more life activities, including

Basic daily living skills, such as personal safety, eating, and personal hygiene;
Recipient Eligibility
Reference: “Tribal Rural Behavioral Health Provider Clinical Handbook Desk Guide”, Section 3.2
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

Instrumental living skills, such as managing money and negotiating transportation;
Functioning in social, family, or vocational/educational contexts
Child or Adult with a Substance Use Disorder- A recipient of any age experiencing a disorder that is
identified by a diagnostic code found in the American Psychiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders that is related to:

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

alcohol, amphetamine, or similar acting sympathomimetics;
cannabis, cocaine, hallucinogens, inhalants, nicotine, or opioids
analogs of phencyclidine (PCP) or similar arylcyclohexylamines; or
sedatives, hypnotics, or anxiolytics
Child Experiencing an Emotional Disturbance- A recipient under the age of 21who is experiencing
a non-persistent mental, emotional, or behavioral disorder that is identified and diagnosed during
a professional behavioral health assessment; and is not the result of intellectual, physical, or
sensory deficits.
Child Experiencing a Severe Emotional Disturbance (SED)- A recipient under the age of 21 who has
or at any time in the past year had a diagnosable mental, emotional, or behavioral disorder of
sufficient duration to meet diagnostic criteria specified within the American Psychiatric
Association’s Diagnostic and Statistical Manual of Mental Disorders that has resulted in a
functional impairment which substantially interferes with or limits the child’s role or functioning
(achieving or maintaining the developmentally appropriate social, behavioral, cognitive,
communicative or adaptive skills) in family, school, or community activities as indicated by a
global assessment of functioning score of 50 or less; exhibits specific mental, emotional, or
behavioral disorders that
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place the individual at imminent risk for out-of-home placement;
place the individual at imminent risk for being placed in the custody of the
Division of Juvenile Justice
have resulted in the individual being placed in the protective custody of Office
of Children’s Services
Functional Impairment- Difficulties that substantially interfere with or limit role functioning in one or
more major life activities including daily living skills, skills needed to maintain a household, manage
money, get around the community, maintain health, and function in society, a family, and work or school
environments.
Responsibilities: TO BE DEFINED
Recipient Eligibility
Reference: “Tribal Rural Behavioral Health Provider Clinical Handbook Desk Guide”, Section 3.2
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Procedure:
Professional Behavioral Health Assessments
Upon admission and as new information becomes available, a qualified behavioral health staff member
conducts one of the following behavioral health assessments:
1. Mental Health Intake Assessment (Mental Health Professional Clinician)
2. Substance Use Intake Assessment (Substance Abuse Counselor, Social Worker, or other qualified
program staff)
3. Integrated Mental Health and Substance Use Intake Assessment (Mental Health Professional
Clinician)
4. A Psychiatric Assessment may serve as an intake assessment if the recipient's condition indicates
the need for a more intensive assessment, including an assessment to evaluate the need for
medication (physician, physician assistant, advanced nurse practitioner)
Professional behavioral health assessments must include a determination that the recipient has a mental
health disorder and/or a substance abuse disorder. They must also determine the nature and the severity
of those disorders. Well-developed client eligibility statements help fulfill this requirement by
documenting a description of the persistence of the disorder, behaviors that put the recipient at risk, and
the functional impairments that limit role functioning. Clear documentation that describes the target
behaviors and functional impairments will also serve as the basis for sound the treatment planning.
Clinic and Rehabilitation Services
Behavioral health services are divided into two distinct categories; clinic and rehabilitation services. The
behavioral health services recommended by qualified staff developing the treatment plan will depend on
the services for which each recipient is eligible. Clinic services are provided on the premises of the
community behavioral health center by a physician, physician assistant, advanced nurse practitioner, or
mental health professional clinician.
Clinic services can be delivered to:

A Child Experiencing an Emotional Disturbance

An Adult Experiencing an Emotional Disturbance

A Child Experiencing a Severe Emotional Disturbance

An Adult Experiencing a Serious Mental Illness
Rehabilitation services are expected to increase the recipient's ability to function within their home,
school, and community. Rehabilitation services may be provided on the premises of the Community
Recipient Eligibility
Reference: “Tribal Rural Behavioral Health Provider Clinical Handbook Desk Guide”, Section 3.2
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Behavioral Health Center, in the recipient's home, or any community setting appropriate for providing the
services as specified in the recipient's treatment plan.
Rehabilitation services can be delivered to:

A Child or an Adult Experiencing a Substance Abuse Disorder

A Child Experiencing a Severe Emotional Disturbance

An Adult Experiencing a Serious Mental Illness
Clinic services include:

Integrated Mental Health and Substance Abuse Intake Assessment

Mental Health Intake Assessment

Pharmacological Management

Psychiatric Assessment

Psychological Testing and Evaluation

Psychotherapy (individual, group, family, multifamily)

Short-Term Crisis Intervention
Rehabilitation services include:

Alcohol and Drug Detoxification Treatment Services

Case Management

Behavioral Health Treatment Plan Review and Development, including a Client Status Review

Client Status Review

Comprehensive Community Supports for Adults

Daily Behavioral Health Rehabilitation Services for Children

Day Treatment Services for Children

Facilitation of Telemedicine Sessions

Medical Evaluation for Detoxification Treatment Program Services

Medication Administration

Behavioral Health Treatment Plan Review for Methadone Treatment Program Services

Peer Support Services
Recipient Eligibility
Reference: “Tribal Rural Behavioral Health Provider Clinical Handbook Desk Guide”, Section 3.2
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
Recipient Support Services

Residential Substance Use Disorder Treatment Services

Short-Term Crisis Stabilization

Substance Use Assessment

Therapeutic Behavioral Health Services for Children
PLEASE NOTE:
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
Please refer to the “Tribal Rural Behavioral Health Provider Clinical Handbook Desk Guide “as
noted in the “Attachments/Forms” section on page 1 of this document for additional information.
Billing codes, service limitations and service authorization information can be found in the
“Alaska Medical Assistance Program Policies and Claims Billing Procedures for Community
Behavioral Health Services” as noted in the “Attachments/Forms” section on page 1 of this
document.
If you are using AKAIMS as your electronic clinical record, please enter information as
instructed per the AKAIMs User Manual.
Recipient Eligibility
Reference: “Tribal Rural Behavioral Health Provider Clinical Handbook Desk Guide”, Section 3.2
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