5. DSS/ Residential RCL 12 w/Day Treatment
w/BHCS Contracts
a. In-County (Including Project Destiny
placements, Adoption Assistance Program* placements)
Program
•Coordinates admission to program
with DSS
•Checks Medi-Cal status
•Completes the Placement
Authorization (PA) Form and Day Treatment
Authorization Criteria Form
•Turns both forms into RCL 13/14
Coordinator for signature
RCL 13/14 Coordinator
•RCL 13/14 Coordinator places
signed PA Form into designated PA In-box
Clerical Staff
•Faxes signed PA Form to
Program
•Distributes copies per in-house
Placement Authorization In Box Procedure
Program
•Enters services into PSP
•Chart goes to CQRT for continued
Authorization
Ø Every 90 days for Intensive Day Tx.
Ø Every 180 days for
Rehabilitative Day Tx.
Forms to use:
•PLACEMENT AUTHORIZATION
FORM
•DAY TREATMENT AUTHORIZATION
CRITERIA FORM