8. Project Destiny youth in Day Treatment
other than RCL 12, 13 and 14, in-county Providers only
Day Treatment Program :
•Identify Project Destiny
status
•Check Medi-cal Status
•Complete the Placement
Authorization (PA) Form and the Day Treatment
Authorization Criteria Form
•Fax both forms to AB3632
Coordinator
AB3632 Coordinator
•AB3632 Coordinator places signed
PA Form into designated PA in-box
Clerical Staff
•Distributes copies per CSS
protocol
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