Utilization Management

Forms  

• Acute Inpatient Hospital Concurrent Review Changes Memo
• Inpatient Authorization Request Form

• 1603-6 “Concurrent Review of Crisis Residential Treatment Services and Adult Residential Treatment Services” (10/07/22)
• SMHS Residential Treatment Service Authorization Request Form: DOCX | PDF
• Level of Care Determination Tool for Residential Providers: DOCX | PDF
• ART Training - This training covers the regulations for Adult Residential Specialty Mental Health Services programs governing the authorization process with Utilization Management and clinical documentation standards.
• Crisis Residential Authorization and Documentation Training SMHS - This training covers the regulations for Crisis Residential Specialty Mental Health Services programs governing the authorization process with Utilization Management and clinical documentation standards.

• Day Rehabilitation & Day Treatment Intensive Service Authorization Request Form
• 200-3 “Prior Authorizations for Day Rehabilitation and Day Treatment Intensive” (10/22/22)

• 406-1-1 Eating Disorders (12/16/19)
• MHS FFS Eating Disorder Services Utilization Table
• Prior Payment Authorizations (Please refer to Prior Payment Authorization section within + MHIP Handbook)
• Utilization Table for Fee for Service Individual and Organizational Providers- Effective July 1, 2024 - 9/3/24

• Policy and Procedure In the process of development ***In the process of development
• Referral Form and Authorization Request Form ***In the process of development

• Authorization of Services for Kin-GAP and AAP populations (forthcoming)
• Service Authorization Request Form

• Drug Medi-Cal Organized Delivery System (DMC-ODS) Requirements for the Period of 2022 – 2026” (5/13/22)
• Authorizations of Substance Use Residential Treatment Services under Drug Medi-Cal – Organized Delivery System (DMC-ODS)
• DMC-ODS Residential Treatment Authorization Request Form
• Documenting Medical Necessity for ASAM Residential Level 1 Training Slide Dec