The client has achieved the goals articulated in his or her individualized recovery plan, thus resolving the problem(s) that justified admission to the present level of care; OR The client has been unable to resolve the problems(s) that justified admission to the present level of care, despite amendments to the recovery plan. Service at another level of care or type of service therefore is indicated; OR The client has demonstrated a lack of capacity to resolve his or her problem(s). Service at another level of care or type of service therefore is indicated; OR The client has experienced an intensification of his or her problem(s), or has developed a new problem(s), and can be treated effectively only at a more intensive of care. Comment on client progress or status (be specific): CONTINUED STAY/ADDITIONAL SERVICES CRITERIA Check DIMENSION 2: 1. The client is making progress but has not yet achieved the goals articulated in the individualized recovery plan. Continued service at the present level of care OR Biomedical additional service is assessed as necessary to permit the client to continue to work Conditions and toward his or her recovery goals; OR Complications 2. The client is not yet making progress, but has the capacity to resolve his or her problems. He or she is actively working toward the goals articulated in the individualized recovery plan. Continued service at the present level of care OR SCORE (0-4) additional service is assessed as necessary to permit the client to continue to work toward his or her recovery goals; AND/OR 3. New problems have been identified that are appropriately treated at the present level of care OR require additional service. For continued stay requests, it is assessed that this level is the least intensive at which the client’s new problems can be addressed effectively. 4. Not Applicable: No problem or stable Check TRANSFER/DISCHARGE CRITERIA The client has achieved the goals articulated in his or her individualized recovery plan, thus resolving the problem(s) that justified admission to the present level of care; OR
The client has achieved the goals articulated in his or her individualized recovery plan, thus resolving the problem(s) that justified admission to the present level of care; OR The client has been unable to resolve the problems(s) that justified admission to the present level of care, despite amendments to the recovery plan. Service at another level of care or type of service therefore is indicated; OR The client has demonstrated a lack of capacity to resolve his or her problem(s). Service at another level of care or type of service therefore is indicated; OR The client has experienced an intensification of his or her problem(s), or has developed a new problem(s), and can be treated effectively only at a more intensive of care. Comment on client progress or status (be specific): DIMENSION 2: Biomedical Conditions and Complications SCORE (0-4) CONTINUED STAY/ADDITIONAL SERVICES CRITERIA Check 1. The client is making progress but has not yet achieved the goals articulated in the individualized recovery plan. Continued service at the present level of care OR additional service is assessed as necessary to permit the client to continue to work toward his or her recovery goals; OR 2. The client is not yet making progress, but has the capacity to resolve his or her problems. He or she is actively working toward the goals articulated in the individualized recovery plan. Continued service at the present level of care OR additional service is assessed as necessary to permit the client to continue to work toward his or her recovery goals; AND/OR 3. New problems have been identified that are appropriately treated at the present level of care OR require additional service. For continued stay requests, it is assessed that this level is the least intensive at which the client’s new problems can be addressed effectively. 4. Not Applicable: No problem or stable TRANSFER/DISCHARGE CRITERIA Check The client has achieved the goals articulated in his or her individualized recovery plan, thus resolving the problem(s) that justified admission to the present level of care; OR
ServiceAuthorizationRequestJustificationForm9.29.15.docx