Medical Necessity Guidelines for Pennsylvania Behavioral Health HealthChoices
Community Care uses the state of Pennsylvania "Appendix T" criteria for most levels of mental health care and for substance use disorder services for adults. View the Appendix T criteria or ASAM criteria. If you cannot access these criteria via the website, please contact us for a paper copy.
The Medical Necessity Guidelines for Intensive Behavioral Health Services (IBHS) delivered through Individual Services, ABA Services and Group Services can be found in Appendix S(2) of Pennsylvania’s Program Standards and Requirements Appendices.
Some supplemental levels of care are not addressed in Appendix T. Community Care has developed supplemental medical necessity guidelines for these levels of care. They include: Psychiatric Rehabilitation Services, Community Treatment Team, Diversion and Acute Stabilization, and Community Residential Rehabilitation (CRR) Host Home. Not all of these supplemental levels of care are available in each county.
- 23-Hour Bed Rapid Assessment and Stabilization
- Adult Acute Stabilization and Diversion
- Adult and Children Acute Inpatient Treatment: Mental Health
- Adult Diversion and Crisis Stabilization Residential Services
- Assertive Community Treatment (ACT) – Modified Teams
- Child and Adolescent Acute Stabilization and Diversion
- Child and Adolescent Diversion and Crisis Stabilization Residential Services
- Child and Adolescent Short-Term RTF - Acute Stabilization and Diversion Unit
- Community Residential Rehabilitation (CRR) Host Home
- Community Treatment Team
- Electroconvulsive Therapy
- Family Focused Solution Based Services
- Intensive Behavioral Health Services (IBHS) Functional Family Therapy (FFT)
- Intensive Behavioral Health Services (IBHS) – Multisystemic Therapy (MST)
- Mental Health/Adult Outpatient Treatment in an Alternative Setting
- Mobile Medication Team
- Peer Support Services
- Psychiatric Rehabilitation
- Psychological and Neuropsychological Testing
- Residential Treatment Facility - Adults