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.
Community Care uses the State of Pennsylvania "Appendix S" Medical Necessity Guidelines in reviewing BHRS relating to Applied Behavior Analysis using BSC and TSS services for children and youth with diagnoses of autism spectrum disorders. If you cannot access these guidelines via the website, please contact us for a paper copy.
Community Care also uses the following Medical Necessity Guidelines for Intensive Behavioral Health Services (IBHS) as stipulated in OMHSAS Bulletin 20-05: IBHS Individual MNG, IBHS ABA MNG, IBHS Group MNG.
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 Individual Residential Treatment/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
- Behavioral Health Rehabilitation Service (BHRS) – Multisystemic Therapy (MST)
- Behavioral Health Rehabilitation Services (BHRS) Functional Family Therapy (FFT)
- 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 Supplemental Services: Adult
- Family Focused Supplemental Services: Child and Adolescent
- 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