C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-17, subsec. 144-101-II-17.03
For Community Integration Services and Assertive Community Treatment (ACT) Services, providers must conduct an initial face-to-face intake or initial assessment visit within seven (7) calendar days of referral, regardless of source of referral. In the event a provider receives a referral and does not have capacity to initiate services, the provider must offer the option of placing the member on a hold for service. Except as expressly provided in Section 17.04, a member is eligible for the covered services specified in Section 17.04 for as long as he or she meets the criteria for eligibility specified in Section 17.02, subject to prior authorization and/or utilization review. Utilization review (Continuing stay reviews) consider the member's complete clinical situation and what the progress has been throughout treatment, in conjunction with the LOCUS score or functional impairment criteria as evidenced by other approved standardized assessment tools. An improvement in functioning level or adaptive behaviors will not in and of itself necessarily mean ineligibility for services.
Hold for Service
Members have the option to be placed on hold for service if the agency, upon receipt of a referral from any source, has determined that it does not have the capacity to conduct an intake or initial assessment within seven (7) calendar days as required in Sec. 17.03. To be placed on hold for service, providers must offer the member alternatives to being placed on hold for service, including but not limited to giving information on other service providers within a 25-mile radius servicing the area. This information shall be provided in writing. Should members wish to be on hold for service with an agency, the provider will document the member choice and the offering of alternatives in the member's referral record. At this time, the seven (7) calendar day face-to-face requirement will be suspended. Agencies must follow up with members no more than thirty (30) calendar days after being placed on hold to reevaluate their desire to remain on hold for service, which will be documented in the member record. Agencies must continue to follow up with members in successive thirty (30) day increments to reevaluate the member's desire to remain on hold. When the agency has determined it has the capacity to serve the member, it will contact the member immediately and have seven (7) calendar days to conduct the intake or initial assessment.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-17, subsec. 144-101-II-17.03