Adult Behavioral Health Therapeutic Home

Adult Behavioral Health Therapeutic Home (ABHTH) - A licensed residence that provides behavioral health treatment, which maximizes the ability of an individual experiencing behavioral health symptoms to live and participate in the community and to function in an independent manner that includes assistance in the self-administration of medication and any ancillary services (such as living skills and health promotion) indicated by the member's Treatment Plan, as appropriate.

Adult Recovery Team (ART) - A group of individuals that follows the Nine Guiding Principles for Recovery-Oriented Adult Behavioral Health Services and Systems who work in collaboration and are actively involved in an individual's assessment, service planning, and service delivery.

Active Treatment – The member is expected to be engaged in active treatment. This means services available at this level of care can reasonably be expected to:

1. Improve the member’s condition in order to achieve discharge from the TFC at the earliest possible time, and
2. Facilitate the member’s return to primarily outpatient care in a non-therapeutic/non-licensed setting.

Assessment - An analysis of the member’s needs for physical health services or behavioral health services to determine which services a health care institution shall provide to the patient as specified in AA.C. R9-10-101.

Collaborating Health Care Institution (CHI) - A health care institution licensed to provide outpatient behavioral health services that has a written agreement with an adult behavioral health therapeutic home or a behavioral health respite home to:

1. Coordinate behavioral health services provided to a resident at the adult behavioral health therapeutic home or a recipient at a behavioral health respite home, and
2. Work with the provider to ensure a resident at the adult behavioral health therapeutic home or a recipient at a behavioral health respite home receives behavioral health services according to the resident’s treatment plan.

Designated Representative - An individual acting on behalf of the member with the written consent of the member or member’s legal guardian. As used in this policy the Designated Representative is distinct and separate from the Health Care Decision Maker.

Adult BH Therapeutic Home Discharge Planning - A comprehensive discharge plan shall be created during the development of the initial Treatment Plan and shall be reviewed and/or updated at each review thereafter. The discharge plan shall document the following:

1. Clinical status for discharge.
2. Follow-up treatment, crisis, and safety plan.
3. Coordination of care and transition planning are in process when appropriate.

Service Plan (ISP) - A comprehensive written description of all covered health services and other informal supports which includes individualized goals, family support services, care coordination activities and strategies to assist the member in achieving an improved quality of life.

Treatment Outcomes - Treatment outcomes align with:

1. The Nine Guiding Principles for Recovery-Oriented Adult Behavioral Health Services and Systems as specified in AMPM Policy 100, and
2. The member’s individualized physical, behavioral, and developmentally appropriate needs.

Treatment Goals – Treatment goals for members placed in an ABHTH are:

1. Specific to the member’s behavioral health condition that warranted treatment,
2. Measurable and achievable,
3. Unable to be met in a less restrictive environment,
4. Based on the member’s unique needs,
5. Inclusive of input from the member’s family/Health Care Decision-Maker and Designated Representative’s choices where applicable, and
6. Supportive of the member’s improved or sustained functioning and integration into the community.

ABHTH Treatment Planning - The ABHTH Treatment Plan is developed by the CHI in collaboration with the ABHTH Provider and the ART within the first 30 days of placement.

• The Treatment Plan includes the following:
  • Describe strategies to address ABHTH Provider needs and successful transition for the member to begin service with ABHTH Provider, including pre-service visits when appropriate,
  • Compliment and not conflict with the ART Service Plan and other defined treatments, and shall also include reference to the member’s:
    • Current physical, emotional, behavioral health and developmental needs,
    • Current educational placement and needs,
    • Current medical treatment,
    • Current behavioral health treatment through other Providers, and
    • Current prescribed medications.
  • Address safety, social, and emotional well-being, discharge criteria, acknowledgement of member’s permanency objectives and post-discharge services,
  • Include short-term, proactive treatment goals that are measurable, time-limited, and in keeping with the ART Service Plan,
  • Clearly identify responsible individuals from treatment team to implement each aspect of the ABHTH Treatment Plan and the timing of completion. The CHI has the responsibility to ensure the treatment team is implementing the ABHTH Treatment Plan,
  • Include specific elements that build on the members’ strengths while also promoting pro-social, adaptive behaviors, interpersonal skills and relationships, community, family and cultural connections, self-care, daily living skills, and educational achievement,
  • Include specifics to coordinate with natural supports and informal networks as a part of treatment,
  • Include plans for engagement of the member’s family of choice and other natural supports that can support the member during ABHTH placement and after transition,
  • Be reviewed by the ABHTH Provider and CHI at every home visit,
  • Be reviewed by the CHI Clinical Supervisor at each staffing,
  • Be revised as appropriate or quarterly at minimum, and
  • Include documentation of the ABHTH Treatment Plan which shall be kept by the ABHTH Provider and CHI.
• Contractors and providers shall ensure that members/Health Care Decision Maker and designated representatives receive a copy of the treatment plan and any updated treatment plans.

Applicable To: Medicaid – Care1st Health Plan Arizona

Arizona Care 1st

• Room and Board is not a covered services in conjunction with Therapeutic Foster Care.

Exclusionary Criteria

Admission to an ABHTH is not be used as a substitute for the following:

1. An alternative to detention or incarceration.
2. As a means to ensure community safety in an individual exhibiting primarily conduct disordered behaviors.
3. As a means of providing safe housing, shelter, supervision or permanent placement.
4. A behavioral health intervention when other less restrictive alternatives are available and meet the member’s treatment needs, including situations when the member/Health Care Decision Maker is unwilling to participate in the less restrictive alternative.

CRITERIA FOR ADMISSION

1. There is evidence that the member’s was recommended for ABHTH through the ART process.
2. There is evidence of an assessment by a licensed Behavioral Health Professional that indicates the member’s behavioral health diagnosis, and symptoms and behaviors that necessitate ABHTH placement.
3. There is evidence that – within the last 90 days - the member has had a disturbance of mood, thought or behavior that has resulted in moderate impairment of functional and/or psychosocial abilities, which renders the member incapable of independent or age-appropriate self-care or self-regulation.
4. This moderate functional and/or psychosocial impairment per Assessment by a BHP:
   1. It cannot be reasonably expected to improve in response to a less intensive level of care, and
   2. Does not require or meet clinical criteria for a higher level of care, OR
   3. Demonstrates that appropriate treatment in a less restrictive environment has not been successful or is not available, therefore warranting a higher level of care.
5. There are documented plans at admission for discharge and transition which include:
   1. Participation of Health Care Decision Maker and all stakeholders,
   2. Identified tentative disposition/living arrangements, and
   3. Recommendations for aftercare treatment based upon treatment goals.

CRITERIA FOR CONTINUED STAY

1. All of the following must be met for continued stay:
   1. The member continues to meet the diagnostic threshold for the behavioral health condition that warranted admission to ABHTH.
   2. The member continues to demonstrate (within the last 90 days) moderate functional or psychosocial impairment as a result of the behavioral health condition, as identified through disturbances of mood, thought, or behavior, which substantially impairs independent or appropriate self-care or self-regulation.
   3. Active treatment is reducing the severity of disturbances of mood, thought, or behaviors, which were identified as reasons for admission to ABHTH, and
   4. Treatment at the ABHTH is empowering the member to gain skills to successfully function in the community.
   5. It is expected that continued treatment at the ABHTH will result in improvements to the member’s condition, such that, this type of service shall no longer be needed, and
   6. There is evidence that the ART is meeting at least monthly to review progress, and have revised the Treatment Plan and/or Service Plan to respond to any lack of progress.

CRITERIA FOR DISCHARGE

1. Sufficient symptom or behavior relief has been achieved, as evidenced by, completion of the ABHTH treatment goals.
2. The member’s functional capacity is improved, and the member can be safely cared for in a less restrictive level of care.
3. The member can participate in needed monitoring and follow-up services, or a Provider is available to provider monitoring n a less restrictive level of care.
4. Appropriate services, providers, and supports are available to meet the member’s current behavioral health needs at a less restrictive level of care.
5. There is no evidence to indicate that continued treatment in ABHTH would improve member’s clinical outcome.
6. There is potential risk that continued stay in TFC may precipitate regression or decompensation of member’s condition.

References:

Arizona Health Care Cost Containment System Medical Policy Manual (AMPM) Chapter 320-X-Adult Behavioral Health Therapeutic Homes.

Original Effective Date: 3/10/2020
Revised Date(s): 11/9/2021