Individuals qualifying for Mental Health Skill Building Services must demonstrate a clinical necessity for the service arising from a condition due to mental, behavioral, or emotional illness that results in significant functional impairments in major life activities. Services are provided to individuals who require individualized training to achieve or maintain stability and independence in the community.

 

Individuals age 18 and over shall meet all of the following criteria in order to be eligible to receive mental health skill-building services:

• The individual shall have one of the following as a primary Axis I DSM diagnosis:

• Schizophrenia or other psychotic disorder as set out in the DSM,

• Major Depressive Disorder – Recurrent;

• Bipolar I; or Bipolar II;

• Any other Axis I mental health disorder that a physician has documented specific to the identified individual within the past year to include all of the following: (i) that is a serious mental illness; (ii) that results in severe and recurrent disability; (iii) that produces functional limitations in the individual’s major life activities that are documented in the individual’s medical record, AND; (iv) that the individual requires individualized training in order to achieve or maintain independent living in the community.

 

The individual shall require individualized training in acquiring basic living skills such as symptom management; adherence to psychiatric and medication treatment plans; development and appropriate use of social skills and personal support system; personal hygiene; food preparation; or money management.

 

The individual shall have a prior history of any of the following: psychiatric hospitalization; residential crisis stabilization, ICT or Program of Assertive Community Treatment (PACT) services; placement in a psychiatric residential treatment facility (RTC Level C); or TDO pursuant to the Code of Virginia §37.2-809(B) evaluation as a result of decompensation related to serious mental illness. This criterion shall be met in order to be initially admitted to services, and not for subsequent authorizations of service.

 

The individual shall have had a prescription for anti-psychotic, mood stabilizing, or antidepressant medications within the 12 months prior to the assessment date. If a physician or other practitioner who is authorized by his license to prescribe medications indicates that anti-psychotic, mood stabilizing, or antidepressant medications are medically contraindicated for the individual, the provider shall obtain medical records signed by the physician or other licensed prescriber detailing the contraindication. This documentation shall be maintained in the individual’s mental health skill-building services record, and the provider shall document and describe how the individual will be able to actively participate in and benefit from services without the assistance of medication. This criterion shall be met upon admission to services, and not for subsequent authorizations of service.

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