Iowa Admin. Code r. 441-25.6 - Intensive mental health services
The purpose of intensive mental health services is to provide
a continuum of services and supports to adults with complex mental health and
(1)
Access
centers. The purpose of an access center is to serve adults
experiencing a mental health or substance use crisis who are not in need of an
inpatient psychiatric level of care and who do not have alternative, safe,
effective services immediately available.
a.
Regional coordination. Each region shall designate at least
one access center provider and ensure that access center services are available
to the residents of the region consistent with subrule 25.4(9).
(1) Regions shall work collaboratively to
develop a minimum of six access centers strategically located throughout the
state, with the support of the medical assistance program .
(2) Access centers may be shared by two or
more regions.
(3) Each region shall
establish methods to provide for reimbursement of a region when a
non-Medicaid-eligible resident of another region utilizes an access center or
other non-Medicaid-covered services located in that region .
b.
Access center
standards. A designated access center shall meet all of the following
criteria:
(1) An access center shall have no
residential facility-based setting with more than 16 beds.
(2) An access center provider shall be
accredited to provide crisis stabilization residential services pursuant to
441-Chapter 24.
(3) An access
center provider shall be licensed to provide subacute mental health services as
described in rule 441-77.56 (249A).
(4) An access center provider shall be
licensed as a substance abuse treatment program pursuant to Iowa Code chapter
125 or have a cooperative agreement with and immediate access to licensed
substance abuse treatment services or medical care that incorporates withdrawal
management.
(5) An access center
shall provide services on a no reject, no eject basis to individuals who meet
service eligibility criteria.
(6)
An access center shall accept and serve eligible individuals who are
court-ordered to participate in mental health or substance use disorder
treatment.
(7) An access center
shall provide all required services listed in 25.6(1)"d" in a
coordinated manner. An access center may provide coordinated services in one or
more locations.
c.
Eligibility for access center services. To be eligible to
receive access center services, an individual shall meet all of the following
criteria:
(1) The individual is an adult in
need of screening, assessment, services or treatment related to a mental health
or substance use crisis.
(2) The
individual shows no obvious signs of illness or injury indicating a need for
immediate medical attention.
(3)
The individual has not been determined to need acute inpatient psychiatric
hospitalization.
d.
Access center services. An access center shall provide or
arrange for the provision of all of the following:
(1) Immediate intake assessment and screening
that includes but is not limited to mental and physical health conditions,
suicide risk, brain injury , and substance use. A crisis evaluation that
includes all required screenings may serve as an intake assessment .
(2) Comprehensive person-centered mental
health assessments by appropriately licensed or credentialed professionals, as
indicated by the intake assessment .
(3) Comprehensive person-centered substance
use disorder assessments by appropriately licensed or credentialed
professionals, as indicated by the intake assessment .
(4) Peer support services , as indicated by a
comprehensive assessment .
(5)
Mental health treatment, as indicated by a comprehensive assessment .
(6) Substance use treatment, as indicated by
a comprehensive assessment .
(7)
Physical health care services as indicated by a health screening.
(8) Care coordination .
(9) Service navigation and linkage to needed
services including housing, employment, shelter services, intellectual and
developmental disability services , and brain injury services, with warm
handoffs to other service providers.
(2)
Assertive community treatment
(ACT ) services. The purpose of assertive community treatment is to
serve adults with the most severe and persistent mental illness conditions and
functional impairments. ACT services provide a set of comprehensive,
integrated, intensive outpatient services delivered by a multidisciplinary team
under the supervision of a psychiatrist, an advanced registered nurse
practitioner, or a physician assistant under the supervision of a psychiatrist.
An ACT program shall designate a staff member to be responsible for
administration of the program and with the authority to sign documents and
receive payments on behalf of the program.
a.
Regional coordination. Each region shall designate at least
one ACT provider and ensure that ACT services are available to the residents of
the region consistent with subrule 25.4(9). Regions may work collaboratively
with other regions when an ACT team is serving more than one region .
(1) Each region shall determine the number
and size of ACT teams needed to serve the ACT -eligible population in that
region .
(2) Each region shall
verify that all ACT programs operating in the region have periodic fidelity
reviews consistent with evidence-based practice standards published by the
Substance Abuse and Mental Health Services Administration (SAMHSA). Each ACT
program shall have a fidelity review, including a peer review, on the following
schedule:
1. Within the first 12 months of
operation.
2. Annually during each
of the second and third years of operation.
3. Biennially thereafter for teams with
satisfactory fidelity reviews. Teams with unsatisfactory reviews shall be
reviewed again after one year.
Results of the
b.
ACT team composition.
Each ACT team shall include a minimum of six members and must include a member
qualified to fill each of the eight following roles. One team member may fill
more than one role if all other qualifications are met.
(1) A psychiatrist, an advanced registered
nurse practitioner, or a physician assistant under the supervision of a
psychiatrist who is board-certified or eligible for board
certification.
(2) A team
leader.
(3) A registered
nurse.
(4) A mental health
professional .
(5) A substance abuse
treatment provider .
(6) A community
support specialist.
(7) A peer
support specialist .
(8) An
employment specialist.
c.
Staff qualifications. ACT team members shall meet the
following qualifications:
(1) Psychiatrist. A
psychiatrist on the team shall be a person who meets all of the following
criteria:
1. Is a doctor of medicine (M.D.)
or a doctor of osteopathy (D.O.).
2. Is licensed in Iowa pursuant to
653-Chapter 9.
3. Is certified or
is eligible to be certified as a psychiatrist by the American Board of Medical
Specialties' Board of Psychiatry and Neurology or by the American Osteopathic
Board of Neurology and Psychiatry.
4. Has experience working with persons with
severe and persistent mental illness .
5. Provides a minimum of 16 hours per week of
psychiatrist time for every 50 ACT clients.
(2) Advanced registered nurse practitioner.
An advanced registered nurse practitioner on the team shall be a person who
meets all of the following criteria:
1. Is
licensed pursuant to 655-Chapter 7.
2. Has a mental health
certification.
3. Has experience
working with persons with severe and persistent mental illness .
4. Provides a minimum of 16 hours per week of
advanced registered nurse practitioner time for every 50 ACT clients.
(3) Physician assistant. A
physician assistant on the team shall be a person who meets all of the
following criteria:
1. Is licensed pursuant to
645-Chapter 326.
2. Has experience
working with persons with severe and persistent mental illness .
3. Is practicing under the supervision of a
psychiatrist who is board-certified or eligible for board
certification.
4. Provides a
minimum of 16 hours per week of physician assistant time for every 50 ACT
clients.
(4) Team leader.
A team leader shall be a person on the team who meets all of the following
criteria:
1. Has a master's degree in a mental
health field, including but not limited to nursing, social work, mental health
counseling, psychiatric rehabilitation, or psychology.
2. Is actively involved in direct contact
with individuals being served by the team.
3. Is a full-time staff member whose
responsibilities are limited to the ACT team and who serves as the clinical and
administrative supervisor of the team.
(5) Registered nurse. A registered nurse on
the team shall be a person who meets all of the following criteria:
1. Is licensed as a registered nurse pursuant
to 655-Chapter 3.
2. Has experience
working with persons with severe and persistent mental illness .
(6) Mental health professional . A
mental health professional on the team shall be a person who meets all of the
following criteria:
1. Is a mental health
counselor or marital and family therapist licensed pursuant to 645-Chapter 31;
a social worker licensed as a master or independent social worker pursuant to
645-Chapter 280; or an occupational therapist licensed pursuant to 645-Chapter
206.
2. Has experience working with
persons with severe and persistent mental illness .
(7) Substance abuse treatment professional. A
substance abuse treatment professional on the team shall be a person who meets
all of the following criteria:
1. Is an
appropriately credentialed counselor pursuant to 641-subparagraph
155.21(8)"b"(1).
2. Has at least three years of experience
working with persons with substance use disorders.
(8) Community support specialist. A community
support specialist on the team shall be a person who meets all of the following
criteria:
1. Has a bachelor's degree with at
least 30 semester hours or equivalent quarter hours in a human services field,
including but not limited to sociology, social work, counseling, psychology, or
human services.
2. Has experience
working with persons with severe and persistent mental illness .
(9) Peer support specialist . A
peer support specialist on the team shall be a person who meets all of the
following criteria:
1. Has been diagnosed with
a severe and persistent mental illness .
2. Has met all requirements of the
Appalachian Consulting Group Peer Support Training Model by no later than six
months after the date of hire.
(10) Employment specialist. An employment
specialist on the team shall be a person who meets all of the following
criteria:
1. Has experience working with
persons with severe and persistent mental illness .
2. Meets one of the following:
* Has a bachelor's degree with at least 30 semester hours or equivalent quarter hours in a human services field, including but not limited to sociology, social work, counseling, or psychology, and completes at least 12 hours of employment services training within six months of the date of hire.
* Has a high school diploma or equivalent, has at least one
year of specialized vocational training or supervised experience in vocational
and related services, including but not limited to
(11)
Psychologist. A psychologist on the team shall be a person who meets all of the
following criteria:
1. Is licensed pursuant to
645-Chapter 240.
2. Has experience
working with persons with a severe and persistent mental illness .
d.
ACT
provider standards. Organizations seeking regional designation as an
ACT provider shall meet the following criteria at initial application and
annually thereafter. A designated ACT provider shall:
(1) Develop and maintain written ACT -specific
admission policies and procedures, including but not limited to a gradual rate
of admission and program eligibility requirements.
(2) Develop and maintain written ACT -specific
discharge policies and procedures. Discharge criteria shall include but are not
limited to the following:
1. An individual
reaches individually established goals for discharge, and the individual and
program staff mutually agree to the termination of services; or
2. An individual requests discharge,
demonstrates the ability to function in all major role areas without ongoing
assistance from the program and without significant relapse when services are
withdrawn, and the program staff agree to the termination of services;
or
3. An individual moves outside
the geographic area of the team's responsibility. In such cases, the team shall
arrange for transfer of responsibility for mental health services to an ACT
program or another provider wherever the individual is relocating, and the team
shall maintain contact with the individual until the service transfer is
implemented; or
4. An individual
declines or refuses services and requests discharge despite the team's best
efforts to develop an acceptable treatment plan with the individual .
(3) Documentation of
discharges. Documentation shall include:
1.
The reason(s) for discharge as stated by both the individual and the
team.
2. A summary of the
individual 's biopsychosocial status at the time of discharge.
3. A written final evaluation summary of the
individual 's progress toward the goals in the treatment plan.
4. A plan developed in conjunction with the
individual for follow-up treatment after discharge.
5. The signature of each of the following:
* The
* The service coordinator.
* The team leader.
* The psychiatrist, advanced registered nurse practitioner, or physician assistant under the supervision of a board-certified psychiatrist.
e.
ACT team standards. All
designated ACT teams shall:
(1) Participate
in all of the individual 's mental health services.
(2) Ensure that services for the psychiatric
needs of the individual are available 24 hours a day.
(3) Develop a specific treatment plan based
on the assessment of needs and including goals and actions to address the
individual 's medical, social, educational, and other needs.
(4) Make referrals to services and related
activities to assist the individual with the individual 's assessed
needs.
(5) Monitor and perform
follow-up activities necessary to ensure that the treatment plan is carried out
and that the individual has access to necessary services. Activities may
include monitoring contacts with providers, family members, natural supports,
and others.
(6) Hold team meetings
at least four times a week to facilitate ACT services and briefly review the
status of the individual with other members of the team.
(7) Have the capacity to provide multiple
contacts a week with individuals experiencing severe symptoms, trying a new
medication, experiencing a health problem or serious life event, trying to go
back to school or starting a new job, making changes in a living situation or
employment, or having significant ongoing problems in daily living. All members
of the team share responsibility for addressing the needs of all individuals.
The number of team contacts per individual served shall average at least three
per week per individual when calculated across all individuals served by the
team. Contacts may be weekly, daily, or more frequent. The frequency of
contacts is determined by the needs of the individual .
(8) Have the capacity to rapidly increase
service intensity to an individual when the individual 's status requires it or
the individual requests it.
(9)
Ensure that treatment, rehabilitation, and support activities are available 24
hours a day, 7 days a week, 365 days a year, including nights, weekends, and
holidays. If there are insufficient numbers of staff to operate an after-hours
on-call system, staff shall provide crisis response during regular work hours
and arrange coverage for all other hours through a reliable crisis response
service.
(10) Provide no more than
20 percent of service contacts in office-based settings.
f.
Staff-to-client ratio.
ACT teams shall maintain a ratio of at least one full-time or full-time
equivalent staff person to every ten individuals served. The ACT team
staff-to-client ratios do not include the psychiatrist, advanced nurse
practitioner, or physician assistant practicing under the supervision of a
psychiatrist.
g.
Eligibility criteria for ACT services. To be eligible to
receive ACT services, the individual shall meet all of the following criteria:
(1) Is at least 17 years of age.
(2) Has a severe and persistent mental
illness or complex mental health symptomology. Individuals with a primary
diagnosis of substance use disorder , developmental disability, personality
disorder, or organic disorder are not eligible for ACT services.
(3) Is in need of a consistent team of
professionals and multiple mental health and support services to live
independently in the community and reduce hospitalizations, as evidenced by one
or both of the following:
1. A pattern of
repeated treatment failures during the previous 12 months, including at least
two psychiatric hospitalizations or psychiatric care delivered at least twice
in an emergency department , at an access center , or by a mobile crisis team;
or
2. The need for multiple or
combined mental health and basic living supports to prevent the need for a more
intrusive level of care.
(4) Presents a reasonable likelihood that ACT
services will lead to specific, observable improvements in the individual 's
functioning and assist the individual in achieving or maintaining independent
community living. Specifically, the individual :
1. Is medically stable;
2. Does not require a level of care that
includes more intensive medical monitoring;
3. Presents a low risk to self, others, or
property, with treatment and support; and
4. Lives independently in the community or
demonstrates a capacity and desire to live independently in the community .
h.
ACT
services. ACT teams shall provide the following services:
(1) Initial assessment and treatment
planning.
1. An assessment of the individual
shall be completed within 30 days of admission that includes psychiatric
history, medical history, educational history, employment, substance use,
problems with activities of daily living, social interests, and family
relationships.
2. An individualized
written treatment plan shall be developed based on the assessment. The
treatment plan shall identify the necessary psychiatric rehabilitation
treatment and support services, including all of the following:
* Treatment objectives and outcomes.
* The expected frequency and duration of each service.
* The location where the services will be provided.
* A crisis plan.
* The schedule for updates of the treatment plan.
(2) Evaluation and
medication management .
1. The evaluation
portion of ACT services consists of a comprehensive mental health evaluation
and assessment of the individual by a psychiatrist, advanced registered nurse
practitioner, or physician assistant.
2. Medication management consists of the
prescription and management of medication by a psychiatrist, advanced
registered nurse practitioner, or physician assistant in response to the
individual 's complaints and symptoms. A psychiatric registered nurse assists in
this management by making contact with the individual regarding medications and
their effect on the individual 's complaints and symptoms.
(3) Integrated therapy and counseling for
mental health and substance abuse. Integrated therapy and counseling consists
of direct counseling for treatment of mental health and substance abuse
symptoms by a psychiatrist, licensed mental health professional , advanced
registered nurse practitioner, physician assistant, or substance abuse
specialist. Individual counseling may be provided by other team members under
the supervision of a psychiatrist or licensed mental health
practitioner.
(4) Skill teaching.
Skill teaching consists of side-by-side demonstration and observation of daily
living activities by any team member.
(5) Community support. Community support may
be provided by any team member and consists of the following activities focused
on recovery and rehabilitation:
1. Personal
and home skills training to assist the individual to develop and maintain
skills for selfdirection and coping with the living situation.
2. Community skills training to assist the
individual in maintaining a positive level of participation in the community
through development of socialization skills and personal coping
skills.
(6) Medication
monitoring. Medication monitoring services shall be provided by a psychiatric
nurse and other team members under the supervision of a psychiatrist or
psychiatric nurse and consists of:
1.
Monitoring the individual 's day-to-day functioning, medication compliance, and
access to medications; and
2.
Ensuring that the individual keeps appointments.
(7) Case management for treatment and service
plan coordination. Case management consists of the development of an
individualized treatment and service plan, including personalized goals and
outcomes, to address the individual 's medical symptoms and remedial functional
impairments. Case management includes:
1.
Assessments, referrals, follow-up, and monitoring.
2. Assisting the individual in gaining access
to necessary medical, social, educational, and other services.
3. Assessing the individual to determine
service needs by collecting relevant historical information through records and
other information from relevant professionals and natural
supports.
(8) Crisis
response. Crisis response consists of direct assessment and treatment of the
individual 's urgent or crisis symptoms in the community by any team member, as
appropriate.
(9) Work-related
services. Work-related services may be provided by any team member. Services
consist of assisting the individual in managing mental health symptoms as they
relate to job performance and may include:
1.
Collaborating with the individual to look for job situations of the
individual 's choice and creating strategies to manage situations that cause
symptoms to increase.
2. Assisting
the individual to develop or enhance skills to obtain a work placement, such as
individual work-related behavioral management.
3. Providing supports to maintain employment,
such as crisis intervention related to employment.
4. Teaching communication, problem-solving,
and safety skills.
5. Teaching
personal skills, such as time management and appropriate grooming for
employment.
(10) Peer
support services . Peer support services are provided by a peer support
specialist and include, but are not limited to, education and information,
individual advocacy, and crisis response.
(11) Support services. All team members are
responsible for providing support services. Services consist of assisting the
individual in obtaining the basic necessities of daily life, including but not
limited to:
1. Medical and dental
services.
2. Safe, clean, and
affordable housing.
3. Financial
support.
4. Benefits
counseling.
5. Social
services.
6.
Transportation.
7. Legal advocacy
and representation.
(12)
Education, support, and consultation to family members and other major supports
of individuals. All team members are responsible for providing education,
support, and consultation to family members and other major supports of
individuals with the agreement or consent of the individual . Services include
but are not limited to:
1. Individualized
psychoeducation about the individual 's illness and the role of the family and
other significant people in the therapeutic process.
2. Intervention to restore contact, resolve
conflicts, and maintain relationships with family or other significant people
or both.
3. Ongoing communication
and collaboration, face-to-face and by telephone, between the ACT team and the
family.
4. Introduction and
referral to family self-help programs and advocacy organizations that promote
recovery.
5. Assistance to obtain
necessary services for individuals with children , including but not limited to:
*
* Parenting training.
* Service coordination.
* Services to help the
* Services to help the
* Services to help the
(3)
Mobile response . The purpose of mobile response is to provide
short-term individualized crisis stabilization, following a crisis screening or
assessment, that is designed to restore the individual to a prior functional
level. Mobile response services shall be provided as described in rule
441-24.36 (225C).
(4)
23-hour observation and holding. The purpose of 23-hour
observation and holding is to provide up to 23 hours of care for adults in a
safe and secure, medically staffed treatment environment. Twenty-three-hour
observation and holding shall be provided as described in rule
441-24.37 (225C).
(5)
Crisis
stabilization community-based services . The purpose of crisis
stabilization community based services is to provide short-term services
designed to de-escalate a crisis situation and stabilize an individual
following a mental health crisis in the setting where the individual lives,
works, or recreates. Crisis stabilization community-based services shall be
provided as described in rule
441-24.38 (225C).
(6)
Crisis stabilization residential
services . The purpose of crisis stabilization residential services is
to provide a short-term alternative living arrangement in a setting of no more
than 16 beds that is designed to de-escalate a crisis situation and stabilize
an individual following a mental health crisis. Crisis stabilization
residential services shall be provided as described in rule
441-24.39 (225C).
(7)
Subacute mental health services . The purpose of subacute
mental health services is to provide a comprehensive set of wraparound services
to adults who have had or are at imminent risk of having acute or crisis mental
health symptoms.
a.
Regional
coordination. Each region shall designate at least one subacute mental
health service provider and ensure that subacute mental health services are
available to the residents of the region consistent with subrule
25.4(4).
b.
Subacute mental
health services standards.
(1)
Subacute mental health services in a facility-based setting shall be provided
as described in Iowa Code chapter 135G and 481-Chapter 71.
(2) Subacute mental health services in a
community -based setting are the same as assertive community treatment (ACT )
services provided as described in subrule 25.6(2).
(8)
Intensive residential
services . The purpose of intensive residential services is to serve
adults with the most intensive severe and persistent mental illness conditions
who have functional impairments and may also have multi-occurring conditions .
Intensive residential services provide intensive 24-hour supervision,
behavioral health services, and other supportive services in a community -based
residential setting.
a.
Regional
coordination. Each region shall designate at least one intensive
residential services provider and ensure that intensive residential services
are available to the residents of the region consistent with subrule 25.4(9).
(1) Regions shall work collaboratively to
develop intensive residential services strategically located throughout the
state with the capacity to serve a minimum of 120 individuals, with the support
of the medical assistance program .
(2) Intensive residential services may be
shared by two or more regions.
(3)
Each region shall establish methods to provide for reimbursement of a region
when the non-Medicaid-eligible resident of another region utilizes intensive
residential services or other non-Medicaid-covered services located in that
region .
(4) Regional reimbursement
rates for non-Medicaid individuals receiving intensive residential services
shall be negotiated by the region and the provider and shall be no less than
the minimum Medicaid rate.
b.
Intensive residential services
standards. An organization that seeks regional designation as an
intensive residential service provider shall meet the following criteria at
initial application and annually thereafter. A designated intensive residential
service provider shall:
(1) Be enrolled as an
HCBS 1915(i) habilitation provider or an HCBS 1915(c) intellectual disability
waiver supported community living provider and in good standing with Iowa
Medicaid.
(2) Provide staffing 24
hours a day, 7 days a week, 365 days a year.
(3) Maintain a minimum staffing ratio of one
staff to every two and one-half residents. Staffing ratios shall be responsive
to the needs of the individuals served.
(4) Ensure that all staff members have the
following minimum qualifications:
1. One year
of experience working with individuals with a mental illness or multi-occurring
conditions .
2. A high school
diploma or equivalent.
(5) Ensure that within the first year of
employment, staff members complete 48 hours of competency based training in
mental health and multi-occurring conditions . During each consecutive year of
employment, staff members shall complete 24 hours of competency-based training
in mental health and multi-occurring conditions . Staff training shall include,
but is not limited to, the following:
1.
Applied behavioral analysis.
2.
Autism spectrum disorders, diagnoses, symptomology and treatment.
3. Brain injury diagnoses, symptomology and
treatment.
4. Crisis management and
de-escalation and mental health diagnoses, symptomology and
treatment.
5. Motivational
interviewing.
6. Psychiatric
medications.
7. Substance use
disorders and treatment.
8. Other
diagnoses or conditions present in the population served.
(6) Provide coordination with the
individual 's clinical mental health and physical health treatment, and other
services and supports.
(7) Provide
clinical oversight by a mental health professional . The mental health
professional shall review and consult on all behavioral health services
provided to the individual , and any other plans developed for the individual ,
including but not limited to service plans, behavior intervention plans, crisis
intervention plans, emergency plans, cognitive rehabilitation plans, or
physical rehabilitation plans.
(8)
Have a written cooperative agreement with an outpatient mental health provider
and ensure that individuals have timely access to outpatient mental health
services, including but not limited to ACT .
(9) Be licensed as a substance abuse
treatment program pursuant to Iowa Code chapter 125 or have a written
cooperative agreement with and timely access to licensed substance abuse
treatment services for those individuals with a demonstrated need.
(10) Accept and serve eligible individuals
who are court-ordered to intensive residential services .
(11) Provide services to eligible individuals
on a no reject, no eject basis.
(12) If funded through HCBS and not licensed
as a residential care facility, serve no more than five individuals at a
site.
(13) Be located in a
neighborhood setting to maximize community integration and natural
supports.
(14) Demonstrate
specialization in serving individuals with an SPMI or multi-occurring
conditions and serve individuals with similar conditions in the same site.
c.
Eligibility
criteria for admission to intensive residential services . To be
eligible to receive intensive residential services , an individual shall meet
all of the following criteria:
(1) The
individual is an adult with a diagnosis of a severe and persistent mental
illness or multioccurring conditions.
(2) The individual has had a standardized
functional assessment and screening for multi-occurring conditions completed 30
days or less prior to application for intensive residential services , and the
functional assessment and screening demonstrates that the individual :
1. Has a diagnosis that meets the criteria of
severe and persistent mental illness as defined in rule
441-25.1 (225C);
2. Has three or
more areas of significant impairment in activities of daily living or
instrumental activities of daily living;
3. Is in need of 24-hour supervised and
monitored treatment to maintain or improve functioning and avoid relapse that
would require a higher level of treatment;
4. Has exhibited a lack of progress or
regression after an adequate trial of active treatment at a less intensive
level of care;
5. Is at risk of
significant functional deterioration if intensive residential services are not
received or continued; and
6. Meets
one or more of the following:
* Has a record of three or more psychiatric hospitalizations
in the 12 months preceding application for
* Has a record of more than 30 medically unnecessary
psychiatric hospital days in the 12 months preceding application for
* Has a record of more than 90 psychiatric hospital days in
the 12 months preceding application for
* Has a record of three or more emergency room visits related
to a psychiatric diagnosis in the 12 months preceding application for
* Is residing in a state resource center and has an
* Is being served out of state due to the unavailability of medically necessary services in Iowa.
* Has an
* Is
Notes
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