1. Requests for funding specialized
out-of-state mental health treatment will be considered only for adult clients
of DMHMRSAS, as currently defined.
2. Requests for grant funding specialized
out-of-state mental health treatment will only be considered when all other
sources of funding have been exhausted (such as reciprocal Medicaid agreements,
third party insurance, personal resources, etc.). Every effort must have been
made to fund the treatment jointly with other responsible agencies
3. The client must have a
current psychiatric evaluation that reports findings of instability secondary
to an Axis I major mental illness, as defined by the current edition of the
Diagnostic and Statistical Manual. The current clinical picture must clearly
demonstrate medical necessity for treatment, as defined by evidence of severe
dysfunction in aspects of daily living or danger to self or others, which has
existed for at least 6 months or longer.
4. Requests for specialized out-of-state
mental health treatment will only be considered when it has been demonstrated
that in-state treatment AND treatment at a lower level of care have reasonably
been attempted and failed, OR that there is no appropriate, safe and effective
treatment available in the state.
5. The specific treatment plan or program
being requested must have proven efficacy in the treatment of the client's Axis
I diagnosis, be consistent with best clinical practice and qualitatively
different from a program available in the state of Maine. Specialized
out-of-state treatment will be authorized only when the program and/or facility
meets applicable licensing regulations and there is reason to expect the
program requested will significantly improve the condition of the client,
returning him/her to a former level of stability. At the Department's
discretion, a Departmental staff person may be designated to conduct an on-site
review of the program being considered.
6. Requests for specialized out-of-state
treatment will be approved only when it can be demonstrated that without the
requested treatment, the client will continue to be unstable or will
7. The client
must voluntarily accept the specialized out-of-state treatment and evidence
some capacity to benefit from the treatment. The guardian, if applicable, must
also approve the specialized out-of-state treatment plan.
8. The specialized out-of-state treatment
plan must be cost effective, demonstrated by the reasonable expectation for
reduced future behavioral or somatic medical care costs AND by favorable cost
comparison to other similar treatments.
9. Every preauthorization of specialized
out-of-state treatment shall be for a specific length of time. The client's
clinical progress will be monitored during treatment, consistent with good
utilization review practices. When it is clinically appropriate, or if the
client's condition does not improve in a reasonable period of time, the
authorization for continued treatment may be withdrawn and the client
transferred to a less intensive level of care or an instate program. Such a
withdrawal and transfer will be done with sufficient notice to the client,
family and providers involved.
Before preauthorization will be granted, there must be a preliminary discharge
or transition plan developed, for the client to return to an instate treatment