№ files_lp_3_process_9_71655
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Administrative healthcare authorization form used to request, document, and determine eligibility and medical necessity for Therapeutic Behavioral Services for Medi-Cal beneficiary youth under age 21.
Document Type:
Prior Authorization Request and Referral Form
Program:
Therapeutic Behavioral Services (TBS)
Related Services:
Specialty Mental Health Services
Funding Program:
Medi-Cal
Submitting Entity:
Specialty Mental Health Provider (SMHP)
Reviewing Organization:
Optum
Target Population:
Youth under 21 years of age
Eligibility Criteria:
Full-scope Medi-Cal beneficiary status and receipt of specialty mental health services
Authorization Period:
Up to 6 months per cycle
Maximum Weekly Service Amount:
Up to 25 hours (unless otherwise authorized)
Clinical Requirements:
Diagnosis, documented impairment, medical necessity criteria
Involved Parties:
SMHP, TBS Provider, Parent/Caregiver, CWS/Probation (if applicable)
Determination Outcomes:
Authorized, Modified, Reduced, Denied, Terminated, or Suspended
Notification Timeline:
Determination within 5 business days of receipt
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Note:
Year
Topic:
Behavioral Health Services
Document Type:
Assessment Tool
Target Audience:
Service providers, healthcare professionals
Year:
Not specified
Region / City:
Not specified
Theme:
Mental health services, youth support
Document Type:
Form
Organization / Institution:
Optum
Author:
Not specified
Target Audience:
Health professionals, social workers, mental health providers
Effective Period:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2021
Meeting:
3GPP TSG RAN WG1#105e E-meeting
Dates:
19–27 May 2021
Agenda Item:
8.9.3
Topic:
Support of 1736-bit DL TBS for eMTC
Document Type:
Feature Lead Summary
Organization:
3GPP TSG RAN WG1
Source:
Moderator (Sony)
Release:
LTE Release 17
Technology:
eMTC (LTE-M) / NB-IoT related discussion
Feature:
Maximum DL TBS of 1736 bits
UE Category:
HD-FDD Cat. M1 UEs in CE mode A
Configuration Method:
Unicast RRC configuration
Companies Providing Input:
ZTE, Ericsson, Nokia, Sony
Related Working Groups:
RAN1, RAN2
Referenced Documents:
R1-2104718, R1-2105891
Technical Aspects Discussed:
compatibility with other eMTC features, PUR configuration, multi-TB scheduling, multicast SC-MTCH, L2 buffer size considerations
Year:
2021
Event:
RAN1#105e E-meeting
Organization:
3GPP TSG RAN WG1
Authors:
Moderator (Sony), Ericsson, ZTE, Nokia NSB
Document type:
Technical summary
Scope:
eMTC, HD-FDD Cat. M1 UEs, CE mode A
Agenda item:
8.9.3
Proposals discussed:
DL TBS of 1736 bits in PUR, multi-TB scheduling, SC-MTCH/multicast
Conclusions:
1736-bit DL TBS assumed compatible with all other eMTC features
L2 buffer size recommendations:
24000 bytes for 1000-bit UL-SCH, 30000 bytes for 2984-bit UL-SCH
Date of meeting:
19–27 May 2021
References:
R1-2104718, R1-2105891
Document Type:
Prior Authorization Request and Referral Form
Program:
Therapeutic Behavioral Services (TBS)
Service System:
Specialty Mental Health Services (SMHS)
Related Program:
Medi-Cal
Institution / Organization:
Optum
Submitting Entity:
Specialty Mental Health Provider (SMHP) or TBS Provider
Target Population:
Youth under age 21 receiving Medi-Cal funded specialty mental health services
Eligibility Reference:
DMH Information Notice No. 08-38
Medical Necessity Standard:
BHIN 21-073
Associated Services:
Behavioral Health Assessment (BHA), Outpatient Authorization Request (OAR)
Authorization Period:
Up to 6 months of TBS intervention
Maximum Weekly Service Level:
Up to 25 hours of TBS intervention per week
Service Components:
Assessment (SC48), Plan Development (SC46), Intervention (SC47), Collateral (SC49)
Reviewing Authority:
Optum Clinician
Decision Outcomes:
Authorized, Modified, Reduced, Denied, Suspended, or Terminated
Beneficiary Program:
Medi-Cal Full-Scope Beneficiary
Submission Context:
Request for authorization of behavioral intervention services for eligible youth receiving specialty mental health treatment
Year:
N/A
Region / City:
N/A
Subject:
Therapeutic Hypothermia, Neonatal Care
Document Type:
Clinical Guideline
Organization:
N/A
Author:
N/A
Target Audience:
Healthcare Providers
Period of Validity:
N/A
Approval Date:
N/A
Date of Changes:
N/A
Note:
Year
Topic:
Behavioral Health Services
Document Type:
Assessment Tool
Target Audience:
Service providers, healthcare professionals
Year:
2023
Region/City:
Illinois
Topic:
Youth support services, Therapeutic support services, Prior authorization process
Document Type:
Form
Organization:
Illinois Department of Healthcare and Family Services (HFS)
Author:
Unknown
Target Audience:
Providers of therapeutic and individual support services
Period of Action:
N/A
Approval Date:
N/A
Amendment Date:
N/A
Year:
2021
Region / City:
Australia
Topic:
Vaporiser Nicotine Product Standards
Document Type:
Legislative Instrument
Organization / Institution:
Department of Health
Author:
[Name of delegate]
Target Audience:
Manufacturers, Health Authorities, Regulatory Bodies
Period of Validity:
From 1 October 2021
Approval Date:
1 October 2021
Amendment Date:
Not specified
Year:
2021
Region / City:
Philadelphia
Theme:
Health Communication, Education
Document Type:
Course Syllabus
Institution:
Community College of Philadelphia
Author:
Jocelyn Lewis
Target Audience:
Students in health-related fields
Effective Period:
Fall 2021
Approval Date:
February 10, 2021
Date of Revisions:
February 10, 2021
Year:
2026
Region / City:
Canberra, Australia
Topic:
Haemodialysis, Plasma Exchange, Medical Procedures
Document Type:
Clinical Procedure
Organization / Institution:
Canberra Health Services
Author:
Not specified
Target Audience:
Renal Nurses, Medical Staff
Effective Period:
Ongoing
Approval Date:
Not specified
Date of Last Revision:
Not specified
Note:
Year
Subject:
Anticoagulation management in adults
Document Type:
Procedure
Organization / Institution:
Canberra Health Services
Target Audience:
Medical Officers
Year:
[effective date]
Region / City:
[Facility Location]
Topic:
Intravenous to Oral Antibiotic Conversion
Document Type:
Policy
Organ / Institution:
[Facility Name]
Author:
[Approving individual or committee]
Target Audience:
Clinical staff, healthcare providers
Period of Effectiveness:
[Effective date]
Approval Date:
[Approval Date]
Date of Changes:
[Date of Changes]
Year:
Not specified
Region / City:
Not specified
Theme:
Therapeutic hypothermia for newborns, clinical protocols
Document Type:
Clinical guideline
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Medical professionals involved in neonatal care
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
November 2025
Region / City:
Trust-wide
Topic:
Therapeutic Engagement, Observation, Mental Health Care
Document Type:
Policy
Organization:
Borough Lead Nurses, Quality Committee
Author:
Director of Nursing
Target Audience:
Healthcare staff, Mental Health and LD services
Period of Validity:
November 2025 – November 2028
Approval Date:
November 2025
Date of Changes:
August 2024, November 2025
Year:
2026
Country:
Australia
Type of document:
Application form
Issuing authority:
Therapeutic Goods Administration (TGA)
Intended audience:
Medical practitioners
Purpose:
Application to become an authorised prescriber of unapproved medicines or medical devices
Regulatory reference:
Therapeutic Goods Regulations 1990, Regulation 12B(1B)
Required attachments:
Ethics committee or specialist college approval/declaration (if applicable)
Information collected:
Personal details of medical practitioner, patient consent, product information, prescribing details
Submission method:
Email or fax to TGA
Year:
2022
Region / City:
Norfolk, Norwich
Topic:
Nuclear Medicine
Document Type:
Procedural Document
Organization / Institution:
Norfolk and Norwich University Hospitals NHS Foundation Trust
Author:
Matthew Gray
Target Audience:
Medical staff working in nuclear medicine and related departments
Effective Date:
14/12/2022
Review Date:
12/2024
Date of Approval:
12/2022
Date of Amendments:
10/08/2022
Research Theme: Cancer Biology - Investigating R-Loop Biology for Therapeutic Applications in Cancer
Year:
Not specified
Region / City:
Not specified
Subject:
Cancer Biology, R-Loop Biology
Document Type:
Research Project Proposal
Institution:
Not specified
Author:
Li Hoi Yeung
Target Audience:
PhD candidates, researchers in cancer biology
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Modifications:
Not specified
Year:
2020
Region / city:
Global
Topic:
COVID-19, Clinical Trials, Remote Monitoring, Data Verification
Document Type:
Guide/Playbook
Organization:
European Medicines Agency (EMA)
Author:
Not specified
Target Audience:
Clinical Trial Monitors, Healthcare Professionals, Regulatory Agencies
Period of Action:
Ongoing during COVID-19 pandemic
Approval Date:
July 2020
Date of Changes:
Not specified