№ lp_1_2_61498
File format: docx
Character count: 11354
File size: 57 KB
Clinical review checklist defining administrative, clinical, and eligibility criteria for authorizing Intensive In-Home services under Medicaid and state-funded behavioral health programs.
Program:
Intensive In-Home (IIH)
Service code:
H2022
Funding source:
Medicaid; State-funded
Policy reference:
Medicaid Clinical Coverage Policy 8A
Service category:
Mental Health; Substance Abuse; Developmental Disabilities
Document type:
Clinical review checklist
Review type:
Initial; Concurrent; Administrative; Expedited
Applicable population:
Medicaid members; State-funded members
Age group:
Children and adolescents under 21
Assessment frameworks:
DSM-5; LOCUS; CALOCUS; ASAM; CANS
Required documentation:
Service Authorization Request; Person-Centered Plan; Treatment Plan; Comprehensive Clinical Assessment; Crisis Plan
Authorization constraints:
Units and dates per service definition; submission timelines
Governing entities:
Managed Care Organization; State Medicaid program
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2024
Region / City:
North Carolina
Subject:
In-Home Aide Monitoring, Home and Community Care Block Grant (HCCBG), ARPA funding
Document Type:
Instructional Guide
Agency / Organization:
North Carolina Division of Aging and Adult Services
Author:
Not specified
Target Audience:
AAA monitors, service providers
Period of Validity:
FY24
Approval Date:
Not specified
Modification Date:
Not specified
Note:
Year
Year:
2024
Region / City:
Indiana
Topic:
Service Agreement
Document Type:
Memorandum of Agreement
Organization / Institution:
LifeStream Services, Inc.
Author:
LifeStream Services, Inc.
Target Audience:
Service providers, Agency staff
Period of Validity:
October 1, 2024 to September 30, 2026
Approval Date:
October 1, 2024
Date of Changes:
N/A
Contextual Description:
A memorandum outlining the terms for provider partners to deliver in-home services under the Agency’s program, including service authorization, billing, and delivery standards.
Year:
Not specified
Region / City:
Not specified
Theme:
Medicaid Services, Clinical Coverage, Mental Health
Document Type:
Clinical Policy
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Healthcare providers, Medicaid service providers
Period of validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2018
Region / City:
Victoria, Australia
Subject:
Energy Efficiency, Victorian Energy Upgrades program
Document Type:
Template
Agency / Institution:
Essential Services Commission
Author:
N/A
Target Audience:
Accredited providers, energy consumers
Period of validity:
N/A
Approval Date:
10 December 2018
Date of Changes:
N/A
Context:
Template for recording the assignment of rights for VEEC certificates under the Victorian Energy Upgrades program, including installation details and declarations by both installer and consumer.
Organization:
Adelphoi Village
Program Name:
Community Based In-Home Prevention, Treatment and Aftercare Program
Document Type:
Statement of Purpose
Service Setting:
Community-based, in-home services
Target Population:
Youth ages 10–20 involved with Juvenile Court or Children and Youth Services
Special Population:
Youth under 10 eligible for trauma services following assessment
Eligibility Criteria:
Youth identified as Low, Moderate or High risk; involvement with Juvenile Court or Children and Youth Services
Exclusion Criteria:
IQ below 65; serious medical condition requiring specialized oversight; documented need for 24-hour residential or inpatient psychiatric supervision
Referral Source:
Juvenile probation officer or caseworker
Assessment Tools:
Trauma Assessment; Suicide Assessment; Child and Adolescent Needs and Strengths (CANS); Family Advocacy and Support Tool (FAST); Daniel Memorial Assessment; Aggression Replacement Training assessment; DSM-5 related assessments; YLS
Services Provided:
Preventative or post placement care; treatment for problematic sexual behaviors; trauma services (PTSD); anger management; family preservation; independent living support; mentorship; academic and employment support
Family Involvement:
Mandatory participation in family counseling when youth remain in the home
Service Intensity:
Weekly individual and family sessions; availability of on-call therapeutic support
Geographic Scope:
Community-based
Year:
Not specified
Region / City:
Atlanta metropolitan area
Country:
United States
Institution:
Georgia Tech College of Computing
Researchers:
Dr. Anthony Tang; Dr. Keith Edwards
Type of Document:
Research recruitment and informed participation letter
Study Duration:
4 months
Number of Households Needed:
8
Compensation:
$300 per household ($150 at beginning; $150 at end)
Subject Criteria:
Households with broadband Internet access and at least two connected devices
Household Types:
Single; Roommates; Young-Spouses; Parents with young children; Parents with older children; Older adults 50+
Connection Types:
Cable (Comcast, Adelphia, Charter, Cox, Road Runner); DSL (AT&T, Verizon, Qwest, Earthlink); Clear Network
Data Collection Methods:
In-home router monitoring; interviews; surveys; weekly phone calls; internet problem diary
Anonymity Measures:
Households and computers assigned special codes
Contact Information:
[email protected]
Note:
; (425) 445-7637; (404) 385-6783
Document Type:
Child welfare case plan form
Purpose:
Planning and documentation of actions required to reduce safety threats and strengthen caregiver protective capacities
Subject Area:
Child protection and family services
Responsible Role:
Social worker and supervising authority
Participants:
Parent or caregiver, child (if over 12), social worker, supervisor, other involved parties
Plan Types:
In-Home Case Plan; Out-of-Home Case Plan
Key Components:
Objectives, tasks, services, service providers, start and end dates
Special Consideration:
Native American Heritage indicator with reference to ICW policy requirements
Signatories:
Parent/Caregiver, Child (over 12 years), Social Worker, Supervisor, Other
Implementation Period:
Defined by plan start date and target end dates for objectives and services
Note:
Date
Subject:
In-Home Therapy Referral
Document Type:
Referral Form
Organization:
HPTC
Target Audience:
Families seeking In-Home Therapy services
Year:
2026
Region / city:
United Kingdom
Topic:
Energy consumption and accessibility
Document type:
Transcript
Organization:
RNIB
Author:
Madleen, David Clarke
Target audience:
People with sight loss and their families
Technology discussed:
Smart meters, Accessible In-Home Display (AIHD)
Key features:
Speech output, high-contrast screen, tactile buttons
Purpose:
Monitoring household energy use independently
Source format:
Video transcript
Note:
Year
Subject:
Legal, Juvenile Law
Document Type:
Court Order
Authority / Institution:
Wisconsin Circuit Court
Author:
Court
Target Audience:
Juvenile, Legal Professionals, Parents
Approval Date:
[Date]
Amendment Date:
[Date]
Community Support Team (CST) Clinical Coverage Policy 8A-6 State-Funded MH/SA/DD Service Definitions
Note:
Year
Contextual Description:
A policy document detailing eligibility criteria and administrative review procedures for clinical coverage within state-funded mental health, substance abuse, and developmental disabilities services.
Year:
N/A
Region / city:
Oregon
Topic:
Environmental analysis, NEPA compliance
Document type:
Worksheet
Agency / institution:
Oregon Department of Transportation (ODOT)
Author:
Oregon Department of Transportation (ODOT), Public Transportation Division (PTD)
Target audience:
Applicants for state-funded projects requiring environmental review
Period of validity:
N/A
Approval date:
N/A
Date of revisions:
N/A
Year:
Not specified
Region / City:
Not specified
Theme:
Medicaid Services, Clinical Coverage, Mental Health
Document Type:
Clinical Policy
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Healthcare providers, Medicaid service providers
Period of validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
20__
Region / City:
New York State
Subject:
M/WBE Participation in State-Funded Projects
Document Type:
Resolution
Organization / Institution:
[name of organization]
Author:
Board of Directors
Target Audience:
Contractors, Subcontractors, Compliance Officers
Period of Action:
Ongoing
Approval Date:
___ day of __, 20
Amendment Date:
N/A
Note:
Year
Year:
[Not provided]
Region / City:
Florida
Subject:
State-funded grant agreement for project participation
Document Type:
Agreement
Authority:
Florida Department of Transportation
Author:
[Not provided]
Target Audience:
[Not provided]
Effective Period:
[Not provided]
Approval Date:
[Not provided]
Amendment Date:
[Not provided]
Year:
2026
Region / City:
Kentucky, USA
Document Type:
Template
Subject:
Transportation construction project bidding
Agency / Organization:
Local Public Agency (LPA)
Author:
Kentucky Transportation Cabinet (KYTC)
Target Audience:
Contractors submitting bids
Sections:
Scope of Work, Employment and Wage Requirements, Certifications, Specifications and Drawings, Insurance, Bid Items
Completion Period:
Project-specific, indicated in days or calendar dates
Bid Opening Date:
Project-specific, indicated in MMM DD, 20YY format
Bid Guarantee:
Minimum 5% of total bid
Applicable Law:
Kentucky Standard Specifications for Road and Bridge Construction 2012, KRS regulations