Individuals qualifying for in-home counseling shall demonstrate a clinical necessity for the service arising from mental, behavioral or emotional illness which results in significant functional impairments in major life activities. The diagnosis must be the primary clinical issue addressed by services and meet the following criteria:
The diagnosis must support the mental, behavioral or emotional illness attributed to the recent significant functional impairments in major life activities.
At Risk Criteria
The impairments experienced by the member are to such a degree that they meet the criteria for being at risk of out of home placement as defined in the below section.
- Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization* or out-of-home placement** because of conflicts with family or community.
- Exhibit such inappropriate behavior that documented, repeated interventions by the mental health, social services, or judicial system are or have been necessary resulting in being at risk for out of home placement.
- Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or recognize significantly inappropriate social behavior resulting in being at risk for out of home placement.
These services shall be provided in this level of care when the clinical needs of the individual put him at risk for out-of-home placement, as these terms are defined in this section:
- When services that are far more intensive than outpatient clinic care are required to stabilize the individual in the family situation, or
- When the in-home counseling as the setting for services is more likely to be successful than a clinic.
- At least one parent/legal guardian or responsible adult with whom the individual is living must be willing to participate in the intensive in-home counseling services with the goal of keeping the individual with the family.
- In the instance of this service, a responsible adult shall be an adult who lives in the same household with the child and is responsible for engaging in therapy and service-related activities to benefit the individual.