Treatment Response Review

(A) Each psychiatric day treatment program must assess the member’s recovery status at intake into the program, and assess treatment response every 90 days that the member remains in the program, and at discharge from the program. These assessments must be completed using instruments, subject to review by the MassHealth agency, for measuring an individual member’s treatment response. Results of the assessments of treatment response must be kept in the member’s medical record. (B) The MassHealth agency may decide to review a member’s treatment if examination of the member’s treatment response review indicates that one or more of the following applies: (1) no progress has been made for four months; (2) the member has regressed in their recovery; or (3) another reason deemed appropriate by the MassHealth agency. (C) The MassHealth agency may review a member’s treatment or conduct a utilization review for the reasons listed in 130 CMR 417.411(B) to determine whether a member’s receipt of psychiatric day treatment services should be continued, modified, or terminated. The utilization review determines only the medical necessity of the service and neither establishes nor waives any other prerequisite for payment, such as member eligibility.