Clinical Eligibility Requirements for Admission

(A) Members seeking a psychiatric day treatment program services must be evaluated by a multidisciplinary team composed of the treatment team and a psychiatrist (if the psychiatrist is not a member of the treatment team) following the admission procedures set forth in 130 CMR 417.432. The multidisciplinary team may admit the member to the program only if it determines that the member has a mental illness and functional impairment appropriate to psychiatric day treatment. Documentary evidence must support these findings. (B) Members are considered appropriate for psychiatric day treatment program services if they have symptoms of thought, mood, behavior, or perception that significantly impair functioning in at least two of the following areas: (1) emotional stability; (2) vocational/educational productivity; (3) social relations; and (4) self-care. (C) Members would not benefit from psychiatric day treatment program services if currently: (1) sufficient impairment exists to require a more intensive level of service; (2) has medical conditions or impairments that would prevent beneficial utilization of services; (3) the primary impairment is not psychiatric; (4) imminent risk to self or others; (5) requires a level of structure and supervision beyond the scope of the program; or (6) does not voluntarily consent to admission to treatment and/or refuses or is unable to participate in all aspects of treatment.