1. DMH Adult Clinical ServiceDMH Adult Clinical Service
Authorization: How to ApplyAuthorization: How to Apply
for DMH Servicesfor DMH Services
Felice De Ruggiero, LICSWFelice De Ruggiero, LICSW
Kim Clougherty, DMH Director ofKim Clougherty, DMH Director of
Program EvaluationProgram Evaluation

2. OverviewOverview
 Summarize the Adult DMH determinationSummarize the Adult DMH determination
process and eligibility criteriaprocess and eligibility criteria
 Assess an applicant’s immediate or emergingAssess an applicant’s immediate or emerging
needs in relation to eligibility criterianeeds in relation to eligibility criteria
 Summarize the 688 process and timelinesSummarize the 688 process and timelines
 Identify the steps in the appeals processIdentify the steps in the appeals process
 Submit a comprehensive DMH adult applicationSubmit a comprehensive DMH adult application
in order to secure appropriate clinical andin order to secure appropriate clinical and
professional services for the applicantprofessional services for the applicant

3. Applicants for adult services underApplicants for adult services under
18 (688 referrals)18 (688 referrals)
 The adult application must be signed byThe adult application must be signed by bothboth
the applicant and the guardian (DCFthe applicant and the guardian (DCF
guardian, custodial guardian or permanentguardian, custodial guardian or permanent
legal guardian)legal guardian)
 Include a copy of the guardianship decreeInclude a copy of the guardianship decree oror
thethe Care and Protection orderCare and Protection order
 Include DMH two-way releases of informationInclude DMH two-way releases of information
signed bysigned by both the applicant and the guardianboth the applicant and the guardian
for all psychiatric hospitalizations in the past 5for all psychiatric hospitalizations in the past 5
years, any neuropsych testing reports,years, any neuropsych testing reports,
residential programs, outpatient providers, andresidential programs, outpatient providers, and
DCFDCF

4. Applicants for adult services underApplicants for adult services under
18 (688 referrals)18 (688 referrals)
 Include a copy ofInclude a copy of the 688 referral formthe 688 referral form whichwhich
notes the LEA and SPED datenotes the LEA and SPED date
 If there is a history of substance abuse,If there is a history of substance abuse, thethe
applicant and their guardian must initial,applicant and their guardian must initial,
sign, and date the Protected Healthsign, and date the Protected Health
Information SectionInformation Section on the second page of theon the second page of the
release in order for DMH to obtain recordsrelease in order for DMH to obtain records
 Submit as muchSubmit as much current clinical informationcurrent clinical information
as possible with the applicationas possible with the application

5.  Summarize the Adult DMH determinationSummarize the Adult DMH determination
process and eligibility criteriaprocess and eligibility criteria
 What happens when the application isWhat happens when the application is
receivedreceived
 What diagnoses are qualifying vs. non-What diagnoses are qualifying vs. non-
qualifyingqualifying

6. Qualifying DiagnosesQualifying Diagnoses
 Schizophrenia, Schizoaffective Disorder, PsychoticSchizophrenia, Schizoaffective Disorder, Psychotic
Disorder, NOSDisorder, NOS
 Mood Disorder, NOS, Depressive Disorder, NOS, MajorMood Disorder, NOS, Depressive Disorder, NOS, Major
Depressive Disorder, Bipolar DisorderDepressive Disorder, Bipolar Disorder
 Anxiety Disorder, NOS, Generalized Anxiety Disorder,Anxiety Disorder, NOS, Generalized Anxiety Disorder,
Panic Disorder with or without Agoraphobia, ObsessivePanic Disorder with or without Agoraphobia, Obsessive
Compulsive Disorder, Social Anxiety Disorder, PTSDCompulsive Disorder, Social Anxiety Disorder, PTSD
 Dissociative Identity Disorder, Delusional DisorderDissociative Identity Disorder, Delusional Disorder
 Anorexia Nervosa, BulimiaAnorexia Nervosa, Bulimia
 On Axis II: Borderline Personality Disorder (the onlyOn Axis II: Borderline Personality Disorder (the only
qualifying Axis II diagnosis)qualifying Axis II diagnosis)

7. Non-Qualifying DiagnosesNon-Qualifying Diagnoses
 Adjustment Disorder, Dysthymia, CyclothymiaAdjustment Disorder, Dysthymia, Cyclothymia
 Schizophreniform DisorderSchizophreniform Disorder
 ADHDADHD
 Any disorder that is due to a medical conditionAny disorder that is due to a medical condition
(i.e. Mood Disorder Due to a Medical Condition,(i.e. Mood Disorder Due to a Medical Condition,
Substance-Induced Mood Disorder, etc.)Substance-Induced Mood Disorder, etc.)
 DementiaDementia
 DeliriumDelirium
 Cognitive Disorder, NOSCognitive Disorder, NOS

8. Non-Qualifying Diagnoses,Non-Qualifying Diagnoses,
ContinuedContinued
 Traumatic Brain Injury or Head InjuryTraumatic Brain Injury or Head Injury
 Mental RetardationMental Retardation
 Learning Disorder, NOSLearning Disorder, NOS
 Autism Spectrum DisorderAutism Spectrum Disorder
 Pervasive Developmental DisorderPervasive Developmental Disorder
 Asperger’s SyndromeAsperger’s Syndrome
 Any personality disorder other thanAny personality disorder other than
BorderlineBorderline

9. A Word About Substance AbuseA Word About Substance Abuse
 An individual with a substance abuse problem is eligibleAn individual with a substance abuse problem is eligible
if he or she is determined to have a qualifying mentalif he or she is determined to have a qualifying mental
disorder, meets impairment and duration criteria,disorder, meets impairment and duration criteria,
requires DMH continuing care services, and has no otherrequires DMH continuing care services, and has no other
means for obtaining them. The qualifying mentalmeans for obtaining them. The qualifying mental
disorder must be confirmed before assessing whetherdisorder must be confirmed before assessing whether
the applicant meets duration and functional impairmentthe applicant meets duration and functional impairment
criteria. Functional impairment will be determined basedcriteria. Functional impairment will be determined based
on the applicant’s presentation. It is presumed that theon the applicant’s presentation. It is presumed that the
functional impairment in a person with a co-occurringfunctional impairment in a person with a co-occurring
disorder is due to the primary psychiatric diagnosis.disorder is due to the primary psychiatric diagnosis.

10.  Summarize the 688 process and timelinesSummarize the 688 process and timelines

11.  Identify the steps in the appeals processIdentify the steps in the appeals process
 Gather support letters from currentGather support letters from current
providers that outline theproviders that outline the symptoms thatsymptoms that
support the diagnosessupport the diagnoses
 Importance of the face to face interviewImportance of the face to face interview
 Present any new documentation toPresent any new documentation to
support the application at this timesupport the application at this time

12. In SummaryIn Summary
 QuestionsQuestions
 Complete sign-in sheetsComplete sign-in sheets
 EvaluationEvaluation

13. Application Cheat SheetApplication Cheat Sheet
 Make sure to include:Make sure to include:
 An application that is signed and dated by the applicant and theirAn application that is signed and dated by the applicant and their
legal guardianlegal guardian
 Guardianship decree, if applicableGuardianship decree, if applicable
 DMH two way releases completely filled out and signed, initialedDMH two way releases completely filled out and signed, initialed
and dated by both the applicant and guardian for all psychand dated by both the applicant and guardian for all psych
hospitalizations in the past 5 years, any neuropsych testing reports,hospitalizations in the past 5 years, any neuropsych testing reports,
residential programs, outpatient providers, and DCFresidential programs, outpatient providers, and DCF
 688 referral form, if applicable688 referral form, if applicable
 A support letter from a clinician outlining Axis I-V diagnoses andA support letter from a clinician outlining Axis I-V diagnoses and
symptoms that support those diagnosessymptoms that support those diagnoses
 DCF placement reportDCF placement report
 Submit as much clinical information as possible with the applicationSubmit as much clinical information as possible with the application