POTOMAC CASE MANAGEMENT SERVICES, INC.
REFERRAL GUIDELINES
ADULT TARGETED CASE MANAGEMENT ELIGIBILITY
In order to receive
mental health case management services a person must be 18 years of age or
older, have limited financial resources to obtain required treatment, be a
resident of Washington County, elect to receive mental health case management
services, be in a federal eligibility category for Maryland Medical Assistance
and must meet the following criteria:
A. Primary Diagnosis: Major mental illness as defined by:
1. Schizophrenic
disorder (DSM-III-R 295.00-295.99); or
2. Major
affective disorder (DSM-III-R 296.00-296.99); or 3. Other psychotic disorder (DSM-III-R
297.00-297.99,
298.90); or
4. Borderline,
schizoid or schizotypal personality disorders
(DSM-III-R 301.83,
301.20-301.22) with the exclusion of
an
abnormality that is manifested only by repeated criminal
or
otherwise antisocial conduct; and
B. History of Psychiatric Treatment
1. Single
psychiatric hospitalization of six (6) months or more in
duration
during the past ten (10) years; or
2. More
than one psychiatric hospitalization during the past two
(2) years;
or
3. Psychiatric
treatment or mental health community support
services
for six (6) or more months during the past two (2) years; and
C. Impaired Role Functioning Resulting
From Mental Illness
Meeting at least three (3) of the following five (5) criteria on a
continuing or intermittent basis for the last two (2) years:
1. Is unemployed, employed
in a sheltered setting or has markedly limited
job
skills and a poor work history;
2. Exhibits inappropriate
social behavior;
3. Due to cognitive
disorganization is unable to procure the financial
assistance
necessary to remain in the community;
4. Is
unable to establish or maintain a personal social support system;
5. Requires that another
person assist with daily living skills; and
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D. Meets one of the Following Criteria
1. Is leaving supervised housing;
2. Has had at
least ten (10) state or private psychiatric hospitalizations
within the past two (2) years;
3. Is 18 to 21 years of age and leaving a
residential treatment center,
including a state hospital or an out-of-state placement, and
needs
assistance with transition to adult mental health services;
4. Has been hospitalized
for at least 365 days in the past two (2) years;
5. Is a homeless person or a person whose
basic human needs are not
being met or are being met inappropriately; or
E. Meets
Two of the Following Criteria
1. Has had at
least two (2) incarcerations for misdemeanors at a local
jail within the past two (2) years;
2. Has had six to nine state or private psychiatric
hospitalizations
within the past two (2) years;
3. Has had at least three (3) emergency
room visits within the past
six (6) months as the primary site for psychiatric
interventions;
4. Has been hospitalized for the treatment
of mental illness for at
least 180 days in the past two (2) years;
5. Is determined by the provider or the
MHA to be vulnerable and
at risk of harm to self or from others;
6. Has multiple
physical or mental disabilities, as well as needs not
being met by the coordinated system of care; or
7. Is in danger of losing the current
place of residence.
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original forms/referral guidelines
participant eligibility
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