Code of Massachusetts Regulations › 104 CMR - DEPARTMENT OF MENTAL HEALTH › Title 104 CMR 29.00 - Application for DMH services, referral, service planning and appeals › Section 29.04 - Application for DMH Services; Domicile, Clinical Criteria and Determination of Need; Services Provided Pursuant to a PASRR Evaluation and Determination

Current through Register 1525, July 5, 2024
Except as provided in
				104
				CMR 29.04(6)  for
				individuals determined to have a serious mental illness as a result of a PASRR
				Level II evaluation,
				104
				CMR 29.04 shall apply to all individuals for
				whom an application for DMH services is submitted.
(1)
Application for DMH
			 Services
.
(a) An application for
			 DMH services for an individual shall be submitted to the DMH Area Office where
			 the individual or, in the case of a minor, where the minor's legally authorized
			 representative, resides.
(b) An
			 application may be submitted by:
1. An
			 individual or the individual's legally authorized representative. An individual
			 may be assisted by another person in completing the application.
2. A facility or program on behalf of an
			 individual:
a. if the facility or program
			 submitting the application has obtained authorization from the individual or
			 the individual's legally authorized representative to do so; or
b. if the facility or program believes an
			 individual lacks the capacity to apply for services, and has filed a petition
			 with the Probate and Family Court for guardianship for the
			 individual.
(c)
			 An application shall include the following:
1.
			 a completed application form;
2.
			 supporting documentation of psychiatric evaluations and clinical records, and
			 place of domicile that are available to the individual. The individual or the
			 individual's legally authorized representative may be asked to authorize the
			 Department to obtain additional information which it deems necessary to support
			 the application.
(d) The
			 Department may, in its discretion, require a personal interview and/or a
			 clinical evaluation of the individual to gather additional information to
			 support the application.
(e) An
			 application shall be considered complete when the Department has received the
			 completed application form and such additional information which it deems
			 necessary to support the application.
(f) Time frame for actions to be taken on an
			 application:
1. Within five business days of
			 receipt of an application form, the Area Director or designee shall review the
			 application to determine whether additional information is required, and shall
			 notify the applicant that the application has been received and request any
			 additional information identified. If it appears that the applicant is not
			 domiciled within Massachusetts, as provided in
			 104
			 CMR 29.04(2), the Area
			 Director or designee shall deny the application and shall so notify the
			 applicant pursuant to
			 104
			 CMR 29.04(2)(c).
2. Within 20 business days of receipt of an
			 application form, the Area Director or designee shall determine whether the
			 application is complete, and if any additional information requested has not
			 been received, and shall so notify the applicant or take other appropriate
			 steps to obtain such information.
3. Within 20 business days of receipt of the
			 completed application, including any additional information requested by the
			 Department, the Area Director or designee shall determine whether the
			 individual meets clinical criteria set forth in
			 104
			 CMR 29.04(3).
4. During the pendency of an application, the
			 Area Director or designee shall actively engage the applicant in completing the
			 application process, including provision of any additional information. Such
			 engagement may include provision of critical need case management pursuant to
			 104
			 CMR 29.05(3)  or other short
			 term services that do not require full service authorization pursuant to
			 104
			 CMR 29.04(1)(i)
a. If within 90 days of receipt of the
			 application, any additional information, personal interviews and/or clinical
			 evaluations have not been received or completed, the Area Director or designee
			 may make a determination on the application based upon such information as is
			 then available.
b. If at the end of
			 such 90-day period the Area Director or designee determines that there is
			 insufficient information upon which to make a determination, but the applicant
			 and/or the applicant's family is engaged in the application process, the Area
			 Director or designee shall extend the 90-day period for a reasonable length of
			 time in order to complete the process.
c. If at the end of such 90-day period, or
			 extension thereof, the Area Director or designee determines that there is
			 insufficient information upon which to make a determination and the applicant
			 and/or the applicant's family is not engaged in the application process, and if
			 despite active attempts to engage the applicant, the applicant refuses to
			 provide such additional information or to participate in a personal interview
			 and/or clinical evaluation, the application may be deemed
			 withdrawn.
5. Within 20
			 business days of an individual being determined to meet clinical criteria for
			 DMH services as set forth in
			 104
			 CMR 29.04(3), the Area
			 Director or designee shall determine whether the individual needs DMH services
			 as set forth in
			 104
			 CMR 29.04(4).
6. The Area Director or designee may extend
			 the time periods within
			 104
			 CMR 29.04(1)(f)  for good
			 cause.
(g) The Department
			 may redetermine whether a client continues to meet the criteria for DMH
			 Services pursuant to
			 104
			 CMR 29.04(3) and (4)
			 annually; when a client's circumstances have changed; or when information
			 becomes available that may affect the Department's decision regarding service
			 authorization.
(h) If during the
			 application process the Area Director or designee determines that the
			 individual is in need of short term services, in addition to active engagement
			 as provided in
			 104
			 CMR 29.04(1)(f)4, including
			 critical need case management, the Area Director or designee may authorize such
			 services. During this period, the individual's application shall be considered
			 "pending". Provision of such services does not indicate whether an application
			 will be approved, and shall not be subject to appeal pursuant to
			 104
			 CMR 29.16.
(i) The Department may develop services that,
			 in the Department's sole discretion, may be authorized without requiring an
			 applicant to submit a full application or to meet the clinical and service need
			 requirements as provided in
			 104
			 CMR 29.04.
1. Requests for and approval of such services
			 shall be based on criteria determined by the Department to be applicable to
			 such services.
2. An individual who
			 receives such services shall not be considered a DMH client for purposes of
			 104 CMR
			 29.00; provided however, a provider of such services
			 may be required by contract to comply with service planning provisions of
			 104 CMR
			 29.00.
3.
			 An individual receiving services pursuant to
			 104
			 CMR 29.04(1)(i)  may, in
			 addition, apply for and be authorized for services pursuant to
			 104
			 CMR 29.03.
4. Denial of a request for services pursuant
			 to 104 CMR 29.04(1)(i)
			  shall not be subject to appeal pursuant to
			 104
			 CMR 29.16.