CG-BEH-14 Intensive In-home Behavioral Health Services

This policy addresses intensive in-home behavioral health services (II-HBHS), a multidisciplinary, home-based therapy for children, adolescents, and adults with severe behavioral disorders at high risk for hospitalization. Coverage is medically necessary when all criteria are met: DSM/ICD psychiatric symptoms linked to functional impairment and risk of serious harm; identifiable deficits appropriate for II-HBHS; engaged participation by the member and supports; and a reasonable expectation of improvement with in-home treatment. It is not covered when these criteria are not met or when reassessment shows no measurable improvement or clinical deterioration requiring a higher level of care.

"Intensive in-home behavioral health services may be consideredmedically necessarywhenALLof the following selection criteria are met (A, B and C):"

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