MHSUDS Information Notice No.: 19-026

Authorization of Specialty Mental Health Services (QM6049)
Utilization Management Policy (QM6050)
Inpatient Hospitalization Concurrent Review Request Procedure (QM6051)
Inpatient Hospitalization Concurrent Review Request for Acute Days Form (QM080)
Inpatient Hospitalization Concurrent Review Request for Administrative Day Form (QM081)
Inpatient Hospitalization Concurrent Review Request Authorization Letter
Authorization of Adult Residential Treatment Services (ARTS) and Crisis Residential Treatment Services (CRTS) Procedure (CLP0839)
Authorization of Adult Residential Treatment Services (ARTS) and Crisis Residential Treatment Services (CRTS) Request Form (CLP046)
Day Rehabilitation and Day Treatment Intensive Prior Authorization Request Procedure (CLP0840)
Day Rehabilitation and Day Treatment Intensive Prior Authorization Request Form (CLP048)
Prior Authorization for Intensive Home Based Services (IHBS) Procedure (CHD0321)
Prior Authorization for Intensive Home Based Services (IHBS) Request Form (CHD023)
Prior Authorization for Therapeutic Behavioral Services (TBS) Procedure (CHD0319)
Prior Authorization for Therapeutic Behavioral Services (TBS) Request Form (CHD022)
Prior Authorization for Therapeutic Foster Care (TFC) Procedure (CHD0320)
Prior Authorization for Therapeutic Foster Care (TFC) Request Form (CHD024)
Therapeutic Foster Care (Services) Screening Tool