QM - Utilization Management contact:
Utilization Management and Support: [email protected] or [email protected]
Residential Care Continuum
The enhanced adult residential programs provide services for clients with Serious Mental Illness (SMI) and co-occurring disorder clients 18 years of age and older. The treatment facilities are designed for persons who can live in the community but who would be at risk of returning to a hospital without the support of counseling and a therapeutic environment. Services under this program include housing, medication, behavioral health treatment, and social support for clients with SMI that will support the client’s stabilization, facilitate the transition to community services, and provide rehabilitative treatment services in a non-institutional and therapeutic community setting for clients at risk of (re)hospitalization or (re)institutional placements. To make a referral, a completed Supplemental Service Application form must be sent to [email protected].
These programs are licensed by the California Department of Health Care Services (DHCS) and provide 24-hour/day care and supervision to adults 18-65 years of age. They provide locked, skilled nursing facility care and supervision for adults who require extended treatment following an acute psychiatric hospitalization, allowing clients an opportunity to stabilize and prepare for community discharge. They focus on recovery and rehabilitation, which is accomplished through service components designed to meet the needs of this population, such as: Life and Leisure Skills, Dual Recovery Program and Medication Education/Peer Support. All clients must be conserved under the Lanterman-Petris-Short Act (LPS). To make a referral, a completed Supplemental Service Application form must be sent to [email protected].
These facilities provide 24-hour/day skilled nursing care and supervision to clients with a primary psychiatric diagnosis, who may also have co-existing medical conditions. These facilities offer programs for adults as well as Geri-Psych programs for clients 65 years of age and older. In most cases, clients are conserved under Lanterman-Petris-Short Act (LPS). These facilities may bill Medi-Cal for adults as well as those 65 years or older.
In addition to skilled nursing our providers offer specialized services for those with neurobehavioral needs. These services are designed to meet the particular needs of a behaviorally difficult patient population who are disabled due to brain injury and have a tendency to "act out" physically and verbally. All clients have concurrent physical health needs that are addressed at these facilities. To make a referral, a completed Supplemental Service Application form must be sent to [email protected].
The Behavioral Health Services Department provides a supplemental payment to Licensed Residential Care Facilities that contract with the County. These facilities are located throughout the county and offer a broad array of specialized services, including cultural and language proficient care. They provide individualized care and supervision within a homelike setting to adults and older adults with SMI, to support their successful community living. To make a referral, a completed Supplemental Service Application form must be sent to [email protected].
The substance use residential treatment services are delivered to members when medically necessary in a short-term residential program corresponding to at least one of the following levels:
• Level 3.1 - Clinically Managed Low-Intensity Residential Services
• Level 3.5 - Clinically Managed High Intensity Residential Service
Services under this program include assessment, care coordination, counseling, family therapy, medication services, and crisis intervention services. The average length of stay is 30 days. As SUTS Residential beds for youth and adults require pre-authorization, providers shall complete a Pre-Authorization Request Form via DocuSign and attach the assessment, medical clearance, and Medi-Cal Verification.
For instructions on how to complete the form, please visit: Authorization Request Form Directions. If you have additional questions or need to send additional documents, please send them to: [email protected].
The crisis residential programs provide services for Seriously Mentally Ill (SMI) and co-occurring disorder clients 18 years of age and older. The CRT treatment facilities are designed for persons who can live in the community but who would be at risk of returning to a hospital without the support of counseling and a therapeutic community.
Services under this program include housing, medication, behavioral health treatment, and social support for SMI clients that help prevent a client from becoming a danger to themselves, a danger to others, or becoming gravely disabled. To make a referral, a completed Supplemental Service Application form must be sent to [email protected].
These residential programs are designed for members with eating disorders who need 24/7 support, including around-the-clock observation and daytime medical and psychiatric supervision.
Treatment includes individual, family, and group therapy, weight and vital checks, and nutritionist sessions (meal planning, preparation, and psychoeducation) in a homelike setting. A structured daily schedule incorporates groups, community meetings and individual therapy, focusing on recovery skills, relapse prevention, and addressing the factors maintaining members' eating disorders. To make a referral, a completed ED Referral form must be sent to [email protected].