.07 Participant Eligibility — Level III — Intensive Care Coordination.

A. The participant shall meet at least one of the following conditions:

(1) The participant has been enrolled in the 1915(i) program for 6 months or less;

(2) The participant is currently enrolled in Level I or Level II Care Coordination services under this chapter and has experienced one of the following adverse childhood experiences during the preceding 6 months:

(a) Emotional, physical, or sexual abuse;

(b) Serious emotional or physical neglect; or

(c) Significant family disruption or stressors;

(3) The participant meets the following conditions:

(a) The participant has a behavioral health disorder amenable to active clinical treatment, diagnosed through a face-to-face psychosocial assessment by a licensed mental health professional;

(b) There is clinical evidence the minor has a SED and continues to meet the service intensity needs and medical necessity criteria for the duration of their enrollment;

(c) A comprehensive psychosocial assessment performed by a licensed mental health professional finds that the participant exhibits a significant impairment in functioning, representing potential serious harm to self or others, across settings, including the home, school, or community;

(d) The psychosocial assessment supports the completion of the Early Childhood Service Intensity Instrument (ECSII) for youth ages 0—5 or the Child and Adolescent Service Intensity Instrument (CASII) for youth ages 6—21, by which the participant receives a score of:

(i) 3 on the ECSII; or

(ii) 3 or higher on the CASII;

(e) Youth with a score of 3, 4, or 5 on the CASII also shall meet the conditions outlined in §B of this regulation; and

(f) Youth with a score of 3 or 4 on the ECSII also shall meet the conditions outlined in §C of this regulation.

B. Youth with a score of 3, 4, or 5 on the CASII shall meet one of the following criteria to be eligible based on their impaired functioning and service intensity level:

(1) Transitioning from a residential treatment center; or

(2) Living in the community, be 6 through 21 years old, and have:

(a) Any combinations of 2 or more inpatient psychiatric hospitalizations or emergency room visits in the past 12 months; or

(b) Been in an RTC within the past 90 calendar days.

C. Youth who are younger than 6 years old who have a score of a 3 or 4 on the ECSII shall either:

(1) Be referred directly from one of the following:

(a) Inpatient or day hospital unit;

(b) Primary care provider (PCP);

(c) Outpatient psychiatric facility;

(d) Early Childhood Mental Health (ECMH) Consultation program in daycare;

(e) Head Start program;

(f) Judy Hoyer Center; or

(g) Home visiting program; or

(2) If living in the community, meet one or more of the following criteria in the past 12 months:

(a) Had one or more psychiatric inpatient or day hospitalizations;

(b) Had one or more ER visits;

(c) Exhibit severe aggression;

(d) Display dangerous behavior;

(e) Been suspended from school or childcare setting;

(f) Display emotional or behavioral disturbance prohibiting their care by anyone other than their primary caregiver;

(g) Be at risk for out-of-home placement or placement disruption;

(h) Have severe temper tantrums that place the child or family members at risk of harm;

(i) Have trauma exposures and other adverse life events; or

(j) Be at risk of family-related risk factors, including safety, parent-child relational conflict, and poor health and developmental outcomes.​