Mental Health Skill Building Service
Wellness Within, Inc. provides Mental Health Skill-Building Services to individuals with mental health diagnosis and are in need of life skills to become more stabilized in the community. Mental Health Skill-Building Services are goal directed training to enable individuals to achieve and maintain community stability and independence in the most appropriate, least restrictive environment. Mental Health Skill-building Services (MHSS) emphasizes on the rehabilitative nature of the service. MHSS shall include goal directed training in the following areas in order to qualify for reimbursement by Medicaid or its BHSA: functional skills and appropriate behavior related to the individual’s health and safety; activities of daily living, and use of community resources; assistance with medication management; and monitoring health, nutrition, and physical condition.
Our team is expected to develop collaborative intake processes with relevant community and institutional referral sources to determine an individual’s eligibility for admission and to effectively prioritize and engage new clients. Our MHSS program is expected to respond to any referral resource within a 24-hour period and enroll eligible individual within three days of receipt of the enrollment.
Skill-building may include:
1. Teaching activity of daily living skills
2. Improving Functionality
3. Reduce inappropriate behavior
4. Finding community resources
5. Medication Management
6. Providing education about good hygiene
7. Assisting with grocery shopping and meal planning
8. Finding ways to manage stress, depression and anxiety
9. Counseling in Health & Wellness
Medical Necessity (Admission) Criteria
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Individuals qualifying for Mental Health Skill-building Services must demonstrate a clinical necessity for the service arising from a condition due to mental, behavioral, or emotional illness that results in significant functional impairments in major life activities. Services are provided to individuals who require individualized training to achieve or maintain stability and independence in the community.
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Individuals age 21 and over shall meet all of the following criteria in order to be eligible to receive mental health skill-building services.
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The individual shall have one of the following as a primary Axis I DSM diagnosis:
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Schizophrenia or other psychotic disorder as set out in the DSM,
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Major Depressive Disorder – Recurrent;
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Bipolar I; or Bipolar II;
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Any other Axis I mental health disorder that a physician has documented specific to the identified individual within the past year to include all of the following: (i) that is a serious mental illness; (ii) that results in severe and recurrent disability; (iii) that produces functional limitations in the individual’s major life activities that are documented in the individual’s medical record, AND; (iv) that the individual requires individualized training in order to achieve or maintain independent living in the community.
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The individual shall require individualized training in acquiring basic living skills such as symptom management; adherence to psychiatric and medication treatment plans; development and appropriate use of social skills and personal support system; personal hygiene; food preparation; or money management.
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The individual shall have a prior history of any of the following: psychiatric hospitalization; residential crisis stabilization, MHSS or Program of Assertive Community Treatment (PACT) services; placement in a psychiatric residential treatment facility (RTC Level C); or TDO pursuant to the Code of Virginia §37.2- 809(B) evaluation as a result of decompensation related to serious mental illness. This criterion shall be met in order to be initially admitted to services, and not for subsequent authorizations of service.
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3. The individual shall have had a prescription for anti-psychotic, mood stabilizing, or antidepressant medications within the 12 months prior to the assessment date. If a physician or other practitioner who is authorized by his license to prescribe medications indicates that anti-psychotic, mood stabilizing, or antidepressant medications are medically contraindicated for the individual, the provider shall obtain medical records signed by the physician or other licensed prescriber detailing the contraindication. This documentation shall be maintained in the individual’s mental health skill-building services record, and the provider shall document and describe how the individual will be able to actively participate in and benefit from services without the assistance of medication. This criterion shall be met upon admission to services, and not for subsequent authorizations of service.
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Individuals younger than 21 years of age shall meet all of the above criteria in order to be eligible to receive mental health skill-building services and the following:
The individual shall be in an independent living situation or actively transitioning into an independent living situation. (If the individual is transitioning into an independent living situation, Services shall only be authorized for up to six months prior to the date of transition). Independent living situation means a situation in which an individual, younger than 21 years of age, is not living with a parent or guardian or in a supervised setting and is providing his own financial support.
Individuals eligible for this service may have a dual diagnosis of either mental illness and developmental disability or mental illness and substance abuse disorder. If an individual has co-occurring mental health and substance abuse disorders, integrated treatment for both disorders is allowed within Mental Health Skill-building Services as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition. The impact of the substance abuse condition on the mental health condition must be documented in the service specific provider intake, the ISP, and the progress notes.
