Required to use review or authorization for dual diagnosis


MABH


 
 MABH

"5.0  UTILIZATION MANAGEMENT...
  5.01.01  Develop a Utilization Management Department that shall be operational on the Full Service Start Date and shall be responsible for the following: ...
h.  specialty services and programs, such as:
  1.  Dual Diagnosis..."  Massachusetts MH/SAP Contract, Appendix B, page 28.

"5.07 Dual Diagnosis
  The Contractor shall: ...
  5.07.04  Design, develop, and implement a plan within the first sixth months of the Contract, and submit the plan to the Division for prior review and approval prior to implementation, which shall be used by the Utilization Management staff to facilitate the transfer of an Enrollee's care who has a Dual Diagnosis from one Provider to another Provider, when the Enrollee with a Dual Diagnosis is in ongoing treatment with a Provider who does not have training, experience, or education working with individuals with a Dual Diagnosis."  Massachusetts MH/SAP Contract, Appendix B, pages 44-45.