BAY-ARENAC BEHAVIORAL HEALTH AUTHORITY POLICIES AND PROCEDURES MANUAL

Transcription

1 Page: 1 of 5 Policy It is the policy of Bay-Arenac Behavioral Health Authority (BABHA) that Electroconvulsive Therapy (ECT) and ancillary charges will only be authorized and funded for persons who are not covered by insurance or who have Medicaid when the Medicaid Health Plan denies authorization and when it is clinically justified. Clinical justification will be outlined in a procedure and the BABHA Medical Director will make the final determination on whether the ECT will be approved. Purpose This policy and procedure was developed to describe the criteria and processes associated with providing adults, children and adolescents with ECT and/or any procedure intended to produce convulsions or coma when such procedures are warranted. Education Applies to All BABHA Staff Selected BABHA Staff, as follows: All Clinical Staff, Clinical Management, and Ancillary Care All Contracted Providers: Policy Only Policy and Procedure Selected Contracted Providers, as follows: Policy Only Policy and Procedure Other: Definitions Electro-Convulsive Therapy (ECT): Means a method of treatment for mental distress or mental illness. It is mainly used for people with a diagnosis of severe depression who do not appear to be getting better or are not responding to medication. ECT involves passing a current of electricity through the head, which causes a convulsion (fit) in the brain. As medication is given to relax the muscles, there is very little movement of the body.

2 Page: 2 of 5 Procedure BABHA recognizes that short term ECT is a long established, effective treatment option that is given to decrease the symptoms of severe major depression, bipolar, acute mania and some forms of schizophrenia. It has been found to be particularly effective in severe endogenous depression, delusional depression and acute mania. ECT is considered by BABHA as a treatment of last resort. Clinical justification for ECT will include: Individual is currently experiencing an intractable form of severe major depression, serious delusional depression or acute mania and All conventionally approved treatments have been attempted unsuccessfully and It is determined by a psychiatrist under contract with BABHA that the individual has a high potential to harm himself or others and The BABHA Medical Director has determined that the procedure is clinically appropriate The following must be in place prior to consideration of short term ECT: The individual must be an enrolled in BABHA services The individual must be referred for ECT by a psychiatrist under contract with BABHA The referral must be accompanied by: o Clinical justification for ECT, including a description of the treatment interventions (pharmacological and psychotherapeutic) that have been attempted unsuccessfully, explanation of the need for rapid/short term improvement of severe symptoms, and the factors that led the clinician to believe that absent this treatment there could be potentially life threatening consequences for the individual. o In the case of a child or youth, two qualified psychiatrists, who were not actively involved in treating the child or youth, will examine the child or youth, consult with the treating psychiatrist and document his/her conclusion with the treatment. o Evidence of denial from the Medicaid Health Plan for persons with Medicaid or indigent status with ability to pay.

3 Page: 3 of 5 o Written legal consent for ECT must be obtained, available in the record, and included in the referral. a) The recipient, if he or she is 18 years of age or older and does not have a guardian for medical purposes b) The recipient s parent who has legal and physical custody of the recipient, if the recipient is less than 18 years of age c) The recipient s guardian, if the guardian has power to execute legal consent to procedures described in this section d) The recipient s designated representative, if a durable power of attorney or other advance directive grants the representative authority to consent to procedures described in this section The referral information will be forwarded to the Director of Integrated Care. The material will be reviewed to determine whether the referral packet is complete. Any questions or details missing will be gathered at that time. The referral packet will be forwarded to the BABHA Medical Director for final review and consideration. Doctor to doctor consultation may be required to collect sufficient information to formulate a decision. The Medical Director will use best practice criteria to determine if the request is clinically justified. If the request is denied, the Medical Director will consult with the referring network psychiatrist and provide clinical justification for the denial. Alternative treatment options will be offered. A written denial with clinical justification will be forwarded to the individual and referring psychiatrist. If the request is approved, the Director of Integrated Care will contact the PHIP, forward appropriate documentation, and secure authorization for the procedure. He/she will contact the network psychiatrist s office staff to notify them of the authorization and the contact person at the PIHP, who will work with them to arrange the procedure. Attachments

4 Page: 4 of 5 Related Forms Related Materials References/Legal Authority Michigan Mental Health Code

5 Page: 5 of 5 Submission Form Approving Body/Committee/Supervisor: PNLT J. Pinter Author/Reviewer: K. Withrow/M. Swank J. Pinter Approval/Review Date: 1/7/09 6/14/10 7/2/10 12/5/13 02/10/16 Result: Deletion New No Changes Replacement Revision List reason for deletion/replacement/revision here. If replacement, list policy to be replaced. Language updated to affirm necessity of written legal consent. Updated to include BABHA acronym and correction of job title Review only, the word "Medicaid" put in place of "Qualified" in policy/procedure statements, no changes in policy intent or procedures. Triennial review: Updated with Person First Language. Updated job title and name of PIHP. Moved from C04-S23-T01 (Referral and Service Authorization) to C04-S29-T10 (Ancillary and Other Services) as part of PP reorganization after closing of AAM