Attachment 3 - DMH Decision Tree.docx

This is a decision tree document for the Department of Mental Health (DMH) that outlines transportation eligibility criteria for services provided through two primary agencies: Community Psychiatry Resources (CPR) and Community Services Training and Rehabilitation (CSTAR). The decision tree guides staff in determining whether to approve or deny transportation requests based on the type of service sought and the provider involved. The tool establishes that trips are approved for CPR services, CSTAR services, and other allowable MHD services when the requesting member meets specific criteria. Transportation requests are denied when services fall outside covered categories or when members do not meet the documented service requirements.

The decision tree includes specific pathways for determining eligibility based on service type, including substance use treatment services, medication-related visits with prescribers, and participation in psychosocial rehabilitation, day programs, day treatment, or clubhouse activities. The document distinguishes between first visits and assessment updates, and includes a specific pathway addressing methadone-only visits. The tool requires staff to clarify whether members are certain about their service needs and whether the trip involves visits to healthcare professionals who prescribe medications for substance use or related mental health issues, ensuring that transportation assistance is allocated only for medically necessary and covered services within the DMH service delivery system.