Attachment 3 - DMH Decision Tree.docx

This file is a decision tree diagram used by the Department of Mental Health (DMH) to determine transportation eligibility and arrange rides for members seeking mental health and substance use disorder services. The document outlines a flowchart process that begins by identifying the provider or agency location for the requested trip, then branches into specific service categories including Community Psychiatric Rehabilitation (CPR), Community Support and Treatment Services (CSTAR), and other allowable Mental Health Division (MHD) services. The decision tree guides staff through a series of yes-or-no questions to verify whether requested trips qualify for coverage, including questions about the nature of services (CPR or CSTAR), whether trips are for alcohol or other drug treatment, physician visits for substance use or mental health medication management, and participation in psychosocial rehabilitation (PSR), day programs, day treatment, or clubhouse activities. The flowchart concludes with trip arrangement or denial based on the responses provided.

The decision tree serves as an operational tool to ensure consistent application of transportation coverage policies across DMH-funded services. It is designed to reduce administrative burden by providing clear pathways for eligibility determination, allowing staff to quickly assess whether a requested trip falls within covered services or should be denied. The document does not contain pricing information, contract terms, renewal options, or funding details, as it functions solely as an internal process guide for determining member transportation eligibility under existing DMH service parameters.