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RESOURCE

CH-008: Crisis Respite Request

Behavioral Health
Care Management

Oregon Behavioral Health Support Program

Please complete form CH-008 to request authorization for crisis respite stays for individuals in residential settings. To be completed by crisis respite provider.

Resource File
RESOURCE

Form CH-009: Secure Residential Treatment Facility (SRTF) Medical Necessity/Medical Appropriateness Review Referral

Behavioral Health
Care Management

Oregon Behavioral Health Support Program

A medical necessity/medical appropriateness approval is required for individuals in an SRTF placement before the 1915(i) assessment process (including development/update of the Level of Service Inventory [LSI], Level of Care Utilization System [LOCUS] and person-centered care plan [PCSP]) can be initiated by the IQA. Please note, a brief summary from the referring provider of how an SRTF placement will support the current behavioral health needs of the individual is also required on the form.

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