<p>Section Program Operation Policy number 5-D Topic Ineligible for Services Last Review Date 06/22/16</p><p>CARF 2.A.4-5; 2.B.3.e; 2.B.4.a; 2.B.4.c.(2) Last Revision Date 11/17/12 Standards Purpose To ensure that clients who are ineligible for services are informed about their options</p><p>1. Referrals may be ineligible for services for the following reasons: a. Client is less than 2 years old b. Client does not display behavioral or emotional difficulties c. Caregiver of minor client is unwilling to participate in sessions on a regular basis d. Services requested are not within the scope of Adapt’s treatment model (e.g., in-school only, individual therapy for child only) e. Client’s issues are more appropriate for services that Adapt does not provide (e.g., substance abuse treatment, residential treatment, tutoring, psychiatric services) f. Client has insurance that does not cover services with Adapt g. Client has no source of funding for services h. Client owes fees to Adapt from a previous admission 2. If a referred client does not meet admission criteria, the Referral Coordinator will inform the client and/or referral source of the admission criteria within 2 business days after determination and document the reasons and the notification on the Referral Form. 3. If a referred client’s issues are determined to need services not provided by Adapt, the Referral Coordinator will refer the client and/or referral source to an agency more appropriate to meet their needs within 2 business days after determination. This notification is documented on the Referral Form. 4. If a referred client has insurance that does not cover services by Adapt, the referral Coordinator will notify the client and/or referral source of this and refer them back to the insurance to seek services from a provider in that network within 2 business days after determination. This communication is documented on the Referral Form. 5. If a referred client has no source of funding for services, the Referral Coordinator will inform the client and/or referral source of the following options within 2 business days after determination, documenting the communication on the Referral Form: a. Alternate funding sources that are available (e.g., FSPT, TANF, Healthy Kids) and given an application for these funders, if available. b. Referral to other agencies that have services available for uninsured individuals c. Pay for the services themselves 6. If an active client becomes ineligible for services due to funding reductions or modifications, the Primary Clinician will notify the client of the following options within 2 business days after determination, documenting this communication on a Progress Note: a. Contact the insurance company to resolve the funding issue b. Apply for alternate funding (e.g., FSPT, TANF, Healthy Kids) c. Refer to an agency that has alternate funding for uninsured individuals d. Pay for services themselves</p><p>Program Operation – Ineligible for Services 2.A.4.a When a person served is found ineligible for services, the person served is Ineligible for informed as to the reasons Services 2 2.A.4.b.(1) When a person served is found ineligible for services, in accordance with the Ineligible for choice of the person served, the family/support system is informed as to the Services 6 reasons 2.A.4.b.(2) When a person served is found ineligible for services, in accordance with the Ineligible for choice of the person served, the referral source is informed as to the reasons Services 2 2.A.4.c When a person served is found ineligible for services, recommendations are Ineligible for made for alternative services Services 3,5 2.A.5 Each program/service implements procedures that address unanticipated Ineligible for service modification, reduction, or exits/transitions precipitated by funding or Services 5,6 other resource issues 2.B.3.e The organization implements policies and written procedures that define Ineligible for exclusionary or ineligibility criteria Services 1 2.B.4.a When screening is conducted by the organization, it is documented Screening & Admission Ineligible for Services 2,3,4,5,6 2.B.4.c.(2) When screening is conducted by the organization, it identifies alternate Ineligible for resources when services cannot be provided Services 3,4</p><p>Program Operation – Ineligible for Services</p>