Psychosocial Rehabilitation (H2017) Service Definition and Eligibility Requirements

Service Definition

Psychosocial Rehabilitation is a program of two or more consecutive hours per day provided to groups of adults in a nonresidential setting. Individuals must demonstrate a clinical need for the service arising from a condition due to mental, behavioral, or emotional illness that results in significant functional impairments in major life activities.

This service provides education to teach the individual about mental illness, substance abuse, and appropriate medication to avoid complication and relapse and opportunities to learn and use independent skills and to enhance social and interpersonal skills within a consistent program structure and environment.

Medical Necessity Criteria

The service-specific provider intake, as defined at 12VAC30-50-130, shall document the individual's behavior and describe how the individual meets criteria for this service. Individuals qualifying for this service must demonstrate a clinical necessity for the service arising from a mental, behavioral, or emotional illness that results in significant functional impairments in major life activities.

Individuals must meet both Criteria A and B to qualify for reimbursement.

Criteria A

Individuals must meet two of the following criteria on a continuing or intermittent basis:

Criteria B

Individuals must meet one of the following criteria: