BHO Research Paper

MCO Name
Affinity (BHO)-
Amerigroup (BC/BS)
HealthFirst
HealthPlus (BC/BS)
HIP (BHO)
MetroPlus (BHO)
Fidelis
United Healthcare
Visiting Nurse Svc (BHO)
WellCare

H.

I.
ACT recipients are served with a person-centered approach with no artificial time constraints. When recipients have exhibited substantial progress in their status or request a discharge, our ACT team members will escort them to community providers to tour their facility, ask questions and become more acquainted with the services of the community provider. ACT team members will act in a supportive fashion to address any ambivalence, apprehension or resistance to engaging in services with a new provider. It is anticipated that it may take numerous visits to a single provider

or it may entail visits to numerous community providers to engage the recipient in the process. Discharge is based on the achievement of recovery goals.
Specific Criteria for Discharge is as follows
Recipients who demonstrate, over a period of time, an ability to function in major life roles (i.e., work, social, self-care) and can continue to succeed with less intensive service.

Recipients who move outside the geographic area of our ACT team’s responsibility. Our ACT team will arrange for transfer of mental health service responsibility to an appropriate provider and will maintain contact with the recipient until the provider and the recipient are engaged in this new service arrangement.
Recipients that need a medical nursing home placement, as determined by a physician.
Recipients who are hospitalized or locally incarcerated for three months or longer. However, an appropriate provision will be made for these individuals to return to our ACT program upon their release from the hospital or jail.
Recipients who request discharge, despite our team’s best, repeated efforts to engage them in service planning. Special care will be taken in this situation to arrange alternative treatment when the recipient has a risk history indicative of suicide, assault or forensic involvement.
Recipients who are lost to follow-up for a period of greater than 3 months after persistent efforts to locate them, including following all local policies and procedures related to reporting individuals as "missing

persons".
For all persons discharged from our ACT team to another service provider within the Bronx, there is a three-month transfer period during which recipients who do not adjust well to their new program may voluntarily return to the ACT program. During this period, our ACT team will maintain contact with the new provider, to support the new provider’s role in the recipient’s recovery and illness management goals.
Notification will be made to the SPOA process coordinator for recipients being discharged to other programs managed through the SPOA process.
If a recipient of our ACT services is under a court order to receive Assisted Outpatient Treatment, the discharge must be planned in coordination with the respective AOT program administrator.
The decision not to take medication is not a sufficient reason for discharging an individual from an ACT program. While efforts will be made to engage the individual in discussions regarding medication adherence and the potential benefit from prescribed medication, we respect the autonomy and decision-making of our ACT recipients
GCC will develop and maintain a procedure regarding discharge and will transmit discharge summaries with
appropriate content to receiving program.