What is a Complex Case?
A Complex Case is a case involving an individual under the age of 22 as defined in 101 CMR 27.03 ( 101 CMR 27.00: Interagency review of complex cases | Mass.gov),where there is a lack of consensus or resolution between state agencies as to the individual’s current service needs or placement, and the individual is waiting in a hospital emergency department, a medical bed, at home or other location and in urgent need of a disposition (placement or identifying entity responsible for payment).
When to refer to the Interagency Review Team?
- Area level and regional level meetings have occurred to explore all service options and there is a lack of consensus or resolution.
- A youth/young adult is waiting in a hospital emergency department, a medical bed, at home or other location and in urgent need of a disposition (placement or identifying entity responsible for payment).
Who is Eligible?
- Youth/young adult under the age of 22 who;
- is disabled or has complex behavioral health or special needs; and
- qualifies or may qualify for services from one or more state agencies, or for special education services through their school district.
- Has submitted a referral in conjunction with the documents and information required in 101 CMR 27.05 for the Interagency Review Team.
Who is Ineligible?
- The individual has an appeal pending with an EOHHS state agency, a mediation or hearing pending with the BSEA (see 603 CMR 28.08(3)), or a court case, and the subject of such appeal, mediation, hearing, or court case is substantially related to the reason that the individual’s case is being referred for review by an IRT, as determined by the co-chairs at their discretion. Once such appeal, mediation, hearing, or court case is completed, the individual’s case may again be referred for review; or
- The individual’s case is not eligible, under 101 CMR 27.06(1), including if the case is not determined to be a complex case as defined in 101 CMR 27.03. Consistent with the definition in 101 CMR 27.03, an individual’s case is not a complex case and therefore ineligible for IRT review.
- The individual is deemed to meet hospital level of care requiring admission to an acute care hospital or inpatient psychiatric facility inclusive of the DMH Adolescent Continuing Care Unit, an Intensive Residential Treatment Program (IRTP), or at a psychiatric inpatient developmentally disabled unit.
- There is agreement as to the services or placement necessary for the individual, including agreement as to which entity is responsible for payment, and the individual has been on the waiting list for such services or placement for less than 60 days.
- If the co-chairs determine based upon the referral submission that consensus or resolution may be possible at the regional level or that regional representatives have not yet been engaged, the co-chairs may refer the individual’s case to the regional representatives of an interagency team currently involved in the individual’s case, or which represents the region responsible or likely responsible for the individual, for investigation and resolution. If that regional team is unable to resolve the case within 20 business days, the regional team will submit the case back to the IRT co-chairs to determine eligibility for IRT review, unless the parties involved including the individual or the person legally authorized to consent on behalf of the individual, agree otherwise.
- The co-chairs will notify the legal custodian, or the individual if 18 years of age or older or otherwise authorized by law, in writing whether such individual’s case is eligible for review by the IRT and, if applicable, will include any reasons for ineligibility. Such notification will also be provided to the referral source, if different, and if there is a valid consent for the referral source.
Who can make a referral for an Interagency Review Team
- May self-refer if individual is 16 years of age or older.
- A state agency or a representative of a state agency’s ombudsman’s office.
- A juvenile court in the Commonwealth of Massachusetts.
- A hospital or emergency service provider.
- A school district.
- An attorney representing the individual or the individual’s parent or guardian.
- The individual’s parent or guardian.
- A physician or behavioral health care provider authorized to act on behalf of a parent or guardian who is seeking access to services for the individual or the individual’s parent or guardian.
How to make a referral to the Interagency Review Team
Please fill out the referral in its entirety, all applicable sections, and include relevant clinical documentation to support the referral. For example, but not limited to, neuropsychological testing, Individualized Educational Plan (IEP), clinical assessments, placement history.