Appendix C – Priority Population – Adults
SEVERELY MENTALLY ILL
PRIORITY POPULATION DEFINITION - ADULTS (SMI)
Revised 9/1/03, 3/10/14, 7/8/14 Reviewed 05/10/07, 1/25/10
INCLUDED DIAGNOSES (DSM-5 – including ICD-9 and ICD-10 diagnosis codes):
295.40/F20.81 Schizophreniform Disorder
295.70/F25.0 Schizoaffective Disorder, Bipolar Type
295.70/F25.1 Schizoaffective Disorder, Depressive Type
298.8/F28 Other Specified Schizophrenia Spectrum and Other Psychotic Disorder
298.9/F29 Unspecified Schizophrenia Spectrum and Other Psychotic Disorder 297.1/F22 Delusional Disorder
296.33/F33.2 Major Depressive Disorder, Recurrent Episode, Severe
296.34/F33.3 Major Depressive Disorder, Recurrent Episode, With Psychotic Features 296.43/F31.13 Bipolar I Disorder, Current or Most Recent Episode Manic, Severe 296.44/F31.2 Bipolar I Disorder, Current or Most Recent Episode Manic, With Psychotic Features 296.53/F31.4 Bipolar I Disorder, Current or Most Recent Episode Depressed, Severe 296.54/F31.5 Bipolar I Disorder, Most Recent Episode Depressed, With Psychotic Features 296.40/F31.0 Bipolar I Disorder, Current or Most Recent Episode Hypomanic 296.40/F31.9 Bipolar I Disorder, Current or Most Recent Episode Hypomanic, Unspecified 296.7/F31.9 Bipolar I Disorder, Current or Most Recent Episode Unspecified 296.80/F31.9 Unspecified Bipolar and Related Disorder 296.89/F31.81 Bipolar II Disorder 301.22/F21 Schizotypal Personality Disorder 301.83/F60.3 Borderline Personality Disorder -and-
In order to be included in the PRIORITY POPULATION, individuals must meet the target diagnostic criteria and meet the following functional limitations:
Serious mental illness is characterized by impaired role functioning, on a continuing or
intermittent basis, for at least two years, including at least three of the following:
•Inability to maintain independent employment, •Social behavior that results in interventions by the mental health system, •Inability, due to cognitive disorganization, to procure financial assistance to support living in the community, •Severe inability to establish or maintain a personal support system, or •Need for assistance with basic living skills.
The diagnostic criteria may be waived for the following two conditions:
1.An individual committed as not criminally responsible who is conditionally released from a Mental Hygiene Administration facility, according to the provisions of Health General Article, Title 12, Annotated Code of Maryland. Or 2.An individual in a Mental Hygiene Administration facility with a length of stay of more than 6 months who requires RRP services, but who does not have a target diagnosis. This excludes individuals eligible for Developmental Disabilities services.
Referrals can be mailed, email or faxed to the address below:
Lower Shore Clinic, Inc.
505 East Main St. Salisbury, MD 21804
ATTN: Centralized Referral
Fax: 410 341-3397