Kepro Coverage Criteria for payment of services in settings licensed as secure.
Secure Residential Treatment Facility (SRTF) means any Residential Treatment
Facility, or portion thereof, approved by the Division that restricts an individual’s
exit from the setting through the use of approved locking devices on individual
exit doors, gates, or other closures.
This criteria is used to determine appropriateness for referral to SRTF and to
authorize admission and continued stay for the purposes of Medicaid
reimbursement.
Area 1: Legal
Age 18 or over; and
Been diagnosed with a chronic mental illness as defined in ORS 426.495; and
one of the following:
(1) Under current civil commitment; or
(2) Under the jurisdiction of the Psychiatric Security Review Board; or
(3) Under an aid and assist order
Area 2: Current Level of Care Criteria – Person must be in one of the following
levels of care or on a planned diversion from a hospital level of care
(1) Transitioning from the Oregon State Hospital; or
(2) Acute Care Hospital; or
(3) On a planned diversion from hospitalization
Area 3: Determination of Need - A determination that the individuals served, or
proposed to be served, have a history of behavioral concerns involving threats to
the safety and well-being of themselves or others. Determination is based on
documentation from a licensed healthcare provider that within 15-days of
transfer the person has:
(1) Attempted suicide or engaged in intentional physical self-harming
behaviors, or substantial concern for suicidal ideation; or
(2) Communicated as a serious expression of intent to inflict bodily harm upon
another person or has physically assaulted another person due to the
symptoms of a mental illness; or

2018-0892 010 12/19/2018

 (3) Demonstrated an inability to care for his/her basic needs without
substantial assistance and the lack of self-care abilities places that person
at risk of developing or exacerbating a severe health condition; or
(4) Due to the symptoms of a mental illness, the person will not remain in a
place of service for the time needed to receive the services and supports
necessary to resolve the symptoms of a mental illness that pose a threat to
the person’s safety and well-being.

Coverage Limitations
Authorization for admission to a secure setting and reimbursement for services
rendered in a secure setting may not exceed 90 days.
At 90 days, authorization for continued stay is required.
Continued Stay Criteria
Kepro will determine re-authorization and authorization of continued stay using
the following criteria:
(1) The recipient continues to meet all basic elements for admission to an
SRTF and Medicaid administrative rule for medical appropriateness; and
(2) One of the following:
a. Documentation that the treatment provided is resulting in
measurable clinical outcomes but that the recipient is not
sufficiently stabilized or yet developed the skills necessary to
support transition to a less restrictive level of care; or
b. The recipient has developed new or worsening symptoms or
behaviors that require continued stay in the current level of care.

Requests for continued stay based on these criteria shall include documentation
of ongoing re-assessment and necessary modification to the current treatment
plan or residential plan of care.

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 SRTF Determination Worksheet
Area 1: Legal
Age 18 or over
Been diagnosed with a chronic mental illness as defined in ORS 426.495
Under current civil commitment
Under an aid and assist order .370
Under PSRB jurisdiction
Total
Required
Area 2:Current Level of Care
Oregon State Hospital
Acute Care Hospital
Planned Diversion
Total
Required
Area 3: 15 day determination of need
Attempted suicide or engaged in intentional physical self-harming
behaviors, or substantial concern for suicidal ideation
Communicated as a serious expression of intent to inflict bodily harm
upon another person or has physically assaulted another person due to
the symptoms of a mental illness
Demonstrated an inability to care for basic needs without substantial
assistance and the lack of self-care abilities places that person at risk of
developing or exacerbating a severe health condition
Due to the symptoms of a mental illness, the person will not remain in
a place of service for the time needed to receive the services and
supports necessary to resolve the symptoms of a mental illness that
pose a threat to the person’s safety and well-being
Total
Required

*
*

3

1

1

*- Both age 18 or over and presence of a chronic medical illness are required

Signature of Reviewer
Date of Review

2018-0892 012 12/19/2018