• Please note: Days are attributed to the quarter of admit.
• The Alternative Payment Model (AMP) began March 1, 2021. Data in Q1 of CY 21 includes March only.

This measure is important because the Clinical Integrity Unit (CIU) ensures that services provided are medically necessary, are at the appropriate level of care (LOC) and length of stay (LOS) and are consistent with prevailing professionally recognized standards of Practice. Inpatient authorizations include acute, sub-acute, waiting placement, and variance.

• Acute is authorized when a member is exhibiting acute symptoms/behaviors and is receiving acute interventions. 
• Sub-acute is authorized when the acute LOC is no longer necessary but requires a residential level of care and no discharge placement has been identified or discharge placement has been identified but not available. 
• Waiting placement is authorized when the acute LOC is no longer necessary, and the member is being discharged to a lower LOC (non-residential). 
• Variance days are authorized when a member is meeting acute LOC for either symptoms/behaviors OR interventions but not both therefore not meeting acute LOC.  
• Disposition delays are noted when children/adolescents at the BR are no longer meeting acute LOC but are unable to discharge. In these cases, the BR is not responsible for the delays, rather these are situations such as the member is waiting for residential LOC and can’t return to the community in the interim; the member refuses to return home with the parent/guardian; or the parent/guardian refuses to pick the member up upon discharge. 

The Retreat provides essential capacity to Vermont’s mental health system of care., The Retreat is the only inpatient psychiatric facility that serves children and adolescents in Vermont. When a member is no longer meeting acute LOC criteria, the goal is to discharge the member to a lower LOC to include residential placements, step down (e.g., Hospital Diversion), or to the community with outpatient supports. Representatives from DCF, DMH, DVHA and the Retreat meet weekly to discuss members with potential disposition issues and work to problem solve so that members who are not meeting acute LOC do not remain at the Retreat longer than necessary.   

As seen in the above trendline, the % of days meeting acute LOC decreased during Q2 and Q3 in CY21. This can be explained by an increase in disposition delays during that time. There is a lack of residential placements and waitlists for the placements that do exist. For CY22 Q1 there was an increase in authorizations of waiting placement. During this period there were several members who were stable and clinically appropriate for discharge, but the members refused to discharge and therefore their stays were extended and authorized at waiting placement LOC.  In CY22 Q2 there was again an increase in disposition delays due to members waiting for residential placement, but the trendline indicates that disposition issues decreased through the remainder of CY22 into CY23. 

Narrative last updated:  04/13/23

• Brattleboro Retreat 
• Department of Children and Families (DCF)
• Department of Mental Health (DMH) 
• Department of Aging and Independent Living (DAIL)