24 Hour Level of Care Capacity Updates

Please complete the survey when/if there are changes to your facility operations that are or will impact Magellan Behavioral Health of Pennsylvania member access to care. This includes closing OR re-opening access.

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* 1. Date of Survey Completion

Date

Date

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* 2. Magellan Staff submitting form:
(Note: Please respond with N/A if not applicable)

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* 3. Provider Name:

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* 4. Contact Name

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* 5. Contact Phone Number

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* 6. Contact Email Address

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* 7. Please complete if your agency provides Inpatient Mental Health Level of Care:

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 8. Please complete if your agency provides Inpatient Detox (ASAM 4.0 WM):

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 9. Please complete if your agency provides Inpatient Rehab (ASAM 4.0):

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 10. Please complete if your agency provides Non-hospital Detox:

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 11. Please complete if your agency provides Non-hospital Rehab:

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 12. Please complete if your agency provides Halfway House:

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 13. Please complete if your agency provides Crisis Residential Services:

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 14. Please complete if your agency provides Community Residential Rehabilitation (adults):

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 15. Please complete if your agency provides Residential Treatment Facility (youth):

What is your current LICENSED bed capacity?

Are any of your beds on hold to admission? (Have you had to take beds offline because of staffing or COVID isolation? Or any other issues)

If yes, how many beds are on hold to admission (e.g. 120 licensed beds, 20 beds are offline/on hold/closed to admission for any reason, capacity is 100)

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* 16. Please provide any other information in the comment box shown below.