This part of the draft states, “Members with diagnoses that fall outside of these categories may be eligible depending on the level of associated long-term disability; in these cases, a physician letter (documentation from a physician) justifying this exception should accompany the service authorization request.”  This is an unnecessary request. The state of Virginia authorizes and grants trust and autonomy to LMHP’s to make quality decisions regarding a member’s diagnosis as well as the associated level of disability and functional impairment stemming from their SMI. Additionally,  DMAS requirement to have the LMHP trained in Clubhouse International would further exemplify the LMHP’s expertise and knowledge of who is  and who is not appropriate for the service. Asking for a doctor who is completely removed from the ideology of the Clubhouse and who may or may not know the member well (if at all)  and having them make a recommendation for specific service is unnecessary and will only result in delayed  access to services.