When a TRICARE East beneficiary needs more acute mental health care, substance use detoxification or rehabilitation, inpatient trauma treatment, partial hospitalization or intensive outpatient care than first authorized, Humana Military needs this continued stay request. It updates diagnoses, medications, clinical progress, behavior on the unit, mental status, safety plan, barriers to discharge and the estimated discharge date.
The treating behavioral health facility or provider completes all five pages, including the attending or rendering provider and utilization review contact, the authorization or referral ID, and units or days completed and requested.
Download the current version from the source each time; forms change without notice.
Mental health continued stay request
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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To extend an existing Humana Military authorization for acute mental health, substance use detoxification or rehabilitation, inpatient trauma treatment, full or half-day partial hospitalization, or intensive outpatient care. Enter the initial authorization or referral ID, units completed as of a date, and the additional units requested.
No. Residential Treatment Center referrals have their own initial and concurrent review forms. This continued stay request covers inpatient, detoxification, rehabilitation, trauma, partial hospitalization and intensive outpatient programs, including services delivered by telemedicine.
The last page asks for barriers to discharge and the discharge plan with an estimated length of stay or tentative discharge date. Earlier pages cover the biopsychosocial situation, family therapy, which is required for children and adolescents, and the safety plan.