Alcohol and Substance Abuse Services Sample Clauses

Alcohol and Substance Abuse Services. This Plan will cover the diagnosis and treatment of Substance Abuse, which includes alcohol and drug abuse disorders in an Inpatient and outpatient setting. Inpatient services include Hospitalization for alcohol and drug abuse detoxification, Rehabilitation partial Hospitalization. Rehabilitation does not include a Residential Treatment Center or other facility using a social model to provide Rehabilitation. Inpatient services require Preauthorization and all services must be furnished by a licensed and qualified Provider. Outpatient services includes assessment, outpatient detoxification, individual, family or couple therapy and counseling, intensive outpatient program (IOP), group therapy, as well as medication management by a licensed and qualified Provider. This Plan will cover the diagnosis and treatment of Behavioral Disorders or Mental Illness disorders in an Inpatient and outpatient setting. Inpatient services include Hospitalization, partial Hospitalization, and electroconvulsive therapy (ECT). Inpatient and ECT services require Preauthorization and must be furnished by a licensed and qualified Provider. Continued stay must meet medical necessity criteria and any applicable state law requirements. Outpatient services include assessment, individual, group, family or couple therapy and counseling, intensive outpatient program (IOP), electroconvulsive therapy (ECT) and medication management. All services must be provided by a licensed and qualified Provider.

Alcohol and Substance Abuse Services. The Contractor shall provide support services to assist PCPs in providing coordination if it is not provided directly by the Contractor.

Alcohol and Substance Abuse Services. The Contractor shall identify or shall ensure that providers identify enrollees with special health care needs as defined in WAC 300-000-000. The Contractor’s obligation for identification of enrollees with special health care needs is limited to identification in the course of any contact or health care visit initiated by the enrollee and any information available to the Contractor regarding an enrollee’s special health care needs. The Contractor shall maintain a record of all enrollee’s identified as enrollee’s with special health care needs.

Alcohol and Substance Abuse Services o To obtain Alcoholism/Substance Abuse services, Members may contact our Behavioral Health Department at 505) 923-5470 or toll-free at 0-000-000-0000. The Behavioral Health Practitioner/Provider will be responsible for any additional Prior Authorizations. o For Out-of-network Services, Members need to contact our Behavioral Health Department in order to obtain Prior Authorization, when required. Please refer to the Prior Authorization Section. o In all cases, treatment must be Medically Necessary in order to be Covered. o Acute Medical Detoxification Benefits are Covered under Inpatient and Outpatient Hospital Services found in the Benefits Section of this Agreement. Inpatient Hospital Services must be Prior Authorized.  Nutritional Supplements for prenatal care when prescribed by a Practitioner/Provider are Covered for pregnant women.  Nutritional supplements that require a prescription to be dispensed are Covered when prescribed by an In-network Practitioner/Provider and when Medically Necessary to replace a specific documented deficiency. Prior Authorization is required.  Nutritional supplements administered by injection at the Practitioner’s/Provider’s office are Covered when Medically Necessary.  Enteral formulas or products, as Nutritional support, are Covered only when prescribed by an In-network Practitioner/Provider and administered by enteral tube feedings.  Total Parenteral Nutrition (TPN) is the administration of nutrients through intravenous catheters via central or peripheral veins and is Covered when ordered by an In-network.  Practitioner/Provider.  Special Medical Foods as listed as Covered benefits in the Genetic Inborn Errors of Metabolism (IEM) Benefit of this Section. Prior Authorization is required.  Outpatient Medical Services Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis, and those preventive, Medically Necessary diagnostic and treatment procedures that are prescribed by your In-network Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Outpatient services provided by Out-of-network Providers/Practitioners are not Covered except as provided in How the Plan Works, Eligibility and Enrollment...

Alcohol and Substance Abuse Services o To obtain Alcoholism/Substance Abuse services, Members may contact our Behavioral Health Department at (000) 000-0000 or toll-free at 0-000-000-0000. The Behavioral Health Practitioner/Provider will be responsible for any additional Prior Authorizations. o For Out-of-network Services, Members need to contact our Behavioral Health Department in order to obtain Prior Authorization, when required. Please refer to the Prior Authorization Section.