Behavioral Health Care Services. The Contractor shall provide all medically necessary community-based, partial hospital and inpatient hospital behavioral health services as identified in Contract Exhibits 2 and 3. Contractors shall pay CMHCs at no less than the Indiana Medicaid FFS rate for any covered non-MRO service that the CMHC provides to members. The Contractor shall provide behavioral health services through hospitals, offices, clinics, in homes, at school and other locations, as permitted under state and federal law. A full continuum of services, including crisis services, as indicated by the behavioral health care needs of members, shall be available to members, including partial hospitalization services as described in 405IAC 5-20- 8. Behavioral health services codes billed in a primary care setting shall be reviewed for medical necessity and, if appropriate, shall be paid by the Contractor. The Contractor must allow members to self-refer to any behavioral health care provider in the Contractor’s network without a referral from the PMP. Members may also self-refer to any IHCP-enrolled psychiatrist.
Behavioral Health Care Services. The Contractor shall provide all medically necessary community-based, partial hospital and inpatient hospital behavioral health services as identified in Contract Exhibit 2. Contractors shall pay CMHCs at no less than the Medicare rate or 130% of Medicaid FFS rate for any covered non-MRO service that the CMHC provides to a HIP member. The Contractor shall provide behavioral health services through hospitals, offices, clinics, in homes, and other locations, as permitted under state and federal law. A full continuum of services, including crisis services, as indicated by the behavioral health care needs of members, shall be available to members, including partial hospitalization services as described in 405 IAC 5-20-8. Behavioral health services codes billed in a primary care setting shall be reviewed for medical necessity and, if appropriate, shall be paid by the Contractor. The Contractor shall allow members to self-refer to any behavioral health care provider in the Contractor’s network without a referral from the PMP. Members may also self- refer to any IHCP-enrolled psychiatrist. The Contractor shall ensure the availability of behavioral health crisis intervention services twenty-four (24) hours a day, seven (7) days a week. The Contractor shall maintain processes for crisis intervention.
Behavioral Health Care Services. The Contractor shall provide all medically necessary community-based, partial hospital and inpatient hospital behavioral health services as identified in Contract Exhibits 2 and
Behavioral Health Care Services. The Contractor shall provide all medically necessary community-based, partial hospital and inpatient hospital behavioral health services as identified in Contract Exhibit 2. Contractors shall pay CMHCs at a rate not less than the Medicaid fee schedule for any covered non-MRO service that the CMHC provides to a HIP member.
Behavioral Health Care Services. SPECIFIC REQUIREMENTS -------------------------------------------------------
Behavioral Health Care Services. The Contractor shall provide all medically necessary community-based, partial hospital and inpatient hospital behavioral health services as identified in Contract Exhibit 4. Contractors shall pay CMHCs at no less than the Medicare rate or 130% of Medicaid FFS rate for any covered non-MRO service that the CMHC provides to a HIP member. The Contractor shall provide behavioral health services through hospitals, offices, clinics, in homes, and other locations, as permitted under state and federal law. A full continuum of services, including crisis services, as indicated by the behavioral health care needs of members, shall be available to members, including partial hospitalization services as described in 405 IAC 5- 20-8. Behavioral health services codes billed in a primary care setting shall be reviewed for medical necessity and, if appropriate, shall be paid by the Contractor. The Contractor shall allow members to self-refer to any behavioral health care provider in the Contractor’s network without a referral from the PMP. Members may also self-refer to any IHCP-enrolled psychiatrist.
Behavioral Health Care Services. SPECIFIC REQUIREMENTS -------------------------------------------------------
6.6.1 HMO must provide or arrange to have provided to Members all behavioral health care services included as covered services. These services are described in detail in the Texas Medicaid Provider Procedures Manual (Provider Procedures Manual) and the Texas Medicaid Bulletins, which is the bi-monthly update to the Provider Procedures Manual. Clinical information regarding covered services are published by the Texas Medicaid program in the Texas Medicaid Service Delivery Guide.
6.6.2 HMO must maintain a behavioral health provider network that includes psychiatrists, psychologists and other behavioral health providers. HMO must provide or arrange to have provided behavioral health benefits described as covered services. These services are indicated in the Provider Procedures Manual and the Texas Medicaid Bulletins, which is the bi-monthly update to the Provider Procedures Manual. Clinical information regarding covered services are published by the Texas Medicaid Program in the Texas Medicaid Service Delivery Guide. The network must include providers with experience in serving children and adolescents to ensure accessibility and availability of qualified providers to all eligible children and adolescents in the service area. The list of providers including names, addresses and phone numbers must be available to TDH upon request.
6.6.3 HMO must maintain a Member education process to help Members know where and how to obtain behavioral health care services.
6.6.4 HMO must implement policies and procedures to ensure that Members who require routine or regular laboratory and ancillary medical tests or procedures to monitor behavioral health conditions are provided the services by the provider ordering the procedure or at a lab located at or near the provider's office.
6.6.5 When assessing Members for behavioral health care services, HMO and network behavioral health providers must use the DSM-IV multi-axial classification and report axes I, II, III, IV, and V to TDH. TDH may require use of other assessment 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 40 instrument/outcome measures in addition to the DSM-IV. Providers must document DSM-IV and assessment/outcome information in the Member's medical record.
6.6.6 HMO must permit Members to self refer to any in-network behavioral health care provider without a referral from the Member's PCP. HMO must permit Members to participat...
Behavioral Health Care Services. Services provided by Orange County Health Care Agency staff for PARTICIPANTS in need of treatment for mental health and/or substance abuse which pose barriers to employment.
Behavioral Health Care Services. For all Covered Services, see the Schedule of Benefits for any applicable Deductible, Coinsurance,
Behavioral Health Care Services. SPECIFIC REQUIREMENTS -------------------------------------------------------
6.6.1 HMO must provide or arrange to have provided to Members all behavioral health care services included as covered services. These services are described in detail in the Texas Medicaid Provider Procedures Manual (Provider Procedures Manual) and the Texas Medicaid Bulletin, which is the bi-monthly update to the Provider Procedures Manual. Clinical information regarding covered services is published by the Texas Medicaid program in the Texas Medicaid Service Delivery Guide (See Article 6.
6.6.2 HMO must maintain a behavioral health provider network that includes psychiatrists, psychologists and other behavioral health providers. HMO must provide or arrange to have provided behavioral health benefits described as covered services (see Article
6. 1). The network must include providers with experience in serving children and adolescents to ensure accessibility and availability of qualified providers to all eligible children and adolescents in the service area. The list of providers including names, addresses and phone numbers must be available to TDH upon request.
