Common use of Behavioral Health Care Services Clause in Contracts

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. 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 5-5- 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.