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 1B SCOPE OF WORK Exhibits 2.B and 3.A. 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 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 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. 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 3. EXHIBIT 1B 1 SCOPE OF WORK Exhibits 2.B and 3.A. – HOOSIER HEALTHWISE 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 405 IAC 405IAC 5-20- 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. 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 Exhibit 2. EXHIBIT 1B 1 SCOPE OF WORK Exhibits 2.B and 3.A. – HEALTHY INDIANA PLAN Contractors shall pay CMHCs at no less than the Indiana Medicare rate or 130% of Medicaid FFS rate for any covered non-MRO service that the CMHC provides to membersa HIP member. 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 405 IAC 5-20- 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 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-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.