Behavioral Health Covered Services for Standard and CommonHealth Covered Individuals Sample Clauses

Behavioral Health Covered Services for Standard and CommonHealth Covered Individuals. Inpatient Services – 24-hour services, delivered in a licensed hospital setting, that provide clinical intervention for mental health or substance use diagnoses, or both. Inpatient Mental Health Services – hospital services to evaluate and treat an acute psychiatric condition which 1) has a relatively sudden onset; 2) has a short, severe course; 3) poses a significant danger to self or others; or 4) has resulted in marked psychosocial dysfunction or grave mental disability. Medically Managed Inpatient Substance Use Disorder Services (Level 4) – Intensive inpatient services provided in a hospital setting, able to treat Covered Individuals with acute medically complex withdrawal management needs, as well as co-occurring biomedical and/or psychiatric conditions. Services are delivered by an interdisciplinary staff of addiction credential physicians and other appropriate credential treatment professionals with the full resources of a general acute care or psychiatric hospital available. Observation/Holding Beds – hospital services, for a period of up to 24 hours, in order to assess, stabilize, and identify appropriate resources for Covered Individuals. Administratively Necessary Day (AND) Services – a day(s) of inpatient hospitalization provided to Covered Individuals when said Covered Individuals are clinically ready for discharge, but an appropriate setting is not available. Services shall include appropriate continuing clinical services.
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