Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.
Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. For inpatient hospital and intermediate care services described below, network providers are responsible for submitting notification of admission to us. When these services are received from non-network providers you are responsible for ensuring notification of admission has been provided to us. In many cases, the non-network provider may submit the notification on your behalf. However, prior to receiving these services, please check with your provider to ensure notification has been made.
Behavioral Health Services. Therapeutic recreation programs or wilderness programs. • Recreation therapy, non-medical self-care, or self-help training (e.g. Alcoholics Anonymous (AA), Narcotics Anonymous (NA) meetings/services). • Services provided in any covered program that are recreational therapy programs, wilderness programs, educational programs, complimentary programs, or non- clinical services. Examples include, but are not limited to, Tai Chi, yoga, personal training, meditation. • Computer /internet/social media based services and/or programs. • Behavioral training assessment, education, or exercise services unless provided for applied behavioral analysis. • Psychoanalysis for educational purposes, regardless of symptoms. • Psychotherapy services you may receive which are credited towards a degree or to further your education or training. • Chiropractic services received in your home.
Behavioral Health Services. Behavioral health services are the evaluation, management, and treatment of a patient with a mental health or substance use disorder. For the purposes of this agreement, mental health disorder shall be defined as mental illness. Mental illness means: • Any mental disorder and substance use disorder that is listed in the most recent revised publication or the most updated volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association or the International Classification of Disease Manual (ICO) published by the World Health Organization and that substantially limits the life activities of the person with the illness; • Substance use disorder does not include addiction to or abuse of tobacco and/or caffeine; and • Mental disorders do not include mental retardation, learning disorders, motor skills disorders, communication disorders, and “V” codes as defined in DSM/IV Diagnostic Criteria published by the American Psychiatric Association. This agreement provides parity in the benefits for behavioral health services. This means that coverage of benefits for mental health and substance use disorders is generally comparable to, and not more restrictive than, the benefits for physical health. Financial requirements (such as deductibles (if any) or copayments) or quantitative treatment limits (such as visit benefit limits) that apply to behavioral health services within a category (such as inpatient services received from an network provider) are not more restrictive than the benefit limit that applies to most of the medical benefits within that same category.
Behavioral Health Services. The PH-MCO is not responsible to provide services as set forth in the agreements between the Department and the BH-MCOs in effect at the same time as this Agreement, as outlined in Exhibit U, Behavioral Health Services.
Behavioral Health Services. Services for marriage or pre-marital counseling; services for court- ordered care or testing including any care or testing required as a condition of parole or probation; services for testing of aptitude, ability, intelligence or interest; services for testing and evaluation for the purpose of maintaining employment; services for cognitive remediation; services for educational purposes; and inpatient confinements that are primarily intended as a change of environment.
Behavioral Health Services. ATTACHMENT O & ATTACHMENT P of this Agreement presents the continuum of care for children, adolescence and adult behavioral health services. These services will be provided by the Contractor as an in-plan benefit. The Contractor needs to comply with the requirements of ATTACHMENT O & ATTACHMENT P. The Contractor must comply with MHPAEA requirements and establish coverage parity between mental health/substance abuse benefits and medical/surgical benefits. The Contractor will cover mental health or substance use disorders in a manner that is no more restrictive than the coverage for medical/surgical conditions. The Contractor will publish any processes, strategies, evidentiary standards, or other factors used in applying Non-Quantitative Treatment Limitations (NQTL) to mental health or substance use disorder benefits and ensure that the classifications are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. The Contractor will provide EOHHS with its analysis ensuring parity compliance when: (1) new services are added as an in-plan benefit for members or (2) there are changes to non-quantitative treatments limitations. The Contractor will publish its MHPAEA policy and procedure on its website, including the sources used for documentary evidence. In the event of a suspected parity violation, the Contractor will direct members through its internal complaint, grievance and appeals process as appropriate. If the matter is still not resolved to the member's satisfaction, the member may file an external appeal (medical review) and/or a State Fair Hearing. The Contractor will track and trend parity complaints, grievances and appeals on the EOHHS approved template at a time and frequency as specified in the EOHHS Medicaid Managed Care Organization (MCO) Requirements for Reporting and Non-Compliance. The Contractor is required to ensure that its non-quantitative treatment limits for behavioral health services will not be more restrictive, nor applied more stringently, than non-quantitative treatment limits for its commercial population. This includes policies and procedures for medical necessity determination, prior approval, and concurrent and retrospective review.
Behavioral Health Services. Behavioral training assessment, education, or exercise services unless provided for applied behavioral analysis. • Psychotherapy and Psychoanalysis services you may receive which are credited towards a degree or to further your education or training. • Chiropractic services received in your home.
Behavioral Health Services. Behavioral health services are the evaluation, management, and treatment of a patient with a mental health or substance use disorder. For the purposes of this agreement mental health disorder shall be defined as mental illness. Mental illness means: Any mental disorder and substance use disorder that is listed in the most recent revised publication or the most updated volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association or the International Classification of Disease Manual (ICD) published by the World Health Organization; Substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. This agreement provides parity in the benefits for behavioral health services. This means that coverage of benefits for mental health and substance use disorders is generally comparable to, and not more restrictive than, the benefits for physical health. Financial requirements (such as deductibles or copayments) or quantitative treatment limits (such as visit benefit limits) that may apply to behavioral health services within a category (such as inpatient services received from a network provider) are not more restrictive than those that apply to most of the medical benefits within that same category.
Behavioral Health Services. The CONTRACTOR shall develop and implement a process to evaluate the effectiveness and outcomes of the training provided.
