BEHAVIORAL HEALTH 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. HMO is responsible for Behavioral health services provided by PCPs and other physicians within the scope of their license. This includes screening for behavioral health problems and arranging for or providing diagnosis, treatment and medication management to STAR Members. PCPs are expected to screen children for behavioral health problems as part of the THSteps medical checkups, to screen adults during adult well checks, and to provide treatment or referral to the NorthSTAR Program, as medically appropriate. Also included under HMO Capitation Payment:
6.6.1.1 Ambulatory laboratory and X-ray services related to behavioral health, diagnosis and treatment.
BEHAVIORAL HEALTH SERVICES - SPECIFIC REQUIREMENTS. 6.6.1 HMO must provide or arrange to provide to Members all Behavioral Health Services listed in Appendix C - Scope of Services, which is attached and incorporated into this contract.
6.6.2 HMO must maintain a Member education process to help Members know where and how to obtain behavioral health services.
6.6.3 HMO must require its PCPs to have medical history, screening and evaluation procedures for behavioral health problems and disorders and either treat or refer the Member for evaluation and treatment of known or suspected behavioral health problems and disorders. PCPs may provide any clinically appropriate behavioral health services within the scope of their practice.
6.6.4 HMO must establish policies and procedures that require PCP and behavioral health providers to coordinate HMO and behavioral health organization (BHO) covered services.
6.6.5 HMO must have policies and procedures which allow confidential information to be shared by the PCP and the primary behavioral health care provider.
6.6.6 HMO must execute a Memorandum of Agreement (MOA) with NorthStar-contracted BHOs in the service area. The MOA must contain provisions for coordination of care and must address the following:
6.6.6.1 How HMO and BHO will provide education to Members regarding the services that each will provide and how the Member can access the services;
BEHAVIORAL HEALTH SERVICES - SPECIFIC REQUIREMENTS. 6.6.1 HMO must provide or arrange to have provided to Members all Behavioral Health Services listed in Appendix C - Scope of Services which is attached and incorporated into this contract.
6.6.2 HMO must maintain a behavioral health provider network that includes psychiatrists, psychologists and other behavioral health providers. HMO must provide the scope of behavioral health benefits described in Appendix C. 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 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 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 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 participate in the selection or assignment of the appropriate behavioral health individual practitioner(s) who will serve them. HMO must provide a written copy of its policies and procedures for self-referral to TDH for approval 90 days prior to El Paso Service Area HMO Contract the Implementation Date in the service area. Changes or amendments to those policies and procedures must be submitted to TDH for approval at least 60 days prior to their effective date.
6.6.7 HMO must require its PCPs to have medical history, screening and evaluation procedures for behavioral health problems and disorders and either treat or refer the Member for evaluation and treatment of known or suspected behavioral health problems and disorders. PCPs may provide any clinically appropri...
BEHAVIORAL HEALTH SERVICES - SPECIFIC REQUIREMENTS. 6.6.1 HMO must provide or arrange to have provided to Members all Behavioral Health Services included as covered services. These services are described in detail in the Texas Medicaid Provider Procedures Manual TDHS/HMO CONTRACT August 11, 1999 37 44 (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 State upon request.
6.6.3 HMO must maintain a Member education process to help Members know where and how to obtain behavioral health 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 services, the HMO and network behavioral health providers must use the DSM-IV multi-axial classification and report axes I, II, III, IV, and V to the State. The State may require use of other assessment 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. The HMO must permit Members to participate in the selection or assignment of the appropriate behavioral health individual practition...
