Common use of Intensive Outpatient Treatment Program Clause in Contracts

Intensive Outpatient Treatment Program. This is a Hospital‐based program that provides services for at least 3 hours per day, 2 or more days per week, to treat Mental Illness or Substance Use Disorders or specializes in the treatment of co‐occurring Mental Illness and Substance Use Dis­ orders. Dual diagnosis programs offer integrated and aligned assessment, treatment and discharge planning services for treatment of severe or com­ plex co‐occurring conditions which make it unlikely that you will benefit from programs that focus solely on Mental Illness conditions. Dual diag­ nosis programs are delivered by Behavioral Health Practitioners who are cross‐trained. Intensive Outpatient Program services may be available with less intensity if you are recovering from severe and/or chronic Mental Illness and/or Substance Use Disorder conditions. If you are recovering from severe and/ or chronic Mental Illness and/or Substance Use Disorder conditions, services may include psychotherapy, pharmacotherapy, and other interven­ tions aimed at supporting recovery such as the development of recovery plans and advance directives, strategies for identifying and managing early warning signs of relapse, development of self‐management skills, and the provision of peer support services. Intensive Outpatient Programs may be used as an initial point of entry into care, as a step up from routine Outpatient services, or as a step down from acute Inpatient, residential care or a Partial Hospitalization Treatment Pro­ gram. Approved Clinical Trials — Benefits for Covered Services for Routine Patient Costs are provided in connection with a phase I, phase II, phase III, or phase IV clinical trial or other Life Threatening Disease or Condition and is recognized under state and/or federal law. Autism Spectrum Disorder(s) — Your benefits for the diagnosis and treatment of Autism Spectrum Disorder(s) are the same as your benefits for any other con­ dition. Treatment for Autism Spectrum Disorder(s) shall include the following care when prescribed, provided or ordered for an individual diagnosed with an Autism Spectrum Disorder by (a) your Primary Care Physician or Woman's Principal Health Care Provider who has determined that such care is medically necessary, or (b) a certified, registered or licensed health care professional with expertise in treating effects of Autism Spectrum Disorder(s) when the care is determined to be medically necessary and ordered by your Primary Care Physi­ cian or Woman's Principal Health Care Provider: — psychiatric care, including diagnostic services; — psychological assessment and treatment; — habilitative or rehabilitative treatment; — therapeutic care, including behavioral Occupational, Physical and Speech Therapies that provide treatment in the following areas: a) self care and feeding, b) pragmatic, receptive and expressive language, c) cognitive functioning, d) applied behavior analysis (ABA), intervention and modifi­ cation, e) motor planning and f) sensory processing. Habilitative Services — Your benefits for Habilitative Services are the same as your benefits for any other condition if all of the following conditions are met:

Intensive Outpatient Treatment Program. This is a Hospital‐based program that provides services for at least 3 hours per day, 2 or more days per week, to treat Mental Illness or Substance Use Disorders or specializes in the treatment of co‐occurring Mental Illness and Substance Use Dis­ orders. Dual diagnosis programs offer integrated and aligned assessment, treatment and discharge planning services for treatment of severe or com­ plex co‐occurring conditions which make it unlikely that you will benefit from programs that focus solely on Mental Illness conditions. Dual diag­ nosis programs are delivered by Behavioral Health Practitioners who are cross‐trained. Intensive Outpatient Program services may be available with less intensity if you are recovering from severe and/or chronic Mental Illness and/or Substance Use Disorder conditions. If you are recovering from severe and/ or chronic Mental Illness and/or Substance Use Disorder conditions, services may include psychotherapy, pharmacotherapy, and other interven­ tions aimed at supporting recovery such as the development of recovery plans and advance directives, strategies for identifying and managing early warning signs of relapse, development of self‐management skills, and the provision of peer support services. Intensive Outpatient Programs may be used as an initial point of entry into care, as a step up from routine Outpatient services, or as a step down from acute Inpatient, residential care or a Partial Hospitalization Treatment Pro­ gram. Approved Clinical Trials — Benefits for Covered Services for Routine Patient Costs are provided in connection with a phase I, phase II, phase III, or phase IV clinical trial or other Life Threatening Disease or Condition and is recognized under state and/or federal law. GB‐16 HCSC 44 Autism Spectrum Disorder(s) — Your benefits for the diagnosis and treatment of Autism Spectrum Disorder(s) are the same as your benefits for any other con­ dition. Treatment for Autism Spectrum Disorder(s) shall include the following care when prescribed, provided or ordered for an individual diagnosed with an Autism Spectrum Disorder by (a) your Primary Care Physician or Woman's Principal Health Care Provider who has determined that such care is medically necessary, or (b) a certified, registered or licensed health care professional with expertise in treating effects of Autism Spectrum Disorder(s) when the care is determined to be medically necessary and ordered by your Primary Care Physi­ cian or Woman's Principal Health Care Provider: — psychiatric care, including diagnostic services; — psychological assessment and treatment; — habilitative or rehabilitative treatment; — therapeutic care, including behavioral Occupational, Physical and Speech Therapies that provide treatment in the following areas: a) self care and feeding, b) pragmatic, receptive and expressive language, c) cognitive functioning, d) applied behavior analysis (ABA), intervention and modifi­ cation, e) motor planning and f) sensory processing. Habilitative Services — Your benefits for Habilitative Services are the same as your benefits for any other condition if all of the following conditions are met:

Intensive Outpatient Treatment Program. This is a Hospital‐based program that provides services for at least 3 hours per day, 2 or more days per week, to treat Mental Illness or Substance Use Disorders or specializes in the treatment of co‐occurring Mental Illness and Substance Use Dis­ orders. Dual diagnosis programs offer integrated and aligned assessment, treatment and discharge planning services for treatment of severe or com­ plex co‐occurring conditions which make it unlikely that you will benefit from programs that focus solely on Mental Illness conditions. Dual diag­ nosis programs are delivered by Behavioral Health Practitioners who are cross‐trained. Intensive Outpatient Program services may be available with less intensity if you are recovering from severe and/or chronic Mental Illness and/or Substance Use Disorder conditions. If you are recovering from severe and/ or chronic Mental Illness and/or Substance Use Disorder conditions, services may include psychotherapy, pharmacotherapy, and other interven­ tions aimed at supporting recovery such as the development of recovery plans and advance directives, strategies for identifying and managing early warning signs of relapse, development of self‐management skills, and the provision of peer support services. Intensive Outpatient Programs may be used as an initial point of entry into care, as a step up from routine Outpatient services, or as a step down from acute Inpatient, residential care or a Partial Hospitalization Treatment Pro­ gram. GB‐16 HCSC 45 Approved Clinical Trials — Benefits for Covered Services for Routine Patient Costs are provided in connection with a phase I, phase II, phase III, or phase IV clinical trial or other Life Threatening Disease or Condition and is recognized under state and/or federal law. Autism Spectrum Disorder(s) — Your benefits for the diagnosis and treatment of Autism Spectrum Disorder(s) are the same as your benefits for any other con­ dition. Treatment for Autism Spectrum Disorder(s) shall include the following care when prescribed, provided or ordered for an individual diagnosed with an Autism Spectrum Disorder by (a) your Primary Care Physician or Woman's Principal Health Care Provider who has determined that such care is medically necessary, or (b) a certified, registered or licensed health care professional with expertise in treating effects of Autism Spectrum Disorder(s) when the care is determined to be medically necessary and ordered by your Primary Care Physi­ cian or Woman's Principal Health Care Provider: — psychiatric care, including diagnostic services; — psychological assessment and treatment; — habilitative or rehabilitative treatment; — therapeutic care, including behavioral Occupational, Physical and Speech Therapies that provide treatment in the following areas: a) self care and feeding, b) pragmatic, receptive and expressive language, c) cognitive functioning, d) applied behavior analysis (ABA), intervention and modifi­ cation, e) motor planning and f) sensory processing. Habilitative Services — Your benefits for Habilitative Services are the same as your benefits for any other condition if all of the following conditions are met:

Intensive Outpatient Treatment Program. This is a Hospital‐based program that provides services for at least 3 hours per day, 2 or more days per week, to treat Mental Illness or Substance Use Disorders or specializes in the treatment of co‐occurring Mental Illness and Substance Use Dis­ orders. Dual diagnosis programs offer integrated and aligned assessment, treatment and discharge planning services for treatment of severe or com­ plex co‐occurring conditions which make it unlikely that you will benefit from programs that focus solely on Mental Illness conditions. Dual diag­ nosis diagno­ sis programs are delivered by Behavioral Health Practitioners who are cross‐trained. Intensive Outpatient Program services may be available with less intensity if you are recovering from severe and/or chronic Mental Illness and/or Substance Sub­ stance Use Disorder conditions. If you are recovering from severe and/ or and/or chronic Mental Illness and/or Substance Use Disorder conditions, services may include psychotherapy, pharmacotherapy, and other interven­ tions interventions aimed at supporting recovery such as the development of recovery plans and advance directives, strategies for identifying and managing early warning signs of relapse, development of self‐management skills, and the provision of peer support services. IL‐G‐H‐OF‐2016 51 Intensive Outpatient Programs may be used as an initial point of entry into care, as a step up from routine Outpatient services, or as a step down from acute Inpatient, residential care or a Partial Hospitalization Treatment Pro­ gram. Approved Clinical Trials — Benefits for Covered Services for Routine Patient Costs are provided in connection with a phase I, phase II, phase III, or phase IV clinical trial or other Life Threatening Disease or Condition and is recognized under un­ der state and/or federal law. Autism Spectrum Disorder(s) — Your benefits for the diagnosis and treatment of Autism Spectrum Disorder(s) are the same as your benefits for any other con­ ditioncondi­ tion. Treatment for Autism Spectrum Disorder(s) shall include the following care when prescribed, provided or ordered for an individual diagnosed with an Autism Spectrum Disorder by (a) your Primary Care Physician or Woman's Principal Health Care Provider who has determined that such care is medically necessary, or (b) a certified, registered or licensed health care professional with expertise in treating effects of Autism Spectrum Disorder(s) when the care is determined to be medically necessary and ordered by your Primary Care Physi­ cian Physician or Woman's Principal Health Care Provider: — psychiatric care, including diagnostic services; — psychological assessment and treatment; — habilitative or rehabilitative treatment; — therapeutic care, including behavioral Occupational, Physical and Speech Therapies that provide treatment in the following areas: a) self care and feeding, b) pragmatic, receptive and expressive language, c) cognitive functioningfunc­ tioning, d) applied behavior analysis (ABA), intervention and modifi­ cationmodification, e) motor planning and f) sensory processing. Habilitative Services — Your benefits for Habilitative Services are the same as your benefits for any other condition if all of the following conditions are met:

Intensive Outpatient Treatment Program. This is a Hospital‐based program that provides services for at least 3 hours per day, 2 or more days per week, to treat Mental Illness or Substance Use Disorders or specializes in the treatment of co‐occurring Mental Illness and Substance Use Dis­ orders. Dual diagnosis programs offer integrated and aligned assessment, treatment and discharge planning services for treatment of severe or com­ plex co‐occurring conditions which make it unlikely that you will benefit from programs that focus solely on Mental Illness conditions. Dual diag­ nosis diagnos­ is programs are delivered by Behavioral Health Practitioners who are cross‐trained. Intensive Outpatient Program services may be available with less intensity if you are recovering from severe and/or chronic Mental Illness and/or Substance Sub­ stance Use Disorder conditions. If you are recovering from severe and/ or and/or chronic Mental Illness and/or Substance Use Disorder conditions, services may include psychotherapy, pharmacotherapy, and other interven­ tions interventions aimed at supporting recovery such as the development of recovery plans and advance directives, strategies for identifying and managing early warning signs of relapse, development of self‐management skills, and the provision of peer support services. Intensive Outpatient Programs may be used as an initial point of entry into care, as a step up from routine Outpatient services, or as a step down from acute Inpatient, residential care or a Partial Hospitalization Treatment Pro­ gram. Approved Clinical Trials — Benefits for Covered Services for Routine Patient Costs are provided in connection with a phase I, phase II, phase III, or phase IV clinical trial or other Life Threatening Disease or Condition and is recognized under un­ der state and/or federal law. Autism Spectrum Disorder(s) — Your benefits for the diagnosis and treatment of Autism Spectrum Disorder(s) are the same as your benefits for any other con­ ditioncondi­ tion. Treatment for Autism Spectrum Disorder(s) shall include the following care when prescribed, provided or ordered for an individual diagnosed with an Autism Spectrum Disorder by (a) your Primary Care Physician or Woman's Principal Health Care Provider who has determined that such care is medically necessary, or (b) a certified, registered or licensed health care professional with expertise in treating effects of Autism Spectrum Disorder(s) when the care is determined to be medically necessary and ordered by your Primary Care Physi­ cian Physician or Woman's Principal Health Care Provider: — psychiatric care, including diagnostic services; — psychological assessment and treatment; — habilitative or rehabilitative treatment; — therapeutic care, including behavioral Occupational, Physical and Speech Therapies that provide treatment in the following areas: a) self care and feeding, b) pragmatic, receptive and expressive language, c) cognitive functioningfunc­ tioning, d) applied behavior analysis (ABA), intervention and modifi­ cationmodification, e) motor planning and f) sensory processing. Habilitative Services — Your benefits for Habilitative Services are the same as your benefits for any other condition if all of the following conditions are met:

Intensive Outpatient Treatment Program. This is a Hospital‐based program that provides services for at least 3 hours per day, 2 or more days per week, to treat Mental Illness or Substance Use Disorders or specializes in the treatment of co‐occurring Mental Illness and Substance Use Dis­ orders. Dual diagnosis programs offer integrated and aligned assessment, treatment and discharge planning services for treatment of severe or com­ plex co‐occurring conditions which make it unlikely that you will benefit from programs that focus solely on Mental Illness conditions. Dual diag­ nosis programs are delivered by Behavioral Health Practitioners who are cross‐trained. Intensive Outpatient Program services may be available with less intensity if you are recovering from severe and/or chronic Mental Illness and/or Substance Use Disorder conditions. If you are recovering from severe and/ or chronic Mental Illness and/or Substance Use Disorder conditions, services may include psychotherapy, pharmacotherapy, and other interven­ tions aimed at supporting recovery such as the development of recovery plans and advance directives, strategies for identifying and managing early warning signs of relapse, development of self‐management skills, and the provision of peer support services. Intensive Outpatient Programs may be used as an initial point of entry into care, as a step up from routine Outpatient services, or as a step down from acute Inpatient, residential care or a Partial Hospitalization Treatment Pro­ gram. Approved Clinical Trials — Benefits for Covered Services for Routine Patient Costs are provided in connection with a phase I, phase II, phase III, or phase IV clinical trial or other Life Threatening Disease or Condition and is recognized under state and/or federal law. GB‐16 HCSC 45 Autism Spectrum Disorder(s) — Your benefits for the diagnosis and treatment of Autism Spectrum Disorder(s) are the same as your benefits for any other con­ dition. Treatment for Autism Spectrum Disorder(s) shall include the following care when prescribed, provided or ordered for an individual diagnosed with an Autism Spectrum Disorder by (a) your Primary Care Physician or Woman's Principal Health Care Provider who has determined that such care is medically necessary, or (b) a certified, registered or licensed health care professional with expertise in treating effects of Autism Spectrum Disorder(s) when the care is determined to be medically necessary and ordered by your Primary Care Physi­ cian or Woman's Principal Health Care Provider: — psychiatric care, including diagnostic services; — psychological assessment and treatment; — habilitative or rehabilitative treatment; — therapeutic care, including behavioral Occupational, Physical and Speech Therapies that provide treatment in the following areas: a) self care and feeding, b) pragmatic, receptive and expressive language, c) cognitive functioning, d) applied behavior analysis (ABA), intervention and modifi­ cation, e) motor planning and f) sensory processing. Habilitative Services — Your benefits for Habilitative Services are the same as your benefits for any other condition if all of the following conditions are met: