Mental Health and Substance Abuse Benefits. Blue Shield’s Mental Health Service Administrator (MHSA) arranges and administers Mental Health Services and Substance Abuse Services for Blue Shield Members within California. See the Out-Of- Area Program, BlueCard Program section for an explanation of how payment is made for out of state services. All Non-Emergency inpatient Mental Health and Substance Abuse Services, including Residential Care, and Non-Routine Outpatient Mental Health and Substance Abuse Services are subject to the Benefits Management Program and must be prior authorized by the MHSA. See the Benefits Management Program section for complete information.
Mental Health and Substance Abuse Benefits. Blue Shield’s Mental Health Service Administra- tor (MHSA) arranges and administers Mental Health Services and Substance Abuse Services for Blue Shield Members within California. See the Out-Of-Area Program, BlueCard Program section for an explanation of how payment is made for out of state services. All Non-Emergency inpatient Mental Health and Substance Abuse Services, including Residential Care, and Non-Routine Outpatient Mental Health and Substance Abuse Services are subject to the Benefits Management Program and must be prior authorized by the MHSA. See the Benefits Man- agement Program section for complete informa- tion Benefits are provided for professional (Physician) office visits for the diagnosis and treatment of Mental Health Conditions and Substance Abuse Conditions in the individual, family or group set- ting Benefits are provided for Outpatient Facility and professional services for the diagnosis and treat- ment of Mental Health and Substance Abuse Con- ditions. These services may also be provided in the office, home or other non-institutional setting. Non-Routine Outpatient Mental Health and Sub- stance Abuse Services include, but may not be lim- ited to, the following:
Mental Health and Substance Abuse Benefits. 11 All services provided through Blue Shield’s Mental Health Service Administrator (MHSA). Services by MHSA Partici- pating Providers Services by MHSA Non- Participating Providers 10 Inpatient Hospital services $100 per admis- sion plus 20% 40% of up to $600 per day 12 Inpatient Professional (Physician) services You pay nothing 40% Residential care for Mental Health Condition $100 per admis- sion plus 20% 40% of up to $600 per day Residential care for Substance Abuse Condition $100 per admis- sion plus 20% 40% of up to $600 per day Behavioral Health Treatment in home or other non-institutional set- ting You pay nothing 40% Behavioral Health Treatment in an office-setting You pay nothing 40% Electroconvulsive Therapy (ECT) 14 You pay nothing 40% Intensive Outpatient Program 14 You pay nothing 40% Office-based opioid treatment: outpatient opioid detoxification and/or maintenance therapy including methadone maintenance treat- ment You pay nothing 40% Partial Hospitalization Program 13 You pay nothing per episode 40% of up to $350 per day per episode Psychological testing to determine mental health diagnosis You pay nothing 40% Transcranial magnetic stimulation You pay nothing 40% Professional (Physician) office visits 20% 40% Benefit Member Copayment 3 Services by Preferred, Par- ticipating, and Other Providers 4 Services by Non-Preferred and Non-Participating Providers 5 Office visits 20% 40% Orthotic equipment and devices 20% 40% Outpatient Prescription Drug Benefits 15, 16, 17, 18, 19 Participating Pharmacy Non-Participating Pharmacy Retail Prescriptions Contraceptive Drugs and Devices 18 You pay nothing Applicable Generic, Brand or Non-Formulary Copayment Generic Drugs $10 25% of purchase price plus $10 Formulary Brand Drugs $25 25% of purchase price plus $25 Non- Formulary Brand Drugs $40 25% of purchase price plus $40 Contraceptive Drugs and Devices 18 You pay nothing Not covered Generic Drugs $20 Not covered Formulary Brand Drugs $50 Not covered Non- Formulary Brand Drugs $80 Not covered Specialty Drugs 20 30% up to $200 out-of-pocket maximum Not covered Benefit Member Copayment 3 Services by Preferred, Participating, and Other Providers 4 Services by Non-Pre- ferred and Non-Partici- pating Providers 5 Outpatient X-Ray, Pathology, and Laboratory Benefits Outpatient diagnostic X-ray, pathology, diagnostic examination and clinical laboratory services, including mammography and Pa- panicolaou test. See Radiological and Nuclear Imaging Benefits for CT scan...
Mental Health and Substance Abuse Benefits. The Department of Administrative Services, with the active consultation and review of the JHCC, shall develop and implement a managed mental health and substance abuse program for all State employees enrolled in either Ohio Med, an HMO or other managed care program. The program shall be effective July 1, 1995, or as soon thereafter as is practicable. Upon the effective date of the program, the State shall contract for State employee mental health and substance abuse benefits only under this program. Premiums for the managed mental health/substance abuse program shall be calculated into the Ohio Med premium and shall be added to the HMO premiums. Should the State, upon consultation with the JHCC, determine that this managed care program is unfeasible or will create an undue financial burden to the State and/or its employees, it may then cancel the program. Programs must include the following features:
A. A full range of culturally diverse service providers, including psychiatrists, psychologists, social workers, and licensed and certified alcohol and drug counselors;
B. A full range of facilities, including inpatient facilities and facilities for residential treatment (halfway houses, transitional programs, etc.);
C. A full range of programs at various treatment levels, including inpatient treatment, a variety of intensive outpatient programs, and a variety of outpatient programs;
D. A range of service providers and facilities within a reasonable distance in all parts of the state;
E. Group programs on smoking cessation, stress management, weight control, family discord, and other like stress management issues;
F. Timely responses to emergency calls;
G. Protocols and programs for integrating mental health/substance abuse and other physical health programs;
H. Coordination with the State Employee Assistance Program.
I. No preset caps on employee visits or treatment;
J. A provision that the program will pay the costs of treatment by a provider not included in the managed care network for those persons for whom an appropriate provider is not available in his/her home county;
K. Separate standards and incentives, for the program to provide appropriate amounts of treatment at the various treatment levels (inpatient, intensive outpatient, etc.) and for discrete categories of illness (e.g. mental health, substance abuse, eating disorders):
L. Use of the proper placement criteria;
M. Separate, appropriate diagnostic capacity for discrete categories of illness (e.g....
Mental Health and Substance Abuse Benefits. Blue Shield’s Mental Health Service Administra- tor (MHSA) arranges and administers Mental Health and Substance Abuse Services for Blue Shield Members within California. All non-emer- gency inpatient Mental Health and Substance Abuse Services, including Residential Care, and Non-Routine Outpatient Mental Health and Sub- stance Abuse Services must be prior authorized by the MHSA. Benefits are provided for professional office visits for the diagnosis and treatment of Mental Health and Substance Abuse Conditions in the individual, Family or group setting. Benefits are provided for Outpatient Facility and professional services for the diagnosis and treat- ment of Mental Health and Substance Abuse Conditions. These services may also be provided in the office, home or other non-institutional setting. Non-Routine Outpatient Mental Health and Sub- stance Abuse Services include, but may not be lim- ited to the following:
Mental Health and Substance Abuse Benefits. (1) In-patient treatment at the facilities listed in the attached sheet will be without limit subject to the same considerations as in the current program.
(2) Out-patient treatment limits shall be $5,000 per year, subject to the total lifetime cap.
(3) Treatment at facilities other than those listed in the attached shall be subject to a $25,000 per stay annual limit and a $50,000 lifetime limit.
(4) The list of the approved facilities is subject to change by mutual agreement of the Township and the Superior Officers Association.
