Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorders. An established plan of treatment may be required. This includes Inpatient (Inpatient and Residential Treatment), and Outpatient (Outpatient and Day Treatment Program), services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be:
1. Supervised by a licensed Physician, licensed psychologist, or licensed clinical social worker; and
2. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and substance use disorder treatment services when Medically Necessary:
1. Applied behavioral health services;
2. Room and board, including general nursing for inpatients;
3. Prescription drugs, biologicals, and solutions administered to inpatients;
4. Supplies and use of equipment required for medical withdrawal monitoring and management;
5. Diagnostic and evaluation services;
6. Intervention and assessment;
7. Facility‐based professional and ancillary services;
8. Individual, group, couple and/or family psychotherapy and professional counseling services;
9. Medication checks;
10. Individual or group alcohol and drug counseling services;
11. Psychological and Neuropsychological testing;
12. Emergency treatment for the sudden onset of a mental health or substance use condition requiring immediate and acute treatment. Outpatient visits for substance use disorder conditions may be furnished during the acute withdrawal management stage of treatment or during stages of early recovery and maintenance. .
Mental Health and Substance Use Disorder. Parity Insurer shall comply with the requirements of 42 CFR 457.496. Insurer shall assist and cooperate with FHKC as needed to ensure the Program is in compliance with parity requirements. In the event Insurer is directly or indirectly preventing the Program from meeting parity requirements, Insurer shall implement appropriate, timely changes to allow the Program to become compliant.
Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorders. An established plan of treatment may be required. This includes Inpatient, Outpatient, and Day Treatment Program services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be:
a. Supervised by a licensed Physician, licensed clinical psychologist, or licensed clinical social worker; and
b. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and Substance Use Disorder treatment services when Medically Necessary:
a. Room and board, including general nursing;
b. Prescription drugs, biologicals, and solutions administered to inpatients;
c. Supplies and use of equipment required for detoxification and rehabilitation;
d. Diagnostic and evaluation services;
e. Intervention and assessment;
f. Facility-based professional and ancillary services;
g. Individual, group, and family therapy and counseling;
h. Medication checks;
i. Psychological testing; and
j. Emergency treatment for the sudden onset of a mental health or Substance Use Disorder condition requiring immediate and acute treatment. Outpatient visits for Substance Use Disorder conditions may be furnished during the acute detoxification stage of treatment or during stages of rehabilitation. The Member cost-sharing will be waived for the first 3 outpatient office visits in the Plan Year to an In-Network mental health or Substance Use Disorder provider.
Mental Health and Substance Use Disorder. Inpatient* – Services are considered inpatient when you are admitted to a facility. Refer to your Schedule of Benefits for Cost Share information. Mental Health and Substance Use Disorder: Outpatient – Covered Services are paid according to the plan based on place of service, provider type, and provider billing. Refer to your Schedule of Benefits for Cost Share information. Mental Health and Substance Use Disorder Services* – The Plan covers Medically Necessary treatment of Mental Health conditions and Substance Use Disorders. Refer to the Benefit Exclusions section for more information on Services not covered by this Plan. Samaritan Health Plans covers Services and treatment for those Mental Health and Substance Use Disorder diagnoses covered under the Mental Health and Addiction Equity Act of 2008. Samaritan Health Plans is compliant with state and federal Mental Health parity. Multidisciplinary Programs* – Include, but are not limited to, pain management, and child development and rehabilitation center (CDRC) programs. Services usually consist of a team of providers coordinating and working for the benefit of one Member. These programs do not Nursery Care* – Routine nursery care of eligible newborns, while the mother is hospitalized and eligible for maternity benefits under the Plan, are covered. Newborn stays less than 5 days do not require Prior Authorization. Nutritional Therapy and/or Counseling – Covered Services of a registered and licensed dietician for the treatment of celiac sprue, hyperlipidemia, eating disorders, obesity, or otherwise stated as Medically Necessary by a provider are covered and paid based on place of service, provider type, and provider billing. Registered and licensed dieticians are considered Specialists. Occupational Therapy* – Covered Services are paid according to the plan. Services must be prescribed by a Professional Provider. The written prescription must include site, modality, duration, and frequency of treatment. Occupational, physical, and Speech Therapy are covered up to a combined maximum of 30 visits per Calendar Year. We cover Medically Necessary therapy and Services for the treatment of traumatic brain injury. These Services can be provided in both inpatient and outpatient settings and are referred to as Rehabilitative and Habilitative Services. Refer to your Schedule of Benefits for Cost Share information. Osteopathic Manipulation – Covered Services are paid according to the plan only for the treatment of dis...
Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorder. An established plan of treatment may be required. This includes Inpatient, Outpatient, residential, and Day Treatment Program services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be:
a. Supervised by a licensed Physician, licensed psychologist, or licensed clinical social worker; and
b. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and Substance Use Disorder treatment services when Medically Necessary:
a. Applied behavioral health services b. Room and board, including general nursing;
c. Prescription drugs, biologicals, and solutions administered to inpatients;
d. Supplies and use of equipment required for detoxification and rehabilitation;
e. Diagnostic and evaluation services;
f. Intervention and assessment;
g. Facility-based professional and ancillary services;
h. Individual, group, and family therapy and counseling;
i. Medication checks;
j. Psychological and Neuropsychological testing; and
k. Emergency treatment for the sudden onset of a mental health or Substance Use Disorder condition requiring immediate and acute treatment. Outpatient visits for Substance Use Disorder conditions may be furnished during the acute detoxification stage of treatment or during stages of rehabilitation. The Member cost-sharing will be waived for the first 3 outpatient office visits in the Plan Year to an In- Network mental health or Substance Use Disorder provider.
Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorders. An established plan of treatment may be required. This includes Inpatient (Inpatient and Residential Treatment), and Outpatient (Outpatient and Day Treatment Program) services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be:
a. Supervised by a licensed Physician, licensed psychologist, or licensed clinical social worker; and
b. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and substance use disorder treatment services when Medically Necessary:
a. Applied Behavioral health services,
b. Room and board, including general nursing for inpatients;
c. Prescription drugs, biologicals, and solutions administered to inpatients;
d. Supplies and use of equipment required for medical withdrawal monitoring and management;
e. Diagnostic and evaluation services;
f. Intervention and assessment;
g. Facility‐based professional and ancillary services;
h. Individual, group, couple and/or family psychotherapy and professional counseling services;
i. Medication checks;
j. Individual or group alcohol and drug counseling services;
k. Psychological and Neuropsychological testing;
l. Emergency treatment for the sudden onset of a mental health or substance use disorder condition requiring immediate and acute treatment.
m. Consultation services Outpatient visits for substance use disorder conditions may be furnished during the acute withdrawal management stage of treatment or during stages of early recovery and maintenance.
