MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. Members, a designated representative, or a provider on behalf of the Member may contact the MHSA by telephone, letter, or online to request a review of an initial determination concerning a claim or service. Members may contact the MHSA at the telephone number provided below. If the telephone inquiry to the MHSA’s Customer Service Department does not resolve the question or issue to the Member’s satis- faction, the Member may submit a grievance at that time, which the Customer Service Representative will initiate on the Member’s behalf. The Member, a designated representative, or a provider on behalf of the Member may also initiate a grievance by submitting a letter or a completed “Grievance Form”. The Member may request this Form from the MHSA’s Customer Service Depart- ment. If the Member wishes, the MHSA’s Customer Service staff will assist in completing the Grievance Form. Completed Grievance Forms must be mailed to the MHSA at the address provided below. The Member may also submit the grievance to the MHSA online by visiting xxx.xxxxxxxxxxxx.xxx.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. HOSPITAL ADMISSIONS MUST BE AUTHORIZED OR APPROVED BY THE MENTAL HEALTH AND SUBSTANCE USE DISORDER MANAGEMENT PROGRAM. PRIOR AUTHORIZATION WILL BE OBTAINED BY CONTRACTING PROVIDERS.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. Blue Shield contracts with a Mental Health Service Administrator (MHSA) to underwrite and deliver all Mental Health and Substance Use Disorder Ser- vices through a unique network of MHSA Partici- pating Providers. All non-emergency Mental Health and Substance Use Disorder Hospital ad- missions and Other Outpatient Mental Health and Substance Use Disorder Services must be arranged through and authorized by the MHSA. Members are not required to coordinate Mental Health and Substance Use Disorder Services through their Pri- xxxx Care Physician. All Mental Health and Substance Use Disorder Services must be provided by an MHSA Partici- pating Provider, apart from the exceptions noted in the next paragraph. Information regarding MHSA Participating Providers is available online at xxx.xxxxxxxxxxxx.xxx. Members, or their Pri- xxxx Care Physician, may also contact the MHSA directly at 0-000-000-0000 to obtain this informa- tion. Mental Health and Substance Use Disorder Ser- vices received from an MHSA Non-Participating Provider will not be covered except as an Emer- gency or Urgent Service or when no MHSA Par- ticipating Provider is available to perform the needed services and the MHSA refers the Member to an MHSA Non-Participating Provider and au- thorizes the services. Mental Health and Substance Use Disorder Services received from a health pro- fessional who is an MHSA Non-Participating Provider at a facility that is an MHSA Participat- ing Provider will also be covered. Except for these stated exceptions, all charges for Mental Health or Substance Use Disorder Services not rendered by an MHSA Participating Provider will be the Mem- ber’s responsibility. For complete information re- xxxxxxx Benefits for Mental Health and Substance Use Disorder Services, see the Mental Health and Substance Use Disorder Benefits section.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. HOSPITAL ADMISSIONS MUST BE AUTHORIZED OR APPROVED BY THE MENTAL HEALTH AND SUBSTANCE USE DISORDER MANAGEMENT PROGRAM
9.1 Definitions Mental Illness and Emotional Disorders are broadly defined as including any mental disorder, mental illness, psychiatric illness, mental condition, or psychiatric condition (whether organic or non-organic, whether of biological, non-biological, chemical or non-chemical origin, and irrespective of cause, basis, or inducement). This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. (This is intended to include disorders, conditions and illnesses classified on Axes I and II in the current edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Washington, D.C.) Mental Health and Substance Use Disorder Management Program refers to utilization management, benefits administration, and provider network activities administered by or on behalf of CareFirst to ensure that mental health and Substance Use Disorder services are Medically Necessary Partial Hospitalization means the provision of medically directed intensive or intermediate short- term treatment in a licensed or certified facility or program for treatment of Mental Illnesses, Emotional Disorders, and Drug and Alcohol Use Disorders.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. See the Prior Authorization Amendment for Covered Services that may require prior authorization.
9.1 Definitions Mental Illness and Emotional Disorders are broadly defined as including any mental disorder, mental illness, psychiatric illness, mental condition, or psychiatric condition (whether organic or non-organic, whether of biological, non-biological, chemical or non-chemical origin, and irrespective of cause, basis, or inducement). This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. (This is intended to include disorders, conditions and illnesses classified on Axes I and II in the current edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Washington, D.C.) Mental Health and Substance Use Disorder Management Program refers to utilization management, benefits administration, and provider network activities administered by or on behalf of CareFirst to ensure that mental health and Substance Use Disorder services are Medically Necessary Partial Hospitalization means the provision of medically directed intensive or intermediate short- term treatment in a licensed or certified facility or program for treatment of Mental Illnesses, Emotional Disorders, and Drug and Alcohol Use Disorders.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. See the Prior Authorization Amendment for Covered Services that may require prior authorization. . Prior Authorization will be obtained by Contracting Providers.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. Coverage for Mental Health and Substance Use Disorder Services also includes coverage for biologically based mental illness services. Biologically based mental illness means schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, and panic disorder, as these terms are defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. We cover intermediate levels of care, such as residential treatment, partial hospitalization and intensive outpatient services. Please refer to the Schedule of Benefits for Cost-Sharing requirements and any Preauthorization or Referral requirements that apply to these benefits. Mental Health Disorders and Substance Abuse treatment is covered like other medical and surgical coverage under this Policy. This Plan is compliant with the Mental Health Parity and Addiction Equity Act.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. 1) Contractor shall cover Outpatient Mental Health Services that are within the scope of practice of Primary Care Providers and mental health care Providers, in accordance with the Outpatient Mental Health Services requirements as defined in Exhibit E, Attachment 1, Definitions. Contractor’s policies and procedures shall define and describe what services are to be provided by Primary Care Providers. In addition, Contractor shall cover and ensure the provision of psychotherapeutic drugs prescribed by its Primary Care Providers or other mental health care professionals, except those specifically excluded in this Contract as stipulated below.
2) Contractor shall cover all Medically Necessary Covered Services for the Member, including the following services:
a) Emergency room professional services, except services provided by psychiatrists, psychologists, licensed clinical social workers, marriage, family and child counselors, or other Specialty Mental Health Providers.
b) Facility charges for emergency room visits which do not result in a psychiatric admission.
c) All laboratory and radiology services when these services are necessary for the diagnosis, monitoring, or treatment of a Member’s mental health condition.
d) Emergency Medical Transportation services necessary to provide access to all Medi-Cal Covered Services, including emergency mental health services, as described in 22 CCR 51323.
e) All NEMT services, as provided for in 22 CCR 51323, required by Members to access Medi-Cal covered mental health and substance use disorder services. These services include outpatient opioid detoxification, tobacco cessation, and Alcohol Misuse Screening and Counseling (AMSC) services, and are subject to a written prescription by Contractor’s mental health or substance use disorder Provider within Contractor’s mental health and substance use disorder Provider Network.
f) Medically Necessary Covered Services after Contractor has been notified by a Specialty Mental Health Provider that a Member has been admitted to an inpatient psychiatric facility, including an Institution for Mental Diseases (IMD) as defined by Title 9 CCR Section 1810.222.1, regardless of the age of the Member. These services include, but are not limited to:
i. The initial health history and physical examination required upon admission and any consultations related to Medically Necessary Covered Services.
ii. Notwithstanding this requirement, Contractor shall not be responsible for room and board ch...
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. (MHSUDS) Information Notices published annually containing updated rates for each service over the term of this agreement. No additional compensation will be paid for secretarial, clerical support staff, or overhead costs. Contract does not include payment for Non-Medi-Cal services; therefore, no Non-Medi-Cal rates are included.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. Members covered by this Agreement are allowed direct access to a licensed/certified Participating Provider for covered Mental Health and Substance Use Disorder Services. There is no requirement to obtain a referral from your Primary Care Physician for individual or group therapy visits to the Participating Provider of your choice for Mental Health and Substance Use Disorder Services.
