Common use of Mental Health/Substance Abuse Clause in Contracts

Mental Health/Substance Abuse. A managed mental health and substance abuse program is provided to all participants enrolled in any Employer-sponsored health plan. Premiums for the managed mental health and substance abuse program shall be calculated and shall be added to the health plan premiums. The Employer shall contract for mental health and substance abuse benefits only under this program provided, however, that by agreement of the Director of DAS and the JHCC the benefit delivery system for this benefit may be changed. The managed care vendor shall provide quarterly reports to DAS, which shall share the reports with the JHCC, on utilization and treatment outcomes, and on the composition of its provider network (including contracted facilities). The vendor will also provide information about its programs for use in the participant education 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 life 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 participant 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 as follows: an outpatient provider shall be available to ninety percent (90%) of employees within 20 miles of their home; an inpatient provider shall be available within 60 miles of an employee’s home; k. Separate standards and incentives, for the program to provide appropriate amounts of treatment at the various treatment levels (inpatient, intensive outpatient, etc.); l. Use of the proper placement criteria; m. Separate, appropriate diagnostic capacity for discrete categories of illness (e.g. Mental health, substance abuse, eating disorders); n. Internal financial arrangements which will not encourage under-treatment, placement at inappropriately low levels of treatment, or withholding of treatment; o. Capacity to provide appropriate critical incident stress debriefing in conjunction with the State Employee Assistance Program;

Mental Health/Substance Abuse. A managed mental health and substance abuse program is provided to all participants State employees enrolled in any Employer-sponsored health plan. Premiums for the managed mental health and substance abuse program shall be calculated and shall be added to the health plan premiums. The Employer shall contract for State employee mental health and substance abuse benefits only under this program provided, however, that by agreement of the Director of DAS and the JHCC the benefit delivery system for this benefit may be changed. The managed care vendor shall provide quarterly reports to DAS, which shall share the reports with the JHCC, on utilization and treatment outcomes, and on the composition of its provider network (including contracted facilities). The vendor will also provide information about its programs for use in the participant education program. Programs must include the following features: a. (a) A full range of culturally diverse service providers, including psychiatrists, psychologists, social workers, and licensed and certified alcohol and drug counselors; b. (b) A full range of facilities, including inpatient facilities and facilities for residential treatment (halfway houses, transitional programs, etc.); c. (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. (d) A range of service providers and facilities within a reasonable distance in all parts of the State; e. (e) Group programs on smoking cessation, stress management, weight control, family discord, and other life stress management issues; f. (f) Timely responses to emergency calls; g. (g) Protocols and programs for integrating mental health/substance abuse and other physical health programs; h. (h) Coordination with the State Employee Assistance Program; i. (i) No preset caps on participant employee visits or treatment; j. (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 as follows: an outpatient provider shall be available to ninety percent (90%) of employees within 20 miles of their home; an inpatient provider shall be available within 60 miles of an employee’s home; k. (k) Separate standards and incentives, for the program to provide appropriate amounts of treatment at the various treatment levels (inpatient, intensive outpatient, etc.); l. (l) Use of the proper placement criteria; m. (m) Separate, appropriate diagnostic capacity for discrete categories of illness (e.g. Mental health, substance abuse, eating disorders); n. (n) Internal financial arrangements which will not encourage under-treatment, placement at inappropriately low levels of treatment, or withholding of treatment; o. (o) Capacity to provide appropriate critical incident stress debriefing in conjunction with the State Employee Assistance Program;; The managed care vendor shall provide quarterly reports to DAS, which shall share the reports with the JHCC, on utilization and treatment outcomes, and on the composition of its provider network (including contracted facilities). The vendor will also provide information about its programs for use in the employee education program.