Member Education and Self. Referral for Substance Abuse and Dependency Treatment Services MCOs must maintain a Member education process (including hotlines, manuals, policies and other Member Materials) to inform Members of the availability of and access to substance abuse treatment services, including information on self-referral.
Member Education and Self referral for Behavioral Health Services The MCO must maintain a Member education process to help Members know where and how to obtain Behavioral Health Services. The MCO must permit Members to self refer to any Network Behavioral Health Services Provider without a referral from the Member’s PCP. The MCOs’ policies and procedures, including its Provider Manual, must include written policies and procedures for allowing such self-referral to Behavioral Health Services. The MCO must permit Members to participate in the selection of the appropriate behavioral health providers, and must provide the Member with information on accessible Network Providers with relevant experience.
Member Education and Self referral for Behavioral Health Services The HMO must maintain a Member education process to help Members know where and how to obtain Behavioral Health Services. The HMO must permit Members to self refer to any in-network Behavioral Health Services Provider without a referral from the Member’s PCP. The HMOs’ policies and procedures, including its Provider Manual, must include written policies and procedures for allowing such self- referral to BH services. The HMO must permit Members to participate in the selection of the appropriate behavioral health individual practitioner(s) who will serve them and must provide the Member with information on accessible in-network Providers with relevant experience. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 8 Version 1.7
