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. See the Prior Authorization Amendment for Covered Services that may require prior authorization.
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. Inpatient Mental Health Services and Substance Use Disorder Services include those received on an inpatient basis in a Hospital, Related Institution, Residential Treatment Facility, or entity licensed by the Department of Health and Mental Hygiene to provide Residential Crisis Services. Benefits include the following services provided on inpatient basis: Diagnostic evaluations and assessment (Including psychological and neuropsychological testing for diagnostic purposes). Treatment planning. Referral services. Medication evaluation and management (pharmacotherapy). Individual, family, therapeutic group and provider-based case management services. Treatment and counseling, including individual and group therapy visits Crisis intervention and stabilization for acute episodes and Residential Crisis Services. Services at a Residential Treatment Facility. Residential Crisis Services. Electroconvulsive therapy. Inpatient professional fees. Inpatient Hospital and inpatient Residential Treatment Facility services include: 1) room and board (including xxxx, Semi-private Room, or intensive care accommodations. A private room is a Benefit only when a private room is necessary in terms of generally accepted medical practice, or when a Semi- private Room is not available); 2) general nursing care; and meals and special diets; and 3) other facility services and supplies for services provided by a Hospital or Residential Treatment Facility. Benefits for detoxification services are provided as described above under Detoxification Services. The Mental Health/Substance Use Disorder Designee determines coverage for all levels of care. If an Inpatient Stay is required, it is covered on a Semi-private Room basis. We encourage you to contact the Mental Health/Substance Use Disorder Designee for referrals to providers and coordination of care.
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES. Inpatient Network 100% No Yes When Benefit limits apply, the limit refers to any combination of Network Benefits and Non-Network Benefits unless otherwise specifically stated. Covered Health Service Benefit (The Amount We Pay, based on Eligible Expenses) Apply to the Out-of-Pocket Maximum? Must You Meet Annual Deductible? Non-Network 80% Yes Yes
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. EXHIBIT C PLACER COUNTY INSURANCE AND INDEMNITY REQUIREMENTS CONTRACTOR shall file with COUNTY concurrently herewith a Certificate of Insurance, in companies acceptable to COUNTY, with a Best’s Rating of no less than A-:VII evidencing all coverages, limits, and endorsements listed below:
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. 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.
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.
