Behavioral Health Needs Management Sample Clauses

Behavioral Health Needs Management. 2.5.6.7.1. The Contractor must maintain a structured process for identifying and addressing complex behavioral health needs at all levels of care and in all residential settings. Qualified Behavioral Health Providers must proactively coordinate and follow Enrollee progress through the continuum of care.
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Behavioral Health Needs Management. The Contractor must maintain a structured process for identifying and addressing complex behavioral health needs at all levels of care and in all residential settings. Qualified behavioral health Providers must proactively coordinate and follow Enrollee progress through the continuum of care. The Contractor shall implement all Current Procedural Terminology (CPT) evaluation and management codes for behavioral health services set forth in Appendix A as most recently adopted by the American Medical Association and CMS; and shall pay no less than the MassHealth rate for such CPT codes. Substance Use Disorder Services Prior authorization shall not be required for the following services: Inpatient Substance Use Disorder Services (Level IV), as defined in Appendix A, Exhibit 1; Acute Treatment Services (ATS) for Substance Use Disorders (Level III.7), as defined in Appendix A, Exhibit 1; Clinical Support Services (CSS), as defined in Appendix A, Exhibit 1, for Substance Use Disorders (Level III.5). The Contractor may implement utilization review procedures on the seventh day of a patient’s stay for CSS, but shall not make any utilization review decisions that impose any restriction or deny any future medically necessary CSS unless a patient has received at least 14 consecutive days of CSS; The following Outpatient Services: Counseling (including Couples/Family Treatment, Group Treatment, and Individual Treatment) and Ambulatory Detoxification, as defined in Appendix A, Exhibit 1; The following Non-24-Hour Diversionary Services: Structured Outpatient Addiction Program (SOAP), as defined in Appendix A, Exhibit 1; Intensive Outpatient Program (IOP), as defined in Appendix A, Exhibit 1; Partial Hospitalization as defined in Appendix A, Exhibit 1, with short-term day or evening mental health programming available seven days per week; and The initiation or re-initiation of a buprenorphine/naloxone prescription of 32 mg/day or less, for either brand formulations (e.g. Suboxone™, Zubsolv™, Bunavail™) or generic formulations, provided, however, that the Contractor may have a preferred formulation. Contractor may establish review protocols for continuing prescriptions. Notwithstanding the foregoing, the Contractor may implement prior authorization for buprenorphine (Subutex™) and limit coverage to pregnant or lactating women and individuals allergic to naloxone, provided such limitations are clinically appropriate. Providers providing Clinical Support Services for Substanc...
Sample 1

Related to Behavioral Health Needs Management

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. Inpatient This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

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  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Health Services At the time of employment and subject to (b) above, full credit for registered professional nursing experience in a school program shall be given. Full credit for registered professional nursing experience may be given, subject to approval by the Human Resources Division. Non-degree nurses shall be placed on the BA Track of the Teachers Salary Schedule and shall be ineligible for movement to any other track.

  • Traffic Management The Customer will not utilize the Services in a manner which, in the view of the Centre Operator, significantly distorts traffic balance on the Centre Operator’s circuits which are shared with other users. If, in the reasonable view of the Centre Operator, the Customer’s traffic patterns cause or may cause such distortion, the Customer should have a dedicated circuit capability. If the Customer declines to do so then the Centre Operator may suspend the Services while the matter is being resolved. If there is no resolution within 5 business days then either party may terminate the Agreement.

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