Common use of Behavioral Health Services Clause in Contracts

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.

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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute 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.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute behavioral health residential treatment facilities, which provide: •  intensive clinical treatment, typically eight hours of clinical treatment services daily; •  medication evaluation management; and •  24-hour on site availability of health professional staff, as required by licensing regulationsclinical supervision. 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.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute behavioral health residential treatment facilities, which provide: • intensive clinical treatment, typically eight hours of clinical treatment services daily; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulationsclinical supervision. 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.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute behavioral health residential treatment facilities, which provide: • intensive clinical treatment, typically eight hours of clinical treatment services daily; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulationsclinical supervision. 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.

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. For inpatient hospital and intermediate care services described below, network providers are responsible for submitting notification of admission to us. When these services are received from non-network providers you are responsible for ensuring notification of admission has been provided to us. In many cases, the non-network provider may submit the notification on your behalf. However, prior to receiving these services, please check with your provider to ensure notification has been made. Customer Service may assist you in the event the non-network provider has not submitted the notification on your behalf. Inpatient Hospital 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.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute behavioral health residential treatment facilities, which provide: •  intensive clinical treatment, typically eight hours of clinical treatment services daily; •  medication evaluation management; and •  24-hour on site availability of health professional staff, as required by licensing regulationsclinical supervision. 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.  Home and Community Based Adult Intensive Service (AIS) and Child and Family Intensive Treatment (CFIT) – AIS/CFIT programs offer services primarily based in the home and community for qualifying adults and children with moderate- to-severe mental health conditions. These programs consist at a minimum of ongoing emergency/crisis evaluations, psychiatric assessment, medication evaluation and management, case management, psychiatric nursing services, and individual, group, and family therapy. In a Provider’s Office/In Your Home This plan covers individual psychotherapy, group psychotherapy, and family therapy when rendered by:  Board certified psychiatrists;  Licensed clinical psychologists;  Clinical social workers (licensed or certified at the independent practice level);  Advance practice nurses/clinical nurse specialists;  Licensed mental health counselors; and  Licensed marriage and family therapists. Psychological Testing This plan covers psychological testing is covered as a behavioral health benefit when rendered by:  neuropsychologists;  psychologists; or  pediatric neurodevelopmental specialists. This plan covers neuropsychological testing as described in the Tests, Labs and Imaging section.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute 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.

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. • Home and Community Based Adult Intensive Service (AIS) and Child and Family Intensive Treatment (CFIT) – AIS/CFIT programs offer services primarily based in the home and community for qualifying adults and children with moderate- to-severe mental health conditions. These programs consist at a minimum of ongoing emergency/crisis evaluations, psychiatric assessment, medication evaluation and management, case management, psychiatric nursing services, and individual, group, and family therapy. In a Provider’s Office/In Your Home This plan covers individual psychotherapy, group psychotherapy, and family therapy when rendered by: • Psychiatrists; • Licensed Clinical Psychologists; • Licensed Independent Clinical Social Workers; • Advance Practice Registered Nurses (Clinical Nurse Specialists/Nurse Practitioners- Behavioral Health); • Licensed Mental Health Counselors; and • Licensed Marriage and Family Therapists. Psychological Testing This plan covers psychological testing as a behavioral health benefit when rendered by: • neuropsychologists; • psychologists; or • pediatric neurodevelopmental specialists. This plan covers neuropsychological testing as described in the Tests, Labs and Imaging section.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute 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.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute 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.  Home and Community Based Adult Intensive Service (AIS) and Child and Family Intensive Treatment (CFIT) – AIS/CFIT programs offer services primarily based in the home and community for qualifying adults and children with moderate- to-severe mental health conditions. These programs consist at a minimum of ongoing emergency/crisis evaluations, psychiatric assessment, medication evaluation and management, case management, psychiatric nursing services, and individual, group, and family therapy. In a Provider’s Office/In Your Home This plan covers individual psychotherapy, group psychotherapy, and family therapy when rendered by:  Board certified psychiatrists;  Licensed clinical psychologists;  Clinical social workers (licensed or certified at the independent practice level);  Advance practice nurses/clinical nurse specialists;  Licensed mental health counselors; and  Licensed marriage and family therapists. Psychological Testing This plan covers psychological testing as a behavioral health benefit when rendered by:  neuropsychologists;  psychologists; or  pediatric neurodevelopmental specialists. This plan covers neuropsychological testing as described in the Tests, Labs and Imaging section.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute behavioral health residential treatment facilities, which provide: •  intensive clinical treatment, typically eight hours of clinical treatment services daily; •  medication evaluation management; and •  24-hour on site availability of health professional staff, as required by licensing regulationsclinical supervision. 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. o Home and Community Based Adult Intensive Service (AIS) and Child and Family Intensive Treatment (CFIT) – AIS/CFIT programs offer services primarily based in the home and community for qualifying adults and children with moderate-to-severe mental health conditions. These programs consist at a minimum of ongoing emergency/crisis evaluations, psychiatric assessment, medication evaluation and management, case management, psychiatric nursing services, and individual, group, and family therapy. In a Provider’s Office/In Your Home This plan covers individual psychotherapy, group psychotherapy, and family therapy when rendered by:  Board certified psychiatrists;  Licensed clinical psychologists;  Clinical social workers (licensed or certified at the independent practice level);  Advance practice nurses/clinical nurse specialists;  Licensed mental health counselors; and  Licensed marriage and family therapists. Psychological Testing This plan covers psychological testing is covered as a behavioral health benefit when rendered by:  neuropsychologists;  psychologists; or  pediatric neurodevelopmental specialists. This plan covers neuropsychological testing as described in the Tests, Labs and Imaging section.

Behavioral Health Services. Behavioral health services include the evaluation, management, and treatment for of a patient with a mental health or substance use disorder conditiondisorder. 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. We review behavioral health programs to determine whether the services provided are clinically appropriate in the setting in which they are rendered. The following behavioral health services are covered when medically necessary and when rendered by a provider licensed by the State of Rhode Island or by the state in which the provider is located. 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 acute behavioral health residential treatment facilities, which provide: • intensive clinical treatment, typically eight hours of clinical treatment services daily; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulationsclinical supervision. 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. o Home and Community Based Adult Intensive Service (AIS) and Child and Family Intensive Treatment (CFIT) – AIS/CFIT programs offer services primarily based in the home and community for qualifying adults and children with moderate-to-severe mental health conditions. These programs consist at a minimum of ongoing emergency/crisis evaluations, psychiatric assessment, medication evaluation and management, case management, psychiatric nursing services, and individual, group, and family therapy. In a Provider’s Office/In Your Home This plan covers individual psychotherapy, group psychotherapy, and family therapy when rendered by: • Board certified psychiatrists; • Licensed clinical psychologists; • Clinical social workers (licensed or certified at the independent practice level); • Advance practice nurses/clinical nurse specialists; • Licensed mental health counselors; and • Licensed marriage and family therapists. Psychological Testing This plan covers psychological testing is covered as a behavioral health benefit when rendered by: • neuropsychologists; • psychologists; or • pediatric neurodevelopmental specialists. This plan covers neuropsychological testing as described in the Tests, Labs and Imaging section.

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.