Common use of Behavioral Health Clause in Contracts

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Services, are a covered benefit under the HIP program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, inpatient drug and alcohol rehabilitation, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3. As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health or

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Services, are a covered benefit under the HIP Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, inpatient drug and alcohol rehabilitation, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.33.12.4. As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Healt h Parity and Additions Equity Act (MHPAEA). In furnishing behavioral mental health or substance use disorder benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Servicesservices, are a covered benefit under the HIP program. The Contractor shall be is responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, detoxification and inpatient drug and alcohol rehabilitation, with the exception of treatment rendered in a State Hospital as described in Section 3.12.3, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3). As described in Section 3.15, the Contractor is encouraged to develop and EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. ▪ Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of HIP members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Servicesservices, are a covered benefit under the HIP program. The Contractor shall be is responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, detoxification and inpatient drug and alcohol rehabilitation, with the exception of treatment rendered in a State Hospital as described in Section 3.12.3, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3). As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN ▪ Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of HIP members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Servicesservices, are a covered benefit under the HIP program. The Contractor shall be is responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, detoxification and inpatient drug and alcohol rehabilitation, with the exception of treatment rendered in a State Hospital as described in Section 3.12.3, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3). As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. ▪ Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of HIP members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Servicesservices, are a covered benefit under the HIP Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital servicess ervices, inpatient drug and alcohol detoxification, detoxification and inpatient drug and alcohol rehabilitation, with the exception of treatment rendered in a State Hospital as described in Section 3.12.4, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3). As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral mental health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral health or substance use disorder benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health. EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Servicesservices, are a covered benefit under the HIP program. The Contractor shall be is responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, detoxification and inpatient drug and alcohol rehabilitation, with the exception of treatment rendered in a State Hospital as described in Section 3.12.3, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3). As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. ▪ Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN ▪ Provide care that addresses the needs of HIP members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Servicesservices, are a covered benefit under the HIP Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, detoxification and inpatient drug and alcohol rehabilitation, with the exception of treatment rendered in a State Hospital as described in Section 3.12.4, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3). As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral mental health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral health or substance use disorder benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out- of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Servicesservices, are a covered benefit under the HIP Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, detoxification and inpatient drug and alcohol rehabilitation, with the exception of treatment rendered in a State Hospital as described in Section 3.12.4, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3). As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral mental health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral health or substance use disorder benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE ▪ Not applying any financial requirement or treatment limitation to mental health or substance s ubstance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out - of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; EXHIBIT 1

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Servicesservices, are a covered benefit under the HIP Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, detoxification and inpatient drug and alcohol rehabilitation, with the exception of treatment rendered in a State Hospital as described in Section 3.12.4, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.3). As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral mental health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral health or substance use disorder benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health orEXHIBIT 1

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Services, are a covered benefit under the HIP Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, inpatient drug and alcohol rehabilitation, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.33.12.4. As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral mental health or substance use disorder benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to t o members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Services, are a covered benefit under the HIP Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, inpatient drug and alcohol rehabilitation, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.33.12.4. As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral mental health or substance use disorder benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with phys ical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

Behavioral Health. Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services as described in Section 3.11 Carved-Out Services, are a covered benefit under the HIP Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. The Contractor shall provide timely access to behavioral health screening, assessment, referral and treatment services, including outpatient services as well as inpatient psychiatric hospital services, inpatient drug and alcohol detoxification, inpatient drug and alcohol rehabilitation, and residential treatment services for opioid use disorder (OUD) and substance use disorder (SUD) apart from treatment rendered in a State Hospital as described in Section 3.12.33.12.4. As described in Section 3.15, the Contractor is encouraged to develop and purchase enhanced services which can provide services in a less restrictive setting and/or which would result in improved outcomes for members. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). In furnishing behavioral mental health or substance use disorder benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibiting the application of more restrictive limits to mental health/substance use disorder benefits than to medical/surgical benefits. Compliance with the MHPAEA and State requirements includes, but is not limited to: ▪ Not applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to members (whether or not the benefits are furnished by the same Contractor) per 42 CFR 438.910(b)(1). ▪ If a member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, outpatient, emergency care, or prescription drugs), mental health or substance use disorder benefits shall be provided to the member in every classification in which medical/surgical benefits are provided per 42 CFR 438.910(b)(2). ▪ Not applying any cumulative financial requirements for mental health or substance use disorder benefits in a classification (inpatient, outpatient, emergency care, prescription drugs) that accumulates separately from any established for medical/surgical benefits in the same classification per 42 CFR 438.910(c)(3). ▪ Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits. Per 42 CFR 438.910(d), the Contractor shall not impose Non-Quantitative Treatment Limits (NQTLs) for mental health oror substance use disorder benefits in any classification unless, under the policies and procedures of the Contractor as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification. ▪ Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work. ▪ Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request. ▪ Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members. ▪ Providing out-of-network coverage for mental health or substance use disorder benefits. The Contractor shall use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to and applied no more stringently than those applied for out-of-network medical/surgical benefits in the same classification as required by 42 CFR 438.910(d)(3). ▪ Coordinating transition of care for members going from a higher to a lower level of care. Coordinating transition of care to approved lower level of care for patients who are, due to lack of medical necessity, denied a higher level of care. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to: ▪ Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health; ▪ Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and ▪ Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.