Behavioral Health Service/Benefit Descriptions
Behavioral Health Service/Benefit DescriptionsFor more information see http://www.cenpaticointegratedcareaz.com/for-members/access-services/benefits-review/
|Behavioral Health Counseling and Therapy||Interactive therapy designed to draw out information, identify behavioral problems or conflicts, and provide support, and education for future use.||Can be provider to an individual, a group of people, a family or multiple families|
|Behavioral Health Screening, Mental Health Assessment and Specialized Testing||Gathering and assessment of historical and current information, face to face with member, family, or group of individuals in a written summary or report|
|Other Professional||Other treatment services provided by qualified individuals in order to ease symptoms and improve or maintain functioning.||Includes but not limited to: Psychiatric services without face to face contact, biofeedback|
|Skills Training and Development||Teaching independent living, social and communication skills to persons and/or their families in order to help them live more independently and be a part of the community.||Includes but not limited to: Self-care, taking care of a residence, managing money and using other resources|
|Cognitive Rehabilitation||Assisting in the recovery from cognitive (mental) issues to be more independent or function at the highest level possible||Includes but not limited to: Relearning of certain mental abilities, making functions stronger, substituting new skills to replace lost ones|
|Behavioral Health Prevention/Promotion Education||Educating and training an individual or group in relation to a person’s treatment plan||Includes but not limited to: Increasing knowledge of a health related topic, use of medicines for best results, stress management, parenting skills|
|Psycho Educational Services and Ongoing Support to maintain employment||Designed to assist a person or group to choose, find and keep a job or other meaningful community activity||Custom-made to support persons in a variety of settings such as part time work, unpaid work experience or meaningful volunteer work appropriate to the person’s age, mental and physical status.|
|Medication Services||Drugs prescribed by a licensed physician, nurse practitioner or physician assistant to prevent, stabilize or improve symptoms that are part of a behavioral health condition or its treatment.||See the Cenpatico-IC formulary at www.CenpaticoIntegratedCareAZ.com/ members/medication-formulary/|
|Lab, Radiology and Medical Imaging||Medical tests for diagnosing, screening, or monitoring a behavioral health condition.||This may include but is not limited to blood and urine tests, CT scans, MRI, EKG, and EEG|
|Medical Management||Assessment and management services that are provided by a licensed medical professional (i.e., physician, nurse practitioner, physician assistant or nurse) to a person as part of their medical visit for ongoing treatment purposes.||Includes use of medicines for best results which includes learning about the effects and side effects of medications and how new medicines can make you feel when you first start taking them.|
|Electro-Convulsive Therapy||A treatment where a brief electric current is passed through a person’s brain, most often used for major depression.||Services must be provided by a licensed physician with anesthesia support in a hospital.|
|Case Management||A supportive service provided to boost treatment goals and effectiveness.||Includes but not limited to: Assistance in using and continuing use of covered services;
|Personal Care||Support activities to assist a person in carrying out daily living tasks and other activities needed to live in a community.||Includes but not limited to: assistance with homemaking, personal care, taking medicines properly,|
|Home Care Training (Family)||Home care training family services (family support) involve face-to-face contact with family member(s) with a goal to rebuild, improve, or keep a the family functioning so the person can stay in the home and community||May involve support activities such as assisting the family to adjust to the person’s disability, building skills to help guide the person, understanding the causes and treatment of behavioral health issues, understanding and being able to use system services|
|Respite Care||Short-term behavioral health services or general supervision that provides rest or relief to a family member or other individual caring for the behavioral health member.||Services may be provided on a short-term basis (i.e., few hours during the day) or for longer periods involving overnight stays.|
|Supported Housing||Support to obtain and maintain housing in an independent community setting including the person’s own home or apartments and homes owned or leased by a subcontracted provider.||May include help with paying for rent and utilities, and help with moving so members and their families can find and keep a home.|
|Sign Language or Oral Interpretive Services||Services that are available to members at no cost; services for all non-English languages and the D/deaf or hard of hearing must be available to potential members, at no cost, when asking for information.||Sign language or oral interpretive services are provided to persons and/or their families with limited language skills or other communication barriers (e.g., sight or sound) during instructions on how to access services, counseling, and treatment activities that will help them get the mental health services they need.|
|Flex Fund Services||T/RBHAs may access flex funds to purchase any of a variety of one-time or occasional goods and/or services needed for members (children or adults) and their families, when the goods and/or services cannot be purchased by any other funding source, and the service or good is directly related to the member’s service plan.||The funds are intended to promote wellness, comfort, and safety for vulnerable children and adults returning to the community in a respectful, individualized manner. Non-medically necessary covered services and/or supports|
|Transportation||Assisting a member in going from one place to another to help them get services and achieve their service plan goals.||This includes both emergency and non-emergency transportation.
Emergency transportation does not prior authorization.
Non-emergency transportation must be provided for persons and/or families who are unable to arrange or pay for their transportation or who do not have access to no-cost transportation in order to access medically necessary covered behavioral health services.
|CRISIS INTERVENTION SERVICES|
|Crisis Intervention – Mobile||Services provided by a mobile team or individual who travels to the place where the person is having the crisis (e.g., person’s place of residence, emergency room, jail, community setting)||Includes services aimed at the assessment and immediate stabilization of acute symptoms of mental illness, alcohol and other drug abuse, and emotional distress. The purpose of this service is to:
|Crisis Intervention- Telephone||Services to provide triage, referral, and telephone-based support to persons in crisis; often providing the first place of access to the behavioral health system.||The service may also include a follow-up call to ensure the person is stabilized.|
|Crisis Intervention-Stabilization||Immediate and unscheduled behavioral health service provided: (a) In response to an individual’s behavioral health issue to prevent imminent harm, to stabilize or resolve an acute behavioral health issue; and (b) At an inpatient facility or outpatient treatment center||Crisis intervention services (stabilization) must be provided by facilities that are DLS licensed facilities. Individuals providing these services must be behavioral health professionals, behavioral health technicians or behavioral health para-professionals|
|Hospital||Inpatient services (including room and board)||Provides continuous treatment that includes general psychiatric care, medical detoxification, and/or forensic services in a general hospital or a general hospital with a distinct part or a freestanding psychiatric facility. Also includes 24-hour nursing supervision and physicians on site and on call.|
|Behavioral Health Inpatient Facility||Inpatient psychiatric treatment, which includes an integrated residential program of therapies, activities, and experiences provided to persons who are under 21 years of age and have severe or acute behavioral health symptoms. There are two types of residential treatment centers: Secure - a residential treatment center that generally employs security guards and uses monitoring equipment and alarms.
Non-secure – an unlocked residential treatment center setting.
|Continuous treatment to a person who is experiencing acute and severe behavioral health and/or substance abuse symptoms. Services may include emergency reception and assessment; crisis intervention and stabilization; individual, group and family counseling; detoxification and referral. Also includes 24-hour nursing supervision and physicians on site or on call.|
|Behavioral Health Residential Facility||Residential services are provided by a licensed behavioral health agency. These agencies provide a structured treatment setting with 24-hour supervision and counseling or other therapeutic activities for persons who do not require on-site medical services, under the supervision of an on-site or on-call behavioral health professional.||Room and Board is not covered by Title 19/21 for persons residing in behavioral health residential facilities.|
|Room and Board||The provision of lodging and meals to a person residing in a residential facility or supported independent living setting||Includes but is not limited to services such as food and food preparation, personal laundry, and housekeeping|
|BEHAVIORAL HEALTH DAY PROGRAMS|
|Supervised Day||A regularly scheduled program of individual, group and/or family activities/services related to the enrolled person's treatment plan designed to improve the ability of the person to function in the community||May include the following rehabilitative and support services: skills training and development, behavioral health prevention/promotion, medication training and support, ongoing support to maintain employment, and self-help/peer services.|
|Therapeutic Day||A regularly scheduled program of active treatment modalities||Includes but not limited to services such as individual, group and/or family behavioral health counseling and therapy, skills training and development, behavioral health prevention/promotion, medication training and support, ongoing support to maintain employment, home care training family (family support), medication monitoring, case management, and self-help/peer services|
|Medical Day||A regularly scheduled program of active treatment modalities, including medical interventions, in a group setting.||May include individual, group and/or family behavioral health counseling and therapy, skills training and development, behavioral health prevention/promotion, medication training and support, ongoing support to maintain employment, home care training family (family support), and/or other nursing services such as medication monitoring, methadone administration, and medical/nursing assessments.|