Alcohol and Drug/Chemical Dependency Treatment

Inpatient Benefits

HMSA plans provide unlimited benefits for treatment of drug and alcohol abuse at parity with coverage for other medical conditions for all diagnoses related to substance abuse.

Inpatient services must be performed in a qualified treatment facility that has been specifically accredited to render alcohol or drug dependency services by the state of Hawaii (or by the state in which the facility is located). As with other inpatient services, hospitals must also notify HMSA's Medical Management department to report the admission of a behavioral health or substance abuse patient.

Inpatient Professional Services

HMSA plans provide unlimited benefits for treatment of drug and alcohol abuse at parity with coverage for other medical conditions for services provided to a patient who is confined in a hospital and being treated for a mental illness or alcohol or drug dependency.

Qualified Providers

In compliance with the provisions of the Hawaii Revised Statutes (Chapter 431M), HMSA requires that the treating provider possess one of the following certifications:

• Certified Substance Abuse Counselor (CSAC).
• Certified Substance Abuse Program Administrator (CSAPA).
• American Society of Addiction Medicine (ASAM).
• Board Certification in Addiction Psychiatry.
• American Psychological Association Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders.
• Licensed Clinical Social Worker (LCSW).
• Advanced Practice Registered Nurse (APRN).

Outpatient Benefits

HMSA plans provide unlimited benefits for treatment of drug and alcohol abuse at parity with coverage for other medical conditions for all diagnoses related to substance abuse.

Benefit Limit

The cost of detoxification services and educational programs to which drinking or drugged drivers are solely referred by the judicial system, or services performed by mutual self-help groups, are not eligible for benefits.

QUEST Integration

The QUEST Integration plan requires precertification in specified situations (see Precertification). Payment for services will not be made unless precertification is obtained through HMSA's Behavioral Health Services QUEST Integration (Magellan Hawai’i) for the following services:

• All services rendered by providers outside the QUEST Integration network (nonparticipating).
• All services provided out of state.

Non-medical services such as interisland travel, lodging, and language translation provided in connection with behavioral health care must be authorized by calling QUEST Integration Provider Services.

Precertification

Behavioral health services for commercial,, Postal FEP, Fed 87, and HMSA Plan for Postal Service Employees, members provided as part of the medical plan (such as Speech Therapy Services/Rehabilitation) are subject to the precertification requirements for those medical services. Two-for-one Benefit Exchange also requires precertification. In addition, inpatient admissions for mental health or substance abuse must be reported to HMSA's Medical Management department.

Revision History