QUEST Integration - Behavioral Health Services

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

HMSA's behavioral health services are a progressive, data-supported approach to delivering behavioral health care benefits with the goal of improving behavioral health treatment outcomes. The services feature:

Standard Benefit Package

• Outpatient psychiatric or psychological evaluation and treatment including individual and group counseling and monitoring.
• Inpatient hospitalization
• Medically necessary alcohol and chemical dependency services
• Psychotropic medications and medication management.
• One 15-minute medication management and one hour of psychotherapy can be done on the same day as long as the medication management is performed by a psychiatrist and the psychotherapy is conducted by a psychologist.
• Ambulatory mental health services for crisis intervention through the Department of health Adult Mental health Division.
• Methadone management services

Services for Adults with SPMI

Members age 18 years or older with a diagnosis of serious and persistent mental illness (SPMI) are eligible for comprehensive additional behavioral health services within the CCS Program

Benefits for Children with SEBD

Children/youth under age 18 years with a diagnosis of serious emotional behavioral disorders are eligible for additional behavioral health services within the Department of Health, Children and Adolescent Mental Health Division (CAMHD) Support for Emotional and Behavioral Development (SEBD) program.

Precertification Requirements

The QUEST Integration plan requires precertification in specified situations (see QUEST Integration - Services that Require Precertification). Payment for services will not be made unless precertification is obtained through HMSA's Behavioral Health Services QUEST Integration (Carelon Behavioral Health^SM) for the following services:

• All services rendered by providers outside the QUEST Integration network (non-participating).
• 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.

Revision History