Mental Health & Substance Abuse Services (Commercial Plan Only) Mental Health Services Valley Health Plan Commercial Members are eligible to receive the following Outpatient Counseling services. The following Outpatient Services do NOT require an authorization; Member must see a VHP Network provider: • • • • •
Evaluations, crisis intervention, and short-term therapy. Counseling services including, but not limited to assessment, diagnosis, and treatment planning (if couples or family counseling, all attendees must be eligible VHP Members). Psychological and neuropsychological testing performed by a Psychologist. Individual and group psychotherapy. Applied behavior analysis and evidence-based behavior intervention programs that develop or restore, to the maximum extent practical, the functioning of an individual with Pervasive Developmental Disorder or Autism.
Valley Health Plan Commercial Members are eligible to receive the following services. These services require Prior Authorization; Member must see a VHP Network provider: • • •
Inpatient Mental and Behavioral Health Services Psychiatrist visits for evaluation and treatment. Crisis intervention, crisis residential services and partial hospital services.
Substance Abuse Treatment Services The Member may contact the Gateway Program at 1-800-488-9919. A Member may request Substance Abuse treatment services directly from the Gateway Program. Gateway will assess the Member’s needs and if appropriate, accept for treatment. The Gateway Program will notify VHP Utilization Management (UM) Department of a referral on the first business day after the referral. Outpatient Substance Abuse Services • Diagnosis and counseling for alcohol and/or drug dependency and medical treatment for withdrawal symptoms (includes Methadone maintenance). Inpatient Substance Abuse Services • Short term acute detoxification. Residential Recovery Services • Sober Living Environments are not covered benefits
www.valleyhealthplan.org rev.2020
Section 7
Page 31 of 68
SECTION 7: MENTAL HEALTH & SUBSTANCE ABUSE SERVICES (Commercial Plan Only)
Outpatient Section 7: Mental Health Services performed by a LCSW, MFT or Psychologist
