Mental Health & Substance Abuse Services (Commercial Plan Only

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: Section 7: Outpatient Mental Health Services performed by a LCSW, MFT or Psychologist • 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.

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.

• Diagnosis and counseling for alcohol and/or drug dependency and medical treatment for withdrawal symptoms (includes Methadone maintenance).

• Short term acute detoxification.

• Sober Living Environments are not covered benefits

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SCFHP Members receive Mental Health Services through SCFHP. To arrange for services, contact SCFHP at 1(800) 704-0900.

For Commercial Members, Primary Care Physicians must complete a “Treatment Authorization Request for Services” to a Network psychiatrist and fax it to the UM Department at (408) 885-4875. The “Treatment Authorization Request for Services” must include: • All information in the "Patient Information" box • Request Type (Check One) • Requested Provider • Services Requested • Requesting Provider/Physician (Please print) • MD Signature • Date

VHP will review the request and authorize the services, if appropriate. The authorization will cover a specific time period and number of visits. The PCP, Network Mental Health Specialist and the Member will receive a written notice of the authorization or denial. Except in emergencies, prior authorization is required for psychiatric services. Mental Health Specialists may request an authorization for treatment or continuation by providing a Treatment Plan to UM Department for Mental Health prior to Services. The UM Department may authorize further visits after review of the Treatment Plan. The PCP, Mental Health Specialist and the Member will receive a written notice of the authorization or denial.

Fax Treatment Plans to VHP UM Department at (408) 885-4875.

Formulary Drug prescriptions are filled at VHP Network Pharmacies. To Request Non-Formulary Drugs, a Physician must complete the “Non-Formulary Drug Request” form (see-Section 14 Forms & Attachments and mail to VHP Utilization Management Department or fax to (408) 885-4875. Upon receipt, the UM Department will review and process the request within 48 hours or two working days.