Managing Behavioral Healthcare, 3rd edition, 2010 update
Contents List
¨ Managed behavioral health care – Introduction; Managing behavioral health care; Psychiatric Consultation and Care; Integration of care/Collaborative care; Group therapy; Levels of care - criteria for acute inpatient hospital, day/partial hospital, residential treatment centers, adults and children/adolescents (I, II, III, IV secure), ambulatory care; Medical Necessity defined; Health and Behavioral Intervention Services; Brief therapy or short-term therapy; Behavioral Health Benefits; Telehealth benefit; Evidence for a ‘chronic’ diagnosis; mental health benefit interpretation examples; typical behavioral health limitations/exclusions; Medicare payment criteria for part B Mental Health Services;
¨ Behavioral/Mental Health Services Coverage Criteria – Court ordered mental health services; Psychiatric Diagnostic Interview; Pathologic gambling; List of non-covered conditions/treatments; Transcendental meditation (TM); Eye movement desensitization and reprocessing (EMDR) therapy; Marital counseling, ‘72 hour hold’ admissions; \
Psychotherapy: Psychotherapy, introduction, coverage considerations; Family Medical Psychotherapy; Group Psychotherapy; Interactive Group Medical Psychotherapy; Hypnosis/Hypnotherapy; Individual psychotherapy, insight oriented, behavior modifying, and/or supportive; Interactive Individual Psychotherapy; Narcotherapy;
Testing: Psychological testing; Neuropsychological Testing; Developmental skills testing; Screens;
‘Rebirthing techniques’; Autism, Lovaas therapy for the
management of; Brain mapping or quantitative EEG for the diagnosis of
psychiatric disorders; Stereotactic Cingulotomy; Dyslexia; Electroconvulsive therapy
(ECT); Home Health - Skilled Care for Psychiatric Services; Learning
disabilities; Vision therapy/training; Music therapy; Play therapy; Smoking Cessation; Psychiatric
Pharmacotherapy; Social services, outpatient; Transition
of behavioral health care services;
¨
Behavioral health treatment programs – BH
treatment plans; Triage with screening form; Outreach - monitoring the course of
therapy; Partial
Hospitalization Programs/Day Hospital; Group Therapy; Psychosocial
Rehabilitation Programs; Treatment plan
and authorization form.
¨
Provider issues –
Access standards; therapy goals; behavioral health staffing;
productivity incentives; Provider profiles; Provider compensation; Patient management ‘control’ issues;
Telephone
Communications – a risk management issue; Transition
of behavioral health care services; Discharges Against Medical Advice
(‘AMA’).
¨
Admission
and Discharge criteria for Mental Health
Disorders
–
Inpatient criteria; Observation status; Support network considerations;
Intensity of service/Severity of illness criteria; Severity of illness criteria
justifying acute inpatient therapy; Age-related considerations; Hospital care
reviews; Review for continued medical necessity; Day/Partial treatment programs;
Retrospective review; Criteria not justifying inpatient admission; Criteria
justifying discharge; Case Management; Discharges
Against Medical Advice (‘AMA’)..
¨ Disease State Management/Therapy – Special populations - Geriatric, Obstetric Mental Health; Childhood and Adolescent w/clinical pathway; Suicide - suicide prevention; Therapeutic preschool; Residential treatment centers; Wilderness/Camping/Outdoor Programs
¨ ¨ Case Management (CM) - Policies, Procedures, 'Red Flags', Triggers, CM and Clinical CM functions; Children and Adolescent behavioral health case management; Client Assessment Record (CAR)
¨ Review Criteria and Case Management Guidelines, by disease state –
Alcohol/Chemical Dependency/Substance Abuse; Detoxification – includes: outpatient, Detoxification – inpatient, Continued stay criteria, Discharge criteria; Chemical Aversion Therapy; Electrical Aversion Therapy; Treatment of Alcoholism and Drug Abuse in a Freestanding Clinic; Treatment of Drug Abuse (Chemical Dependency); Methadone treatment; Childhood and adolescent treatment; Inpatient Hospital Stays for the Treatment of Alcoholism; Outpatient Hospital Services for the Treatment of Alcoholism; Alcohol and drug rehabilitation centers; Criteria for admission to a substance abuse rehabilitation program, ‘Open access’ referral P & P for chemical dependency, Chemical dependency benchmarks; Insurance denials for alcohol-related emergency treatment; Web resources;
Auditory Processing Disorder/Central Auditory Processing Disorder (APD/CAPD);
Delirium;
Eating Disorders - Anorexia nervosa, Bulimia nervosa, Residential and outpatient treatment criteria for eating disorders; Obesity; Web resources;
Schizophrenic disorders,
Delusional disorders;
Mood Disorders - Depressive disorders; Cognitive Behavioral Therapy; Transcranial Magnetic Stimulation (TMS); Telephone psychotherapy for depression; Vagal nerve stimulation for depression;
Bipolar Disorders;
Anxiety, Phobias and Somatoform Disorders - Anxiety disorders, Panic disorder, Anxiety disorders of childhood or adolescence; Post-traumatic stress disorder;
Obsessive compulsive disorder (OCD); Psychosurgery for OCD;
Somatoform disorders;
Dissociative Disorders;
Personality Disorders; Dialectical behavior therapy for borderline personality disorder;
Adjustment Disorders; Impulse-Control Disorders, not
otherwise classified: Intermittent explosive disorder, Conduct Disorders,
Oppositional defiant disorder, Attention Deficit/Hyperactivity Disorders;
Cognitive/Mental disorders d/t general medical condition, children, adolescents;
Web resources.
¨
Utilization management –
Behavioral
Health Care: Authorization models; Adult Levels of Care for Psychiatric
Diagnoses: Authorization criteria; Levels of Care Covered Services Model
– summary table/grid; Authorization
procedures; Authorization Process, Forms; Discharge Summary Format; Encounter
Form for Providers; Case Management policy and procedures; Continued Stay Review
Form; LOS and other utilization benchmark data for population groups and by DRG
for all payers and for NY State Medicaid patients; Referral authorization form examples; Other
forms related to UM/QM; Pharmacy
Therapy Compliance Improvement Strategy.
¨ Medical/Behavioral Health Records – Behavioral Health Patient Information Intake form; Acknowledgment form for new patients; Medical Records Release - policy and procedures, example forms; Treatment/Visit Report form; Psychotherapy notes; Psychiatry Summary Information Form for Primary Physician; JCAHO Medical Record Review Form; Web resources.
¨
Consent forms –
Introduction, capacity to consent; Consents for treatment (adult, child), Audio/videotaping release; Standard
introduction to consent statement for any consent; Non-covered services
disclosure format; Treatment of child by Psychiatrist release form;
Confidentiality Agreement; Employee/staff Non-disclosure Agreement; Permission
to contact form; Non-covered
services disclosure format; Consent
to release/exchange information; Employee/staff
non-disclosure agreement; Permission
to Contact form; other forms.
¨
Addenda – Contract to provide capitated behavioral health care services –
example; CMS Pub 09
Rehabilitation Manual, Section 260. Partial Hospitalization Coverage Criteria
for Medicare; CMS Pub 10 Hospital Manual, Section 212. Psychiatric admission
coverage criteria for Medicare.
¨
Glossaries – Glossary National Associations/Organizations For Health Care; BH review
firms, ‘Carve-outs’; Accreditation/Certification for Behavioral Health Care
Organizations; Consultants; Accreditation readiness check lists.
¨ References and resources – Extensive literature references are listed by condition or issue throughout and in this section of the manual.
Click link to view contents list for Disease State Management Guidelines for Behavioral Healthcare on the main page.
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