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Chapter 7: Mental Health and Substance Use

United Behavioral Health, operating under Optum, provides UnitedHealthcare Community Plan members with mental health and substance use disorder (SUD) benefits. The national Optum network manual generally applies to all types of business. Some sections may apply differently based on state law.

The National Optum Behavioral Health manual is located on providerexpress.com.

This chapter does not replace the national Optum network manual. Rather, it supplements the national manual by focusing on Medicaid’s specific services and procedures.

You must have an NPI number to see Medicaid members and receive payment from UnitedHealthcare Community Plan.

To request an ID number, go to the ODM website at medicaid.ohio.gov > Providers > Enrollment and Support > Provider Enrollment.

Credentialing information is available at providerexpress.com > Clinical Resources > Guidelines/Policies & Manuals > Credentialing Plans > Optum.

UnitedHealthcare Community Plan offers covered behavioral health services for mental, emotional and substance use disorders. We offer care management to help members, clinicians, and PCPs using and offering behavioral health services. We provide information and tools for mental health and substance abuse diagnoses, symptoms, treatments, prevention and other resources in one place.

liveandworkwell.com, accessed through a link on myuhc.com, includes mental health and well-being information, articles on health conditions, addictions and coping, and provides an option for members to take self-assessments on a variety of topics, read articles and locate community resources.

For member resources, go to providerexpress.com > Clinical Resources > Live and Work Well (LAWW) clinician center > Mind & Body > Recovery and Resiliency. This page includes tools to help members addressing mental health and substance use issues.

Benefits include:

  • Crisis stabilization services (includes treatment crisis intervention).
  • Inpatient psychiatric hospital (acute and sub-acute).
  • Psychiatric residential treatment facility.
  • Outpatient assessment and treatment:
    • Partial hospitalization
    • Social detoxification
    • Day treatment
    • Intensive outpatient
    • Medication management
    • Outpatient therapy (individual, family, or group), including injectable psychotropic medications
    • SUD treatment
    • Psychological evaluation and testing
    • Initial diagnostic interviews
    • Hospital observation room services (up to 23 hours and 59 minutes in duration)
    • Child-parent psychotherapy
    • Multi-systemic therapy
    • Functional family therapy
    • Electroconvulsive therapy
    • Telemental health
  • Rehabilitation services
  • Day treatment/intensive outpatient
  • Dual-disorder residential
  • Intermediate residential (SUD)
  • Short-term residential
  • Community support
  • Psychiatric residential rehabilitation
  • Secure residential rehabilitation

Some services are available without a referral:

  • Dental care
  • Vision care
  • Women’s routine and preventive health care services provided by a women’s health specialist (obstetrics, gynecology, certified nurse midwife)
  • Specialty care (except for chemotherapy and pain management specialist services)
  • Emergency care
  • Services provided by qualified family planning providers (QFPP)
  • Medicaid Community Mental Health Centers (CMHCs), certified Medicaid providers affiliated with the Department of Mental Health and Addiction Services (MHA) and certified providers affiliated with the MHA and any outpatient participating care provider for routine outpatient therapy.
  • Mental health and substance abuse services
  • Services provided at FQHC)/RHC
  • Dialysis
  • Radiation therapy
  • Mammograms

Access to behavioral health services rendered by other care providers requires prior authorization. This includes outpatient ECT, home health and psychological testing.

Members must use a participating care provider for all self-referred services except for emergency care or for services provided at FQHC/Rural Health Clinics, QFPP, community mental health centers, and Ohio Department of Alcohol and Drug Addiction Services facilities, which are Medicaid providers.

Verify the UnitedHealthcare Community Plan member’s Medicaid eligibility on day of service before treating them. View eligibility online on the Eligibility and Benefits application on Link at UHCprovider.com.

Members may access all behavioral health outpatient services (mental health and substance use) without a referral. Prior authorization may be required for more intensive services, such as intensive outpatient program; day treatment; or partial, inpatient or residential care.

Help ensure prior authorizations are in place before rendering non-emergent services. Get prior authorization by going to UHCprovider.com/priorauth, calling 866-604-3267, or faxing 866-940-7328.

Coordination of Care

When a member is receiving services from more than one professional, you must coordinate to deliver comprehensive, safe and effective care. This is especially true when the member:

  • Is prescribed medication,
  • Has coexisting medical/psychiatric symptoms, or
  • Has been hospitalized for a medical or psychiatric condition.

Please talk to your patients about the benefits of sharing essential clinical information.

Website: UHCprovider.com

Access Link, the gateway to UnitedHealthcare Community Plan’s online tools, on this site. Use the tools to verify eligibility, review electronic claim submission, view claim status, and submit notifications/ prior authorizations.

View the Prior Authorization list, find forms and access the care provider manual. Or call the Provider Services at 800-600-9007 to verify eligibility and benefit information (available 8 a.m. - 5 p.m. Central Time, Monday through Friday).

Website: providerexpress.com

Update provider practice information, review guidelines and policies, and view the national Optum Network Manual. Or call Provider Services at 800-600-9007.

Submit claims using the 1500 Claim Form (v 02/12) or UB-04 form, whichever is appropriate. Use applicable coding, including ICD diagnosis code(s), CPT, Revenue and HCPCS coding. Include all necessary data to process a complete claim. Find out more about filing claims in Chapter 11.

We conduct routine care provider on-site audits. These audits focus on the physical environment, policies and procedures, and quality record documentation.

Combating the opioid epidemic must include prevention, treatment, recovery and harm reduction.

Brief Summary of Framework

  • Prevention:
    • Prevent Opioid-Use Disorders before they occur through pharmacy management, provider practices, and education.
  • Treatment:
    • Access and reduce barriers to evidence-based and integrated treatment.
  • Recovery:
    • Support case management and referral to person- centered recovery resources.
  • Harm Reduction:
    • Access to Naloxone and facilitating safe use, storage, and disposal of opioids.
  • Strategic community partnerships and approaches:
    • Tailor solutions to local needs.
  • Enhanced solutions for pregnant mom and child:
    • Prevent neonatal abstinence syndrome and supporting moms in recovery.
  • Enhanced data infrastructure and analytics:
    • Identify needs early and measure progress.

Increasing Education & Awareness of Opiods

It is critical you are up-to-date on the cutting edge research and evidence-based clinical practice guidelines. We keep Opioid Use Disorders (OUD) related trainings and resources available on our provider portal to help ensure you have the information you need, when you need it. For example, state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines, free substance use disorders/OUD assessments and screening resources, and other important state-specific resources. Additionally, Pain Management Toolkits are available and provide resources to help you identify our members who present with chronic physical pain and may also be in need of behavioral health services to address the psychological aspects of pain. Continuing education is available and includes webinars such as, “The Role of the Health Care Team in Solving the Opioid Epidemic,” and “The Fight Against the Prescription Opioid Abuse Epidemic.” While resources are available, we also work to help ensure you have the educational resources you need. For example, our Drug Utilization Review Provider Newsletter includes opioid trends, prescribing, and key resources.

Access these resources at UHCprovider.com. Then click “Drug Lists and Pharmacy”. Click Resource Library to find a list of tools and education.

Prescribing Opioids

Go to our Drug Lists and Pharmacy page to learn more about which opioids require prior authorization and if there are prescription limits.

Pharmacy Lock-In

Pharmacy lock-ins minimize drug abuse. Pharmacy lock-ins identify and manage members who meet criteria indicative of potential prescription medication misuse or abuse, and specific therapeutic categories with the potential for high abuse, (e.g. narcotic analgesics, narcotic containing cough and cold preparations, sedative hypnotics, central nervous system stimulants, muscle relaxants, controlled substances). When lock-in is determined appropriate, a member is placed into a lock-in where they can only receive prescriptions from a single pharmacy for at least one year.

Evidence-based medication-assisted treatment  (MAT) is central to OUD treatment. MAT takes a chronic condition approach and incorporates medication use in addition to other services, such as counseling, cognitive behavioral therapies, and recovery support, to provide a comprehensive approach to OUD. We expand MAT access and help ensure we have an adequate member MAT network.

To find a behavioral health MAT provider in Ohio:

  1. Go to UHCprovider.com.
  2. Select “Find a Provider” from the menu on the home page.
  3. Select under “Specialty Directory and Tools” the option of Optum Behavioral Health, EAP, Worklife & Mental Health Services.
  4. Click on “Search for a Behavioral Health Provider.”
  5. Enter “city” and “Ohio” for options.
  6. If needed, refine the search by selecting “Medication-Assisted Treatment.”

We contract with OUD Centers of Excellence (where available), which are designated as premier facilities to help ensure people with OUD stay in treatment and receive appropriate follow-up care and supports within their communities.

To find medical MAT providers, see the MAT section in the Medical Management chapter.