Limits to Mental Health/Substance Use Treatment Removed
Posted 7/26/11
Currently, HealthChoice applies limits to its coverage of mental health/substance use disorder treatment; however, effective January 1, 2012, these limits will be removed. The graph below shows the current HealthChoice benefits and the changes that will be effective January 1.
| Mental Health and Substance Use Disorder Treatment |
2011 Benefits | 2012 Benefits |
| Inpatient Treatment Including Day Treatment and Residential Treatment |
Limited to 30 days per calendar year*; certification is required | No limit on the number of days per calendar year; certification is required |
| Outpatient Treatment | Limited to 26 visits per calendar year*; certification is required after 15 visits | No limit on the number of visits per calendar year; certification is required after 15 visits |
Inpatient treatment must be certified within 3 working days of a scheduled hospital admission, or within 1 working day following an emergency admission. To request certification for an inpatient admission, contact APS Healthcare toll-free at 1-800-848-8121.
Outpatient treatment must be certified for medical necessity when visits exceed 15 per calendar year. To request certification for outpatient treatment, contact the HealthChoice Health Care Management Division at 1-405-717-8879 or toll-free 1-800-543-6044, ext. 8879.
For additional information regarding the certification process, call Provider Relations at 1-405-717-8790 or toll-free 1-800-543-6044. You can also reference the Utilization Review section of the HealthChoice Network Provider Manual.
* Exceptions to the 30 day limit are made for diagnoses of schizophrenia, bipolar disorder/manic-depressive illnesses, major depressive disorder, panic disorder, obsessive-compulsive disorder, and schizo-affective disorder.
Last Modified on 07/26/2011