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Integrated behavioral health

Whole health means focusing on the whole person. So it just makes sense to integrate medical and behavioral health as equal parts on the health care continuum.

Questions?

Check your provider manual (PDF) for answers

Whole health is the goal

Whole health is the goal

We help members and their families by making key connections between medical and behavioral health, as well as disability, wellness and prevention. These are the connections that help members take steps toward whole health. 

 

Behavioral health includes services for the assessment and treatment of mental health and substance use disorders (abuse of alcohol and other drugs). Members who need treatment for mental health, addiction or other behavioral health disorders can get a range of services to meet their health care needs and promote recovery. 

 

We work with members and providers to focus on prevention and wellness by:

 

  • Screening members for medical and behavioral health issues that could lead to illness and referring them to treatment
  • Encouraging providers to adopt a whole-health approach to member care 
  • Offering care coordination services to our members and providers to support integrated behavioral health care 

Treating a member in crisis?

Treating a member in crisis?

You can call our behavioral health hotline 24 hours a day, 7 days a week. Members can call, too. 

 

Call the number based on the plan and service area. Then, choose the option for crisis:

 

CHIP and CHIP Perinatal

 

Behavioral health coverage

Behavioral health coverage

Basic behavioral health

 

These services are provided by medical or behavioral health professionals. Some common services include:

 

  • Screening for common mental health conditions
  • Screening for alcohol or substance use issues
  • Medication management
  • Coordination of referrals to specialized behavioral health services

Members can get behavioral health education and resources on these pages:

 

  • Inpatient mental health services
  • Outpatient mental health services
  • Inpatient substance abuse services
  • Outpatient substance abuse services
  • Targeted case management
  • Mental health rehabilitation

  • Inpatient mental health services
  • Outpatient mental health services
  • Inpatient substance abuse treatment services
  • Outpatient substance abuse treatment services

Effective October 1, 2024, we will offer ILOS to members who are diagnosed with a mental health and/or substance use disorder. ILOS are available to members twenty-one years of age and older. Members must agree to accept ILOS (PDF) instead of a covered service or setting.

 

ILOS includes Mental Health and SUD Partial Hospitalization (PHP) and Intensive Outpatient Programs (IOP). Services require prior authorization. For information on submitting a prior authorization, visit our Prior Authorization page.

Licensed mental health or addiction professionals provide assessment and treatment services in a range of settings to meet the member's needs. Member behavioral health benefits include inpatient and outpatient care. 

Everyone wins with coordination of care

Everyone wins with coordination of care

Working closely with providers to coordinate medical and behavioral care for members ensures appropriate screening, evaluation, treatment and referral for:

 

  • Physical health
  • Behavioral health or substance use disorders
  • Dual or multiple diagnoses 
  • Intellectual and developmental disabilities

Sharing info for healthier members

Sharing info for healthier members

When medical and behavioral health providers work together, members benefit. Our behavioral health and medical providers share information with that goal in mind. This results in appropriate and effective coordination between medical and behavioral health care.

PCPs screen for behavioral health issues

If you’re a PCP, you’ll want to:

 

  • Use behavioral health screening tools, such as those listed in the Texas Medicaid Provider Procedures Manual
  • Treat behavioral health issues within your scope of practice 
  • Help members get specialized behavioral health care when appropriate (PCP referral isn’t required)

Behavioral health providers screen for physical health issues

If you’re a behavioral health provider, you’ll want to:

 

  • Screen members for coexisting medical issues
  • Refer those who have untreated physical health issues to their PCP (with consent), as well as those who haven’t seen their PCP in the past year for a physical exam
  • Provide physical health care services within the scope of your license
  • Share any concerns with their PCP and work together on a care plan (with consent)

Resources

Member self-referrals

 

Covered members can self-refer to any mental health/substance use provider in our network.

 

PCP referrals

 

We promote early intervention and health screening to educate members and find behavioral health problems. To that end, we expect network providers to:

 

  • Screen, evaluate, treat and/or refer (as medically appropriate) any behavioral health problem or disorder
  • Treat mental health and/or substance use disorders within the scope of their practice
  • Call us (number on member’s insurance card) for behavioral health providers in member’s service area or visit our find a provider page

When reviewing requests for clinical authorization, our utilization management processes use the most current:

 

In the event of a denial, you can ask for a copy of the relevant guideline or criteria. Just contact Provider Relations based on the plan and service area.

Also of interest: