2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Behavioral Healthremove barriers to care, and promote familyinvolvement. School-based providers arerequired to coordinate with the member’sassigned care coordinator as well as otherproviders.Need to coordinate Centennial Carebehavioral health services with non-Medicaidservices. Many times members benefit fromcommunity services that are not part of thebenefits they receive from Centennial Care.Communication and coordination by theprovider with these services increasecompliance with the members’ overalltreatment objective.Need to coordinate Centennial Carebehavioral health services with a provider inthe planning of institutional care for themember.Need to coordinate Centennial Carebehavioral health services with the member’sassigned PCP and the behavioral healthprovider.Need to coordinate Centennial Carebehavioral health services with CSAs whenthe CNA is being performed.Need to coordinate Centennial Carebehavioral health services with servicesprovided by the Children, Youth, and FamiliesDepartment (CYFD).Need to coordinate Centennial Carebehavioral health services provided to childrenin tribal custody or under tribal supervision.Presbyterian Centennial Care PCPs are required torefer members for behavioral health services whenthey identify one or more of the following:Suicidal or homicidal ideation or behaviorRisk of hospitalization because of a behavioralhealth conditionChildren or adolescents at imminent risk ofout-of-home placement in a psychiatric acutecare hospital or residential treatment facilityThe member is a victim of traumaThere is serious threat of physical or sexualabuse or risk to the member’s life or healthbecause of the member’s impaired mentalstatus and judgment, mental retardation, orother developmental disabilitiesRequest by a member or representative forbehavioral health servicesClinical status that suggests the need forbehavioral health servicesIdentified psychosocial stressors andprecipitantsTreatment compliance complicated bybehavioral characteristicsBehavioral and psychiatric factors influencingmedical conditionVictims or perpetrators of abuse or neglectand members suspected of being subject toabuse or neglectNon-medical management of substanceabuseFollow-up to medical detoxification9-72014 Practitioner and Provider Manual - Ver. 3