Behavioral Health Care

Behavioral Health Care

More Effective Care Planning and Management

Behavioral Health Care includes:

  • Behavioral health guidelines – Identify the most effective level of care for specific behavioral conditions.
  • Level of care guidelines – Assess a patient’s level of care needs in situations when a diagnosis-specific guideline does not apply.
  • Therapeutic and testing procedures – Provide specific criteria for determining when a procedure, treatment, or diagnostic test may be indicated.
  • Detailed discharge criteria – Focus on specific care elements to consider when discharging patients to a lower level of care.
  • Flexible recovery courses – Manage longer behavioral health episodes with recovery courses listed in care days for inpatient treatments and stages for outpatient treatments.
  • Alternative care planning – Select effective alternative therapies and levels of care based on the specifics of a patient’s case.
 
Qualified healthcare professionals may use our guidelines as a tool to support medical necessity decisions, but they should not use them as the sole basis for denying treatment or payment. Our guidelines must be applied to individual patients on a case-by-case basis and always in the context of a qualified healthcare professional's clinical judgment. 
 
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