Behavioral Health

Health Net Behavioral Health does not require authorization for in-network routine outpatient services, such as psychotherapy and medication management.

The health plan does perform retrospective review on routine outpatient treatment using a population-based model that reviews provider practice patterns and treatment that is at variance with expected treatment norms. Health Net is committed to the quality of our members' treatment experience and our outpatient review process reflects this focus.

Psychological and neuropsychological testing are covered services in most benefit plans and require prior authorization by Health Net Behavioral Health. Other services such as Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS), Intensive Outpatient Programs, Partial Hospital Programs, and Applied Behavioral Analysis (ABS) also require prior authorization.

For questions or to obtain services requiring prior authorization, it is recommended that you contact Health Net Behavioral Health utilizing the number on the back of the member ID card.

Health Net Behavioral Health utilizes a number of resources in the development of Clinical Practice Guidelines, including our own research on the effectiveness of elements of the guidelines, reviewing the literature about treatment of disorders and reviewing guidelines from professional organizations. These guidelines are reviewed by quality committee and then submitted to the Medical Affairs Committee (MAC) for further review and approval.

We currently have the following Clinical Practice Guidelines:

• Guidelines for When a Therapist is Seeing a Member More Than Once Weekly in Outpatient Treatment (PDF)
• Guidelines for When a Therapist is Seeing More Than One Family Member at a Time in Outpatient Treatment (PDF)
• Guidelines Regarding Dual (PDF)
• Medical Necessity (PDF)

We currently have the following Clinical Position Papers:

• Ketamine Use for Treatment Resistant Depression or PostTraumatic Stress Disorder (PDF)
• Position Statement on Medication Assisted Treatment Guidelines for Substance Use Disorders (PDF)
• Position Statement on Criteria and Guidelines for Authorization of Psychological and Neuropsychological Testing (PDF)
• Position Statement on Harm Reduction in Substance Use Disorder Treatment (PDF)
• Position Statement on the Utilization of Intranasal Spray of Spravato (esketamine) for Treatment of Treatment-Resistant Depression (PDF)
• Position Statement on Wilderness Programs (PDF)
• Position Statement on Criteria Standards for Single Case Agreements (PDF)
• Position Statement on Highly Specialized Populations (PDF)

These documents are available online via the links above. It is important to remember that the guidelines are suggestions for treatment, and elements of the guidelines may not be applicable in all cases. You must use your clinical judgment in making final decisions about application of the guidelines.

In response to accrediting requirements, Health Net evaluates compliance with our Practice Guidelines in the following ways:

For Substance Use Disorder, we monitor:

• whether the patient was referred to a self-help/peer support group
• the HEDIS AOD Initiation Measure
• the HEDIS AOD Engagement Measure
• the HEDIS FUA Measure

Information gleaned from the evaluation of compliance with the Clinical Practice Guidelines will be used both to improve practitioner performance and also assist us in our continuous process to update and improve our Clinical Practice Guidelines.

Treatment Record Documentation Standards

1. Each page in the treatment record contains the patient's name/identification number.
2. Each record includes the patient's address, employer or school, home and work telephone numbers including emergency contacts, marital/legal status, appropriate consent forms and guardianship information, if relevant.
3. All entries in the record include the provider's name, signature, professional degree, and identification number (if applicable).
4. All entries are legible.
5. All entries are dated.
6. Each record includes copies of appropriate release of information, consistent with State/Federal regulations.
7. Informed consent for medication/treatment and the patient's understanding of the treatment plan is documented.
8. Presenting problems and relevant psychological and social history affecting the patient's medical and psychiatric status are documented.
9. Special situations such as imminent risk of harm and suicidal ideation are prominently noted, documented and revised. For patients who become homicidal, suicidal, or unable to conduct activities of daily living and are promptly referred to the appropriate level of care, the disposition is noted.
10. If applicable, each record indicates what psychotropic medications have been prescribed, dosages of each, and dates of prescription or refills. Each record indicates that psychotropic medication side effects have been explained.
11. If applicable, each record indicates that results of laboratory tests, if ordered, have been documented and reviewed.
12. If applicable, allergies and adverse reactions and/or lack of known allergies/sensitivities to pharmaceutical and other substances are prominently noted.
13. A medical and psychiatric history is documented, including previous treatment dates, provider identification, therapeutic interventions and responses, sources of clinical data, and relevant family information.
14. A complete developmental history for children and adolescents, including prenatal and postnatal events, is documented.
15. A substance use disorder assessment for patients 12 and older, which includes past and present use of cigarettes and alcohol, as well as illicit, prescribed and over-the-counter drugs, is documented.
16. A mental status evaluation, which includes the patient's affect, speech, mood, thought content, judgment, insight, attention/concentration, memory and impulse control, is documented.
17. A DSM-5 Diagnosis code and criteria is documented, consistent with the presenting problems, history, mental status examination, and/or other assessment data. This will include insight specifier (good, poor, absent), diagnosis specific severity scale, and diagnostic rule out.
18. Treatment plans are consistent with diagnoses and have objective, measurable goals and estimated time frames for goal attainment or problem resolution. The focus of treatment interventions is consistent with the treatment plan goals and objectives.
19. Progress notes describe patient strengths and limitations in achieving treatment plan goals and objectives.
20. Patient/family education and recommendations are documented.

MHN Treatment Record Handling Standards

1. Providers will maintain confidentiality of treatment records according to applicable state and federal regulations.
2. Providers will limit access to treatment records.
3. Providers will release treatment records only in accordance with a court order, subpoena, or statute. Providers should assure that any such request for records be legally obtained.
4. Treatment record locations must be secure and accessed only by approved personnel.
5. Any treatment records sent to storage must be secure and retrievable.
6. The treatment record must be available at each appointment.
7. Purging of treatment records must be done according to state statute.

Following are forms commonly used by practitioners working with Health Net.

• Provider Dispute Resolution Request Form (PDF)
• Non-Contracted Provider's Waiver of Liability Form (Medicare Appeals) (PDF)