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Mental Health Care (Inpatient) Blue Cross and Blue Shield of Illinois Provider Manual HMO Scope of Benefits Section 2020 Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association BCBSIL Provider Manual — June 2020 1 Mental Health Care (Inpatient) Benefit Mental health services are in benefit when provided for the treatment of a mental illness. The extent of inpatient benefits available to any given member is defined by the member’s benefit plan and state law. (Refer to the HMO Benefit Matrix for a description of these benefits.) Separate benefit programs cover Mental Health and Chemical Dependency. Effective Jan. 1, 2019, Public Act (PA)100-1024 created a new definition as follows: "Mental, emotional, nervous, or substance use disorder or condition" means a condition or disorder that involves a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the current edition of the International Classification of Disease or that is listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. In addition, the Public Act deleted the definition of “serious mental illness.” (Included for historical purposes) In June 2006, the law Public Act (PA) 094-0906 and PA 094-0921 was signed impacting the existing Illinois Compiled Statutes (215 ILCS 5/370c). This law required all HMOs to comply with all provisions of the SMI statute effective Jan. 1, 2007. SMI includes psychiatric illnesses of: • Schizophrenia • Paranoid and other psychotic disorders • Bipolar disorders (hypo manic, manic, depressive, and mixed) • Major depressive disorders (single episode or recurrent) • Schizoaffective disorders (bipolar or depressive) • Pervasive developmental disorders (PDD) – see Autism scope for additional information • Obsessive-compulsive disorders • Depression in childhood and adolescence • Panic disorder • Post-traumatic stress disorders (acute, chronic, or with delayed onset) • Anorexia Nervosa (effective Jan. 1, 2008) • Bulimia Nervosa (effective Jan. 1, 2008) • Eating disorders, including but not limited to, anorexia nervosa, bulimia nervosa, pica, rumination disorder, avoidant/restrictive food intake disorder, other specific feeding or eating disorder (OSFED), and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (effective Aug. 24, 2017) Refer to the note at the end of this section for a list of SMI diagnosis. Interpretation Based on medical necessity, the Primary Care Physician should approve a referral for all inpatient services with a primary psychiatric diagnosis (except for chemical dependency services—please see Benefits Interpretation for Chemical Dependency). All services must be delivered by a mental health professional (defined as a psychiatrist, psychologist, psychiatric social worker, or other mental health professional under the supervision and guidance of a physician). Services may include individual psychotherapy, group therapy, family therapy, pharmacotherapy, electroconvulsive therapy. Justification for an inpatient admission can include, but is not limited to the following: • Manic, markedly agitated and/or depressed behavior. • Incapacitating physical and/or mental changes. • Disorientation, depersonalization or confusion. • Homicidal or suicidal acts or significant threats; uncontrolled destructive behavior towards self, others, or personal property. • Child and adolescent behavioral disorder that reflects a recent onset or exacerbation - usually with a precipitating event- with the capacity to establish a therapeutic alliance and a reasonable expectation for a positive response to treatment. BCBSIL Provider Manual — June 2020 2 A mental health inpatient admission is not in benefit (without a mental health diagnosis) for reasons such as: • Behavioral dysfunction such as truancy, family conflicts, runaways, clashes with authority, delinquent behavior, drug abuse, manipulative provocation, rebelliousness, or as an alternative to jail. • Diagnostic evaluations that could be performed on an outpatient basis. • Non-medical purposes such as the need for a structured environment, non-supportive home environment, court-mandated admission (in absence of medical necessity), or absence of a halfway house, boarding school, or other such facility. If a necessary mental health inpatient admission is prolonged for these or other non-medical reasons, benefits will not be extended past the period of medical necessity. Partial hospitalization, intensive outpatient psychiatric programs and residential programs are included in the member’s inpatient mental health benefit. Members admitted to BCBSIL contracted psychiatric partial hospitalization programs or intensive outpatient programs will have everyone day in the program charged as 0.25 units towards the IPA’s Utilization Management (UM) Fund. Everyone day in a residential facility will be charged as 0.5 unit towards the IPA’s UM Fund. Serious Mental Illness (SMI) Policies issued or renewed after Jan. 1, 2007, are subject to the provisions of (215 ILCS 5/370c). This law provided additional coverage for inpatient and outpatient services: • Increased inpatient mental health benefits to 45 days in addition to the purchased benefits • Increased outpatient mental health benefits to include 60 visits in addition to the purchased benefits • Twenty additional speech therapy visits for members with a PDD diagnosis • Allowed members to self-refer to any mental health provider (regardless of contracted status) for a non- SMI diagnosis and receive 50 percent coverage. The benefits are described in the paid by section of this scope. The IPA should stamp any self-directed claims as NGA OON (out of network) and submit them to the HMO. • No impact on coverage for chemical dependency Effective Aug. 1, 2012, the HMOs have made an administrative decision to cover diagnosis code 311 for members under 18 years of age as a non-SMI diagnosis. Effective Aug. 24, 2017, the Public Act 100-0305 updated the definition of a SMI to include: eating disorders, including, but not limited to, anorexia nervosa, bulimia nervosa, pica, rumination disorder, avoidant/restrictive food intake disorder, other specified feeding or eating disorder (OSFED), and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. BCBSIL Provider Manual — June 2020 3 Mental Health Parity Mental Health Parity and Addiction Equity Act of 2008 The Emergency Economic Stabilization Act of 2008 included the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (The MHPAEA or ACT). The ACT does not require coverage of mental health (MH) or substance use (SU) benefits but if plans do cover such benefits, it required that group health plans and group health insurers apply the same treatment and financial limits to medical-surgical and mental health and substance use disorders. Under this law, all previous day/visit limits were removed for a member being treated by a mental health provider. The requirements of the new law were effective for plan years beginning on or after one year from the date the legislation was signed into law. (Oct. 3, 2008). As a result, the provisions applied to new contracts and renewals on or after Oct. 3, 2009, but not before Nov. 1, 2009. From Nov. 1, 2009, through July 1, 2010, a copay was charged based upon provider type (e.g. a specialist visit would have the specialist copay charged). Starting July 1, 2010, upon employer group renewal; the copay policy is: • If a member is treated by their PCP, the PCP co-pay is applied. • If a member is treated by any MH/SU professional, the PCP co-pay is applied. • If member is seeing a rehab therapist, the rehab co-pay applies. The co-pay is applied as above whether it’s SMI or Non-SMI or Substance Use Disorder. Paid by GA Professional Charges IPA Professional Charges (in area - non SMI/SMI/Substance Use – HMO – 50% paid to the provider non-emergency - NGA) if accepts benefit assignment, to the member if does not Professional Charges (out of area emergency – regardless of HMO diagnosis) Outpatient lab services billed independently of a group IPA approved residential program services GA Facility Charges HMO Facility Charges (in area - non SMI/SMI/Substance Use – non- HMO - 50% paid to provider emergency - NGA) Facility Charges (out of area emergency – regardless of HMO diagnosis) Special Coverage Note—Electroconvulsive Therapy (ECT) Inpatient ECT services are in benefit. These services are considered to be medical services. ECT is subject to the usual Utilization Management Fund chargeback. BCBSIL Provider Manual — June 2020 4 List of Serious Mental Illness (SMI) – ICD-10 Diagnosis Code DESCRIPTION F20.0 Paranoid Schizophrenia F20.1 Disorganized Schizophrenia F20.2 Catatonic Schizophrenia F20.3 Undifferentiated Schizophrenia F20.5 Residual Schizophrenia F20.8 Other Schizophrenia F20.81 Schizophreniform Disorder F20.89 Other Schizophrenia F25.0 Schizoaffective Disorder, Bipolar Type F25.1 Schizoaffective Disorder, Depressive Type F25.8 Other Schizoaffective Disorders F25.9 Schizoaffective Disorder, unspecified F28 Other Psychotic Disorder not due to a Substance or known physiologic condition
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