Behavioral Health

Cigna-HealthSpring provides comprehensive mental health and substance abuse services to its customers. Its goal is to treat the customer in the most appropriate, least restrictive level of care possible, and to maintain and/or increase functionality.

Cigna-HealthSpring’s network is comprised of mental health and substance abuse services and providers who identify and treat customers with behavioral health care needs. Integration and communication among behavioral health and physical health providers is most important. Cigna-HealthSpring encourages and facilitates the exchange of information between and among physical and behavioral health providers. Customer follow-up is essential. High risk customers are evaluated and encouraged to participate in Cigna-HealthSpring’s behavioral health focused case management program where education, care coordination, and support is provided to increase customer’s knowledge and encourage compliance with treatment and medications. Cigna-HealthSpring works with its providers to become part of the strategy and the solution to provide quality behavioral health services.

Behavioral Health Services

Behavioral Health services are available and provided for the early detection, prevention, treatment, and maintenance of the customer’s behavioral health care needs. Behavioral health services are interdisciplinary and multidisciplinary: a customer may need one or multiple types of behavioral health providers, and the exchange of information among these providers is essential. Mental health and substance abuse benefits cover the continuum of care from the least restrictive outpatient levels of care to the most restrictive inpatient levels of care.

Behavioral Health Services Include:

  • Access to Cigna-HealthSpring's Customer Service for orientation and guidance
  • Routine outpatient services to include psychiatrist, addicitionologist, licensed psychologist and LCSWs, and psychiatric nurse practitioners. PCPs may provide behavioral health services within his/her scope of practice
  • Initial evaluation and assessment
  • Individual and group therapy
  • Psychological testing according to established guidelines and needs
  • Inpatient hospitalization
  • Inpatient and outpatient detoxification treatment
  • Medication management
  • Partial hospitalization programs

 

Responsibilities of Behavioral Health Providers

Cigna-HealthSpring encourages behavioral health providers to become part of its network. Their responsibilities include but are not limited to:

  • Provide treatment in accordance with accepted standards of care
  • Provide treatment in the least restrictive level of care possible
  • Communicate on a regular basis with other medical and behavioral health practitioners who are treating or need to treat the customer
  • Direct customers to community resources as needed to maintain or increase customer’s functionality and ability to remain in the community

 

Responsibilities of the Primary Care Physician

The PCP can participate in the identification and treatment of their customer’s behavioral health needs. His/her responsibilities include:

  • Screening and early identification of mental health and substance abuse issues
  • Treating customers with behavioral health care needs within the scope of his/her practice and according to established Clinical Practice Guidelines. These can be customers with co-morbid physical and minor behavioral health problems or those customers refusing to access a mental health or substance abuse provider, but requiring treatment
  • Consultation and/or referral of complex behavioral health patients or those not responding to treatment
  • Communication with other physical and behavioral health providers on a regular basis

 

Access to Care

Customers may access behavioral health services as needed:

  • Customers may self-refer to any in-network behavioral health provider for initial assessment and evaluation,
    and ongoing outpatient treatment
  • Customers may access their PCP and discuss their behavioral health care needs or concerns and receive treatment that is within their PCP’s scope of practice. They may request a referral to a behavioral health practitioner. Referrals however, are not required to receive most in-network mental health or substance
    abuse services
  • Customers and providers can call Cigna-HealthSpring Behavioral Health Customer Service to receive orientation on how to access behavioral health services, provider information, and Prior Authorizations at
    1-866-780-8546.

 

Medical Record Documentation

When requesting Prior Authorization for specific services or billing for services provided, behavioral health providers must use the current DSM multi-axial classification system and document a complete diagnosis. The provision of behavioral health services require progress note documentation that corresponds with day of treatment, the development of a treatment plan, outcome of treatment and the discharge plan as applicable for each customer in treatment.

Continuity of Care

Continuity of Care is essential to maintain customer stability. Behavioral health practitioners and PCPs, as applicable, are required to:

  • Evaluate customer if he/she was hospitalized for a behavioral health condition within 7 days post-discharge
  • Provide customers receiving care with contact information for any emergency or urgent matter arising that necessitates communication between the customer and the provider
  • Evaluate customer needs when the customer is in acute distress
  • Communicate with the customer’s other health care providers
  • Identify those customers necessitating follow-up and refer to Cigna-HealthSpring’s behavioral health focused case management program as necessary
  • Discuss cases as needed with a peer reviewer
  • Make request to Cigna-HealthSpring for authorization for customer in an active course of treatment with a non-participating practitioner.


Utilization Management

Cigna-HealthSpring’s Health Services Department coordinates behavioral health care services to ensure appropriate utilization of mental health and substance abuse treatment resources. This coordination assures promotion of the delivery of services in a quality-oriented, timely, clinically appropriate, and cost-effective manner for the customers.

Cigna-HealthSpring’s Utilization Management staff base their utilization-related decisions on the clinical needs of customers, the customer’s Benefit Plan, Interqual Criteria, the appropriateness of care, Medicare National Coverage Guidelines, health care objectives, scientifically-based clinical criteria and treatment guidelines in the context of provider and/or customer-supplied clinical information and other relevant information. For requests for behavioral health services that require authorization, Cigna-HealthSpring will approve the request or issue a notice of denial if the request is not medically necessary.