Community Behavioral Health (CBH) and its network of providers do not discriminate against members based on race, sex, religion, national origin, disability, age, sexual orientation, gender identity, or any other basis prohibited by law.

As a CBH member, you have the following rights and responsibilities.

Member Rights

You have the right:

  1. To be treated with respect, recognizing your dignity and need for privacy, by CBH staff and network providers;
  2. To get information that you can easily locate and understand about CBH, its services, and the providers that treat you when you need it;
  3. To pick any CBH network providers that you want to treat you. You may change providers if you are unhappy;
  4. To get emergency services when you need them from any provider without CBH’s approval;
  5. To get information that you can easily understand from your providers and be able to talk to them about your treatment options, without any interference from CBH;
  6. To make decisions about your treatment. If you cannot make treatment decisions by yourself, you have the right to have someone else help you make decisions or make decisions for you. You may refuse treatment or services unless you are required to get involuntary treatment under the Mental Health Procedures Act;
  7. To talk with providers in confidence and to have your information and records kept confidential;
  8. To see and get a copy of your medical records and to ask for changes or corrections to your records;
  9. To ask for a second opinion;
  10. To file a grievance if you disagree with CBH’s decision that a service is not medically necessary for you (information about the process can be found in the Complaints and Grievances section of the CBH website or Member Handbook).
  11. To file a complaint if you are unhappy about the care or treatment you have received (information about the process can be found in the Complaints and Grievances section of the CBH website or Member Handbook).
  12. To ask for a Department of Human Services Fair Hearing (information about the process can be found in the Complaints and Grievances section of the CBH website or Member Handbook).
  13. Be free from any form of restraint or seclusion used to force you to do something, to discipline you, to make it easier for the provider, or to punish you.
  14. To get information about services that CBH or a provider does not cover because of moral or religious objections and about how to get those services.
  15. To exercise your rights without it negatively affecting the way the Department of Human Services, CBH, or network providers treat you.

Member Responsibilities

Members need to work with their providers of behavioral health services. CBH needs your help so that you get the services and supports you need.

These are the things you should do:

  1. Provide, to the extent you can, the information needed by your providers.
  2. Tell your provider the medicines you are taking. Include over-the-counter medicines, vitamins, and natural remedies.
  3. Be involved in decisions about your health care and treatment.
  4. Work with your providers to create and carry out your treatment plans.
  5. Tell your providers what you want and need.
  6. Take your medications as prescribed and tell your provider if there is a problem.
  7. Keep your appointments.
  8. Learn about CBH coverage, including all covered and non-covered benefits and limits.
  9. Use only network providers unless CBH approves an out-of-network provider.
  10. Respect other patients, provider staff, and provider workers.
  11. Report fraud and abuse to the CBH Compliance Hotline and the Department of Human Services Fraud and Abuse Reporting Hotline at 1-844-347-8477.

 

Consent to Mental Health Care

Children under 14 years of age must have their parent’s or legal guardian’s permission to get mental health care. Children 14 years or older do not need their parent’s, or legal guardian’s, permission to get mental health care. All children can get help for alcohol or drug problems without their parent’s or legal guardian’s permission. They can consent to mental health care and have the right to decide who can see their records if they consented to the mental health care. In addition, a parent or legal guardian can consent to mental health care for a child who is 14 years old or older, but under 18 years of age.

The chart below explains who can consent to treatment.

If the Child is Then They
Under 14 years of age Must have parent’s or legal guardian’s permission to get mental health care
14 years of age or older Can get mental health care without parent’s or legal guardian’s permission
Any age Can get help for alcohol or drug problems without parent’s or legal guardian’s permission

It is important for everyone that supports a child to work together and be part of the planning for the child’s care. Everyone that supports a child should, whenever possible, share information necessary for the child’s care.

To learn more about who can consent to treatment, you can contact CBH Member Services. Sometimes it is hard to understand that a child has privacy rights and can consent to mental health care. CBH can help you better understand these rights so that you can provide the best support for your child that you can.

 

Notice of Privacy Practices

Effective Date: May 1, 2020

The Notice of Privacy Practices describes how your medical information may be used and disclosed and how you can get access to this information. Please review it carefully.

 

Billing Information

Providers in CBH’s Network may not bill you for services that CBH covers. Even if your provider has not received payment or the full amount of his or her charge from CBH, the provider may not bill you. This is called balance billing.

When Can a Provider Bill Me?

Providers may bill you if:

  • You received services from an out-of-network provider without approval from CBH and the provider told you before you received the service that the service would not be covered, and you agreed to pay for the service;
  • You received services that are not covered by CBH and the provider told you before you received the service that the service would not be covered, and you agreed to pay for the service;
  • You received a service from a provider that is not enrolled in the Medical Assistance Program.

What Do I Do If I Get a Bill?

If you get a bill from a CBH Network Provider and you think the provider should not have billed you, you can contact CBH Member Services.

If you get a bill from a provider for one of the above reasons that a provider is allowed to bill you, you should pay the bill or call the provider.

 

Third-Party Liability

You may have Medicare or other health insurance. Medicare and your other health insurance is your primary insurance. This other insurance is known as Third Party Liability (TPL). Having other insurance does not affect your Medical Assistance eligibility. In most cases, your Medicare or other insurance will pay your service provider before CBH pays. CBH can only be billed for the amount that your Medicare or other health insurance does not pay.

You must tell both your CAO and CBH Member Services if you have Medicare or other health insurance. When you go to a provider or to a pharmacy it is helpful to show the provider or pharmacy your Medicare card and your ACCESS card. This helps make sure your health care bills are paid.

 

Coordination of Benefits

If you have Medicare, and the service or other care you need is covered by Medicare, you can get care from any Medicare provider you pick. The provider does not have to be in CBH’s Network. You also do not have to get prior authorization from CBH. CBH will work with Medicare to decide if it needs to pay the provider after Medicare pays first, if the provider is enrolled in the Medical Assistance Program.

If you need a service that is not covered by Medicare but is covered by CBH, you must get the service from a CBH network provider. All CBH rules, such as prior authorization and specialist referrals, apply to these services.

If you do not have Medicare but you have other health insurance and you need a service or other care that is covered by your other insurance, you must get the service from a provider that is in both the network of your other insurance and CBH’s network. You need to follow the rules of your other insurance and CBH, such as prior authorization and specialist referrals. CBH will work with your other insurance to decide if it needs to pay for the services after your other insurance pays the provider first.

If you need a service that is not covered by your other insurance, you must get the services from a CBH network provider. All CBH rules, such as prior authorization and specialist referrals, apply to these services.

 

Reporting Fraud and Abuse

How Do You Report Member Fraud or Abuse?

If you think that someone is using your or another member’s ACCESS card to get services, equipment, or medicines, is forging or changing their prescriptions, or is getting services they do not need, you can call the CBH Fraud and Abuse Hotline to give CBH this information. You may also report this information to the Department of Human Services Fraud and Abuse Reporting Hotline.

How Do You Report Provider Fraud or Abuse?

Provider fraud is when a provider bills for services, equipment, or medicines you did not get or bills for a different service than the service you received. Billing for the same service more than once or changing the date of the service are also examples of provider fraud. To report provider fraud you can call the CBH Fraud and Abuse Hotline. You may also report this information to the Department of Human Services Fraud and Abuse Reporting Hotline.

 

Mental Health Advance Directives

A mental health directive is a document that allows you to state the mental health care you want if you become physically or mentally unable to decide for yourself. There are two types of mental health advance directives: Mental Health Declarations and Mental Health Powers of Attorney. If you have either a Mental Health Declaration or a Mental Health Power of Attorney, you should give it to your mental health care providers, and a trusted family member or friend so that they know your wishes.

Both the Mental Health Declaration and the Mental Health Power of Attorney must be in writing. Just saying what you want is not enough.

If the laws regarding Mental Health Declarations and Mental Health Powers of Attorney are changed, CBH will tell you in writing what the change is within 90 days of the change. For information on CBH’s policies on Mental Health Declarations and Mental Health Powers of Attorney, contact CBH Member Services.

Mental Health Declaration

A Mental Health Declaration is a document that you create. It can include:

  • What kind of treatment or care you prefer.
  • Where you would like to have your care take place.
  • Any specific instructions you may have about your mental health treatment.

Your provider must have a copy of your Mental Health Declaration in order to follow it. Your Mental Health Declaration will be used if you are physically or mentally unable to make decisions for yourself. You may revoke or change a Mental Health Declaration as long as you are able to revoke or change it.

Mental Health Power of Attorney

A Mental Health Power of Attorney is a document in which you give someone else the power to make mental health treatment decisions for you if you are physically or mentally unable to make decisions for yourself. It also states what must happen for the Power of Attorney to take effect. To create a Mental Health Power of Attorney, you may but do not have to get legal help. You may revoke or change a Mental Health Power of Attorney as long as you are able to revoke or change it.

Help Creating Mental Health Declarations and Mental Health Powers of Attorney

If you would like to have a Mental Health Declaration or a Mental Health Power of Attorney, or both, and need help creating one, you can contact an advocacy organization such as the Mental Health Association in Pennsylvania (1-866-578-3659 or info@mhapa.org) or Mental Health Partnerships (215-751-1800). They will provide you with forms and answer any questions.

What to Do If a Provider Does Not Follow Your Mental Health Declaration or Your Mental Health Power of Attorney

Providers do not have to follow your Mental Health Declaration or Mental Health Power of Attorney if, as a matter of conscience, your decisions are against clinical practice and medical standards, because the treatment you want is unavailable, or because what you want the provider to do is against the provider’s policies. If your provider cannot follow your Mental Health Declaration or Mental Health Power of Attorney, contact CBH Member Services to help you find a provider that will carry out your wishes.

If a provider does not follow your Mental Health Declaration or Mental Health Power of Attorney, you may file a Complaint.