Mental Health Outpatient (MHOP)

OP providers may have developed internal policies to manage continuity of care, but the CBE/CBR is not a requirement for this level of care. The unique circumstances of the individual should be considered, and efforts made to minimize the burden of administrative redundancy. A brief review of changes since last contact and confirmation that treatment goals remain relevant is advised. Documentation from other providers can be accepted with member consent and will support strong clinical collaboration and clarity in treatment planning. Frequent billing for CBE/CBR for the same member, without a clear rationale, may raise concerns of Fraud, Waste, or Abuse for regulatory bodies.

Yes. Members should receive support if they indicate concerns with the assigned staff and be given factual information about how a change may affect the continuity of care as well as the benefits of working through interpersonal challenges with a clinician. For members who want to change a provider for any reason, CBH will help to identify a new provider or assist with any provider concerns. Members may be asked to call CBH Member Services at 1-888-545-2600 for help. If the request is related to a concern of ethical or compliance breaches, appropriate reporting is required.

Psychotherapy can be useful in combination with medication to treat mental health conditions through supporting skill development and resolving trauma responses. However, a member has the right to choose if they would like to participate in psychotherapy. Prescribers should clearly explain the provider policy on how often members are expected to have a clinical consult or re-evaluation to support ongoing medication management.

This varies significantly. Ideally, yes, a member would step down from a more restrictive setting to the community with an ample supply of medication to afford adequate time to connect to community-based care and ongoing medication access. However, we know that medication access barriers exist, and at times members will request expedited access to OP care when they have a 7- or 14-day supply and no scheduled refills. Care coordination with probation officers and case managers, as well as the review of discharge paperwork, can support more effective warm handoffs. Pharmacies are an important resource for care coordination and support the appropriate use of the PA Medicaid formulary.

Resource: DBHiDS Behavioral Health and Justice Division – Clinical Unit
CBH may be able to provide information when a member experiences an unplanned discharge and subsequently seeks care. CBH does not pay for medication. Medications, including those taken for behavioral health, are covered by Physical Health Managed Care Organizations (PH-MCO). Please refer to a member’s PH-MCO to find out which medications are covered and recently prescribed.

The individual receiving services must provide informed consent to participate in any services, including utilizing telehealth communication. The individual (including the parent/guardian for any child under 14 years of age) has the right to choose the form of service delivery, which includes the right to refuse telehealth services, without jeopardizing access to other available services within the agency. The members must also be made aware of any alternatives available and any challenges that such alternatives will pose, including delays in service, need to travel, service verification methods, etc. Additional Telehealth considerations are discussed below.

For adolescents aged 14-17, PA Act 65 of 2020 (which supersedes Act 147 of 2004) details the parameters for consent to treatment.

Records concerning persons receiving or having received treatment must be kept confidential and should not be released nor their information disclosed without the consent of a person given under § 5100.34 (relating to consensual release to third parties), except that relevant portions or summaries may be released or copied as follows:

• To those actively engaged in treating the individual, or to persons at other facilities, including professional treatment staff of State Correctional Institutions and county prisons, when the person is being referred to that facility and a summary or portion of the record is necessary to provide for continuity of proper care and treatment.
• To third-party payors, both those operated and financed in whole or in part by any governmental agency and their agents or intermediaries or identified as payors or co-payors for services and who require information to verify that services were provided. Information to be released without consent or court order under this subsection is limited to the staff names, the dates, types, and costs of therapies or services, and a short description of the general purpose of each treatment session or service.

Crisis services are for anyone, anywhere, and anytime. Crisis services include:

• crisis lines accepting all calls and dispatching support based on the assessed need of the caller
• mobile crisis teams are dispatched to wherever the need is in the community (not hospital emergency departments)
• crisis receiving and stabilization facilities that serve everyone that comes through their doors from all referral sources

Outpatient facilities may complete assessments and recommend acute care. Support is available through the Provider Emergency Services (PES) hotline at 215-413-7171.