BH Provider Manual - CareOregon

[Pages:69]Behavioral Health

Metro Area Provider Manual

Contents

Values & Principles......................................................................................................................................................3 Values........................................................................................................................................................................3 Principles..................................................................................................................................................................3

Contractual Compliance with Provider Manual..............................................................................................4 Glossary............................................................................................................................................................................5

General Terms.........................................................................................................................................................5 Provider Category Terms ...................................................................................................................................5 Authorization Terms..............................................................................................................................................5 CareOregon Clinical Practice Guidelines...........................................................................................................6 Utilization Management Criteria for Behavioral Health ............................................................................. 7 Mental Health.......................................................................................................................................................... 7 Substance Use Disorder (SUD) ........................................................................................................................ 7 Access ..............................................................................................................................................................................8 Behavioral Health .................................................................................................................................................8 Substance Use Disorders...................................................................................................................................9 Out-of-Office Planning for Independent Practitioners...............................................................................9 Members' Rights ..........................................................................................................................................................9 Members have the right to:................................................................................................................................9 Declaration for Mental Health Treatment ....................................................................................................... 10 Member Assignment & Termination................................................................................................................... 10 Transfers .........................................................................................................................................................................11 Care Integration & Coordination ..........................................................................................................................11 Coordination with Physical Health ..................................................................................................................11 Members with No Identified PCP.................................................................................................................... 12 Members with Chronic Disease...................................................................................................................... 12 Member Complaints.................................................................................................................................................. 12 Resolving Complaints at the Provider's Office........................................................................................... 12 Resolving Complaints at CareOregon.......................................................................................................... 13 Oregon Health Plan Complaint Forms.......................................................................................................... 13 Provider Crisis Response Requirements.......................................................................................................... 13 Interpreter Services .................................................................................................................................................. 13 Privacy and Confidentiality of Member Information & Records ............................................................ 14 Health Related Services, Flexible Options, Mental Health Providers.................................................. 14 Requirements for HRS-Flex Options ............................................................................................................ 15 HRS-Flexible Options Grievance Requirements ...................................................................................... 15 Provider Fee Schedules ......................................................................................................................................... 15

Effective Date: January 1, 2020

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