MBHP Provider Manual - Masspartnership

1 2022 MBHP Provider Manual Please click on the links below to find the section/document you are looking for. Credentialing Criteria Medical Necessity Criteria Performance Specifications Chapter 1: Welcome and Introduction Chapter 2: Clinical Operations Chapter 3: Administrative Operations Chapter 4: Quality Management Chapter 5: Provider Quality Management and Credentialing MBHP Provider Manual : Welcome and Introduction 2022 1 Welcome and Introduction Welcome and Introduction 2 MBHP Goals 3 MBHP Services Principles of Recovery and Rehabilitation 4 Cultural Humility 5 Special Populations 5 Data-Driven Network and Utilization Management 6 Evidence-Based Clinical Practices 7 Integration of Medical and Behavioral Healthcare 7 Integrated Care Management Services 7 MBHP Contacts Main Office - Boston 8 Glossary of Terms 10 MBHP Provider Manual .

2 Welcome and Introduction 2022 Page 2 of 25 Welcome and Introduction Welcome to the Massachusetts Behavioral Health Partnership s (MBHP) Provider network. We at MBHP feel privileged to work with a network of behavioral healthcare professionals who share our commitment to providing the highest quality mental health and substance use disorder services to our Members. We especially appreciate your support in advancing the Commonwealth s vision of a comprehensive, integrated, equitable healthcare delivery system that ensures access, quality, and cost-effectiveness, with an emphasis on being person-centered and recovery-oriented. Under contract with the Commonwealth s MassHealth Behavioral Health Program, MBHP (a Beacon Health Options company) manages mental health and substance use disorder services for 678,864 Members in MassHealth s Primary Care Clinician (PCC) Plan, Community Care Cooperative (C3), Mass General Brigham ACO, Steward Health Choice, and 51,396 Members in the BeHealthy Partnership.

3 In addition, MBHP manages these services for children in the care or custody of the state, including the Departments of Children and Families and Youth Services, and a subset of children who have commercial coverage as their primary insurance are also covered. MBHP s network includes more than 3,500 behavioral health providers, including more than 1,752 individual providers, 111 outpatient clinics, 356 group practices, and 100 inpatient mental health facilities. Currently, 74 percent of all child psychiatrists in Massachusetts are practitioners in our network. In addition, we work closely with more than 380 primary care practices across Massachusetts. In addition to general network management, MBHP collaborates with our providers to address social determinants of health (SDOH), the conditions in which individuals live, work, and play that affect a wide range of health risks and outcomes.

4 Through a variety of clinical initiatives and programming, we work with our providers to address factors in our Members environments that impede their emotional well-being, such as a lack of stable housing, inadequate nutritious food, and racism. MBHP shares MassHealth s commitment to advancing health equity and reducing health disparities. This commitment is a guiding principle in all our work. The MBHP Provider Manual has been developed to answer your questions about MBHP and to provide information about how our services are delivered and managed. The Manual contains background information about MBHP clinical goals and important information and guidelines about referrals, service authorizations, and claims submission. Following these guidelines will help ensure that you receive timely service authorizations and claims reimbursement.

5 A glossary of frequently used terms and copies of required forms are also included for your reference. Thank you for your participation in the MBHP Provider network. If you have any questions or comments regarding the Manual , please contact our Community Relations Department at 1-800-495-0086. MBHP Provider Manual : Welcome and Introduction 2022 Page 3 of 25 Important Notice MBHP s Provider Manual and Provider Agreement outline the current requirements for participation in the MBHP network. Please note that the Provider Manual is an online product that is continuously updated as information changes. Therefore, every time you access the Provider Manual on MBHP s website, , you will be accessing the most up-to-date information relevant to providers. The MBHP Provider Manual is an extension of MBHP Provider Agreements.

6 In combination, the MBHP Provider Manual and the MBHP Provider Agreement outline the current requirements for participation in the MBHP network. To ensure that you have the most up-to-date information, MBHP will notify providers about any changes in its policies via Provider Alerts and Beacon/MBHP Broadcasts. It is important to note that the Provider Manual and all MBHP Provider Alerts and Beacon/MBHP Broadcasts are considered part of the Provider Agreement, and as such, providers are required to adhere to all changes outlined in these materials. MBHP reserves the right to interpret all terms or provisions in this Manual and to amend the Manual at any time. To the extent that there is an inconsistency between the Manual and the Provider Agreement, MBHP reserves the final and binding right to interpret such inconsistency.

7 MBHP providers may access the Provider Manual online at To do so, providers must complete a website registration form, which can be filled out electronically or downloaded from the Behavioral Health Provider log in page at Alternatively, a copy of the registration form may be requested by contacting the Community Relations Department at 1-800-495-0086. MBHP Goals The mission of MBHP is to help Members live their lives to the fullest potential, to improve the quality of mental health and substance use disorder care for MBHP Members, and to support the goals of the MassHealth Behavioral Health Program. In keeping with this mission, MBHP s goals are to: Continuously improve the quality of care available to MBHP Members by monitoring, measuring, and addressing opportunities to improve all aspects of service delivery, including clinical, recovery, network, administrative, and quality management services; Meet the behavioral and primary healthcare needs of MBHP Members, as they define them, and incorporate a strong focus on consumer and family involvement, rehabilitation, and recovery in all program aspects; Advance health equity by addressing social determinants of health and implementing initiatives to reduce health disparities; Strengthen the overall integration of the behavioral health service delivery system across state agencies, community-based organizations, and institutional providers.

8 MBHP Provider Manual : Welcome and Introduction 2022 Page 4 of 25 Improve cost-effectiveness of care delivery by ensuring the availability and appropriateness of services; and Improve integration of primary care with behavioral healthcare through quality-driven network management activities and care management. MBHP s goals are reflected in virtually every action taken by MBHP staff on behalf of Members, from negotiating annual program goals and objectives, to monitoring program responsiveness and outcomes, training providers and families, and sponsoring joint quality initiatives. MBHP Services MBHP engages in a wide range of clinical and administrative activities to serve MBHP Members. The following material provides a sample of MBHP programs and focus areas. Principles of Recovery and Rehabilitation MBHP has a strong commitment to promoting the principles of recovery and rehabilitation in the treatment of its Members and aims to integrate recovery principles and values into its service system, creating conditions to empower individuals, organizations, and providers to achieve transformation throughout the state.

9 These principles hold that working in partnership with people to assist them in meeting their self-generated life goals of increasing social connection, health, work, and/or other useful activity leads to greater safety, stability independence and inter-dependence. In a recovery-oriented health care system, an important source of support comes from "peer specialists" - that is, individuals with lives behavioral health experience, who are trained and certified, and are working in paid or voluntary capacities to support Members currently receiving services. MBHP s dedicated Rehabilitation and Recovery (RR) Department provides the expertise and leadership in building a recovery infrastructure that allows MassHealth members to access timely and appropriate services and supports to lead lives of safety, stability, and contribution to their communities.

10 MBHP also maintains strong ties to recovery-oriented community organizations, both by working with them on projects and by soliciting their input and feedback on services and supports. Member feedback is also obtained and implemented regularly through consultation with our Consumer and Family Advisory Councils, and Member and family voices have been prioritized since MBHP s inception. MBHP has been at the forefront of launching innovative programs that foster rehabilitation and recovery principles and has long supported organizations run by persons in recovery from behavioral health conditions. MBHP is ensuring the Provider network s dedication to the principles of recovery by: 1. Helping providers focus on recovery, strengths, and wellness, rather than on symptom management; 2. Offering Members the opportunity to learn from others who are in long-term recovery from behavioral health conditions; 3.