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Coverage criteria policies

Court-ordered care – mental health

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Court-ordered mental health services do not require prior authorization; however, prior notification is required to ensure that the criteria noted below are met. Clinical data must be submitted for concurrent review in order to ensure that after care services are well coordinated. Members may check with the HealthPartners Member Services Department to verify coverage by your health plan.

A copy of the court order and the mental health evaluation it was based on must be submitted with the initial request for services.

Coverage

If a court orders mental health services and the court order is based on a mental health evaluation performed by a psychiatrist or licensed doctoral level psychologist, the services will be covered to the limit of the member’s plan documents and will not be subject to medical necessity review.

Services will be provided by a network or approved provider, unless the court order specifies another provider as required by rule or law, or another provider is approved by the health plan.

The mental health evaluation, on which the order for services was based, will be covered at the in-network benefit level when performed by an in-network provider.

Indications that are covered

In order to be eligible for payment, the services must be covered benefits under the terms of the member’s plan documents.

Indications that are not covered

Services that do not meet the conditions above will be subject to review under medical necessity coverage policies.

Court-ordered chemical dependency services are outside the scope of this policy, but will be subjected to medical necessity reviews.

Services covered under an emergency 72-hour hold are outside the scope of this policy. Coverage for these services are subject to state regulations, with provisions for emergency medical services.

Definitions

Court-ordered services include mental health services which are provided as part of a court hold, any type of commitment (which may include an order for early intervention), a stay of commitment, a continuance, a revocation of a provisional discharge, and mental health services ordered by a court of competent jurisdiction which could include services for a juvenile child adjudicated as needing protection or services, services which may be ordered by a criminal court as a condition of probation, or other circumstances in which a court of competent jurisdiction has included provision of, or participation in, mental health services as a condition in its findings.

Mental health services means all covered services that are intended to treat or ameliorate a mental health, behavioral, or psychiatric condition and that are covered by the policy, contract, or certificate of coverage of the member’s health plan or by law.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. These coverage criteria relating to Minnesota Health Care Programs medical coverage criteria are taken directly from the Minnesota State Statute 62Q.535 at https://www.revisor.mn.gov/statutes/?id=62Q.535

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Policy activity

  • 03/22/2005 - Date of origin
  • 06/27/2017 - Effective date
Review date
  • 05/2017

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