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Coverage criteria policies

Designated network for children’s psychiatric residential treatment services

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

All Children’s Psychiatric Residential Treatment Services require prior authorization and concurrent review.

Requests are to be directed to the HealthPartners Behavioral Health Department at telephone triage line 952-883-7501 or 1-866-669-3856 or fax at 952-853-8830.

Coverage

The purpose of the designated network for psychiatric residential treatment services is to provide care for the state mandated services per Minnesota statute 62A.151 Health Insurance Benefits For Emotionally Disabled Children.

Children’s Psychiatric Residential Treatment Services are covered at the highest benefit level when they are delivered by a facility in the Designated Network for Children’s Psychiatric Residential Treatment Services.

For members living in Minnesota and Wisconsin, the program in the Designated Network is:

  • Eau Claire Academy: Eau Claire, Wisconsin

For members living outside of Minnesota and Wisconsin, the programs in the national network will be considered the Designated Network.

In the case that the designated network program lacks capacity to admit a child or adolescent, the Behavior Health department will assist in accessing an alternative residential treatment program and in these cases, coverage will be at the best level.

Definitions

Children’s psychiatric residential treatment services are a 24 hour a day program providing therapeutic treatment and supervised room and board services.

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. Minnesota State Statute 62A.151 Health Insurance Benefits For Emotionally Disabled Children

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Policy activity

  • 07/26/2007 - Date of origin
  • 08/01/2017 - Effective date
Review date
  • 08/2018
Revision date
  • 02/10/2017

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