Behavioral Health - Community Health Plan of Washington - Medicare Advantage

Behavioral Health

CHPW Medicare Advantage and our providers are responsible for keeping members well, both body and mind. We provide care for our members across the full continuum of physical and behavioral health services.

Your Responsibilities as a Provider

As a primary care provider, you are responsible for coordinating with your patient’s behavioral health provider. You do not need to submit a referral for your patient’s mental health or substance use treatment. If you need help finding an appropriate behavioral health provider for your patient, please call CHPW, or direct your patient to call on their own behalf. No referral is required to see a mental health provider.

As a Behavioral Health Provider in an Integrated Managed Care (IMC) region, you are responsible for conducting an initial assessment for first-time patients to assess their level of need. You will coordinate with your patient’s primary care provider to create an appropriate care plan.

If you are a Behavioral Health Provider in a non-IMC region, you are responsible for conducting an initial assessment to determine treatment needs. You must also assess whether they meet Washington’s Access to Care Standards, and secure follow-up appointments with an appropriate behavioral health provider.

CHPW Will Ensure Access to Care

Providers seeking mental health treatment for their CHPW patients are no longer burdened with making multiple calls. CHPW has a new Customer Service process to take on the responsibility of ensuring access to appropriate mental health providers for members. Simply, instruct members to call customer service if they need help finding a mental health provider. Care management staff that will identify available providers in the area and secure an appointment for your patient.

The new CHPW process is designed to reduce challenges faced by members who are searching for mental health provider. Since primary care providers often help patients access specialty services, including behavioral health, we want to let providers know about the new process for members to call Community Health Plan of Washington customer service.

Multi Chronic Care Management (MCCM)

MCCM is available for high‐risk members with multiple chronic conditions exacerbated by behavioral comorbidities and psychosocial challenges. MCCM focuses on addressing physical, psychological, and social drivers of maladaptive behavior. This helps members increase motivation, adhere to treatment, and achieve their personal health goals. Contact the Care Management team for more information or to refer to a member.

Summary of Services

Psychiatric & Substance Use Disorder

  • Acute Psychiatric Inpatient
  • Evaluation & Treatment
  • Inpatient Acute Withdrawal (Detoxification)
  • Crisis Stabilization in a residential setting
  • Substance Use Disorder inpatient rehabilitation and residential treatment center
  • Psychiatric inpatient residential treatment center
  • Any facility-based service providing 24 hours/day and 7 days per week services

High-Intensity Outpatient Programs

  • Intensive Outpatient Program (IOP)
  • Partial Hospitalization Program (PHP)
  • Day Treatment Program

Community Support Services

  • SUD Recovery Services
  • Psychosocial Case Management/other Case Management services
  • Psychosocial Rehabilitation
  • Peer Support

Psychological and Neuropsychological Testing

Psychological and Neuropsychological testing requires prior authorization and notification.

➔ Download the request form before administering treatment

➔ Review our Medical Management policy on neuropsychological testing

Repetitive Transcranial Magnetic Stimulation

➔ Click here to view billing codes and notes for pre-authorized services

DID YOU KNOW...?

Provider Education and Training

Laughing Female Doctor at Desk in OfficeCHPW provides the resources you need to best care for members and stay compliant with local and federal regulations. Some training programs are optional and others are mandatory.

All CHPW contracted providers and clinic staff must complete the following: Model of Care Training, Patient Rights and Responsibilities & Advance Directives Training, and CMS Fraud, Waste, and Abuse Training.

Learn more about required training in the provider manual.

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