Mental Health Coverage
Mental Health and Substance Use Disorder Services for All Ages
If You or a Loved One Is In Crisis, Dial 988 for the Suicide & Crisis Lifeline 24/7
If emergency medical care is needed, call 911 or go to the emergency room of your nearest hospital.
No Referral Needed
You don’t need a referral from your primary care doctor to access mental health and substance use disorder services. However, only services offered through participating providers will be covered, except in limited circumstances. The best way to ensure coverage is to find a provider in your network before taking the next step.
Ready Access to Services
When a mental health or substance use disorder service is not available from a participating provider within geographic and timely access standards, Community Care Health will arrange for you to get the service from a non-participating provider. This includes any necessary follow-up care. You will pay no more than the amount you would pay for the same covered services received from a participating provider.
SimpleBehavioral
Community Care Health has partnered with SimpleBehavioral to provide mental health and substance use disorder services. Members have direct access to participating providers for mental health and substance use disorder services without obtaining a referral from their primary care doctor.
While they might not need a referral, certain services, such as applied behavior analysis (ABA) and facility-based services, require prior authorization. Services requiring prior authorization are identified on our prior authorization list.
Providers and members can call SimpleBehavioral at (888) 425-4800 to request prior authorization. The line is available 24/7/365. For all other questions, please call SimpleBehavioral at (855) 424-4457.
CCH Plan Coverage
As a Community Care Health member, you have access to all medically necessary mental health and substance use disorder services including, but not limited to:
- Office visits with mental health professionals
- Inpatient hospital services
- Intensive outpatient services
- Partial hospitalization services
For more information about your benefits, please see your Evidence of Coverage or call Customer Service toll-free at 1-855-343-2247.
Utilization Review Criteria
If you are interested in learning more about the criteria we use to review the medical necessity of mental health and substance-use disorder services, please log in to the member portal. If you don’t already have an account, click here to sign up.
Other stakeholders who are interested in mental health and substance use disorder utilization review criteria education programs can find that information below.
| Criteria | Education Program |
|---|---|
| The American Society of Addiction Medicine (ASAM) Criteria | Enroll online at: https://elearning.asam.org/products/the-asam-criteria-utilization-management-course |
| Level of Care Utilization System (LOCUS) | Enroll online at: http://locusonline.com/training.asp |
| Child and Adolescent Level of Care Utilization System/Child and Adolescent Service Intensity Instrument (CALOCUS/CASII) | Enroll online at: https://www.aacap.org/Shared_Content/Shop/Categories/CASII-ESCII.aspx |
| Early Childhood Service Intensity Instrument (ECSII) | Enroll online at: https://www.aacap.org/Shared_Content/Shop/Categories/CASII-ESCII.aspx |
| World Professional Association for Transgender Health (WPATH) Standards of Care | Contact WPATH at: www.wpath.org |