Behavioral Health Treatment
Effective July 1, 2018, Behavioral Health Treatment is no longer a covered benefit solely for Members Diagnosed with Autism Spectrum Disorder. The coverage criteria have been expanded to include IEHP members who meet ALL the below:
- Under 21 years of age
- Have a recommendation from a licensed physician and surgeon or a licensed psychologist that evidence-based BHT services are medically necessary.
- Be medically stable
- Not be in need of 24-hour medical/nursing monitoring or procedures provided in a hospital or intermediate care facility for persons with intellectual disabilities.
Behavioral Health Treatment (BHT) is the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the direct observation, measurement and functional analysis of the relations between environment and behavior.
BHT services teach skills through the use of behavioral observation and reinforcement, or through prompting to teach each step of targeted behavior. BHT services are based on reliable evidence and are not experimental. Treatment may or may not include Applied Behavioral Analysis (ABA).
BHT is medically necessary after the Provider has completed a comprehensive developmental surveillance and screening, and have recommended BHT services is clinically warranted to treat persistent developmentally inappropriate behavior and/or diagnoses that may be able to be corrected or ameliorated with BHT services. Aberrant behaviors include but are not limited to self-injury, aggression, and deficits in language skills, daily living skills, and social skills.
Primary Care Physicians will continue to referral a Member directly to IEHP Behavioral Health for any BHT services and/or diagnostic needs regardless of IPA.
You can call IEHP Member Services at 1-800-440-IEHP (4347) or 1-800-718-4347 for TTY users, Monday – Friday, 8:00 am to 5:00 pm if you have any questions or ask your Primary Care Provider for screening, diagnosis and treatment.
Cost to Member:
There is no cost to the Member for these services.