Behavioral Health Benefits

Substance use disorder (SUD) treatment services

The plan covers substance use disorder treatment services provided by a community mental health center, community health center, federally qualified health center (FQHC), rural health center (RHC), mental health provider, acute care hospital, psychiatric hospital, Masters Licensed Alcohol and Drug Counselor (MLDAC), Licensed Alcohol Drug Counselor (LADC), psychiatrist, psychiatric advance practice registered nurse (APRN), physician, certified recovery support worker, residential treatment and rehabilitation facility, methadone clinic or opioid treatment programs, and peer recovery programs.

Covered services may include:

• Screening, Brief Intervention, and Referral to Treatment (SBIRT).
• Substance use screenings.
• Individual, group, and family therapy.
• Intensive outpatient substance use disorder services.
• Partial hospitalization program (PHP).
• Medically monitored outpatient withdrawal management.
• Crisis intervention.
• Peer recovery support.
• Non-peer recovery support.
• Continuous recovery monitoring.
• Opioid treatment services.
• Medication-assisted treatment.
• Medically monitored residential withdrawal management.
• Residential treatment services, including specialty services for pregnant and postpartum women.

Outpatient mental health services

We cover outpatient mental health services provided by a community mental health center, psychiatrist, psychiatric APRN, mental health therapy provider, psychologist, licensed psychotherapy provider, community health center, FQHC, RHC, and outpatient mental health facility.

Covered services include:

• Medication visits.
• Individual, group and family therapy.
• Diagnostic evaluations.
• Partial hospitalization program (PHP).
• Intensive outpatient program (IOP).
• Emergency psychiatric services.
• Electroconvulsive therapy (ECT).
• Transcranial magnetic stimulation.
• Crisis intervention.
• Individualized Resiliency and Recovery Oriented Services (IROS).
• Case management services, including assertive community treatment (ACT).
• Psychological testing.

Inpatient mental health services

We cover inpatient mental health services that include:

• Inpatient mental health services to evaluate and treat an acute psychiatric condition.*
• Psychiatric consultation on an inpatient medical unit.*

*Special coverage rules apply for some inpatient stays. If you are age 21-64, contact Member Services at 1-833-704-1177 (TTY 1-855-534-6730) to see if you meet coverage requirements.

There is no lifetime limit on the number of days a member can have in an inpatient mental health care facility.

Flexible recovery benefit to support recovery

A one-time flexible benefit up to $500 is available for members who have successfully completed a non-hospital SUD residential treatment stay. Subject to prior authorization, members will be eligible for recovery-oriented services.This includes programs available at the residential facility, including massages, chiropractic, and acupuncture therapies, and yoga classes.

Members may also use the benefit to cover peer support recovery services beyond those covered by the Department of Helath and Human Services, post discharge meals (14 meals, seven days), transportation to support group meetings (e.g. AA and NA), transportation for one family session before the member is discharged from a residential treatment facility; tenancy supports, (such as home maintenance counseling, budgeting, and lease understanding), and child care for specific events (job-related for interviews/training or recovery-related for AA and NA meetings).

Mental health parity assurance

Federal and state laws require that we provide coverage for mental health and substance use disorder treatments as favorably as we provide coverage for other medical health services. This is referred to as parity. Parity laws require coverage for mental health and/or substance use disorders be no more restrictive than coverage for other medical conditions, such as diabetes or heart disease. For example, if we provide unlimited coverage for physician visits for diabetes, we must do the same for depression or schizophrenia.

Parity means that:

• We must provide the same level of benefits for any mental health and/or substance use disorder as we would for other medical conditions you may have.
• We must have similar prior authorization requirements and treatment limitations for mental health and substance use disorder benefits as we do for other medical benefits.
• We must provide you or your provider with the medical necessity criteria we use for prior authorization upon either your request or your provider’s request.
• We must not impose aggregate lifetime or annual dollar limits on mental health or substance use disorder benefits.
• Within a reasonable time frame, we must provide you the reason for any denial of authorization for mental health and/or substance use disorder services.
• If we provide out-of-network coverage for other medical benefits, we must provide comparable out-of-network coverage for mental health and/or substance use disorder benefits.

The parity requirement applies to:

• Drug copayments.
• Limitations on service coverage (such as limits on the number of covered outpatient visits).
• Use of care management tools (such as prescription drug rules and restrictions).
• Criteria for determining medical necessity and prior authorizations.
• Prescription drug list structure, including copayments.

If you think that we are not providing parity as explained above, you have the right to file an appeal or file a grievance. 

If you think we did not cover behavioral health services (mental health and/or substance use disorder services) in the same way as medical services, you may also file a grievance or complaint with the New Hampshire Department of Insurance Consumer Services Hotline at 1-800-852-3416 (TTY 1-800-735-2964), Monday through Friday, 8 a.m. to 4:30 p.m. ET, or online at https://www.nh.gov/insurance/consumers/complaints.htm.

What if you or someone you know struggles with addiction or substance use?

AmeriHealth Caritas New Hampshire understands that addiction is a disease and that access to immediate help is critical to recovery.

If you are an AmeriHealth Caritas New Hampshire member struggling with addiction and are in need of urgent care, contact Member Services at 1-833-704-1177 (TTY 1-855-534-6730), at any time, 24 hours a day, seven days a week.

If someone you know struggles with addiction or substance use, you can call the 24-hour toll-free NH Statewide Addiction Crisis Line at 1-844-711-HELP (4357).