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Behavioral Health

‘Ohana Health Plan provides behavioral health benefits to members enrolled in our Medicaid plans. We are committed to quality service and partnership with providers to ensure members get the most of their benefits.

Crisis Intervention

In the event of a crisis, please direct members to the Department of Health access line at 1-800-753-6879.

Care Management

The plan offers additional behavioral health care management services for qualifying adults with a diagnosis of serious persistent mental illness.

Authorizations

Behavioral health services requiring prior authorization include:

  • Acute inpatient
  • Partial hospitalization program
  • Intensive outpatient program 
  • ECT treatment
  • Psychological testing 

Behavioral health services that do NOT require prior authorization: 

  • Psychiatric or psychological evaluations
  • Physician services including medication management
  • Some outpatient counseling and therapy (Reference the Behavioral Health Authorization List below for code details)
  • Methadone treatment services

Helpful Resources


The table below outlines how procedure & revenue codes are grouped together for the purposes of authorization requirements and claims payment.

METS takes a unique approach to member care. We partner with the provider and CCS Case Manager to ensure that the member achieves the ultimate level of recovery and resiliency.

Because ‘Ohana recognizes important partnerships, we have developed the 2021 Behavioral Health Bonus Program to reward eligible Behavioral Health practitioners for providing specific services listed in the attached document.

Contains key phone numbers and information on claims, appeals and more.

The exchange of information among participants responsible for different aspects of care

Titration has historically been used when talking about slowly reducing medications; however, it also applies to other forms of treatment as well.

Important Steps of Treatment Planning

Other Helpful Information

Behavioral Health Forms

Find forms for authorizations, referrals and more.

Community Care Services

Adult Medicaid members age 21 years or older with a diagnosis of serious mental illness (SMI) or a severe and persistent mental illness (SPMI) may be eligible for additional behavioral health services from the Community Care Services (CCS) program offered by 'Ohana Health Plan.

  • Forms

    Behavioral Health Forms

    Find forms for authorizations, referrals and more.

  • Community Care Services

    Community Care Services

    Adult Medicaid members age 21 years or older with a diagnosis of serious mental illness (SMI) or a severe and persistent mental illness (SPMI) may be eligible for additional behavioral health services from the Community Care Services (CCS) program offered by 'Ohana Health Plan.

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Last Updated On: 12/13/2020
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