Mental Health & Substance Use
Resources available to anyone in suicidal crisis or emotional distress
- Free, confidential support for anyone in suicidal crisis or emotional distress
- Call or text 988 to reach the 988 Lifeline
- Available 24/7 with language assistance offered
- Free, confidential support for mental and substance use disorders
- Available 24/7 with language assistance offered
- For calls, dial 988 and press “1” to be connected with the Veterans Crisis Lifeline
- Free, confidential support for Veterans, service members, and their loved ones
- Available 24/7 with language assistance offered
A mental illness is a condition that affects a person's thinking, feeling or mood. Such conditions may affect someone's ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis. Recovery, including meaningful roles in social life, school and work, is possible, especially when you start treatment early and play a strong role in your own recovery process.
- Depression OverviewOpens a PDF
- Depression - What is it?Open a PDF
- Treatment for DepressionOpen a PDF
- Suicide – What You Should KnowOpen a PDF
- Anxiety – What Is it?Open a PDF
- Eating Disorders – What Are They?Open a PDF
- Additional Mental Health Resources:
- Western New York Comprehensive Care Center for Eating Disorders:http://www.nyeatingdisorders.org/family-caregivers.html
- American Psychiatric Association: https://www.psychiatry.org/
- National Alliance on Mental Illness: https://www.nami.org/
- NYS Mental Health Treatment Finder: https://my.omh.ny.gov/bi/pd/saw.dll?PortalPages
- National Eating Disorder Association: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia
There is no universal approach to addiction treatment. You have options. Learn about your treatment options so you can make an informed decision about your treatment and recovery plan. We have provided a toolkit with many resources to assist in answering questions and help make the next decision a positive one.
- What is a Substance Use Disorder?Open a PDF
- What is an Opioid Use Disorder?Open a PDF
- Treatment for Substance Use DisordersOpen a PDF
- Additional Substance Use Disorder Resources:
- SAMSHA: https://www.samhsa.gov/
- Patient Guide for Opioid Disorder & Treatment: https://www.asam.org/docs/default-source/publications/asam-opioid-patient-piece_-5bopt2-5d_3d.pdfOpen a PDF
- NYS Provider Finder: https://webapps.oasas.ny.gov/providerDirectory/index.cfm?search_type=2
- Medication Assisted Treatment for Opioids: https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
- Substance Use: https://www.combataddiction.ny.gov/
Additional Mental Health and Substance Use Resources
The Healthwise® Knowledgebase - provides information on a variety of mental health and substance use disorders, medications, and treatment options.
The American Psychiatric Association - offers information about mental illness and treatment.
Health Risk Assessments offer an opportunity for individuals to identify a variety of health concerns including depression and alcohol use. This tool is not designed to diagnose any illness. If you are concerned about any mental health symptoms that you or a loved one is experiencing, please see your primary care physician or a mental health professional.
Types of Behavioral Health Providers
Mental Health Providers - Private Practitioners
Psychiatrists (M.D., D.O.) are medical doctors who have specialized in psychiatry. Psychiatrists can prescribe medication and may also practice psychotherapy. Psychiatrists are licensed by the New York State Education Department and may be Board Certified in psychiatry and or child psychiatry. Some psychiatrists have extra training and certification in areas such as geriatrics, addiction medication, or forensic psychiatry.
Licensed Clinical Social Workers (LCSWR) have a master's degree in Social Work (MSW) and a minimum of six years of supervised clinical experience. Social Workers receive training in individual, family, and group therapy and are licensed by the New York State Education Department. Social Workers may have experience in treating adults and/or children/adolescents.
Psychologists (Ph.D., Psy.D.) are doctoral level practitioners trained in clinical psychology and licensed by the New York State Education Department (they are not medical doctors and do not prescribe medication). Psychologists receive training in individual, family, and/or group therapy and also in psychological research and have at least two years of clinical experience in a supervised setting. In addition to providing psychotherapy, some psychologists may also practice psychological or neuropsychological testing. Like psychiatrists and social workers, psychologists may specialize in treating adults or children/adolescents and may have received additional training in treating specific mental health conditions.
Licensed Mental Health Counselor (LMHC) have a master's degree and are required by the Health Plan to qualify six years of supervised clinical experience. Mental Health Counselors receive training to provide individual, family and group psychotherapy. LMHC's are licensed by the New York State Education Department and treat adults, children and/or adolescents.
Licensed Marriage & Family Therapist (LMFT) have a master's degree or higher and are required by the Health Plan to qualify six years of supervised clinical experience. Marriage and family therapists receive training to provide individual, family and group psychotherapy. LMFT's are licensed by the New York State Education Department and treat adults, children and/or adolescents.
Nurse Practitioner (NP) is an RN who has earned a separate license as an NP through advanced clinical nursing education (usually a master's degree) in a distinct specialty area of psychiatry practice. Nurse practitioners may diagnose, treat, and prescribe for a patient’s condition that falls within their specialty area of practice.
Licensed Clinical Social Workers (LCSW) have a master's degree in Social Work (MSW), with at least 12 semester hours of clinical coursework and have at least 3 years of post (MSW) supervised experience. Social Workers receive training in individual, family, and group therapy and are licensed by the New York State Education Department. Social Workers may have experience in treating adults and/or children/adolescents.
Mental Health Providers - Facilities
Outpatient Mental Health facilities offer comprehensive outpatient treatment, including services provided by psychiatrists, social workers, and clinical psychologists. Outpatient facilities offer individual, family, and group treatment, as well as medication and psychological testing.
Inpatient Hospitalization (24-Hour inpatient treatment) is offered at many general hospitals and at private psychiatric hospitals for the diagnosis and treatment of patients with severe mental health symptoms. Patients admitted for inpatient hospitalization cannot be treated safely at a less restrictive level of care. Patients follow a treatment plan developed by a psychiatrist. The plan may involve the use of medication and treatment provided by nurses, social workers, clinical psychologists, and other medical and counseling staff. Most member contracts require the hospital to pre-authorize inpatient admissions.
Partial Hospitalization (also known as Day-Night Care in some member contracts) is offered in some Health Plan regions. These programs are designed for the diagnosis and treatment of serious mental disorders, and patients usually attend five to six days per week for several hours a day. Partial Hospitalization is used when it is necessary to maintain a patient's functional level and prevent relapse or inpatient hospitalization.
Mental Health Residential Supervised housing with 24 hour awake staff. Individuals are provided a safe living environment with a high degree of behavioral accountability. Services include medical and clinical oversight of chronic but stable medical and psychiatric symptoms and conditions in a community treatment program. Services also include: community meetings; activities of daily living (ADL) support; case management; and vocational support and clinical services to support transition to independent living.
Substance Use Providers - Facilities
Outpatient Treatment services provide assessment for and treatment to individuals with substance use or dependence or to significant others of a person who has a substance dependence or use condition. Outpatient treatment is designed for individuals who are able to participate and comply with treatment outside a more intensive treatment setting.
- Intensive Outpatient Treatment is available at some licensed treatment facilities and is designed to treat patients with a higher risk for relapse and to help the patient avoid a more restrictive inpatient admission.
Inpatient Detoxification services are designed to treat patients with moderate to severe substance withdrawal symptoms that pose an immediate health risk or interfere with the individual's ability to engage in outpatient treatment. Inpatient detoxification is available at general hospitals and at some private substance use treatment facilities.
Stabilization Services in a Residential Setting - OASAS-certified providers of residential programs that provide medical and clinical services including: medical evaluation; ongoing medication management and limited medical intervention; ancillary withdrawal and medication assisted substance use treatment; psychiatric evaluation and ongoing management; and group, individual and family counseling focused on stabilizing the individual and increasing coping skills until the individual is able to manage feelings, urges and craving, co-occurring psychiatric symptoms and medical conditions within the safety of the residence. This service has a physician who serves as medical director, psychiatrist, nurse practitioner and/or physician assistants to provide and oversee medical and psychiatric treatment. Medical staff are available in the residence daily, but 24-hour medical/nursing services are not. There is medical staff available on call 24/7 and there are admitting hours 7 days per week.
Rehabilitative Services in a Residential Setting - Certified OASAS providers of residential programs which provide rehabilitative services for individuals who are stable enough to manage emotional states, urges and cravings, co-occurring psychiatric symptoms and medical conditions within the safety of a residential setting. This service requires a physician who will serve as medical director, nurse practitioner, psychiatrist and nursing staff on site daily and clinical staff provide monitoring for medical and psychiatric symptoms that are stable. Services include medical monitoring of chronic conditions including routine medication management and individual, group and family counseling focused on rehabilitation. The service requires a treatment plan to address functional needs including personal and interpersonal functioning. The treatment program teaches individuals to manage self and interactions with others with increasing independence.
Reintegration Services in a Residential Setting - Certified OASAS providers of residential programs that provide reintegration services to transition from structured treatment environments to more independent living. This setting does not require a physician to serve as medical director and staff coordinate treatment services but do not provide direct clinical care. Most services are provided in the community and include clinical and social services. Individuals are provided a safe living environment with a high degree of behavioral accountability. Services include medical and clinical oversight of chronic but stable medical and psychiatric symptoms and conditions in a community treatment program including an outpatient Substance Use Disorder treatment program. Services also include: community meetings; activities of daily living (ADL) support; case management; and vocational support and clinical services to support transition to independent living. Reintegration services may be provided in a congregate or scatter-site setting.
Inpatient Substance Use Rehabilitation:
This is an elective admission. When a person is abusing drugs/and or alcohol and they are in need of help in a 24/7 supervised program.
Substance use inpatient rehabilitation services provide intensive management of substance use symptoms and medical management/monitoring of physical or mental complications from substance use to clients who cannot be effectively served as outpatients and who are not in need of medical detoxification or acute care.
This level of care is offered at free standing facilities, acute care hospitals, and some state facilities.
Certified providers conduct intensive evaluation, treatment and rehabilitation services in a medically supervised 24 hour/day, 7 days/week setting.
Substance use inpatient services include the following basic clinical procedures: individual and group counseling and activities therapy; alcohol and substance use disease awareness and relapse prevention; education about, orientation to, and opportunity for participation in, available and relevant self-help groups; assessment and referral services for patients, families and significant others; HIV education, risk assessment and supportive counseling and referral; vocational and/or educational assessment, and medical and psychiatric evaluation
Find a Behavioral Health or Substance Use Treatment Provider
Follow this link to Search our Online Provider Directories to find a participating health provider:
- Use "Find a Doctor/Provider" to search for a participating psychiatrist, psychologist or licensed clinical social worker.
- Use "Find a Hospital, Urgent Care or Other Provider" to search for a participating outpatient or inpatient mental health facility or a substance use treatment provider.
Tips for Choosing an Outpatient Behavioral Health Provider
Mental Health professionals can be highly specialized. Some have general practices while others concentrate on a specific area of mental health, such as addiction or geriatrics. They may provide individual, group or couple/family therapy. Not all outpatient practitioners specialize in treating certain conditions or age groups, such as children or adolescents. Once you have some names of participating private practitioners or facilities, contact the providers to obtain more information about the services they provide.
You should consider the following before scheduling an appointment with the provider:
- Does the provider participate with my health insurance?
- Is the service a covered benefit?
- Does the provider have experience treating my mental health condition?
- Does the provider specialize in treating certain age groups, such as children, adolescents, or seniors?
- Is the provider accepting new patients?
- What hours is the provider available for appointments?
- What types of therapy does the provider offer?
After meeting with the provider, it's ok if you feel a little uncomfortable during the first few sessions. Sharing personal information can be difficult and it may take some time to build trust. However it's important to eventually feel comfortable with your provider. If you are still uncomfortable after several sessions, don't hesitate to try a different provider.
As a patient, you should expect:
- Sensitivity to issues such as race, culture, gender, and sexual orientation
- Involvement in your treatment plan
Court Ordered Treatment for Mental Health and Substance Use Disorder
When there is a court order for treatment; a preauthorization request must be submitted by the provider or facility if a preauthorization is required for the service being requested. The Court Ordered Certification Form must also be submitted with the preauthorization request for a medical necessity determination.
Behavioral Health Specialty Programs
After Hospitalization Follow-up - Continuing with outpatient care after an inpatient admission can help you avoid a relapse of your mental health symptoms. During your inpatient stay, you’ll work closely with hospital staff to prepare for your aftercare treatment. You should have an aftercare appointment scheduled within 7 days following discharge. The Behavioral Health team will contact you by phone to remind you of this appointment. If you’re unable to keep your appointment, Behavioral Health staff will help you reschedule and address any barriers that may keep you from sticking to your discharge plan.
- Authorization Release FormOpen a PDF
- Authorization Release Form - (Spanish)Open a PDF
- Care Management with Wellframe - (Requires Login)
- Case Management Consent Form
- Behavioral Health Care Management Program
- Substance Use & Mental Health Residential FacilitiesOpen a PDF
- Mental Health Parity DisclosuresOpen a PDF
We use the policies and guidelines below to help decide how to approve your care. We also use guidelines from the Centers for Medicare and Medicaid Services (CMS) and eMedNY, when appropriate.
Get Help Understanding a Decision
Confused about a behavioral health decision? Our Behavioral Health Advocate can help you understand the details of a decision and explain how to ask for an appeal. Call 1-844-809-7518 (TTY 711) Monday through Friday from 8 a.m. to 5 p.m. ET. If you have Medicaid, Child Health Plus, or a Health and Recovery Plan (HARP), call 1-844-635-2662 (TTY 711).
General Policies and Criteria
Substance Use Disorder Care
Inpatient Substance Use Disorder Care
First 28 Days of Care
You are approved for up to 28 days of inpatient care at a New York state facility approved by the Office of Addiction Services and Supports (OASAS) if you have a primary diagnosis of substance use disorder. Your provider decides on the level and amount of care you need. They must tell us within two business days that you have entered a treatment facility. Note: You need prior approval to get care at an out-of-network facility, including facilities outside New York state.
Care Beyond 28 Days
For care past 28 days, we review information from your provider about your progress to that point. This information may include details about your medications, withdrawal symptoms, and general wellbeing. We put these details into a online, evidenced-based tool called Level of Care for Alcohol and Drug Treatment Referral (LOCADTR). LOCADTR is used by all health insurance companies in New York and helps to determine if a continued stay is appropriate.
Your provider may also put their information into LOCADTR. If our LOCADTR results match with your provider’s results, your continued care is approved. If our results are different, we contact your provider for more information and use the questionnaires below to help us understand why your provider may be asking for more care.
- Inpatient Rehabilitation & Residential QuestionnaireOpen a PDF
- Inpatient Detoxification QuestionnaireOpen a PDF
Outpatient Substance Use Disorder Care
In most cases, you do not need approval for outpatient substance use disorder. You can get care from any provider or facility in our network.
Partial Hospitalization Program (PHP) Requests for Substance Use Disorder
Substance use PHPs involve 20 or more hours of care per week but do not make you to stay overnight. We use national criteria from the American Society of Addiction Medicine (ASAM) when making decisions about substance use disorder PHPs outside New York state. ASAM CriteriaOpen a PDF are the most widely used and comprehensive set of guidelines for these programs.
Keep in mind that not all plans provide coverage for substance use PHPs. If you have questions about your plan’s benefits, please call the number on the back of your member card or call Customer Care at 1-800-499-1275 (TTY 711).
Mental Health Care
Inpatient Mental Health Care
Within New York State
Your provider decides on the level and amount of care you receive at inpatient mental health facilities within New York state. This includes acute care in a hospital as well as care in a 24-hour intensive residential setting. Keep in mind that any facility you enter must be approved by the Office of Mental Health.
Your provider must tell us within two business days that you’ve entered a treatment facility. We then review a list of New York state-identified triggers to see if they apply to your situation. These triggers help us understand if you may need extra support. They also affect the amount of care you’re approved for. Throughout your inpatient stay, we have collaborative calls with your provider to assess and provide interventions based on your needs.
After your initial approval period, we review information from your provider about your progress to that point. This information may include details about your medications, symptoms, and general health. We review these details using InterQual criteria and our corporate medical policies to determine if a continued stay is appropriate.
Outside New York State
You need prior approval for inpatient mental health care outside New York state. For this approval, we review information from your provider about the level and amount of care they want you to have. This information may include details about your medications, symptoms, and general health. We review these details using InterQual® criteria to determine if a stay is appropriate.
After Inpatient Mental Health Care
After you leave inpatient treatment, your provider sends us a copy of your discharge summary. You should also receive a copy of this summary. We use this summary to follow up to make sure you have the resources and support you need.
Outpatient Mental Health Care
In most cases, you do not need approval for outpatient mental health care. You can get care from any provider or facility in our network.
Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) Requests for Mental Health Care
Within New York State
Your provider decides on the level and amount of care you receive at PHP or IOP facilities within New York state. Keep in mind that any facility you enter must be approved by the Office of Mental Health.
Your provider must tell us within two business days that you’ve entered a PHP or IOP facility. We then review a list of New York state-identified triggers to see if they apply to your situation. These triggers help us understand if you may need extra support. They also affect the amount of care you’re approved for. Throughout your treatment, we have collaborative calls with your provider to assess and provide interventions based on your needs.
Outside New York State
You need prior approval for mental health PHP or IOP care outside New York state. For this approval, we review information from your provider about the level and amount of care they want you to have. This information may include details about your medications, symptoms, and general health. We review these details using InterQual criteria to determine if this care is appropriate.
Modal for Medicare Local Coverage Determination (LCD)
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