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Mental Health & Substance Use
EXC-MBR-INP-Mental Health & Substance Use accordion
Available to anyone in suicidal crisis or emotional distress
- 24-hour, toll-free and confidential
- Available to anyone in suicidal crisis or emotional distress
- National network of more than 150 crisis centers
- Crisis numbers are listed by City, County, or Service Area
- 24-hour, toll-free and confidential
- Treatment referral for mental and/or substance use disorders
- Spanish speaking available
- Toll-free hotline, online chat, or text
- Connects veterans in crisis and their families and friends
- Caring department of Veterans Affairs responders
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/
- About Narcan to Stop Overdose: http://stopoverdoseil.org/narcan.html
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 psycotherapy. 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 interfre 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 in outpatient care after discharge from an inpatient admission can greatly help patients avoid a relapse of their mental health symptoms. While treated in an inpatient setting, patients work closely with hospital staff to prepare for their aftercare treatment and should have an aftercare appointment scheduled within 7 days following discharge. The Behavioral Health Department assists members in following their aftercare plan by contacting members by telephone to remind them of their first aftercare appointment. If members are unable to keep their outpatient appointment, Behavioral Health staff will assist members in scheduling another appointment and will work with members to eliminate barriers to adhering to their discharge plan.
Child and Adolescent Psychiatry Phone Consultation Service - It is estimated that more than 10% of children and adolescents have a psychiatric illness and that only a small portion of these children receive psychiatric services. This is partly due to a shortage of Child and Adolescent Psychiatrists both nationally and in there Upstate New York region. These factors result in the demand for pediatricians and family practitioners to treat psychiatric illnesses in their offices often without adequate training or support.
In an effort to offer support to pediatricians and family practitioners, the Health Plan has implemented an initiative to offer two hours a week of phone consultation with a Board Certified Child and Adolescent Psychiatrist. The goal of the program is to increase the skill and knowledge of pediatricians and family practitioners in managing psychiatric illness for their patients.
From this point forward, in order to review clinical criteria, you will need to log on to your member account, using your username and password.
Our clinical criteria listed below are evidenced based decision making guidelines. We also use guidelines from CMS (Centers for Medicare and Medicaid Services) and eMedNY when applicable.
- Medicare Local Coverage Determination (LCD)Opens a dialog
- View our Medical Policies
- View our Drug Policies
- View InterQual® Criteria
LOCADTR 3.0 is a web based level of care determination application. NYS OASAS in partnership with The National Center on Addiction and Substance Use at Columbia University developed this tool to determine the most appropriate level of care for substance use disorder.
Substance use reviews for inpatient detoxification, rehabilitation and residential levels of care will use the following questionnaire to document clinical information when determining medical necessity. This questionnaire will be used when the outcome of LOCADTR results in a discrepancy for the level of care being requested by the provider. The questionnaire is to ensure that all pertinent clinical information is documented to make the appropriate medical necessity determination.
- Substance Use Disorder Inpatient Rehabilitation & Residential QuestionnaireOpen a PDF
- Substance Use Disorder Inpatient Detoxification QuestionnaireOpen a PDF
For Substance Use Disorder Partial Hospital Program requests outside of New York State, Excellus BCBS uses the ASAM Criteria to complete medical necessity reviews.
A partial hospitalization program (PHP) request is considered 20 or more hours per week, sometimes also known as “day rehab,” because the patient can spend evenings at home.
The ASAM criteria is the most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions in the United States.
The Behavioral Health Department also uses the corporate medical policy called “Partial Hospitalization for Substance Use Disorders,” to make its decision.
Our plan also has a Behavioral Health Advocate who is available to help you understand a decision, how to ask for an appeal or find a participating provider. To talk to the Behavioral Health Advocate, please call 1-844-809-7518 (Members with Medicaid, Child Health Plus, or HARP plans should call 1-844-635-2662).
Improving Access to Substance Use Treatment
Members with a primary substance use diagnosis are given an approval for the first 28 days of inpatient detoxification, rehabilitation, and residential treatment at any New York State Office of Addiction Services and Supports (OASAS) facility licensed to provide these services. Licensed providers are required to notify the plan within 2 business days of admission. Coverage of additional days will be reviewed for medical necessity.
To learn more, please call a Behavioral Health Advocate at 1-844-809-7518 (Members with Medicaid, Child Health Plus, or HARP plans should call 1-844-635-2662). Coverage of additional days and retrospective reviews require medical necessity review. Services received at facilities outside of New York State require pre-certification and will be reviewed for medical necessity.
Information about substance use disorder treatment resources in New York State is also available at the website of the New York State Office of Addiction Services and Supports.
- Prohibition on preauthorization for inpatient admissions of children under the age of 18. No preauthorization and/or concurrent review requirements of the first 14 days of inpatient treatment may be conducted of an admission of a member under age 18 to a participating hospital licensed by the New York State Office of Mental Health.
- Provide a written discharge summary to both Excellus BlueCross BlueShield and the patient upon discharge.
GLO-MBM-MDM-INP-Medicare Local Coverage Determination - Modal
Modal for Medicare Local Coverage Determination (LCD)