Effective October 1, 2021, MetroPlusHealth began in-sourcing Adult Behavioral Health Services, including mental health and substance use disorder services. These services give adults (over 21) and their families the power to improve their health, well-being, and quality of life, strengthening families and helping them make informed decisions about their care. Services are provided at home or in the community.
For most services, members may choose from a list of MetroPlusHealth in-network providers.
Behavioral Health Services
(Mental Health and Substance Use Disorder)
Mental Health benefits include:
Inpatient and outpatient psychiatric care – Psychiatric care that is provided either in an office or clinic environment, or in an inpatient hospital service.
Partial Hospitalization Program (PHP) – Active treatment designed to stabilize or reduce acute symptoms in a partial hospitalization program (outpatient level) in a person who would otherwise need hospitalization.
Substance Use Disorder Inpatient Detoxification – Medically managed withdrawal and stabilization in a hospital setting. Designed for individuals who are acutely ill from alcohol-related and/or substance-related addictions or dependence.
Substance Use Disorder Inpatient Rehabilitation – Office of Addiction Services and Supports -certified 24-hour, structured, short-term, intensive treatment services provided in a hospital or free-standing facility.
Crisis Residence and/or Crisis Respite – Services provided by a mobile crisis team to a person who is experiencing or is at imminent risk of having a psychiatric crisis. These services are designed to interrupt and/or lessen a crisis, including a preliminary assessment, immediate crisis resolution and de-escalation.
Assertive Community Treatment (ACT) – A comprehensive & integrated set of psychiatric, psychosocial rehabilitation, case management, and support services. Services are provided by a mobile multi-disciplinary mental health treatment program mainly in the client’s residence or other community locations.
Personalized Recovery Oriented Services (PROS) – A comprehensive recovery-oriented program for individuals with severe and persistent mental illness. The goal of the program is to integrate treatment, support, and rehabilitation in a manner that facilitates the individual’s recovery.
Intensive Psychiatric Rehabilitation Program (IPRT) – a term limited rehabilitative program for adults and/or adolescents which focuses on building skills and developing community supports to assist individuals to attain a specific residential, learning, working, or social goal(s)
Substance Use Disorder benefits include:
Crisis Services- a variety of treatments to provide immediate care for intoxicated or incapacitated individuals. The primary goal is to manage withdrawals from substances, and address associated medical and psychiatric complications. Crisis services include detox services, and are also designed to facilitate connections to continued care.
Medically Managed Withdrawal Management-the highest level of detox treatment for those with the greatest need
Inpatient Rehabilitation – provides a safe and supportive setting for the evaluation, treatment, and rehabilitation of people with substance use disorders. Provides 24 hour, 7-day a-week care, supervised at all times by a medical professional and include intensive management of symptoms related to addiction and monitoring of the physical and mental complications resulting from substance use.
Residential addiction treatment services- designed for people who are in need of 24 hour support in their recovery in order to participate in treatment. They are designed to develop or maintain recovery through a structured, substance-free setting, and include group support, independent living skills development and other services to promote recovery.
Stabilization in Residential Setting-the highest level of support, often the first step, lasting up to a month
Rehabilitation in Residential Setting-the next level of support, often lasting several months
Outpatient addiction treatment services- provide clinical services for people with an addiction to substances and their families. May be delivered at different levels of intensity according to the needs of the patient. These services include counseling, education, and connections to community services.
Intensive Outpatient Treatment-a structured program typically 3 days a week 4 hours a day
Outpatient Rehabilitation Services and Opiate Treatment –
*Outpatient Withdrawal Management – when the home environment is safe and the person is stable enough to engage actively without 24 hour support
Medication Assisted Treatment- includes office based treatment with medications to help opiate, alcohol and other substance use disorders.
Opioid Treatment Programs (OTP)- Opioid Treatment Centers (OTP) are Office of Addiction Services and Supports-certified sites where medication to treat opioid dependency is administered. These medications can include methadone, buprenorphine, and suboxone. In addition to medications, these facilities also offer counseling and educational services. In most cases, patients receiving services at an OTP clinic are provided treatment over a lifetime, similar to management of chronic physical ailments.
Who can get these services and where do they find them?
Adults (over age 21) who have mental health and/or substance use needs can get the full array of Behavioral Health Services at low or no additional cost. These services are mostly covered by all lines of business and are available through the health plan.
Member Handbooks can be found on our individual health plan pages. Find your plan here and learn what Behavioral Health Services are covered. You can also contact Customer Services for additional information or support. See the back of your Member ID card for the phone number you should call.
First Episode Psychosis (FEP)
An abundance of data accumulated over the past two decades supports the value of early intervention with services to help people maximize recovery following a first psychotic episode. Providers (inpatient & outpatient) will assess for and refer members experiencing first episode psychosis to specialty programs such as:
OnTrackNY Providers, trained by The Center for Practice Innovations (CPI) at Columbia Psychiatry/NYS Psychiatric Institute, deliver coordinated, specialty care, for those experiencing FEP, including: “psychiatric treatment, including medication; cognitive-behavioral approaches, including skills training; individual placement and support approach to employment and educational services; integrated treatment for mental health and substance use problems; and family education and support” (CPI website). Each site has the ability to care for up to 35 individuals. Requirements:
1. Ages 16-30
2. Began experiencing psychotic symptoms for more than a week, yet less than 2 years, prior to referral
3. The definition of FEP excludes individuals whose psychotic symptoms are due primarily to substance use *Providers who need to refer members for further behavioral health care should contact Beacon.