Behavioral Health

Clinical Practice Utilization Management Guidelines

The Behavioral Health Utilization/Care Management Clinical staff uses Medical Necessity Criteria sets for New York State Child Health Plus, Commercial, Essential Plan, and Medicaid Manage Care members. The clinical staff verifies eligibility, coverage type, and available benefits in order to identify the correct Medical Necessity Criteria to use. MetroPlusHealth adheres to the New York State guidance that outlines the notification of admission process to be followed by plans and their providers. When appropriate, MetroPlusHealth Medical Necessity Criteria sets for New York State Child Health Plus, Commercial, Essential Plan, and Medicaid Manage Care members are:

last updated: November 30, 2021

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