Covered In-Plan Services
Behavioral health rehabilitation services (BHRS) for children and adolescents are available to children and adolescents. The services can be provided at home, at school, and in other community settings. These services are sometimes referred to as "wrap-around" services.
Clozapine (Clozaril) support services are provided by a psychiatrist or nurse to review how you are doing if you take the medication Clozaril. Services include regular office visits and laboratory tests. Clozapine or Clozaril is a medication used to treat people who have schizophrenia.
The provider who is treating you now can order this medication. Ask them about getting this medicine and if it is right for you.
Crisis intervention services can be used any time of day or night to help you in a crisis. The services keep you safe. They help connect you to the people who can treat the problem until it has passed. Services can be provided by phone or in person at almost any place in the community.
Call your local county crisis providers. If you do not know your local county crisis numbers, call Member Services for help.
Drug and alcohol detoxification, rehabilitation, and halfway house services help you stop using drugs and alcohol. If you need it, 24-hour care for alcohol and other drug problems is provided in a hospital or non-hospital setting.
If you use these services, you may or may not stay at the program overnight.
You can self-refer by calling Member Services, or you can work with your current provider in finding a treatment facility.
Family based mental health services are treatment services provided in the home for children, adolescents, and their families.
A prescription from a licensed psychologist, a psychiatrist, or the child’s primary care provider must be obtained for this level of care.
Methadone is used in a specific medication therapy to treat addictions to opiates, such as heroin or oxycodone.
Discuss this choice with your current substance use provider. They will refer you for this care if this medication is right for you.
Outpatient drug and alcohol services are provided in the community to help a person with alcohol or other drug problems. Services may include evaluation and/or individual or group therapy.
Psychiatric hospitalization includes the most intensive services available, with admission to a hospital for 24-hour care for a mental health or emotional condition.
Hospitalization usually occurs when you or your child:
- Is at risk of harming themselves (or you are at risk or harming yourself) or others.
- Needs close and continual checking of medications.
- Has tried other services in the community and these services have not helped to solve the problems that brought you or your child into service.
If you or your child feels unsafe to the point where you think you or they may harm themselves or others, mental health inpatient care may be needed. Go to the nearest emergency room. If you or your child cannot stay safe until you get to the nearest emergency room, call 911 or crisis intervention.
Psychiatric outpatient services are planned, regularly scheduled visits to a doctor, counselor, or therapist to talk about your mental health issues.
Psychiatric partial hospitalization programs (PHP) are provided during the daytime hours, several days per week at a provider office. These services are planned and regularly scheduled. They include visits to a doctor, counselor, or therapist to talk about your mental health issues. Some laboratory services are also covered if they are ordered by a psychiatrist in our network.
If you would like to go to a PHP, talk to your current provider or call Member Services for help.
Residential treatment facilities (RTF) are a place where children and adolescents, under the age of 21, live while they are receiving inpatient treatment.
A current provider must recommend that you be referred to this level of care. Talk to your current provider about whether this level of care will help your child.
Targeted case management (intensive case management, resource coordination, and blended case management) is a service in which a case manager works with you to help you get the services you need in your community. The case manager will help you set and reach your goals.
Specific services for children and adolescents
- Behavioral health rehabilitation services (BHRS) for children and adolescents.
- Residential treatment facilities (RTF).
- Family-based treatment.
As a rule, services that are not listed in the PerformCare handbook are not paid for by PerformCare. However, it may be possible that PerformCare covers a service not listed. You or your provider should contact Member Services with questions about coverage for a service that is not listed in your handbook.
All services that are not specifically listed as in-plan services or are not approved supplemental services are not covered under your HealthChoices behavioral health program.
Other services available to you or your family
There may be other services and community supports available for you or your family. They may be provided through the County Mental Health and Drug and Alcohol programs in your area. PerformCare can help you get those services. We can help explore any costs that may apply to you.
The PerformCare staff works with other individuals and agencies to help organize your treatment and support. They include your primary care doctor; the Area Agency on Aging; and the Children, Youth, and Family Social Service Provider.
For more information about your covered benefits, or for general help, call PerformCare using the member contact information for your county.