Behavioral Health Providers

The Specialty Network

A behavioral specialty network must cover a wide range of behavioral treatment needs and levels of care. A typical behavioral health specialty network includes individual (solo) practitioners and multispecialty group practices consisting of clinical psychologists (PhDs, PsyDs, EdDs), social workers (LCSWs, LISWs, ACSWs, MSWs, CISWs), masters-level therapists (MPSYs, MFTs, MFCCs, LMFTs, LPCs), psychiatric nurses (ANRPs, RNs), and psychiatrists. A network may also include medical doctors who specialize in addictionology, and developmental behavioral pediatricians (DBPs) to improve access for children with special needs.

In addition to behavioral specialists, the network includes inpatient facilities and programs that accommodate the broad spectrum of treatment needs. Acute inpatient facilities are designated for the most acute treatment needs, meaning individuals who are unable to care for themselves in some way and may be suicidal or homicidal. Partial hospital programs (sometimes called day treatment) offer intensive treatment during the day, but patients return home overnight. Finally, intensive outpatient programs are designed for patients who need more intensive treatment than weekly outpatient therapy provides, but they require fewer hours each day than partial or day facilities provide. Each program or facility may specialize in a certain age group (adult, geriatric, adolescent, child), while some programs focus on mental illnesses only, others on chemical dependency, and a few specialize in co-occurring disorders. MBHOs employ specific criteria to authorize facility-based care and treatment programs for their members, and licensed care managers provide oversight to ensure treatment plans and lengths of stay are appropriate.

Provider Qualification: The Credentialing Process

MBHOs perform primary source verification of practitioners' credentials before they are accepted to practice in their network and serve their members. Areas of scrutiny include investigation into a provider's education, board certification, background and work history, liability insurance and malpractice coverage, practice information (addresses/hours/facility description), population, language and treatment specialties, and hospital admitting privileges. MBHOs conduct recredentialing—typically every two to three years—to ensure that providers maintain quality standards.

Meeting Group Needs: Customized Networks

MBHOs often custom-build behavioral provider networks to meet a group's diverse geographic, cultural, language and specialty needs, as well as member preferences. Standards for member access and availability to services are designed to ensure that members have a choice of providers—outpatient practitioners, inpatient facilities and specialized treatment programs—across the continuum of care, within an acceptable travel distance, and with appropriate clinical subspecialties. Most MBHOs forge alliances with community-based mental health and substance abuse treatment providers to provide both covered services and as referral sources for noncovered services, and they develop these linkages based on the particular needs of the membership being served. Rural areas often have a limited number and diversity of practitioners and facilities. Consequently, Medicaid-supported community mental health centers often dominate as the de facto service provider for a wide range of treatment needs. To increase access to treatment in rural areas, MBHOs may at times work with Medicaid-supported providers to establish these centers as referral options for their members. In addition, MBHOs are beginning to consider telephonic or web based psychiatry to serve rural populations that do not have access to local professionals.