New Coverage for Clinical Stabilization Services
Posted on November 12, 2015
Health New England (HNE) recently expanded substance abuse treatment coverage for members* to include clinical stabilization services (CSS). This new coverage became effective October 1, 2015.
What is CSS?
Clinical stabilization services is a 24-hour clinically managed post-detoxification treatment for adults or adolescents, usually following acute treatment services for substance abuse. This treatment may include education and counseling about the nature of addiction and its consequences, relapse prevention, outreach to families and significant others, and aftercare planning.
HNE’s coverage may now provide for medically necessary clinical stabilization services for up to 14 consecutive days without preauthorization.
Providers or facilities providing clinical stabilization services must notify us if a member is admitted for services within 48 hours of admission. We may initiate utilization review on the 7th day of the member’s stay, which could include discussions about coordination of care and treatment plans. We cannot, however, make any utilization review decisions that impose restrictions or deny any future medically necessary clinical stabilization services unless a patient has received at least 14 consecutive days of clinical stabilization services.
Substance Abuse Programs
For a listing of substance abuse Treatment Programs in Massachusetts, please visit:
https://hhsvgapps01.hhs.state.ma.us/elicensing-pubweb/prog/main.htm
For a listing of substance abuse Prevention Programs in Massachusetts, please visit:
https://hhsvgapps01.hhs.state.ma.us/elicensing-pubweb/prev/main.htm
If you have questions about substance abuse coverage, feel free to contact HNE Member Services, Monday – Friday, 8:00 a.m. – 6:00 p.m., at (413) 787-4004 or (800) 310-2835. For TTY/TTD: (800) 439-2370.
*Fully funded plan members only, including GIC.
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