Clinical Stabilization Services Coverage for Substance Use Disorders

Posted on December 20, 2019

As a Health New England member, you have Behavioral Health coverage, which includes mental health and substance use disorder services.

With a recent rise in the use of detoxification and short-term residential rehabilitation services, also known as clinical stabilization services (CSS), some questions have come up about what is covered for residential care and if payment is required up front.

Below are details to help clarify what Health New England covers for CSS and payment details for members:

• Health New England covers detoxification and/or short-term residential rehabilitation, also
  known as CSS, at facilities licensed by the Massachusetts Department of Public Health (DPH)
  Bureau of Substance Abuse Services for a minimum of fourteen (14) days combined. After the
  14 days, requests for additional coverage are reviewed for medical necessity.
• CSS facilities should not request payment in advance (except for applicable member cost share
  for CSS); nor should they claim that expenses for services provided after 14 days will be
  automatically covered. Services after 14 days require Health New England review/approval
• If a facility requires payment in advance in order to treat the member or makes claims about
  what Health New England will cover, please consider this a red flag. Please contact Health New
  England Member Services if this does occur.

We have also observed an increase in members receiving CSS at out-of-network facilities. Please note, Health New England has a broad network of facilities that offer CSS in both our HMO and PPO networks.

For questions and more information about covered services and member responsibility, or help finding an in-network CSS provider, please call Health New England Member Services at (413) 787-4004 or toll-free at (800) 310-2835.

Categories: Newsletter