Behavioral health member records, treatment planning, and coordination expectations

As Anthem Blue Cross continues to focus on holistic care to ensure that all of our members receive coordinated services and improved health outcomes, we want to reiterate the importance of coordination between our behavioral health and physical health providers. The overarching goal is that all members have access to the right care, in the right place, at the right time.

Coordination expectations

As behavioral health providers are completing their initial assessments and as PCPs are identifying the holistic needs of the members through comprehensive Initial Health Assessments, coordination between providers is essential. A Summary of Care (SOC) document to notify concurrent providers when care is initiated with a shared member is key. In addition, when a new need is identified through these evaluations, referral to necessary care is essential to ensure holistic care to our members. This leads to best practice and collaboration and avoids duplication of services as well as the risk of contraindicated interventions.

Comprehensive assessment

Member records must meet the standards and contain the elements consistent with the licensure of the provider.

Personalized support and care plan

A patient-centered support and care plan based on the psychiatric, medical substance use, and community functioning assessments found in the initial comprehensive assessment must be completed for any member who receives behavioral health services.

There must be documentation in every case that the member and, as appropriate, their family members, caregivers, or legal guardian participated in the development and subsequent reviews of the treatment plan.

The support and care plan must be completed within the first 14 days of admission to behavioral health services and updated every 180 days or more frequently as necessary based on the member’s progress toward goals or a significant change in psychiatric symptoms, medical condition, and/or community functioning.

There must be a signed release of information to provide information to the member’s PCP or evidence that the member refused to provide a signature. There must be documentation that referral to appropriate medical or social support professionals have been made.

A provider who discovers a gap in care is responsible to help the member get that gap in care fulfilled, and documentation should reflect the action taken in this regard.

For providers of multiple services, one comprehensive treatment/care/support plan is acceptable as long as at least one goal is written and updated as appropriate for each of the different services that are being provided to the member.

The treatment/support/care plan must contain the following elements:

• Identified problem(s) for which the member is seeking treatment
• Member goals related to each problem(s) identified, written in member-friendly language
• Measurable objectives to address the goals identified
• Target dates for completion of objectives
• Responsible parties for each objective
• Specific measurable action steps to accomplish each objective
• Individualized steps for prevention and/or resolution of crisis, which includes identification of crisis triggers (situations, signs, and increased symptoms); active steps or self-help methods to prevent, de-escalate, or defuse crisis situations; names and phone numbers of contacts who can assist the member in resolving crisis; and the member’s preferred treatment options, to include psychopharmacology, in the event of a mental health crisis
• Actions agreed to be taken when progress toward goals is less than originally planned by the member and provider
• Signatures of the member, as well as family members, caregivers, or legal guardian as appropriate

If you have any questions about this communication, please reach out to your assigned Provider Relationship Management representative.