Behavioral Health Inpatient Details
Figure 3.5 provides coverage details for inpatient behavioral health care services. Note: This chart is not intended to be all-inclusive.
Figure 3.5 Behavioral Health Care Services: Inpatient Coverage Details
| Service |
Description |
| Acute Inpatient Psychiatric Care |
May be covered on an emergency or nonemergency basis. Prior authorization from Humana Military is required for all non-emergency inpatient admissions. In emergency situations, authorization is required for continued stay.
Limitations:
- Patients age 19 and older: 30 days per fiscal year (FY)1 or in any single admission
- Patients age 18 and under: 45 days per FY1 or in any single admission
- Inpatient admissions for substance use disorder detoxification and rehabilitation count toward the 30- or 45-day limit
Note: Stay limits may be waived if determined to be medically or psychologically necessary.
|
| Partial Hospitalization Program (PHP) |
Psychiatric PHPs provide interdisciplinary therapeutic services at least three hours a day, five days a week, in any combination of day, evening, night, and weekend treatment programs. The following rules apply:
- Prior authorization from Humana Military is required. PHP admissions are not considered emergencies.
- Facilities must be TRICARE-authorized.
- PHPs must agree to participate in TRICARE.
Limitations:
PHP care is limited to 60 treatment days (whether full- or partial-day treatment) per FY1 or for a single admission. These 60 days are not offset by or counted toward the 30- or 45-day inpatient limit.
|
| Residential Treatment Center (RTC) Care |
RTC care provides extended care for children and adolescents with psychological disorders that require continued treatment in a therapeutic environment. The following rules apply:
- Facilities must be TRICARE-authorized.
- Unless therapeutically contraindicated, the family and/or guardian should actively participate in the continuing care of the patient through either direct involvement at the facility or geographically distant family therapy.
- Prior authorization from Humana Military is required. RTC admissions are not considered emergencies.
- RTC care is considered elective and will not be covered for emergencies.
- Admission primarily for substance use rehabilitation is not authorized.
- Care must be recommended and directed by a psychiatrist or clinical psychologist.
Limitations:
- Care is limited to 150 days per FY1 or for a single admission. (Limitations may be waived if determined to be medically or psychologically necessary.)
- RTC care is only covered for patients up to age 21.
|
1 October 1–September 30
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