Types of EAP Service Plans and Care Management
Requirements
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Published: October, 2001
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As you are reviewing this section of the manual, please keep
the following definitions and guidelines in mind.
All EAP services must be pre-authorized. Axis I diagnosis
is not required for EAP only clients. V codes or 799.90 for
diagnosis deferred can be used for EAP claims.
There are three different types of PBH EAP service plans.
- Stand-alone EAP Services
Members have only EAP services available through PBH. Behavioral
health benefits may be part of another medical health plan
or a carve-out behavioral health managed care plan.
- EAP as Gatekeeper to a PBH Managed Care Plan
Members must contact PBH EAP prior to accessing mental health
or chemical dependency treatment through their PBH plan.
Depending on the outcome of the assessment, PBH EAP counselors
refer to EAP services or behavioral health treatment. A
referral can be given separate from, or in conjunction with,
community resources, financial, legal and other EAP services.
If the clinical need exceeds the scope of the EAP service
plan, the member will be given a referral for treatment
under their managed behavioral health care benefit.
- EAP Integrated with PBH Managed Care Plan
Members has "dual" access, and may call PBH EAP
or PBH behavioral health plan for assessment and referral.
Depending on the outcome of the assessment, PBH staff refers
to EAP services or behavioral health treatment. A referral
can be given separate from or in conjunction with community
resources, financial, legal and other EAP services. If the
clinical need exceeds the scope of the EAP service plan,
the member will be given a referral for treatment under
their managed care behavioral health benefit.
Each of the plans above is available with a 3-visit, 5-visit,
8-visit or 10 visit model. It is the provider's responsibility
to know which service plan applies to an individual client.
This information will be provided to you at the time of the
referral. This knowledge can assist the provider during assessment
and subsequent development of a counseling and/or referral
plan. The number of EAP visits must be pre-authorized. For
plans with more than 5 visits, EAP providers should always
call the care manager after the fifth visit when needing to
request additional visits or to transition the client to the
behavioral health plan benefit.
Regardless of the type of EAP service plan a client may have,
PBH advocates an approach that focuses on assessment and referral,
and problem-focused brief counseling.
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