Behavioral health is defined as those services provided for the assessment and treatment of problems related to mental health and substance use disorders. Substance use disorders include abuse of alcohol and other drugs. In order to meet the behavioral health needs of our members, Aetna Better Health of New Jersey will provide a continuum of services to members at risk of or suffering from mental, addictive, or other behavioral disorders.
Behavioral health services are covered for members who are clients of the Division of Developmental Disabilities (DDD). Non-DDD members are covered under the Medicaid Fee-for-Service (FFS) program for behavioral health services. Providers can call the toll-free number located on the back of the member’s identification card to access information about services, participating behavioral health providers, and authorization information for members who request services from a behavioral health provider directly.
In addition, for all categories of members, Aetna Better Health of New Jersey will cover the diagnoses of diseases of organic origin categorized as altering the mental status of a member.
When reviewing requests for clinical authorization, Aetna Better Health of New Jersey’s Utilization Management processes use the most current MCG guidelines for psychiatric/mental health care and the most current ASAM criteria for substance use disorders. In the event of a denial, a copy of the relevant guideline can be provided to the requesting provider.
Here are links for more information about the ASAM Criteria and the MCG website: