Many individuals bravely work through challenges related to substance use and/or mental health, such as depression, anxiety, or other emotional and behavioral struggles.In addition, people may experience some type of trauma that involves serious loss, or a threat or harm to a person’s physical and/or emotional well-being. Fortunately, there are specialized behavioral health and substance use servicesavailable to assist members on their path to healing and recovery. These services offer a wide range of therapeutic options designed for each person’s unique needs. They can be accessed in different settings, including in one’s home or within their local community. Skilled individuals and organizations work with our members to provide person-centered and trauma-informed support and services.The primary goal of behavioral health services is to empower each person on their personal journey towards wellness, recovery, and resilience - ultimately fostering a life of fulfillment and independence in their communities.
Accessing Medicaid Behavioral Health Services
For Behavioral Health Services, please call 1-888-946-1168 (TTY:711) or 757-552-7174.
In addition, our Behavioral Health Crisis line is staffed by professionals who can help those in crisis and help you find a provider. Call 1-833-686-1595 (TTY: 711), 24 hours a day, 7 days a week.
Additional outside resources available include:
- Substance Abuse and Mental Health Services Administration (SAMHSA)- A free and confidential service available 24 hours for referrals and information
- 1-866-622-HELP (1-800-622-4357)
- Suicide and Crisis Lifeline- You can call, text, or chat with trained crisis counselors if you need to talk about any problems you are facing, whether or not you are thinking about suicide, or just need emotional support.
- Call or text 988 or chat 988lifeline.org
- Call or text 988 or chat 988lifeline.org
If you don’t have transportation, you can schedule a ride when you need to go to an appointment for a covered service. Call 1-877-892-3986 (TTY: 711), Monday through Friday, 6 a.m. to 6 p.m. to set up a ride. Trips need to be scheduled at least five business days beforehand. Weekends and holidays do not count toward these days.
Addiction and Recovery Treatment Services (ARTS)
Sentara Health Plans offers many services that help individuals who are living with substance use including alcohol and drug use. Addiction is a medical illness. Many people face addiction and can benefit from treatment. If you need treatment for addiction, we provide a variety of services to help you.
Sentara Health Plans covers the following ARTS services:
- inpatient acute detoxification hospitalization
- partial hospitalization
- group home/halfway house
- residential treatment facility services
- intensive outpatient treatment
- outpatient (individual, family, and group) substance use treatment
- opioid treatment services (includes individual, group counseling; family therapy and medication administration)
- peer support services
Medication-assisted treatment is also covered for prescription or non-prescription drug addiction.
Accessing Addiction and Recovery Treatment Services (ARTS)
Talk to your primary care provider (PCP) or call your Sentara Health Plans' care coordinator to discuss the best option for you.
To find an ARTS provider, you can do any of the following:
- look in the Provider Directory atsentarahealthplans.com/findadoc
- call your Sentara Health Plans care coordinator
- call Members Services at 1-800-881-2166 (TTY: 711).
If you have any questions or if you are interested in finding out more about ARTS, please do not hesitate to reach out to us. We hope you will take advantage of these services that are a benefit and are available at no cost to you.
Prior Authorizations for Behavioral Health and ARTS
Sentara Health Plans requires a prior service authorization for:
- all inpatient behavioral health and substance abuse admissions to hospitals
- partial hospitalization
- residential treatment
- substance abuse group home / halfway house treatment
- intensive outpatient substance abuse services
We also require prior service authorization for the following Mental Health services:
- Mental health case management: Services to help you find needed medical, social, educational, and other resources.
- Therapeutic day treatment services for children (TDT): Services for children with severe behavioral problems. It provides two hours a day of counseling for children during or after the school day. Workers will help with teaching about medication, building daily living skills, building social skills, individual, group and/or family counseling and care coordination.
- Mental health partial hospitalization program (MH-PHP) This program is for children and adults and is designed to support and prevent psychiatric hospitalization. It can also be an in-between service for members who are coming from a psychiatric hospital stay and need extra counseling. A team will work with a member 20 hours per week, five days per week doing intense therapy.
- Mobile Crisis: Rapid response service that responds to behavioral health crisis. This service is about maintaining safety and referring members to behavioral health services and support.
- Community Stabilization: Short-term service designed to help members with crisis response. They will work to set up other mental health services, continue to watch for safety concerns, provide education mental health crisis, and help find a support system for the member.
- 23-Hour Crisis Stabilization: This service gives time to decide whether a member needs to go to the hospital for a mental health crisis or if another mental health service may be able to help.
- Residential Crisis Stabilization: A short-term residential program that is one step down from a psychiatric hospitalization. This service aims to help a member get through a mental health crisis and find support in the community.
- Assertive Community Treatment (ACT): This service gives long-term treatment, rehabilitation, and support to members with severe mental illness and provides 24 hour on-call support.
- Mental Health Intensive Outpatient Services (MH-IOP): A service provided when a member is at risk for psychiatric hospitalization. Members aged 6–17 would get six hours per week of very intensive therapy. Adults over age 18 would get nine hours of intensive therapy each week.
- Mental Health PartialHospitalization Program (MH-PHP): This is a short-term, non-residential treatment program that is more intensive than traditional outpatient or MH-IOP. Services are highly structured and delivered under the direction of a doctor. Members attend this program a minimum of 20 hours per week.
- Mental Health Skill-Building Services (MHSS): This service is for members with serious mental illnesses who need help to learn how to improve their life and need less help later. Members learn how to complete daily living skills, understand why medication is important and how to take it, understand health conditions and how to care for them, good nutrition, and physical condition.
- Intensive In-Home Services: This service is for members under age 21 who are at risk of being removed from their home. It is usually short-term and intense. The service is to help the family learn how to get along, provide modeling, and improve relationships within the family.
- Psychosocial Rehabilitation Services: This service is for groups of individuals in the community. Service provides skills for independent living, learning social skills, and how to get along with others. It is two or more hours a day, several days a week.
- Mental Health Peer Support Services: Services are provided by an individual that has lived experience with mental health conditions and/or substance use disorder that is successful in ongoing recovery. This service helps members on their own journey of wellness and recovery.
- Multi-Systemic Therapy (MST): This service is provided in the home and community to children ages 11–17 who have very severe behavioral problems. Service focuses on overcoming barriers to behavior change, safety planning, and crisis intervention. Referral is needed from juvenile justice, behavioral health, school, or child welfare system.
- Functional Family Therapy (FFT): This is a home-based service for children ages 11-18 and provides help for behavioral or emotional problems including co-occurring substance use disorders. It focuses on the whole family to understand risk and protective factors. Referral is needed from juvenile justice, behavioral health, school, or child welfare system.
- Applied Behavioral Analysis (ABA): This is typically a home-based service for children and adolescents who often have developmental and behavioral issues. Through design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences, this service aims to produce socially significant improvement in human behavior.
To find out more about how to request approval for these treatments or services, call 1-800-881-2166 (TTY: 711).
Behavioral Health Services Administrator (BHSA)
Some behavioral health services, such children’s residential treatment and therapeutic foster care case management, are covered for you through the behavioral health services administrator (BHSA) for the Department of Medical Assistance Services (DMAS). Sentara Health Plans Member Services can refer you to a behavioral health care coordinator who can help coordinate the services you need, including those that are provided through the BHSA.
Any child or youth admitted to a Psychiatric Residential Treatment Facility (PRTF) or aTherapeutic Group Home (TGH) will not be excluded from Sentara Health Plans Medicaid; however, these services are provided and managed through DMAS’ Behavioral Health Service Administrator. Please note, if a member is residing in a TGH and needs medical services, these services will be covered by Sentara Heath Plans.
