Delegated Utilization Management - Behavioral Health

Health Net and MHN, Health Net's behavioral health division, have written standards for centralized triage and referral functions for behavioral health services. They are intended to ensure that these functions are correctly adopted and monitored, as well as professionally managed. This is achieved by:

• Making triage and referral decisions according to protocols that define the level of urgency and care setting.
• Adopting triage and referral protocols that are based on sound clinical evidence and currently accepted practices in the industry.
  • Using protocols that specifically address mental health and substance abuse triage and referral.
  • Providing triage and referral staff with up-to-date protocols and guidelines.

  Health Net, MHN and participating physician groups (PPGs) delegated for triage and referral follow these guidelines:

• Triage and referral decisions that do not require clinical judgment are made by staff who have relevant knowledge, skills and professional experience.
• Triage and referral decisions that require clinical judgment are made by a licensed behavioral health care provider with qualified experience.
• Triage and referral staff are supervised by a licensed behavioral health care provider with a minimum of a Master's degree and five years of post-degree clinical experience.
• A licensed psychiatrist or licensed doctoral-level clinical psychologist experienced in clinical risk management oversees triage and referral decisions.