The NH Healthy Families Provider Network works to provide substance use disorder services, behavioral health services, specialty therapy and rehabilitative services all throughout New Hampshire. To focus on providing superior service, the network collaborates with health care providers to guarantee that members are recipients of programs that are both effective and life-changing. All programs are evidence-based and provide tools, technical assistance and training.
In the NH Healthy Families Provider Network, successful outcomes are the goals of every major substance dependency provider in terms of accurate and timely care and claims payment. The network keeps a detailed manual of care and systems of delivery throughout the state of New Hampshire.
NH Healthy Families Managed Care Philosophy
NH Healthy Families is dedicated to the concept of providing quality treatment at the lowest level of intensity as required that fulfills the member’s needs. The network holds that personalized evaluations of each participant’s treatment program needs are necessary for the best medical outcomes. Outpatient treatment is the first type of treatment considered, but inpatient possibilities are taken into account if strongly indicated. NH Healthy Families gives priority to outpatient treatment for the following reasons:
• Outpatient treatment allows for the recipient to mind their own familial responsibilities, individual pursuits and career-related problems while still managing to get treatment. Immediate feedback is provided for any problems that crop up. Confidence will increase with every success that the member achieves; incremental improvements are easy to measure during the treatment process.
• Scholastic activities, social events and occupational relationships are allowed to continue so that the privacy and confidentiality of the treatment are nearly guaranteed. Acquaintances and co-workers don’t need to be aware of the recipient’s treatment program unless they disclose it willingly.
• The potential management for treatment motivators such as social and family responsibilities is maximized during an outpatient treatment program because it involves these networks strongly.
• Outpatient treatment provides the recipient a maximum amount of preexisting social networks and support systems during therapy in a way that is the least imposing on their normal day-to-day life.
Confidentiality and privacy are taken to heart at NH Healthy Families. There are policies, procedures and processes that align with mandated state and federal regulatory demands.
The entire continuum of care focuses on one thing: improving lives. The three important pillars of care are:
• Active local involvement
• A process that looks at the whole health of the body
• A focus on individuals
The core beliefs that drive this provider network impact each decision the medical professionals make while the insurer strives to uplift the lives of members. NH Healthy Families employees pay close attention to all aspects of the company, including case management and utilization of technology that allows them to predict trends and projections accurately. They strive to consistently improve in order to increase the positive outcomes for all member populations regarding long-term recovery.
NH Healthy Families positions itself to guarantee substance use disorder treatment, quality behavioral health and specialty services. Quality improvement committees, along with dedicated focus studies, are conducted concurrently for behavioral and physical health care monitoring. NH Healthy Families informs behavioral and physical health care providers about acceptable exchanges of medical information.
The company reimburses and manages claims for services that are covered, which include behavioral health and substance use disorder. Benchmarks for recovery and program performance are measured regularly; non-compliance results in the formation of a plan of corrective action that helps see the individual back on track to recovery. NH Healthy Families is dedicated to helping members make a timely recovery.
Eligibility for NH Healthy Families
Eligibility comes to fruition during the first day of any given calendar month upon successful enrollment. The eligibility criteria for those seeking to participate in the NH Healthy Families network are defined by the New Hampshire Department of Health and Human Services. Those who would like to apply to the program can be directed to the online application process known as the NH EASY system.
Verifying Member Enrollment
Providers must manage the process of discerning eligibility each time a member would like to schedule an appointment and when they show up for treatment. Eligibility and enrollment verification is assisted by NH Healthy Families’ customer service team. Representatives are accessible during typical business hours and have access to up-to-date enrollment and eligibility information. However, there are a few important bits of information required when calling to check for eligibility. These are:
• Medicaid number
• Social Security number
• Telephone number
• Correctly spelled full name of the member
It’s important to understand that until the date of enrollment with New Hampshire Healthy Families comes into effect, the network will not be financially responsible for any of the treatments or services provided to the individual attempting to enroll. Also, NH Healthy Families will not cover any costs incurred for services or treatment after membership in the program network has been terminated. The network will, however, cover the cost of those who are in an inpatient treatment facility and switch health plans during their stay in rehab confinement.
Provider Network Participation
New Hampshire Healthy Families works with providers that have a track record for meeting or exceeding high-quality clinical standards. Each provider is dedicated to helping overcome language barriers and tackle cultural concerns in order to facilitate an effective treatment process. This circle of care includes:
• Community medical health centers
• Outpatient substance use disorder programs
• Social workers
• FQHCs and RHCs
Density Standards and Provider Access
NH Healthy Families guarantees that provider access is maintained in order for there to be a standard of coverage for participants throughout New Hampshire. Members utilizing the NH Healthy Families network can access substance use disorder rehabilitation, behavioral health services and specialist-led therapy. Primary care physicians don’t need to refer the member in order for them to participate in services. Members can also be self-referred for behavioral health services by medical consenters or caregivers. If there is an assessment that is required, then NH Healthy Families will need to give permission for it first.
Providers are to meet the state’s waiting times for an appointment with full compliance with stated timetables. For Medicaid holders, providers are required to make every attempt to align with the ideal timetables set forth by NH Healthy Families:
• Office waiting times are not to exceed one hour from the scheduled appointment time.
• Urgent care must be provided within 48 hours as needed.
• Routine symptom care must be addressed within 10 business days.
• Routine care without any symptoms must be addressed within 30 business days.
• Behavioral services and aftercare must be scheduled within seven days of being discharged from the hospital.
Network providers are to ensure that these services are accessible 24/7 and that the member’s health and behavioral condition dictate the level of need. People with disabilities must be able to access care within the hours of operation with specialized, aided guidance within normal business hours offered to all commercial enrollees.
Customer Service and Standards of Care
There is a toll-free emergency hotline run by New Hampshire Healthy Families. This hotline runs Monday to Friday between 8:00 a.m. and 5:00 p.m. EST and has after-hours services during weekends, evenings and holidays. The hotline is based around the company’s mission statement to provide behavioral health services that are cost-efficient and reliable.
The main focus of the customer service department is to facilitate the approval of services covered by NH Healthy Families for members so that they may have treatment via a specific clinic or team of clinicians. Information about care providers and guidance on how to select the best one is also available. Customer service is able to discern through questioning the member any special needs for the purpose of dictating the urgency of care and support.
The step-by-step process of dealing with member concerns and providing critical assistance is to:
1. Verify member eligibility
2. Verify benefits of the member
3. Obtain member authorizations
4. Provide informed referrals
5. Troubleshoot eligibility, addressing referral issues and researching prior services
6. Establish any needed translation and interpretation needs and provide said services
Coverage After-Hours and 24/7 Nurse Advice Line
NH Healthy Families provides an advice line that runs every hour of the day. This help line is staffed by an accredited nursing staff with bilingual help available. Nurse referrals are provided along with assessments for care needs. The referral service entails:
• Assistance with deciding the appropriate level of care with the help of any available clinical information and criteria
• Notification and documentation of admissions for inpatients who are admitted outside of typical hours
• Emergency after-hours refills for medications
• Emergency assessment for acute treatments and services
• Interventions during crisis situations
• Verification of member eligibility for treatments and providers
• After-hours referrals
Translation and Interpretation Services
NH Healthy Families is dedicated to ensuring that employees are educated about, are sensitive to and remain cognizant of the cultural and linguistic needs of all members. So that these needs might be properly addressed, NH Healthy Families will provide:
• Trained and professional language translators and interpreters who can be made available for face-to-face services in clinical office settings
• Telephonic translation and interpretation services
• Disability communication services such as American Sign Language
• Bilingual personnel with a focus on English and Spanish translation
No-Show Appointments and Hold-Harmless Policy
A no-show is defined as not showing up for a scheduled appointment without giving any notification to the provider within 24 hours. No-show appointments need to be marked in the member’s records, and they cannot be levied against the member’s benefit maximum. Members of NH Healthy Families cannot be billed a fee for any no-show appointment.
Member Treatment Requirements
Care providers are required to:
• Provide a member’s clinical data to other providers and practitioners treating the member should the member express suicidal thoughts or homicidal ideation as per the law of the state
• Comply with all federal and state requirements as given by the governing agencies within them regarding emergency aid, screening services and post-stabilization care
• Make admissions or referrals of members for behavioral health services that are covered within the New Hampshire Healthy Families Providers Network
• Guarantee that all members receive understandable, respectful and effective treatments provided in a way that is compatible with their cultural beliefs and practices within their preferred language
• Reschedule and attempt to contact members who have missed appointments within a 24-hour period
• Guarantee that members who are leaving inpatient crisis stabilization or psychological inpatient care have appropriate follow-up contacts within seven days of discharge
• Provide physical health treatments only if said treatments are within the appropriate scope of the clinical licensure
• Refer all members with suspected or known physical health and welfare problems and mental disorders to the member’s primary care physician for treatment and continued examination
Granite Recovery Centers Behavioral Health
Granite Recovery Centers focuses on evidence-based behavioral health improvements in order to rehabilitate those with substance use disorders and keep them sober with follow-up treatment. Situated within scenic New Hampshire vistas and away from areas of temptation and chaos, this facility is well-known for its ability to help recovering individuals regain their sense of wholeness.
Granite Recovery Centers has a low client-to-clinician ratio that allows for personal care provided by licensed staff with a track record for success. When a recovering person is discharged, then support groups, a network of program graduates and 12-step programming will be ready to act as scaffolding for sobriety. With cognitive behavioral therapy and other mental health treatments implemented under the understanding guidance of trained psychiatrists and therapists, Granite Recovery Centers is strategically placed to keep members within the New Hampshire Healthy Families Network in control of their own lives.