Members - Benefits Overview

Benefits Overview

We work with the State of Kansas to provide mental health and substance abuse services for you and your children. We want you and your children to feel good about yourselves and be  healthy.

Covered Services*
Cenpatico covers a full range of treatment. Covered services for Cenpatico members include services such as:

 Covered Service  Service Description
(A Cenpatico network provider must provide all medically necessary services)
 Limits and Rules
 Diagnostic Services  An evaluation to determine your mental health or substance abuse treatment needs.  No prior authorization required for an evaluation conducted every 6 months
 Emergency Services
  •  Behavioral health emergency and crisis services are avalable 24 hours a day, seven days a week, and 365 days a year
  • You may call 866-896-7293 any time for help
 No prior authorization required for emergency services
 Acute Inpatient Hospital Services  This is services in an acute psychiatric hospital  Prior authorization required
 Day Treatment – Partial Hospitalization Program (PHP)  Day Treatment/PHP is a short-term program that provides support and treatment. It includes coordinated, intensive treatment that is more intense than outpatient care. The structured format provides medical monitoring, plus therapeutic groups and activities.  Prior authorization requiredMembers using this service return home in the eveningMembers may attend daily sessions, 6 to 8 hours in length, Monday through Friday
 Residential Treatment Services/PRTF Services for mental health and substance abuse treatment includes:

  • individual, group, or family therapies;
  • case management services
  • medication management

provided in a residential treatment facility where the member temporarily stays overnight.

 Prior authorization required
 Intensive Outpatient Program (IOP)  The Intensive Outpatient Program is very structured and includes some combination of individual, group, and family counseling. Counseling and education may be for substance abuse-related disorders or mental health. Prior authorization requiredMembers may attend sessions of 3 hours a day at least 3 times a week
 Outpatient Services  Individual, family or group therapy, usually offered in an office but sometimes in the home or other setting. Includes services to evaluate and treat mental health and substance abuse.  No prior authorization required for initial evaluation and five (5) visitsPrior authorization required after initial evaluation and visits
 Psychological Testing  Testing to more clearly determine diagnoses and status  Prior authorization requiredNote: IQ testing or testing to determine if a person has learning disabilities is not covered
 Medication Management  Prescription and medication monitoring for the treatment of a behavioral health condition or disorder  No authorization required for outpatient visits to a participating doctor, nurse practitioner, or physician’s assistant
 Home-based Family Therapy
  •  Individual, family or group therapy is provided in the home
  • It may be more helpful in this setting than in an outpatient setting
 Prior authorization required
 Family Education and Support Services  Services include information about the member’s disorder, information and training in managing the member’s disorder, and training in supporting the member in staying healthy  The member or responsible party must agree that the member’s information may be released to the family members

*Please refer to your member handbook for a full list of covered and non-covered services.