Wellcare Dual Liberty (HMO D-SNP) (001): Outpatient Substance Abuse Services

Ongoing group and individual therapy sessions are critical for mental health maintenance, including substance abuse and addiction services.

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Cost

$0 copay for each Medicare-covered visits

Prior Authorization Required

Yes

Provider Referral or Order Required

How To Receive

Details on how to apply

$0 copay for each Medicare-covered individual therapy visit.
$0 copay for each Medicare-covered group therapy visit.

Search network outpatient substance abuse facilities.

Our coverage is the same as Original Medicare’s, which is coverage for services that are provided in the outpatient department of a hospital to patients who, for example, have been discharged from an inpatient stay for the treatment of substance abuse or who require treatment but do not require the availability and intensity of services found only in the inpatient hospital setting.

The coverage available for these services is subject to the same rules generally applicable to the coverage of outpatient hospital services. Services provided by a state-licensed psychiatrist or doctor, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, physician assistant, or other Medicare-qualified health care professional as allowed under applicable state laws.

Covered services include: Assessment, evaluation, and treatment for substance use related disorders by a Medicare eligible provider to quickly determine the severity of substance use and identify the appropriate level of treatment

Availability

1 assessment in a 12 month period; Sessions ongoing, until goals are achieved

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Treatment for substance abuse focuses on understanding the nature of addiction, becoming drug-free, and preventing relapse.

There are many individual, group, or family therapy options and they are frequently used in combination. Therapies include talk therapy (the bedrock of therapy), cognitive-behavioral therapy, dialectical therapy, motivational interviewing, 12-step facilitation, yoga and meditation, art and music therapy, online therapy, and of course adjuvant medication therapy.

Substance abuse services are provided in an office, clinic environment, an individual’s home, or other appropriate locations. Services are provided by a physician, clinical psychologist, clinical social worker, nurse practitioner, clinical nurse specialist, certified nurse midwife, physician assistant, or other Medicare-qualified health care providers.

Covered services include but are not limited to:

Initial and ongoing evaluation/assessment
An individualized plan of care with clear treatment goals based on needs and response to treatment
Individual and group psychotherapy that focuses on behaviors associated with alcohol and/or drug use, including lifestyle, attitudes, relapse prevention, and coping skills
Family counseling and involvement as appropriate
Discharge planning that includes the identification of realistic discharge criteria

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