Plan Benefits

• Psychological testing
• Psychiatric or psychological evaluation and treatment (including neuropsychological evaluation)
• Psychosocial history
• Screening for and monitoring treatment of substance abuse and mental illness
• Other medically necessary behavioral health diagnostic services to include labs

Substance Use Disorder Services

AlohaCare CCS coordinates with Department of Health Alcohol and Drug Abuse Division (DOH-ADAD) to help meet the needs of our members with substance use disorders. They link members with the ADAD specialists within our Provider Network.  Do you need help accessing these providers for substance use disorder treatment? Please work with your CCS case manager or contact Member Services toll-free at 1-888-397-9899 or TTY/TDD 1-877-447-5990.  Alternatively, you can access ADAD providers and substance use disorder treatment 24/7 by calling the Hawaii CARES line: 

Oahu: 1-808-832-3100

Neighbor Islands: 1-800-753-6879

Alcohol and Chemical Dependency Services

• This covers all medically necessary services.

Methadone Management Services

• This includes the provision of methadone or suitable alternative (I.e. LAAM or buprenorphoine) as well as outpatient counseling services.

Medication Management

• Medication evaluation
• Medication counseling and education
• Psychotropic medications

Prescription Drugs

• The plan covers drugs listed on our Preferred Drug List (PDL)
• This list will also have drugs that may have limits such as prior authorization, quantity limits, step therapy, age limits or gender limits
• Alternate drugs may be covered with a prior authorization

Behavioral Health Crisis Services

• 24 hours, 7 days a week emergency/crisis intervention
• Mobile crisis response
• Crisis stabilization
• Crisis hotline
• Crisis residential services

Emergency Department (ED)

Any covered inpatient and outpatient services given by a qualified provider; these services are needed to evaluate or stabilize an emergency medical condition

• An emergency medical condition must be a result of serious mental illness (SMI) or serious and persistent mental illness (SPMI diagnosis)
• The health plan may not deny payment for these services when a representative from the health plan instructed the member to seek services

Urgent Care

• Covered as medically necessary. No prior authorization is required.

Supported Employment Services

• Work assessment service
• Pre-employment service

Inpatient Psychiatric Hospitalization 24 Hours

• Room and board
• Nursing care
• Medical supplies, equipment and drugs
• Diagnostic services
• Psychiatric services
• Other practitioner services as needed
• Physical, occupational, speech and language therapy
• Post-stabilization services
• Other medically necessary services

Partial Hospitalization or Intensive Outpatient Hospitalization including:

• Medication management
• Prescribed drugs
• Medical supplies
• Diagnostic tests
• Therapeutic services including individual, family and group therapy, and aftercare
• Other medically necessary services

Intensive Case Management

• Coordination of behavioral, medical and pharmacy care
• Assistance obtaining food and housing
• Assistance securing and maintaining eligibility for general assistance or Social Security benefits
• Medication monitoring and management
• Hospital discharge planning
• Crisis services

Residential and Outpatient Treatment

• Work assessment service
• Intensive outpatient program
• Day treatment
• Residential treatment services
• Psychosocial rehabilitation

• Pre-tenancy services
• Tenancy Services
• Other Housing & Tenancy Services
• Medical Respite
• Representative Payee

Provides non-emergency ground and air services to and from medically necessary provider appointments or services for members who: 

• Have no means of transportation. 
• Reside in areas not served by public transportation. 
• Cannot access public transportation due to his or her mental condition. 
• Do not live in a community care foster family home, adult residential care home, expanded adult residential care home, or domiciliary home.

Transportation may require prior authorization. For transportation requiring emergency* services, members should call 911.  

Adult members who have a diagnosis of SMI, provisional SMI, or SPMI and who require alcohol abuse and/or drug abuse diagnosis, treatment and/or rehabilitative services, will get these services from us. We make decisions about admission to treatment programs, continued stay and discharge criteria based on the most recent edition of the American Society of Addiction Medicine (ASAM) Patient Placement Criteria. 

* Emergency care services = inpatient or outpatient hospital services necessary to prevent death or serious impairment of health and, because of the danger to life or health, require the use of the most accessible hospital equipped to furnish those services