Does Blue Cross Blue Shield cover residential treatment?

Blue Cross Blue Shield Description of Procedure or Service

 

Does Blue Cross Blue Shield cover residential treatment
Does Blue Cross Blue Shield cover residential treatment

A residential treatment facility is a 24-hour facility that is not a hospital, but which offers treatment for
patients that require close monitoring of their behavioral and clinical activities related to their
psychiatric treatment, eating disorder, or to their chemical dependency or addiction to drugs or alcohol.
These programs are comprehensive and address potential symptoms/behaviors and incorporate
psychotherapeutic treatments and education through a multidisciplinary team approach. The treatment
plan is individualized and intensive, offering individual therapy, family counseling, group therapy, and
recreational activities. The program will generally offer a prolonged after-care component and
facilitates peer support. The patient must meet medical necessity criteria for admission into a
residential facility.
Most residential treatment facilities provide limited direct MD or Ph.D. patient care. Facility-employed
counselors provide most care, which is included in the daily costs. A physician or psychiatrist should
evaluate the patient within the first 24 hours. Continuous assessment of the patient’s need for
continued residential treatment must be made by a physician or psychiatrist. This level of care is
determined by matching the patient’s status and needs to recover and regain the highest level of
function to the appropriate level of care.
Residential treatment facilities are not for “providing housing”, custodial care, a structured environment
whose use is simply to change the person’s environment, or a wilderness center training camp.
Related Policy:
Drug Testing in Pain Management and Substance Abuse Treatment

 

Blue Cross Blue Shield Residential Treatment

8/7/12 Specialty Matched Consultant Advisory Panel review 7/18/12. No changes to policy
statement. Policy returned to Active status. (sk)
3/11/14 Specialty Matched Consultant Advisory Panel review 7/17/13. No changes to policy
statement. References added. (sk)
11/11/14 Specialty Matched Consultant Advisory Panel review 7/29/14. Added admission criteria
and continued stay criteria for Psychiatric Residential Treatment and Eating Disorders
Residential Treatment. Reference added. Clarified that Residential Treatment is not
covered unless criteria are met. Title changed to Residential Treatment. Medical Director
review. (sk)
9/1/15 Specialty Matched Consultant Advisory Panel review 7/29/15. Reference added. (sk)
8/30/16 Criteria for admission and continued stay in residential treatment for chemical dependency
extensively revised for clarity. Specialty Matched Consultant Advisory Panel review
7/27/2016. Policy intent unchanged. (an)
7/28/17 Specialty Matched Consultant Advisory Panel review 6/28/2017. No change to policy
statement. (an)
7/27/18 Specialty Matched Consultant Advisory Panel review 6/27/2018. No change to policy
statement. (an)
7/30/19 Specialty Matched Co

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