Molina’s Behavioral Health
Service Model
Overview
Behavioral Health Service Model
• Care Management
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Utilization Management
Transition of Care
Utilization Management
Community Connectors
• Continuity and Coordination Between
Medical and Behavioral Healthcare
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Care Management Model
The care management model is multi phased
and follows the member throughout their care
depending on each unique individuals need.
Services include:
• Utilization Management
• Transition of Care
• Utilization Management , and
• Community Connector support
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Utilization Management (UM)
UM is the process of active care coordination
with the Molina provider network when the
following services are requested:
• Inpatient Hospitalization
• Detoxification
• Residential Services
• Psychological and Neuropsychological
Testing
• Outpatient Electroconvulsive Therapy
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Transition of Care (ToC)
Hospitalized members are eligible to participate
in ToC:
• ToC begins with face to face interaction with
the member while hospitalized
• There are 30 days of face to face and
telephonic follow-up post hospitalization, and
• When members need additional support,
beyond 30 days, a Community Connector
can be assigned for continued in-community
support
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Case Management (CM)
CM is a collaborative process that:
• Assesses, plans, implements, coordinates,
monitors and evaluates the services required
to meet the member’s unique needs
CM is characterized by:
• Advocacy, communication, resource
management and promotes quality and cost
effective interventions and outcomes
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Community Connectors (CC)
CC’s are the ”eyes and ears” of case managers
and work with members on a face to face
basis and excel at:
• Community Knowledge
• Capacity Building (e.g., promote positive health behaviors)
• System Navigation
• Health Coaching, and
• Health Outreach
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Continuity and Coordination of Care
Continuity and coordination of care between
medical and behavioral healthcare providers
are the attributes that influence quality.
Integration of care is influenced by the:
• Timeliness and frequency of shared clinical
information
• Completeness and accuracy of shared
clinical information, and
• Clarity and adequacy of shared clinical
information
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Continuity and Coordination of Care
To promote care coordination behavioral health
providers are expected to communicate the
following information, with the member’s
medical providers, within 30 days of when
treatment begins and when changes occur:
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Diagnosis
Initial and annual assessments
List of medications
Dates of related hospitalizations
Medical condition(s) that require attention, and
Treatment plan and annual treatment plan updates
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For More Information
Please contact your provider representative for
more information about Molina’s behavioral
health program and to learn about the:
• Behavioral Health Toolkit for Primary Care
Providers, and the
• Behavioral Health Toolkit for Behavioral
Health Specialists
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