The AmeriHealth Caritas Delaware behavioral health benefit for members under the age of 18 is limited to thirty (30) units per calendar year. After the member has reached 30 units of behavioral health service for the calendar year, the Plan is no longer responsible for the member’s behavioral health utilization until the calendar year ends.
Members under age 18 requiring more than 30 units of behavioral health services during the calendar year will have their behavioral health utilization managed by the Delaware Department for Services for Children, Youth and Families (DSCYF).
Members 18 and older who participate in PROMISE and receive these services become the responsibility of the State and are paid through the State’s Delaware Medicaid Enterprise System DMES:
- Substance use disorder services other than medically managed intensive inpatient detoxification.
- Licensed behavioral health practitioner services.
- Community psychiatric support and treatment, including Assertive Community Treatment (ACT)/Intensive Care Management (ICM).
- Community-based residential supports excluding assisted living.
- Peer support.
- Psychosocial rehabilitation.