8 behavioral care standards
Based on credible, objective evidence from multiple sources produced at trial, the court determined the eight following principles to be generally accepted standards of care among behavioral health professionals:
- Effective treatment requires treatment of the individual’s underlying condition and is not limited to alleviation of the individual’s current systems.
- Effective treatment requires treatment of co-occurring behavioral health disorders and/or medical conditions in a coordinated manner that considers the interactions of the disorders and conditions, and their implications for determining the appropriate level of care.
- Patients should receive treatment for mental health and substance use disorders at the least intensive and restrictive level of care that is safe and effective.
- When there is ambiguity as to the appropriate level of care, the practitioner should err on the side of caution by placing the patient in a higher level of care.
- Effective treatment of mental health and substance use disorders includes services needed to maintain functioning or prevent deterioration.
- The appropriate duration of treatment for behavioral health disorders is based on the individual needs of the patient. There is no specific limit on the duration of such treatment.
- The unique needs of children and adolescents must be taken into account when making level of care decisions involving their treatment for mental health or substance use disorders.
- The determination of the appropriate level of care for patients with mental health and/or substance use disorders should be made on the basis of a multidimensional assessment that takes into account a wide variety of information about the patient.
The court found UBH fell short of these standards. The court further stated that UBH based its coverage decisions for Transcranial Magnetic Stimulation, a treatment for major depressive disorder, and Applied Behavior Analysis, a treatment for autism spectrum disorder, based on how authorization of coverage would negatively affect UBH’s bottom line.
Page 3: Key takeaways from the court’s ruling