Behavioral health glossary

A 2024 final rule implements section 3221 of the CARES Act and aligns parts of Part 2 with the HIPAA Privacy, Breach Notification, and Enforcement rules, including breach notification and civil money penalties [1]. The rule was effective April 16, 2024, and the compliance date was February 16, 2026 [1]. A patient may give one written consent for all future uses and disclosures for treatment, payment, and health care operations, and may revoke that consent in writing [2]. Patient consent for the use and disclosure of records, or testimony relaying information contained in a record, in a civil, criminal, administrative, or legislative investigation or proceeding cannot be combined with a consent to use and disclose a record for any other purpose [3]. The use and disclosure restrictions cover a record that would identify a patient as having or having had a substance use disorder, either directly, by reference to publicly available information, or through verification of that identification by another person when a federally assisted substance use disorder program obtained the substance use disorder information after March 20, 1972, or a federally assisted alcohol use disorder or substance use disorder program obtained the alcohol use disorder information after May 13, 1974, for the purpose of treating a substance use disorder, making a diagnosis for that treatment, or making a referral for that treatment [4]. They also cover using that information, whether or not it is recorded, to initiate or substantiate criminal charges against the patient or to conduct a criminal investigation of the patient [4]. Information obtained before the pertinent date is covered when a part 2 program maintains it after that date as part of an ongoing treatment episode that extends past that date [4].

The Behavior Analyst Certification Board describes behavior analysis as the science of behavior, and applied behavior analysis as the approach that teaches more effective ways of behaving through positive reinforcement and works to change the social consequences of existing behavior [1]. Its practice areas include autism and other developmental disabilities and substance use disorders, among others [1].

A.R.S. § 36-2904 says the administration shall execute prepaid capitated health services contracts for health and medical services [1]. AHCCCS describes the program as an integrated managed care model operated through a Research and Demonstration 1115 Waiver, and says contracted health plans coordinate and pay for physical and behavioral health care services [2].

The fourth edition adult overview lists the dimensions as intoxication, withdrawal, and addiction medications; biomedical conditions; psychiatric and cognitive conditions; substance use-related risks; recovery environment interactions; and person-centered considerations [4]. Readiness to change is no longer its own dimension [1]. ASAM is not a regulatory body. Public entities, including state and local regulatory bodies, and payers decide if and when to implement the standards [2].

Arizona Administrative Code R9-10-101 defines a behavioral health professional as a person licensed under A.R.S. Title 32, Chapter 33, whose scope allows independent practice of behavioral health or, except for a licensed substance abuse technician, practice under direct supervision; a psychiatrist; a psychologist; a physician; a behavior analyst; a registered nurse practitioner licensed as an adult psychiatric and mental health nurse; or a registered nurse with a psychiatric-mental health nursing certification or one year of experience providing behavioral health services [1]. A behavioral health technician is not a behavioral health professional. With clinical oversight by a behavioral health professional, the technician provides services that, outside a health care institution, would have to be provided by a person licensed under A.R.S. Title 32, Chapter 33, or the technician provides health-related services [1].

CMS defines a bundled payment that way and contrasts it with paying each service separately [1]. CMS describes retrospective and prospective ways to calculate the payment [1].

CARF describes accreditation as advancing service excellence through a consultative peer-review survey process that affirms conformance to evolving, international consensus standards [1].

SAMHSA says a Certified Community Behavioral Health Clinic must serve anyone who requests care for mental health or substance use, regardless of ability to pay, place of residence, or age, including developmentally appropriate care for children and youth [1]. SAMHSA describes clinics supported through the Section 223 Medicaid demonstration, through SAMHSA expansion grants, or through a state program outside that demonstration [1]. Demonstration clinics are certified by their states as being in compliance with the CCBHC certification criteria and are reimbursed through a prospective payment system for the 9 required services defined in the criteria [2]. Independent state programs use a Medicaid state plan or section 1115 demonstration authority, not the Section 223 demonstration, to define the CCBHC services and the payments for those services [2]. The demonstration SAMHSA describes is the Section 223 Protecting Access to Medicare Act of 2014 demonstration [2]. The Bipartisan Safer Communities Act (Public Law 117-159), section 11001, amended that section so that, beginning July 1, 2024, and every two years after that, up to 10 additional states may join the demonstration [3].

Arizona Administrative Code R9-10-101 defines admission as the point when, after a health care institution completes an individual’s screening or registration, the individual begins receiving physical health services or behavioral health services and is accepted as a patient of the institution [1].

When the consent is a single consent for all future uses and disclosures for treatment, payment, and health care operations, a Part 2 program, covered entity, or business associate may use and disclose those records for treatment, payment, and health care operations as permitted by the HIPAA regulations, until the patient revokes that consent in writing [1]. The consent must include the patient’s right to revoke the consent in writing, except to the extent that the Part 2 program or other lawful holder of patient identifying information that is permitted to make the disclosure has already acted in reliance on it, and how the patient may revoke consent [2].

The ASAM Criteria, fourth edition, describes a continuum of four broad treatment levels and says patients are regularly reassessed so the transition and continued-service criteria can show whether the patient is ready to move to a less intensive level, requires a more intensive level, or should continue at the current level [1]. HUD’s Continuum of Care Program is the department’s homelessness assistance program, including coordinated entry and homeless management information systems [2].

NCQA says organizations must establish the qualifications of their licensed medical professionals by assessing their background and legitimacy to provide care [1]. NCQA Credentialing Accreditation evaluates organizations that provide full-scope credentialing, including verification of practitioner credentials and credentialing and recredentialing committee review. NCQA Credentialing Certification assesses organizations that verify practitioner credentials [1].

DSM-5-TR is a text revision of DSM-5, which was published in 2013, and it includes updates to ICD-10-CM codes since that publication [1]. The APA states that there are no DSM codes and that clinicians should use ICD-10-CM codes to submit claims [1]. The APA’s highlights of changes from DSM-IV-TR to DSM-5 direct readers to Section I of DSM-5 for the changes to the multiaxial system [2].

Healthy People 2030 describes SAMHSA’s Evidence-Based Practices Resource Center as providing tools and information on prevention, treatment, and recovery support services for mental and substance use disorders. The collection includes treatment improvement protocols, toolkits, resource guides, and clinical practice guidelines [1].

CMS defines an electronic remittance advice as an explanation from a health plan to a provider about a claim payment and the adjustments the plan made [1]. CMS defines an explanation of benefits as a summary from a health plan of the total charges for services received and how much the covered person and the plan will have to pay; it may be mailed or electronic, and it is not a bill [2]. X12 claim adjustment reason codes describe why a claim or service line was paid differently than it was billed [3]. Code descriptions that include a usage note refer readers to the 835 Healthcare Policy Identification Segment when that segment is present [3].

Under the Security Rule now in the Code of Federal Regulations, encryption and decryption of electronic protected health information is an addressable implementation specification at 45 CFR 164.312(a)(2)(iv), and encryption during transmission is addressable at 45 CFR 164.312(e)(2)(ii) [1]. A notice of proposed rulemaking published January 6, 2025 (90 FR 898) would revise the Security Rule; as of September 2026 that document is still a proposed rule and has no effective date [2].

In the fourth edition adult volume, Level 2 is intensive outpatient and high-intensity outpatient care [1]. Clinically managed Level 2.1 programs provide 9 to 19 hours of clinical services per week, and those hours primarily, but not exclusively, consist of counseling and psychoeducation [1]. Clinically managed Level 2.5 programs provide at least 20 hours per week and have a greater focus on psychotherapy [1].

The fourth edition keeps four broad levels, numbered 1 through 4 [1]. The adult overview names them outpatient treatment, intensive outpatient and high-intensity outpatient treatment, residential treatment, and medically managed inpatient treatment [2]. The fourth edition adds Level 1.0, long-term remission monitoring for patients in sustained remission, including recovery management checkups and rapid reengagement in care when needed [1]. The overview does not list Level 0.5 [2]. The fourth edition overview lists Early Intervention and Secondary Prevention as its own chapter [2].

42 CFR 8.12(h)(2) says an opioid treatment program shall use only those medications for opioid use disorder that the FDA has approved under 21 U.S.C. 355 for use in the treatment of opioid use disorder. A program that is fully compliant with the protocol of an investigational use of a drug and the other conditions set forth in the application may administer a drug the FDA has authorized under an investigational new drug application under section 505(i) of the Federal Food, Drug, and Cosmetic Act for investigational use in that treatment [1]. The rule currently considers methadone, buprenorphine and buprenorphine combination products that have been approved for use in the treatment of opioid use disorder, and naltrexone to be approved for that use [1]. To obtain certification from the Secretary, the program must meet the federal opioid use disorder treatment standards in § 8.12, must be the subject of a current, valid accreditation by an accreditation body or other entity the Secretary designates, and must comply with any other conditions for certification the Secretary establishes [4]. Those standards require adequate medical, counseling, vocational, educational, and other screening, assessment, and treatment services, with the combination and frequency tailored to each patient based on an individualized assessment and a care plan created after shared decision making between the patient and the clinical team [1]. The Part 8 final rule states that the Consolidated Appropriations Act, 2023 (Public Law 117-328) eliminated the DATA-waiver, and that section 1262 of that law removed the requirement to obtain a waiver before prescribing buprenorphine for opioid use disorder [2]. The notes to 21 U.S.C. § 823 record that section 1263(a) of the same law added the prescriber training requirement, and the statute says the Attorney General shall not require that training more than once [3].

National Standard 3.0 distinguishes four residence types known as levels or levels of support [1]. The compendium says that since 2011, affiliates have been certifying safe, ethical, and quality residences, and that promulgation of the standard includes affiliate organizations, recovery residence operators, and other stakeholders who are responsible for certifying recovery residences [1].

OASAS funds, regulates, and supports programs that range from school-based prevention to community-based harm reduction and state-run treatment [1].

The PHQ-9 is a brief depression severity measure; Kroenke, Spitzer, and Williams reported its validity in primary care and obstetrics-gynecology clinics [1]. The PHQ screeners site says the Patient Health Questionnaire and the GAD-7 offer concise, self-administered screening and diagnostic tools for mental health disorders, and that the screeners improve recognition of depression and anxiety [2]. The AUDIT-C is a brief alcohol screening questionnaire [3].

Medicare publishes payment-rate updates for the federally qualified health center prospective payment system [1]. In the Section 223 CCBHC demonstration, clinics are certified by their states as being in compliance with the CCBHC certification criteria and are reimbursed through a prospective payment system for the 9 required services defined in the criteria [2]. Independent state programs use a Medicaid state plan or section 1115 demonstration authority, not the Section 223 demonstration, to define the CCBHC services and the payments for those services [2].

A CMS final rule published February 8, 2024 (89 FR 8758) adds electronic prior authorization requirements for Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and qualified health plan issuers on the Federally-facilitated Exchanges [1].

HFMA defines revenue cycle management as the process health care systems use to track revenue from a patient’s initial appointment or encounter through final payment [1]. Activities leading to payment include patient registration, benefits verification, care delivery, claim submission, and reimbursement [1]. HFMA also identifies claim processing, payer payment analysis, third-party follow-up, and denial processing as parts of the revenue cycle [1].

Healthy People 2030, from the U.S. Department of Health and Human Services, groups these conditions into five domains and gives social determinants of health an increased and overarching focus [1].

The DSM page says DSM-5-TR is the standard classification of mental disorders used by mental health professionals in the United States [1]. The same page says the manual includes updated diagnostic criteria and ICD-10-CM codes since DSM-5 was published [1].

The Joint Commission’s mission is to enable and affirm the highest standards of healthcare quality and safety for all [1]. The January 2026 manual covers Behavioral Health Care and Human Services, including care, treatment, and services and opioid treatment programs [1].

42 CFR 456.1 requires a statewide program to control the utilization of all Medicaid services, specific controls for Medicaid services in institutions, and an outpatient drug use review program [1]. For the inpatient services in hospitals, mental hospitals, and intermediate care facilities that the section ties to the federal payment penalty, a physician must certify the need for care at admission, and a physician, or a physician assistant or nurse practitioner under a physician’s supervision, must periodically recertify that need [1].

The Health Care Payment Learning and Action Network’s Alternative Payment Model Framework establishes a common vocabulary and pathway for measuring successful payment models [1]. Originally published in 2016 and refreshed in 2017, the framework classifies alternative payment models in four categories and eight subcategories [1].