Updated Behavioral Health Information

Caring for your patients who have behavioral health issues is important to their overall health. To help you support your patients’ mental health, we updated the behavioral health section of our provider website, including: 

• Behavioral health clinical practice guidelines.
• Behavioral health and substance use.
• Provider manual chapter 26 on behavioral health services.

Collaboration among medical and behavioral health providers is key to better patient health outcomes. Visit our behavioral health page to view these resources.

As part of proactive behavioral health care, remember to include routine depression screenings for your patients, which support early identification to help your patients receive timely, appropriate care. This includes screenings for adolescents age 12 through 17 and adults age 18 and older. 

New Provider Bonus

Providers treating our state-sponsored program members can also earn EmblemHealth’s new Depression Screening Bonus, which was recently introduced as part of the 2026 Quality Incentive Program. To help qualifying providers earn this bonus, see our Tip Sheet: Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) which includes guidelines, best practices, and follow-up care options for patients who receive a positive depression screening.

Effectiveness of Care FMC HEDIS Measure 

Behavioral health visits, substance use disorder visits, and/or a community mental health center visits are all part of follow-up care for patients with high-risk chronic conditions who recently had an emergency department (ED) visit. These are included in the Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC) HEDIS Measure. 

This Effectiveness of Care FMC HEDIS Measure looks at the percentage of patients 18 years or older who have multiple high-risk chronic conditions and have had a follow-up service within seven days of an ED visit. This measure helps ensure patients with high-risk chronic conditions, who often receive care from multiple providers, are monitored and followed to improve long-term health. This also helps decrease adverse outcomes like frequent ED visits, hospitalizations, nursing home admissions, medication errors, and even death. Follow-up services include:

• Behavioral health visit.
• Substance use disorder visit.
• Community mental health visit.
• Outpatient visit.                                                
• Telephonic visit.                                                
• Virtual care visit.                                               
• E-visit or virtual check-in.
• Telehealth visit.                                                 
• Transitional care management visit.             
• Care management visit.
• Complex care management services.
• Intensive outpatient or partial hospitalization.
• Rest home/domiciliary visit.                           
• Partial hospitalization visit.
• Electroconvulsive therapy.                                                          

HEDIS Measure follow-up tips

• Contact the patient when you receive the ED notification and schedule a follow-up visit within seven days of discharge.
• You can schedule a visit on the date of the discharge.
• Keep appointments open so patients with an ED visit can be seen within seven-days.  
• Review the discharge summary with the patient to confirm they understand their instructions.
• Complete a medication reconciliation with the patient and/or their caregiver.
• Ensure new prescriptions have been filled at their pharmacy.
• Instruct patients to call with concerns, symptoms, or changes in their condition.
• Explain the importance of regular follow-up appointments.
• Visits can be completed by office staff including a medical assistant, licensed practical nurse (LPN), registered nurse (RN), and social worker.