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MYPAC
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Charlene Toten, Division Director |
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Mental Health Services offered by Medicaid include:
Acute Freestanding Psychiatric Facilities–provide acute services for children under
21, with an average length of stay of 7-10 days. Prior authorization is required.
Therapeutic and Evaluative Mental Health Services for Children–provide the Expanded Early Periodic Screening,
Diagnosis, and Treatment (EPSDT) program for children under 21 years of age, which
includes therapeutic and evaluative services. All services must be medically necessary
and require prior authorization from the Division of Medicaid. Service standards
apply but can be over-ridden.
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Find a mental health provider in your area |
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Billing Guidelines for Therapeutic & Evaluative Mental Health Services for Children
(Formerly Billing Guidelines for Community-based Mental Health Services)
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Community
Mental Health Center Services – mental health services provided for children
and adults by one of the regional Community Mental Health Centers or Community Services
Division of a State Hospital.
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Community Mental Health Center Billing Guidelines |
Federally Qualified Health Center and Rural Health Clinics–provide mental health
services in the community, but are based on visits. Each person is allowed a medical
visit and a separate mental health visit. All visits count against the service limits
for adults. Children under the age of 21 may receive more visits, if medically necessary,
with prior authorization.
Geriatric Psychiatric services are NOT covered.
Inpatient Detox for Chemical Dependency –limited to detoxification. Medicaid does not cover
alcohol and drug treatment; however, with a primary mental health diagnosis, the
rules for psychiatric units apply.
Intellectual Disabilities/Developmental Disabilities
The ID/DD Waiver provides services to individuals who, but for the
provision of home and community-based services, would require placement in an Intermediate
Care Facility for the Mentally Retarded (ICF/MR). Individuals in this program must
qualify for one of the following eligibility categories: SSI, TANF, Disabled Child
Living at Home, or income up to 300% of the SSI Federal Benefit Rate. The ID/DD
waiver is administered by the Department of Mental Health, Bureau of Mental Retardation.
The Department, through its regional centers, provides support coordination and,
through an assessment process, makes referrals for the following services: In-Home
Respite, ICF/MR Respite, Community Respite, Residential Habilitation, Day Habilitation,
Prevocational Services, Supported Employment, Physical Therapy, Occupational Therapy,
Speech, Language and Hearing Therapy, Specialized Medical Supplies, Behavioral Support/Interventions,
and Attendant Care Services.
Approved 1915(c) Waiver (full content)
ID/DD Brochure
ID/DD Waiver Fee Schedule
Outpatient Hospital Services
– mental health services are covered when provided in an outpatient
department of a general hospital. They are not covered at acute freestanding psych
facilities.
Pre-Admission Screening and Resident Review (PASRR) –an administrative
activity, which determines if applicants for nursing facility placement meet the
criteria for needed specialized mental health services due to an indication of Mental
Illness or Mental Retardation. The screening is performed by Community Mental Health
Centers (CMHC) and Regional Centers around the State. If determined necessary, CMHCs
may provide specialized mental health services to the resident in the nursing facility.
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Fees for PASRR Administrative Services
PreAdmission
Screening Resident Review Summary Level II for MI form
PreAdmission Screening Resident Review Summary Level II for MR form
PASRR FAQ's
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Psychiatric Residential
Treatment Facilities–residential services for children under 21, with
an average length of stay of 6 months. Prior authorization is required.
Psychiatry Services by Physician or Nurse Practitioner–limited to 12 visits per
fiscal year, which do not affect the 12 physician office visits for medical issues.
Children under the age of 21 may receive more visits, if medically necessary, with
prior authorization.
Psychiatric Units at General Hospitals–provide acute psychiatric services for both
children and adults, with an average length of stay of 7-10 days. There is a limit
of 30 days per fiscal year for adults. Children may have more days, if medically
necessary. Prior authorization is required.
Fee Schedule by individual procedure code and service date through Envision
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