Proposed AMDD Medicaid Services Provider Manual for SUD and Adult Mental Health, Effective July 1, 2020

Printing the manual material found at this website for long-term use is not advisable. Department Policy material is updated periodically and it is the responsibility of the users to check and make sure that the policy they are researching or applying has the correct effective date for their circumstances. State Website Disclaimer.

 TABLE OF CONTENTS

Section/Subsection

 

Title/Content

Issued/Revised

     

Introduction

 
  001   Purpose 07/01/2020
  002   Definitions 07/01/2020

100

Section 1 - General Requirements

 
  105   Severe and Disabling Mental Illness 07/01/2020
  110   Substance Use Disorder 07/01/2020
  115   Assessments 07/01/2020
  120   Individualized Treatment Plans for Behavioral Health Treatment 07/01/2020
  125   Screening, Brief intervention, and referral to Treatment (SBIRT) 07/01/2020
  130   Progress Notes 07/01/2020
  135   Individualized Discharge Summary 07/01/2020

200

Section 2 - Utilization Management

 

  205   Requesting a Prior Authorization – Non-Acute Services 07/01/2020
  206   Requesting Auto Authorization – Acute Services 07/01/2020
  206a   Auto-Authorization Quality Assurance 07/01/2020
  210   Requesting a Continued Stay Review – Non-Acute Services 07/01/2020
  215   Utilization Review Determinations and Notifications 07/01/2020
  220   Reconsideration Review Process 07/01/2020
  230   Integrated Service Delivery and Explanation of Concurrent Service 07/01/2020

300

Section 3 - Administrative Reviews

 
  305   Retrospective and Quality Reviews 07/01/2020
  310   Administrative Review, Fair Hearing, & Sanctions 07/01/2020

400

Section 4 - Medicaid Adult Mental Health Services

 
  405   MH Targeted Case Management (TCM) 07/01/2020
  410   Illness Management and Recovery Services (IMR) 07/01/2020
  415   Certified Behavioral Health Peer Support Services (CBHPSS) – Mental Health 07/01/2020
  420   Community Based Psychiatric Rehabilitation Support Services (CBPRS) 07/01/2020
  425   Mental Health (MH) Outpatient (OP) Therapy 07/01/2020
  430   Dialectical Behavior Therapy (DBT) 07/01/2020
  435   Day Treatment (Day TX) 07/01/2020
  440   Adult Foster Care (AFC) 07/01/2020
  445   Behavioral Health Group Home (BHGH) 07/01/2020
  450   Crisis Stabilization Program 07/01/2020
  455   Community Maintenance Program – Stand Alone (sCMP) 07/01/2020
  460   Program of Assertive Community Treatment (PACT) 07/01/2020
  465   Acute Partial Hospital Program (PHP) 07/01/2020
  470   Acute Inpatient Hospital 07/01/2020

500

Section 5 – Medicaid Substance Use Disorder (SUD) Services

 
  505   SUD Drug Testing 07/01/2020
  510   SUD Targeted Case Management 07/01/2020
  515   SUD Certified Behavioral Health Peer Support Services (CBHPSS) - Adult 07/01/2020
  520   SUD Outpatient (OP) Therapy (ASAM 1.0) 07/01/2020
  525   SUD Intensive Outpatient (IOP) Therapy (ASAM 2.1) 07/01/2020
  530   SUD Partial Hospitalization (ASAM 2.5) 07/01/2020
  535   SUD Clinically Managed Low-Intensity Residential (ASAM 3.1) 07/01/2020
  540   SUD Clinically Managed High-Intensity Residential (ASAM 3.5) 07/01/2020
  545   SUD Medically Monitored Intensive Inpatient (ASAM 3.7) 07/01/2020
  550   Medication Assisted Treatment (MAT) 07/01/2020

 

Note: Please refer to AMDD Medicaid Services Provider Manual for SUD and Adult Mental Health for effective dates prior to 7-1-2020