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Mental Health Services

The Mental Health Services division oversees the following programs:

  • Acute Freestanding Psychiatric Facilities
  • Community/Private Mental Health Centers (CMHC/PMHC)
  • Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)
  • Outpatient Mental Health Hospital Services
  • Psychiatric Residential Treatment Facilities (PRTF)
  • Psychiatric Units at General Hospitals
  • Psychiatric Services by Physicians or Nurse Practitioners
  • Therapeutic and Evaluative (T&E) Mental Health Services for Children

Acute Freestanding Psychiatric Facilities

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.

Community/Private Mental Health Center Services (CMHC/PMHC)

Community/Private Mental Health Centers provide mental health services to children and adults. Services may be provided at Community Mental Health Centers or Private Mental Health Centers.

Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)

Federally Qualified Health Centers and Rural Health Clinics provide mental health services in the community. Each person is allowed a medical visit and a separate mental health visit on the same day. 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.

Outpatient Mental Health Hospital Services

Outpatient Mental Health Hospital Services are covered when provided in an outpatient department of a general hospital. Services are not covered at acute freestanding psychiatric facilities.

Psychiatric Residential Treatment Facilities (PRTF)

Psychiatric Residential Treatment Facilities provide residential services for children under 21, with an average length of stay of 6 months. Prior authorization is required.

Psychiatric Units at General Hospitals

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.

Psychiatry Services by Physicians or Nurse Practitioners

Psychiatry Services by Physicians or Nurse Practitioners are 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.

Therapeutic and Evaluative (T&E) Mental Health Services

Therapeutic and Evaluative Mental Health Services are a component of the Expanded Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program for beneficiaries under the age of 21, and are managed by the Division of Mental Health Services. The service ends on the last day of the 21st birthday month. All services must be medically necessary. Some services require prior authorization from the Division of Medicaid’s designated Utilization Management Quality Improvement Organization (UM/QIO) or the appropriate Coordinated Care Organization (CCO), whichever is applicable. Service standards do apply, yet may be exceeded with proper prior authorization.

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