BHDD Medicaid Services Provider Manual Effective March 8, 2025
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Medicaid Manual
Introduction |
Issued/ Revised |
|
| 001 | Purpose | 10/01/2022 |
| 002 | Definitions | 01/01/2025 |
100 |
Section 1 - General Requirements |
Issued/ Revised |
| 105 | Severe and Disabling Mental Illness | 05/12/2023 |
| 110 | Substance Use Disorder | 10/01/2022 |
| 115 | Assessments | 10/01/2022 |
| 120 | Individualized Treatment Plans for Behavioral Health Treatment | 10/01/2022 |
| 130 | Progress Notes | 10/01/2022 |
| 135 | Continuing Care Plan | 10/01/2022 |
200 |
Section 2 - Utilization Management |
Issued/ Revised |
| 205 | Requesting a Prior Authorization – Non-Acute Services | 10/01/2022 |
| 206 | Requesting Auto Authorization – Acute Services | 10/01/2022 |
| 206QA | Auto-Authorization Quality Assurance | 10/01/2022 |
| 210 | Requesting a Continued Stay Review – Non-Acute Services | 10/01/2022 |
| 215 | Utilization Review Determinations and Notifications | 05/12/2023 |
| 220 | Reconsideration Review Process | 10/01/2022 |
| 230 | Integrated Service Delivery | 3/08/2025 |
300 |
Section 3 - Administrative Reviews |
Issued/ Revised |
| 305 | Retrospective and Quality Reviews | 01/01/2025 |
| 310 | Administrative Review, Fair Hearing, & Sanctions | 05/12/2023 |
500 |
Section 5 – Medicaid Substance Use Disorder (SUD) Services |
Issued/ Revised |
| 505 | Specimen Collection for SUD Drug Testing | 10/01/2022 |
| 510 | SUD Targeted Case Management | 10/01/2022 |
| 514 | Screening, Brief Intervention, and Referral to Treatment (SBIRT) | 10/01/2022 |
| 515 | SUD Certified Behavioral Health Peer Support Services (CBHPSS) - Adult | 05/12/2023 |
| 520 | SUD Outpatient (OP) Therapy (ASAM 1.0) | 10/01/2022 |
| 525 | SUD Intensive Outpatient (IOP) Therapy (ASAM 2.1) | 03/08/2025 |
| 530 | SUD Partial Hospitalization (ASAM 2.5) | 01/01/2025 |
| 535 | SUD Clinically Managed Low-Intensity Residential (ASAM 3.1) | 03/08/2022 |
| 536 | SUD Withdrawal Management (ASAM 3.2) (New) | 10/01/2022 |
| 537 | SUD Clinically Managed Population‐specific High‐Intensity Residential (ASAM 3.3) Adult (New) | 10/01/2022 |
| 540 | SUD Clinically Managed High-Intensity Residential (ASAM 3.5) | 10/01/2022 |
| 545 | SUD Medically Monitored Intensive Inpatient (ASAM 3.7) | 10/01/2022 |
| 550 | Medication Assisted Treatment (MAT) | 10/01/2022 |
600 |
Section 6 – Medicaid HEART Waiver (NEW) |
Issued/ Revised |
| 600 | HEART Waiver- Purpose | 01/01/2025 |
| 602 | HEART Waiver – Tenancy Support Services – Progress Notes | 01/01/2025 |
| 603 | HEART Waiver – Tenancy Support Service – Eligibility and Enrollment | 01/01/2025 |
| 604 | HEART Waiver – Tenancy Support Service – Housing Plan | 01/01/2025 |
| 605 | HEART Waiver – Tenancy Support Service – TSS | 01/01/2025 |
| 606 | HEART Waiver – Tenancy Support Service – Application Fee and Security Deposit Assistance | 01/01/2025 |
If you are looking for more information regarding HEART Waiver, you can find it on our HEART Waiver Services page.
All BHDD Medicaid resources can be located on our Forms and Applications webpage.
Looking for the Fee Schedules?
This can be found on the Medicaid Provider website:
Adult Mental Health and HEART Waiver Services:
- Please read and review the end user agreement. If you agree, click "I Accept" box.
- Find "Mental Health Center" link
- Locate "Fee Schedule- Medicaid Mental Health Adults 18 and Over"
- Select "January 2025 Medicaid Mental Health for Adults"
Substance Use Disorder Services:
- Please read and review the end user agreement. If you agree, click "I Accept" box.
- Find "Substance Use Disorder" link
- Locate "Fee Schedule- Substance Use Disorder"
- Select recently updated fee schedule, there is a Medicaid and Non Medicaid version.
