Adult Behavioral Health Benefits in Medicaid and the Marketplace
Appendix A: Explicitly Covered Specialty Behavioral Health Services by State
ARIZONA
Appendix Table 1: Arizona Adult Inpatient Behavioral Health Service Coverage | |||||
Health Plans | Psychiatric Hospital Visit | 23-Hour Observation | Residential Treatment Facility | Adult Group Homes | |
Medicaid | Medicaid RHBA or TRBHA | X | X | X | |
Platinum | Health Net CommunityCare HMO Open Access Platinum | X | |||
Humana Connect Platinum 1000/1500 Plan | X | ||||
Health Net PPO Platinum | X | ||||
Health Choice Essential Platinum | X | ||||
Gold | Health Net CommunityCare HMO Open Access Gold | X | |||
Humana Connect Gold 2500/3500 Plan | X | ||||
Health Net PPO Gold | X | ||||
Aetna Premier 2000 PD | X | ||||
Health Choice Essential Gold | X | ||||
FitRewards 1500 | X | ||||
myCigna Health Flex 1250 | X | X | |||
Meritus Healthy Gold | X | ||||
Gold Canyon 575 | X | ||||
Silver | Health Net CommunityCare HMO Open Access Silver | X | |||
Humana Connect Silver 4600/6300 Plan | X | ||||
Health Net HAS PPO Silver | X | ||||
Meritus Community Network – Phoenix | X | ||||
EverydayHealth Select (Maricopa) 4000 | X | ||||
Health Choice Essential Silver | X | ||||
Aetna Classic 3500 PD | X | ||||
myCigna Health Savings 3400 | X | X | |||
Silver Canyon 1575 | X | ||||
Bronze | Health Net CommunityCare HAS Open Access Bronze | X | |||
Health Net PPO Bronze | X | ||||
Aetna Advantage 6350 | X | ||||
EverydayHealth Alliance (Maricopa) 6000 | X | ||||
Health Choice Essential Bronze | X | ||||
Meritus Premium Saver Bronze | X | ||||
myCigna Health Savings 6100 | X | X | |||
Bronze Canyon | X |
Appendix Table 2: Arizona Adult Outpatient Behavioral Health Service Coverage | |||||||
Health Plans | Case Management | Day Treatment | Partial Hospitalization | Psychosocial Rehabilitation | Intensive Outpatient | Mental Health Rehabilitation | |
Medicaid | Medicaid RHBA or TRBHA | X | X | X | |||
Platinum | Health Net CommunityCare HMO Open Access Platinum | ||||||
Humana Connect Platinum 1000/1500 Plan | |||||||
Health Net PPO Platinum | |||||||
Health Choice Essential Platinum | X | X | |||||
Gold | Health Net CommunityCare HMO Open Access Gold | ||||||
Humana Connect Gold 2500/3500 Plan | |||||||
Health Net PPO Gold | |||||||
Aetna Premier 2000 PD | |||||||
Health Choice Essential Gold | X | X | |||||
FitRewards 1500 | |||||||
myCigna Health Flex 1250 | X | ||||||
Meritus Healthy Gold | |||||||
Gold Canyon 575 | |||||||
Silver | Health Net CommunityCare HMO Open Access Silver | ||||||
Humana Connect Silver 4600/6300 Plan | |||||||
Health Net HAS PPO Silver | |||||||
Meritus Community Network – Phoenix | |||||||
EverydayHealth Select (Maricopa) 4000 | |||||||
Health Choice Essential Silver | X | X | |||||
Aetna Classic 3500 PD | |||||||
myCigna Health Savings 3400 | X | ||||||
Silver Canyon 1575 | |||||||
Bronze | Health Net CommunityCare HAS Open Access Bronze | ||||||
Health Net PPO Bronze | |||||||
Aetna Advantage 6350 | |||||||
EverydayHealth Alliance (Maricopa) 6000 | |||||||
Health Choice Essential Bronze | X | X | |||||
Meritus Premium Saver Bronze | |||||||
myCigna Health Savings 6100 | X | ||||||
Bronze Canyon |
Appendix Table 3: Arizona Adult Outpatient Provider Behavioral Health Service Coverage | |||||||||
Health Plans | Psychiatric Services –Evaluation | Psychiatric Services –Testing | Medication Evaluation, Prescription, and Management | Psychological Testing | Individual Testing | Individual Therapy | Group Therapy | Family Therapy | |
Medicaid | Medicaid RHBA or TRBHA | X | X | X | X | X | X | X | X |
Platinum | Health Net CommunityCare HMO Open Access Platinum | ||||||||
Humana Connect Platinum 1000/1500 Plan | |||||||||
Health Net PPO Platinum | |||||||||
Health Choice Essential Platinum | X | X | X | ||||||
Gold | Health Net CommunityCare HMO Open Access Gold | ||||||||
Humana Connect Gold 2500/3500 Plan | |||||||||
Health Net PPO Gold | |||||||||
Aetna Premier 2000 PD | |||||||||
Health Choice Essential Gold | X | X | X | ||||||
FitRewards 1500 | |||||||||
myCigna Health Flex 1250 | X | X | |||||||
Meritus Healthy Gold | |||||||||
Gold Canyon 575 | X | X | X | ||||||
Silver | Health Net CommunityCare HMO Open Access Silver | ||||||||
Humana Connect Silver 4600/6300 Plan | |||||||||
Health Net HAS PPO Silver | |||||||||
Meritus Community Network – Phoenix | |||||||||
EverydayHealth Select (Maricopa) 4000 | |||||||||
Health Choice Essential Silver | X | X | X | ||||||
Aetna Classic 3500 PD | |||||||||
myCigna Health Savings 3400 | X | X | |||||||
Silver Canyon 1575 | X | X | X | ||||||
Bronze | Health Net CommunityCare HAS Open Access Bronze | ||||||||
Health Net PPO Bronze | |||||||||
Aetna Advantage 6350 | |||||||||
EverydayHealth Alliance (Maricopa) 6000 | |||||||||
Health Choice Essential Bronze | X | X | X | ||||||
Meritus Premium Saver Bronze | |||||||||
myCigna Health Savings 6100 | X | X | |||||||
Bronze Canyon | X | X | X |
Appendix Table 4: Arizona Adult Substance Use Service Coverage | ||||||||||
Health Plans | Inpatient Rehab. | Inpatient Detox. | Outpatient Detox. | Residential Rehab. | Methadone Maint. | Suboxone Treatment | Intensive Outpatient | Smoking and Tobacco Use | Partial Hospitalization | |
Medicaid | Medicaid RHBA or TRBHA | X | X | X | X | |||||
Platinum | Health Net CommunityCare HMO Open Access Platinum | X | X | |||||||
Humana Connect Platinum 1000/1500 Plan | X | |||||||||
Health Net PPO Platinum | X | X | ||||||||
Health Choice Essential Platinum | X | X | X | Medication Management | Medication Management | X | X | X | ||
Gold | Health Net CommunityCare HMO Open Access Gold | X | X | |||||||
Humana Connect Gold 2500/3500 Plan | X | |||||||||
Health Net PPO Gold | X | X | ||||||||
Aetna Premier 2000 PD | X | X | ||||||||
Health Choice Essential Gold | X | X | X | Medication Management | Medication Management | X | X | X | ||
FitRewards 1500 | X | X | ||||||||
myCigna Health Flex 1250 | X | X | X | |||||||
Meritus Healthy Gold | X | X | ||||||||
Gold Canyon 575 | X | * | * | X | X | |||||
Silver | Health Net CommunityCare HMO Open Access Silver | X | X | |||||||
Humana Connect Silver 4600/6300 Plan | X | |||||||||
Health Net HAS PPO Silver | X | X | ||||||||
Meritus Community Network – Phoenix | X | |||||||||
EverydayHealth Select (Maricopa) 4000 | X | |||||||||
Health Choice Essential Silver | X | X | X | Medication Management | Medication Management | X | X | X | ||
Aetna Classic 3500 PD | X | |||||||||
myCigna Health Savings 3400 | X | X | X | |||||||
Silver Canyon 1575 | X | * | * | X | X | |||||
Bronze | Health Net CommunityCare HAS Open Access Bronze | X | X | |||||||
Health Net PPO Bronze | X | X | ||||||||
Aetna Advantage 6350 | X | |||||||||
EverydayHealth Alliance (Maricopa) 6000 | X | |||||||||
Health Choice Essential Bronze | X | X | X | Medication Management | Medication Management | X | X | X | ||
Meritus Premium Saver Bronze | X | |||||||||
myCigna Health Savings 6100 | X | X | X | |||||||
Bronze Canyon | X | * | * | X | X | |||||
* University of Arizona Health plans provide pharmaceutical coverage for medication provided during an inpatient residential stay and for medication management during a detoxification. |
Colorado
Appendix Table 5: Colorado Adult Inpatient Behavioral Health Service Coverage | |||||
Health Plans | Psychiatric Hospital Visit | 23-Hour Observation | Residential Treatment Facility | Adult Group Homes | |
Medicaid | Colorado Medical Assistance Program | X | X | ||
Platinum | Navigate | X | |||
Colorado HMOx | X | ||||
Gold | Navigate | X | |||
Denver LocalPlus | X | ||||
CCHP Network | X | ||||
CoOp State Wide Two | X | ||||
DHMP Expanded Network | X | Virtual Residency Therapy | |||
Pathway x Enhanced | X | ||||
Colorado HMOx | X | ||||
Kaiser Permanente Southern Colorado | X | ||||
Access Health Colorado | X | ||||
Rocky Mountain HMO Statewide Provider Network | X | ||||
Silver | Navigate | X | |||
Denver LocalPlus | X | ||||
CCHP Network | X | ||||
CoOp State Wide One | X | ||||
DHMP Closed Network | X | Virtual Residency Therapy | |||
Pathway x Enhanced | X | ||||
Colorado HMOx | X | ||||
Kaiser Permanente Southern Colorado | X | ||||
Access Health Colorado | X | ||||
Rocky Mountain HMO Statewide Provider Network | X | ||||
Bronze | Navigate | X | |||
Denver LocalPlus | X | ||||
CCHP Network | X | ||||
CoOp State Wide One | X | ||||
Pathway x Enhanced | X | ||||
Colorado HMOx | X | ||||
Kaiser Permanente Southern Colorado | X | ||||
Access Health Colorado | X | ||||
Rocky Mountain HMO Statewide Provider Network | X |
Appendix Table 6: Colorado Adult Outpatient Behavioral Health Service Coverage | |||||||
Health Plans | Case Management | Day Treatment | Partial Hospitalization | Psychosocial Rehabilitation | Intensive Outpatient | Mental Health Rehabilitation | |
Medicaid | Colorado Medical Assistance Program | X | X | X | X | X | |
Platinum | Navigate | X | |||||
Colorado HMOx | |||||||
Gold | Navigate | X | |||||
Denver LocalPlus | |||||||
CCHP Network | |||||||
CoOp State Wide Two | X | X | |||||
DHMP Expanded Network | X | X | |||||
Pathway x Enhanced | X | X | X | ||||
Colorado HMOx | |||||||
Kaiser Permanente Southern Colorado | X | ||||||
Access Health Colorado | X | X | X | ||||
Rocky Mountain HMO Statewide Provider Network | |||||||
Silver | Navigate | X | |||||
Denver LocalPlus | |||||||
CCHP Network | |||||||
CoOp State Wide One | X | X | |||||
DHMP Closed Network | X | X | |||||
Pathway x Enhanced | X | X | X | ||||
Colorado HMOx | |||||||
Kaiser Permanente Southern Colorado | X | ||||||
Access Health Colorado | X | X | X | ||||
Rocky Mountain HMO Statewide Provider Network | |||||||
Bronze | Navigate | X | |||||
Denver LocalPlus | |||||||
CCHP Network | |||||||
CoOp State Wide One | X | X | |||||
Pathway x Enhanced | X | X | X | ||||
Colorado HMOx | |||||||
Kaiser Permanente Southern Colorado | X | ||||||
Access Health Colorado | X | X | X | ||||
Rocky Mountain HMO Statewide Provider Network |
Appendix Table 7: Colorado Adult Outpatient Provider Behavioral Health Service Coverage | |||||||||
Health Plans | Psychiatric Services –Evaluation | Psychiatric Services –Testing | Medication Evaluation, Prescription, & Management | Psychological Testing | Individual Testing | Individual Therapy | Group Therapy | Family Therapy | |
Medicaid | Colorado Medical Assistance Program | X | X | X | X | X | X | X | X |
Platinum | Navigate | X | Psychiatric Treatment | X | X | ||||
Colorado HMOx | X | ||||||||
Gold | Navigate | X | X | X | |||||
Denver LocalPlus | |||||||||
CCHP Network | |||||||||
CoOp State Wide Two | X | X | X | X | X | ||||
DHMP Expanded Network | X | X | X | ||||||
Pathway x Enhanced | X | X | X | X | X | ||||
Colorado HMOx | X | ||||||||
Kaiser Permanente Southern Colorado | X | Psychiatric Treatment | X | X | |||||
Access Health Colorado | X | X | X | X | X | ||||
Rocky Mountain HMO Statewide Provider Network | X | X | X | X | |||||
Silver | Navigate | X | X | X | |||||
Denver LocalPlus | |||||||||
CCHP Network | |||||||||
CoOp State Wide One | X | X | X | X | X | ||||
DHMP Closed Network | X | X | X | ||||||
Pathway x Enhanced | X | X | X | X | X | ||||
Colorado HMOx | X | ||||||||
Kaiser Permanente Southern Colorado | X | Psychiatric Treatment | X | X | |||||
Access Health Colorado | X | X | X | X | X | ||||
Rocky Mountain HMO Statewide Provider Network | X | X | X | X | |||||
Bronze | Navigate | X | X | X | |||||
Denver LocalPlus | |||||||||
CCHP Network | |||||||||
CoOp State Wide One | X | X | X | X | X | ||||
Pathway x Enhanced | X | X | X | X | X | ||||
Colorado HMOx | X | ||||||||
Kaiser Permanente Southern Colorado | X | Psychiatric Treatment | X | X | |||||
Access Health Colorado | X | X | X | X | X | ||||
Rocky Mountain HMO Statewide Provider Network | X | X | X | X |
Appendix Table 8: Colorado Adult Substance Use Service Coverage | ||||||||||
Health Plans | Inpatient Rehab. | Inpatient Detox. | Outpatient Detox. | Residential Rehab. | Methadone Maint. | Suboxone Treatment | Intensive Outpatient | Smoking and Tobacco Use | Partial Hospitalization | |
Medicaid | Colorado Medical Assistance Program | X | X | X | X | X | ||||
Platinum | Navigate | Monitor Drug Therapy | X | |||||||
Colorado HMOx | X | |||||||||
Gold | Navigate | Monitor Drug Therapy | X | |||||||
Denver LocalPlus | X | |||||||||
CCHP Network | X | |||||||||
CoOp State Wide Two | Covers Medication Management | Covers Medication Management | X | X | ||||||
DHMP Expanded Network | X | X | X | |||||||
Pathway x Enhanced | X | X | Covers Medication Management As Part of Medical Detox | Covers Medication Management As Part of Medical Detox | X | X | ||||
Colorado HMOx | X | |||||||||
Kaiser Permanente Southern Colorado | X | X | Medical Management of Withdrawal Symptoms | Medical Management of Withdrawal Symptoms | X | |||||
Access Health Colorado | X | X | As Part of Medical Detox | As Part of Medical Detox | X | X | ||||
Rocky Mountain HMO Statewide Provider Network | ||||||||||
Silver | Navigate | Monitor Drug Therapy | X | |||||||
Denver LocalPlus | X | |||||||||
CCHP Network | X | |||||||||
CoOp State Wide One | Covers Medication Management | Covers Medication Management | X | X | ||||||
DHMP Closed Network | X | X | X | |||||||
Pathway x Enhanced | X | X | Covers Medication Management As Part of Medical Detox | Covers Medication Management As Part of Medical Detox | X | X | ||||
Colorado HMOx | X | |||||||||
Kaiser Permanente Southern Colorado | X | X | Medical Management of Withdrawal Symptoms | Medical Management of Withdrawal Symptoms | X | |||||
Access Health Colorado | X | X | As Part of Medical Detox | As Part of Medical Detox | X | X | ||||
Rocky Mountain HMO Statewide Provider Network | ||||||||||
Bronze | Navigate | Monitor Drug Therapy | X | |||||||
Denver LocalPlus | X | |||||||||
CCHP Network | X | |||||||||
CoOp State Wide One | Covers Medication Management | Covers Medication Management | X | X | ||||||
Pathway x Enhanced | X | X | Covers Medication Management As Part of Medical Detox | Covers Medication Management As Part of Medical Detox | X | X | ||||
Colorado HMOx | X | |||||||||
Kaiser Permanente Southern Colorado | X | X | Medical Management of Withdrawal Symptoms | Medical Management of Withdrawal Symptoms | X | |||||
Access Health Colorado | X | X | As Part of Medical Detox | As Part of Medical Detox | X | X | ||||
Rocky Mountain HMO Statewide Provider Network |
CONNECTICUT
Appendix Table 9: Connecticut Adult Inpatient Behavioral Health Service Coverage | |||||
Health Plans | Psychiatric Hospital Visit | 23-Hour Observation | Residential Treatment Facility | Adult Group Homes | |
Medicaid | Husky A | X | X | X | X |
Husky C | X | X | X | X | |
Husky D | X | X | X | X | |
Gold | Anthem Gold Direct Access (cddm) | X | X | ||
Anthem Gold Direct Access Standard (cddk) | X | X | |||
ConnectiCare Standard Gold POS | X | X | |||
HCT Healthy Partner Preferred | X | X | |||
Silver | Anthem Silver Direct Access (cdne) | X | X | ||
Anthem Silver Direct Access Standard (cboa) | X | X | |||
ConnectiCare Standard POS | X | X | |||
HCT Healthy Partner Max 1 | X | X | |||
Bronze | Anthem Bronze Direct Access (cdad) | X | X | ||
Anthem Bronze Direct Access Standard (cdcm) | X | X | |||
Anthem Bronze Direct Access w/ HSA | X | X | |||
ConnectiCare Bronze POS 10/20 | X | X | |||
ConnectiCare Bronze POS 20/30 | X | X | |||
ConnectiCare POS | X | X | |||
HCT Healthy Partner Essential | X | X | |||
HCT Healthy Partner Basic Plus | X | X |
Appendix Table 10: Connecticut Adult Outpatient Behavioral Health Service Coverage | |||||||
Health Plans | Case Management | Day Treatment* | Partial Hospitalization | Psychosocial Rehabilitation | Intensive Outpatient | Mental Health Rehabilitation** | |
Medicaid | Husky A | X | X | X | X | X | |
Husky C | X | X | X | X | X | ||
Husky D | X | X | X | X | X | ||
Gold | Anthem Gold Direct Access (cddm) | X*** | X | X | |||
Anthem Gold Direct Access Standard( cddk) | X*** | X | X | ||||
ConnectiCare Standard Gold POS | X | X | |||||
HCT Healthy Partner Preferred | X | X | |||||
Silver | Anthem Silver Direct Access (cdne) | X*** | X | X | |||
Anthem Silver Direct Access Standard (cboa) | X*** | X | X | ||||
ConnectiCare Standard POS | X | X | |||||
HCT Healthy Partner Max 1 | X | ||||||
Bronze | Anthem Bronze Direct Access (cdad) | X*** | X | X | X | ||
Anthem Bronze Direct Access Standard (cdcm) | X*** | X | X | X | |||
Anthem Bronze Direct Access w/ HSA | X*** | X | X | X | |||
ConnectiCare Bronze POS 10/20 | X | X | X | ||||
ConnectiCare Bronze POS 20/30 | X | X | X | ||||
ConnectiCare POS | X | X | X | ||||
HCT Healthy Partner Essential | X | X | |||||
HCT Healthy Partner Basic Plus | X | X | |||||
* Community Behavioral Health Program.
** Limited to those in Private Nonprofit Mental Institutions (PNMIs).
*** Plan may also extend Covered Services beyond the Benefit Maximums of this Plan.
|
Appendix Table 11: Connecticut Adult Outpatient Provider Behavioral Health Service Coverage |
|||||||||
Health Plans | Psychiatric Services –Evaluation | Psychiatric Services –Testing | Medication Evaluation, Prescription, & Management | Psychological Testing | Individual Testing | Individual Therapy | Group Therapy | Family Therapy | |
Medicaid | Husky A | X | X | X | X | X | X | X | X |
Husky C | X | X | X | X | X | X | X | X | |
Husky D | X | X | X | X | X | X | X | X | |
Gold | Anthem Gold Direct Access (cddm) | ||||||||
Anthem Gold Direct Access Standard (cddk) | |||||||||
ConnectiCare Standard Gold POS | |||||||||
HCT Healthy Partner Preferred | |||||||||
Silver | Anthem Silver Direct Access (cdne) | ||||||||
Anthem Silver Direct Access Standard (cboa) | |||||||||
ConnectiCare Standard POS | |||||||||
HCT Healthy Partner Max 1 | |||||||||
Bronze | Anthem Bronze Direct Access (cdad) | ||||||||
Anthem Bronze Direct Access Standard (cdcm) | |||||||||
Anthem Bronze Direct Access w/ HSA | |||||||||
ConnectiCare Bronze POS 10/20 | |||||||||
ConnectiCare Bronze POS 20/30 | |||||||||
ConnectiCare POS | |||||||||
HCT Healthy Partner Essential |
Appendix Table 12: Connecticut Adult Substance Use Service Coverage | ||||||||||
Health Plans | Inpatient Rehab. | Inpatient Detox. | Outpatient Detox. | Residential Rehab. | Methadone Maint. | Suboxone Treatment | Intensive Outpatient | Smoking and Tobacco Use | Partial Hospitalization | |
Medicaid | Husky A | X | X | X | X | X | X | X | ||
Husky C | X | X | X | X | X | X | X | |||
Husky D | X | X | X | X | X | X | X | |||
Gold | Anthem Gold Direct Access (cddm) | X | X | X | X | |||||
Anthem Gold Direct Access Standard (cddk) | X | X | X | X | ||||||
ConnectiCare Standard Gold POS | X | X | X | X | X | |||||
HCT Healthy Partner Preferred | X | ` | X | * | ||||||
Silver | Anthem Silver Direct Access (cdne) | X | X | X | X | |||||
Anthem Silver Direct Access Standard (cboa) | X | X | X | X | ||||||
ConnectiCare Standard POS | X | X | X | X | X | |||||
HCT Healthy Partner Max 1 | X | X | * | |||||||
Bronze | Anthem Bronze Direct Access (cdad) | X | X | X | X | |||||
Anthem Bronze Direct Access Standard (cdcm) | X | X | X | X | ||||||
Anthem Bronze Direct Access w/ HSA | X | X | X | X | ||||||
ConnectiCare Bronze POS 10/20 | X | X | X | X | X | |||||
ConnectiCare Bronze POS 20/30 | X | X | X | X | X | |||||
ConnectiCare POS | X | X | X | X | X | |||||
HCT Healthy Partner Essential | X | X | * | |||||||
HCT Healthy Partner Basic Plus | X | X | * | |||||||
* Smoking cessation is covered if the beneficiary meets program criteria. |
MICHIGAN
Appendix Table 13: Michigan Adult Inpatient Behavioral Health Service Coverage | |||||
Health Plans | Psychiatric Hospital Visit | 23-Hour Observation | Residential Treatment Facility | Adult Group Homes | |
Medicaid | Medicaid Program (fee-for-service Medicaid) | ||||
Medicaid Health Plans (managed care Medicaid) | |||||
Prepaid Inpatient Health Plans (specialty managed behavioral health care organizations) | X | X | |||
Platinum | HAP Personal Alliance 500 | X | X | ||
Humana Connect Platinum 100/1500 Plan | X | ||||
McLaren Rewards Platinum | X | ||||
Gold | Blue Cross Gold, a Multi-State Plan | X | |||
Consumers Mutual Premier – No Deductible | X | ||||
HAP Personal Alliance 1500 PPO | X | X | X | ||
Humana Connect Gold 2500/3500 Plan | X | ||||
McLaren Rewards Gold | X | ||||
Meridian Choice: Your Connection to Bronson Healthcare | X | ||||
Molina Marketplace Gold Plan | X | X | |||
MyPriority Access HSA Gold 1250 | X | ||||
Total HMO Standard | X | ||||
Silver | Blue Cross Preferred Silver | X | X | ||
Consumers Mutual Choice – Low Deductible | X | ||||
HAP Personal Alliance 3000 | X | X | X | ||
Humana Connect Silver 4600/6300 Plan | X | ||||
McLaren Rewards Silver | X | ||||
Meridian Choice: Your Connection to Bronson Healthcare | X | ||||
Molina Silver 150 Plan | X | X | |||
MyPriority MyHealth Silver 2000 | X | ||||
Totally You | X | ||||
Bronze | Blue Cross Select Bronze | X | X | ||
Consumers Mutual Basic – High Deductible | X | ||||
HAP Personal Alliance 5000 | X | X | |||
Humana Connect Bronze 6300/6300 Plan | X | ||||
Meridian Choice: Your Connection to Bronson Healthcare | X | ||||
Molina Marketplace Bronze Plan | X | X | |||
MyPriority HSA Bronze 6000 | X |
Appendix Table 14: Michigan Adult Outpatient Behavioral Health Service Coverage | |||||||
Health Plans | Case Management | Day Treatment | Partial Hospitalization | Psychosocial Rehabilitation | Intensive Outpatient | Mental Health Rehabilitation | |
Medicaid | Medicaid Program (fee-for-service Medicaid)* | Not Required | |||||
Medicaid Health Plans (managed care Medicaid) | |||||||
Prepaid Inpatient Health Plans (specialty managed behavioral health care organizations) | X | X** | X | Yes, as Clubhouse | |||
Platinum | HAP Personal Alliance 500 | X | X | ||||
Humana Connect Platinum 100/1500 Plan | X | ||||||
McLaren Rewards Platinum | X | ||||||
Gold | Blue Cross Gold, a Multi-State Plan | X | X | ||||
Consumers Mutual Premier – No Deductible | X | X | |||||
HAP Personal Alliance 1500 PPO | X | X | |||||
Humana Connect Gold 2500/3500 Plan | X | ||||||
McLaren Rewards Gold | X | ||||||
Meridian Choice: Your Connection to Bronson Healthcare | X | X | |||||
Molina Marketplace Gold Plan | X | X | |||||
MyPriority Access HSA Gold 1250 | X | X | |||||
Total HMO Standard | X | X | |||||
Silver | Blue Cross Preferred Silver | X | X | X | |||
Consumers Mutual Choice – Low Deductible | X | X | |||||
HAP Personal Alliance 3000 | X | X | |||||
Humana Connect Silver 4600/6300 Plan | X | ||||||
McLaren Rewards Silver | X | ||||||
Meridian Choice: Your Connection to Bronson Healthcare | X | X | |||||
Molina Silver 150 Plan | X | X | |||||
MyPriority MyHealth Silver 2000 | X | X | |||||
Totally You | X | X | |||||
Bronze | Blue Cross Select Bronze | X | X | X | |||
Consumers Mutual Basic – High Deductible | X | X | |||||
HAP Personal Alliance 5000 | X | X | |||||
Humana Connect Bronze 6300/6300 Plan | X | ||||||
Meridian Choice: Your Connection to Bronson Healthcare | X | X | |||||
Molina Marketplace Bronze Plan | X | X | |||||
MyPriority HSA Bronze 6000 | X | X | |||||
* MHPs must provide up to 20 visits-per-year and may be provided through contracts with PIHPs/CMSHPs.
** Medicaid Provider Manual uses the term “day program.”
|
Appendix Table 15: Michigan Adult Outpatient Provider Behavioral Health Service Coverage | |||||||||
Health Plans | Psychiatric Services –Evaluation | Psychiatric Services –Testing | Medication Evaluation, Prescription, & Management | Psychological Testing | Individual Testing | Individual Therapy | Group Therapy | Family Therapy | |
Medicaid | Medicaid Program (fee-for-service Medicaid) | ||||||||
Medicaid Health Plans (managed care Medicaid) | |||||||||
Prepaid Inpatient Health Plans (specialty managed behavioral health care organizations) | X | X | X | X | X | X | |||
Platinum | HAP Personal Alliance 500 | X | X | ||||||
Humana Connect Platinum 100/1500 Plan | X | X | |||||||
McLaren Rewards Platinum | X | X | |||||||
Gold | Blue Cross Gold, a Multi-State Plan | X | X | X | X | ||||
Consumers Mutual Premier – No Deductible | X | Diagnostic Coverage | Diagnostic Coverage | X | X | ||||
HAP Personal Alliance 1500 PPO | X | Diagnostic Coverage | X | Diagnostic Coverage | X | X | |||
Humana Connect Gold 2500/3500 Plan | X | X | |||||||
McLaren Rewards Gold | X | X | |||||||
Meridian Choice: Your Connection to Bronson Healthcare | Diagnostic Coverage | Diagnostic Coverage | X | X | |||||
Molina Marketplace Gold Plan | X | X | X | X | |||||
MyPriority Access HSA Gold 1250 | Diagnostic Coverage | X | Diagnostic Coverage | X | X | ||||
Total HMO Standard | X | X | X | ||||||
Silver | Blue Cross Preferred Silver | X | X | X | X | ||||
Consumers Mutual Choice – Low Deductible | X | Diagnostic Coverage | Diagnostic Coverage | X | X | ||||
HAP Personal Alliance 3000 | X | Diagnostic Coverage | X | Diagnostic Coverage | X | X | |||
Humana Connect Silver 4600/6300 Plan | X | X | |||||||
McLaren Rewards Silver | X | X | |||||||
Meridian Choice: Your Connection to Bronson Healthcare | Diagnostic Coverage | Diagnostic Coverage | X | X | |||||
Molina Silver 150 Plan | X | X | X | X | |||||
MyPriority MyHealth Silver 2000 | Diagnostic Coverage | X | Diagnostic Coverage | X | X | ||||
Totally You | X | X | X | ||||||
Bronze | Blue Cross Select Bronze | X | X | X | X | ||||
Consumers Mutual Basic – High Deductible | X | Diagnostic Coverage | Diagnostic Coverage | X | X | ||||
HAP Personal Alliance 5000 | X | X | |||||||
Humana Connect Bronze 6300/6300 Plan | X | X | |||||||
Meridian Choice: Your Connection to Bronson Healthcare | Diagnostic Coverage | Diagnostic Coverage | X | X | |||||
Molina Marketplace Bronze Plan | X | X | X | X | |||||
MyPriority HSA Bronze 6000 | Diagnostic Coverage | X | Diagnostic Coverage | X | X |
Appendix Table 16: Michigan Adult Substance Use Service Coverage | ||||||||||
Health Plans | Inpatient Rehab. | Inpatient Detox. | Outpatient Detox. | Residential Rehab. | Methadone Maintenance | Suboxone Treatment | Intensive Outpatient | Smoking and Tobacco Use | Partial Hospitalization | |
Medicaid | Medicaid Program (fee-for-service Medicaid) | Not Required* | Not Required | Not Required | Not Required | Not Required | Not Required | X | ||
Medicaid Health Plans (managed care Medicaid) | X | |||||||||
Prepaid Inpatient Health Plans (specialty managed behavioral health care organizations) | X | X | X | X | X | X | ||||
Platinum | HAP Personal Alliance 500 | X | X | X | ||||||
Humana Connect Platinum 100/1500 Plan | X | X | ||||||||
McLaren Rewards Platinum | X | X | ||||||||
Gold | Blue Cross Gold, a Multi-State Plan | X | X | Pays for Drugs Used in Facility | Pays for Drugs Used in Facility | X | ||||
Consumers Mutual Premier – No Deductible | Intensive Inpatient | X | X | X | X | X | ||||
HAP Personal Alliance 1500 PPO | X | X | X | X | X | |||||
Humana Connect Gold 2500/3500 Plan | X | X | ||||||||
McLaren Rewards Gold | X | X | ||||||||
Meridian Choice: Your Connection to Bronson Healthcare | Intensive Inpatient | X | X | X | X | X | ||||
Molina Marketplace Gold Plan | X | X | Prescription Drugs for Withdrawal | Prescription Drugs for Withdrawal | X | X | ||||
MyPriority Access HSA Gold 1250 | Intensive Inpatient | X | X | Pays for Drugs Used in Facility | Pays for Drugs Used in Facility | X | X | X | ||
Total HMO Standard | Intensive Inpatient | X | X | X | X | X | X | |||
Silver | Blue Cross Preferred Silver | X | X | X | X | X | X | |||
Consumers Mutual Choice – Low Deductible | Intensive Inpatient | X | X | X | X | X | ||||
HAP Personal Alliance 3000 | X | X | X | X | X | |||||
Humana Connect Silver 4600/6300 Plan | X | X | ||||||||
McLaren Rewards Silver | X | X | ||||||||
Meridian Choice: Your Connection to Bronson Healthcare | Intensive Inpatient | X | X | X | X | X | ||||
Molina Silver 150 Plan | X | X | Prescription Drugs for Withdrawal | Prescription Drugs for Withdrawal | X | X | ||||
MyPriority MyHealth Silver 2000 | Intensive Inpatient | X | X | Pays for Drugs Used in Facility | Pays for Drugs Used in Facility | X | X | X | ||
Totally You | Intensive Inpatient | X | X | X | X | X | X | |||
Bronze | Blue Cross Select Bronze | X | X | X | X | X | X | |||
Consumers Mutual Basic – High Deductible | Intensive Inpatient | X | X | X | X | X | ||||
HAP Personal Alliance 5000 | X | X | X | |||||||
Humana Connect Bronze 6300/6300 Plan | X | X | ||||||||
Meridian Choice: Your Connection to Bronson Healthcare | Intensive Inpatient | X | X | X | X | X | ||||
Molina Marketplace Bronze Plan | X | X | Prescription Drugs for Withdrawal | Prescription Drugs for Withdrawal | X | X | ||||
MyPriority HSA Bronze 6000 | Intensive Inpatient | X | X | Pays for Drugs Used in Facility | Pays for Drugs Used in Facility | X | X | X | ||
* Only required if hospitalized for medical complications due to substance abuse. |