Behavioral Health

The Medicaid benefit for children and adolescents covers screening, diagnosis and treatment for mental health and substance use conditions. This section describes state practices and approaches to screenings, referrals, and diagnoses for behavioral health for children, strategies to deliver behavioral health services to children covered by Medicaid and CHIP, and cross-agency collaborations to improve access to behavioral health services.
The Alabama ABCD Screening Academy Project worked to spread structured developmental and social emotional screening in primary health care practices. Through this project, the state expanded Medicaid reimbursement for standardized screening, and sustained and spread the use of validated, objective screening tools. More information regarding the state’s ABCD efforts can be found here.
Alabama Medicaid allows qualified providers to bill for Intensive Developmental Diagnostic Assessments (using the 96110 and 96111 CPT codes) for children under age two. These assessments are performed by multidisciplinary teams and may include both developmental screening tests and early language milestone screens (as well as interpretation and reporting of results).
Behavioral and mental health services are covered on a fee-for-service basis as deemed medically necessary.
As described in Alaska’s Integrated Behavioral Health Regulations, Medicaid-covered behavioral health services for children include therapeutic behavioral health services and day treatment services for children.
The state’s EPSDT provider billing manual encourages developmental screenings and assessments. The Alaska Department of Health and Social Services recommends a number of developmental screening tools, including the Ages and Stages Questionnaire, the Battelle Developmental Inventory Screening Tool, and Parents’ Evaluation of Developmental Status.
Behavioral health services are carved out of Medicaid managed care in Arizona. The state Medicaid agency contracts with the Department of Health Services to provide these services, which in turn contracts with Regional Behavioral Health Authorities (RBHAs) to administer care. The state is divided into 6 geographic areas, with an RBHA responsible for administering care in each region.
Arizona’s Medicaid agency had made available to primary care providers three Childhood and Adolescent Behavioral Health Tool Kits for:
Arizona released a Request for Information in December 2013 to seek input for an integrated health care service delivery system to provide physical and behavioral health care services to maximize care coordination statewide.
Arkansas Medicaid and ARKids First partners with the Arkansas Division of Behavioral Health Services, which provides all public behavioral health services including: mental health and substance abuse prevention, treatment, and recovery services.
Medicaid-enrolled children and adolescents in California receive behavioral health services through county mental health departments. A brochure from the state notifies children and families of behavioral health services available as part of the EPSDT benefit, including:
  • Individual therapy
  • Group therapy
  • Family therapy
  • Crisis counseling
  • Case management
  • Special day programs
  • Mental health medication
California’s Medicaid program reimburses for developmental screenings performed with a standardized tool (using the 96110 CPT code). Tools recommended by the state include the Ages and Stages Questionnaires and the Parents’ Evaluation of Developmental Status instruments.
California’s Medicaid program also offers Therapeutic Behavioral Services to Medicaid-enrolled children with mental health needs who are as risk of admission to a hospital or psychiatric health facility. The California Department of Health Care Services provides a statewide list of providers offering these services.
Behavioral health benefits are provided by Behavioral Health Organizations, which are contractually obligated to provide or arrange all medically necessary services covered under EPSDT.
Under the state’s Child Mental Health Treatment Act, children (both Medicaid-eligible and non-Medicaid eligible children) with a mental illness and under age 18 have access to a variety of community, residential, and transitional treatment services. Transitional services provided include case management and post-discharge services provided by community mental health centers, while covered community-based services include:
  • therapeutic foster care,
  • intensive in-home treatment,
  • intensive case management, and
  • day treatment
Coordinated behavioral health service delivery: Since 2005, the DSS has partnered with the Department of Children and Families (and subsequently the Department of Mental Health and Addiction Services, as well) to integrate public behavioral health services for children and families under the Connecticut Behavioral Health Partnership (CTBHP), the Behavioral Health Partnership Oversight Council oversees ongoing implementation of the CBHP. The Oversight Council is comprised of stakeholders representing policy, provider, and patients. The participating departments have contracted with ValueOptions to serve as the administrative services organization for behavioral health, authorizing and managing behavioral health services for all Medicaid participants.
Screening services: Connecticut’s Medicaid program reimburses pediatricians for developmental and mental health screenings. The state uses both the 96110 and 96111 codes (developmental testing with interpretation and report, limited and extended, respectively) to support developmental screens. The state also added CPT code 99420, “Administration and interpretation of health risk assessment instrument,” to its Medicaid fee schedule as of January 1, 2012. This allows primary care physicians to be paid for mental health screenings separately from the well-child visit reimbursement; these screenings can be billed in conjunction with a well-child visit.
For more information about behavioral health services for children in enrolled in Medicaid in Connecticut, see “Behavioral Health in the Medicaid Benefit for Children and Adolescents: Connecticut.”
Delaware No information at this time.
District of Columbia
The Department of Health Care Finance (DHCF) contracts with managed care organizations (MCOs) to provide most behavioral health care. Children with significant behavioral health needs may voluntarily enroll into a specialized MCO that serves only children with special health care needs and provides an integrated behavioral and physical health care benefit. The Health Services for Children with Special Needs (HSCSN) Plan is a managed care organization that focuses on the SSI/SSDI child population. Enrollment in the plan is voluntary; children who do not choose to enroll in the plan remain in fee-for-service Medicaid.
Integrating primary care with developmental, behavioral and oral health care Physicians are expected to screen for developmental and behavioral health issues within the standard well-child visit; the HealthCheck Manual and a collection of screening guidelines, tools, and recommendations provided for District physicians offer guidance on performing these and other screens as part of the well-child visit. In 2013, the DHCF partnered with Georgetown University and The National Alliance to Advance Adolescent Health to develop new training modules on transition issues for pediatricians on its HealthCheck website, including modules on mental health, autism spectrum disorders, and substance use and abuse.
Children enrolled in Florida’s Medicaid program have access to community-based behavioral health providers who can offer treatments such as Therapeutic Behavioral On-Site Services for Children and Adolescents, Behavioral Health Day Services for children under 5, and crisis intervention mental health services.
The state has made available (through managed care organizations) a Behavioral Health and Developmental Screening Form that can be used by providers to determine when a child should be referred for additional evaluation.
Medicaid-enrolled children on the autism spectrum can receive Applied Behavioral Analysis (ABA) services if they receive prior authorization. Providers must fill out an ABA review form.
Providers can also bill Medicaid for Screening, Brief Intervention and Referral to Treatment (SBIRT) services.
Georgia requires that primary care providers performance developmental screenings for children at 9 months, 18 months, and 30 months. Providers must use standardized tools, though the Health Check handbook does not recommend particular screening tools.
Autism screenings are required at 18 months and 24 months and the state recommends the MCHAT screening tool
Alcohol and drug use assessments are required at all adolescent well visits, but standardized screening instruments are only required when a parent raises a concern.
CHIPRA Quality Demonstration
Georgia partnered with Maryland and Wyoming on a CMS CHIPRA Quality Demonstration Grant to implement a project called “Care Management Entities for Children With Serious Behavioral Health Needs.”
The grant will support the development of a Care Management Entity provider model to improve the service delivery to Medicaid and CHIP enrolled children with serious behavioral health disorders. Stated goals are to:
  • improve access to appropriate services;
  • employ health information technology to support data-driven, clinical decision-making;
  • reduce the unnecessary use of restrictive and costly services;
  • improve clinical and functional outcomes for children and youth with serious behavioral health needs; and
  • build resiliency in youth and families, strengthening their involvement both in their own care and in the design and implementation of the behavioral health care delivery system.
Hawaii No information at this time.
One of the qualifying Medicaid populations for Idaho’s ACA Section 2703 State Plan Amendment is pediatric patients with serious and persistent mental illness or serious emotional disturbance. Additionally, Idaho has the EPSDT Service Coordination Program (ESC) to help children with at least one of the following: a developmental delay or disability, special healthcare needs, or a severe emotional disorder. The ESC Service Coordinators help families with children who have special needs find and coordinate services their children need, such as health, educational, early intervention, advocacy and social services.
Idaho also offers Case Management services through its Children’s Developmental Disabilities Services Program. Services offered through this program include:
  • Respite
  • Habilitative supports
  • Family education
  • Habilitative intervention and evaluation
  • Family training
  • Therapeutic consultation
  • Interdisciplinary training
  • Crisis intervention and supports
Behavioral health services that exceed what is offered through the Idaho Medicaid state plan and are deemed medically necessary are delivered through Optum Idaho, a managed care contractor.

Illinois covers several facets of behavioral health screening with an array of CPT codes, including the 99420 code for mental health screening, substance abuse and chronic conditions.

The state details in section HK203.9.1 of its EPSDT Provider Handbook the codes and the recommended screening tools to accompany those codes. The state also provides appendices (see appendices 3 and 4) to the EPSDT Provider Handbook that includes a mental health screen for children ages 3 – 20, referral information to Division of Mental Health Certified Medicaid Providers by County, and substance abuse screening and referral resources. The Department of Healthcare and Families Services’ (HFS) policy on behavioral health risk assessments for children and adolescents was reiterated in an informational notice to physicians, nurses, FQHCs, hospitals, local education agencies and health departments, and school-based health centers in March 2013.
Under the 2003 Children’s Mental Health Act, Illinois has developed a Screening, Assessment, and Support Services (SASS) initiative designed to improve the coordination and delivery of mental health services to children and adolescents with acute mental health treatment need. This initiative is a cooperative partnership between the Illinois Department of Children and Family Services (in which the Medicaid agency resides) and the Department of Human Services. The initiative seeks to develop a single, statewide system to serve children requiring public funding from one of the three agencies. The program features a single point of entry, Crisis and Referral Entry Service, (CARES) for all children entering the system and ensures that the children receive the appropriate services in the setting most conducive to their wellbeing.
Children with behavioral health treatment needs that do not rise to the level of acuity required for participation in the SASS initiative can receive care from community mental health centers, which can be reimbursed by Medicaid for a range of services. The state’s Community Mental Health Services Service Definition and Reimbursement Guide offers providers service descriptions, describes the applicable populations for each service, lists applicable reimbursement codes, and provides additional information.

For more information about behavioral health services for children enrolled in Medicaid, see: “Behavioral Health in the Medicaid Benefit for Children and Adolescents: Illinois.”

Managed care entities in Indiana are required to:
  • Develop networks of psychiatrists, psychologists, clinical social workers, and other behavioral health providers capable of delivering a spectrum of behavioral health services;
  • Provide a continuum of inpatient behavioral health services;
  • Train primary care providers and specialists to identify and treat beneficiaries with behavioral health conditions; and
  • Train providers in screening for co-occurring mental health and substance abuse disorders.

Medicaid providers can bill for structured developmental screenings at select well-child visits (at 9 months, 18 months, and 30 months). The state suggests the following tools be used when billing for a developmental screening:

  • Ages and Stages Questionnaire (ASQ)
  • Ages and Stages Questionnaire/Social Emotional (ASQ-SE)
  • Denver DST/Denver II
  • Battelle Developmental Screener
  • Bayley Infant Neurodevelopment Screener (BINS)
  • Parents Evaluation of Development (PEDS)
  • Early Language Accomplishment Profile (ELAP)
  • Brigance Screens II
  • Modified Checklist for Autism in Toddlers (M-CHAT)
  • Vanderbilt Rating Scales
  • Behavior Assessment Scale for Children-Second Edition (BASC-II)
In Iowa, Medicaid behavioral health services are carved out of physical care and are available through the Iowa Plan for Behavioral Health. The Iowa Plan is a managed care program that delivers mental health and substance abuse services to almost all Medicaid beneficiaries in Iowa through a behavioral health organization (BHO), Magellan Health Services.
The state produced a behavioral provider manual that contains codes that providers in Iowa can bill for health and behavior assessments, including 96510 and 96511 (health and behavior assessment, initial assessment and re-assessment).
1st Five Healthy Mental Development Initiative
The Iowa Department of Public Health’s 1st Five Healthy Mental Development Initiative was designed to bridge public and private health care systems to improve early detection of social-emotional delays and promote prevention of mental health problems among young children. The model promotes the use of standardized screening tools, educates and supports medical practices in implementing developmental screening tools, and uses trained care coordinators who work with families to assure follow-up and access to services. 1st Five care coordination for Medicaid beneficiaries is reimbursed as a covered EPSDT service.

For more information about behavioral health services for children enrolled in Medicaid, see “Behavioral Health in the Medicaid Benefit for Children and Adolescents: Iowa.”

The three KanCare MCOs are required to cover behavioral health services; and some use subcontractors to provide these services. Kansas also has a HCBS waiver for individuals age 5 and over who meet thee definition of having a developmental disability or are eligible for care in an Intermediate Care Facility. As of January 2014 this waiver and the services provided are incorporated into KanCare. The services from this waiver that are now provided by KanCare include long-term services and supports services and targeted case management.

Kansas is also working on an Affordable Care Act Section 2703 Health Homes State Plan Amendment that will be used to provide comprehensive and intensive coordination of care to those with Serious Mental Illness and Chronic Conditions. Kansas anticipates launching its Health Homes effective July 1, 2014.

Behavioral health services for Medicaid enrollees in Kentucky (including children) are provided primarily through a network of 14 regional mental health centers and four psychiatric hospitals maintained by the state Department of Behavioral Health, Developmental and Intellectual Disabilities, though managed care organizations can provide access to additional behavioral health service providers.
Medicaid managed care contract language requires plans to employ a Behavioral Health Director who coordinates all efforts to provide behavioral health services to plan members.  The Behavioral Health Director must meet monthly with the state’s mental health agency to discuss substance abuse protocols, rules, and regulations.
Plans are also required to establish a protocol for coordination of physical and behavioral health services for members with behavioral health or developmental conditions.
Kentucky implemented the Supports for Community Living (SCL) waiver program to provide alternatives to institutional care for Medicaid-eligible children and adults with intellectual and developmental disabilities. The program provides a variety of supports and services, including children’s day habilitation, community living supports, psychological services, and residential supports. As of January 1, 2014, additional community supports and services are available through the SCL2 Waiver.
Behavioral health services are integrated into the services provided by the managed care plans. Louisiana also has two waiver programs that they use to provide services to individuals with developmental disabilities within a home or community-based setting.
The New Opportunities Waiver (NOW) provides: individualized and family support services, center-based respite, community integration and development, supported living, skilled nursing services, and others. To qualify for NOW the child must meet financial criteria and be three years and older and have a developmental disability that manifested prior to age 22.
The Children’s Choice Waiver (CC) offers support to children with developmental disabilities who currently live at home with their families, or who will leave an institution to return home. Services provided under this waiver include: all medically necessary Medicaid services, case management, family support, center-based respite, and family training. To qualify for CC the child must meet financial criteria, be age birth through 18 years, meet certain medical and/or psychological criteria, and meet the federal definition for developmental disability.
The focus of the Phase II First STEPS Learning Initiative was to improve developmental, autism, and lead screening rates for children under age three. Twelve pediatric and family practices, including 45 physicians who serve an estimated 20,000 children with MaineCare coverage, participated in the initiative. Practices agreed to track both improvements of specific Improving Health Outcomes for Children (IHOC) measures for developmental, autism and lead/anemia screening rates, and rates of referrals to developmental specialists and Children’s Developmental Services. As part of this phase, MaineCare added modifiers to the developmental screening and assessment CPT codes (96110 and 96111): HI for autism screening and HK for autism testing.
The goal of Phase II was to improve these rates by 50% with the target of achieving rates of 75% for each measure. Information on rates was gathered from chart reviews, MaineCare claims data, administrative data supplied by other programs, self-reported pre/post office surveys, and key informant interviews. The Phase II evaluation found that:
  • Most Phase II providers integrated developmental screening into well child visits; fewer focused on autism and lead screening;
  • Developmental and autism screening rates more than doubled in all age groups and exceeded 75% screening targets in several age groups;
    Increased billing and improved coding of developmental and autism screenings to MaineCare improved claims-based rates; and
  • New screening tools helped identify developmental delays earlier and increased tracking, follow-up and referrals for treatment.

Ultimately, developmental screening rates for practices participating in the initiative rose from the year prior to Phase II to the year after Phase II. The rates rose from:

  • 5.3% to 17.1% for children age one,
  • 1.5% to 13.1% for children age two, and
  • 1.2% to 3.3% for children age three.

2703 Health Homes
Stage B of Maine’s health home initiative seeks to develop Behavioral Health Homes for children and adults with significant behavioral health needs. This new service will be implemented in April 2014 and will provide integrated behavioral and physical health services using a team-based care approach. The Behavioral Health Home Organization (BHHO) will be composed of a primary care provider and a licensed community mental health provider.

Service delivery
Primary mental health services in Maryland are mental health services provided in the primary care office; the state allows primary care providers to treat mental health conditions if the treatment falls within the scope of the provider’s practice, training and expertise. Conditions that cannot be treated in primary care settings are referred to the state’s local public mental health system.
The Specialty Mental Health System, frequently called the Public Mental Health System, provides a full range of mental health services. The Maryland Mental Hygiene Administration (MHA), along with local Core Service Agencies (CSAs), has oversight of the mental health authorities in each jurisdiction. Specialty mental health services are covered by Maryland Medicaid and available to all Medicaid recipients.
Maryland requires that general developmental screening be performed for all children at the 9-, 18-, and 24-30 month Healthy Kids preventive care visits, and whenever a concern is identified through developmental surveillance. If the child is not seen at these recommended ages, screening should be conducted at the next preventive care visit. Healthy Kids recommends the following standardized, validated developmental screening tools for use in general developmental screening at the intervals noted above:
  • The Ages and Stages Questionnaire (ASQ)
  • Pediatric Evaluation of Developmental Status (PEDS),
The state also provides an additional list of approved standardized, validated general developmental screening tools.
In addition to requiring general developmental screening, the MD Healthy Kids Program recommends autism-specific surveillance at all visits and requires structured autism-specific screening at 18 and 24-30 month well child visits. The Maryland Healthy Kids Program recommends the Modified Checklist for Autism in Toddlers (MCHAT) screening instrument.
The Healthy Kids Program developed a series of age-specific Mental Health Questionnaires to help primary care providers identify behavioral and emotional problems. The state also allows providers to bill for substance abuse screening (using the 99408 and 99409 CPT codes) and recommends use of the CRAFFT substance abuse screening tool for adolescents.
No information at this time.
Local Community Mental Health Services Programs coordinate delivery of public behavioral health benefits in Michigan. Prepaid Inpatient Health Plans cover behavioral health services for children with serious emotional disturbance.
The state also has a Children with Serious Emotional Disturbances Waiver that provides behavioral health services to children in community settings.
Children’s Therapeutic Services and Supports (CTSS)
CTSS is a flexible package of mental health rehabilitative services available to youth enrolled in Medical Assistance or MinnesotaCare who have been diagnosed with an emotional disturbance of any severity. Services include: psychotherapy, skills training, Mental Health Behavioral Aide (MHBA) and direction of MHBA, crisis assistance, children’s day treatment, and therapeutic preschool programs. CTSS services can be provided both by traditional mental health providers and a variety of approved social service agencies, including Head Start.
Integrated Behavioral Health Homes
Minnesota received a CMS planning grant to develop Section 2703 Health Homes for Medicaid enrollees with chronic conditions. Children experiencing a severe emotional disturbance (SED) are one of four target populations in this initiative. The goals of the integrated behavioral health homes are to: improve health outcomes; improve experience of care for the individual; improve the quality of health & wellness of the individuals; and reduce health care costs.
For more information about behavioral health services for children enrolled in Medicaid, see: “Behavioral Health in the Medicaid Benefit for Children and Adolescents: Minnesota.”
Mississippi Medicaid delivers behavioral health services on a fee-for-service basis  through Mississippi’s private mental health providers and community mental health centers.
The state provides 1915(c) waiver services to children with Serious Emotional Disturbance (SED) through Mississippi Youth Programs Around the Clock (MYPAC). MYPAC provides services and supports including intensive case management, wraparound services, and respite services. On the MYPAC website, Mississippi provides the MYPAC Initial Screening Form to determine if a child meets criteria for the waiver services, and a Freedom of Choice Form for the families to ensure they have made an informed choice between treatment in a Psychiatric Residential Treatment Facility and participation the MYPAC community-based demonstration.
Mississippi Medicaid has developed an Adolescent Counseling Form for use by physicians during the EPSDT screen for children aged nine and above. The form facilitates a structured interview with adolescents on issues such as substance use, coping skills, and relationships. Providers can bill Medicaid for an EPSDT adolescent screen separately from other EPSDT services using screening code 99401-EP.
No information at this time.
In Montana, Magellan Medicaid Administration provides utilization Management services to the state for mental health benefits (including for children). The Children’s Mental Health Services Bureau in Montana’s Department of Public Health and Human Services has produced a Provider Manual and Clinical Guidelines for Utilization Management as it pertains to mental health services provided to Medicaid-enrolled children.
Montana’s Medicaid provider manual specifies that each well-child visit should include an age-appropriate developmental screen. Risk assessment screenings for “signs and symptoms of emotional disturbances” as well as risky behaviors (including substance abuse).

Montana’s 1915(i) State Plan Home and Community-Based Services are available to children with a Serious Emotional Disturbance (SED). The state has created a brochure for families of children with SED advertising the availability of:

  • wraparound facilitation
  • peer to peer support for youth and parent
  • in-home therapy
  • respite
  • crisis intervention services
  • specialized evaluation services
  • supplemental supportive services
  • additional services designed to help the youth remain at home and in the community
A more detailed Policy Manual on 1915(i) services for children with SED provides more information on the services available and eligibility requirements for children and providers.
In September 2013, Nebraska’s Medicaid program implemented a full-risk behavioral health managed care program.
The state’s managed care contract with Magellan lists a number of services covered for Medicaid-enrollees under ago 19, including:
  • Crisis stabilization services
  • Inpatient services
  • Residential services (including at Psychiatric Residential Treatment Facilities), and
  • Outpatient mental health and substance abuse assessment and treatment services
In late 2011 Nevada Medicaid implemented payment for developmental screens (including those that focus on social/emotional development) billed under CPT code 96110 in their state (See Nevada EPSDT Provider Manual, Section 1503.3A(2)).  Providers must use a valid, standardized developmental screening tool. While Nevada does not include a list of tools they do explicitly reference the AAP’s policy that establishes criteria for screening tools.  Nevada has also developed EPSDT well child visit forms that prompt pediatricians to use a validated developmental screening tool, and to identify which tool was used.
New Hampshire Behavioral health benefits are included in New Hampshire’s new managed care program. Managed care organizations are required to contract with Community Mental Health Centers to deliver behavioral services to Medicaid beneficiaries, including children with a severe emotional disturbance. Clinicians providing community mental health services to Medicaid-enrolled children must be certified in the use of Child and Adolescent Needs and Strengths Assessment.
Children receive behavioral health assessments as part of well-child visits. The New Jersey Department of Human Services provides an approved screening tool (Section B.4.9 of the managed care contract appendices) to be used on children when an indication of a potential behavioral health issue is uncovered.
New Mexico permits pediatricians to bill for developmental/behavioral screening at the 30-month well child visit.  Physicians may bill for use of a validated screening tool using the 96110 code, in addition to a well child code on the same day.
The state’s Medicaid periodicity schedule and preventive services guidance for children is based on the American Academy of Pediatrics’ Bright Futures guidelines, which recommend the following screening tools: Pediatric Symptom Checklist, Strengths and Difficulties Questionnaire, Checklist for Autism in Toddlers, Modified Checklist for Autism in Toddlers, and the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) Screening Questionnaires for substance abuse.
Cross-agency treatment options
In 2004 New Mexico created the Behavioral Health Purchasing Collaborative to coordinate resources being used for behavioral health prevention, treatment and recovery. While 15 state agencies are participate in the Collaborative, funds are contributed primarily by five agencies: the Human Services Department Medical Assistance Division (Medicaid); the Behavioral Health Services Division; the Children, Youth and Families Department; the Corrections Department; and the Department of Health. Funding from these agencies is combined, but managed separately to ensure compliance with reporting and other requirements.
Braided behavioral health funding allows the state to integrate and coordinate services: children have coordinated access to services funded by Medicaid as well as other state agencies.  In addition, children with serious needs can access Comprehensive Community Support Services through the state’s system of Core Service Agencies (CSAs).
CSAs are typically Community Mental Health Centers that are enrolled as Medicaid providers and licensed by the Children, Youth and Families Department. They are responsible for coordinating a wraparound planning process that connects families to providers and resources in the local community necessary to implement an individualized plan of care. The CSAs serve as a single point of contact and entry to the state’s behavioral health system for children with serious behavioral health needs, including children with substance abuse or juvenile justice involvement. Medicaid managed care contracts require managed care organizations to make best efforts to contract with entities designated as CSAs.
New York’s provider manual for the Child Teen Health Program was a joint Title V/Medicaid effort, and was revamped to ensure that it addressed child and adolescent emotional and behavioral health and incorporated evidence based practices.
New York Medicaid reimburses for Screening, Brief Intervention and Referral to Treatment (SBIRT) services for all Medicaid beneficiaries who are 10 years of age and older. These services are covered in hospital outpatient and emergency departments, free-standing diagnostic and treatment centers (including School-Based Health Centers), and office-based primary care practices.
New York has several home and community-based services waivers that target services to children with behavioral health conditions including:
  • A developmental disabilities waiver, which allows enrollees to access a set of services and supports that enables children with developmental disabilities to remain in the community as an alternative to Intermediate Care Facilities (ICFs). Children with autism can take advantage of the habilitation and respite services available through the waiver.
  • A waiver for children with serious emotional disturbances that offers children between the ages of 5 and 17 an array of social services not funded through Medicaid, including care coordination, respite, family support services, intensive in-home services, crisis response and skill building; and
  • Three Bridges to Health (B2H) waivers for children in foster care: B2H for children with developmental disabilities; B2H for children with serious emotional disturbance; and B2H for medically fragile children.
In New York’s EPSDT/CTHP Provider Manual For Child Health Plus A (Medicaid), providers are referred to the Bright Futures in Practice: Mental Health Volume 2 Tool Kit for screening tools, including the Pediatric Symptom Checklist.

For more information about behavioral health services for children enrolled in Medicaid, see “Behavioral Health in the Medicaid Benefit for Children and Adolescents: New York.”

In North Carolina an EPSDT medical screening exam should include a developmental level and mental health assessment. Services including therapy (physical, occupational, and speech/language), rehabilitation, in-home care, substance abuse, and in-home care services, are all covered by EPSDT if needed to correct or ameliorate a child’s health problem.
North Dakota
Children receive developmental and mental health screens as a part of Health Tracks visits. These visits also include maternal depression screening for mothers of newborns. Health Tracks will also pay for mental, developmental, and behavioral health services as deemed medically necessary.
North Dakota Medicaid, in partnership with the North Dakota Department of Health, offers an online training course to help professionals recognize mental health problems affecting children from birth to age 21. The course includes a series of videos and links to various screening tools including the Ages and Stages Questionnaire and the Pediatric Symptom Checklist. North Dakota also maintains a list of recommended mental health screening tools that contains these screening tools as well as several others.
Ohio Community mental health centers can apply to become Medicaid Health Home providers, offering services to individuals with serious and persistent mental illness. Services offered through Medicaid Health Homes include: “comprehensive care management, care coordination, health promotion, comprehensive transitional care, individual and family support services, referrals to community and social support services, and the use of health information technology to link health home activities.”
No information at this time.
Oregon has worked to improve screening practices among pediatric primary care providers to increase identification of young children with developmental, behavioral, and/or psychosocial delays.
State regulations specify that if mental health or substance abuse conditions are discovered during a primary care screening, physicians may refer children to the Addictions and Mental Health Services Division (AMH). Additionally, Oregon’s Medicaid fee schedule allows providers to bill the 96110 code for developmental screening, and the 96111 code for more extended developmental testing.
Oregon’s Coordinated Care Organizations (CCOs) are required to contract with Community Mental Health Programs (CMHPs), which provide services to persons with mental or emotional disorders and developmental disabilities. The CMHPs are often county mental health departments and are responsible for providing a range of Integrated Services and Supports for behavioral health, including services for children. Developmental screening in the first 36 months of life is an incentive measure for the CCOs.
Oregon’s CCO contracts also stipulate that, starting July 1, 2014, the CCOs will provide a Child and Adolescent Needs and Strengths Comprehensive Screening (CANS Oregon) and a Mental Health Assessment for all children within 60 days of notification that the child is entering foster care.
For more information about behavioral health services for children enrolled in Medicaid, see: “Behavioral Health in the Medicaid Benefit for Children and Adolescents: Oregon.”
No information at this time.
No information at this time.
South Carolina
South Carolina Medicaid allows providers to bill for developmental screenings at select well-child visits (9 months, 18 months, 24 months, and 48 months). Providers must use a standardized screening tool; the state suggests: the
  • Ages and Stages Questionnaire (ASQ) or Ages and Stages Questionnaire/Social Emotional (ASQ-SE)
  • Denver DST/Denver II
  • Battelle Developmental Screener
  • Bayley Infant Neurodevelomental Screener(BINS)
  • Early Language Accomplishment Profile (ELAP)
  • Brigance Screens II
  • Modified Checklist for Autism in Toddlers (M-CHAT)
  • Vanderbilt Rating Scales
  • Behavior Assessment Scale for Children-Second Edition (BASC- II)
The state allows Child Service Professionals—required to have training in children’s behavioral health but not specific certification is required—to provide rehabilitative behavioral health services to children. Medicaid covers Behavioral Modification for children in the community, as well as Skills Training and Development Services for Children.
South Dakota
South Dakota manages its behavioral health services through the same primary care case management (PCCM) system it uses to deliver physical care. The Division of Community Behavioral Health oversees children’s behavioral health services. A Behavioral Health Services Work Group was formed in to help South Dakota think about how to leverage all of its available resources, including Medicaid. The workgroup’s final report was released in 2011.
The South Dakota Department of Education’s Birth to 3 Connections program provides a range of early intervention services to children who have a disability or a developmental delay, including delays In social and emotional development. Beginning in 2008, the Department of Education instructed the state’s Birth to 3 providers to enroll with South Dakota Medicaid in order to obtain reimbursement for eligible children.
Managed care organizations must secure services for enrollees from a range of behavioral health providers, including: community mental health agencies; case management agencies; psychiatric rehabilitation agencies; psychiatric and substance abuse residential treatment facilities; and psychiatric and substance abuse inpatient facilities.
Tennessee also has three different Home and Community Based Services Waiver programs that it uses to provide behavioral health services: the Arlington Waiver Program, Self Determination Waiver Program, and Statewide Waiver Program. The Self Determination and Statewide waiver programs include children with developmental delays and intellectual disabilities as part of the target population. The Statewide Waiver Program in particular is explicitly aimed at children. Services provided by Tennessee through these waivers include, but are not limited to:
  • Behavioral Respite Services
  • Behavior Services
  • Day Services
  • Occupational Therapy
  • Residential Habilitation
  • Support Coordination
  • Transitional Case Management
Behavioral health screenings are required at each Texas Health Steps checkup. Texas Health Steps offers primary care providers several developmental and behavioral health screening forms:
  • The Ages and Stages Questionnaire
  • The Modified Checklist for Autism in Toddlers (M-CHAT)
  • Parents’ Evaluation of Developmental Status (PEDS)
Texas Health Steps requires one of those standardized instruments to be used for a checkup to be considered complete.
No information at this time.
No information at this time.
While children enrolled in managed care organizations (MCOs) receive assessments, evaluations, and outpatient psychiatric and substance abuse therapy services through managed care, several services are carved out of managed care and offered on a fee-for-service basis, including:
  • Intensive In-Home Services for Children and Adolescents
  • Therapeutic Day Treatment for Children and Adolescents
  • Day Treatment/Partial Hospitalization
  • Psychosocial Rehabilitation
  • Crisis Intervention
  • Intensive Community Treatment
  • Crisis Stabilization Services
  • Mental Health Support Services
  • Case Management
  • Substance Abuse Crisis Intervention
  • Substance Abuse Intensive Outpatient
Under the Children’s Mental Health Program in Virginia, Case Management and Home and Community-Based services are available to Medicaid-enrolled children who have been in a Psychiatric Residential Treatment Facility for more than 90 days. These provide team-based services in the community for children with a serious emotional disturbance.
Virginia Medicaid also covers two kinds of EPSDT Behavioral Therapy: Intensive In-Home Services, and Outpatient Programs – Applied Behavioral Analysis. Additionally, Targeted case management may be reimbursed while an individual is authorized for EPSDT Behavioral Therapy in the home environment. Covered services include, but are not limited to: services and methods used to validate the child’s treatment progress as included in the Individual Service Plan (ISP) as approved by the State’s Medicaid agency, family training, counseling, and home visits; clinical supervision and behavioral modification services.
Publicly funded behavioral health services in Washington, including services for children and adolescents, are delivered through Regional Support Networks (RSNs). The RSNs contract with community mental health agencies to deliver behavioral services to Medicaid-enrolled children.
Medicaid managed care contracts require managed care organizations (MCOs) to contract with RSNs, and to collaborate with other MCOs to define screening tools to assess development and behavioral health conditions in children. MCOs and RSNs must have in place operational agreements to coordinate physical and behavioral health service delivery. In addition to establishing protocols for care transitions between MCOs and RSNs, these agreements must contain provisions for the exchange of health information regarding Medicaid beneficiaries’ diagnoses, treatment plans, medications, lab tests, and treating providers.
West Virginia’s Medicaid program requires that a developmental screening be administered with a standardized screening tool at the 9-month, 18-month, and 30-month well-child visits.
The HealthCheck Provider Manual instructs providers to conduct autism surveillance at all well-child visits. Primary care providers are also expected to use a standardized autism-specific screening tool to conduct screens at the 18-month and 24-month well-child visits.
Children are screened for behavioral health issues during HealthCheck preventive visits.
Managed care contract language requires that managed care organizations develop relationships—through memoranda of understanding or contracts—with community agencies that deliver behavioral health services to Medicaid beneficiaries.
Wisconsin Medicaid covers Screening, Brief Intervention, and Referral to Treatment (SBIRT) services for enrollees 10 years of ago and older. Substance abuse screening tools approved for use by the state are:
  • The AUDIT,
  • The DAST,
  • The ASSIST,
  • The CRAFFT, and
  • The POSIT.
Wisconsin Medicaid is a partner to two initiatives called Children Come First and Wraparound Milwaukee. These are multi-agency, community based programs of mental health and other drug abuse services for children with severe emotional disturbances (SED). The goal of the programs is to both keep children with SED out of institutions, and to reallocate resources previously used for institutionalization of SED children into community-based services.
The target population for the Care Management Entities created under the Wyoming CHIPRA Quality Demonstration Grant includes Medicaid-enrolled children and south with serious emotional disturbance, as well as children in Psychiatric Residential Treatment Facilities (or at risk of such a placement). Medicaid-enrolled children whose use of prescription drugs does not conform to state prescribing guidelines are also targeted under the grant.
The children that meet these criteria, and live in the southeastern part of the state (the focus area for the pilots), are eligible to be treated by a Care Management Entity (CME). The CME is an organizational entity that serves as a centralized accountable hub to coordinate all care for youth with complex behavioral health needs and who are receiving care in multiple systems. The authority Wyoming uses to run the CMEs is its 1915(i) State plan Home and Community-Based Services benefit, which was approved in July 2013.
Wyoming also offers ongoing case management for Medicaid beneficiaries under age 21 with a behavioral health disorder.  This includes linking beneficiaries to needed services; monitoring and follow-up; referrals; other advocacy on behalf of the beneficiary; and crisis intervention.



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