EPSDT Behavioral Health Services

HOW TO ACCESS:

Aetna

AmeriHealth Caritas

Healthy Blue

Louisiana Healthcare Connections

United Healthcare Community Plan

1-855-242-0802

1-888-756-0004

1-844-521-6941

1-866-595-8133

1-866-675-1607

 


Any Medicaid eligible adult may receive the following behavioral health service if medical necessity is established by a licensed mental health professional (LMHP).


ELIGIBILITY:

Medicaid eligible adult
Adults eligible to receive mental health rehabilitation (MHR) services under Medicaid State Plan include those who meet the following criteria:

  • Must have a mental health diagnosis and
  • Must be assessed by an LMHP

Members receiving CPST and/or PSR:

  • Must have at least a level of care of three on the LOCUS.
  • Must have a rating of three or greater on the functional status domain on the level of care utilization system (LOCUS).

Members receiving IPS and PCS must be

  • 21 years and older:
  • Transitioned from a nursing facility or been diverted from nursing facility level of care through the My Choice Louisiana program.

For more information, please refer to the BHS Provider Manual  

COVERED SERVICES:

1. Community Psychiatric Support & Treatment (CPST)
2. Psychosocial Rehabilitation (PSR)
3. Crisis Intervention (CI)
4. Assertive Community Treatment (ACT)
5. Crisis Responses Services
a. Mobile Crisis Response (MCR)
b. Behavioral Health Crisis Care (BHCC)
c. Community Based Crisis Service (CBCS)
6. Crisis Stabilization (CS)
7. Individual Placement and Supports (IPS)
8. Personal Care Services (PCS)
9. Peer Support Services (PSS)
10. Outpatient Therapy with Licensed Practitioners (medication management, individual, family, and group counseling)
11. Addiction Services (outpatient, residential, and inpatient)
12. Psychiatric Inpatient Hospital 18-21 years and over 65 years of age

COMMENTS:

Adult Behavioral Health services are administered by the Healthy Louisiana Plans. CPST, PSR, CI follow-up, ACT, CBCS, CS, IPS, PCS, and PSS must be Prior Authorized.