RFP 250000002670 - Schedule H - Medicaid Behavioral Health and Substance Use Disorder Payment Responsibility Grid.docx

Michigan.gov/MiProcurement SCHEDULE H – MEDICAID BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER PAYMENT RESPONSIBILITY GRID Request for Proposal No. 250000002670 Prepaid Inpatient Health Plan (PIHP) Contractor must utilize the Medicaid Behavioral Health and Substance Use Disorder Payment Responsibility Grid located in the link below:

https://www.michigan.gov/mdhhs/keep-mi-healthy/mentalhealth/mentalhealth/practiceguidelines

Note: MDHHS will be modifying the Medicaid Behavioral Health and Substance Use Disorder Payment Responsibility Grid to reflect changes in mental health payment responsibility that will be effective with this Contract. These changes will include, but may not be limited to:

· Medicaid Health Plan (MHP) coverage of the following State Plan mental health services for MHP beneficiaries who are not in a 1915(c) Home and Community-Based Services waiver (CWP, HSW, SED) or 1915(i) State Plan Behavioral Health benefit and who have been identified as having a lower level of mental health need or whose level of mental health need has not yet been assessed, including:

· Inpatient psychiatric hospital services

· Partial hospitalization

· Crisis residential services

· Targeted case management

· Outpatient office mental health services Contractor will continue to cover the remaining State Plan mental health services for these MHP beneficiaries, such as Emergency Intervention Services.

· Contractor coverage of all State Plan mental health services for MHP beneficiaries who are in a 1915(c) Home and Community-Based Services waiver (CWP, HSW, SED) or the 1915(i) State Plan Behavioral Health benefit or who have been identified as having a higher level of mental health need through a State-specified standardized assessment process, including but not limited to:

· Outpatient office mental health services, regardless of setting of service, with the expectation that Contractor expands their network to include providers of such services beyond those contracting with CMHSPs.

· Clarification that MHP beneficiary’s level of mental health need for the purpose of mental health coverage responsibility will be based on criteria determined per Medicaid policy.

Contractor shall work with MDHHS to implement mental health coverage responsibility changes. MDHHS reserves the right to make further modifications to coverage.

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