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| STATE |
Column 6 WHO TO CALL ABOUT BECOMING A PROVIDER - PROVIDER RELATIONS |
Column 7 WEBSITE FOR |
Column 8 COMMENTS |
|---|---|---|---|
| ALASKA | NA | NA | State has no Managed Behavioral Health Care program |
| ARIZONA | 1) Value Options 602-914-5800 2) Community Partnership of Arizona (CPSA) 520-325-4268, 520-417-9430 3) Northern Arizona Behavioral Health Authority (NARBHA) 928-774-7128 4) PMA Gila Behavioral Health Association (PGBHA) 480-982-1317 5) The EXCEL Group 928-329-8995 |
1) www.valueoptions.com/arizona 2) www.CPSA-rbha.org 3) www.narbha.org 4) www.pgbha.org 5) www.excelgroup.org |
State has Managed Behavioral Health Care but some of the RBHA's appear to contract with the provider groups on a fee for service basis with the provider group taking the risk. |
| ALABAMA | 800-352-1504 | Medicaid, General www.Medicaid.state.al.us | State has no Managed Behavioral Health Care Program. |
| CALIFORNIA | DMH website provides all county MHC directors, contact information. Excellent links. | www.dmh.ca.gov www.dmh.ca.gov/SpecialPrograms/medi-cal.asp |
State has just received input via "MEDI-CAL REDESIGN, SPRING 2004", an initiative of the Governor's Office to make services more affordable including the Medi-Cal Managed Mental Health Program. Input has been obtained, but redesign is not yet completed. |
| COLORADO |
1) Access Behavioral Health Care |
1) Web address continues on 2nd line: www.coloradoaccess.com/public/ accessBehavioralCare.jsp 2) Web address continues on 2nd line: www.coloradoaccess.com/public/ accessBehavioralCare.jsp 3) bhi@bhicares.org 4) www.jcmh.org/contact.html 5) info@mhbc.org 6) NA 7) NA 8) NA 9) NA |
State runs 2 large inpatient programs and Community Mental Health Centers accept Medicaid patients. Access Behavioral Care maintains an extensive website with full list of providers and information for both patients and providers. Part of states largest Medicaid MCO. Separate program for Pikes Peak (Colorado Springs) All other programs are regional and much smaller in numbers of Medicaid patients. |
| CONNECTICUT | 1) Sue Tharnish, 202-579-7387 2) Mark McAndrew 860-262-5355 3) Rhonda Kincaid 860-859-4531 4) Michael Michaud 860-293-6342 5) Sue Tharnish, 203-805-6418 |
Region 1) sue.tharnish@po.state.ct.us Region 2) mark.mcandrew@po.state.ct.us Region 3) rhonda.kincaid@po.state.ct.us Region 4) michael.michaud@po.state.ct.us Region 5) sue.tharnish@po.state.ct.us |
State has had success with managed behavioral health care via contracts with 4 HMOs. Has proposed that Medicaid FFS patients be switched to managed care with state assuming all risk since utiliation is so high. |
| DELAWARE | NA | NA | NA |
| DISTRICT OF COLUMBIA | 866-867-2537, General information number which can redirect providers. | Info@valueoptions.com or http://dchealth.dc.gov/information/maa_outline.shtm |
D.C. added Managed Mental Health and Substance Abuse in August, 2002. Prior to this all FFS, except for selected population of child MH problems. |
| FLORIDA | General info. 800-808-8033 Provider specific 813-246-7238 |
(Web address continues on 2nd line) http://www.fdhc.state.fl.us/MCHQ/ Managed_Health_Care/MHMO/overview.shtml |
State has low penetration of Medicaid Managed care. This is only area with a Behavioral Health Managed Care plan in place. |
| GEORGIA | NA | NA | State has no Medicaid Managed Behavioral Health Care Programs, Utilize a management utilization model for some Medicaid behavioral health care. |
| HAWAII | NA | (Web address continues on 2nd line) http://www.med-quest.us/providers/ Reference/manual.html |
State has a combination of FFS and Medicaid Managed Care with emphasis on MMC. Behavioral Health benefit is provided by MCO but is limited to severe inpatient mental illness for patients under 21 years old and outpatient psychologist services. |
| IDAHO | NA | NA | No Managed Behavioral Health Care in state. |
| ILLINOIS | Phone numbers available for each MCO on website. | State has voluntary Managed Behavioral Health Care in limited area. Relativley low penetration (10% of Medicaid in state is covered.) Majority of Medicaid benefits are FFS including Behavioral Health Services. | |
| INDIANA | 317-233-4697 | (Web address continues on 2nd line) http://www.indianamedicaid.com/ihcp/ HoosierHealthwise/content/contact_info.asp |
High penetration of managed care for Medicaid primary care. PCP must approve referral to specialists, including Mental Health Providers who are paid on a FFS basis. |
| IOWA | 515-281-8621 | (Web address continues on 2nd line) http://www.dhs.state.ia.us/MedicalServices/ MedicalServices.asp |
NA |
| 515-281-8621 | djansse@dhs.state.ia.us | County Program: counties required by legislation to establish mental health managed care plan for non-Medicaid beneficiaries or services. | |
| KANSAS | NA | NA | State has some managed Medicaid, but no managed Behavioral Health. |
| KENTUCKY | David Harma, Director, Div. of Medicaid Services for Mental Health and Mental Retardation 502-564-5198 | CHS.DMSWeb@ky.gov | State is primarily using a PCCM system. Recipient must select a PCP who manages their care. Mental health services provided by a PCP, including medications are covered. All Behavioral Health referrals are paid on a FFS basis. |
| LOUISIANA | Provider Relations 800-473-2783 |
NA | Limited Managed Care for Medicaid with exclusion for Behavioral Health. |
| MAINE | MaineCare. Diane Bailey, Mgr.Provider Services. 207-287-9345, Ext 213 | Diane.Bailey@maine.gov | Managed Medicaid for primary care only. Behavioral Health is excluded. |
| MARYLAND | Contact Health Partners Provider Relations: PLStuehler@magellanhealth.com | http://www.dhmh.state.md.us/mha/ | All providers must be enrolled by both the Maryland Medical Assistance Program and by Maryland Health Partners. |
| MASSACHUSETTS | Provider Enrollment and Credentialling 617-322-2909, 800-322-2909 | maproviderenrollment@unisys.com | State has carve-out called CommonHealth Plan for Mental Health for persons with disabilities. Not capitated on provider side. |
| MICHIGAN | Provider Support 800-292-2550 | providersupport@michigan.gov
contact point for all medicaid providers www.michigan.gov/mdch excellent website to access all programs and lists of providers, MCOs, etc. Provider handbooks on site. |
100% Medicaid Managed Care. Behavioral heallth is delivered in several different models, but all is capitated. There are large numbers of providers in the various sytems. All care is arranged either at the county level or at the region level for MCOs. |
| MINNESOTA | Provider Enrollment 651-282-5545 or 800-366-5411, option 5 | (Web address continues on 2nd line) www.dhs.state.mn.us/main/groups/agencywide/ documents/pub/dhs_Home_Page.hcsp A well annotated website which is easy to navigate and find provider information. |
State has placed a heavy emphasis on Managed Care, including Behavioral Health for Medicaid recipients. Carve outs with FFS are only for special needs populations. |
| MISSISSIPPI | NA | No managed Medicaid in state. No Behavioral Health coverage, except in Residential Treatment centers. All is fee for service. | NA |
| MISSOURI | Provider Communications Unit 800-392-0938 or providerenrollment@mail.medicaid.state.mo.us | http://dss.missouri.gov/mcplus/hregions.htm This website lists each MCOs operating in the three regions of MO where there is Medicaid Managed Care. It includes phone numbers for each MCO. |
State has Managed Care plans in place in the middle of the state, including the most populous areas. There are three regions with 2-4 MCOs in each. The vast bulk of the state Medicaid is FFS, but it is entirely the rural areas. |
| MONTANA | Provider Enrollment, P.O. Box 4936, Helena, MT 59604; 406-442-1837 | (Web address continues on 2nd line) http://www.dphhs.state.mt.us/hpsd/ medicaid/index.htm |
A primary care case management program (PCCM) - every client must choose a primary care provider. A range of behavioral health providers may enroll. Some services require approval and/or prior authorization. |
| NEBRASKA | see web site | Nebraska's managed care program is called Nebraska Health Connection. Behavioral services are cared out and managed by Magellan Behavioral Health Care, Inc. | |
| NEVADA | Provider Relations Department, First Health Services Corporation, P.O. box 30026, Reno NV 89520-3026; 877-638-3472 | http://www.dhcfp.state.nv.us/ | Medicaid services, including behavioral health services, provided through a combination of traditional fee-for-service provider networks and managed care. Fiscal agent: First Health Services Corporation. Behavioral health clinical services can be provided by a variety of Nevada licensed professionals/entities that meet requirements for "mental health specialty clinics". |
| NEW HAMPSHIRE | NH DHHS Office of Health Planning and Medicaid, 603-271-5254 |
(Web address continues on 2nd line) |
|
| NEW JERSEY | See website for individual HMO provider relations numbers | (Web address continues on 2nd line) http://www.state.nj.us/humanservices/ dmahs/aged-blind.html |
Providers wishing to participate in caring for Medicaid patients must be part of a HMO provider network. |
| NEW MEXICO | Enrollment: 1-800-282-4477; Cimarron Provider Enrollment: 505-342-4703; Lovelace Provider Enrollment: 505-232-2700; Presbyterian Provider Services: 1-800-998-2375 |
http://www.state.nm.us/hsd/mad | New Mexico has both a fee for services program and SALUD Medicaid Managed Care. Behavioral health services are now directly managed by the 3 MCOs which contract with providers. (Prior to July 2001 each MCO subcapitated 1 or more managed behavioral health organizations.) |
| NEW YORK | See website for health plans by county |
(Web address continues on 2nd line) |
Medicaid managed care varies by county - optional in some, mandatory in others. Providers enroll with specific MCOs. |
| NORTH CAROLINA | Provider Services, NC Division of Medical Assistance, 2501 Mail Service Center, Raleigh NC 27699-2501; 919-857-4017. To enroll as an HMO provider must contact HMOs directly. | http://www.dhhs.state.nc.us/dma | Managed care options are available in all 100 counties. Options include Carolina ACCESS (a PCCM approach) and Healthcare Connection involving risk contracting with a state-licensed HMO in Mecklenberg County. |
| NORTH DAKOTA | Provider Enrollment, Medical Services, ND Dept. of Human Services, 600 E Boulevard Ave- Dept 325, Bismarck ND 58505-0250; 800-755-2604 & 701-328-4033; Managed Care Program: 800-755-2604 & 701-328-1884 | http://www.state.nd.us/humanservices | This is a statewide Medicaid program - called the Primary Care Provider Program. Managed care exists only Grand Forks County where the State contracts with an HMO, AltruCare Plan, operated by Blue Cross Blue Shield of North Dakota. Specific protocols and medical necessity criteria, as a part of a review and authorization process, have been developed for both adult and children's behavioral health care services across the State. |
| OHIO | Provider Enrollment Unit, 1-800-686-1516 | http://jfs.ohio.gov/ohp | Managed care is voluntary in some counties, mandatory in others. |
| OKLAHOMA | SoonerCare Provider Services 877-823-4529 | http://www.ohca.state.ok.us | A Primary Care Provider Case Management system - OHCA contracts directly with providers. Primary care providers receive a monthly capitated rate for a fixed set of services. All other services, including behavioral health services, are fee-for-service. |
| OREGON | OMAP Provider Enrollment, 1-800-422-5047 | Oregon Health Plan Plus covers the Medicaid population. Services provided by managed care plans via capitation or PCCM and by individual health care providers on a fee for service basis. Arrangements vary by county. Enrollee may be in health plan and/or dental plan and/or mental health plan depending on location. If in a Mental Health Plan, services are provided or coordinated by the Mental Health Organization (MHO) which has a contract directly with the state. | |
| PENNSYLVANIA | 877-787-6397 | Two managed care programs: Health Choices, which is mandatory, and voluntary managed care. Varies by county - mandatory program is being phased in across the state. 25 counties presently have HealthChoices. Health Choices includes the Physical Health Program (provided through MCOs) and the Behavioral Health Program (provided through Behavioral Health MCOs). Each enrollee is assigned a Behavioral Health MCO based on county of residence and have a choice of providers within the specific network. | |
| RHODE ISLAND | Provider Services Department, 1-401-784-8100 | http://www.dhs.state.ri.us/ | Managed care program is called RIte Care. There are 3 participating health plans: Neighborhood Health Plan of Rhode Island, United HealthCare of New England, and Coordinated Health Partners/Blue CHiP. |
| SOUTH CAROLINA | Medicaid Provider Enrollment, 803-788-7622 ex 41650 | http://www.dhhs.state.sc.us/ | Voluntary managed care, via HMO or PEP (Physicians Enhanced Program). Behavioral health services provided through community mental health centers or practicing psychiatrists. |
| SOUTH DAKOTA | Provider Enrollment, Department of Social Services 605-773-3495 | http://www.state.sd.us/social/medical | South Dakota's managed care program is required for all recipients. It provides a medical home and recipients must receive services or a referral from the Primary Care Provider. Behavioral health services are not handled differently and are provided by referred/specialty providers. |
| TENNESSEE | Premier Behavioral Systems of Tennessee: 1-800-325-7864; Tennessee Behavioral Health, Inc.: 1-800-447-7242 | http://www.state.tn.us/tenncare | Behavioral Health Organizations (BHO) are managed care contractors approved by the Tennessee Department of Finance and Administration to deliver mental health and substance abuse services to Medicaid enrollees under the TennCare Partners Program. There are currently two BHOs. |
| TEXAS | TMHP (Texas Medicaid & Healthcare Partnership) Customer Service - 1-800-925-9126 | http://www.hhsc.state.tx.us/medicaid | Managed care has been a pilot program since 1993 - known as STAR (State of Texas Access Reform). Now covers 8 service areas. There are two models: PCCM and a fully capitated HMO. A legislatively mandated study was carried out by the Lewin Group in 2003 which resulted in plans for expansion of managed care. See "Medicaid Managed Care in Texas: Framework for Expansion" on website. No mention of any special arrangements for behavioral health services. TMHP is a coalition of contractors headed by ACS which carries out claims payment, PPCM administration, provider services, etc. |
| UTAH | 1-800-662-9651 | http://health.utah.gov/medicaid/ | Capitated managed care in specific counties. Providers must be affiliated with managed health care plan. In most counties mental health services, outpatient and inpatient, are provided only by Prepaid Mental Health Plans, which must have a contract with the state. In some counties the PMHP is a community mental health center. |
| VERMONT | EDS, 800-925-1706 or 802-878-7871 | http://www.dpath.state.vt.us/ | NA |
| VIRGINIA | First Health Services Corporation 804-270-5105 or 1888-8295373 | Providers must contract with both DMAS (via First Health) and with the Medicald HMO in the locality. | |
| WASHINGTON | Provider Relations 1-800-562-6188 | http://fortress.wa.gov/dshs/maa | Managed care program is called "Healthy Options". 7 different plans. Behavioral health services are the responsibility of the health plan under its contract with the state. |
| WEST VIRGINIA | Provider Services, 888-483-0793 & 304-348-3360 | http://www.wvdhhr.org | West Virginia has two forms of managed care: the PAAS Program (Physician Assured Access System) and Mountain Health Trust Program - HMO. Behavioral health services continue to be accessed under fee-for-service. Unisys is the fiscal agent for West Virginia Medicaid and handles provider services including enrollment. |
| WISCONSIN | Provider Services: 1-800-947-9627 or 608-221-9883 | http://dhfs.wisconsin.gov/medicaid | Bureau of Managed Health Care Programs operates a Medicaid HMO program for Medicaid, CHIP and three specialized programs. Medicaid contracted HMOs are required to provide all medically necessary mental health services that would be covered under fee-for-service Medicaid. |
| WYOMING | Wyoming Provider Services, 1-800-251-1268 | http://wyequalitycare.acs-inc.com/
and http://wdhfs.state.wy.us |
Wyoming Medicaid Program is part of EqualityCare - administered by the Office of Medicaid, Wyoming Department of Health. No managed care program. The fiscal agent is ACS, which handles provider services including enrollment. |
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