In addition to meeting medically necessary criteria, services marked with an asterisk* require a doctor’s prescription.
Assertive Community Treatment (ACT) provides basic services and supports essential for people with serious mental illness to maintain independence in the community. An ACT team will provide behavioral health therapy and help with medications. The team may also help access community resources and supports needed to maintain wellness and participate in social, educational and vocational activities. ACT may be provided daily for individuals who participate.
Assessment includes a comprehensive psychiatric evaluation, psychological testing, substance use disorder screening, or other assessments, conducted to determine a person’s level of functioning and behavioral health treatment needs. Physical health assessments are not part of the CMH/PIHP services.
*Assistive Technology includes adaptive devices and supplies that are not covered under the Medicaid Health Plan or by other community resources. These devices help individuals to better take care of themselves, or to better interact in the places where they live, work, and play.
Autism Related Services are for beneficiaries who are less than 21 years of age who are diagnosed with Autism Spectrum Disorder. The benefit includes Applied Behavioral Analysis services at two different levels: Comprehensive Behavioral Intervention (CBI) is a more intense level of services (16-25 hours per week); Focused Behavioral Intervention (FBI) is a less intense level of services (5-15 hours per week).
Behavior Treatment Review: If a person’s illness or disability involves behaviors that they or others who work with them want to change, their individual plan of services (IPOS, also known as a Person Centered Plan or PCP) may include a plan that talks about the behavior. This plan is often called a “behavior treatment plan.” The behavior treatment plan is developed during person-centered planning (PCP)and then is approved and reviewed regularly by a team of specialists to make sure that it is effective and dignified, and continues to meet the person’s needs.
Clubhouse Programs: are programs where members (consumers) and staff work side by side to operate the clubhouse and to encourage participation in the greater community. Clubhouse programs focus on fostering recovery, competency, and social supports, as well as vocational skills and opportunities. More about Clubhouses.
Community Inpatient Services are hospital services used to stabilize a behavioral health condition in the event of a significant change in symptoms, or in a behavioral health emergency. Community hospital services are provided in licensed psychiatric hospitals and in licensed psychiatric units of general hospitals.
Community Living Supports (CLS) are activities provided by paid staff that help adults with either serious mental illness or intellectual/developmental disabilities live independently and participate actively in the community. Community Living Supports may also help families who have children with special needs (such as intellectual/developmental disabilities or serious emotional disturbance).
Crisis Interventions are unscheduled individual or group services aimed at reducing or eliminating the impact of unexpected events on behavioral health and wellbeing.
Crisis Residential Services are short-term alternatives to inpatient hospitalization provided in a licensed residential setting.
*Enhanced Pharmacy includes doctor-ordered nonprescription or over-the-counter items (such as vitamins or cough syrup) necessary to manage your health condition(s) when a person’s Medicaid Health Plan does not cover these items.
*Environmental Modifications are physical changes to a person’s home, car, or work environment that are of direct medical or remedial benefit to the person. Modifications ensure access, protect health and safety, or enable greater independence for a person with physical disabilities. Note that other sources of funding must be explored first, before using Medicaid funds for environmental modifications.
Family Support and Training provides family-focused assistance to family members relating to and caring for a relative with serious mental illness, serious emotional disturbance, or intellectual/developmental disabilities. “Family Skills Training” is education and training for families who live with and/or care for a family member who is eligible for the Children’s Waiver Program.
Fiscal Intermediary Services help individuals manage their service and supports budget and pay providers if they are using a “self-determination” approach.
Health Services include assessment, treatment, and professional monitoring of health conditions that are related to or impacted by a person’s behavioral health condition. A person’s primary care health professional will treat any other health conditions they may have.
Home-Based Services for Children and Families are provided in the family home or in another community setting. Services are designed individually for each family, and can include things like behavioral health therapy, crisis intervention, service coordination, or other supports to the family.
Housing Assistance is assistance with short-term, transitional, or one-time-only expenses in an individual’s own home that his/her resources and other community resources could not cover.
Intensive Crisis Stabilization is another short-term alternative to inpatient hospitalization. Intensive crisis stabilization services are structured treatment and support activities provided by a behavioral health crisis team in the person’s home or in another community setting.
Medication Administration is when a doctor, nurse, or other licensed medical provider gives an injection, or an oral medication or topical medication.
