Covered Behavioral Health Services for Medicaid Members

Medallion and CCC+ Plans 

Many people struggle with depression, anxiety, or other mental health conditions. Substance use can also be an issue.

Behavioral health services can help. They offer a wide range of treatment options. These services help people live in their community. That way, they can maintain the most independent and satisfying lifestyle possible.

Services range from outpatient counseling to hospital care. This includes day treatment and crisis services. Members can get these services in their home or community. They can occur over a short or long time frame. All services are performed by qualified individuals and organizations.

Virginia Premier provides most of the Medicaid EPSDT covered services. This includes Applied Behavioral Analysis (ABA). ABA services enhance communication skills and decrease maladaptive patterns of behavior. ABA does this through data collection.

ABA services:

  • are available to members under 21 years of age
  • involve a member’s family or caregiver. The caregiver must be trained to support the member in the home and community. They must use the skills learned while actively participating in services
  • may not be combined with:
    • Intensive In-home Services
    • Mental Health Skill-building Services
    • Psychological Rehabilitation
    • Multisystemic Therapy
    • Functional family therapy
    • partial Hospitalization Program or Assertive Community Treatment

Please reach out to case management for assistance with accessing EPSDT services. Their phone number is below.

How to Access Medicaid Behavioral Health Services

For behavioral health services, call Virginia Premier Member Services at 1-800-727-7536 (TTY: 711), Monday through Friday, 8:00 am to 5:00 pm. The call is free. You can also be connected to your care coordinator during the call.

How to Access Non-Emergency Transportation Services

If you need a ride to an appointment for a covered service, we can help. Call us at 1-855-880-3480 (TTY: 711), Monday – Friday, 6:00 am – 6:00 pm to set up a ride. Trips need to be scheduled at least five business days beforehand. Weekends and holidays do not count toward these days.

Behavioral Health Services Administrator (BHSA)

Some behavioral health services are covered through Magellan of Virginia. This includes children’s residential treatment and therapeutic foster care case management. Magellan of Virginia is the behavioral health services administrator (BHSA) for the Department of Medical Assistance Services (DMAS). Virginia Premier’s Member Services Department can help you get the services from the BHSA.

Mental Health Services and Trauma Informed Care

Virginia Premier covers traditional inpatient and partial psychiatric hospitalization. Mental Health Services are available for our members. These services also include:

  • Community Mental Health Rehabilitative Services (CMHRS)
  • Enhanced Behavioral Health (EBH) Services
  • Mental Health Case Management.

These services help members who have experienced trauma. Trauma means intense and overwhelming experiences that involve serious loss, threat or harm to a person’s physical and/or emotional well-being. Trauma can happen at any time in a person’s life. It could be a single event. Or it could be repeated over many years. People often find a way of coping that works in the short run. But they may still be suffering in the long run.

Virginia Premier’s providers deliver services to members through a trauma-informed care framework.

Addiction and Recovery Treatment Services (ARTS)

Virginia Premier offers many services for people struggling with substance use. This includes alcohol and drug use. Addiction is a medical illness, just like diabetes. Many people face addiction. All of them can benefit from treatment.

Virginia Premier covers these ARTS services:

  • inpatient acute detoxification hospitalization
  • partial hospitalization
  • group home or halfway house
  • residential treatment facility services
  • substance abuse intensive outpatient treatment
  • outpatient (individual, family, and group) substance abuse treatment
  • opioid treatment services (includes individual, group counseling; family therapy and medication administration)
  • substance abuse peer specialist services

You can get these services at no cost.

Medication-assisted treatment options are also available, even for addiction to non-prescription drugs. Peer services are provided by someone who has had similar issues and who is in recovery. Case management services are also available.

How to Access Addiction and Recovery Treatment Services (ARTS)

If you’re interested in these services, talk to your Primary Care Provider (PCP) or call a Virginia Premier Care Coordinator. They can help figure out the best option for you. We hope you will make use of these services if you need them.

There are many ways to find an ARTS provider. You can:

  • look in the Provider and Pharmacy Directory
  • visit our website at virginiapremier.com
  • call your Virginia Premier Care Coordinator
  • contact Member Services at 1-800-727-7536, 8:00 am to 8:00 pm, Monday through Friday

If you have any questions about ARTS, please reach out to us.

Prior Authorizations for Behavioral Health and ARTS

Virginia Premier requires a prior service authorization for some services. This includes:

  • all inpatient behavioral health and substance abuse admissions to hospitals
  • partial hospitalization
  • residential treatment
  • substance abuse group home / halfway house treatment
  • intensive outpatient substance abuse services

We also require prior service authorization for these Mental Health services:

  • Mental health case management: These services find medical, social, educational, and other resources.
  • Therapeutic day treatment services for children (TDT): These are services for children with severe behavioral problems. They give two hours a day of counseling for children. Counseling happens during or after the school day. Counselors will instruct on:
    • medication
    • building daily living skills
    • building social skills
    • individual, group and/or family counseling and care coordination
  • ** Mental health partial hospitalization program (MH-PHP) This is a new EBH service starting July 1, 2021. It is for children and adults. It supports and prevents psychiatric hospitalization. It may also be an in between service for members who are coming from a psychiatric hospital stay and need extra counseling. A team will give intensive therapy. They will work together 20 hours and five days per week.
  • ** Mobile Crisis: This is a new EBH service starting December 1, 2021. It is a rapid response service for behavioral health crisis. Its focus is on maintaining safety. The service refers to behavioral health services and support.
  • ** Community Stabilization: This is a new EBH service starting December 1, 2021. It is a short-term service for members who have had contact with crisis response. The service:
    • helps set up other mental health services
    • watches for safety concerns
    • gives education regarding mental health crises
    • locates friends, family, and others who can support the member
  • ** 23-Hour Crisis Stabilization: This is a new EBH service starting December 1, 2021. It is for members having a mental health crisis. This service allows time to decide whether a member will need to go to the hospital. It may decide that another mental health service can help instead.
  • ** Residential Crisis Stabilization: This is a new EBH service starting December 1, 2021. It is a short-term residential program. It is a step down from a psychiatric hospitalization. The service helps members get through a mental health crisis and find support in the community.
  • ** Assertive Community Treatment (ACT): This is a new EBH service starting July 1, 2021. This service gives long-term treatment, rehabilitation, and support to members with severe mental illness. It has 24-hour on-call support. This support comes from a team of mental health experts.
  • ** Mental health intensive outpatient services (MH-IOP): This is a new EBH service starting July 1, 2021. It helps members at risk for psychiatric hospitalization. Members age six through 17 get six hours per week of intensive therapy. Adults get nine hours each week.
  • Mental health skill-building services (MHSS): This service is for members with serious mental illness. It teaches members about:
    • completing daily living skills
    • the importance of taking medication
    • health conditions and how to care for them
    • good nutrition and physical health
  • Intensive in-home services: This service is for members under age 21. It is only for members at risk of removal from their home. It is usually short term and intensive. It helps the family learn how to get along. It also provides modeling, and works to improve relationships between family members.
  • Psychosocial rehabilitation services: This service is two or more hours a day, several days a week. It involves groups of individuals in the community. The service teaches skills for independent living and how to get along with others.
  • Mental health peer support services: These services support members with resources and self-help efforts. They may be gotten either individually or in groups. They come from someone who:
    • has had mental health conditions and/or substance use disorder
    • is successfully in ongoing recovery
  • ** Multisystemic therapy (MST): This is a new EBH service starting December 1, 2021. This service is given in the home and community. It is for children ages 11-17 who have very severe behavioral problems. Referral is needed from juvenile justice, behavioral health, school, or child welfare system. The service focuses on:
    • overcoming barriers to behavior change
    • safety planning
    • and crisis intervention
  • ** Functional family therapy (FFT): This is a new EBH service starting December 1, 2021. This is a home-based service. It is for children ages 11-18. It gives help for behavioral or emotional problems. These problems can include substance use disorders. The service focuses on the whole family to understand risk and protective factors. Referral is needed from juvenile justice, behavioral health, school, or child welfare system.

To find out more about how to request approval for these treatments or services, contact Member Services at 1-800-727-7536, 8:00 am to 5:00 pm, Monday through Friday. You can also call your Care Coordinator.

Any person or child admitted to a Therapeutic Group Home (TGH) will not be excluded from the Medallion 4.0 or CCC Plus Program; however, the TGH per diem service is “carved out” of the Medallion 4.0 and CCC Plus contracts and will be administered through Magellan of Virginia. Any professional medical services rendered to individuals in the TGH will be administered by Virginia Premier.