| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
Alaska
|
|
Yes
|
|
|
Residential substance abuse treatment services covered in state-certified facilities only, services in residential psychiatric treatment centers and day treatment services not covered
|
Fee for service
|
CN
|
|
Arizona
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Arkansas
|
|
Yes
|
|
Specified services
|
Substance abuse services require mental health primary diagnosis
|
Fee for service
|
CN & MN
|
|
California
|
|
Yes
|
$1/visit
|
Specified services
|
Residential habilitation treatment covered only for developmentally disabled, substance abuse treatment providers must be state-approved
|
Residential treatment facilities paid standard per diem by facility bed size, substance abuse services paid fee for service or negotiated rate
|
CN & MN
|
|
Colorado
|
|
Yes
|
|
|
Rehab centers must be state-approved
|
Fee for service or prospective cost based rate
|
CN
|
|
Connecticut
|
|
Yes
|
|
|
10 days/occurrence in approved Alcohol Abuse Treatment Center for acute and evaluation phase of treatment
|
Prospective per diem or global rate
|
CN & MN
|
|
Delaware
|
|
Yes
|
|
|
30 residential treatment days/year plus 2 days available for each unused inpatient psychiatric treatment day not used for outpatient treatment, approved treatment includes minimum of 1 hour/week face-to-face clinical contact
|
Fee for service or prospective cost based rate
|
CN
|
|
District of Columbia
|
|
Yes
|
|
Yes
|
Rehab centers must be state-approved
|
Fee for service
|
CN & MN
|
|
Florida
|
|
Yes
|
$2/day
|
|
Quantity and frequency limits vary by service
|
Capitated payment or fee for service
|
CN & MN
|
|
Georgia
|
|
Yes
|
|
|
|
Fee for service at 84.645% of CMS RBRVS rates for 2000
|
CN & MN
|
|
Hawaii
|
|
Yes
|
|
Yes
|
|
Fee for service or prospective payment system rate
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
|
Psychosocial rehab 10 hours/week, substance abuse therapy 12 individual sessions/ week and 24 group sessions/week
|
Fee for service
|
CN
|
|
Illinois
|
|
Yes
|
|
Residential-based services, active community treatment
|
|
Fee for service, cost based per diem or certified cost
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
Yes
|
14 therapeutic leave days/year in psychiatric residential treatment facilities
|
Fee for service with services of specified mid-level practitioners paid 75% of physician fee, prospective cost based per diem for psych residential treatment facilities
|
CN
|
|
Iowa
|
|
Yes
|
$2/day
|
Initial care plan and at least annually thereafter
|
Limited to services for treatment of chronic mental illness
|
Fee for service
|
CN & MN
|
|
Kansas
|
|
Yes
|
|
Specified substance abuse services
|
|
Capitated payment or fee for service
|
CN & MN
|
|
Kentucky
|
|
Yes
|
|
|
Adult coverage of substance abuse services as a primary diagnosis limited to pregnant women; covered as secondary diagnosis for other adults
|
Prospective cost based per diem
|
A, B, C & D - See state-specific FN
|
|
Louisiana
|
|
Yes
|
|
Yes
|
Substance abuse treatment not covered
|
Fee for service, some services paid monthly rate
|
CN & MN
|
|
Maine
|
|
Yes
|
$.50-$2/day, depending on payment, up to $20/month
|
|
Substance abuse services limited to 30 weeks
|
Fee for service or negotiated rate
|
CN & MN
|
|
Maryland
|
|
Yes
|
|
Yes
|
Mental Health service and visit limits vary based on medical need
|
Fee for service for mental health care, cost based payment for substance abuse treatment in most settings
|
CN & MN
|
|
Massachusetts
|
|
Yes
|
|
|
|
Fee for service or negotiated rate
|
CN & MN
|
|
Michigan
|
|
Yes
|
|
|
|
Capitation payment
|
CN & MN
|
|
Minnesota
|
|
Yes
|
|
|
Mental health service and visit limits vary
|
Fee for service or negotiated rates
|
A & B - See state-specific FN
|
|
Mississippi
|
|
Yes
|
|
|
Limited to therapies and medication related services only
|
Fee for service
|
CN
|
|
Missouri
|
|
Yes
|
|
|
Services limited to the severely mentally ill
|
Fee for service
|
CN & MN
|
|
Montana
|
|
Yes
|
|
Specified services
|
Substance abuse treatment limited to state-approved facilities
|
Fee for service
|
A & B - See state-specific FN
|
|
Nebraska
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Nevada
|
|
Yes
|
|
|
Rehab potential required
|
Fee for service
|
CN
|
|
New Hampshire
|
|
Yes
|
|
|
Community mental health care limited to $1,800/year unless specified criteria met, low service utilizer with severe or persistent mental illness limited to $4,000/year
|
Fee for service
|
CN & MN
|
|
New Jersey
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
New Mexico
|
|
Yes
|
A - $5/visit, B - $7/visit - see state-specific FN
|
|
|
Fee for service
|
CN
|
|
New York
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
North Carolina
|
|
Yes
|
|
|
|
Fee for service using quarter hour or hourly rates
|
CN & MN
|
|
North Dakota
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Ohio
|
|
Yes
|
|
|
|
Cost based payment
|
CN
|
|
Oklahoma
|
|
Yes
|
|
|
Service limits vary by type of treatment, outpatient behavioral health services not covered for nursing facility residents
|
Fee for service or all-inclusive daily rate
|
CN
|
|
Oregon
|
|
Yes
|
A - $3/visit
|
Specified procedures
|
|
Fee for service or negotiated rate
|
A & B - See state-specific FN
|
|
Pennsylvania
|
|
No
|
|
|
|
|
|
|
Rhode Island
|
|
Yes
|
|
|
Specified services not covered
|
Negotiated rate
|
CN & MN - see state-specific FN
|
|
South Carolina
|
|
Yes
|
|
|
Centers must be state-approved
|
Fee for service
|
CN
|
|
South Dakota
|
|
Yes
|
5% of payment for mental health services
|
|
Substance abuse services limited to pregnant women
|
Prospective cost based rate
|
CN
|
|
Tennessee
|
|
Yes
|
B1 - $5/MH Clinic visit, B2 - $10/MH Clinic visit
|
|
10 days detoxification treatment/lifetime with $30,000 limit/lifetime on inpatient and outpatient drug and alcohol treatment
|
|
A & B - See state-specific FN
|
|
Texas
|
|
Yes
|
|
|
Limited to persons with severe or persistent mental health disorders
|
Cost based payment
|
CN & MN
|
|
Utah
|
|
Yes
|
|
|
Ambulatory detox services not covered
|
Fee for service
|
A, B & C - See state-specific FN
|
|
Vermont
|
|
Yes
|
|
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Virginia
|
|
Yes
|
$3/visit
|
|
Limits vary by service
|
Fee for service
|
CN & MN
|
|
Washington
|
|
Yes
|
|
Specified services
|
Ambulatory detox and other specified services not covered
|
Fee for service or percentage of charge
|
CN & MN
|
|
West Virginia
|
|
Yes
|
|
Specified procedures
|
B - 20 visits/year
|
Fee for service
|
B
|
|
Wisconsin
|
|
Yes
|
$.50-$3, depending on service, copayment for psychotherapy limited to 15 hours or $500
|
|
Substance abuse services limited to 15 hours or $500/year, in-home services not covered for adults
|
Fee for service
|
CN & MN
|
|
Wyoming
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
American Samoa
|
|
Yes
|
|
|
|
|
See territory-specific FN
|
|
Guam
|
|
No
|
|
|
|
|
|
|
Northern Mariana Islands
|
|
No
|
|
|
|
|
|
|
Puerto Rico
|
|
Yes
|
|
|
Limited to services rendered by contracted staff
|
Fee for service or capitated payment
|
CN & MN
|
|
Virgin Islands
|
|
No
|
|
|
|
|
|
