| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
Yes
|
|
null
|
|
Prospective cost based per diem
|
CN
|
|
Alaska
|
|
Yes
|
|
Initially to determine LOC, initially and periodically for LOS
|
|
Prospective cost based per diem
|
CN
|
|
Arizona
|
|
Yes
|
|
|
|
Acute Care program - capitated payment through contractor, ALTCS program - prospective acuity-based per diem or negotiated rate for heavy care residents and certain facilities
|
CN & MN
|
|
Arkansas
|
|
Yes
|
|
Yes
|
7 consecutive therapeutic leave days
|
Prospective cost based per diem
|
CN & MN
|
|
California
|
|
Yes
|
|
Admission
|
|
Prospective cost based all-inclusive per diem using peer groups or negotiated rate with county-operated facilities
|
CN & MN
|
|
Colorado
|
|
Yes
|
|
|
|
Prospective cost based per diem or cost based payment
|
CN
|
|
Connecticut
|
|
Yes
|
|
|
|
Cost based payment
|
CN & MN
|
|
Delaware
|
|
Yes
|
|
|
|
Prospective cost based per diem
|
CN
|
|
District of Columbia
|
|
Yes
|
|
|
|
Prospective cost based per diem
|
CN & MN
|
|
Florida
|
|
Yes
|
|
Yes
|
LOS limited by state's utilization reiew authority and restricted to approved residential treatement facilities
|
Prospective cost based all-inclusive per diem
|
CN
|
|
Georgia
|
|
Yes
|
|
|
|
Cost based payment
|
CN
|
|
Hawaii
|
|
Yes
|
|
|
Coverage limited to 40 days/year
|
Prospective cost based per diem
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
|
Leave days not covered
|
Cost based payment
|
CN
|
|
Illinois
|
|
Yes
|
|
Yes
|
LOS in private hospitals limited by State's Utilization Review authority, alcohol and substance abuse treatment limited to 120 day LOS/residential treatment facility
|
Per diem based on certified cost for state-operated facilities, prospective cost based per diem for all other facilities,
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
Yes
|
14 therapeutic leave days/year
|
Prospective cost based per diem, leave days paid at 50% of facility's rate
|
CN
|
|
Iowa
|
|
Yes
|
|
|
10 hosp leave days/hospitalization, 14 consecutive therapeutic leave days up to 30 days/year
|
Prospective cost based per diem with limits, leave days paid at facility's full rate
|
CN
|
|
Kansas
|
|
Yes
|
|
|
5 hosp leave days per acute care hospitalization, 7 therapeutic leave days for visitation/stay, 5 days/year for other types of leave
|
Prospective cost based per diem
|
CN & MN
|
|
Kentucky
|
|
Yes
|
|
Admission and at 30-day intervals
|
|
Prospective cost based per diem
|
A, B, C & D - See state-specific FN
|
|
Louisiana
|
|
Yes
|
|
Admission and LOS certification
|
|
Prospective cost based per diem
|
CN & MN
|
|
Maine
|
|
Yes
|
|
Admission
|
|
Cost based payment using percentage of charge
|
CN & MN
|
|
Maryland
|
|
Yes
|
|
Admission and continued stay
|
Therapeutic leave must be less than 24 hours with return before census check
|
Prospective cost based per diem set by rate commission
|
CN & MN
|
|
Massachusetts
|
|
Yes
|
|
|
|
Prospective cost based all-inclusive per diem
|
CN & MN
|
|
Michigan
|
|
Yes
|
|
|
|
Prospective cost based per diem for public facilities, private facility reimbursement determined by contracted PIHPs
|
CN & MN
|
|
Minnesota
|
|
Yes
|
|
|
18 acute care hosp leave days/year
|
Prospective cost based per diem for private facilities, cost based payment for public facilities
|
A - See state-specific FN
|
|
Mississippi
|
|
Yes
|
|
|
|
Prospective cost based per diem
|
CN
|
|
Missouri
|
|
Yes
|
|
|
|
Prospective cost based per diem, some facilities receive standard rate
|
CN & MN
|
|
Montana
|
|
Yes
|
|
Therapeutic leave exceeding 3 days
|
14 therapeutic leave days/year
|
Prospective cost based all-inclusive per diem
|
A - See state-specific FN
|
|
Nebraska
|
|
Yes
|
|
|
Psych services limited to approved facilities
|
Prospective cost based per diem using peer groups, with limits
|
CN & MN
|
|
Nevada
|
|
Yes
|
|
For admission
|
Continuing stay authorizations required
|
Cost based payment, negotiated rate for residential treatment facilities
|
CN
|
|
New Hampshire
|
|
Yes
|
|
|
Psych services limited to approved facilities
|
Prospective cost based per diem
|
CN & MN
|
|
New Jersey
|
|
Yes
|
|
|
|
Cost based payment
|
CN
|
|
New Mexico
|
|
Yes
|
|
|
|
Cost based payment with limits
|
CN
|
|
New York
|
|
Yes
|
|
|
|
Prospective cost based all-inclusive per diem, some services may be paid on a fee for service basis
|
CN & MN
|
|
North Carolina
|
|
Yes
|
|
Admission
|
Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year, 3 administrative leave days to facilitate transfer to less restrictive setting
|
Prospective cost based per diem
|
CN & MN
|
|
North Dakota
|
|
Yes
|
|
|
|
Prospective cost based per diem for private hospitals, cost based payment for state-owned facilities
|
CN & MN
|
|
Ohio
|
|
Yes
|
|
|
|
Prospective payment/discharge using DRG
|
CN
|
|
Oklahoma
|
|
Yes
|
|
Yes
|
|
Prospective cost based per diem
|
CN
|
|
Oregon
|
|
Yes
|
|
|
|
Prospective cost based per diem
|
A - See state-specific FN
|
|
Pennsylvania
|
|
Yes
|
|
Admission to residential treatment facility
|
Two periods of therapeutic leave up to 12 hours each per month
|
Prospective cost based per diem
|
CN & MN
|
|
Rhode Island
|
|
Yes
|
|
Admission
|
|
Percentage of charge
|
CN & MN - see state-specific FN
|
|
South Carolina
|
|
Yes
|
|
Admission
|
Limited to residential treatment facilities
|
Prospective cost based per diem with limits
|
CN
|
|
South Dakota
|
|
Yes
|
|
|
|
Cost based payment
|
CN
|
|
Tennessee
|
|
Yes
|
B1 - $100/admission, B2 - $200/admission
|
|
|
|
A & B - See state-specific FN
|
|
Texas
|
|
Yes
|
|
|
Services in private residential treatment facility not covered
|
Prospective cost based per diem
|
CN & MN
|
|
Utah
|
|
Yes
|
|
|
|
Prospective payment/discharge
|
A & B - See state-specific FN
|
|
Vermont
|
|
Yes
|
|
|
|
Prospective payment/discharge using DRG
|
A & B - See state-specific FN
|
|
Virginia
|
|
Yes
|
|
Admission
|
|
Prospective per diem
|
CN
|
|
Washington
|
|
Yes
|
|
|
48-hour weekend absences for therapeutic leave up to 14 days/year
|
Prospective per diem
|
CN & MN
|
|
West Virginia
|
|
Yes
|
|
Yes
|
|
Cost based payment
|
A & B
|
|
Wisconsin
|
|
Yes
|
|
|
|
Prospective cost based per diem
|
CN & MN
|
|
Wyoming
|
|
Yes
|
|
Level of care at admission
|
|
Acuity adjusted contracted rate
|
CN
|
|
American Samoa
|
|
Yes
|
|
|
|
|
See territory-specific FN
|
|
Guam
|
|
No
|
|
|
|
|
|
|
Northern Mariana Islands
|
|
No
|
|
|
|
|
|
|
Puerto Rico
|
|
Yes
|
|
Specified services
|
|
All-inclusive per diem or capitated payment
|
CN & MN
|
|
Virgin Islands
|
|
No
|
|
|
|
|
|
