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Benefits by Service: Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics (October 2008) Definition/Notes

Note: Totals include 50 states and D.C.

"Benefits Covered" Totals

"Benefits Not Covered" Totals

Is the benefit covered?

Is there a co-payment requirement?

Yes: 22

No: 27

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Alabama
Yes			Mental Health Clinic therapy, day treatment and other services with varying limits, Public Health Clinics not covered	Negotiated rate	CN
Alaska
Yes	$3/visit		Mental Health Clinics must be state approved, Public Health Clinics not covered	Fee for service	CN
Arizona
Yes				Fee for service	CN & MN
Arkansas
Yes			Developmental day treatment clinic services up to 4 time units/year for physical, occupational and speech evaluations, 4 time units/day (15 minutes each) for individual and group therapy	Fee for service	CN & MN
California
Yes	$1/visit		Adult day treatment for elderly and disabled limited to 6-12 hours/day, 5 days/week	Fee for service	CN & MN
Colorado
Yes	$2/visit		Clinics must be state approved	Fee for service or prospective cost based rate	CN
Connecticut
Yes		Specified services	1 psych evaluation/year, 1 psych therapy/day with maximum of 13 services in 90 days or 26 services in 6 months, medication reviews not separately reimbursable	Fee for service	CN & MN
Delaware
Yes			20 outpatient treatment days/year plus 3 days available for each unused inpatient psychiatric treatment day not used for residential treatment, all Mental Health clinics must be state-approved	Fee for service or negotiated rate	CN
District of Columbia
Yes			Mental health clinics must be state-approved	Fee for service	CN & MN
Florida
Yes	$2/day at Mental Health Clinic		1 encounter/day for primary or preventive care	Fee for service or prospective cost based rate for primary care	CN & MN
Georgia
Yes			Public Health Clinics not covered	Fee for service at 84.645% of CMS RBRVS rates for 2000	CN & MN
Hawaii
Yes			24 one-hour individual or group psych therapy visits/year plus 6 more if combination of therapy, limits on session duration	Fee for service	CN & MN
Idaho
Yes			Public Health Clinics must be state-contracted, Enhanced Plan - 45 hours psych therapy/year at Mental Health Clinics whether public or private, Basic Plan - 26 hours psych therapy/year at Mental Health Clinics whether public or private	Fee for service	CN
Illinois
Yes				Fee for service, encounter rates for specified clinics	CN & MN
Indiana
Yes				Fee for service or reasonable charge	CN
Iowa
Yes			Public Health Clinics must be state-approved and there are service specific limits, Day Treatment in Mental Health Clinics limited to 3-5 hours/day for 3-4 days/week based on individual treatment plans	Fee for service	CN & MN
Kansas
Yes				Capitated payment or fee for service	CN & MN
Kentucky
Yes	A - $2/visit		Mental Health Clinics not covered - see Rehab Services	Fee for service	A, B, C & D - See state-specific FN
Louisiana
Yes			Substance abuse treatment not covered	Prospective all-inclusive rate per encounter	CN & MN
Maine
Yes	$.50-$3/day at Mental Health Clinic, depending on payment, up to $20/month	Specified procedures and services		Fee for service	CN & MN
Maryland
Yes			1 visit/day	Cost based payment for Public Health Clinics, Mental Health Clinics paid reasonable charge per visit depending on length of visit and beneficiary age	CN & MN
Massachusetts
Yes			Public Health Clinics not covered	Fee for service	CN & MN
Michigan
Yes	$3/dental visit; $2/physician visit other than for mental health - see state-specific FN			Cost based payment for Public Health Clinics, Mental Health Clinics generally paid capitation rate, Public Dental Clinics paid average commercial rate	CN & MN
Minnesota
Yes	$3/visit for non-preventive service			Fee for service	A & B - See state-specific FN
Mississippi
Yes	$3/visit		12 Public Health Clinic visits/year included in physician visit limit, Mental Health Clinics not covered	Cost based payment	CN
Missouri
Yes	$.50/day			Fee for service	CN & MN
Montana
Yes	$1/visit to Public Health Clinic			Fee for service	A & B - See state-specific FN
Nebraska
Yes	Public Health Clinic: $2/physician visit (not applicable to primary care services), $3/dental visit (specified services) - see state-specific FN		Coverage limitations dependent upon type of service rendered	Public Health Clinic: fee for service, Mental Health Clinic: cost based or prospective cost based per diem or fee for service, depending on mental health clinic service	CN & MN
Nevada
Yes		Specified services		Fee for service	CN
New Hampshire
Yes			Mental Health Clinics covered under Rehab benefit	Fee for service	CN & MN
New Jersey
Yes			1 Psych service/day with some exceptions up to $6,000/year	Fee for service	CN & MN
New Mexico
Yes	A - $5/visit, B - $7/visit non-preventive services - see state-specific FN			Fee for service	CN
New York
Yes	$3/visit to Public Health Clinic		10 visits/year for Public Health Clinic medical care in combination with other specified providers and 3 visits/year for dental care, 40 visits/year for Mental Health Clinic care	Fee for service or prospective cost based rate	CN & MN
North Carolina
Yes		Specified services including more than 8 outpatient psychiatric visits	22 ambulatory visits/year to PH Clinic included in limits with other specified practitioners - limits set annually by the legislature	Fee for service	CN & MN
North Dakota
Yes				Cost based payment	CN & MN
Ohio
Yes			24 visits/year that count toward physician visit limit	Fee for service	CN
Oklahoma
Yes	$1/PH Clinic service		Outpatient behavioral health services not covered for nursing facility residents	Fee for service	CN
Oregon
Yes	A - $3/visit	Specified procedures		Fee for service	A & B - See state-specific FN
Pennsylvania
Yes	$.50-$3/service, depending on payment rate; $.50/unit of psychotherapy service		Visit limits dependent on type of service	Fee for service	CN & MN
Rhode Island
No
South Carolina
Yes	$2/visit			Fee for service	CN
South Dakota
Yes	5% of payment for mental health services		Mental Health Clinics not covered	Fee for service for high volume procedures, percentage of charge for low volume procedures and for supplies	CN
Tennessee
Yes	B1 - $5/MH Clinic visit, B2 - $10/MH Clinic visit				A & B - See state-specific FN
Texas
Yes		Specified services		Prospective cost based rate per episode of care	CN & MN
Utah
Yes	A - $2/visit		B - 30 days of psych care at Mental Health Clinic/year included in limits for hospital care, C - Mental Health Clinics not covered	Fee for service or capitated rate	A, B & C - See state-specific FN
Vermont
Yes			Public Health Clinics not covered	Fee for service	A & B - See state-specific FN
Virginia
Yes	$1/visit	After initial 26 Mental Health treatment visits	Mental health service limits vary	Fee for service	CN & MN
Washington
Yes				Fee for service	CN & MN
West Virginia
Yes		Specified procedures	A - substance abuse treatment not covered, B - 20 substance abuse treatment visits/year	Fee for service	A & B
Wisconsin
No
Wyoming
Yes				Fee for service	CN
American Samoa
Yes					See territory-specific FN
Guam
Yes				Fee for service	CN
Northern Mariana Islands
Yes					CN & MN - See territory-specific FN
Puerto Rico
Yes			Primary care physician referral required	All-inclusive per diem in private facility, capitated payment in public facility	CN & MN
Virgin Islands
Yes				Fee for service	CN

Definition/Notes: Link to Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics Footnote


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