Behavioral Health Outpatient Configuration Changes

UPDATE: 11/20/2024

LOB: Medicaid
Audience: Behavioral Health Providers and Community Stakeholders

The intent of this notice is to provide correction and clarification regarding behavioral health payment responsibility. Outpatient Behavioral Health continues to be a covered service under Meridian Health Plan for Medicaid and Healthy Michigan (HMP) members.

Following the issuance of the Provider Bulletin Meridian posted on 10/14/2024, we received feedback from our provider partners about the complexity of the carve-out and that payment responsibility for Serious Mental Illness (SMI) cannot be determined by diagnosis and procedure codes alone. In response to this feedback, the configuration was removed on 10/18/2024.  All denials that occurred in this very short time frame were overturned to pay and payment correction of these denials was completed as of 11/12/2024. No retrospective provider claims recoveries were initiated or communicated. Outpatient behavioral health providers may continue billing Meridian for services rendered for mild or moderate mental health diagnoses as they have done historically.

Lastly, an additional point of clarification is that Meridian does not require prior authorization (PA) for neuropsychological evaluation and testing, or individual, group, and family therapy. These services continue to be covered services paid by Meridian. Meridian will continue to pursue clarity in operationalizing benefits to maximize the member and provider experience through continued partnership with State partners, providers, CMH, PIHP, and provider representatives.

We apologize for any confusion that our misinterpretation has created and again emphasize that Meridian remains committed to our joint partnership to provide the best care possible. For questions or concerns related to this bulletin or benefits please reach out directly to your Provider Relations Representative or submit an inquiry at any time using our Provider Relations Representative Inquiry Form

The State Medicaid Behavioral Health Payment Responsibility Grid is linked for reference and is also available within the Michigan Medicaid Provider Manual: Medicaid Behavioral Health and Substance Use Disorder Authorization and Payment Responsibility Grid (PDF) (michigan.gov)