HealthChoice

Maryland Medical Programs

Updated
November 01, 2011

Specialty Mental Health Services

Mental Health Services

As part of the 1115 HealthChoice waiver, specialty mental health services, those services provided by a mental health professional or a mental health service agency which are not performed as part of a primary practitioner's office visit, are carved out into a separate managed fee‑for‑service system. This system, the Specialty Mental Health System (SMHS), is administered by the Mental Hygiene Administration (MHA), local Core Service Agencies (CSA's), and an administrative services organization (ASO), which is currently Value Options. Value Options authorizes services and pays claims for the PMHS. Any claims for non‑emergency specialty mental health services for both HealthChoice and non ‑HealthChoice recipients must be authorized and paid by Value Options.

For organizations and practitioners, claims for services may be paid by Value Options. These include special acute psychiatric facilities, inpatient and outpatient services, special chronic psychiatric facilities, inpatient and outpatient services, residential treatment centers, Federally Qualified Health Centers, individual practitioner including licensed psychologists, certified nurse psychiatric specialists, licensed clinical social workers, licensed professional counselors, community mental health centers, psychiatric rehabilitation programs, mental health case management programs, m mobile treatment services. For other organizations and practitioners, only specific services rendered to recipients with defined diagnoses will be paid by Value Options.

Practitioners who want to participate individually or as groups as specialty mental health providers must be appropriately licensed and must be able to provide services under their licensure. Organizations that want to participate as specialty mental health providers must be licensed or approved by the Office of Health Care Quality. All providers, individuals, groups, or organizations must be enrolled by the Maryland Medical Assistance Program and by ValueOptions. For further information contact the Mental Hygiene Administration at http://www.dhmh.state.md.us/mha/.