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Service Definitions and Scopes of Work

All services require prior authorization unless other noted in the Medicaid and Non-medicaid benefit plans.
ServiceMedicaid FundedState FundedScope of Work
DHHS Behavioral Health Clinical Coverage PoliciesBH Clinical Coverage PoliciesState-Funded Enhanced Services

ADVPService Definition
Assertive Community Treatment TeamClinical Coverage Policy 8A

Scope of Work
Behavioral Health Urgent Care (BHUC)Scope of Work
Clinical Assessment/Medication ManagementClinical Coverage Policy 8CClinical Coverage Policy 8C
Community Guide - B3Service Definition
Community Support TeamClinical Coverage Policy 8AService DefinitionScope of Work
Community Transition-One-Time Transitional CostsB3 Service DefinitionScope of Work
Criterion V (902)Clinical Coverage Policy 8B
Day ActivityService Definition
Developmental Day - Child OnlyService Definition
Developmental Therapy
Dialectical Behavior Therapy (DBT)Service Definition
Enhanced Therapeutic Foster CareScope of Work
Evaluation and ManagementClinical Coverage Policy 8CClinical Coverage Policy 8C
High Fidelity Wraparound TeamScope of Work
Intensive Alternative Family Treatment (IAFT)Scope of Work
ICF-IDDClinical Coverage Policy 8E
Inpatient Hospital Psychiatric Treatment-MH Clinical Coverage Policy 8B
Inpatient HospitalizationClinical Coverage Policy 8B
Intensive In-Home ServicesClinical Coverage Policy 8AScope of Work
Medication Assisted TreatmentClinical Coverage Policy 1A-41
Office-Based Opioid TreatmentClinical Coverage Policy 1A-41
Outpatient Behavioral Health ServicesClinical Coverage Policy 8C
Parent Child Interaction Therapy - PCITClinical Coverage Policy 8CScope of Work
Personal AssistanceService Definition
Psychological and Developmental TestingClinical Coverage Policy 8CClinical Coverage Policy 8C
Psychosocial RehabilitationClinical Coverage Policy 8A
Research Based Behavioral Health Treatment for Autism Spectrum Disorder Clinical Coverage Policy 8F
Supervised LivingService Definition
Supported Employment - IndividualB3 Service DefinitionService Definition
Supported Employment - GroupB3 Service DefinitionService Definition
Supported Employment - Long TermService Definition
TF-CBTClinical Coverage Policy 8C
TBI Waiver
Care SupportScope of Work
Day TreatmentScope of Work
Psychosocial RehabilitationScope of Work
This page was last reviewed for accuracy on 04/27/2021